Thursday, March 31, 2011

German study confirms benefits of drinking in elderly

One of the hardest ideas to wrap one’s head around is the idea that alcohol consumption (in moderation) actually improves mental function and lowers the risk of developing Alzheimer’s disease as we age. But a recent study from Germany adds to the already considerable evidence, and to the ongoing controversy. The study enrolled more than 3200 subjects aged 75 or more from primary care practices, and gathered detailed information about drinking and lifestyle patterns. Additionally, they were tested comprehensively for signs of declining mental function, and specifically Alzheimer’s dementia. The average age in the group was more than 80 years, and after 1.5 and 3 years of follow-up a clear benefit to the moderate drinking cohort was found. Drinkers were 30% less likely to experience mental decline, and 40% less likely to have Alzheimer’s.

The controversy relates to the question of moderate drinking as a lifestyle “marker” for a range of healthy behaviors. In other words, people in this group –as opposed to heavy drinkers or nondrinkers – tend to exercise more, be better integrated socially, less likely to be depressed, and have a higher level of education. If this is the case, so goes the reasoning, the alcohol has little to do with the health benefits. But the pattern held up even after these other factors, known as confounding variables, were accounted for in the statistical analysis.

In any case, what is clear is that moderate drinking in old age is associated with both measureable reduction in the odds of mental decline and the healthy lifestyle factors that are likely to also contribute. Independent data from other studies verifies that wine drinkers enjoy a higher quality of life in old age. My take on it is that there are synergies between living the good life and moderate drinking, much as the polyphenol molecules in wine seem to have the best effects in combination and with alcohol.

What is confounding to me is why we are still so conflicted on the question. It’s not like we are talking about keggers at the nursing home, just a glass or two of wine with dinner.
 More info at AIM.

Tuesday, March 22, 2011

Healthy wine drinking is a family value

There are few more controversial subjects than the topic of underage drinking, so let me just say at the outset that I am not encouraging it. But with many such questions, things aren’t always so black and white, as a recent study on teenage drinking demonstrated. In a nutshell, the study evaluated beverage preferences among high school students who display risky drinking patterns, concluding that hard liquor and beer are preferred over wine. The study, called the Youth Risk Behavior Survey, questioned nearly 8000 adolescent drinkers, and the correlation between preference for liquor and/or beer was strongest among those who exhibited the riskiest behaviors (binge drinking, drinking and driving.)

No surprises there you say, we all know that liquor is quicker where the beverage is merely a vehicle for alcohol consumption as a drug. We don’t expect teenagers to be wine connoisseurs, even if it were legal. But there is the well-known European tradition of starting children on watered-down wine with meals and special occasions, in the context of wine as part of a meal. Growing up with such a view of wine as food probably contributes to lifelong healthy drinking habits, and it does begin in the teenage years. On the other hand, a typical American household views alcohol as a drug no matter what the form it takes, holding it out as a special reward of adulthood (placing it in the same category as pornography.)

And beer, for all its potential list of positives, tends to be portrayed in TV commercials in the context of parties and recreational events, virtually never as a nutritional part of the evening meal. Simply put, it is marketed as a drug, a message only reinforced by the admonishment to “drink responsibly.”

So is there a way to bring some balance to the message? I say make drinking a family value: wine with dinner means drinking at home, setting a positive example as an alternative to kegger parties and binging on weekends; drinking for aesthetic reasons, not anesthetic ones. In so doing we take away some of the mystique of the forbidden fruit. This of course presumes that we adults set the right example.

Monday, March 14, 2011

Which types of wine are the healthiest?

I am often asked after lecturing on the healthful properties of wine which type is best to drink. Since much of the discussion has to do with the polyphenol antioxidants from the skins and seeds of the grape, red wine is the first criterion since it is fermented with the whole grape rather than the pressed juice. This allows for extraction and concentration of these compounds, familiar ones being resveratrol and tannins. But beyond that, which varietals have the highest concentrations?

According to the Roman philosopher Pliny the Elder, “The best kind of wine is that which is pleasant to him that drinks it” but modern science expects more specifics. (The point of course is that if you have a wine that you enjoy you are more likely to drink regularly and therefore reap the benefits.) But there are several difficulties in singling out certain wines for their healthful properties. Which compounds to measure? Are we talking about heart health or the whole gamut? Is it the varietal of the grape or the viticultural method that is most important? For all of these reasons there are different answers.

Let’s begin with the well-known anti-oxidant capacity of wine. Anti-oxidants of course play a role in reducing the risk of a range of diseases and wine polyphenols are among the most potent ones. One would therefore think that there would be plenty of published resource material but in fact there is surprisingly little. One study from France evaluated comparative antioxidant capacity and found the highest readings for grenache and pinot noir based wines, followed by syrah, cabernet sauvignon, and merlot. Interestingly, they also found significant year to year variation, indicating the importance of growing conditions. These factors in concert with region-specific viticultural techniques probably contribute as much or more to polyphenol content as varietal. Given that grapes express these compounds in response to stress it makes sense.

But looking specifically at the heart health question, it appears likely that the primary benefit comes from compounds called oligomeric proanthocyanidins (let’s agree to call them OPC’s) which are associated primarily with the seeds of the tannat grape. Malbecs from Argentina are reported to have respectable amounts of OPC's, as do wines from Spain and southern Italy. These compounds may impart a more bitter flavor, and so often the wines with high levels are more “rustic.” Australian reds, big and lovely though they are, often lack in this category.

One thing is sure, the health benefits of wine are not reducible to a list of chemicals anyway. It is all of them working together, with alcohol, with food, as part of a healthy lifestyle. Pliny had it right all along.

Monday, March 7, 2011

Is any amount of alcohol good? Resolving the conflict

Sometimes it happens that opposing views on a controversial subject juxtapose. Such is the case this week, with a new large study published on the role of alcohol and health, another outlining the reasons for it, and an opinion piece questioning whether any amount at all is beneficial. In brief, the argument goes something like this: Anti-tobacco activists point out that any amount of tobacco is harmful, and since alcohol in excess has many hazards it must be bad in small doses too, if less so. On the other hand, if moderate wine consumption is a good thing for health, as I affirm in my book Age Gets Better with Wine, then we must account for a positive role of alcohol in the health equation.

The case against alcohol is made by one Professor David Nutt, professor of neuropsychopharmacology at Imperial College in London. Professor Nutt outlines his reasons why he belives that it is a myth that small amounts of alcohol are not harmful: First, alcohol is a toxin, and amounts only 4 times as high as those required to reach legally defined intoxication levels can be fatal. True enough, but there is a long list of things that if consumed in 4 times a sensible amount would also be very bad news; for example, a radio station recently held a water drinking challenge that resulted in a fatality from drinking too much water! The professor then mentions that while most people are not likely to become abusers of alcohol, some do, and so that apparently is reason enough why the rest of us should abstain. The professor’s final argument is that the evidence for alcohol’s benefits is weak, which brings us to the just-released studies both in the British Medical Journal.

These two papers are particularly helpful because they are based on a review of all published studies on the question of alcohol and health, a major challenge. The focus of these reports was purely on heart disease, and the conclusion was “Light to moderate alcohol consumption is associated with a reduced risk of multiple cardiovascular outcomes.” The reasons for this are also well-defined, relating to improved levels of HDL cholesterol (the good kind), as well as apolipoprotein A1, adiponectin, and lowered levels of fibrinogen, all good things for cardiovascular risk. One questions whether professor Nutt actually read any of the literature on the subject before dismissing it.

Anti-alcohol activists are quick to point out the hazards of alcohol consumption, which are also well-known and itemized by the professor. The assumption is that these hazards would disappear if alcohol were to be banned or somehow eliminated. The opposite is more likely to be the case, as deaths from cardiovascular diseases would outnumber the decrease in alcohol abuse-related deaths by a substantial multiple. With hundreds of studies out now, questioning the health benefits of moderate drinking is just nutty.

Tuesday, March 1, 2011

Red wine compound resveratrol supports anti-cancer therapy

Resveratrol, for all appearances the miracle molecule from red wine, has disappointed on several research fronts but don’t count it out just yet. In the right amounts it may be an important part of an anti-cancer diet, but the story now is synergy: compounds working together in ways that enhance their effectiveness. Evidence has been slowly coming to light in recent years that the compounds in red wine amplify each other’s health benefits, explaining why studies continue to support the benefits of moderate drinking but supplements often fail in clinical tests. New research demonstrating how resveratrol supports the anti-cancer drug rapamycin provides another example of synergy.

Rapamycin , derived from a bacterium first found in the soil on Easter Island (hence the name, from Rapa Nui, the original name of the island), is clinically used as an anti-immune drug for organ transplantation. Its anti-cancer capabilities are being explored, in particular for breast cancer. But as with other therapies, drug resistance can develop, and here’s where resveratrol comes in. Resveratrol appears to prevent this resistance from developing when given along with rapamycin, at least in the lab. This points to one of the more interesting properties of resveratrol, which pulls off this feat with a range of other drugs and tumor types, rendering them more sensitive and preventing resistance from emerging. All this is preliminary of course, pending long-term clinical trials.

But rapamycin is emerging as an interesting player in the anti-aging arena too. Because of its anti-immune properties and general toxicity, it is not practical as an anti-aging intervention, but its actions at the molecular level reveal a pathway that could lead to practical therapies. Recall that resveratrol was thought to be able to activate the same enzymes (sirtuins) responsible for a longevity effect, but was unable to do so in mammals (like we humans.) But rapamycin does extend life in lab rats, via a more direct pathway.

So don’t give up on resveratrol just yet, despite the many questions about its future. Given its propensity for working well with others, the smart money is on whole wine for anti-aging and combination therapy for cancer.