Wine is Good News for Health in 2007

There continues to be a plethora of research and epidemiological studies in the scientific literature supporting the health benefits of wine. The inconsistencies, conflicting findings, and the vagaries of human nature make definitive claims in medicine always difficult, and can, excuse the pun, drive you to drink. Barbara Cohn Ph.D., a researcher of breast cancer said, “It is essential for the public to have the chance to appreciate how difficult human research is. One study does not prove a finding - it is important to see whether what we find is consistent with lab studies and other things we can learn with human populations.”

Most of this research has centered around the polyphenols in grapes, a group of chemicals known as phytoalexins or phytochemicals, naturally occurring compounds in many plants that have biological activity in the human body. The polyphenols are not unique to wine and occur in many other fruits and vegetables including raspberries, blueberries, plums, pomegranates, tea, olive oil, walnuts, peanuts, and chocolate/cocoa. There are more polyphenols in wine than in grape juice because the fermentation process extracts more of these phytochemicals. Red wine contains significantly more phenolic compounds (one glass = 200 mg) than white wine (one glass = 40 mg). The polyphenols can be further subdivided into tannins, lignins and flavonoids. The polyphenols most studied have been the lignins catechin and quercetin and the flavonoids resveratrol and procyanidin.

Wine has been shown to have a wide range of biological effects on many body systems, but the actions of beneficial wine compounds are complex and poorly understood at this time. The effects on the cardiovascular system alone are numerous including antioxidant actions (preventing oxidation of molecules such as LDL or low-density lipoprotein, the so-called “bad cholesterol”), suppressing endothelin- 1, a substance produced by the lining of blood vessels that promotes atherosclerosis, direct effects such as increasing HDL or high-density lipoprotein, the “good cholesterol,” which can reduce the risk of atherosclerosis, and anti-thrombotic or anti-coagulation effects that reduce the “stickiness” of platelets.

Why is it important to research the possible positive health effects of polyphenols and alcohol? The Milken Institute reports that the United States has 40 million cases of cancer, diabetes mellitus, heart disease, cerebrovascular accident, mental disorders and pulmonary disease costing 1.1 trillion dollars per year to treat. The Rollins School of Public Health at Emory University reports that Americans have much higher rates of serious disease including cancer, heart disease, diabetes mellitus, and hypertension in the over 50-year-old age group than comparably aged Europeans. Heart disease is diagnosed nearly twice as frequently in Americans than their European counterparts, arthritis and cancer more than twice as often.

The American Heart Association under their 2006 Diet Recommendations include vegetables and fruits, whole-grain foods, fish, lean meats, low-fat dairy products, limited saturated fat, trans fat and cholesterol, avoidance of beverages with added sugars, minimal salt intake, no smoking and drinking alcohol in moderation (one drink a day for women, two drinks a day for men). This message has been largely ignored. According to Gourmet (July, 2007), one-fifth of Americans live on a diet of 10 foods or less. The most common choices: French fries, fried chicken, chocolate chip cookies and Kraft macaroni and cheese!

In the following pages, I have summarized the most pertinent world’s literature published in 2007 on wine and health. Keep in mind that the definition of levels of drinking vary, but in general moderate drinking is defined as no more than 1 drink per day for women and no more than 2 drinks per day for men. Heavy drinking exceeds these daily limits. A standard alcoholic drink is a 12 oz beer, 5 oz of wine, or 1.5 oz of 80 proof spirits or liquor.

Longevity Wine drinkers live longer than beer and spirit drinkers in a 29-year Finnish study. Findings showed a 34% lower death rate in men who were moderate wine drinkers compared to beer and spirit drinkers and wine drinkers had better overall mental and physical health. Journal of Gerontology, 2/07.

Moderate wine drinkers live longer than nondrinkers in an Italian review of 35 independent studies involving more than 1 million subjects. Archives of Internal Medicine, 12/06.

Dutch researchers reported that light alcohol intake long-term in middle-aged men was associated with less cardiovascular and all-cause death and longer life expectancy at age 50. Those who drank 1- 2 drinks per day had a 36% lower risk of all-cause death and a 34% lower risk of cardiovascularrelated death. On average, light and moderate drinkers of any type of alcohol lived 16 years longer than teetotalers. Wine drinkers lived the longest of all drinkers, on average an additional 3.8 years longer. American Heart Association 47th Annual Conference on Cardiovascular Disease Epidemiology & Prevention. Cognitive (Brain)

Grape polyphenols (in both Cabernet red wine and Concord grape juice) were shown to counteract beta-amyloid plaques in the brain in an experimental mouse model of Alzheimer’s Disease. In Alzheimer’s Disease there is an accumulation of beta-amyloid plaques in the brain identifiable on imaging examinations. From the Center for Research in Alternative & Complimentary Medicine in Alzheimer’s Disease at Mount Sinai School of Medicine and reported at Neuroscience 2007 in San Diego, California.

Patients with Alzheimer’s Disease live an average 4 years longer when they eat a Mediterranean diet (which includes the moderate intake of wine). The Mediterranean diet also lowers the risk of developing Alzheimer’s Disease. Neurology, 09/07.

One drink of alcohol (mostly wine) a day can delay dementia, including Alzheimer’s Disease in those people beginning to show memory problems (mild cognitive impairment). An 85% slower rate of dementia was reported in the study. It was theorized that alcohol might act by improving circulation in the brain. Neurology, 05/22/07.

Italian and British researchers found that drinking French Champagne may prevent brain injuries from strokes and other neurological disease. Journal of Agriculture & Food Chemistry, 04/18/07.

A Portuguese study found that moderate consumption of red wine may prevent brain damage caused by alcohol. The study was performed in rats but the findings are likely to apply to humans. Neuroscience, 06/08/07.

Moderate amounts of alcohol (a 2½ % ethanol diet which is less than the legal driving limit of 1-2 drinks per day in humans) administered to rats led to improved memory compared to rats who received no alcohol in their diet.. The rats on a heavy alcohol diet did poorly on tasks requiring object recognition, but did better on emotional memory tasks. The authors of the study hypothesize that people who drink to “drown their sorrows” may actually promote traumatic memories and lead them to further drinking leading to alcoholism. Journal of Neuroscience, 09/07.

Men with high blood pressure are 30% less likely to have a heart attack if they drink 1-2 glasses of wine a day. Light drinkers had about the same rate of heart attack as nondrinkers. Research was done at the Harvard School of Public Health. Annals of Internal Medicine 01/02/07. (Note: those with high blood pressure can drink moderately as long as they are on anti-hypertension medication).

An Australian study showed that regular intake of red wine (a little more than ½ a bottle of Cabernet daily) by subjects of all ages lowered cholesterol levels and decreased oxidative stress on their blood vessels as measured by blood testing. Nutrition Journal 09/24/2007.

The United States Institute on Ageing at the University of Florida reported a study showing that men and women, ages 70-79, who drank 1-7 alcoholic drinks a week had significantly lower risk of heart problems and death compared to abstainers. With light to moderate alcohol consumption, there was a 260% decreased risk of all-cause mortality and a 30% decreased risk of cardiac events such as myocardial infarction compared to non-drinkers. Archives Internal Medicine 04/07.

Red wine, apples and pears decreased the risk of heart-related mortality in postmenopausal women. Iowa Women’s Health Study by the University of Minnesota.

Both young and older people who drank ½ bottle of red wine a day showed increased HDL cholesterol levels and increased antioxidant levels (harmful free radical levels were reduced). The changes could be observed in as little as two weeks after regular wine intake. Nutrition Journal 09/24/07.

Cardiovascular researchers suggest the need for a large prospective randomized trial on the health benefits of wine. After reviewing the literature, the researchers concluded that the preponderance of data suggests 1-2 drinks a day for men and 1 drink a day for women benefits the cardiovascular system. Circulation, 09/07.

Moderate consumption of Spanish sparkling wine (cava) decreases levels of substances (inflammatory markers) that cause buildup of arterial plaques. The sparkling wine had more anti-inflammatory effect than gin which was studied for comparison. Journal of Nutrition 10/07.

Chinese men who consumed moderate amounts of alcohol were at about the same risk of stroke as nondrinkers, while light drinkers (up to 6 drinks a week) showed an 8% lower chance of stroke. Heavy drinkers were at a much higher risk for stroke. Wine may provide added protection in moderate drinkers, but the study did not measure this as most of the men preferred liquor or beer. Annals of Neurology, 08/20/07.

Cancer Men, ages 40-64, who drink 4-7 glasses of red wine a week are only 52% as likely to develop prostate cancer as those who abstain. Red wine showed more benefit than white wine. The researchers theorized that antioxidants in red wine may counterbalance androgens (male hormones) that stimulate the prostate. Harvard Men’s Health Watch, 06/07.

Laboratory mice fed resveratrol had less tumors of the prostate compared to mice fed a normal diet. The lead author of this study, Coral Lamartiniere, has a family history of prostate cancer and he drinks a glass of Cabernet nightly and takes resveratrol supplements every day. Journal of Carcinogenesis, 09/07.

Dr. Arthur Klatsky, a noted researcher on wine and health, reported to the European Cancer Conference in Barcelona, Spain on 09/27/07 that females who consume 1-2 drinks per day increase their risk of breast cancer by 10% compared to those who drank less than 1 drink per day. The risk was increased to 30% if women drank more than 3 drinks per day - comparable to the risk of taking estrogen or smoking one pack of cigarettes a day. Eating high amounts of folic acid (leafy greens, citrus fruits, beans and peas) may eliminate any risk of breast cancer due to moderate alcohol consumption.

Researchers compiled 10 studies that excluded smokers. They found that wine drinkers have a lower risk of lung cancer compared to abstainers regardless of the level of wine consumption. There was a lower risk with wine than with other types of alcohol. The findings were only statistically significant in men. Cancer Epidemiological Markers & Prevention, 11/07.

Gastrointestinal

Italian researchers at the University of Pavia have found that both red and white wine act as antimicrobial agents reducing the population of streptococci bacteria in the mouth. Streptococci cause tooth decay and sore throats. They postulated that the organic acids which occur naturally in wine and which are also produced as a byproduct of malolactic fermentation are the most effective killers of the bacteria. The study supports the idea that wine can help prevent tooth decay, gum disease and sore throats. Journal of Agriculture & Food Chemistry, 07/11/07.

A laboratory study showed that Cabernet, Pinot Noir, Merlot and Shiraz kill harmful bacteria in the gastrointestinal tract, but not the beneficial strains that aid digestion. The research exonerates wine as a cause of heartburn and gastric reflux (both of which are known side-effects of alcohol). Archives of Internal Medicine

Bones

Low and consistent doses of alcohol in laboratory mice slowed the onset of rheumatoid arthritis. Proceedings of National Academy of Sciences 01/02/07.

Diabetes Mellitus

Resveratrol may counter type 2 (adult-onset) diabetes mellitus and insulin resistance according to a Chinese report. When the body becomes less sensitive to insulin, a hormone that controls blood sugar, type 2 diabetes mellitus may result. The study showed that resveratrol blocks insulin resistance in mice. The mechanism is presumably due to activation of the gene SIRT1 which boosts insulin sensitivity. A person would need to drink 3L of red wine each day to get the 15 mg necessary for reservatrol’s beneficial effects. Cell Metabolism, 10/07.

Pregnancy

Wine labels in the United States warn against any alcohol during pregnancy and most doctors discourage drinking wine throughout pregnancy. There have been over 5,000 articles published on the effects of alcohol during pregnancy and the last word is still not in. However, there is enough evidence for various adverse alcohol-related birth defects that most clinicians recommend abstinence to patients contemplating pregnancy or already pregnant. The issue is currently quite controversial in the United Kingdom with conflicting guidance from different sources. The British Medical Association and the Government Department of Health suggest those pregnant and those trying to get pregnant abstain from drinking alcohol (they had previously stated that one to two drinks once or twice a week was acceptable). In contrast, the Royal College of Obstetrics & Gynecology has publicly said that moderate drinking in pregnancy is safe. The National Institute for Health and Clinical Excellence has said it is safe for women to have less than one drink of alcohol a day after the first trimester of pregnancy.

Resveratrol

Most of the scientific research on wine polyphenols has focused on the so-called “miracle molecule,” resveratrol. The preponderance of research has been on mice and in vitro (outside the living organism). Some of the beneficial effects of resveratrol have been shown to include protection against cancer, heart disease and diabetes mellitus. Resveratrol has been demonstrated to lower cholesterol, reduce inflammation, decrease pain, prevent hearing loss, and increase the life expectancy of fruit flies, earthworms, mice and strains of yeast in the lab. A study reported in Nature in 2006 by Harvard Medical School and the National Institute of Aging involving obese mice fed high-fat, high-calorie diets found that they lived a normal life span if they took large doses of resveratrol. They outlived over-indulgers who took no resveratrol. The researchers postulated that resveratrol works by activating the SIRT1 gene. It is theorized that resveratrol interacts in a cell with SIRT1 activating it. New mitochondria (the powerhouse of cells) are formed in muscles and other tissues boosting the body’s metabolic rate, which may in turn mimic the slow-aging effects of a calorie-restriction diet.

In one study, humans were given resveratrol caplets and then their blood was analyzed to see how much of it became absorbed. At the highest dose, unchanged resveratrol levels were found to be about half as high as the level previously shown to have cancer-preventing effects in vitro. But resveratrol metabolites were present in high levels and may have similar effects as resveratrol itself. Cancer Epidemiology, Biomarkers & Prevention, 06/07.

University of California Irvine researchers had colon cancer patients take resveratrol for two weeks between diagnosis and surgery and then compared diagnostic biopsies with tissue excised at surgery. They found a 50% inhibition of cell changes with more inhibition in healthy tissue than cancerous tissue. This suggests that resveratrol may be of value in preventing colon cancer. American Association for Cancer Research, 04/07.

Resveratrol was shown to decrease the risk of deadly prostate tumors in mice. Carcinogenesis, 08/07.

Resveratrol taken along with statin drugs works better than either alone in reducing lipid levels in rats with high cholesterol and improving their recovery time after heart attacks. Journal Molecular & Cellular Cardiology

With all of the hype surrounding resveratrol, there are a number of supplements available on the market. The safety of these have not been established as they have not been thoroughly tested in humans, but they are probably safe if used in moderate doses. Karen Raun, writing in the Los Angeles Times (October 8, 2007) related a testimonial from aseveral doctors about resveratrol including this one. Dr. Nilanjana Maulik, Professor of Surgery at the University of Connecticut said, “I take resveratrol every day, 750 mg, which is equivalent to 100 glasses of red wine. Why I take that is a real secret. Ok, I will let you know. I am 45 years old, but I look like 34. I can work round the clock 24/7. I do extensive brain work, but I am always cheerful and I am never tired. So the bottom line is, I have a lot of energy, and that is from resveratrol I am sure.”

Many researchers feel that only a small daily amount of resveratrol is necessary to produce many of its myriad of beneficial effects in the human body. Those in agreement feel it makes more sense to drink red wine in which resveratrol occurs naturally then to consume resveratrol supplements. A group of British scientists wrote in the respected medical journal, Lancet, “If wine is ever found to contain a constituent protective against cardiovascular disease, then we consider it almost a sacrilege that this constituent be isolated. The medicine is already in a highly palatable form.” Leroy Creasy at Cornell University studied the concentration of resveratrol in over 100 American wines. He found that Oregon’s Willamette Valley Vineyards Pinot Noir had more than 4 times the level of California red wines. The American Muscadine grapes, notably Scuppernong, which are native to the coastal Southwest United States, have more antioxidants than other grape varieties. The largest producer in the world of Muscadine wines is Duplin Winery in Rose Hill, North Carolina.

Two noted researchers, Roger Corder, a professor of experimental therapeutics at William Harvey Research Institute in London and his colleague Alan Crozier of the University of Glasgow feel that procyandins not resveratrol are responsible for the health benefits of red wine. They postulate that the amount of resveratrol necessary to produce health benefits is too small in the quantity of wine normally consumed. They point out that one would need to drink several hundred liters a day to get the benefits. The amount of procyandins in a half bottle of wine on the other hand, is all you need for the same effect. Resveratrol is available at one one-hundredth or one one-thousandth of the levels of and Corder has written a book titled The Red Wine Diet (Avery/Penguin Group, $15.95). In the book Corder reviews studies of long-lived men in the Gers region of France and in Sardinia where the local wines have the highest procyanidin levels. The inky and tannic wines drank in these areas are made from Tannat, Malbec, Sangiovese, Anglianico, Sargantino and Nebbiolo grapes which are very high in polyphenols, possessing as much as four times more procyandin than other wines. His book discusses his research and provides a recommended diet of procyanidin-rich foods and drinks. He urges moderation and recommends 2small glasses of red wine per day (preferably American Cabernet Sauvignon or Cabernet blends) for women and up to 3 glasses a day for men. Each glass of tannic red wine contains 60-90 mg of procyanidin and Corder recommends 300-500 mg daily from various sources including apples, berries, pomegranates, persimmons, walnuts, and chocolate. The only grape juice that has decent levels of procyanidin is Concord. The exact mechanisms by which procyanidin produces its effects in the human body are unknown and future clinical trials are planned. However you view the health claims for procyanidin, it is hard to argue against a diet rich in fruits, vegetables, and a modicum of red wine.

The whole key to drinking wine for health is moderation. We know that overdrinking can lead to a number of health problems including sudden death from high blood pressure, heart attack or stroke, cardiac myopathy, cirrhosis of the liver, acute alcoholic hepatitis, osteoporosis, chronic gastritis, irritable bowel syndrome, hallucinations, tremors, insomnia, nightmares and night sweats, dementia (Korsakoff’s Syndrome), and cancer of the mouth, pharynx, larynx, esophagus, stomach, liver, colon and breast. Meir Stampfer, Professor of Nutrition and Epidemiology at Harvard School of Public Health has noted, “It is better not to drink at all than to drink too much.”

Long before the French Paradox was popularized in the United States, Raymond Pearl, M.D., wrote a book in 1926 that was the bane of prohibitionists, titled Alcohol and Longevity. In the book, his studies led him to conclude that moderate drinking of alcohol led to lower rates of mortality and greater expectations of life compared to abstention from drinking. Even the great sage, Johnny Carson, knew the benefits of wine. After undergoing quadruple bypass surgery, he offered the following advice to David Letterman who was recovering from quintiple bypass surgery, “Drink more red wine.”