Monday, May 31, 2010

The Prohibition Hangover: What a Headache!



One of the unanticipated joys of having a book in publication is meeting other like-minded authors. I had the opportunity to do just that at a book event held at the St. Helena Library in Napa Valley a couple of weeks ago, where the topic was wine books. It’s an annual event, designed to showcase the library’s extensive collection of wine literature. As it turns out, a theme for all three authors’ talks was prohibition. Attorney Richard Mendelson’s book, From Demon to Darling: A Legal History of Wine in America, describes the conflicted state of affairs that prohibition spawned. As I discuss in my book, temperance wasn’t always interpreted as abstinence, especially where wine was concerned. But banning all forms of alcohol outright turned out to be akin to trying to slay the Hydra of mythology, a multi-headed beast who grew two when one was cut off. The concept of healthy drinking, based on a tradition of wine with dinner, was lost.

The history of wine and drinking is another one of the joys I discovered in doing research for my book. When I am giving a PowerPoint lecture, I often include an image from Dr. Benjamin Rush, Jefferson’s correspondent when he wrote “Like my good friend the doctor, I have eaten little animal food  I double, however, the doctor’s glass and a half of wine, even treble it with a friend.” The image is a “Moral and Physical Thermometer” of temperance, allowing that wine or cider in moderation beget cheerfulness and strength, while toddies, morning drams and rum define the road to perdition, with melancholy, hatred of government, even the gallows. It appears to have been adapted from an English doctor’s version, shown above. It was certainly clear on both sides of the Atlantic that wine was a good thing from the point of view of both social welfare and public health. Somehow this not-so-subtle message was lost. So cheers to wine, and check out Mendelson’s book, along with Vivienne Sosnowski's book, When the Rivers Ran Red: An Amazing Story of Courage and Triumph in America’s Wine Country.

Wednesday, May 19, 2010

Study Challenges Health Benefits of Alcohol: A Rebuttal

The news today is a study from France challenging the beneficial effects of alcohol, adding fuel to a debate we thought had flickered out some time ago. Dr. Boris Hansel of the Hopital de la Pitie in Paris, a specialist in cardiovascular disease prevention, acknowledged in an article in the European Journal of Clinical Nutrition that while moderate drinkers are in fact healthier, the alcohol doesn’t deserve the credit. The study was an analysis of lifestyle factors of nearly 150,000 adults, and largely confirmed the long-held theory that moderate drinkers (especially wine drinkers) are healthier. But Dr. Hansel’s conclusion was that the benefit was due to associated lifestyle factors, not the alcohol. Moderate drinkers do a lot of other healthy things too, such as exercise more and eat healthier diets, again most particularly wine drinkers. (http://www.google.com/hostednews/afp/article/ALeqM5jx9U20jDoCjwpIdEN7PbNB32H3EA)


Is it really as simple as that? Not likely. For starters, the emphasis of the study was on cardiovascular disease, now known to be only a small part of the wine and health formula. But even within the category, there are specific physiological effects to credit: alcohol increases HDL cholesterol, the beneficial kind, and wine polyphenols work in several ways to counteract the formation of cholesterol plaques.

The bigger issue is the notion that with a large enough study, we can finally get to the heart of the problem, and figure out what’s really going on. But studies of this type rely on self-reporting of quantity and type of alcohol consumed, which is notoriously unreliable, so the resulting inacurracies in data become magnified. It is far more meaningful to study a small but very-well characterized population, such as a particular town where everyone drinks the local wine and a traditional lifestyle is practiced consistently. This type of study is where the original French paradox was born. The paradox now is why the French are turning their backs on their own revelation to the world about healthy living.

Statisticians may bemoan the difficulty in trying to decipher how much of the French paradox is lifestyle and how much to credit the effects of alcohol and polyphenol biochemistry, but in my way of thinking it is ultimately a useless exercise. The distinction between wine as a pharmacologic supplement and wine as a component of a healthy lifestyle is an intillectual argument that does little to help us lead happier and healthier lives. For the record though, there are several good studies to support the separate contribution of wine to health, and this most recent report provides little evidence to contradict a recommendation to drink wine with dinner whenever possible.

Thursday, May 13, 2010

The Australian Heart Foundation blows the call on health benefits of wine

In a case of opinions in the rear-view mirror appearing larger than the mountain of evidence right in front of them, the Australian Heart Foundation recently released a position paper announcing that there are no health benefits to wine or dark chocolate. According to a spokesperson, the AHF is ''concerned about people thinking that in having red wine or dark chocolate that they are actually doing something to treat or prevent cardiovascular disease when the evidence doesn't support that.” The recommendation is based on a review of more than 100 studies over the past 10 years, and supposedly “puts to rest the popular belief that red wine, coffee and chocolate can keep cardiovascular problems at bay.”


(http://www.themedguru.com/20100512/newsfeature/chocolate-coffee-red-wine-offer-no-health-benefits-86135104.html )

They couldn’t have gotten it more wrong. The thing is, there are more than 3,000 articles over the past 30 years or so on the subject, and I have looked at most of them for my book “Age Gets Better with Wine.” It is true that most of these are not clinical trials per se, and it would be nice to have more of these, but the patterns are consistent: wine and chocolate have a range of distinct benefits in countering heart disease and many other conditions. The focus of the article was on the antioxidants in wine and chocolate, which is too narrow of a view in my opinion. Supplements of antioxidant from wine or vitamins are indeed without evidence of their usefulness, but wine and dark chocolate work in other more specific ways. Dark chocolate has been shown to lower blood pressure and reduce the inflammatory processes that contribute to cardiovascular disease, and wine works in its own numerous and potent ways.

I am reminded of what happened when the data on alcohol consumption and heart disease was first analyzed from the Framingham Heart Study, the granddaddy of all such studies. In reviewing the 25-year data back in the 1970’s, a clear relationship between moderate drinking and lowered risk of heart disease was found. But the study sponsors at the U.S. National Institutes of Health issued a written directive to the authors of the study that it was to state that there was “no significant relationship of alcohol intake to the incidence of coronary heart disease,” citing concerns that it would be “socially undesirable.” Better to quote R. Curtis Ellison, MD, Professor of Medicine and Public Health at Boston University: “…only stopping smoking would have a larger beneficial effect on heart disease than for a nondrinker to begin having a drink or two each day.”

Wednesday, May 5, 2010

Time to reverse course with resveratrol?

It’s been an interesting week in the news for resveratrol. On the one hand, a new publication on how resveratrol affects the brain came out, adding to the very few clinical trials on the use of it as a supplement. On the other, Glaxo halted a clinical trial on resveratrol over safety concerns. Meanwhile, my piece in Web MD (http://www.webmd.com/skin-beauty/news/20100427/is-drinking-wine-a-key-to-antiaging?ecd=wnl_skin_0505100) garnered quite a lot of attention and brings us back to the question of whether we aren’t just better off drinking wine instead anyway.


As I have mused about here before, clinical trial data on the use of resveratrol is all but absent, and what there is tends to show that it isn’t very well absorbed. So anyone bringing some clinical science to the field is to be congratulated. The study out this week actually measured blood flow to the brain during cognitive tasks, in other words things require thinking and concentration. Resveratrol improved blood flow and raised levels of the type of hemoglobin that has released its oxygen, implying higher oxygen extraction in the brain and therefore more processing power. The study was done in comparison to a placebo group, an important requirement for objectivity. The association of wine and IQ has long been known, whether it is due to smart people preferring wine or wine making people smart, so this study would add evidence to the latter explanation.

Not many people even thought about taking resveratrol supplements, however, until a few years ago when it was reported to activate enzymes known as sirtuins, which are involved in enhancing longevity. The biotech company Sirtris was founded to exploit this phenomenon, and was acquired by Glaxo a short time later. They soon developed several derivatives for treatment of cancer, diabetes, and other conditions, and clinical trials were launched on several fronts. This week a trial of resveratrol as an adjunctive treatment for a type of cancer called multiple myeloma was halted because of adverse safety events. However, the condition, a problem with the kidneys, is known to occur with the disease and seems unlikely to be related to the resveratrol. Nonetheless, it was a setback for those awaiting more potent versions of resveratrol to come to market.

For now, I’ll continue to take my medicine in liquid form, with dinner.