It seems that the more studies we see on the relationship
between wine and health, and the larger they are, the more contradictory the
results. Headlines summarizing comprehensive international studies declare the
French paradox dead, and all alcoholic beverages are equally detrimental. I
think there is an overlooked explanation for this: over the past several
decades, convergence of drinking patterns around the world has separated wine
from its role as a daily part of a meal. Globalization has commoditized our
views about drink, toppling it from its role as a culturally specific emblem.Global convergence of drinking
There are several recent reports summarizing the trend,[i],[ii], [iii]
and it applies for both developed and developing countries. Since the early
1960s, wine’s share of global alcohol consumption has more than halved,
declining from 35% to 15%. Beer and spirits have taken up the slack, with beer
gaining 42% and spirits adding 43%, both large gains. The bigger story however
is convergence; Nordic countries for example have reduced consumption of
distilled spirits in favor of wine and beer, while the ratio of wine versus
beer consumption on a per capita basis in France has fallen from around 6:1 to
less than 2:1. Countries historically favoring beer drink more wine and
vice-versa. Consumers in developing countries are moving their preferences
upscale, while in developed nations traditional practices are discarded as
quaint artifacts. The resulting pattern is not particularly healthful.
How does this relate to the French paradox and wine’s
privileged position as a healthy drink? Recall that it all came to light when
the French had a strong affiliation with wine and an ingrained pattern of daily
drinking. A now iconic 1979 paper in Lancet[iv]
laid out the case, well before the “French paradox” was even a thing. Comparing
per capita wine consumption by country to mortality from heart disease, a tight
inverse correlation appeared. Italy, France and Switzerland occupied the high
end of wine consumers, enjoying the lowest rates of heart disease, while
countries such as the U.S. were not so big on wine but suffered dramatically
higher rates of heart attack. What’s clear from studies like this and others
that followed is that it is the wine-centric life that makes the difference. It
needs to be almost the exclusive beverage and consumed with regularity. Wine is
still mainly consumed with meals nowadays, but spirits and beer usually not, so
a move away from wine represents a profound shift in how alcohol is consumed.Why the French paradox is no longer French
The convergence of drinking patterns implies several things
important to epidemiologic research on drinking and health. An important
feature is that populations who consume wine in this strictly traditional way
become difficult to isolate. This could explain much of the disparity between
modern studies and earlier ones, with breast cancer being an enlightening case
in point: Studies generally (but not always) find now that any level of
drinking, of any type, carries some increased risk. But one of the few studies
evaluating breast cancer and alcohol that looked at traditional wine consumers
in a southern French population found a clear J-shaped curve[v].
Comparing several hundred breast cancer cases to matched population controls,
the researchers found that “Women who had an average consumption of less than
1.5 drinks per day had a lower risk when compared with nondrinkers.” They noted
“This protective effect was due substantially to wine consumption since the
proportion of regular wine drinkers is predominant in our study population.
Furthermore, women who consumed between 10 and 12 g/d of wine had a lower risk
when compared with non-wine drinkers.” The odds ratio, a measure of relative
risk, was 0.58 in the light drinking cohort and 0.51 in the moderate drinkers –
half that of nondrinkers.
With wine and health studies, then, bigger is not always
better. Analysis of tens of thousands of people yields limited information when
their drinking habits are not consistent and ritually specific. Researchers try
to get around the issue by categorizing people according to their stated preference of beverage, but convergence
shows that these preferences are increasingly fungible. The French paradox is
alive and well, you’re just more likely to find it at your neighborhood bistro
rather than TGI Friday’s.
[i] Holmes
AJ, Anderson K. Convergence in national alcohol consumption patterns: New
global indicators. Journal of Wine Economics 2017; 12(2): 117–148.
[ii] Bentson
J, Smith V. Structural changes in the consumption of beer, wine and spirits in
OECD countries from 1961 to 2014. Beverages 2018; 4(8).
[iii] Smith
DE, Skalnik JR,"Changing Patterns in the Consumption of Alcoholic
Beverages in Europe and the United States", in E - European Advances in
Consumer Research Volume 2, eds. Flemming Hansen, Provo, UT : Association for
Consumer Research 1995; 343-355.
[iv] St.
Leger AS, Cochrane AL, Moore F. Factors associated with cardiac mortality in
developed countries with particular reference to the consumption of wine.
Lancet 1979 May 12;1017.
[v] Bessaoud
F, Daures JP. Patterns of alcohol (especially wine) consumption and breast
cancer risk: a case-control study among a population in Southern France. Ann Epidemiol.
2008 Jun;18(6):467-75. Case-control study finding lower risk of breast cancer
in moderate wine drinkers.
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