4th International Wine & Heart Health Summit
“The secret to a long life is to stay busy, get plenty of exercise and don’t drink too much.
Then again, don’t drink too little.”
These are the sage words of Hermann Smith-Johannson, a cross-country skier who lived to the ripe age of 103
years. The American public has become obsessed with anti-aging research and claims (note the cover of the
latest issue of Fortune) and yet part of the solution to a long and healthy life has been with us since antiquity.
Physicians have been prescribing wine, as we know from records in ancient Canaan and Cairo, for at least 5000
years. The esteemed physician, Dr. William Osler, was noted to say in the 1800s, “Beverage alcohol is our most
valuable medicinal agent and it is the milk of old age.” And it wasn’t only physicians that knew of the health
benefits of wine. America’s most beloved spokesman, Wills Rogers, once said, “The wine had such ill effects
on Noah’s health that it was all he could do to live 950 years. Just 19 years short of Methuselah. Show me a total
abstainer that ever lived that long.”
The United States is projected to lead the world in volume of wine consumed by year 2010. Appropriate education of the public (and physicians) about regular, moderate, and responsible drinking of wine
could have a very large impact on the health of this country. It is estimated that 71 million Americans
have cardiovascular disease (CVD), or 1 in 3, and CVD is the #1 killer. Cardiovascular disease
touches each of us through our family and friends. A large amount of credible literature has accumulated
in the last 25 years that supports that which educated observers have sensed for a long time,
namely, that wine in moderation is good for heart health.
I recently attended the 4th International Wine and Heart Health Summit
held in Napa Valley, California. This landmark conference, under the
direction of The Desert Heart Foundation in affiliation with the Renaud
Society and the University of New Mexico School of Medicine, presented
to attending doctors, research scientists, food scientists, writers, and
consumers the latest scientific literature on wine and health. The chairman
and the person most responsible for spearheading this biannual
event, is Tedd M. Goldfinger, DO, who heads the Desert Heart Foundation
in Tucson, Arizona.
There is a plethora of research and epidemiologic studies available about alcoholic beverages and
health in addition to the talks presented at this Summit. In this report, I am going to try to sift through
all of this maize of scientific information, and attempt to simplify and summarize the knowledge in a
user-friendly format. I realize that I am preaching to the choir, in that most readers are already wine
enthusiasts who have some belief in the health effects of wine. But perhaps this critical review can
provide further clarity and stimulate the dissemination of this valuable public health information. I
have tried to control my personal biases and look at the data with a critical eye. In addition, I have
attempted to present the facts in layman’s terms whenever possible.
The inconsistencies and conflicting findings and the vagaries of human nature make definitive claims
always difficult in medicine and can, excuse the pun, drive you to drink. Take this humorous piece by
Malcolm Kushner (Vintage Humor for Wine Lovers) which sets the stage for the discussion to follow:
The Japanese eat very little fat and suffer fewer heart attacks than the British or Americans
The French eat a lot of fat and also suffer fewer heart attacks than the British or Americans
The Japanese drink very little red wine and suffer fewer heat attacks than the British or Americans
The Italians drink excessive amounts of red wine and also suffer fewer heart attacks than the
British or Americans
Conclusion: Eat and drink what you like - It’s speaking English that kills you!
In the 1970s, Arthur Klatsky, M.D., first reported on the benefit of
alcohol consumption in reducing mortality and preventing cardiovascular
disease (CVD). He confirmed the J-shaped curve relationship
between daily alcohol intake and total mortality first described by
Raymond Pearl in 1926. The composite alcohol-total mortality
relationship is a J-shaped curve with the lowest risk among drinkers
who take less than 3 drinks per day. This curve has been validated
by extensive epidemiological studies and holds true for CVD, some
cancers, and cognitive dysfunction as well. Definitions vary, but
light to moderate drinking is considered less than 3 drinks per day
while heavy drinking is 3 or more drinks per day. The definition of a
standard drink varies widely from country to country. In the United
States, a standard drink contains 17.7 ml of ethanol (equivalent to 12
oz of beer, 5 oz of wine, and a shot of 80 proof distilled spirits). In the UK, a standard drink has 10 ml of ethanol. In the United States, a half bottle of wine contains about 2½ to 3½ drinks depending on the
alcohol percentage. To determine the number of drinks in a half bottle, multiple 375 ml by the alcohol
percentage and divide by 17.7. If you drink a half bottle of wine that is 13% alcohol, 375 ml x 0.13 =
48.75 divided by 17.7 = 2.7 drinks. A half bottle of 16% alcohol wine will contain ½ drink more.
If we go back to the early 1990s, alcohol was under attack from many sources including MADD
(Mothers Against Drunk Driving) and prohibitionist groups. The business climate for wine production
was strained by many factors including high interest rates. The National Institutes of Health (NIH) refused
to support any research on alcohol and health. The studies of Klatsky and others were largely
pushed into the background. In 1974, the Framingham Heart Study showed that the risk factors for
CVD were smoking, high blood pressure, increased cholesterol, and abstinence from alcohol. The
NIH, which sponsored the study, was so concerned about the “evils” of drinking, they ordered the
researchers to remove all reference to alcohol in their published report. They advised the researchers
to either provide no comment or state that “It (alcohol) has no effect.” During this time period,
Serge Renaud, PhD, working at the French National Institute for Health, and Curtis Ellison, MD, a professor
at Boston University, proposed to the NIH a cross-cultural epidemiological study on the health
effects of alcohol. The NIH rejected the application and these researchers fortunately had the fortitude
to search elsewhere for their funding.
“When I read about the evils of drinking, I quit reading.” … ...H. Youngman
Morley Safer, a reporter on the popular CBS television program, 60 Minutes, was a
Francophile whose neighbor was the French-born chef, Jacque Pépin. Pépin had told
Safer (right) that the French had a very low rate of CVD and Safer was curious. Safer
consulted with Curtis Ellison, MD, professor and chief of preventive medicine and
epidemiology at Boston University School of Medicine. Ellison told him the French
secret came simply down to wine, food and lifestyle. The French were known to outlive
Americans by about two and a half years and suffer 40% fewer heart attacks even though smoking
was a national pastime, their diet was loaded with saturated fat, and exercise was, well, an afterthought.
The French, however, consumed moderate amounts of red wine regularly with meals, they
ate more fresh fruit and vegetables, they took longer to eat meals and snacked less, they ate less red
meat and more cheese, and used more olive oil and less lard or butter. Of these factors, Ellison said
the link with moderate and regular consumption of wine with meals was the strongest and most scientifically
proven. Frenchman, Serge Renaud, PhD, had studied the relationship between the low rate of
CVD and moderate wine intake in the French population and had confirmed Ellison’s beliefs. Safer
aired the now famous program on the “French Paradox” on November 17, 1991. Safer asked Renaud
on air what the lower mortality for CVD in the French was due to. Renaud answered, “I think it is the
alcohol.” Safer closed the show holding up a glass of red wine and by the next day, red wine mania
had hit the United States. Within weeks of this program, sales of red wine in the United States shot up
40% (about 2.5 million bottles), and Gallo Winery had to put their leading brand, Hearty Burgundy, on
allocation. You might say that America had taken the health message to heart. This was a seminal
event that restored optimism in the wine industry, set the tone for political correctness in describing
alcohol as beneficial, and caught the imagination of the public.
Serge Renaud published his now famous paper in the medical journal, The Lancet : “Wine, alcohol,
platelets, and the French paradox for coronary heart disease.” (S. Renaud and M. De Lorgeril, June 20,
1992, pp 1523-1526). In this paper, he emphasized that “At the moderate intake of alcohol associated
with the prevention of coronary heart disease (CHD), the mechanism of protection seems to be, at
least partly, a hemostatic effect, possibly a decrease in platelet reactivity.” It became soon apparent
to Renaud and others that the explanation of the French paradox was “due to at least partly to a moderate
intake of wine, possibly through polyphenols.”
Serge Renaud, now in his 70’s, is pictured above at the recent Summit. His legacy has been preserved
with the formation of The Renaud Society, a group of medical professionals with an interest in better
health and a passion for wine. At the meeting, the inaugural Renaud Society wine was introduced. It is
a meritage Bordeaux Superieur from the 2003 vintage bottled by The Famille Manein in Bordeaux.
Wine has been shown to have multiple biological effects. Below is a summary of the major categories.
Wine is potent against Escheria coli and other bacteria. Interestingly, this has been known back to at
least the time of the Roman Empire, when the armies carried wine with them in their travels to avoid
diarrhea. Wine has been shown to reduce gall bladder disease. An unwelcome effect is that alcohol
will increase gastric reflux and may be troublesome to those with hiatal hernia.
Effects are widespread and multiple including antioxidant effects by preventing oxidation of molecules
such as LDL, (the low-density lipoprotein, so-called “bad cholesterol” which in its oxidized state
contributes to atherosclerosis or plaque formation and hardening of arteries); direct effects such as
increasing HDL (high-density lipoprotein, or “good” cholesterol which is anti-inflammatory and reduces
the risk of atherosclerosis; anti-thrombotic or anti-coagulation effect (reduces the “stickiness” of
platelets); and modification of the function of the vascular endothelium (in cell culture red wine inhibits
endothelin or ET1 which causes blood vessel constriction leading to atherosclerosis). The actions of
wine are very complex, and poorly understood at this time. The lay press has referred to the ability of
polyphenols in wine to “mop up free radicals,” as an explanation for their cardiovascular benefit, but
certainly this public explanation is an over-simplification. Recent research indicates that specific
effects on inflammatory processes are more important than antioxidant effects. Moderate drinkers may
show a mild increase in blood pressure which is thought to have no clinical importance. Those with
hypertension should not be discouraged from drinking moderately as long as they are on treatment
for their high blood pressure. Studies have shown that the low to moderate intake of wine significantly
reduces not only CVD and CHD, but also cerebrovascular accidents or stroke (CVA), congestive heart
failure (CHF), high blood pressure, and peripheral vascular disease.
There is a 30% reduction in risk of developing diabetes mellitus with moderate wine consumption. In
addition, diabetics who imbibe regularly and moderately have a decreased risk of dying from cardiovascular
disease. There is a decreased rate of osteoporosis and multiple sclerosis in wine drinkers.
There is an increased incidence of esophageal and breast cancer with high consumption of alcohol
(more than 8 drinks a day in an Italian study). Women are faced with a dilemma in that there is about
a 10% increase in breast cancer but a 50% reduction in CVD with light to moderate wine intake. If
middle aged and older women have adequate folate in their diet and are not on hormone replacement
therapy, the incidence of breast cancer in low to moderate drinkers of wine is the same as abstainers.
Wine seems to decrease the risk of colorectal cancer, dramatically reduce the risk of gastric cancer,
and decrease the incidence of kidney cancer, prostate cancer, and lymphoma. The beneficial mechanisms
are complex, but it would seem that polyphenols in wine inhibit cellular events associated with
tumor initiation, promotion, and progression. One polyphenol, resveratrol, may have also have therapeutic
value in cancers. In animal studies, it promotes the death of cancer cells by inhibiting a gene,
NF kappa B, which is released by the body’s immune system to protect cells, including cancer cells,
from chemical and radiation attack.
Wine seems to preserve cognitive function in aging individuals. There is a significant decreased risk
of Alzheimer’s disease and dementia in low to moderate wine drinkers. Wine buyers tend to purchase
and eat healthier food compared to people that buy beer. Also, there is an increasing IQ with increased
preference for wine over other alcoholic beverages.
There are lower rates of obesity among drinkers and decreased weight gain overall. Although a drink
of wine provides approximately 100 calories, wine is metabolized differently from other caloric intake.
The French, who have a very low rate of obesity, are a perfect example of this observed effect.
The observed favorable consequences of regular and moderate wine intake are thought to be secondary
to the combined effects of alcohol and multiple polyphenols. Acting together, they influence
vascular, hemostatic, and inflammatory functions that combine to produce cardioprotection, reduction
in carcinogenesis, improved cognitive function, and a number of favorable metabolic changes.
Much of the research on wine and health has centered on the polyphenols. These are chemical
substances known as phytoalexins or phytochemicals, compounds derived from plants that have
biological activity in the human body. In wine they include the flavonoids (resveratrol, quercetin,
catechin, anthocyanin and procyanidin), tannins, and sulfides. The polyphenols are not unique to
wine, and occur in abundance in many foods such as raspberries, blueberries, pomegranates,
peanuts, green tea, extra virgin olive oil, and other plants. There are more polyphenols in wine than in
grape juice because the fermentation process extracts more of these phytochemicals. One glass of
red wine has 200 mg of phenolic compounds compared to 40 mg for white wine. There has been some
interest of late in wines from specific regions, which by virtue of their vineyard locations and respective
winemaking techniques, have particularly high levels of polyphenols such as resveratrol. For example,
resveratrol levels are increased in red wines from Argentina where the vineyards are at high
altitude. Presumably, the elevated concentration of polyphenols in the grapes develop as a protective
response to the intense ultraviolet light at the increased altitudes. These wines have been shown in
animals to be potent inhibitors of ET1 and the press has been quick to anoint these wines as
“healthier.” A crazy idea, of course, because everyone knows Domaine de la Romanee-Conti Le
Tache is the healthiest wine (just kidding). The fact is, and this was emphasized at the meeting I attended,
only small amounts of polyphenols are required to produce their beneficial health effects.
There is absolutely no evidence to indicate that a special polyphenol-endowed wine is healthier in humans.
Don’t fall for the press hype. The crux of the matter is that light to moderate drinking of red
wine is beneficial, regardless of the red wine that is imbibed.
Resveratrol is the polyphenol “most likely to succeed” if you were to believe the press. There were at
least 600 scientific studies in the literature in 2006 that mentioned resveratrol. Resveratrol has been
shown to increase the life span of yeast cells, round worms, fruit flies, and short-lived fish. Research
reported last November caused quite a stir in the press. A research team reported that mice fed high
doses of resveratrol could be kept from gaining weight, despite being kept on a high fat diet. In addition,
their aging process was slowed and their running stamina was improved. David Sinclair has been
involved in a number of resveratrol studies and has partnered with CEO Christophe Westphal to form
Sirtrus Pharmaceuticals to develop medications that have the same effect as resveratrol does on mice.
In the Fortune article pictured on page 1 of this report, it is reported that the co-founders have raised
$82 million over the past 2 years to fund their research. They have already developed a resveratrollike
drug (501) that helps people with diabetes mellitus keep their blood sugar controlled. The drug
delivers a large amount of resveratrol to the blood stream, in theory activating SIRT1 (the origin of the
name Sirtrus for the company) which is an enzyme in cells that stimulates the formation of new, healthier
mitochondria that do not throw off damaging radicals like their aging brethren. The result is a boost
in the metabolic rate. At this point in time, it is not clear whether their research will be successful, as
many scientists believe resveratrol has complex actions on many different molecules, and may need
alcohol and other polyphenols to exert its full effects. The author of the article in Fortune, David Stipp,
advises readers to “Pour a glass of Pinot Noir, and while imbibing, step back and regard the big picture.
The dream (of extending life span) is likely to be realized within, at most, a few decades.”
25 facts to hang your stem on:
1. The mortality rate from CHD is lowest in Japan, second lowest
2. Moderate drinkers of any type of alcohol have less CHD
compared to abstainers (see graph).
3. The benefits of alcohol consumption last approximately 24
hours, so alcohol should be consumed regularly, even daily.
4. Binge drinking (3 drinks in less than 2 hours) negates the
effects. The most benefit is gained from small amounts of alcohol drunk regularly.
5. Moderate drinking has little effect on cardiovascular medications (coumadin, blood pressure,
hypoglycemic medications), in contradiction to warnings to the contrary.
6. There is a lower risk of death in light to moderate drinkers of any type of alcoholic beverage. This
is true for both sexes, and all races.
7. Heavy drinking increases the risk of gastrointestinal cancers, cirrhosis, and breast cancer.
8. The leading cause of death in women is heart disease, not breast cancer as is often believed. More
women die from CVD than cancer at any age.
9. In women, moderate alcohol drinking reduces CVD by 50%.
10. More is better is a fallacy. Research indicates there are enough polyphenols in most any red wine
to produce beneficial physiological effects.
11. Intelligent drinking should be encouraged in middle-aged and older adults as long as there is no
contraindication. It seems that people can drink more as they get older with no harmful effects.
12. Drunkenness is unacceptable behavior and leads to adverse social and health consequences.
13. Resveratrol is the most publicized polyphenol in red wine, but there are many polyphenols that act
synergistically to produce beneficial health effects.
14. Health-improving behaviors are critical to well-being. There are 5 healthy lifestyle factors that are
important in preventing CVD and diabetes mellitus: (1) avoid smoking, (2) stay lean, (3) exercise
regularly (at least 30 minutes a day), (4) follow a diet low in animal fat, high in fiber, and (5) intake
of ½ to 2 drinks of alcohol per day. A 2006 study showed that there is a 70% decreased risk of CVD
if #1-4 are followed, and #5 is then added to the other 4.
15. A small amount of fat is healthy. Mortality increases if a person is too thin. However, obesity is
unhealthy and currently a major health problem. The population in every state of the United States
is now 20-25% obese.
16. Intervention studies in animals show that wine and/or polyphenols from wine show a definite
advantage over the administration of ethanol by itself.
17. Dietary supplements containing high amounts of polyphenols such as resveratrol have no proven
health benefit. Why take a pill when the benefit is perfectly packaged naturally in wine?
18. Danish studies show beverage specific differences with wine drinkers having health advantages
over beer and distilled spirits drinkers. Wine drinkers have a lower cancer risk and less abdominal
obesity than beer or distilled spirits drinkers. In Denmark, moderate consumption of wine
reduces the risk of CHD and CVA by 60%.
19. Breaking research as yet unpublished from Dominique Petithary-Lanzmann, M.D., PhD (who has
worked with Serge Renaud for 20 years) involves a prospective study of 42,883 French men from
eastern France. Many confounding variables were adjusted. The results showed that moderate
wine drinkers compared with abstainers had a lower risk of death from all causes and moderate
beer drinkers compared with abstainers had no decrease of risk.
20. Wine drinkers have lower mortality at all levels of blood pressure.
21. Research (Francois M. Booyse, PhD, University of Alabama Birmingham) has shown that levels of
alcohol and wine polyphenols associated with moderate consumption will be expected to increase
endothelial cell mediated fibrinolysis to promote and sustain increased blood clot lyses in humans.
CVD protection will then be achieved, in part, by the ability of increased fibrinolysis to reduce the
risk for early thrombosis and later acute CHD-related atherothrombotic consequences of myocardial
infarction (heart attack) and hence overall CHD-related mortality. The point is, make sure you
have been drinking red wine at least two weeks before your heart attack.
22. Under-reporting of intake (for example, heavy drinkers reporting lighter intake) lowers the threshold
for apparent harm, and reduces the apparent magnitude of benefit from light to moderate
23. One of the problems of alcohol research is that there are no randomized controlled trials. Some
critics have attributed the findings to the “healthy drinker hypothesis,” that is, attributing the results
to the drinker, not the drink. Light to moderate drinkers might be healthier (exercise more,
eat a healthier diet). A 2006 study refutes this hypothesis. When studies are full-controlled for
confounders, there is still a benefit for light to moderate drinking and the findings confirm the Jshaped
24. Arthur Klatsky will soon publish his latest data validating the J-shaped curve. The benefit of light to
moderate drinking dips below the line and stays until 3-5 drinks a day. The curves for men and
women are similar, with women having a slightly increased benefit of light to moderate drinking
compared to men. There are no ethnic differences in the effect.
25. Educating the public makes an impression: many measures of alcohol abuse have been reduced
in the United States in recent years.