Wednesday, December 26, 2012

A fond farewell to the father of the French Paradox


This has been a year of continued affirmation of the role of wine as a central component of healthy living, but rather than a review I would like to pay tribute to Serge Renaud, considered by many to be the father of the “French paradox.” It was a seminal moment in 1991, on the CBS-television show “60 Minutes” when Dr. Renaud offered that “A moderate and regular wine consumption of one to three drinks per day, which is common in France, protects us” from the much higher incidence of heart disease in America.  Dr. Renaud collapsed walking to the beach near his Mediterranean home on October 28 at age 85.

Though born the son of a winemaker, Renaud’s early studies focused on dietary factors comprising what would later come to be known as the Mediterranean Diet. There were important differences in the composition of dietary fats -specifically omega -3 and 6 fatty acids - that seemed to hold the key. Over time however it became apparent that regular wine consumption was a critical part of the diet, and provided an explanation for lower rates of heart disease in parts of France where the diet included more fatty foods. The French Paradox thusly became an iconic symbol and opened a rich vein of research. Publications on the subject now number in the thousands and new discoveries are reported almost daily.

I was fortunate to have met Dr. Renaud on two occasions. He was gracious and generous. It is hard to overestimate the influence he had, both from his many years of research and his vigorous defense of the French paradox. The idea of wine as health food was radical, but he leaves a legacy of science at its best – finding the unexpected just because that’s where the evidence leads. I like to think that he is enjoying his allocation of the angels’ share.

Monday, December 3, 2012

Red wine headaches syndrome: Why is it still a problem?


If you are prone to headaches from red wine, would you drink wine made from genetically modified yeast if you knew you wouldn’t react to it? The problem of headaches from wine is one of the most frequent questions I get at lectures on wine and health. From an anti-aging point of view, evidence clearly points to red wine as a healthy habit. But if it gives you headaches, it just isn’t worth it. The good news is that we know what causes the headaches and how to make wine that doesn’t provoke them; the bad news is that almost no one is making wine that way.  The reasons behind this are enough to cause befuddle the brain and cause a headache all over again.

You can thank University of British Columbia Biotechnology Professor Hennie van Vuuren for developing the solution. A sufferer of the red wine syndrome himself, Dr. van Vuuren has been working on the solution for some 15 years. The problem stems from compounds called biogenic amines, which include histamine and some rather nasty sounding compounds called cadaverine and putrescine, among others. In addition to headaches, symptoms such as flushing, dirarrhea, and nausea can occur. Some biogenic amines are even considered carcinogenic.

Biogenic amines develop during a secondary fermentation process called malolactic, in which somewhat tart malic acid is converted to softer lactic acid. Most red wines are made this way, and some white wines such as chardonnay, and it generally improves the wine. The problem is that it can be tricky to control because it is catalyzed by bacteria, not the yeast that guides primary fermentation. The solution that Dr. van Vuuren developed was to splice the necessary gene from the bacteria into the yeast, thereby bypassing the need for bacterial fermentation altogether. But controversy abounds with genetically engineered foods, deserved or not.

The malolactic yeast, called ML01, has been in testing and limited use for nearly a decade now, but it is still not widely available or apparently much in demand. It has received FDA approval in the U.S. and Health Canada, and it is likely that many have consumed ML01 wines without knowing it (labeling laws regarding genetic modification are another controversy.) My take on it is that we are better of without biogenic amines in wines, and that genetic modification has been in use for hundreds of years through selective crossbreeding. Science has simply accelerated and refined the process, to our benefit.

Tuesday, November 20, 2012

Resveratrol, wine, and cancer: an update


A recent study on the effects of resveratrol on prostate cancer highlights one of the tantalizing aspects of this red wine antioxidant: a long list of potential anti-cancer properties. It must be pointed out however that nearly all of the evidence for this comes from laboratory research, and though there are some clinical trials in progress it is premature to claim anti-cancer benefits for resveratrol supplements. But if any of it pans out it could lead to significant breakthroughs.

One of the things that make resveratrol so intriguing as an anti-cancer agent is that it not only suppresses cancer cell growth but seems to protect normal cells from the toxic effects of cancer treatment. Radiation treatment is a particularly troublesome therapy because of lasting effects on healthy cells in the treatment zone. But several lines of evidence suggest that resveratrol may pull off the ultimate hat trick: protecting the healthy cells while sensitizing cancerous cells to radiation.

This most recent study evaluated resveratrol as a ‘radiosensitizing” agent on a “radioresistant” clone of prostate cancer cells in culture.  (Again, not an animal study or human clinical trial.) This confirms findings of earlier studies on prostate cancer, but other tumor lines exhibit a similar response to resveratrol. One intriguing example is glioblastoma, a particularly aggressive form of brain cancer. [reference]  Melanoma cells may do likewise [reference] as do some types of lung cancer [reference].

Clinical evidence however points to a role for wine consumption. In a large series  from Italy,  patients undergoing radiation treatment for breast cancer had less irritation of the skin (called radiodermatitis) if they consumed red wine regularly. What is notable about this is that there isn’t enough resveratrol in wine to explain the effect. This is in fact the central dilemma about resveratrol as a candidate for all the healthy things that red wine does: lab studies show a plausible cause-effect explanation for observed inverse correlations between wine and disease, yet the amounts required to produce the effect are far more than what is available by consuming wine.

So what conclusion can we draw from this? First, much work needs to be done in the laboratory and the clinic before we can say definitively that resveratrol (or a derivative) is a useful adjunct to cancer treatment. Wine consumption generally correlates with reduced risk of cancer, in a J-shaped curve with the maximum benefit at moderate levels of consumption and increased risk with heavy consumption. It just doesn’t appear that this has much to do with resveratrol.

Tuesday, October 30, 2012

New study on resveratrol supplements widely misinterpreted


Quote: “A new study is hinting women may want to think twice before picking up a glass and toasting to their health. Health Magazine is reporting that researchers from Washington University School of Medicine have discovered that healthy middle-aged women do not benefit from taking resveratrol supplements.” (from Fox News)

Am I the only one who sees that those two sentences do not make sense? What the study showed is that taking a particular supplement does no good, not that drinking red wine is bad. Seems pretty simple to me but it points out a common misconception that needs to be dispelled (again). The thinking goes like this: We know from a multitude of studies that red wine consumption in moderation is linked to a long list of health benefits. These include lower rates of cardiovascular disease, osteoporosis, Alzheimer’s, and diabetes, to name just a few. But alcohol is of course bad for you, so the whole benefit must be from something else.

Enter resveratrol, the miracle molecule (as I dubbed it in my book Age Gets Better with Wine: New Science for a Healthier, Better, and Longer Life.)  In lab studies, resveratrol seems to do just about everything; it’s a potent antioxidant, reverses many of the harmful effects of a high-fat diet, prevents cancer, you name it. Because resveratrol comes from the skins of red wine grapes, it must therefore be the reason for wine’s health benefits. So just take resveratrol in a pill and skip the alcohol from red wine, and you’re all set. Resveratrol supplement makers proudly proclaim “all the benefits of wine without the alcohol” and pitch it as the next breakthrough weight loss secret and fountain of youth.
But there are fatal flaws with this reasoning. Most importantly, red wine doesn’t have enough resveratrol in it to explain the health benefits of drinking. The researchers in the study cited above acknowledge that the doses were equivalent to drinking gallons of wine a day, and still no measurable benefit. Another reason is that alcohol is not entirely deleterious, and in small amounts – levels that correspond to a glass or two of red wine with dinner – it is probably beneficial when all factors are taken into consideration.

Wednesday, September 19, 2012

Is de-alcoholized wine better for health?


Over the past few weeks there has been a flurry of news coverage over a clinical study finding that de-alcoholized red wine lowered blood pressure, but not whole wine. The usual interpretation was that wine without the alcohol was probably a better choice for health, with the blood pressure drop projected to equate to about a 14% decrease in heart disease risk. Supplement makers proclaimed that their wine-derived resveratrol pills were therefore a smarter choice, others concluded that grape juice would do the trick. But other studies out on alcohol found unique benefits, and as you have seen here before a broader view is needed in order to see the picture clearly.

As with most studies, the blood pressure experiment had problems. For one, there was no “control” group for comparison. But the bigger question always is whether these findings translate into anything meaningful in terms of overall health and longevity. It is not reasonable to assume that a single parameter such as blood pressure tells the whole story with heart health and drinking, even less so when considering the range of healthful effects of moderate wine consumption. What it does do is confirm that the non-alcohol components of wine, taken as a whole, have independent positive effects.

So what of the alcohol? Consider a recent study on the effects of moderate drinking on bone density (a measure of osteoporosis).  Using a cohort of 300 women with an average age of 67, a consistent correlation of alcohol intake and better bone density was found. These finding are in line with previous studies. Another study found lowered rates of rheumatoid arthritis among moderate drinkers. (In my book Age Gets Better with Wine I cite findings from a lab study showing how this might work.) The researchers concluded that this was one of “multiple studies that have shown that alcohol can have a beneficial effect on risk for rheumatoid arthritis.”

So even if alcohol does not contribute directly to heart health, there are other areas where it appears to provide benefit. Heavy consumption is well-known to increase blood pressure, but in moderation as in the study cited above it seemed to be benign. As with all studies occupying the media spotlight for their 15 minutes of fame, nothing here is as bad (or in other cases as good) as it sounds. I am reminded of Michael Pollan’s book on healthy eating called In Defense of Food, subtitled “Eat food, mostly vegetables, not too much.” The same could apply for wine: Drink wine, mostly red, not too much (and I would add not too little.) And by the way, grape juice is not just wine without the alcohol; it has a lot of sugar and lower levels of antioxidant polyphenols.

Tuesday, August 28, 2012

of mice, men and merlot


 

The latest round of enthusiastic news coverage about a study proclaiming that red wine improves balance and prevents falls in the elderly raises some important questions. First a summary of the study, which was presented at a recent conference but not yet published in a peer-reviewed journal: Lab mice fed high doses of resveratrol, a potent antioxidant from red wine, maintained better balance and mobility as they aged. Their nerve tissue resisted the effects of age, and follow-up studies showed that the neurons treated with resveratrol survived toxic doses of a brain chemical called dopamine, which causes stress similar to aging leading to cell death.

The implications of the study were widely interpreted to mean that resveratrol, and by extension red wine, could improve mobility in seniors and prevent fall that can lead to hip fractures and other problems. There are a few really important caveats here though: first, the doses of resveratrol were extraordinarily high, not achievable with wine consumption. Secondly, it isn’t known if equivalent levels are even achievable with oral consumption by humans. Mice are not people, and there are a lot of things that seem like they should work based on mouse studies that don’t pan out in human clinical trials. (An example is an anti-cancer drug called camptothecin, which kills human cancers when transplanted onto mice, but not so well in humans because it is inactivated by a protein in the bloodstream.) So as intriguing as the recent study is, it is not reasonable to presume that resveratrol or red wine would work in people.

There are some interesting lines of research pointing back to red wine though. For one, it is well-documented in several large population studies that wine drinkers maintain better brain function in later years. And though it is tempting to credit resveratrol for the benefits of wine, other studies show that alcohol consumption in moderation is linked to better bone density.  Resveratrol does come into the picture when looking at muscle mass and athletic performance, which may favorably impact mobility in seniors.

In the end it comes down to that same simple things that I have been espousing here all along: Wine drinking is good for prevention of many of the deleterious effects of age. Resveratrol is interesting but does not by itself explain the benefits of moderate drinking. And studies on mice mean little without follow-up clinical studies on humans.

Thursday, June 7, 2012

Is wine a functional food?


Then again, didn’t all foods used to be functional? In the modern era of bulging waistlines, it would seem that nutrition has taken a back seat to processed foods engineered to tweak our taste buds and pleasure centers in the brain. And it is all too easy – and wrong – to cast wine as merely empty calories. But can we really consider wine to be a food, especially a nutritious one?

To begin with, the term “functional food” means that it contains specific nutrients with identifiable health benefits. Sometimes these are added in, as with vitamins A and D in milk or calcium in orange juice. The way I see it, in a well-balanced diet there shouldn’t be a need for such enhancements. Wine for example naturally contains an abundance of antioxidant polyphenols, nutritionally vital ingredients that are increasingly lacking in many foods. A glass of wine with dinner on a daily basis is associated with longer life and better health by a variety of measures, a claim difficult to prove with vitamin supplements. Sounds like a functional food to me.

There are specific reasons too why wine should be considered a food, part of a meal. Wine actually makes other foods healthier, by blunting the rise in blood levels of oxidized fats after eating. Wine drinkers tend to eat and drink more slowly, also healthy habits. This may be one of the reasons why wine drinkers are notably less likely to be overweight, though some interesting findings about wine polyphenols and sugar metabolism have led to research into wine-derived diabetes treatments.

As compared to say grape juice, wine has another advantage: no sugar (at least in dry wines.) Though alcohol may be considered empty calories, it does have some benefits when consumed in the right amounts, where sugar has none. I have an entire chapter in my book on the specific benefits of alcohol in moderation. In fact, it is easy to make a case that sugar has contributed far more to public health problems than alcohol, considering that diabetes and other diseases related to obesity are in epidemic proportions.  

Thursday, May 3, 2012

New study reveals how resveratrol might work (don’t lose your SIRT)


The latest study on resveratrol, the touted polyphenol from red wine, seems at first glance to restore some lost credibility to its increasingly questioned anti-aging capabilities. It has been widely reported but we know from experience by now that a single study never tells the whole story. The whole story would take more space than I have here so here is what you need to know:

There is a unique phenomenon called caloric restriction that extends lifespan dramatically, at least in experimental animals and organisms. By limiting caloric intake severely, a metabolic change occurs that results from activation of a family of genes know as SIRT, which code for proteins known as sirtuins. Resveratrol has been reported to activate sirtuins and thereby cause lifespan extension, at least for yeast cells, fruitflies and worms. Getting it to do the same thing in mammals such as mice and men has been problematic however, casting doubt on the use of resveratrol as a miracle anti-aging tonic. Some labs have reported that resveratrol does not in fact activate SIRT. Meanwhile, the company founded to develop resveratrol-based pharmaceuticals (Sirtris) has scrambled to maintain their case.

This latest study, from Dr. David Sinclair (cofounder of Sirtris) employed a strategy using mice with the SIRT gene “knocked out.” So by testing resveratrol’s effects in knockout vs normal mice, the role of sirtuins can be determined. What they found was that metabolic measurements were healthier in the normal mice given a high-fat diet plus resveratrol, but not the SIRT knockout mice. So resveratrol’s effects do depend on SIRT, (as well as an unhealthy diet) implying that it is a sirtuin activator after all. We are still left, however, with the question of how much this relates to human health.

Recall from previous posts here that there isn’t enough resveratrol in wine to explain the well-established health benefits including longer lifespan associated with moderate consumption. There is also the problem that resveratrol is quickly transformed after ingestion into a different molecule called piceatannol.  So before concluding that this recent study confirms that resveratrol works as a supplement, have a glass of wine and mull it over.

Tuesday, April 17, 2012

The red wine diet to lose weight? Believe it (sort of)

If you follow the news about red wine you will have been deluged with coverage of a recent study finding that it prevents fat cells from maturing, and is therefore the latest miracle weight loss solution. The specific ingredient, a polyphenol called piceatannol, has not previously received a lot of attention. It does provide some answers to questions such as why wine drinkers are less likely to gain weight or develop type 2 diabetes, but raises some new questions too.

What the study found is that piceatannol inhibits the development of young fat cells – called preadipocytes – into permanent adult type fat cells. It accomplishes this by blocking the effect of insulin which activates genes in these cells that signal them to grow up and store fat. In theory, then, this could explain one of the benefits of a daily tipple.

The study also sheds some light on the role of resveratrol, the molecule that has received so much attention in recent years. As I pointed out in my book Age Gets Better with Wine, resveratrol doesn’t seem to last long in the blood stream after ingestion, one reason being that much of it is metabolized into piceatannol. Without knowing much about the effects of piceatannol, it is hard to give much credit to resveratrol. (Another problem still not explained is that there isn’t enough resveratrol in wine to explain the range of benefits that wine drinkers experience.)

So we are still left with a bit of a conundrum in that neither piceatannol nor resveratrol are the answer. It is just too big of a leap from treating cells in a dish in a laboratory to understanding the effects in the human body. Wine drinkers are healthier in large part because they eat better, exercise more, and tend to take a balanced approach to wine consumption. For these and other reasons, I will continue to patronize my local wine shop instead of the supplement store.

Friday, April 6, 2012

new research shows why red wine could reduce breast cancer risk

Last week's post referenced a population study that purported to show that any wine consumption even in moderation would increase the chances of getting beast cancer, but as I repeatedly point out the data is highly inconsistent. A new study further contradicts this by revealing some of the ways that resveratrol (from red wine) directly influences cancer-prone breast cells in human subjects. Researchers at the University of North Dalota recruited 39 women at increased risk for breast cancer (based on genetic analysis) and then monitored the effects of oral resveratrol supplementation for 12 weeks. Cells from the breast were sampled and analyzed, revealing that resveratrol helped activate what are called tumor suppressor genes.
This is particularly powerful information because studies of this type -prospective trials in human subjects with objectively verifiable results - provide the highest level of evidence. (In contrast, population studies such as the one referenced in last week's post are typically retrospective and based on self-reported consumption levels, which are known to be highly innaccurate.) There are certainly many things in red wine besides resveratrol, but this study reinforces the notion of healthy drinking and points to the benefits of wine.

Thursday, March 29, 2012

Wine and breast cancer: Here we go again

Yet another article about a possible link between wine and breast cancer is in the news, and as usual it is being widely quoted without any critical analysis or perspective. The article in question, a review of previously published studies, estimates that even a glass of wine per day increases risk of breast cancer and estimates that 1-2% of all breast cancer cases are attributable to light drinking alone. Rather than pick apart the article item by item, which would take all day since there are so many issues, I will highlight a few important things.

First, there are fundamental problems with the way that these types of studies are done, and reviewing them simply magnifies the underlying mistakes. Here’s the thing: in order to know if for example a glass of wine per day affected breast cancer risk, you would have to follow a large population of women who drink only wine, only a glass per day, every day, rarely more, rarely anything other than wine, and rarely not having a drink; this would need to be compared to a similar population who never drink, another who only drink beer, and so forth. But most people have mixed drinking patterns, they under-report their true level of drinking, and there is simply no reliable way to get any meaningful information. All we really know is that heavy drinking is bad.

Secondly, there are some populations of women in France who have traditionally consumed wine in moderate amounts and in a regular pattern. Their incidence breast cancer is dramatically lower than that of nondrinkers.

Third, breast cancer is nowhere near the leading cause of premature death in women; heart disease is far and away the biggest threat. It is well established that moderate wine consumption lowers heart disease risk, the net effect being overall reduction in risk of premature death.

Moderate wine consumption is also associated with lower odds of Alzheimer’s disease, osteoporosis, diabetes, and measurably improves quality of life and well-being. Wine drinkers outlive nondrinkers by about 5 years on average, and for most even if there is a fractional increase in breast cancer risk, the smart choice favors having a glass of wine with dinner and not stressing over it.

Monday, March 19, 2012

Wine and civilization: we wouldn’t be here without it

As a physician I go to a lot of symposia, the term often used for meetings where exchange if ideas is the goal. It is interesting to note that the word “symposium” actually derives from classical Greek, meaning  “to drink together.” The tradition was that following dinner, the men would retire to a special room dedicated to the purpose of drinking and philosophical discussions. There would be toasts to the gods, ancestors, and fallen heroes, then the revelry would truly begin, often lasting until the early hours of the morning. Here’s an excerpt from Plato: “Socrates took his seat then they turned their attention to drinking. “ A member of the party named Pausanius said “Well gentlemen, how can we arrange to drink less tonight? To be honest, I still have a hangover from yesterday. “ Hard to believe that the canons of Greek philosophy, the underpinnings of modern civilization, had such origins as this.

But going back even further, wine is what civilized our nomadic hunter-gatherer ancestors. Other crops could be re-sown each year in a new place, but vines require year-round maintenance. Pruning, shaping, harvesting, fermenting –all depended on settling in one place. But doing so posed new challenges, such as keeping drinking water sanitary when the source was in proximity to “bathroom” facilities. Here again wine played a role by countering water-borne pathogens, and the tradition of adding wine to water became a necessary tradition in seafaring, voyages of exploration, trading, and military campaigns. Wine both civilized mankind and fueled some of our less laudable actions, and we are still conflicted today.

So what of wine in the modern era? The great tendency now is to treat wine as a pharmaceutical, whether deliberating the evils of alcohol or trying to tease out the secret components that explain why it is so good for us. But doing so misses the point on both counts; alcohol in the right amounts can be a healthy thing, and many of the known health benefits attribute to the lifestyle pattern that defines healthy drinking. So while the science of resveratrol and the long list of polyphenol antioxidants in wine is impressive, it isn’t the whole story and likely never will be.

Monday, January 23, 2012

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.

Tuesday, January 10, 2012

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.