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Wine as Part of a Healthy Lifestyle: A Review of the 2013 Scientific Literature



Health Benefits, Lifestyle, and Longevity


Australia’s School of Agricultural and Wine Sciences and the Pacific Institute for Research and Evaluation Prevention Research Center, reported a study of Australian and Korean consumer samples. The results indicated that the perceived health benefits of red wine were higher in the Australian sample than the Korean sample and Australian consumers had more health related wine knowledge. Both Australian and Korean consumers preferred red wine but the preference was higher for the Korean sample. Korean women preferred red wine as much as men, but Australian women consumed more white wine than men. Published in Teatro Naturale.

A United States study looked at the relationships between wine preference and health determinants in 12,958 adults who participated in the National Longitudinal Study of Adolescent Health. Wine drinkers had more formal education, better dietary and exercise habits, and a better overall health status. More of the wine drinkers were light to moderate drinkers compared to beer or liquor drinkers, and wine drinkers were less likely to be smokers. The findings suggest that wine preference in young adults is related to educational, health and lifestyle factors and may at least partially explain the association between light to moderate wine consumption and morbidity and mortality risk in later adult life. Published in Teatro Naturale.

The Drinks Business (www.thedrinksbusiness.com) reported on a number of centenarians who credit wine for their long life. Alice Mospak, who turned 104 in early 2013 and lives in Jersey City, attributes her long life to red wine and chocolate. Helen Kinsey, of Tattershall, Lincolnshire, celebrated her 100th birthday and agreed with Mospack except her preference was for a glass of white wine rather than red wine. Wine writer Dan Berger pointed out the ages of death of prominent wine business figures: winemaker Andre Techelistcheff, 92; winemaker Louis Foppiano, 101; wine author and bon vivant Andre Simon, 92; wine lover, collector, and Bordeaux chateau manager Harry Waugh, 97; winery owner Ernest Gallo, 97; vineyardist Julio Gallo, 83 (died while driving a 4-wheel drive vehicle in his vineyards); wine researcher Dr. Ralph Kunkee, 84; winery owner Robert Mondavi, 94; winemaker Lee Stewart, 89; wine writer Robert Lawrence Balzer, 99; wine author Leon Adams, 90; and wine professor and researcher Maynard Amerine, 87. Winemaker John Parducci, 96, and winemaker Charlie Barra, 86, are still with us.

A major study by 36 authors was published in 2013 on moderate alcohol consumption and health in Nutrition, Metabolism, & Cardiovascular Disease, and was reviewed by the International Scientific Forum on Alcohol Research (The Forum). There is a tremendous amount of research data available on the relation of alcohol consumption to health and disease. This paper by a large number of Italian scientists tried to reach a consensus on the relation of moderate alcohol consumption to health. The Forum believed that the consensus had great merit. “The overall impression of Forum members is that light-to-moderate drinking in middle-aged and older adults who have no contraindications to alcohol (e.g., prior abuse, uncontrolled epilepsy, and a few other medical conditions) is associated almost exclusively with beneficial health benefits. Such healthy outcomes are generally not seen among the young, due mainly to the rarity of the occurrence of the ‘diseases of aging’ among the young. It is also related to their frequent abuse of alcohol, from binge drinking and purposely drinking just for intoxication.” Members of the forum agree with the authors of this report that changes in one’s drinking habits should be discussed with the person’s physician, as age, sex, underlying medical conditions, religion, and other factors should be taken into account.

A study published in the Journal of Epidemiology Community Health, reported divergent effects of regular moderate and binge drinking over more than 20 years among a large cohort of young to middle-aged Norwegian subjects. The study was unusual in that most of the subjects consumed alcohol once a week or less frequently, but consumed large amounts of alcohol on each drinking day. Only 11% of men and 3% of women consumed alcohol more than once a week. 76% of the men reported binge drinking at least once during the preceding year and 36% of the women reported binge drinking a few times or more frequently in the last year. Men and women who consumed alcohol up to twice a month had about 20% lower mortality than abstainers. All groups reporting binge drinking had higher mortality than non-binge drinkers. Cardiovascular and ischemic heart disease mortality was lower among drinkers but higher among those who reported binge drinking. The Forum said, “The key finding of this study is that there are divergent effects on mortality of the frequency of drinking and the amount of alcohol consumed per occasion. The results support other studies of more moderately drinking populations, namely, that more frequent drinking, but smaller amounts per occasion, is the pattern of alcohol consumption associated with the lowest risk of mortality.”

Americans have misconceived notions about the risks of heavy drinking according to a 2013 national survey of adults released in April by Screening for Mental Health, Inc., and reported at www.prnewswire.com. The survey found that half of all men and one-third of women had at least one at-risk drinking episode (four or more drinks per day for men and three or more for women) in the last year. 20 percent of Americans believe that at risk drinking is not a problem unless it negatively impacts their personal relationships or work performance. 20 percent believed that drinking heavily is a phase that many young people go through, but it won’t hurt their health in the long run. This is not consistent with the findings of the National Institute on Alcohol Abuse and Alcoholism which found that young people who started drinking before age 15 were 50% more likely to become alcohol dependent as adults.

A study by the Center for Addiction and Mental Health (CAMH) reported at www.huffingtonpost.ca and published in Addiction, found that alcohol is now the third leading cause of global disease and injury, despite most adults worldwide abstain from drinking. Drinkers in Europe and parts of Sub-Saharan Africa are the world’s heaviest consumers of alcohol. North Americans in general and Canadians in particular drink more than 50 percent above the global average and demonstrate a more detrimental drinking pattern that most EU countries. The most unhealthy drinkers were in the age bracket of 15 to 29-year-old. People in this age group worldwide still suffer the most deaths from alcohol.

The journal Alcoholism: Clinical & Experimental Research, reported the results of the Hunt Study. Data collected from 19,977 married couples in Norway found that spouses who drank the same amount of alcohol were less likely to divorce than spouses where one partner was a heavy drinker and the other was not (particularly if the woman was the heavy drinker). Divorce was more common among couples with high rates of alcohol consumption (17.2%). Couples in the study who were both light drinkers reported only a 5.8% divorce rate.

A preliminary study by Spanish and Mexican researchers reported in www.beveragedaily.com, January 20, 2014, found that even relatively light weekend drinking may damage young, healthy student DNA. Those who drank had twice as much oxidative damage as well as evidence of significantly increased numbers of DNA damaged cells compared with the group that did not consume alcohol.

A University of Colorado retrospective study of more than 41,000 people from across the United States surveyed for their drinking habits in 1988 and followed until 2006 published in the Journal of Population Research and Policy Review, found that abstainers have a higher mortality risk than light drinkers (on average, less than one drink a day). Considerable scientific evidence has shown that light to moderate alcohol consumption, compared to abstaining and heavy drinking, can help prevent a range of diseases. However, the Colorado study found that nondrinkers have many reasons for abstaining and this affects their individual mortality risk so that some people such as those who choose not to drink because of religious or moral reasons are at the same risk as light drinkers. Former drinkers had the highest mortality risk of all nondrinkers (38% higher mortality risk over the follow-up period). The authors of the study suggested that their findings indicate that not all nondrinkers have a higher mortality than light drinkers. As far as drinkers, those who drank between one and two drinks per day, on average, had a 9 percent higher mortality rate than light drinkers, those that drank between two and three drinks per day had a 49 percent higher mortality and drinkers who consumed more than three drinks per day had a 58 percent higher mortality risk over the follow-up period compared with light drinkers. In concluding, the authors of the study noted that there are probably other factors that lower mortality for light drinkers such as higher socioeconomic characteristics, and “the idea that drinking could be somewhat beneficial seems like it’s overstated.”

The “J-shaped curve” (below) that describes the association between alcohol consumption and mortality has been confirmed by many epidemiological studies over the past decades. Abstinence is an adverse health risk, light-to-moderate drinking lengthens life with the lowest mortality level for men and women at one to two drinks per day, and excessive drinking (more than three drinks per day) is the most dangerous to health and life. This curve holds true also for cardiovascular disease, stroke, some cancers, and cognitive dysfunction. The J-shaped curve is widely accepted whenever health and alcohol consumption is debated. A large study reported in Alcohol Clin Exp Res looked at the J-shaped curve and the relationship of “heavy” (more than 5 drinks on occasion) and “non-heavy” (less than 5 drinks per occasion) alcohol consumption to the risk of all-cause mortality. There was a linear increase of mortality for subjects consuming heavy amounts of alcohol, with the risk increasing as drinking at this level was more frequent. For non-heavy drinkers, there was a J-shaped relation with mortality. The point at which the non-heavy drinker’s risk of mortality exceeded that of abstainers was between 4 and 5 drinking occasions per week. Previous epidemiological studies defined moderate or non-heavy at lower levels of alcohol intake and looked at drinks per day or drinks per week, yet the results of this study of drinking patterns were similar and confirmed the J-shaped curve.



A large study from Australia published in Alcohol Clinical Experimental Research, that included a high percentage of current or former alcohol abusers, had several key findings: moderate alcohol intake had favorable effects on HDL cholesterol and insulin levels, and for most other factors (liver enzymes, triglycerides, blood glucose, and the inflammatory marker CRP) a J-shaped relation or lower values with light drinking and higher levels with larger amounts of alcohol. The Forum felt that this study provided strong support for the results of most prospective epidemiological studies that show lower rates of cardiovascular and other diseases among light-to-moderate drinkers than among abstainers or heavy drinkers.

A consensus statement published in Nutrition, Metabolism & Cardiovascular Disease by 36 prominent nutrition scientists in Italy came as a surprise as some European countries have openly opposed alcohol even in moderation. The statement: “In healthy adults and in the elderly, spontaneous consumption of alcoholic beverages within 30 grams of alcohol daily (up to two drinks) for men and 15 grams for women (1 drink) is to be considered acceptable and does not deserve intervention by the primary care physician.”


Women, Pregnancy & Breast Cancer

Women are drinking more often and drinking too much. This was brought to light in Gabrielle Glaser’s book published in 2013, Her Best Kept Secret: Why Women Drink and How They Can Regain Control. A Q&A published at www.time.com in July explained what she had learned in researching her book. Glaser said that women are drinking more than their mothers did and 11% report regular bouts of binge drinking. A 2010 Gallup poll showed that nearly two-thirds of all American women drank regularly which was a higher percentage than in any other time in twenty-five years. The rate of females being hospitalized from alcohol is increasing five times that of men. She noted that for women, drinking results from stress, depression and anxiety, and drinking allows them to self-medicate their woes, with alcohol functioning as a release valve to allow them to calm down, and “feel sexier and warmer.” Literally, the demands of marriage, career and motherhood are driving women to drink. The more educated and well off a woman is, the more likely she is to drink. White women drink more than women of other racial backgrounds.

Another book published in 2013, Drink: The Intimate Relationship Between Women and Alcohol by Ann Dowsett Johnson, combines in-depth research with her own personal story of recovery. She points out that women are exposed to a wine industry set up to sell Skinnygirl cocktails, book clubs that are really wine clubs, and websites that encourage drinking (for example, Moms Who Need Wine). Johnson describes a syndrome I was unaware of called “drunkorexia,” which is the choosing to limit eating to consume greater quantities of alcohol. Table wine brands that target women are big sellers with Skinnygirl from California the top new seller by far at $4,755,489 in 2012 according to Wines & Vines. Other brands in the top twenty include Fancy Pants, Thorny Rose, Flirt, Butterfly Kiss and Flame Lily.

A third book published in 2013, The Sober Revolution: Calling Time on Wine o’clock by Sarah Turner and Lucy Rocca, looks at women and their relationships with alcohol and offers insights for women to regain control of their drinking. A blog, “Drinking Diaries,” at www.drinkingdiaries.com, is an extension of a fourth book, Drinking Diaries: Women Serve Their Stories Straight Up by Caren Osten Gerszberg and Leah Odze Epstein in which women share their drinking stories honestly and openly in this favorably reviewed book.

According to the Centers for Disease Control and Prevention, increasing numbers of American women are drinking more heavily than before and one in eight women binge drink (six drinks or more in one setting about three times a month). About 24 percent of binge-drinking women are college age and about 10 percent are between the ages of 45 and 64. Binge drinking is more evident in whites and Hispanics, and adult women with household incomes of $75,000 or more. A study reported in Alcoholism: Clinical and Experimental Research, found that college age women drink more often than male students. In the study published in the European Journal of Public Health (previously mentioned in the Introduction), 31 percent of women exceed the weekly drinking guidelines and up to 80% of women exceed the recommended daily limit. Research published in the Journal of the Academy of Nutrition and Dietetics, found that 8 percent of men and 3 percent of women are heavy drinkers and on any given day, 18 percent of men and 11 percent of women drink more alcohol than is advised by federal dietary guidelines. Among women, the heaviest drinkers were ages 51 to 70.

A documentary, “Lipstick & Liquor,” available on digital platforms worldwide since December 2013, explores the secret world of women who drink. A number of experts were interviewed that brought to light many facts: DUI arrests are up 30 percent for women from 10 years ago, while arrests for men are down; binge drinking is increasing in women at alarming rates; women resist getting treatment for alcohol abuse more than men.

A press release from the American Psychological Association (APA) summarized the findings of animal lab experiments presented at the APA’s 121st Annual Convention. Compared to pups of rats that ate regular rodent food, the offspring of rats that ate high-fat or high-sugar diets while pregnant weighed more as adults drank more alcohol. This is relevant because a majority of women in the United States of child bearing age are overweight, which is most likely due to overeating of high-fat, high-sugar foods. The authors of the study concluded, “Our findings suggest that even while rats are still in the womb, exposure to high-fat and sugar-rich diets can lead to an increase in body weight and a predisposition to drink alcohol.”

A study published in BMC Women’s Health looked at United States post-menopausal women aged 50-79 years enrolled in the Women’s Health Initiative Clinical Trials and Observational Study. Women who preferentially consumed wine had a lower risk of hip fracture compared to non-drinkers, past drinkers, and those who preferred hard liquor and beer. Mean alcohol consumption among current drinkers was 3.3 servings per week regardless of choice of alcoholic drink.

One of the most contentious issues in the debate about health and alcohol is drinking during pregnancy. Most physicians and health care agencies advise women that if they are pregnant or trying to get pregnant, they should reduce their alcohol intake as much as possible and most advise eliminating alcohol from their diet completely. Since 1989, all wine bottles have been required to have a label warning against drinking alcoholic beverages during pregnancy because of the risk of birth defects (fetal alcohol spectrum disorders or FASD). The risk of FASD is increased with higher than average alcohol intake during pregnancy, as are sleep disorders, hyperactivity, attention deficit disorder, and poor coordination and balance in long term studies.



The National Institute on Alcohol Abuse and Alcoholism states that no amount of alcohol is safe during pregnancy and consuming any kind of alcohol can potentially harm an unborn child. The March of Dimes adheres to its position that drinking alcohol during pregnancy can cause harm to the child and no amount of drinking while pregnant is safe. The Centers for Disease Control and Prevention urges pregnant women not to drink alcohol any time during pregnancy. The National Institute for Health and Clinical Excellence (NICE) in the UK advises women who are pregnant to avoid alcohol in the first three months in particular, because of an increased risk of miscarriage. The numerous guidelines are meant to err on the side of absolute safety.

A study presented in 2013 at the American Society for Reproductive Medicine in Boston found that women who drank just one or two glasses of wine a week reduced a women’s chances of conceiving by a third. Three or more glasses a week cut the odds of conception by two-thirds. In this small study of 91 women undergoing in vitro fertilization treatment, those who did drank regularly during the week reduced their chances of pregnancy by 70 percent, with binge-drinking reducing the chances even further. Women who abstained had a 90 percent chance of getting pregnant. It is thought that low levels of alcohol can interfere with the normal development of unfertilized eggs, but the mechanism is not clear, and the results of this study could be explained by other factors such as the women who drank were more stressed. Drinking also causes fertility issues in men.

As part of National Alcohol Awareness Month in April 2013, screenings were held, and a key finding was that 77 percent of Americans think pregnant women should avoid alcohol altogether, while 20% said an occasional glass of wine is fine.

Despite the widespread opposition to drinking any alcohol throughout pregnancy, and the knowledge that the risk of FASD is increased with higher than average alcohol intake during pregnancy, as are juvenile sleep disorders, hyperactivity, attention deficit disorder, and poor coordination and balance in long term studies, there were research studies in 2013 that supported the value of light wine drinking pregnancy. The journal Obstetrics & Gynecology reported a study led by Dr. Fergus McCarthy of the Irish Centre for Fetal and Neonatal Translational Research (INFANT) at Cork University Maternity Hospital in Ireland. The researchers interviewed more than 5,600 pregnant woman in Australia, Great Britain, Ireland and New Zealand about their alcohol consumption before pregnancy and during the first 15 weeks of gestation. The majority of the women consumed alcohol during the first four months of pregnancy (60 percent) with 10 percent drinking a glass of wine or a little less than a 12-ounce bottle of beer once a week, nearly 25 percent consuming three to seven drinks a week, 10% drank moderately (eight to fourteen units a week) and 5 percent drank heavily (more than 14 units a week). More than 33 percent admitted to binge drinking in the three months before become pregnant. When the mothers’ drinking patterns were compared with the health of their babies at birth, the researchers concluded that drinking small amounts both pre-pregnancy and during the first 15 weeks of pregnancy did not seem to increase the risk of premature birth, low birth weight, small for gestational age or high blood pressure in the mother (eclampsia). The study did not look at the long term development of the babies. The authors of the study emphasized that it is unclear whether any safe level of alcohol consumption during pregnancy exists.

Research at the School of Social and Community Medicine at the University of Bristol of mothers in the Avon Longitudinal Study of Parents and Children, found that three to seven glasses of wine a week while pregnant does not harm unborn babies and does not impair a child’s neurodevelopment. The study, published in the British Medical Journal, found that babies of mothers who drink wine while pregnant actually performed better in balance testing, a marker for development. The study also found that women who drink wine during pregnancy tend to be wealthier, better educated and older, which could also explain the better balance testing. Almost 7,000 ten-year-old children were assessed. Nearly one in four mothers where either low or moderate consumers of alcohol and nearly one in twenty drank more. Higher alcohol consumption by the father during the first three months of pregnancy was also associated with better performance by children.

A widely publicized Danish study from the University of Copenhagen found that women who drank the equivalent of just over one glass of wine a week while pregnant had better emotional and behaved children than those who abstain. The explanation seems to be that the mothers who drank just over one glass of wine a week were the most educated and led the healthiest lifestyles overall. The authors of this study emphasized that it is not an invitation to pregnant women to drink alcohol as the mothers’ healthy lifestyle and education were significant factors in determining the child’s development. The study did not examine the effect on children whose mothers drank heavily.

A new book by Harvard-educated economist Emily Oster, Expecting Better, argues against the idea that wine and coffee cause damage to unborn babies and calls it nothing more than a “motherhood myth.” The author looked at hundreds of studies related to drinking wine and coffee during pregnancy (she drank both).

About one in eight women in the United States will be diagnosed with breast cancer during her lifetime, and one in thirty-six will die of the disease. A report published in the Journal of the American Medical Association, indicated that advanced (metastatic) cases among those women ages 25-39 have nearly doubled from 1976 to 2009. The trend has not been explained but multiple factors are probably involved including obesity, use of birth control, delayed pregnancy, and high caloric intake. It is still uncommon for young women to be diagnosed with breast cancer (only about 7 percent of all breast cancers diagnosed in the United States).

The relationship between breast cancer and alcohol continues to draw considerable commentary in the press. It is generally agreed that the increased risk for drinkers of light-to-moderate amounts of alcohol is quite small. In most observational studies, according to The Forum, the risk of breast cancer is slightly higher in women who average only about one typical drink per day, in comparison with no alcohol consumption. This increase in risk appears to be ameliorated for women who do not binge drink, have adequate folate levels, and do not take hormone replacement therapy. The Forum has the following position: “An individual will need to weigh the modest risks of light-to-moderate alcohol use on breast cancer development against the beneficial effects on cardiovascular disease to make the best personal choice regarding alcohol consumption.” For women with a family history of breast cancer, consumption of wine may protect against BRCA1-associated tumors, while women with BRCA2 mutations may be at greater risk of alcohol-induced breast cancer.

Researchers at the Washington University in St. Louis published a study in the Journal of the National Cancer Institute of 91,005 mothers who participated in the Nurses’ Health Study II from 1989 to 2009. All were asked about their alcohol consumption in early life, their alcohol consumption was tracked over 20 years, and they were followed for the development of breast cancer and proliferative benign breast disease (BBD), a precursor of breast cancer. Unfortunately, the researchers did not specifically study wine. The authors of the study found that a woman’s drinking habits between menarche and her first full-term pregnancy were linearly related to a risk of breast cancer. If a female averages a drink per day between her first period and her first full-time pregnancy, she increases her risk of breast cancer by 13 percent and the risk of BBD by 15 percent. The more a woman drinks before her first pregnancy, the higher the risk of breast cancer. The mechanism appears to be related to the rapid proliferation of breast tissue during this period. The researchers recommended that women reduce their alcohol intake to less than one drink a day, and hypothesized that exercise and a high-fiber diet between menarche and the first pregnancy may protect women from breast cancer.

Research conduction by the University of Otago in collaboration with the World Health Organization’s Global Burden of Disease 2010 Risk Factors Collaborating Group found that drinking one less glass of wine a night can reduce the risk of women developing breast cancer by 10 percent. Breast cancer was noted to be the leading cause of alcohol-attributable death in New Zealand women.

The evidence for breast cancer risk factors among African-American women is limited. A study published in the British Journal of Cancer looked at 803 African-American women with breast cancer in New York and New Jersey. No association was found between light recent drinking and breast cancer risk (African-American women tend to be light drinkers so heavier drinkers were not studied). A borderline decreased risk with increased lifetime consumption was found especially in women who drank when under 20 years of age, but this may have been due to confounding by socioeconomic factors.

A study in the Journal of Clinical Oncology from the Cancer Prevention Program at Fred Hutchinson Cancer Research Center in Seattle, showed that modest drinking before and after diagnosis does not affect a woman’s chances of dying of breast cancer. Women who drank moderately (about three to six drinks a week) in the years before their cancer diagnosis, were 15 percent less likely to die from cardiovascular disease than nondrinkers over the 11 years post-diagnosis, on average. Cardiovascular disease is a major cause of death among breast cancer survivors and it is known that alcohol in moderation reduces the risk of cardiovascular disease. Drinking beer or spirits did not have the same benefit and higher levels of alcohol consumption reduced survival chances. This study frees women to make a lifestyle choice, whereas before, they might have been warned not to drink at all if they are diagnosed with breast cancer.



Cancer


The strongest link between alcohol and cancer is for cancers of the pharynx, larynx, esophagus, colon, rectum, liver and breast. The risk of thyroid cancer, lymphoma, renal cancer, and certain other cancers have been shown to be lower among moderate drinkers than among abstainers. Researchers recommend a reduction or cessation of alcohol consumption in those who are at risk, while remembering that the majority of moderate drinkers never develop cancer.

A national study reported in the American Journal of Public Health reviewed data from hundreds of thousands of deaths from national medical databases and concluded that alcohol was a cause of 3.5 percent of all cancer deaths in the United States (about 20,000 cancer deaths each year). Breast cancer was the most common cause of alcohol-related deaths in women (about 6,000 deaths annually) and mouth, throat and esophagus cancers were common causes of alcohol-related deaths in men (about 6,000 annual deaths). The risk is highest among those who exceed the recommended dietary guidelines of alcohol consumption, although 30 percent of alcohol related deaths occurred in those who stayed within the guidelines. The study did not examine comparative risks of different alcoholic drinks. Dr. Arthur Klatsky, a well-known alcohol researcher, questioned some of the study’s findings. Dr. Curtis Ellison, a professor of medicine and public health at Boston University School of Medicine, also said the study failed to take into account several factors, such as the pattern of drinking rather than just the amount of alcohol consumed. He pointed out that drinking small, consistent amounts of alcohol is healthier than occasional binge drinking. The study mixed those with alcohol abuse and casual drinkers. The authors of the study acknowledged that alcohol can have health benefits but claimed alcohol causes ten times as many deaths as it prevents and there is no safe level of drinking.

The Forum looked at a study published in the International Journal of Cancer titled “Demographic, socioeconomic, disease history, dietary and lifestyle cancer risk factors associated with alcohol consumption.” A cohort of 29,566 adults were studied, but no new information was revealed. The researchers attempted to group all factors into a single, total number for assessing the relation with alcohol intake and this was a weakness of this study. The Forum said, “Some are very weak predictors of cancer, so adding them all up and calling them ‘cancer risk factors’ may not be justified.”

The Forum also reviewed a paper published in Annals of Oncology. This PubMed meta-analysis of articles explored the relation of alcohol intake to risk of dying from cancer. The meta-analysis confirmed the health hazards of heavy drinking (equal to or more than 50 g/day) and the benefits of light drinking (equal to or less than 12.5 g/day). The analysis demonstrated a J-shaped curve for alcohol and cancer. Light drinkers showed a statistically significant 9% lower risk, moderate drinkers showed no effect, and heavier drinkers showed a 32% increased of all cancer mortality. Forum members concluded, “The findings from this study do not support the premise that any amount of alcohol increases the overall risk of dying from cancer.”

Alcohol consumption and the risk of lymphoid and myeloid neoplasms was the subject of a Netherlands cohort study published in the International Journal of Cancer. Many studies have shown that moderate drinkers are at a lower risk for certain types of lymphoid cancer. This paper did not find a statistically significant reduction in the risk of lymphoid cancers, but a suggestion of an increased risk. The Forum reviewers were concerned about several aspects of this study and did not feel this study should change any current interpretation of the association between alcohol and these types of cancer. The overwhelming scientific evidence indicates that moderate alcohol consumption is associated with a decrease in the risk of many types of lymphoid malignancies while having little effect on myeloid cancers.

The Ovarian Cancer Association Consortium studied data using a meta-analysis of nearly 15,000 cases of ovarian cancer in North America and Europe and found no link between ovarian cancer and alcohol.

Red wine, but no other form of alcohol, seems to be protective against lung cancer in men. A research team in Spain compared the lifestyles of patients with lung cancer and those requiring minor surgery at the same hospital. Almost 60 percent of the lung cancer patients smoked, compared to 25 percent of the controls. Men in both groups drank similar amounts of wine (around 3.5 glasses per day), but just over one-third of the lung cancer patients drank red wine compared to just over one half of the control patients. Researchers said that each daily glass of red wine afforded 13 percent protection against lung cancer. This was evident even when smoking habits were considered. It is postulated that red wine antioxidant tannins help to block tumor development.

Studies of resveratrol and cancer are discussed in the section on polyphenols in wine.



Neurological Diseases and Mental Health


Spanish researchers conducted a 7-year study of 5,505 men and women between the ages of 55 and 80 who were at high risk for depression. The participants were part of the larger PREDIMED (Prevention with Mediterranean Diet) study which examined the health benefits of diet including consuming olive oil and drinking wine. The study, published in the journal BMC Medicine, found after a seven-year followup, that wine consumption in the range of one glass of wine per day is associated with a 28 percent lower incidence of depression, and wine consumption in the range of two to seven drinks a week was associated with a 32 percent lower rate of depression. The Spanish scientists theorized that resveratrol in red wine may exert neuroprotective properties on the hippocampus and prevent moderate drinkers from developing depression. Although the study seemed to indicate that wine helped prevent depression in those who were not depressed, it cannot be claimed that wine will help those who are already depressed.

Scientists at the University of Reading in Great Britain published their research in the journal Antioxidants and Redox Signaling showing in a study of lab rats, that a low-to-moderate dose of Champagne for six weeks led to an improvement in spatial memory. Rats who consumed the human equivalent of about a glass-and-a-half a week performed twice as well on maze tests as rats who received no Champagne. Co-author Jeremy Spencer said, “These results illustrate for the first time that the moderate consumption of Champagne has the potential to influence cognitive functioning such as memory.”

A comprehensive review of the available research on moderate alcohol consumption and cognitive decline and dementia in old age was published by a group of Italian scientists in the International Journal of Geriatric Psychiatry. The review found that moderate alcohol consumption has more benefit for some types of dementia than others. Light to moderate alcohol consumption seemed to be associated with a decreased risk of overall dementia and Alzheimer’s Disease (AD), but beneficial effects on vascular dementia, cognitive decline and predementia syndromes were less evident. Wine is the form of alcohol most likely to have neuroprotective benefits as long as the AD-associated e4 allele of the APOE gene (ApoE4) is not present. No recommendations were made about levels of beneficial alcohol intake. The authors of the review concluded, “There is at present no indication that light to moderate alcohol drinking would be harmful to cognition and dementia.”

A new AD research study published in The Proceedings of the National Academy of Sciences identified a link between the major genetic risk factor for AD known as ApoE4, which is present in two-thirds of the people who develop the disease, and the SirT1 protein that is targeted by resveratrol. ApoE4 causes a dramatic reduction in SirT1 in vitro neural cell lines and in brain samples from patients with ApoE4 and AD. The metabolic benefits of resveratrol may be explained by the increasing of SirT1 which could prevent the abnormalities associated with ApoE4 and AD. The ultimate aim of the research is to find a safe, non-toxic treatment that could be used on anyone who carries the ApoE4 gene to prevent AD.

Findings published in the Journal of Biological Chemistry may prove helpful in understanding the cause and progression of AD. In AD, harmful amyloid proteins latch onto brain cells and kill them. Purified extracts of resveratrol from red wine were able to interrupt this process. Added to human and animal brain cells in the lab, the extract of red wine reshaped the amyloid proteins and the amyloid clumping no longer harmed the nerve cells.

Indiana University researchers reported the first convincing demonstration in humans that an alcoholic drink’s flavor can releases a chemical in the brain which makes people want to drink more. The study, published in the journal Neuropsychopharmacology, involved scanning the brains of 49 men while they tasted beer and when they tasted Gatorade. Only a small amount of beer was given so as not to inebriate the test subjects. The results revealed significantly more dopamine activity when tasting beer than when tasting Gatorade. Dopamine is a neurotransmitter associated with the reward and pleasure centers in the brain. The subjects also said that after tasting the beer they craved more but did not feel the same way about the sports drink, even though some thought it tasted better.

A study published in the American Journal of Clinical Nutrition conducted by French researchers found that there was little benefit to aging brains from a Mediterranean diet. Overall, the study showed that people who ate a diet closest to the Mediterranean diet ideal performed about the same on mental ability testing than those who ate a non-restricted diet. The study did have limitations and did not support previous research that has shown older people who followed a Mediterranean diet were less prone to mental decline as they aged and less at risk for developing Alzheimer’s disease.

Research from Sweden examined individuals admitted with an alcohol use disorder or appendicitis from 1972 to 2008 and followed for up to 37 years for a diagnosis of Parkinson’s Disease (PD). Published in BMC Neurology, the study found that a history of alcohol use conferred an increased risk of admission with a diagnosis of PD in both women and men. In particular, the risk seemed higher at lower ages of first admission with PD. Experimental animal studies have indicated that chronic heavy alcohol consumption may have dopamine neurotoxic effects related to PD.


Cardiovascular


The New England Journal of Medicine released the findings of the latest Mediterranean Diet (Med-Diet) study carried out in Spain. This study had strict biomedical research standards with a large group of subjects randomly assigned to specific groups and followed for nearly five years. Men in the study ranged in age from 55 to 80 and women 60 to 80. All of them were at high risk for cardiovascular disease, having either Type II diabetes or meeting at least three of the following criteria: active smokers, overweight or obese, had a family history of premature heart disease, had high blood pressure, or had elevated cholesterol. The superiority of the unrestricted-calorie Med-Diet supplemented with extra-virgin olive oil or nuts was substantial with followers showing 60% less risk of either a heart attack, stroke or death attributed to cardiovascular disease. When compared with a low-fat diet, the Med-Diet provided 30 percent more benefit than a low-fat diet, with only a small group of people without high blood pressure on the low-fat diet showing better results. Those in the study were allowed to drink wine in moderation, or about seven glasses a week (about one-third of the Med- Diet subjects and one-quarter of the control group reported consuming 7 or less glasses of wine a week during the trial), but alcohol consumption was not evaluated specifically for its effects in this study. The Forum noted, “The striking reduction in risk in the study from the Med-Diet provides further evidence of the effectiveness of such a diet in reducing cardiovascular disease. A very large amount of scientific data now support advice to follow a Mediterranean-type diet, one that does not restrict calories, but encourages the intake of selected fats including extra-virgin olive oil or canola oil, as well as more fruits, vegetables, grains, nuts and wine. It may be the most effective dietary approach for reducing cardiovascular disease.”



The long-term associations between change in alcohol-consumption status and cessation of alcohol use, and fibrinogen levels in a large, young, biracial cohort was studied within the Coronary Artery Risk Development in Young Adults Study (CARDIA). Fibrinogen levels, which is a strong determinant of thrombosis and an important risk factor for coronary heart disease, and alcohol use data were collected at year 7 and year 20 examinations. The results were published in the British Medical Journal. The study found that in comparison with participants who never drank, those who became or stayed drinkers had smaller increases in fibrinogen, while those who quit drinking had the highest increase in fibrinogen over 13 years of follow-up. The Forum considered this a potentially important paper as the finding of higher fibrinogen among never drinkers and those who quit drinking may relate to the higher risk of coronary disease commonly reported from such subjects in prospective studies. The Forum concluded, “More research will be needed to determine if changes in fibrinogen levels are key elements in alcohol’s effects on cardiovascular disease.”

Research published in the Journal of the American College of Cardiology from the University of Illinois found that four years of heavy drinking between the ages of 18 and 25 in nonsmoking college students could permanently increase the risk of heart attack and stroke. Students who didn’t drink had more elastic blood vessels that dilated more easily, compared with the blood vessels of binge drinkers. This could be an early indicator of blood vessel damage and heart disease, which could increase the risk of future heart problems. The authors concluded, “Binge drinking may lead to serious cardiovascular consequences in young adults.”

A study from researchers at Harokopio University in Greece reported that a daily pint of beer could be heart healthy. Published in the Nutrition Journal, the study measured heart health after drinking a pint of beer in 17 healthy non-smoking men compared to the heart health after drinking non-alcoholic beer and vodka. The researchers found that blood vessel endothelial function was significantly improved only after beer consumption. The benefit seems to be mediated by the effects of alcohol and antioxidants. Beer has also recently been found to reduce the chance of developing kidney stones and can help control cold-like viruses.

Researchers from the Universities of Barcelona and Valencia compared the effects of red wine, gin and alcohol-free red wine on the cholesterol and blood sugar of 67 men at high risk of cardiovascular disease in a randomized clinical trial. The men drank about one glass of wine or two large gins and tonics each day for four weeks at a time. The subjects ability to metabolize sugar improved after both types of wine, but not with the gin. Their levels of lipoprotein-a, a compound that are associated with a greater risk of heart attack, decreased with red wine only. The research team suggested that the non-alcoholic fraction of red wine, mainly polyphenols, were responsible as both alcoholic and non-alcoholic wines were nearly equal in their benefit. The study was published in Clinical Nutrition.

A study of 11, 248 Italian men and women who had recently survived a heart attack, published in the International Journal of Cardiology, looked at how wine affects mortality in those who have serious cardiac disease. This research showed that patients who have a heart attack are less likely to have another one and have a greater chance of living longer, if they drink wine in moderation compared to non-drinkers. Men and women who drink two large glasses of either red or white wine a day have a 13 percent less likely chance of suffering another heart attack and reduce their chances of dying from heart disease by about 17 percent compared to non-drinkers. The study results only apply to people who were already drinking wine on a regular basis when they started the study.

A meta-analysis of sixteen studies published in the Journal of Clinical Hypertension revealed that light drinking can reduce the risk of high blood pressure. Women who drank a glass of wine or less per day decreased the risk of high blood pressure by up to 13 percent. Men who drank one to two glasses per day did not show as large a benefit but did not have a higher risk of high blood pressure. Heavy drinkers showed a higher risk of high blood pressure which potentially can lead to cardiovascular disease and stroke.



Diabetes


A longitudinal study in Norway strongly supported considerable previous research showing that moderate alcohol consumption is associated with a lower risk of developing type 2 diabetes mellitus. Published in Diabetes Medicine, the study found the lowest risk among subjects who reported consuming alcohol 5-10 times during the previous two weeks or reporting a daily consumption of 10-15 grams of alcohol per day (slightly less than one to a little over one drink per day, using 12 g of alcohol per day as a standard drink. The overall apparent protection from diabetes in moderate drinkers was 30 percent. The apparent greater effect found among men in this study that was not consistent with many other studies and not explained. Since there are 26 million diabetics in the United States alone, mostly type 2, the possible benefit of moderate alcohol consumption is staggering.

Type 2 diabetes and chronic kidney disease are important public health problems. An observational study published in JAMA Internal Medicine reported that eating a healthy diet and drinking a moderate amount of alcohol may be associated with a decreased incidence and risk of progression of chronic kidney disease in patients with type 2 diabetes mellitus.



Weight & Metabolism.


Science writer Tony Edwards published a book based on medical evidence that in essence says that the consumption of alcohol within sensible limits is good for your health and dispels the myth that drinking makes you fat. The health book, The Good News About Booze, points out that there is no good scientific evidence to show that moderate alcohol consumption causes weight gain. Although a glass of wine contains as many calories as a slice of cake, and a glass or two of wine with dinner may be adding 300 calories to your daily intake, many studies show that regular moderate drinkers (two drinks a day for men and one for women), particularly women, gain less weight than either heavy drinkers or abstainers. British cancer expert Professor Karol Sikora said, “Here you have all the data you need to make your own decision about how much and what to drink.” Dr. Curtis Ellison, Professor of Medicine and Public Health at the Boston University School of Medicine said, “Exceptionally well-written book, informative yet very entertaining. More important, it provides very well-balanced conclusions to the wine/alcohol/health issues.”



An article in The New Zealand Herald refutes the promise that low-alcohol, low-calorie wines are healthier because many of them are not considerably lighter and may lead people to drink more. Treasurer Wine Estates and Australia’s Accolade Wines are promoting “light” wine products for Weight Watchers in the United States. These wines have about 25 percent less alcohol but drinkers may compensate for the diminished calories by eating more food. The author of the article, Julie McIntyre urged the government of Australia to initiate consumption guidelines on “light” wines.

A study published in the Annals of Nutrition and Metabolism conducted by researchers at French universities found that daily, moderate consumption of alcohol may keep men thinner. Nearly 8,000 men between the ages of 50 and 59 were followed. Those who drank occasionally (one to two days a week) were more likely to be obese followed by frequent drinkers (three to five days a week). The subjects who drank daily (an average of 15 glasses of wine per week) were most likely to be trim.



Miscellaneous Studies on Various Body Organs


The factors that predispose to colonic diverticulosis other than age are unknown. A study published in the Journal of Clinical Gastroenterology looked at the potential association of alcohol consumption with diverticulosis using a cross-sectional study of asymptomatic subjects undergoing screening colonoscopy and a review of the worldwide literature. The authors of the study concluded that alcohol use is a significant risk factor for colonic diverticulosis. The Forum members considered that this cross-sectional analysis provided little support for a causative effect of alcohol on the risk of diverticulosis. Most larger observational studies have not shown such an effect.

A Polish study published in Systems Biology in Reproductive Medicine reported that men who drink wine up to three times a week create stronger sperm. Stronger sperm are better swimmers which increases the chance of fertilization. Increased leisure time, light coffee drinking and the wearing of boxer shorts also improved reproductive strength, while the regular use of a mobile phone for more than a decade decreased sperm mobility.

Dental school researchers in Australia and India published a study in Oral Health and Dental Management in which they collected saliva samples from subjects both before and after alcohol consumption and analyzed the samples for levels of acidity, ionic calcium and inorganic phosphate. Increased saliva acidity can damage enamel, and when tooth enamel dissolves, calcium and phosphate ions are released. The study found that a single drinking occasion can measurably affect tooth enamel. A significant reduction in mean salivary pH after consumption of any form of alcohol was observed with the highest reduction caused by beer, followed by whiskey and wine, yet beer showed the lowest increases in calcium and phosphate. The study has implications for wine tasters because pH levels remain significantly decreased for several minutes after a wine taster spits. Wine tasters who swirl and swish before spitting are at greater risk for dental enamel damage. The lead author of the study recommended following wine tasting with a swig of water or milk both of which have a neutral pH. He also suggested that wine tasters not brush their teeth immediately after tasting since the enamel is already softened. The best option is to brush after one hour with a toothpaste that is low in abrasive quality and contains remineralizing agents. It is believed that this enamel erosive effect is unimportant for drinkers in the general population who are exposed to more risk from the widespread ingestion of carbonated soft drinks.

Apparently red wine stains teeth more than coffee following teeth whitening treatments according to a study published in Acta Odontologica Scandinavica. A team of researchers in Brazil studied the effect of coffee and red wine staining on tooth color before and after bleaching. After whitening procedures, both coffee and red wine caused enamel color changes, but the wine led to greater staining than did coffee.

Using data from three large ongoing surveys, the Health Professionals Follow-Up Study (HPFS), and the Nurses’ Health Studies I and II (NHS 1 and NHS II), that included 194,095 participants, the rate of kidney stones in subjects who drank certain beverages was recorded. The study found that consumption of sugar-sweetened soda was linked to a 23 percent increased risk of kidney stones while coffee (26 percent lower risk), tea (11 percent lower risk), orange juice (12 percent lower risk), wine (31 to 33 percent lower risk), and beer (41 percent lower risk) were linked to lower risk for kidney stones. The cause of the increased risk of sugary drinks and the lowered risk of certain other drinks such as wine is unclear. Participants who drank at least one serving of wine every day showed a significantly lower risk of kidney stone formation than occasional drinkers. The study was published in the Clinical Journal of the American Society of Nephrology.

A paper presented at the American Society for Bone and Mineral Research in 2013 reported that grape consumption may help protect bone health. The research used an animal model for menopause to investigate the long-term benefits of grape consumption on bone health. Animals who consumed a grape-enriched diet had improved bone calcium retention compared to a control diet without grapes.

Two studies, one published in the Journal of Functional Foods, and one in the Journal of Cardiovascular Pharmacology, found that drinking red wine with meals is beneficial to one’s health. In the first article, a study from Israel found that free radical molecules associated with oxidative stress were reduced significantly when turkey cutlets were ingested with red wine. In the second article from Germany, subjects who drank red wine while eating French fries and pork sausage had lower levels of inflammation in their blood vessels than those who drank other beverages. Blood vessel inflammation was markedly increased when Coca-Cola was drank with the meal.

A study of Grave’s disease (hyperthyroidism) in Denmark published in Clinical Endocrinology, found that abstainers were more likely to develop Grave’s disease than those who drank alcohol regularly. Subjects who drank in moderation, defined as 1 to 2 glasses per day, had much less Grave’s disease than those who drank lightly, defined as 1 to 2 glasses per week. The type of alcohol consumed made no difference. This study adds Grave’s disease to the list of other autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, and autoimmune diabetes that appear to be less common in moderate consumers of alcohol.

A meta-analysis search of MEDLINE was done to study the association between alcohol consumption and the risk of rheumatoid arthritis and published in the Annals of Rheumatology. Low to moderate wine consumption was found to be inversely associated with the development of rheumatoid arthritis. A J-shaped curve was suggested with a lowered risk on average intake of about 1 to 1.5 standard drinks in comparison with nondrinkers and an increased risk for heavier drinking. The effects seemed to be significant for both sexes. According to The Forum, the beneficial effects of alcohol on autoimmune diseases is likely due to down regulation of the immune response and a decrease in pro-inflammatory cytokines.

In the Women’s Health Initiative Observational Study, the relationship between alcohol consumption and preference for alcohol type with the risk of melanoma and non-melanoma skin cancer was examined and published in Cancer Causes Control. The study’s conclusion was that higher current alcohol consumption, higher lifetime alcohol consumption, and a preference for white wine or liquor were associated with an increased risk of melanoma and risk of non-melanoma skin cancer. It would seem from other researcher’s comments that the association with alcohol is statistically solid, but not the beverage type data. The Forum notes that much of the association may relate to residual confounding by ultraviolet sun exposure which is the most important environmental factor for these skin diseases.

A study on primates published in Vaccine from immunologists at the University of California, Riverside, gathered data to show that moderate alcohol consumption could strengthen our immune system, and potentially our ability to fight infections. The rhesus monkeys who drank heavily showed a diminished response to the vaccine. The moderate drinkers had an enhanced immune response in comparison to the control group. This is the first study to show that moderate alcohol consumption has a specific beneficial effect on immune responses to vaccination.



Summary


Dr. Arthur Klatsky, a well-known investigator in the field of alcohol and health at the Kaiser Permanente Northern California Division of Research, notes, “The major issue with alcohol research to date is residual confounding by diet, smoking and other traits, problematic statistical modeling, and under estimation of drinking amount which lowers the apparent threshold of risk. The association of a behavioral trait such as alcohol drinking with a health outcome in any study could be due to chance, due to bias (confounding), or causal. The accepted standard for elimination of confounding and establishment of likely causality is the double-blind randomized controlled trial. Problems in blinding and prescription of long-term behavior, plus the perceived risk of harmful effects have so far precluded this type of long-term study with chronic disease endpoints. As a result....while even well-performed observational studies cannot completely exclude possible genetic or environmental predilections to health outcomes....criteria exist that can establish a very high probability of causality in these data.”

Klatsky has also said the following regarding causality. “Heavy drinking increases the risk of developing certain cancers, such of those of the mouth, liver, breast, colon and rectum. Light or moderate drinking slightly increases the risk of breast cancer, but its effect on other forms of cancer is not clear cut. For men and women over the age of 50, the benefits of moderate amounts of alcohol generally outweigh the risks, but advice about drinking needs to be individualized. An older man at risk for cardiovascular disease, for example, would benefit from moderate drinking.”

That is not to say that people over 50 years of age should start drinking because of perceived health benefits of alcohol, but rather they should consult their doctor. Dr. Ethan Schram, an oncologist, has said, “I personally tell my patients that they can do most anything in moderation - except smoking.”

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