Is alcohol necessary for wine’s health benefits?

High on the list of controversies about wine and health is the alcohol question, one I get asked about every time I do a seminar on the subject. Why not grape juice, or for that matter wine's goodness in a pill?

New research from the University of Barcelona took the question head on and it's good news for wine drinkers.

There are so many thousands of papers on wine and health now that you can be forgiven for not keeping up (which I am taking care of for you here) but in order to understand the implications of this latest study we need a little background. For one, as I said in the book, wine is not just grape juice without the alcohol; the content of polyphenols antioxidants is much higher in wine for several reasons (for another, grape juice is high in sugar.) There is a great temptation to assume that we could just take the polyphenols from grapes and put them into supplement form, which indeed many have. For non drinkers and occasions where wine consumption is inappropriate, it may not be such a bad idea. But does alcohol make a positive, independent contribution to health?

In terms of cardiovascular health, it is known that alcohol in moderation improves the HDL/LDL cholesterol ratio, and it is tempting to assume that is the end of the story. But atherosclerosis is a much more complex phenomenon than simply sludged up pipes from a high fat diet. Chronic inflammation, at least as biologists use the term, is the important underlying factor. So the scientists in Spain designed a clever clinical study in which volunteers were assigned to three groups: one consumed a standardized amount of red wine daily, another an equivalent amount of de-alcoholized wine, and a third had gin, standardized to the same alcohol amount as the wine group, for 4 weeks. They then measured 25 separate inflammatory biomarker levels. These molecules go by an alphabet soup of names, but the implications of the study were clear: Both alcohol and red wine polyphenols independently improved (“down-regulated”) inflammatory marker levels, and though there was some overlap they generally worked differently.

So is alcohol an anti-inflammatory compound? At least where cardiovascular disease is concerned, it would appear so. That would explain why alcohol from any source appears to offer some benefit, though not as much as when it is in wine. Another important aspect of this study is that it is a randomized prospective clinical trial, meaning we can take very high-level confidence in the results. Not that I had any real doubts.

New evidence that red wine lowers risk of breast cancer

Does drinking red wine increase risk of breast cancer? If you have been following the news over the past few years, you might have a hard time justifying that glass of wine with dinner, as we are told that even in moderation the risk of breast cancer increases. But as I have said here before (see post from Nov 2 2011), the whole topic is widely misunderstood and oversimplified, despite the declarations of medical authorities. But a new study helps to shed some light on the subject.

So why is the party line so negative on wine? At first glance, the evidence seems overwhelming: dozens of studies showing that consumption of alcohol in any form – red or white wine, beer, spirits – increases chances of developing breast cancer by about 10% per drink per day. Some of these studies are quite large, with thousands of women surveyed. A closer analysis reveals some serious problems however. To begin with, any time there are dozens of population studies all looking at the same question, we may fairly ask why the question is so difficult to answer. A quick glance reveals one obvious problem: not all the studies find an association of alcohol consumption with breast cancer. Another, more pernicious problem, has to do with a fundamental weakness of population studies: they rely on self reporting, which in the case of alcohol consumption is notoriously unreliable. The result is that heavy drinkers are misclassified as moderate drinkers, suggesting that low levels of drinking are unsafe.

More to the point is the fundamental question of whether red wine is different in terms of risk than other alcoholic drinks. Since women in the U.S. and Britain tend to have mixed drinking patterns – for example, minimal drinking during the week, and a variety of different drinks when they do – it becomes impossible for all practical purposes to know what the effect of regular, moderate consumption of red wine would be. 

It is also difficult to pin down exactly what alcohol does to increase breast cancer risk, but the theory seems to be that it promotes estrogen and so it is primarily estrogen-dependent tumors that account for most of the problem. This latest study attempted to address that by evaluating the effect of compounds in red wine that inhibit an enzyme called aromatase, which converts testosterone into estrogen. Using what is called a crossover prospective trial, they were able to show that consumption of red wine in volunteers had a positive effect, concluding that “red wine is a nutritional [aromatase inhibitor] and may explain the observation that red wine does not appear to increase breast cancer risk.” (emphasis added). So enjoy a glass of red wine with dinner and enjoy life.

Is it all lifestyle or is wine the key to health? New studies considered.

Much has been made of the recent report from a 20-year study from Harvard that apparently found that it is the lifestyle choices made by wine drinkers, not the wine itself, that is responsible for longer and healthier lives. Following more than 800 people over the age of 55, the researchers found that it was the pattern of moderate drinking and associated lifestyle factors that most closely correlated to health and longevity.

Taken at face value, this study would appear to turn the French paradox on its head. But wasn’t the French paradox defined by heart health despite the unhealthy habits of the French? If that is so, then the findings from the Harvard researchers need to be reconsidered in a new light. On the one hand, it is widely known that aside from the French with their Galoises and penchant for fois gras, wine drinkers do tend to have healthier habits; we are better educated, we exercise more, and eat better. On the other hand, the French paradox – which is supported by substantial statistical data – suggests that there must be something special in the wine after all.

Sorting all of this out becomes tricky, because it isn’t simply all one or all the other. Positive lifestyle factors associated with moderate wine drinking do make a contribution, as this latest study suggests. There are numerous problems with these types of studies, such as self-reporting bias (which we have detailed here before), but the clear message to be drawn is that whatever benefits wine contributes to health and longevity aren’t reducible to biochemistry. It demonstrates that wine consumption with meals, on a consistent basis as an integral part of the lifestyle is where the chips begin to stack up. It underscores the role of alcohol, whether due to its salutary effects on cholesterol profiles or its ability to relax and unite around the dinner table.

So again we see that resveratrol isn’t the explanation, supplements aren’t likely to deliver the same benefits as a glass of wine with dinner, and health and happiness derive from a way of living. With that in mind, let’s all resolve as the new year begins to relax, savor the company of good friends and the joys of good wine. Cheers!

A more detailed critique of the research here.

The biggest myths about wine and health

Just when it seems that people are starting to catch on about the wine and health story, along come the naysayers to muddy the waters with out of date and disproven assumptions. True, a lot of what I am about to cover here is counterintuitive and goes against longstanding beliefs, but it’s a matter of science. Like Lt. Joe Friday used to say in the 50’s TV series Dragnet, it’s “just the facts, ma’am.”

Myth #1.  Alcohol abuse is the biggest cause of liver disease. We all know that alcohol leads to cirrhosis of the liver right? It turns out that by far the largest cause of liver failure in developed countries is Non-Alcoholic Fatty Liver Disease, or NAFLD. What’s more – and here’s the interesting part – wine seems to have a protective effect against NAFLD. The key here if course is amount, so as with all things wine and health, we are talking about a glass or two of red wine with dinner.

Myth #2. Alcohol destroys brain cells. While technically it may be true that alcohol is toxic to neural tissues, the presumption that any level of drinking is bad for the brain is not. In fact, one of the more surprising revelations to come from the research on wine and health is that cognitive function is objectively better in wine drinkers as they age compared to nondrinkers. This has been a remarkably consistent finding. So drinking –wine, at least – is good for the brain.

Myth #3. Any “French Paradox” benefit to heart disease from wine is nullified by alcohol’s contribution to high blood pressure. While not as widely discussed, this one has been a sort of trump card for the anti-alcohol group since it is well known that alcohol consumption contributes to hypertension. However, it has been confirmed that the heart health benefit still holds even among hypertensives – those who already have high blood pressure.

Myth #4. Wine’s benefits are all due to resveratrol, so you are better off taking a pill and skipping the alcohol.  This is an interesting conclusion but widely held even among “experts.” Resveratrol is indeed a remarkable substance, and wine is the best natural dietary source of this potent antioxidant. (That’s why I have a whole chapter on resveratrol in my book.) But while wine has been shown to have a multitude of benefits, there isn’t actually very much resveratrol in wine, at least compared to the amounts used in laboratory studies. So wine’s benefits by definition have to be mostly from something else.

Myth #5. Wine is empty calories and causes weight gain. Not so fast – red wine’s calories are all from alcohol, which is metabolized differently than carbohydrates so it doesn’t cause the spike in blood sugar. Wine drinkers overall have much lower rates of obesity, and while the polyphenol compounds that make wine red may not have calories, they are important components of a healthy diet.

So a toast to your health this Holiday season, and may you have a guilt-free indulgence or two.

Wine and friendship in Spain - a healthy experience

Is there anything more beautiful in life than the joys of breaking bread and sharing wine and food around the table with friends? As I have written here before, there is some scientific evidence of the health benefits of wine with food and companionship, and it helps to explain why wine’s anti-aging properties can’t be reduced to biochemistry and put into a pill. So with that in mind, let me express thanks to some new friends in Spain from my visit to Madrid and the Ribera del Duero.

Rebeca Colina Giralda gave us a wonderful tour of the Abadia Retuerta vineyards and a tasting of their magnificent wines. The juxtaposition of modern winemaking in a thoughtfully restored centuries-old abbey was an inspiring experience, and the wines are wonderful. Running into Rebeca at a tapas bar in Valladolid the next day was like seeing an old friend!

But few have done more to advance winemaking in the Ribera than Alejandro Fernandez, founder of the Tinto Pesquera group. We had the great pleasure of having lunch with one of his daughters, Lucia Fernandez Rivera, and got to know her and the wines (Pesquera, La Granja, Condado de Haza, and El Vinculo.) Their new hotel, another caringly restored old building in the same vein as Abadia, is well worth a visit.

But not all the winemakers in the Duero are adherents to tradition, as in the case of Richard Sanz of Sitios de Bodega. We had a phenomenal dinner with Richard and a small group at the new symphony hall in Valladolid, showcasing modern Spanish cuisine with a range of wines. Bravo!

Thanksgiving dinner (just happened to be that day, not a Spanish holiday) was an experience so unique that I doubt any American has ever done it before. We enjoyed a private tour of the traditional musical instruments museum run by the multitalented Paco Diaz, who then took us to his 400-year old Bodega cave in Cigales and prepared a truly memorable meal. As you might imagine, there was plenty of local wine, singing, and camaraderie. Our companion for the evening was Angel Moreton, director of the new and very sophisticated International School of Culinary Arts. If you have a chance to visit (and I hope you do) look for a copy of my book in their library.

Back in Madrid we had the great privilege of dining at the Café de Oriente with Alfonso de Salas, of the Spanish newspapers El Mundo and El Economista, and founder of the splendid winery Montecastro. Definitely get your hands on some of this wine, and look for a review of my book in the Spanish press.

Thinking back on these memorable experiences, I feel healthier already. And send me an email if you want to know where the best undiscovered medieval hill town in central Spain is, or for more recommendations on Spain’s remarkable Tempranillo wines.

Why the new study on alcohol and breast cancer got it wrong - again

Big news! The latest study on the association between alcohol and breast cancer found what all the numerous prior studies using the same methods found: even small amounts of consumption increase the risk, regardless of the type of alcoholic beverage, even red wine. But as I point out in my book Age Gets Better with Wine, they are simply repeating the same mistakes and failing to see the big picture. Here’s why:

Self-reporting bias. Studies such as this, which seem to derive power from their large numbers, only magnify the errors if the data isn’t reliable. The nurses in this study were asked to fill out questionnaires on their drinking habits and other lifestyle factors every 6 months. It is widely acknowledged that this retrospective self-reporting is highly unreliable. So having a hundred thousand or even a million participants doesn’t yield stronger data, it just magnifies the error. Statisticians are of course aware of this and attempt to make adjustments according to known behaviors, but in a sense it would be better to use a smaller number of subjects and observe them more closely.

No distinction between different drinking patterns. If we were to design a study that could accurately measure the effects of say red wine vs beer or spirits, it would look like this: one group drinks only red wine, in the same amounts, every day, while the others do the same for their assigned beverage. They would be closely followed for many years. This is clearly not the case with the nurses study, which simply asked people what sort of drinks they prefer. By far the vast majority have mixed drinking patterns, both in amounts, types of drinks, and daily patterns. There is simply no realistic way to infer anything about the different drinks from this. On the other hand, studies from areas where drinking patterns are consistent for wine show a substantial decrease in breast cancer incidence.

Ignoring the big picture: Let’s put the numbers in perspective: the overall lifetime risk of breast cancer is around 9 or 10 percent, so a 10% increase in risk from a couple of drinks a week raises it to around 11%, and a 50% increase from heavy drinking brings it up to 15%. But far and away the leading cause of death in women is heart disease (1 in 3), and regular wine consumption clearly reduces that risk. Breast cancer, at 1 in 36, is a ways down the list. Add in also Alzheimer’s, hip fractures from osteoporosis, and diabetes, all of which are reduced among wine drinkers, and you get a very different picture.

That’s why I tried to portray the bigger picture in my book. There is little question that the net effect of regular wine consumption, especially wine with meals, is positive both in terms of disease incidence, lifespan, and quality of life.

New information on resveratrol’s breast cancer fighting properties

There is hardly a stickier subject than alcohol consumption and breast cancer, except perhaps the wildly exaggerated claims for resveratrol supplements. A new study helps to clarify the picture by looking at resveratrol’s interaction with estrogen receptors on breast cancer cells, though we still have a ways to go before resveratrol can be recommended for duty in the breast cancer battle.


Some historical context will help put things into perspective. Most studies have concluded that breast cancer risk is increased by alcohol consumption, though the effect at moderate drinking levels is a very difficult thing to measure. On the other hand, it is well-documented that moderate regular consumption of wine is associated with longer life and lower rates of diseases such as cancer, diabetes, atherosclerosis, and Alzheimer’s. Though red wine contains a number of antioxidant molecules, resveratrol has emerged as one of the more interesting ones despite that fact that wine doesn’t actually have very much of it. Nevertheless, resveratrol is touted as the explanation for the French paradox and an anti-aging miracle. So more sober-minded scientists can be forgiven a bit of cynicism here.

Resveratrol does do some very interesting things though, at least in laboratory studies. One vein of research follows the observation that wine drinkers tend to have lower rates of osteoporosis. This it turns out is explained by resveratrol’s estrogen-like properties. Tied with an impressive array of specific anti-cancer effects (again, in lab studies not clinical trials) it seems that something must be going on with resveratrol and breast cancer. But since many breast cancers are “estrogen receptor positive” (ER+) meaning that too much estrogen could encourage cancer growth, it is important to know the details.

This recent study helps to sort that out, by looking specifically at ER+ cancer cells. What the researchers found was that resveratrol appeared to turn off the gene that makes estrogen receptors, reducing the number of receptors in the cells and ramping down cell growth. Combined with non-ER-related cancer fighting properties, resveratrol or its derivatives could very well be useful in fighting breast cancer. The road to effective cancer treatments is littered with false starts and dead ends, however, so the smart money will wait for clinical trial data.