Wine & Health ~ Lectures & Speeches

Presentation by Dr. Harvey E. Finkel "Wine and Health: A Current Overview" Invited Address sponsored by the Canadian Vintners Association at Bacchus to the Future: The Inaugural Brock University Wine Conference, May 23-25, 2002, Brock University, St. Catharines, Ontario, Canada.

Wine and Health: A Current Overview

Harvey E. Finkel

Clinical professor of medicine at the Boston University Medical Center

Lore, anecdote, and wishful thinking beyond memory held that wine promotes good health. The Talmud warns, "Only where there is no wine are drugs required." A Russian proverb advises, "Drink a glass of wine after your soup, and you steal a ruble from the doctor." Legends abound of miraculous recoveries wrought by wine among many civilizations. There is even a vineyard on the Mosel named "Doktor," with appropriate stories. Many intelligent, urbane, educated (but not in the scientific method) people have believed that the vine extracts an unspecified essence from the earth, and that this, concentrated in wine, is panacea. (Why not potatoes rather than grapes?) A trickle of unheralded reports based on science began to appear in mainstream refereed medical journals about twenty years ago, indicating a possible basis for the beliefs in wine's healthfulness, and I began to pay attention.

That trickle has become a flood. In November, 1991, the world began to pay attention when the television program, 60 Minutes, aired its segment on the so- called French paradox: picture overweight, middle-aged and elderly Frenchmen, Galoises ever dangling, eating a diet replete with foie gras and Normandy butter, whose only exercise is elbow flexion, yet who outlive Canadian and American counterparts, mainly because they have fewer heart attacks. Serge Renaud and others wondered whether what the bent elbows brought--wine, red wine (the French think that wine comes in only one colour)--made the difference. The morning after 60 Minutes, the shelves of shops were emptied of red wine. I shall review some established truths, then mention a few intriguing recent developments.

It looks like life is a J-shaped curve, of which the figure illustrates one version. I believe that this sort of relationship was first noted by Pearl in 1926 among the tuberculosis patients. It appears to obtain with regard to many disorders of various organ systems; it is particularly well grounded with regard to the cardiovascular system. The curve abstracts the kernel of my message: For the vast majority moderate consumption of alcohol, particularly wine, is beneficial. It is associated with improved health and longevity. Abstention can be viewed as a health risk. Abuse of alcohol in any form is very damaging to health, and shortens life. These relationships have been confirmed over and over again: in men and women, in several races, among peoples of the developed world in North America, Europe, Japan, Israel, Australia, and elsewhere. Most of the weight of effect comes from coronary disease, our most frequent killer, but also ischemic stroke, peripheral vascular disease, and atherosclerosis of arterial blood vessels anywhere in the body. Study after study has reported a reduction in illness and resultant disability and, easier to measure, coronary deaths by one-third, on average, among moderate drinkers as compared to abstainers. The likely major mechanisms are set in motion by alcohol, by wine's antioxidant polyphenols (resveratrol, quercetin, the catechins, others), or by both.

We are becoming more familiar with the intimate life of the intima, the key, normally smooth inner lining of blood vessels, the target of the atherosclerotic disease process. Alcohol stimulates the liver to increase its production of high-density lipoprotein cholesterol (HDL), the so-called good cholesterol, which acts as trash carts, carrying the damaging low-density lipoprotein cholesterol (LDL), "bad cholesterol," back from the intima of blood vessels to the liver for excretion in the bile--reverse cholesterol transport. Antioxidants inhibit the oxidation of LDL to its most noxious form. Both alcohol and polyphenols inhibit excessive blood clotting, as does aspirin, without causing bleeding. It is a blood clot on a diseased coronary artery wall that obstructs the flow of blood's oxygen and nutrients to heart muscle, the coup de grâce of a heart attack. The polyphenols enhance the health of the coronary and other arteries by promoting relaxation of the smooth muscle fibers within the vessel walls, by inhibiting overgrowth of these muscles to prevent the vessels from becoming muscle-bound, and by stimulating beneficial nitric oxide production.

There are likely still other mechanisms, but it is early days yet. We must not forget that prolonged alcohol abuse can severely damage the heart, as it can most every organ. It takes a lot of drinking for a long time. How much wine does one need for these benefits? Not much. Common advice is two glasses per day for men, one for women. Less probably works. How much wine is it safe to drink each day (referring to medical effects, not performance)? Assuming more or less average size and no unusual vulnerability, the average man can safely consume, on average, up to fourteen ounces of wine daily without permanently harming his liver. It is best done with meals and regularly. One cannot safely save up one's weekly allotment for Saturday night. Just over three ounces of a usual spirit or a quart of beer is about equivalent to the wine dose of alcohol. This limit was set by liver mavens. The liver is the canary of the body vis-à-vis alcohol, the organ most sensitive to lasting damage. Sixty grams of alcohol per day appears to be the absolute upper limit of the liver's tolerance without beginning lasting impairment, so forty grams was set as the recommended safe upper limit. Since wine on average contains 2.8 grams of alcohol per ounce, we get fourteen ounces of wine, or just over three modest servings daily.

Sex counts. Women have long been known to sustain tissue damage from alcohol at lower intakes than men's. Body size, water and fat content, and hormonal effects had been hypothesized unsatisfactorily. A likely, at least partial, explanation is that the gastric lining of women contains only about half as much of the alcohol-neutralizing enzyme, alcohol dehydrogenase, as that of men. So, when my wife and I dine, I get two-thirds of our bottle of wine. Women are well advised to limit their intakes to half of men's. Let us turn to cancer.

First, the bad news. Alcohol, but only in prolonged excess, distinctly increases the risks of getting some cancers. Cirrhosis of the liver of any cause increases the risk of hepatoma, usually fatal liver cancer. In concert with tobacco, prolonged excessive drinking is a clear promotor of cancers of the upper aerodigestive tract -- mouth, pharynx, larynx, esophagus. The risks of other cancers from alcohol are either minimal or without established foundation. Might wine protect us from cancer? Alcohol does no good here, even in modest dose. The antioxidants of wine, however, may deserve continued attention, for they have been demonstrated in preliminary research to inhibit several cancers in several ways. The oxidative stress that results from normal metabolism afflicts the body variously. There are reasons to believe that such oxidation leads to cancer, degenerative diseases, including dementia, and aging, and hints that wine's antioxidants may have a role in reducing these feared consequences. Limitations of space and time preclude detailed accounts of several potentially important and intensely interesting facets of wine's influences on health. I will just mention a few.

Wine, specifically, appears to combat several gastrointestinal plagues. A polyphenol of wine inhibits the production of endothelin-l , a peptide that may be a prime promoter of atherogenesis. The effects of alcohol on the liver are more complex than had been suspected, perhaps even being beneficial at low dose. Those who are obese may be well advised to severely limit their consumption of alcohol. Alcohol may be more readily absorbed from sparkling than from still wine. Diabetics can safely drink in moderation as long as they eat. They derive at least as much of the health benefits as do others. The basics are reviewed in my In Vino Sanitas? (Washington, D.C.: Society of Wine Educators, 2002, second edition) and updated in my commentaries in The Wine News.

We vary genetically and otherwise, and so, the effects I have described, generalizations, some preliminary, cannot be applied to individuals. To make the best of what we've inherited, modified by lifestyle and luck, we should consult our own qualified physicians, not our wine merchants, about healthy drinking. Wine is not medicine. It exists to enrich life, not to medicate it, although it is the most attractive medicinal package I know. And remember, moderation!