wine and health

Is alcohol necessary for wine’s health benefits?

2012-01-23T08:53:00.000-08:00

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

2012-01-10T08:44:00.000-08:00

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.

2011-12-30T08:56:00.000-08:00

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

2011-12-17T10:49:00.000-08:00

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

2011-12-02T10:35:00.000-08:00

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

2011-11-02T08:35:00.000-07:00

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

2011-10-03T09:48:00.000-07:00

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.

Australian policy group statment on alcohol misses the mark

2011-09-19T08:52:00.000-07:00

Anti-alcohol activists fired another salvo last week in Australia with the release of a paper by the Alcohol Policy Coalition challenging the view that regular consumption of red wine is good for the heart. They even went so far as to proclaim wine’s health benefits a busted myth. The paper authoritatively bases its interpretation on a review of “all the scientific evidence” and asserts that red wine has “no special, protective qualities when it relates to cardiovascular disease.” I too have reviewed a lot of data on this subject for my book “Age Gets Better with Wine” and came to the exact opposite conclusion. So again I am left to wonder how such this well-meaning group of knowledgeable people can still get it so wrong?

It may be that the Australians are just a bit behind the times on this one, so let’s back it up a few years. Nearly all of what is now gospel about lifestyle factors and heart health comes from the Framingham study, now in its fourth generation. Back in the 1970’s, after the study had already been in progress for some 25 years, a review of the role of alcohol and heart disease was done. By now you know the result – moderate drinkers had lower rates of heart disease – but the data was suppressed for years because it didn’t mesh with what policy makers believed. Flash forward some 40 years and we are right in the same place with the Australian policy. In the meantime however, several hundred studies have reaffirmed the pattern of moderate drinking, particularly red wine, as having a protective effect. (References in my book.)

The same tired and discredited arguments prop up the Alcohol Policy Coalition’s paper. To begin with, they limit the benefits discussion to heart health, while the evidence comprehensively shows that red wine drinkers live longer than nondrinkers, have lower rates of Alzheimer’s and better mental function with age, lower rates of diabetes, osteoporosis, on and on. But the counter-argument presented by the Coalition lists all of the health hazards of heavy drinking.

One-sided statistics further cloud the picture; for example, there is the assertion that several hundred thousand deaths annually are attributable to alcohol consumption. Though arguable, even if true it does not take into account the number of deaths delayed due to the health benefits of moderate drinking. Dr. Curt Ellison, a world-renowned expert on the epidemiology of drinking and health, has convincingly demonstrated that the number of lives saved is a multiple of the number of alcohol-related deaths. Back in 1998 he wrote “ Only stopping smoking would have a larger beneficial effect on heart disease than for a non-drinker to begin having a drink or two each day.”

Mention is also made in the Coalition paper that one in five breast cancers is alcohol-related. This is such a wildly speculative figure that it undermines the credibility of the entire paper. While it is true that heavy drinking does increase the odds of developing some types of breast cancer, evidence shows that the risk is offset by a healthy diet containing folate. The risk of moderate drinking remains a matter of extrapolation.

The authors conclude with a recommendation to limit drinking to no more than 2 drinks per day. That is indeed sensible advice, but even more sensible would be to encourage a glass or 2 (no more) of red wine with dinner.

Resveratrol derivative helps obese lab mice live longer – so what?

2011-08-22T10:54:00.000-07:00

Do the new findings about the resveratrol derivative SRT-1720 extending the normally shortened lifespan of obese mice tell us anything new? It’s been a long and ultimately disappointing road with the red wine derivative resveratrol, once touted as the basis for miracle anti-aging drugs and now a fading star. As I have described here before, resveratrol was purported to activate an enzyme system known as sirtuins, which in turn activate anti-aging genes that trigger a unique lifespan extension phenomenon normally associated with severe caloric restriction. Take a pill and skip the starvation diet was the promise, and live up to 40% longer. The idea was so compelling that the biotech company Sirtris was founded to exploit more potent (and patentable) resveratrol derivatives such as SRT-1720.

This latest report showed that giving mice resveratrol after rendering them morbidly obese through an unhealthy diet helped them live longer than they normally would have, by improving insulin sensitivity and otherwise normalizing metabolic parameters thrown out of whack by the diet. But there are problems with the study: firstly, the subject mice still didn’t live as long as mice on a healthy diet. Secondly, there isn’t really anything new here; this has all been reported before.

The real problem is that neither resveratrol nor any of its derivatives has been proven to directly activate sirtuins in the first place. In fact, several labs other than Sirtris have definitely concluded that it doesn’t, that the initial reports were an artifact of the testing method. SRT-1720 may prove to be a useful drug for type 2 diabetes, joining a crowded market. But – and here’s the interesting twist – another diabetes drug, metformin, does extend lifespan in mice on a normal diet.

I have always been a little bit uncomfortable with attributing wine’s well-established health benefits to resveratrol. There isn’t enough resveratrol in wine to explain all of the good things that a glass or two with dinner imparts. There are a lot of things in wine besides resveratrol, including alcohol, and a lot of healthy habits that moderate wine drinkers have. So while I wish the good people at Sirtris all the best of luck, let’s not forget the simple things we can do for a long and healthy life now.

Is organic wine a healthier choice?

2011-08-15T11:25:00.000-07:00

Many people accept as gospel that organic food (and wine is a food) is healthier. No chemicals, harmful pesticides, or hormones must mean more nutritional value, right? Maybe, but there is a surprising lack of evidence in the form of dietary intervention studies –that is, actual measures of health parameters comparing organic and regular diets. That isn’t to say that there aren’t any, and recent studies are helping to shed some light on the subject.

Beyond the questions of environmental stewardship and moral/ethical reasons to eat organic, it is important to identify what sorts of nutrients that organic foods might contain in greater abundance and how this translates into better health. Vitamins aren’t the answer; simple enough to take a multivitamin pill and get what you need. A more promising possibility is antioxidants, nutrients such as the polyphenols that make red wine red and in general seem to be more prevalent in brightly colored foods. Antioxidants come in a variety of types, but in general they act as part of self-defense systems against spoilage and a number of environmental challenges. A well-know example is resveratrol from wine; this pluripotent polyphenol is an antiviral, antifungal, all-around good guy that seems to have a wide range of anti-aging properties. And because plants make these in response to environmental stress, they should make more of them when not pampered with sprays, fertilizers, and all manner of unnatural things, they should be more nutritious when left to fend for themselves. (A related concept is “biodynamic” farming.)

So a diet higher in antioxidants is a good thing. The science, however, is a bit trickier, since there are various ways of measuring antioxidant potency, and what works in the lab may not in the diet. Among the various ways to measure antioxidant potency is the ORAC test (Oxygen Radical Absoption Capacity), and it is possible to measure a sort of whole body ORAC with what is called “human plasma total antioxidant capacity.” The aforementioned study started by determining the ORAC levels of organic vs. traditionally farmed foods, including wine, and the scores were higher for the organic foods (with a few exceptions.) In test subjects converted to an organic Mediterranean diet, an increase of 21% in total body antioxidant capacity was seen after 14 days.

Does this mean your wines (and other foods) should be organic? You could make a case for it, but there are plenty of non-organically grown wines that pack a healthy punch. Winemakers already intentionally stress the vines in specific ways because more polyphenols also means more flavorful and distinctive wines. It is just fortunate that good wines tend to be good for you too.

Red wine may protect against breast cancer for some women at increased risk

2011-07-29T13:00:00.000-07:00

As we have discussed here before, the question of alcohol consumption and breast cancer is a volatile one, but a new study helps to shed some light on the subject. It becomes especially difficult for a subset of women with a genetic trait that places them at increased risk. Two genes, called BRCA1 and BRCA2, are mutations of genes that normally code for tumor suppression. When one of these mutations is present, the chances of developing breast cancer are substantially increased, and it is now routine to test for them when there is a family history of breast cancer. And given the consensus that alcohol consumption further increases the odds of developing breast cancer, it might make sense that the BRCA gene and drinking would be an especially dangerous mix. But when it comes to red wine, the story takes a different turn.

This new study, from the University of Ottawa in Montreal, looked at a large population of women with breast cancer, and tested them for BRCA. Additionally, drinking habits were determined by questionnaire. Interestingly, women with BRCA1 who were primarily red wine drinkers had about half of the expected incidence, and alcohol had no correlation at all. For BRCA2 positive women, alcohol was independently associated with breast cancer but red wine had no relationship.

So for BRCA-positive women, the effect of red wine really depends on which type; BRCA2 women should probably seriously consider avoiding alcohol of any type (unless they choose to have prophylactic mastectomy with reconstruction) while BRCA1 women might seriously consider cultivating a taste for cabernet. It’s a confused message, since the original purpose of the study was to clarify the magnitude of alcohol as a risk factor for BRCA-positive women, but the unexpected benefit for wine drinkers adds a layer of complexity. It’s not the first crack in the consensus about wine and breast cancer though, since populations where wine is regularly consumed there is a much lower incidence of breast cancer. The difficulty is statistically teasing out the true wine drinkers from the mixed and erratic drinking patterns in most populations.

How wine helps diabetes

2011-07-23T10:12:00.000-07:00

If current trends continue, an epidemic of diabetes is looming over the country. Are wine drinkers exempt? There is good evidence that wine drinkers are less likely to develop type 2 (non insulin-dependent) diabetes, and recent research may help explain why: wine derived compounds work in much the same way as popular diabetes medications.

To begin with, type 2 diabetes is typically associated with obesity, a main reason for the upward trend in developed countries. Wine drinkers tend to have healthier lifestyles overall so a certain amount of the benefit relates to healthier eating and exercising regularly. However, there seems to be more to it than that, and now we have biochemical evidence to back us up. One way that diabetes drugs work is to make cells more sensitive to insulin, which in turn helps them take in sugar. (Type 2 diabetics have a problem with insulin sensitivity, not a lack of insulin as in type 1.) Fat cells in particular become resistant to insulin.

Diabetes drugs such as Avandia (rosiglitazone) make cells more responsive to insulin by binding a receptor call PPAR. Red wine contains at least 2 compounds, ellagic acid and epicatechin gallate, that also bind PPAR. On average, a glass of red wine is equivalent (experimentally) to a full dose of Avandia (which by the way cautions against taking it with alcohol.) Other studies have found resveratrol from red wine to have anti-diabetic effects.

Of course anyone on diabetes medication should discuss their alcohol consumption with their doctor, but it helps to be independently informed as well. Alcohol, despite the calories, is metabolized differently from carbohydrates such as sugar; so wine, whose only calories come from alcohol, is less likely to cause problems with blood sugar levels.

Let them drink wine: A Bastille Day toast to healthy drinking

2011-07-08T14:52:00.000-07:00

Marie Antoinette may be popularly credited with spurring the French revolution (and losing her head) with her response to the shortage of bread, but a closer look at the events leading up the storming of the Bastille on July 14, 1789 reveals that access to affordable wine was perhaps an even more important factor. In May a national assembly was convened to air grievances of the common people and demand formation of a constitution. A series of poor harvests and widespread food shortages contributed to general unrest, but the Bastille became a target both because “political” prisoners were housed there on arbitrary orders from the king, and also because it was an armory. But it was not the storming of the Bastille that was the first act of civil unrest in the French revolution, it was attacks on the customs houses where duties on wine were collected.

Wine, however, was not in particularly short supply in the 1780’s. The issue was a tax that was collected on wine as it was brought into the city, which had created an opportunity for enterprising publicans who set up shop just outside the Paris city gates. Affordable wine had thereby been generally available without a long journey at the end of a day’s work in the city. As one member of the legislature, Etienne Chevalier put it in 1789: “Wine is the basis of survival for the poor citizens of Paris. When bread, meat, and other foods are too expensive, he turns to wine; he nourishes and consoles himself with it.” But Paris, a walled city at the time, was growing, and as the walls were moved outward it became increasingly difficult for the “poor citizens of Paris” to maintain easy access to this important source of nutrition and comfort. So it was the customs houses at the gates of Paris that were targeted first in the revolution.

Some 300 years later, the French paradox would confirm the health benefits of regular consumption of wine with the evening meal. If there is a lesson in this historical nugget, perhaps it is this: Let them drink wine. A good baguette wouldn’t hurt either.

Space: The next frontier for wine and health?

2011-07-01T12:34:00.000-07:00

Spaceflight has a number of deleterious effects on health, but recent evidence suggests that resveratrol – a polyphenol antioxidant from red wine – might help to offset some of these effects. If you ask me, not having access to wine with dinner is bad enough, but there is a long list of physical deteriorations that occur with prolonged zero gravity. These include muscle wasting and decrease in bone density, but there are also physiologic alterations such as insulin resistance and a shift from fat metabolism to carbohydrate utilization. These are issues with a months-long stay in the international space station, but extrapolating to the time required for planetary exploration they become serious problems.

A study on rats suggests how resveratrol may help protect against these changes. While the animals were not launched into space, there is an experimental model that mimics the effects to some degree by “unloading” the hind leg. This results in loss of muscle mass, decrease in bone density, and the associated metabolic changes. With resveratrol added to the diet, these changes were completely prevented, including insulin sensitivity and dietary fat processing.

What this means for us terrestrials may be the more intriguing question. Is wine a subsitute for exercise? Previous studies have suggested that resveratrol enhances athletic performance, and slows age-related muscle loss (again in mice only.) There is some evidence that muscle wasting from cancer may also be slowed with resveratrol supplementation. However, several studies support the use of another wine polyphenol, quercetin, for boosting athletic performance and endurance, and the optimal combinations and dosages remain to be determined.
It is of course important to recognize that people are not rats (at least metabolically if not behaviorally) and this notion is completely untested in humans. Absorption and the biological availability of resveratrol in people is different than in rats and so we can’t read too much into this. What we do know is that wine drinkers are healthier and live longer on average, and it appears to be related to a number of things besides resveratrol. The real trick of course will be stocking the space cellar.

Why wine makes food healthier

2011-06-16T09:25:00.000-07:00

In my book Age Gets Better with Wine I have a chapter called “Wine is a Food” in which I emphasize the importance of wine as a part of a healthy meal. There is good scientific evidence for why this is the case, and a new study adds to the picture. Wine with food changes the way the fatty components of the meal are handled by the body.

We all know that saturated fats are bad news nutritionally speaking. High cholesterol levels contribute to increases risk of heart disease and other problems, but it isn’t purely a matter of the fat content in the food. When the fats are absorbed and oxidized, they are converted into a particularly malicious form know as cholesterol oxides and lipid peroxides. This recent study, conducted by INRAN, the Italian Institute for Research on food and Nutrition, (a division of the Ministry of Agriculture, Food and Forestry), recruited 12 volunteers who were given a meal with known cholesterol-laden meal consisting of a double cheeseburger. The 6 men and 6 women in the study were not on any vitamins or other supplements so as to not interfere with the measurements. In the first phase, only water was taken, and the predicted spike in oxidized fats in the blood was measured. Two weeks later, the meal was repeated but with a glass of red wine; in this case, the wine suppressed levels of cholesterol oxides and lipid peroxidation products. It was not determined whether the effect was due to alcohol or antioxidant polyphenols in wine.

These results are in line with earlier studies, and more research is planned in order to further elucidate what mediates the effect. But what is clear is that wine makes the food healthier. Another effect, not evaluated in this study, is that wine consumption with a meal also slows down alcohol absorption. This further explains why those who drink wine with meals have better health and longevity, because it is inconsistent with alcohol abuse. I like to think of it as drinking wine for aesthetic enjoyment rather than for its anesthetic effects.

Whatever your reason, consider opening a bottle of something red with your next summer BBQ. You’ll be happier and healthier for it.

Cholesterol drug Niaspan disappoints; better to just have a glass of wine?

2011-05-28T10:07:00.000-07:00

This week it was announced that a clinical trial on the use of Niaspan (a sustained release formulation of the vitamin niacin) to raise levels of HDL or “good” cholesterol, was suspended because of disappointing results. While it is well-established that higher levels of HDL (high-density lipoprotein) relative to LDL (its low-density counterpart) are associated with reduced risk of heart attack and stroke, the addition of Niaspan to the cholesterol-lowering statin drugs (for example Lipitor) has failed to deliver the same benefit seen in people who naturally have a high HDL/LDL ratio. In this recent trial, there was even a trend to an increased stroke incidence. Sales of Abbott’s Niaspan totaled nearly $1 billion last year, but development of several cholesterol drugs has been suspended recently due to lack of efficacy in preclinical trials.

It seems appropriate then to take a few steps back and see what we know about what does work. Not smoking, along with exercise and a healthy diet are unquestionably the first steps in reducing the risk of cardiovascular disease. But how is a healthy diet defined? Regular consumption of red wine has long been identified as a significant element in a heart-healthy diet, though randomized prospective clinical trials such as those used in drug development are few. Nevertheless, a positive pattern emerges for wine consumption especially with meals.

Wine consumption is known to affect cardiovascular disease risk factors in several ways: First, alcohol in moderate amounts also raises the HDL/LDL ratio, though in light of the Niaspan study the benefit of this effect seems debatable. Alcohol also helps prevent thrombosis, or clotting in the arteries which is the critical event in heart attack. A 2008 prospective clinical trial from the Netherlands pointed to additional benefits from alcohol, observing that the addition of white wine but not grape juice to the diet of postmenopausal women improved insulin sensitivity—a good thing for cardiovascular risk—while raising HDL and lowering LDL along with triglycerides, another bad actor. At a more fundamental level, tissue levels of a substance called adiponectin were increased, providing a possible explanation for less weight gain observed among middle-aged wine drinkers. A similar trial in men, looking a a broader range of alcoholic beverages, found positive effects on blood pressure and various markers of inflammation in the blood after red wine or beer consumption but not whiskey or white wine.

As anti-alcohol activists point out, alcohol also has deleterious effects on blood pressure, but intervention studies find that the threshold for this is at about 4 drinks per day. So alcohol seems to be at least acceptable if not beneficial in moderate amounts, and when combined with the long list of properties associated with the antioxidant polyphenols in wine, it seems clear that a glass or two of wine with dinner should be a central part of a heart-healthy diet.

The French Paradox at 20

2011-05-15T10:38:00.000-07:00

This year will mark twenty years since the CBS television show 60 Minutes christened the term “French paradox” and ushered in the modern era of research on wine and health. It was a provocative idea at the time, attributing the French custom of regular imbibing to health and well-being, and it still has its naysayers; at the other extreme, there are those who reduce the idea to a simple question of nutritional biochemistry and proclaim that all of wine’s health benefits can be put into a pill, conveniently and properly skipping the alcohol. Is there still a useful truth underlying the paradox?

As with many questions in the realm of lifestyle and health, the answers are often nuanced and conditional. Though challenged by government authorities in both America and Europe, the authors of the idea – Serge Renaud in Bordeaux and Curt Ellison in Boston – provided a rigorous defense of the notion. The French paradox is invoked regularly as an excuse for having a few, to the point that it has become a cliché and its real lessons lost. Despite all of the advances in understanding the components of wine and how they contribute to health, at its heart the paradox is a reflection of a lifestyle. Wine is a food, squarely affixed in the daily rituals of the Mediterranean diet.

The science that grew from the seed planted by the French paradox idea has grown far beyond what any of the early researchers could have predicted though. Antioxidant polyphenols from the skins of wine grapes (not so much from juice or table grapes) have emerged as vitally important elements of an anti-aging diet. Among the best known is resveratrol, about which there were 2 articles in the scientific literature in the year of the original broadcast of the story, whereas there a more than 2 every day now. Resveratrol and other wine polyphenols provide a handy explanation for why wine drinkers have lower odds of developing Alzheimer’s, diabetes, osteoporosis, and pretty much all of the disease of aging. They help break up the protein plaques in the brain associated with Alzheimer’s, prevent cholesterol from aggregating into concretions in the arteries, kill cancer cells (while protecting normal ones), even improve insulin sensitivity. Resveratrol appears at first glance to be a miracle molecule, as I dubbed it in my book Age Gets Better with Wine.

But there remains a problem with giving resveratrol all the credit: there isn’t very much of it in wine. Data clearly supports the benefits of regular wine consumption, but is lacking when it comes to the use of resveratrol in supplement form. This brings us back to the role of wine as a lifestyle factor. Wine drinkers tend to do a lot of health things besides having a daily tipple with dinner, and wine contains a lot more than the pittance of resveratrol. It is the synergies of these various things that unleash the true benefits of wine.

New Heart Association Survey on wine: Why are Americans confused about healthy drinking?

2011-05-02T12:02:00.000-07:00

The American Heart Association recently released the results of a survey of Americans on their knowledge of healthy drinking and consumption of sea salt. No surprise, they concluded that we have it all wrong. On the plus side, two thirds agreed with the statement that wine is good for the heart, but less than one third know the AHA’s recommended limits of a daily glass or two for men and no more than one for women. The survey showed that “we need to do a better job of educating people about the heart-health risks of overconsumption of wine” according to a spokesperson.

I say bless their hearts but their paternalistic message only adds to the confusion. For starters, they don’t even have their definitions right, which is a 5-ounce pour as the standard on which research and policymakers have long agreed, but the AHA cuts it back to 4. Granted, they have come a long way since the mid 1990’s when the official policy grudgingly acknowledged that a glass or two a day “might be considered safe” while hastening to add a disclaimer about all of the social ills attributed to alcohol consumption. But these problems are associated with excess and problem drinking, not a glass or two or even three with a leisurely dinner. What statistics consistently show is that wine with dinner is among the most powerful contributors to health.

Part of the problem is the narrow focus on heart health, which we can forgive to some degree for the AHA but it leads to an incomplete picture of the broader benefits of healthy drinking. When consumed with meals, up to 3 glasses for a man and about half that for a woman is associated with the greatest reduction in health problems across the board leading to longer lifespan and a higher quality of life, especially in old age.

Just as interesting to me is the comments that follow the various news postings about the study. It would seem that we are even more confused about wine and health now as ever, judging from remarks suggesting that red grape juice has the same benefits as wine without the alcohol.

Should diabetics drink wine?

2011-04-22T10:54:00.000-07:00

An epidemic of type 2 diabetes looms over the western world, with some estimates predicting that as many as a third of all Americans will have the condition within a decade or two. Obesity is the culprit, a complicated issue to be sure but the role of wine in the diet of diabetics is even more so. A recent study finding that low-dose supplements of the wine-derived polyphenol resveratrol improve glucose tolerance and other parameters in humans provides some guidance in sorting it all out.

It has long been known that wine drinkers, especially those who consume red wine in moderation with dinner on a daily basis, are less likely to gain weight and hence less prone to type 2 diabetes. There are a number of potential explanations, including the fact that wine drinking is linked to a range of healthy lifestyle factors including diet and exercise, but the science of wine polyphenols – including the antioxidant resveratrol – provides some intriguing evidence of a biochemical mechanism at work. Studies in mice have been very promising but this new randomized prospective double-blind study, on 19 human subjects, documents that it can be useful clinically if the results can be verified. Importantly the study used a low dose of 10 milligrams daily, consistent with what you might get in wine.

The question of whether it would be better to take the supplements and avoid the calories from wine remains a subject of debate. Clearly, wine drinkers do better in terms of developing type 2 diabetes, and resveratrol may have little to do with it. But calories from alcohol are metabolized differently that from carbohydrates and other food components, so that the spike in blood sugar is minimized.

All of this brings us back to the role of wine as a food. In the case of diabetics, it may actually be a functional food, by avoiding the types of calories that make the problem worse while providing natural ingredients that could actually improve the condition on a biomolecular level. In order for it to work, however, it all has to be integrated into a healthy lifestyle.

A charitable view of wine and health

2011-04-07T14:21:00.000-07:00

As most of you know I am on the board for the Washington Wines Festival, which raises awareness of Washington’s wonderful wines and funds for worthy charities such as Camp Korey. The wine business has a long and laudable history of charity, dating at least as far back as the famous Hospices de Beaune in Burgundy. Dating to 1443, the hospice was a hospital for the poor and needy, supported by funds raised from the local wine producers. To this day an important wine auction is held every November at the Hospice, maintaining a centuries-long tradition.

Health care continues to be a popular beneficiary of charity wine auctions, and there are some interesting parallels to the circumstances that prevail today with the conditions at the time of the founding of the Hospices de Beaune. The Hundred Years War had just ended, but the long conflict had been financially ruinous. Marauders roamed the countryside, pillaging and plundering, and much of the population was destitute. The Hospice became a refuge for the sick, the disabled, orphans, expectant mothers, and the destitute, all supported by the wine industry. Every year here in the Seattle area, the Auction of Washington Wines raises money for the Uncompensated Care fund at Children’s Hospital, and the Washington Wines Festival supports Camp Korey, one of Paul Newman’s “Hole in the Wall” camps for seriously ill children. Down the road in Oregon a similar event benefits health care for farm workers, a group traditionally excluded from access to health care services. And there is of course the Napa Valley Wine Auction, which includes health care for the needy among its worthy causes. These are only a few of a large number of charitable activities around the country, especially important in a time of economic upheaval. Worldwide, the impact is in the high millions of dollars at the very least. And given that wine is not only a health food but contributes to the enjoyment of life, it is the ultimate win-win.

German study confirms benefits of drinking in elderly

2011-03-31T14:06:00.000-07:00

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.

Healthy wine drinking is a family value

2011-03-22T13:46:00.000-07:00

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.

Which types of wine are the healthiest?

2011-03-14T16:23:00.000-07:00

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.

Is any amount of alcohol good? Resolving the conflict

2011-03-07T11:34:00.000-08:00

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.

Red wine compound resveratrol supports anti-cancer therapy

2011-03-01T10:49:00.000-08:00

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.

An end to wine headaches at last

2011-02-17T11:43:00.000-08:00

Thank food biotechnologist Hennie van Vuuren at the University of British Columbia for finding the solution to one of the most vexing problems for would-be wine lovers: the headache that so often accompanies wine drinking for up to 30% of the population. These unfortunate folks are sensitive to compounds known as biogenic amines such as histamine, which can also impart off-putting flavors to wines. (It isn't the sulfites.) I have long thought that there was a huge opportunity for someone to crack this particularly hard nut and figure out how to make low-amine wines.

van Vuuren apparently had the same idea, and over the past several years he has been developing a strain of yeast for wine fermentation that produces low levels of amines. The yeast, known as Malolactic ML101, has already been approved by Health Canada and the US Food and Drug Administration. According to the developers of the new yeast, Lesaffre Yeast Corporation, there is a good chance you have had wine produced with ML101 without knowing it, since it doesn’t require any special labeling. If you ask me though, they are missing an opportunity to spread the good news to the millions who have been avoiding wine for fear of triggering a migraine.

There is of course a catch in that the FDA and other regulatory agencies in the U.S. take a dim view of winemakers claiming any health benefits about wine, despite the massive amount of supportive data on the subject across a wide range of conditions. That leaves it up to independent wine and health experts (such as yours truly) to spread the word. So winemakers, if you are using ML101 let us know, and consumers, let’s talk it up especially to our friends who have been unable to enjoy wine. (The only winery to confirm that they are using ML101 is Sandhill Winery in British Columbia, though several American wineries do as well.)

Notch up a victory for alcohol and heart health

2011-01-29T12:02:00.000-08:00

OK, we all know that wine is good for the heart; French paradox, old news. And if you are at all interested in anti-aging, you will have heard that wine’s benefits are attributed to the polyphenol antioxidants from the skins, including resveratrol, quercetin, and a menagerie of other exotic molecules. But the role of alcohol has long been questioned. Even though the epidemiologic evidence points to a contributory part for alcohol, the exact mechanisms by which it might accomplish this have not been well understood, other than favorably shifting the high density/low density cholesterol ratio. New findings implicate a signaling molecule called Notch, another one of those exotic breeds that seem to be involved in a lot of things once we get to know them.

Vessel thickening is reduced in the carotid arteries of mice fed the equivalent of two drinks, compared to no-alcohol controls. (Credit: Image courtesy of University of Rochester Medical Center)

Notch does seem to be a multitasker. One important position it occupies is signaling immune system cells called helper T-cells to differentiate into specific subtypes. Research on notch may lead to new therapies for a range of immune system diseases and certain types of infection that require targeted immune responses. But notch, a receptor protein in cell walls, influences many types of cells on their differentiation pathways. This potentially involves notch in several types of cancer too, and the inflammatory processes that lead to the formation of plaques in the walls of arteries. This is where alcohol comes into the picture.

Atherosclerosis is not a passive buildup of sludge in the arteries, but a dynamic condition that includes thickening and proliferation of the muscle cells in the artery wall (it is relaxation or contraction of these muscles that sets blood pressure.) The more thickening that occurs, the stiffer the artery and the more likelihood of a clot and a heart attack. These specialized muscle cells are triggered to grow by notch signaling, a process inhibited by alcohol.

It’s probably fair to say that recognizing the undercurrent of chronic inflammation as one of the most important causes of cardiovascular disease was a major breakthrough. Your aspirin a day is effective not because it protects against a clot forming but because of its anti-inflammatory actions. Now we know that inhibition of notch may be another important pathway for reducing heart disease risk, at least according to a paper from the University of Rochester Medical School. Using muscle cell cultures from human arteries and intact arteries from mice, the researchers identified notch as a sort of relay signal for the cells to divide and grow. Alcohol was identified as a notch inhibitor, and therefore in the right amounts a positive factor in helping to maintain supple arteries. I say cheers to that.

Morrow D, Cullen JP, Liu W, Cahill PA, Redmond EM. Alcohol inhibits smooth muscle cell proliferation via regulation of the Notch signaling pathway. Arterio Scler Thromb Vasc Biol 2010 Dec; 30(12):2597-603.

Aging in oak barrels may improve wine’s healthful properties

2011-01-13T10:57:00.000-08:00

No one knows for sure when the oak barrel was invented, but it probably dates to the 13th century. Wine and oak have had a long and happy marriage, despite occasional excesses and changes of taste, and it is as hard to imagine a big red without oak as it is beer without hops. Vanillins and other compounds improve the wine if managed carefully, but the question of how these molecules may affect the health benefits of wine has just recently begun to be explored.

Collectively these compounds are called lignin-derived polyphenols, which bear a relationship to polyphenols from grape skin and seeds. These molecules are often aromatic, vanilla being a good example. And the prolonged time that red wines often spend in barrels can result in a high degree of extraction into the wine, though levels may still be small in comparison. Nevertheless, their contribution to wine’s effects on health may be as important as their input to flavor and structure, according to recent research.

A study from the University of Alabama found impressive antioxidant capabilities of lignin polyphenols, with free radical scavenging potency in the same range as wine phenolics. Of particular interest is that these compounds bind many of the same proteins as resveratrol, indicating they may send similar metabolic signals. The authors of the study concluded that oak phenolics may contribute to cancer prevention and heart disease prevention to a significant degree.

Traditional methods of winemaking are on the decline though, and the effects of newer techniques such as micro-oxygenation instead of prolonged barrel aging may change the composition of the final product. Oak chips are being substituted for the barrel, which may or may not impart similar compounds. To be sure, barrels are one of the more costly aspects of winemaking, but I guess I am a traditionalist. I am willing to let the angels have their share (the evaporative loss from aging in oak) in return for something I know is good.

new resveratrol revelations

2010-12-29T09:41:00.000-08:00

What a year it has been for resveratrol, the polyphenol molecule from red wine. Last year at this time it was the toast of the town, having been credited with triggering a metabolic change leading to increased lifespan in experimental models, then catapulted into the limelight as a potential cancer cure with clinical trials under the auspices of pharma giant GlaxoSmithKline. Sales of resveratrol supplements were skyrocketing, with audacious claims about weight loss, brain power, and longevity, never mind that none of this had been proven in humans. But with the new year came new controversy. Two of Glaxo’s competitors, Pfizer and Amgen, published their own studies on resveratrol, concluding that the longevity effect was false, an artifact of the testing method. What few clinical trials there are in humans revealed that it is poorly absorbed and doesn’t last very long in the body anyway. Then in November Glaxo abruptly announced the suspension of the clinical trial and all further development of their flagship resveratrol derivative, SRT501. Supplement sellers started to look more and more like snake oil peddlers, while enthusiasm began to fade in the scientific community.

Despite these setbacks, progress on the basic science front continues to reveal interesting properties of resveratrol. One line of research looks at extending lifespan of cells not through metabolic change but by repairing the caps on DNA strands that are clipped each time the cell divides. These caps, called telomeres, are sequences on the ends of the chromosomes that prevent unraveling with the replication cycle; with each division they shorten, limiting the number of times the cycle can repeat and therefore the lifespan of the cell. Cell types that require constant replenishment, such as skin and the linings of blood vessels, show their age more than others as they lose the ability to replicate. But cancer cells have figured out how to by pass this limitation and become immortal by rebuilding telomeres with an enzyme called telomerase. Control telomerase and you harness cellular immortality, and it appears resveratrol may provide the key.

The source of new cells is what are called progenitor cells, which in turn trace their lineage to stem cells. A recent study enticingly called “Immortalization of epithelial progenitor cells mediated by resveratrol” outlines the mechanism by which resveratrol pulls this off in skin cells. There is a lot that remains to be deciphered about this but it looks promising. Another paper reported on the role of resveratrol in reducing senescence of the progenitor cells that replace blood vessel lining, an important step in countering atherosclerosis, by activating telomerase. Just as important though is that resveratrol uses the same metabolic pathways to slow the growth of cancer cells.

Such is the state of affairs with resveratrol: exciting new findings on the leading edge of biomedical research, while verification of its use in clinical medicine seems ever farther off. All I can say is stay tuned.

1. Pearce VP, Sherrell J, Lou Z, Kopelovich L, Wright WE, Shay JW. Immortalization of epithelial progenitor cells mediated by resveratrol. Oncogene 2008 Apr 10;27(17):2365-74.
2. Xia L, Wang XX, Hu XS, Guo XG et al. Resveratrol reduces progenitor endothelial cells senescence through activation of telomerase activity by Akt-dependent mechanisms. Br J Pharmacol 2008 Oct;155(3):387-94.
3. Lanzilli G, Fuggetta MP, Tricarico M, Cottarelli A et al. Resveratrol down-regulates the growth and telomerase activity of breast cancer cells in vitro. Int J Oncol 2006 Mar;28(3):641-8.
4. Fuggetta MP, Lanzilli G, Tricarico M, Cottarelli A et al. Effect of resveratrol on proliferation and telomrease activity of human colon cancer cells in vitro. J Exp Clin Cancer Res 2006 Jun;25(2):189-93.

Believe in wine

2010-12-13T16:57:00.000-08:00

Believing in Santa Claus may not be a scientifically tenable position, but it does come with benefits. As children reach the age where suspicions arise as to the veracity of the notion of a jolly visitor bearing gifts in the night, they come to understand that it is in their best interest to play along. In the case of wine, the science may be on more solid footing as to the benefits of moderate consumption, but what people believe does not always align with the facts here either. That is why it is encouraging to see recent survey data that people are finally acknowledging the connection between wine and health, even if there are still some areas of uncertainty.

London-based Mintel research recently released the results of a survey finding that some 85% of drinkers believe that wine in moderation is good for overall health, while wine drinkers hold that red wine is good for the heart. On the other hand, half of those attribute the same benefits to white wine. Given white wine’s relative lack of the polyphenol antioxidants that red wine has (extracted from the skins and seeds during fermentation of the whole grape), white is probably given more credit than it deserves here, but it is a least a step in the direction of healthy drinking. Some confusion is to be allowed here though since the degree to which red is better depends a lot on what health parameters are being studied, not to mention effects of beer or spirits consumption.

What the report didn’t evaluate is the level of penetration of knowledge about wine’s other benefits. One of the more difficult jobs that wine and health educators have is overcoming the assumption that heart health is the whole story. Sure, it’s the French paradox, I get it, people say. But that is only the beginning of a story whose conclusion is nowhere in sight. For example, every major epidemiologic survey on factors associated with Alzheimer’s disease has found the lowest incidence in wine drinkers, but we rarely hear anything about that. The other misconception out there is that it’s all about the polyphenols, so we just need to take a pill and skip the alcohol. Supplement marketers regularly claim that their brand has “all the benefits of wine” which is a misnomer because alcohol in the right amounts is also healthy (improves the high-density to low-density cholesterol ratio, among other good things.)

Another thing the Mintel report found was that people plan to drink more wine this holiday season, and that overall wine consumption is trending upward over the long-term. As for me, I believe that is a good thing. Cheers to all and best wishes for a good bottle from Santa.

Glaxo pulls the plug on resveratrol drug: end of the line?

2010-12-03T09:39:00.000-08:00

Resveratrol, the antioxidant molecule from red wine (along with miniscule amounts from some berries and the non-edible parts of the peanut plant), took the world by storm a few years back when it was announced that it could trigger a specific metabolic change associated with significant lifespan extension. Though the phenomenon was only found at first in some strains of yeast under certain conditions, it was believed to work by activating an enzyme system known as sirtuins, which in turn control the switching on and off of genes associated with longevity and a range of diseases of aging. The potential for resveratrol-based compounds caught the attention of pharma giant GlaxoSmithKline, which acquired the rights to it for US $720 million in 2008. But this week Glaxo announced the suspension of all development of their product, known as SRT501, citing concerns about complications in a clinical trial for the blood cancer multiple myeloma. Many now wonder whether resveratrol has gone from darling to dud in only 2 short years.

Meanwhile, sales of resveratrol supplements, based on the naturally occurring and non-patentable molecule, have soared in recent years. Purveyors openly tout it as a “fountain of youth in a pill” and a miracle weight loss solution. Some advocates of natural healing are openly celebrating Glaxo’s failure, accusing them of greedily hijacking a perfectly good natural cure in the name of corporate greed by developing synthetic (and patentable) variations. Pfizer and Amgen have both weighed in recently with scientific publications casting doubt on the ability of resveratrol and its derivatives to activate sirtuins at all, pointing to evidence that the testing method was an artifact leading to false positive results. Is this the end of the road for resveratrol?

There’s support for both arguments, but don’t mark your calendars just yet for resveratrol’s funeral. For one, the natural molecule has a wide range of interesting capabilities, at least in lab studies. Clinical trials are ongoing and much remains to be learned about whether this translates to verifiable benefits in humans. (One thing that appears unlikely is the lifespan extension phenomenon via sirtuin activation, as it has not been found in mammals.) Glaxo was careful to point out that other resveratrol derivatives are being studied, and the point of synthesizing variations on the molecule is to find more potent versions with specifically targeted actions. (See the full quote below.) And without the prospect of return on investment, there is little funding available for studying the natural version. Until more results are in, my suggestion is to bear in mind that the whole thing started with red wine, which does confer longer life on average for moderate regular consumers, along with higher quality of life.

From Glaxo: ”We are focusing our efforts now on more selective SIRT1 activator compounds that have no chemical relationship to SRT501 and more favorable drug-like properties. Currently we have two of these latest generation compounds (SRT2104 and SRT2379) in several exploratory clinical trials.”

Hope for wine allergy sufferers

2010-11-22T14:39:00.000-08:00

It seems at every talk I give on wine’s contribution to healthy living, there is at least one person in the audience who asks about wine allergies. Maybe they can’t drink red (thereby missing out on a lot of the antioxidant polyphenols), or maybe not wine at all. Sulfites are often blamed, but they are naturally present in all wines, beyond what is commonly added for preservation, and actual sulfite allergies are comparatively rare. What’s more, sulfites are higher in white wine, while allergic reactions are more common to reds. The question of why so many people have reactions to wine has remained largely unanswered until now.

A study from the Department of Biochemistry and Molecular Biology, University of Southern Denmark, and the Agricultural Research Council, Research Unit for Table Grapes and Wine Growing in Turi, Italy has identified a class of molecules called glycoproteins as the culprit. These are ubiquitous biological compounds that are comprised of a sugar portion (glyco-) attached to a protein. Examples include several hormones, connective tissue structures, and even antibodies. These molecules are commonly ensconced in the cell membrane, where they may help to identify what type of cell they are part of. Immune surveillance can be very tuned in to these molecules and so they are fairly common allergens. The Danish-Italian study identified some 28 different glycoproteins in wine with similarities to known plant allergens.

Unfortunately, glycoproteins in wine are derived from the grapes themselves as well as the yeast required for fermentation. It is possible that different strains of yeast might explain the differences in reactions to different wines (for example, people who are able to drink European wines but not the same varietal from a domestic producer), but using different yeasts would change the character of the wine. But this isn’t to say that nothing can be done. Hopefully some clever winemaker will target the market segment of those who would like to drink wine but can’t, and figure out some fining method or other means to remove glycoproteins from wine without sacrificing character. Clearly there is a lot more to learn about glycoproteins and wine allergy, but at least we now have something to go on.

Palmisano G, Antonacci D, Larsen MR. Glycoproteinomic profile in wine: A sweet molecular renaissance. J Protenome Res 2010 Oct 1; [epub ahead of print]

Madeira for malaria?

2010-11-12T13:40:00.000-08:00

Of all of the scourges of mankind, malaria ranks near the top of the list, affecting more people worldwide that the entire population of the U.S. It has been notoriously resistant to vaccines, in part because of the complex life cycle of the parasite, which spends part of its development in the mosquito and part inside the red blood cells of people. It is this latter part that raises an interesting possibility for treatment with the red wine compound resveratrol, as reported at a recent meeting of tropical medicine specialists.

You may be familiar with the antibiotic properties of resveratrol and other polyphenol molecules from red wine. These compounds come from the skins, where the grapes form them as part of their natural environmental defense. Plants, and especially ripening fruit, are vulnerable to bacteria, viruses and fungus just as animal are, and this explains the broad spectrum of antibiotic capabilities of resveratrol. Wine’s use as a means of purifying drinking water over the past few thousand years is likely based as much on this as its alcohol content. Parasites such as the malaria bug are more difficult to suppress, and so the activity of resveratrol was unexpected.

One reason for this is that resveratrol’s inhibition of malaria works indirectly, by altering the red blood cells that contain the bug. In order for the more sever manifestations of malaria to occur, the blood cells need to adhere to the lining of the blood vessels, which resveratrol prevents (this is actually related to how it helps prevent heart attacks). So the idea isn’t that resveratrol can eradicate the parasite, but rather to mitigate the more severe effects of it while treating with anti-malarial drugs.

Since malaria is most common in tropical climates and developing countries, any effect of wine consumption would be a difficult association to discover. The British, during the Raj turned to quinine and the now-classic gin & tonic rather than claret for the same practical reasons. It is a bit difficult to picture fine Bordeaux becoming the standard prophylaxis in sub-Saharan Africa, but it may well hold the key to minimizing a lot of suffering.

Something new to chew on: Resveratrol chewing gum

2010-10-30T10:35:00.001-07:00

My what a long way we have come since I first started lecturing and writing about wine and health a decade ago. For one, few had heard of resveratrol, the potent antioxidant in red wine, and many of those who had didn’t know how to pronounce it. Flash forward a few years and a few thousand research articles and now resveratrol is the flavor of the month, appearing in everything from diet pills to energy drinks. The discovery that it may activate the enzymes responsible for enhanced longevity normally associated with caloric deprivation catapulted resveratrol into the spotlight. Ads unabashedly tout it as the new fountain of youth. The latest version is a chewing gum, from a company called Gumlink A/S.

A few cautionary notes here, but there are also some good reasons why it might not be such a bad idea. Firstly, resveratrol hasn’t been able to explain all of the benefits associated with moderate wine consumption, and serious doubts have been advanced about whether it is truly capable of activating the longevity effect seen in lab experiments. So a healthy measure of skepticism is advised about any product, with or without resveratrol, that claims to deliver all the benefits of wine. But resveratrol is a remarkable molecule with many potentially useful capabilities for anti-aging. Several clinical trials are ongoing, though few have been completed.

So supplementation with resveratrol might not be a bad idea, we just don’t know enough to say for sure. One big problem with supplements is that resveratrol is poorly absorbed from the digestive tract, so most of it may be wasted. But research has shown that it is absorbed better from the lining of the mouth (oral mucosa) and I have speculated that wine drinkers who savor and swirl might be taking advantage of this without even trying. Another interesting line of research points to benefits of resveratrol in dental health. So assuming the resveratrol gum is sugar-free it just might be the ticket. Especially if it helps whiten those purple teeth from wine drinking.

Wine and breast cancer: an update

2010-10-21T11:28:00.000-07:00

With October being the annual exercise in breast cancer awareness, our attention turns to the ongoing issue of drinking and breast cancer risk. What we usually hear is the established advice that alcohol consumption in any form contributes to the risk of developing breast cancer, in a direct ratio of about one daily drink to a 10% increase. But if you have been following my posts here, you will know that the question of wine consumption and breast cancer is considerably more nuanced, and it remains entirely possible-even likely, in my analysis-that red wine decreases risk, in the right amounts. A recent study from the Fred Hutchinson Cancer Research Center here in Seattle, in collaboration with major cancer centers around the country, helps to shed some light on the subject.

But first we need to revisit the question of why alcohol could contribute to cancer in the first place. As I point out in my book, a scientifically provable basis for alcohol leading to the cellular changes that progress to cancer remains elusive. The best idea out there is that it somehow interacts with estrogen receptors, which would imply that only certain types of breast cancer (know as estrogen-receptor positive) would correlate with drinking. However, no large studies had previously looked at drinking and breast cancer subtypes before the recent Hutch project. What they found was a relationship of ER positive cancer only in an uncommon variant called lobular carcinoma, but not the much more common ductal type. This particular study did not evaluate subcategories of drinking, however, but it nevertheless raises more questions than it answers. Here’s why:

If alcohol contributes to breast cancer via the only plausible mechanism proposed, by interacting with estrogen receptors, the risk would not correlate only to an uncommon subtype that also happened to be ER positive. So we still lack a plausible cause-effect explanation for the role of alcohol in breast cancer. One reason why these studies give such conflicting results is the reliance on self-reporting, which is wildly unreliable when it comes to the question of drinking habits. Another is that drinking habits tend to be erratic; few have only wine, only a glass or two a day, and always with dinner. Studies from populations that do have more traditional wine drinking patterns show a reduction in breast cancer risk. As these populations become more and more modernized, the opportunity to get meaningful data from population studies diminishes. So pink may be the theme color for breast cancer awareness, but I prefer to call it rosé.

Wine and breast cancer risk with BRCA mutation

2010-10-05T08:15:00.000-07:00

One of the more significant developments in the understanding of breast cancer risk factors was the discovery of two inheritable genetic mutations, BRCA1 and BRCA2, that dramatically increase the lifetime risk of breast cancer. These mutations are aberrant forms of a class of genes called “tumor suppressors” so when they don’t function normally, cancers are more likely to develop and spread. (Tests are available for these mutations and many women with BRCA are opting for prophylactic mastectomy and reconstruction.)

Since alcohol consumption is generally regarded as a risk factor for breast cancer, it is important to know how it might affect women with BRCA. Given all of the confusion about whether wine consumption increases or decreases risk, it becomes even more important to know what to recommend. Surely, the knowledge of a high risk of cancer and not being able to have a glass of wine with dinner seems like double punishment. Fortunately a recent study helps to provide some guidance.

The study, from a collaboration called the Hereditary Breast Cancer Clinical Study Group, analyzed matched pairs of breast cancer patients with and without each type of BRCA mutation, according to a range of lifestyle factors. It’s a powerful study because of the numbers of patients surveyed, nearly 2 thousand, and its broad reach from several countries, though most were from Canada and the U.S.

After statistical adjustments for other known factors, there was no increase in risk from moderate alcohol consumption. Some studies have actually found decreased odds of developing cancer among moderate drinkers with BRCA, but in this study the reduction was only seen in wine drinkers. The implication of this is that it is the wine that is responsible for lowering the risk seen in previous analyses where drinking could not be accurately subdivided by type of beverage. This meshes well with findings on breast cancer risk without the BRCA mutation.

Several compounds unique to red wine have impressive anti-cancer properties, specifically for breast cancer. Clinical trials using some of these compounds in conjunction with traditional therapy are underway. But if you or someone close to you has a strong family history of breast cancer, getting tested for the BRCA gene can save their life. The good news is that they can still share a glass of wine with you and not add to their worries.

Dennis J, Ghadirian P, Little J, Lubinski J, Gronwald J, Kim-Sing C, Foulkes W, Moller P, Lynch HT, Neuhausen SL, Domchek S, Armel S, Isaacs C, Tung N, Sweet K, Ainsworth P, Sun P, Krewski D, Narod S; the Hereditary Breast Cancer Clinical Study Group. Alcohol consumption and the risk of breast cancer among BRCA1 and BRCA2 mutation carriers. The Breast 2010;e-pub.

Well hello kitty: Are you really old enough to drink?

2010-09-25T12:18:00.001-07:00

If you are a fan of the Hello Kitty products (the smiling kitten face icon from Japan) then you will want to know that there is now a hello Kitty brand of pink sparkling wine. Produced by the Italian wine producer Tenimenti Castelrotto in partnership with luxury goods company Camomilla, Hello Kitty spumante is currently available only in the U.S., Russia, and Singapore. According to winemaker Patrizia Torti, “'Hello Kitty … is a recognised cult fashion icon among teenagers and adults around the world.” Is Hello Kitty really grown up enough to be in the wine business? What should the minimum drinking age be anyway?

We are dealing with some pretty sticky issues here. We are conflicted about marketing alcoholic beverages to young people (not that Hello Kitty is exclusively a young brand) and there are definitely mixed mesages on drinking. In the U.S. the debate has centered around whether the legal drinking age should be 18 or 21. here’s a brief summary of the arguments:

Against lower drinking age: Teens are undergoing a multitude of physical and mental changes, combined with peer pressure and other factors, which can lead to abusive drinking patterns. Studies show that teens who drink have a greater probability of binge drinking and academic failure.

In favor of a lower drinking age: At age 18, most of the priviledges of adulthood are conferred including voting and military service. Prohibiting teens from drinking in bars, restaurants, and public locations has the effect of forcing them to drink in unsupervised places such as fraternity houses or house parties. A higher legal drinking age actually encourages abuse by sending the message that drinking conveys maturity. A lower legal age makes it less taboo and creates a more favorable environment for teaching moderation and responsible consumption. It is this failure to model healthy drinking that fosters binge drinking.

Statistics are tossed back and forth about whether traffic accidents are increased or decreased by a lower drinking age, but my personal view is that the wheels started to come off the cart when we divorced wine with dinner. There is no healthier way to consume alcohol that to make wine a food, and if you have been paying attention at all here you know that it is an impressively healthy thing indeed. The age-old European practice of serving the young people watered down wine with family meals cannot be considered by any stretch of the imagination as a step toward alcohol abuse.

But Hello Kitty, you may be a special case. Are you sweet and silly or a real grown-up drink?

Better red than dead, wine drinkers outlive teetotalers

2010-09-13T14:54:00.000-07:00

Wine drinkers outlive nondrinkers, or so the studies show. But nondrinkers are not all created equal, and that along with other factors makes it difficult to draw firm inferences about healthy drinking. For example, an oft-cited problem is what is called the “sick quitter” hypothesis, which holds that among the nondrinkers are those with a history of problem drinking. Their health having already suffered, the comparison may be unfair by lumping them in with healthier folks who abstain for religious or other personal reasons. Moderate wine drinkers may differ socioeconomically or in other important demographic variables. Anti-alcohol advocates are quick to point out such problems with population studies.

So while there are several studies showing greater average lifespan in wine drinkers, more needs to be done. One good study out this summer may give comfort to wine drinkers and help dispel some of the critics. The project, a joint effort of Stanford University and the University of Texas, looked at all-cause mortality over a 20-year period, comparing various factors to death rates, beginning with a study cohort of individuals aged 55-65. As we have come to expect from such studies, death rate was twice as high in nondrinkers compared to moderate drinkers, and 70% higher in heavy drinkers. This is the classic J-shaped curve that defines just about any disease condition when plotted against wine consumption.

What’s different about this latest report is that the researchers went to great lengths to adjust for the effects of previous problem drinkers and socioeconomic factors. Taking all of this into account, the differences were less dramatic but still clear, with moderate drinkers still only about half as likely to die of any cause compared to teetotalers.

Ultimately the question of how drinking affects lifespan is too complicated to reduce to a simple mathematical formula anyway. Alcohol remains a part of whatever the formula is, just in the right amounts. Wine drinkers do a lot of other healthy things, and have a higher quality of life in old age too. Viva vino!

Holahan CJ, Schutte KK, Brennan PL, Holahan CK, Moos BS, Moos RH. Late-Life Alcohol Consumption and 20-Year Mortality. Alcohol Clin Exp Res. 2010 Aug 24.

What is responsible drinking?

2010-09-03T11:54:00.000-07:00

The paper today featured a full-page ad exhorting us to drink responsibly over the Labor Day weekend, good advice to be sure. The main point was an emphasis on the equivalency of different forms of drinking in terms of the total amount of alcohol: One 12-oz beer = one cocktail = one 5-oz glass of wine. Perhaps the thinking is that people lose track of the true amount they are consuming with lower-alcohol beverages. Just a couple of beers or a few glasses of wine, not like hitting the hard liquor, right? The tagline was “It’s not just what you drink, it’s how much.” Useful information I suppose but perhaps an oversimplification when it comes to wine, as we have seen so many times before.

My advice here would be to look at the question of not just how much you drink, but how you drink. Beer may be consumed with meals but is marketed as a “party” drink, or refreshment while watching TV or sporting events. Historically (and I mean a very long time ago) it was considered to be a sort of food, a way to get nutrition from grains in a relatively non-perishable form. But I would guess that today beer consumption with meals is only a fraction of the whole. With cocktails it is more clearly all about the drinking for many people (which may explain why this ad was sponsored by the distilled spirits council.)

But when it comes to wine, the pattern of how people consume it is different. While wine may be consumed without food, often it is part of the evening meal. Drinking with food both slows down the absorption of the alcohol and the pace of drinking. A great many other healthy behaviors are linked to wine consumption too, placing wine at the center of a healthy lifestyle. Simply comparing alcohol dosing to beer and distilled spirits misses this very important point about healthy drinking, by presuming that all forms of consumption are equally harmful. It frames wine as a drug instead of a food.

I would suggest that we replace the phrase “responsible drinking” with “healthy drinking” so that we frame the discussion in a more positive light. As long as we view alcohol through a lens that shows only the detrimental aspects of drinking, we paradoxically encourage the view of alcohol as a drug. But moderate drinkers outlive nondrinkers and are healthier, especially with wine. Responsible drinking is healthy drinking, and the “how” and “what” do make a difference.

http://www.standarddrinks.com/

Resveratrol: natural supplement or pharmaceutical breakthrough?

2010-08-23T08:57:00.000-07:00

Before we delve into this too deeply, keep in mind that the answer might be neither one. Resveratrol, the antioxidant polyphenol from red wine that I dubbed the “miracle molecule” in my book, has had an interesting career. It first came into the spotlight in the early 1990’s following the “French paradox” story on the CBS-TV show “60 Minutes” as a potential explanation for the effect. Research attention ramped up quickly, and there seemed to be no end to the list of beneficial properties on health and longevity. The real breakthrough was the discovery that resveratrol was an activator of an enzyme called sirtuin, responsible for a specific metabolic change associated with dramatically increased longevity. Overnight an obscure field of biochemistry research blossomed into a massive supplement industry.

But an interesting thing happened on the way to the marketplace. The scientist who is credited with the discovery of resveratrol’s sirtuin-activating abilities, Christoph Westphal, parlayed the finding into a biotech company that was quickly picked up by pharma giant Glaxo. A more potent resveratrol derivative, dubbed SRT501, is being developed as a prescription diabetes drug, but the ability or resveratrol to activate sirtuins has been widely questioned and may turn out to be less than impressive. Sirtuin activators unrelated to resveratrol are the focus of development at Glaxo now.

Much of this came to light recently with the revelation that Westphal and a Glaxo director of development were peddling resveratrol online through a nonprofit organization called the Healthy Lifespan Institute. Glaxo was none too pleased.

So where does that leave resveratrol? Despite wide acclaim and marketing hype, evidence is still fairly scant that it brings the same benefits in a pill that moderate wine drinkers enjoy. Specifically, the promise of meaningful lifespan extension through sirtuin activation has not been demonstrated in laboratory animals other than worms and fruitflies. There are questions about its bioavailability – the absorption and metabolism in the body – and purity of the various supplements. Despite the thousands of research papers on resveratrol, much remains to be learned about how it works in the human body. Stay tuned, but for now your best bet is to stick with wine.

Is wine-fed beef a healthier choice?

2010-08-11T13:24:00.000-07:00

Leave it to those crazy Canadians to come up with the idea of feeding wine to beef cattle. While so many stockyards are filled with cows standing knee-deep in their own droppings, bloated from a corn-based diet, these bovine bon vivants are sipping red wine and eating organic. According to Jandince Ravndahl of Sezmu Meats in British Columbia, “They moo at one another a little more and seem more relaxed. There are a few that lap it up out of the pail. After they've had it for a while, when they see us coming with the pitchers, they don't run, but they come faster than usual.” Do pre-marinated cows make healthier beef?

Apparently it is at least more tender and has a sweeter taste, though I have not had the opportunity to try it myself. I can however think of many reasons why it would be healthier. Pairing red wine with beef has a specific health advantage, in that the iron in the hemoglobin – this is what makes red meat red – is a potent oxidant neatly counteracted by red wine’s antioxidants. The fats from beef are also tempered in their cholesterol-promoting tendencies by wine polyphenols. Whether these wine benefits are enhanced by wine in the cows’ diet is a matter of speculation, but there’s more.

Again, this is just an idea, but wine polyphenols have natural antibiotic capabilities and so they alter the demographics of intestinal bacteria. With E. coli being such a concern this could translate into a real asset. Then there is the possibility that less stressed cows develop healthier meat, due to stress hormones or other factors.

There are potential environmental benefits too. One little-appreciated fact is that cattle are a major source of methane, a greenhouse gas, so there is a large carbon footprint from every steak and burger. Under normal circumstances, cows expel up to 50 gallons of gas a day, and one calculation puts an estimate of 17% of all greenhouse gas emissions from cattle ranching. But wine cows are believed to produce less methane (perhaps related to an alteration in their intestinal bacteria?).

I don’t know if ranch hands are about to morph into sommeliers, but if this catches on I propose that we update “caballero” to “cabernero.” What do you think?

Why the proposed ban on direct wine shipping would be harmful to public health

2010-08-04T14:02:00.000-07:00

A number of convoluted laws came into place following prohibition, many of which are based on the same faulty reasoning that led to curbs on alcohol sales in the first place. Although wine remained somewhat available during prohibition (people took a lot of sacramental wine it seems), a ban on direct shipping to consumers remained for a number of years. These regulations varied from state to state, with many states allowing wineries to ship directly to their customers within the state, but gradually a system of reciprocity between states with such allowances developed and was confirmed in a 2005 Supreme Court ruling. An echo of prohibition rang out this year however with the proposal in Congress (H.R. 5034) to ban such sales.

Unsurprisingly, the bill was put forth by wholesalers, who would stand to lose by being bypassed. But rather than draw attention to the real reasons behind the proposal, the lobbying campaign in support of it trots out the same tired public health arguments that harken back to a bygone era. Children and minors will have easier access to alcohol, they say, and direct shipping encourages alcohol abuse. As if minors are going to order boutique wines from small producers, and wait a couple of weeks for it, all the while hoping it will be delivered while their parents aren’t home, and that the shipper won’t demand a signature from someone over 21 as clearly stated on the large heavy box also labeled “contains alcoholic beverages.” If you really believe that, I have to ask what you have been smoking.

So are there public health consequences to direct shipping? If there are, I would place them squarely on the benefit side. People who buy wine direct tend to be interested in the wine for its aesthetic attributes more than its anesthetic properties. There are cheaper and more convenient ways to imbibe. Drinking wine because you enjoy the particular qualities of the wine means that it becomes more like a food, part of a meal, a component of a healthy lifestyle.

More information and resources on this issue at http://freethegrapes.org/

Wine is a food: New USDA Guidelines

2010-07-21T13:27:00.000-07:00

There is a chapter in my book “Age Gets Better with Wine” called “Wine is a Food” because what I found in my research for the book that having wine with meals is key to unlocking its healthful properties. There is no question that people use food as a drug, hence the term “comfort food.” I would even make the case that. Given the epidemic of morbid obesity, the effects of food abuse far outweigh those of alcohol abuse. So if wine is indeed a food, what is the recommended daily allowance?

Though authorities have long shied away from explicitly recommending that people drink wine for better health, the U.S. Department of Agriculture recently updated its policy recommendations to reflect the ever-increasing evidence of wine’s health benefits. Notably, mentions of the benefits of moderate drinking have begun to replace the admonishments about the ill effects of alcohol abuse. These two drinking patterns are distinct and separate, though it seems to have taken some time to reach the point where a discussion of this type occurs with federal agencies. Much remains to be done, but baby steps toward recognition of the epidemiologic evidence that moderate drinkers outlive nondrinkers on average are certainly more than welcome.

Wine drinkers not only live longer but are healthier too. A study sponsored by Medicare a few years ago clearly demonstrated that drinkers have lower health care costs, with wine drinkers in the lowest health care expenditure category. Dr. Curtis Ellison, a foremost authority on wine and health, has stated that the single most effective thing a person can do to reduce their odds of heart disease other than not smoking is to take up having a drink or two with dinner. When considering how hard it is to get people to eat a healthy diet, exercise, and take their blood pressure medication, that’s a pretty powerful and simple recommendation.

So if wine is a food, then what is the recommended daily allowance? It may be a good thing to have as part of a meal but I wouldn’t hold your breath waiting for an RDA recommendation on the label. Wine’s nutritional value isn’t based on the traditional data that other foods are, but I would wager that wine does a lot more good than the vitamin and supplement pills that so many people take. Drink real wine, eat whole food. What could be better than that?
The USDA guidelines are available at: http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm.

The weight is over: new hope for the wine diet

2010-07-15T15:44:00.000-07:00

I write this post with a bit of trepidation, because anytime we get in to the topic of wine and weight loss the inevitable controversy about resveratrol diet pills comes up. In fact it is the most recent findings about resveratrol and diet that prompted me to write this, and like so many previous reports it seems to have been widely over-interpreted. Supplement manufacturers are all over it despite the fact that like nearly every previous study, it wasn’t done on humans.

The study in question was however done on lemurs, a type of primate, so in theory they are closer to humans than lab mice or fruit flies. There is however an important difference, in that these lemurs have a variable body temperature regulation system such that their metabolism varies with the time of year. In winter they gain weight, which provided researchers with a convenient model to study the effects of resveratrol. What was found with resveratrol supplementation was increased satiety (i.e. less hunger and eating), with faster metabolism and less weight gain during their “seasonal fattening period.”* Given the pattern that many of us humans experience during the winter holidays this sounds like good news indeed.

But alas we are not lemurs, and honestly we have little to blame our seasonal weight gain on other than a change in behavior. It may be of some comfort however to bear in mind that resveratrol is a red wine polyphenol, and evidence that wine drinkers maintain a health weight as compared to nondrinkers is reasonably substantial. Clinical trials on the use of oral resveratrol supplements on the other hand can practically be counted on, well, the other hand. Encouraging though this recent study is to resveratrol supplement peddlers, it is by no means clear that the same effect will be observed in humans. As for me, I will continue to take my “medicine” in red liquid form, as I believe nature intended. Call it the wine diet if you like.

*Dal-Pan A, Blanc S, Aujard F. Resveratrol suppresses body mass gain in a seasonal non-human primate model of obesity. BMC Physiol. 2010 Jun 22;10(1):11. [Epub ahead of print]

Eye believe: resveratrol may prevent blindness

2010-07-06T11:37:00.000-07:00

Here’s a word that you should know: angiogenesis. Sounds like a cover of a classic Rolling Stones song by Phil Collins’ former band, but what it refers to is the growth of new blood vessels. Sometimes this is a good thing, sometimes not. In the case of some causes of blindness, abnormal angiogenesis is a very bad thing indeed.

Resveratrol, the superstar molecule from red wine, has long been known to inhibit angiogenesis. This may be one of the reasons why it fights cancer, since tumors rely on ingrowth of new blood vessels in order to expand. Abnormal angiogenesis is also involved in some causes of age-related blindness such as diabetic retinopathy and macular degeneration, conditions affecting thousands each year. A recent study suggests that resveratrol’s ability to inhibit angiogenesis might help to save eyesight for many.

Like many such studies, this one was done in mice. These poor subjects had laser treatments to destroy some of the blood vessels in their retinas. Normally, the body would respond by sending signals to stimulate angiogenesis in order to restore the blood flow to the injured eyes, but resveratrol was noted to interfere with this process through specific molecular interactions that the research team was able to decipher. The implication was that protection against disorders related to abnormal angiogenesis might be achieved with resveratrol, though it is important to note that there is a lot to prove in order to apply it in humans.

One case study reported last year did provide some encouragement that oral supplementation with resveratrol might be able to help eyesight. The subject was an 80 year old man with progressively worsening night blindness, despite taking extra lutein and omega-3 fatty acids. This was correlated with deposits of a material called lipofuscin, a substance correlated with age-related loss of vision, in the retina. After 5 months of taking oral supplements containing resveratrol and other wine polyphenols, the subject’s vision improved by objective measurements and the lipofuscin deposits correspondingly decreased. While a case report lacks the heft of an actual clinical trial, it does suggest a potentially fruitful avenue of further research.

There are several other reports demonstrating the protective effects of resveratrol and wine polyphenols against oxidative damage and chemical toxicity of retinal cells, and even some benefits on inhibiting cataract formation. Wine appears to be unique among alcoholic beverage consumption in protecting against cataracts, which implies a role for the polyphenol antioxidants. I’ll keep an eye on the topic for you.

Khan AA, Dace DS, Ryazanov AG, Kelly J, Apte RS. Resveratrol Regulates Pathologic Angiogenesis by a Eukaryotic Elongation Factor-2 Kinase-Regulated Pathway. Am J Pathol. 2010 May 14. [Epub ahead of print]

Richer S, Stiles W, Thomas C. Molecular medicine in ophthalmic care. Optometry. 2009 Dec;80(12):695-701.

Drink to your health: The wine-medical research connection

2010-06-28T08:28:00.000-07:00

As I discovered in researching my book Age Gets Better with Wine, from ancient times it has been wed to health care and healthy living. In modern times, wine has come to support medical research more directly, through charity auctions and direct funding. Credit the granddaddy of them all, the Hospices de Beaune, for showing the way. But some wineries are taking it a step further.

A few years ago I had the singular pleasure of attending the Staglin festival, which raises money for mental health research. What a glorious experience! All the top wineries in Napa participate, and although we had more wine that day than was strictly necessary for medical purposes, it was definitely a boon to my state of mind. Congrats to the Staglin family for raising awareness of an issue that many find uncomfortable and which suffers from a lack of research funding as a result. (The event is held every September, info on the Staglin website.)

Ehlers Estate is another winery that ties its profits directly to medical research, in this case heart health. Held in trust by the nonprofit Leducq Foundation, 100% of its proceeds go directly to fund research in cardiovascular diseases. Despite tremendous advances in treatment and prevention of heart disease (and an increasingly detailed understanding of the positive role of wine), it remains a leading cause of death worldwide.

“Live to Love Life” is the motto of the winery with my favorite name, Cleavage Creek. (Talk about the perfect wine for a plastic surgeon!) Profits from Cleavage Creek go to support breast cancer research, “one glass at a time.” Owner Budge Brown, who lost his wife Arlene to breast cancer in 1995, has made it his personal mission to do whatever he can to find a cure. Though I am sure that it was not what he expected when he started Cleavage Creek, it may very well turn out that wine holds one of the keys to winning that battle. We still have a long way to go, and ongoing funding remains crucial.

So drink to the health of your loved ones, celebrate life, and toast to those who are leading the way - preferably with a glass of Staglin, Cleavage Creek, or Ehlers Estate.

Wine and colon health: More than a gut feeling

2010-06-19T12:16:00.001-07:00

The status of your intestinal tract may not be the sexiest of topics, but for those with problems such as inflammatory bowel disease it is of overriding importance. Whether or not you have a life-changing inflammatory disease, colon health deserves to be taken seriously - at least seriously enough to consider how wine and resveratrol fit in. It’s more good news, as you will have come to expect.

Inflammatory bowel disease is a chronic, relapsing, tissue-destructive disorder for which there is no definitive cure. Patients typically undergo multiple surgeries and are on medication most of the time. It is also a difficult thing to study, but there is a model in mice in which the condition can be created by giving them a toxic compound called DSS. Various treatments can then be tested and markers of inflammation measured.

A series of recent reports indicate that resveratrol and other wine polyphenols (again resveratrol shouldn’t get all the credit) can be quite helpful. Using resveratrol in doses attainable through dietary means, mice with DSS-induced colitis in one study were able to reverse the loss in body weight and decrease several markers of inflammation. Evidence from this and other studies indicates that the wine-derived molecules act at a genetic level, fundamentally altering the inflammatory process. The implications for humans with inflammatory bowel disease are significant, but remain to be tested and proved. But based on what is known about wine and how it alters inflammation in other diseases, this is very encouraging news indeed.

I couldn’t help but notice another theme in these studies that seems to characterize much of the research in this field. The reports I reference here are from South Korea, Italy, and the U.S., highlighting the international nature of wine research. Who knows, it may be wine science that helps build connections between people around the world, much as wine brings friends and family together around the table. Cheers to that.

Exercise your red wine habit for healthy aging

2010-06-09T14:26:00.000-07:00

It seems there is no end to the list of benefits to red wine. One of the more interesting facets being explored is the question of how red wine compounds might work synergistically with other anti-aging behaviors to amplify the effect. We all know, for instance, that regular exercise is an important part of slowing down the aging process, but who would think of having a tipple before hitting the weight room? It’s not such a far-fetched idea according to some recent studies.

Exercise, like most things that are good for us, must also be taken in moderation; too much and the overstressed muscles start releasing lactic acid and other deleterious compounds. With age the problem becomes worse, resulting in more oxidative stress which counteracts the benefits of working out in the first place! A study comparing oxidative stress in young vs old mice given resveratrol showed how this wine extract helps protect against these changes. Using several serum markers for oxidative stress, a group from the Division of Exercise Physiology at West Virginia University School of Medicine found that resveratrol given orally for one week dramatically reduced these signs of muscle stress after exercising the mice by electrically stimulating certain muscles to standardize the amount of exercise. The effect was more dramatic in the aged mice but held for the youngsters as well.

Another research group from Japan looked at mice bred for accelerated aging (“senescence-accelerated prone”). In this case, they were looking at slowing age-related decline in physical endurance. Even with exercise, their exercise capacity slowed over the 12 weeks of the test, but with resveratrol supplementation it remained significantly higher. The researchers pinned the effect to improved oxygen metabolism in a muscle cell component called the mitochondrium. (Mitochondria are in all cells and believed to be important in red wine’s myriad anti-aging properties.)

Resveratrol isn’t the whole story though. Another wine polyphenol, quercetin, has been tested in humans for effects on exercise. On recent study a double-blind, placebo-controlled, crossover examination of maximal exercise tolerance, noted improvements in the quercetin group after only one week of supplementation. This affirms earlier studies. No doubt there are other compounds in wine and elsewhere that contribute to the benefits of exercise and diet, so for now the best advice is to hedge your bets and have a glass of wine, maybe after each workout.

The Prohibition Hangover: What a Headache!

2010-05-31T09:32:00.000-07:00

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.

Study Challenges Health Benefits of Alcohol: A Rebuttal

2010-05-19T10:49:00.000-07:00

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.

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

2010-05-13T13:18:00.000-07:00

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.”

Time to reverse course with resveratrol?

2010-05-05T13:03:00.000-07:00

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.

Does the type of wine matter?

2010-04-07T15:19:00.000-07:00

Questions that seem to come up frequently when I am lecturing about wines include “Does it have to be red in order to get the health benefits?” and “Which types of wine have the highest amount of the healthful polyphenols?” To answer the first, red wines do have much higher levels of resveratrol and other beneficial compounds for several reasons. Since these compounds come from the skins and seeds, the whole grape (berry) must be fermented together in order for optimal extraction. White wines are made by pressing out the juice and then fermenting it without contact of the skins and seeds. So yes, it has to be red for the full dose, and it has to be wine not grape juice.

The second question is a bit trickier. There are natural variations among the different varietals of grapes that wine is made from, but the terroir (local conditions) and methods of viticulture probably have more to do with it. To understand why this is the case, consider why grapes make resveratrol and other polyphenols in the skins in the first place: it is for protection against environmental stress. That is of course the reason why they are such potent antioxidants and anti-microbial agents.

One grape that seems to struggle mightily is pinot noir, so pinots are known to have high levels. One Oregon producer of pinot noir wines has petitioned for permission to state resveratrol content in the wines, which the government has resisted because people might start thinking that wine is actually a healthy beverage (it is.) But other reds have healthy polyphenol content too, and there are several studies now comparing the amount of resveratrol in similar wines from different parts of the world and with different traditions of winemaking.

In the end it may not be all that important, since the evidence that resveratrol explains all of the benefits of wine is pretty scant; for one thing, even wines with high resveratrol levels still don’t have much compared to the amounts used in laboratory studies. Other studies point to the combination of all of the compounds in wine working together as the key, including alcohol. So the answer is drink whatever kind of red wine you enjoy, and if you don’t like red maybe you should continue looking for one that you can at least suffer through.

More good news about chocolate and wine

2010-04-01T08:38:00.000-07:00

Just in time for your Easter egg hunt, more news that chocolate is good for you. A report out just this week from the German Institute of Human Nutrition in Potsdam confirmed that people consuming chocolate on a regular basis had lower rates of heart attack and stroke. The study was impressive in scope, monitoring nearly twenty thousand subjects over a ten-year period, after a dietary assessment at the beginning. It was part of a large project called the European Investigation into Cancer and Nutrition. Those in the top chocolate consumption group had 40% fewer heart attacks and strokes over the course of the study as compared to the low chocolate consumers. A reduction in blood pressure was identified as the reason.

It has been known for some time that compounds called polyphenols, found in both chocolate and wine, are able to relax blood vessels and thereby lower blood pressure. A study from the Institute of Food Safety in the Netherlands (why are the Europeans having all the fun with wine and chocolate studies?) identified exactly how this occurs. A molecule called Nitric Oxide, or NO, is the chemical signal for blood vessels to relax, and certain compounds from wine and chocolate have the specific ability to stimulate NO release. Among these are resveratrol (from wine) and compounds in a family of molecules called catechins, from both wine and chocolate.

These molecules are in much higher quantities in dark chocolate and red wine, so the chocolate eggs in your Easter basket might not be the best way to get the health benefits. Go for something dark and leave the milk chocolate goodies for the kids. And my recommendation for the wine with your ham (a problem match because of the saltiness) is Grenache.

Wine boosts the body’s antioxidant system

2010-03-26T09:16:00.000-07:00

It’s hardly news that wine contains powerful antioxidants, just like other superfoods including blueberries, acai, and pomegranates. What isn’t so obvious though is how these compounds are absorbed into the body and whether or not they actually do any good. This problem of how food-derived nutrients, along with drugs and supplements, are taken up and delivered to “target” tissues throughout the body is called “bioavailability.” There are numerous compounds that perform miracles in a test tube but just aren’t absorbed very well from the digestive tract when taken orally. Resveratrol is a classic example of this; with more than 3,000 research articles published, it’s considered a fountain of youth in a pill (or a glass of wine) by many, but it turns out to have poor bioavailability. There must be something else in wine that explains its long list of health benefits.

Researchers at 2 universities in Spain provided some insight into the role of wine as an antioxidant in a recent study. They used eight volunteers who consumed a standardized diet low in antioxidants, and compared the antioxidant capacity of their blood plasma with and without the addition of red wine to the diet. Samples were taken at days 2 and 7 of the regimen, during the week with wine and without. A significant increase in antioxidant capacity was observed with wine in the diet, as one would hope. (A similar study was done in Chile several years ago, with similar findings and also noting that wine was better than vegetables high in antioxidant vitamins.) This proves that something in the wine is being absorbed and circulated through the body, and having a positive effect. It is probably not resveratrol though, as previous studies of this type have shown that it does not achieve significant levels in the blood after oral ingestion.

Interestingly, dark chocolate is another superfood that has measurable effects when eaten. In this case, it causes the blood vessels to relax and lowers the blood pressure. The cocoa-derived compounds responsible are much the same as antioxidant molecules found in red wine, known as flavonoids. What is important here is to distinguish between studies that actually test what happens in a clinical experiment from what occurs in a laboratory test. Too many supplements are rushed to market based on an incomplete understanding of how they actually work in the human body. It seems we always come back to the point where drinking wine and eating the right foods works better than popping pills. Who would have thought?

Wine may help breast cancer patients receiving radiation

2010-03-18T13:13:00.000-07:00

Despite advances in screening and early diagnosis of breast cancer, little has changed in how it is treated over the past ten or twenty years. For most women, it comes down to a choice of mastectomy or removal of the tumor (lumpectomy) and radiation. If it has spread, then chemotherapy is recommended. The good news for women choosing mastectomy is that breast reconstruction techniques have improved substantially, but for patients opting for “breast conserving therapy” an ordeal of several weeks of radiation treatment is still standard treatment. And despite the fact that the breast is conserved, the radiation causes irreversible changes and even some disfigurement on top of the dent left after the lumpectomy. But now there is some evidence that wine may help prevent some of these changes, despite lingering controversy about the role of alcohol in breast cancer risk.

The data comes from a study from the Catholic University in Campobasso, Italy, a center where wine and health research has been particularly fruitful in recent years. The researchers assessed skin toxicity (redness, irritation) from radiation in each of 3 groups of women receiving different treatment doses. Overall, women who drank wine had a lower incidence of skin toxicity compared to nondrinkers (22% vs. 38%), and the amount of daily drinking had an influence as well. Women who drank a half a glass or less had a 32% incidence, while only14% of those consuming a glass a day experience significant skin irritation. However, the percentage increased as drinking increased above a glass a day, with 2 glasses about as high as none. Those who are familiar with my book Age Gets Better with Wine will recognize this as a J-shaped curve, where moderate drinkers enjoy benefits not associated with abstinence or heavy drinking.

Earlier reports on various types of cancer have revealed that polyphenol molecules in wine, including but not limited to resveratrol, have the effect of protecting cells from the toxic effects of radiation while simultaneously sensitizing cancer cell to it. That would provide an explanation to the findings of this clinical study. What isn’t known, and cannot be directly inferred from this type of study is whether supplements of wine-derived compounds will have the same effect. Clinical trials should provide the answers within the next few years.

Is red wine the new women's diet drink?

2010-03-09T16:04:00.001-08:00

Why is it that we act so surprised when each new study showing that wine is a healthy drink comes out? This week it was a very large study from Brigham and Women’s Hospital in Boston, showing that women who drink red wine are less likely to gain weight. To be fair, although there are several studies already pointing in that direction, this one adds heft to the data because of its size (nearly 20,000 women) and length of follow-up (nearly 13 years.) But if you have read my book or have been following my posts here, your response is more likely to be “well, duh.”

Here are the particulars: The study, published in the Archives of Internal Medicine, identified a population of middle-aged women of normal weight and recorded their lifestyle habits as a baseline. Over the period of follow-up, some 42% became overweight and 4% obese, as determined by Body Mass Index. After statistically adjusting for factors such as exercise habits, smoking, and non-alcohol caloric intake, they found that moderate drinkers were much less likely to gain weight as compared to nondrinkers. The pattern was most dramatic for women who drank red wine.

We do know of course that people who drink red wine regularly and in moderation have other healthy habits, but a significant aspect of this study is that those factors were neutralized. There is clearly something more to the red wine connection than just being a marker for a better diet or regular exercise. This study doesn’t tell us what that might be, but we have some ideas, don’t we?

Is resveratrol the new aspirin for heart attacks?

2010-03-08T07:42:00.001-08:00

The newswires are abuzz this month about a recent report suggesting that resveratrol, the polyphenol molecule from red wine, helps restore blood flow and limit muscle damage after heart attack. The typical headline reads something like “Red wine component pill successful during heart attacks” or something similar, with the clear implication that some sort of clinical trial has been done. In fact, it was a study in mice, and while the results were impressive it is only one small step toward the giant leap of clinical practice. What happens in mice doesn’t always happen in humans, so we are no where near the point where your cardiologist is going to give you a resveratrol pill when you show up in the E.R. with chest pain.

Nevertheless, the results are encouraging. What happens in a heart attack is that the plaques that build up in the coronary arteries that feed the heart muscle cause a clot to form, completely obstructing the vessel and depriving the heart of oxygen. It’s similar to what happens to the brain in a stroke. This oxygen starvation is called “ischemia” and when the clot is dissolved and blood flow re-established, it is called “reperfusion.” Paradoxically, this rush of blood flow releases toxins that have built up in the cells, resulting in what is called “ischemia-reperfusion injury.” Transplant surgeons deal with a related issue. The ability of resveratrol to counteract the detrimental effects of ischemia-reperfusion has been well documented in numerous studies, and the recent one in mice confirms those findings. But a mouse heart is tiny, and the question of whether the same effect applies in the large muscle mass of the human heart remains speculative.

A likely scenario is that one of the synthetic derivatives of resveratrol, many of which are much more potent, will emerge as a viable therapy for heart attack and stroke. But clinical studies on resveratrol are few in number, as I have pointed out here recently.

The politics of drinking: is there room for moderation?

2010-03-04T08:41:00.000-08:00

Much political hay has been made after President Obama’s recent physical exam, with the doctor’s recommendation of “moderation of alcohol intake.” The polarized lens through which American political debate is viewed sees this as an indictment of the president’s drinking habits, as though any level of alcohol consumption sets a bad example, and there is no middle ground between alcohol abuse and abstinence. But as we know, at least in the case of wine, the healthiest place to be is moderate drinking (see “modern view of moderation” posted February 15.) Abstinence and excess share the same risk profile for heart disease and many other conditions; it’s the moderates who are the clear winners here, but I will leave it up to you to interpret the political parallels.
The president’s cholesterol has been creeping up too, and dietary changes were recommended. Here’s where the opportunity for what is called these days a “teachable moment” was missed. Moderate drinking, especially wine with meals, is one of the more effective means of improving cholesterol profiles. In fact, in the words of Dr. R. Curtis Ellison, Professor of Medicine and Public Health at Boston University School of Medicine, “…only stopping smoking would have a larger beneficial effect on heart disease than for a non-drinker to begin having a drink or two each day.” But our government has a long and proud tradition of suppressing information about healthful drinking, as I describe in my book.
See the full report on the president’s exam here: http://www.whitehouse.gov/the-press-office/release-presidents-medical-exam.

Is wine a health food?

2010-02-27T12:46:00.000-08:00

I often joke that wine is a health food, but it actually is when looked at objectively. Of course in order to be a health food, it must be a food, which would in turn require that there be some nutritional value. The calories in dry wines are from alcohol, which is processed by the body in a different way than other carbohydrates, such that it tends not to cause a spike in blood sugar levels. So right away it has benefits over other calorie sources, since these blood sugar variations are believed to contribute to weight gain. Wine drinkers tend to have less of an issue with being overweight, so perhaps this is one of the reasons.

We all know, or have been told often enough to believe, that alcohol is detrimental and that such adverse effects more than counteract any potential benefits. But interestingly, our bodies come equipped with an enzyme called alcohol dehydrogenase, which does nothing but metabolize alcohol. The ability to consume alcohol is programmed in our DNA, so if we aren’t meant to then it is quite a mystery.

So what of the other elements in wine? One thing that recurs in research on wine’s health benefits is the importance of consuming it with meals. There are several explanations for this, such as the fact that the antioxidants in red wine blunt the effects of oxidizers in food, especially such offenders as red meat. Wine actually makes the other foods in the meal healthier. Another reason is that wine with food slows the absorption of alcohol, thereby reinforcing the whole concept of wine as food rather than alcohol consumption as a drug. People who drink in this way have a range of other healthy habits that all mutually reinforce their respective benefits. For this reason, the healthy Mediterranean diet, so prominently featuring daily wine consumption, is best viewed as a lifestyle, a way of living, rather than a menu of prescribed foods.

One could almost make a case for red wine as a vitamin.

Should your doctor prescribe wine? Answer to NY Times piece

2010-02-18T14:55:00.000-08:00

The New York Times online has a Q&A feature which today addressed the question of "prescribing" wine. Dr. Mark Willenbring of the National Institute on Alcohol Abuse and Alcoholism addresses the question. (His answer and my comments here: http://consults.blogs.nytimes.com/2010/02/18/is-a-drink-a-day-good-for-you-is-grape-juice-as-good-as-wine/?scp=2&sq=alcohol&st=cse) The good doctor does allow that it might be helpful in very limited amounts for some people, but dismisses the data as "correlational." In other words, finding a correlation between moderate drinking and health is insufficient to draw conclusions. I agree, but there is so much more than correlational data to draw on. In my book Age Gets Better with Wine I use what I call the skeptic's checklist for that very reason; we need plausible cause-and-effect explanations and evidence to support those explanations. I will leave you to read about it in the book, which is extensively referenced with peer-reviewed scientific and medical literature. Wine is not only safe in moderation for those without susceptibility for alcohol abuse, it is a powerful health food.

A modern view of moderation

2010-02-15T16:33:00.000-08:00

We hear so much about wine being healthy in moderation. Then there is the popular (and cynical) saying, “all things in moderation, including moderation.” If you are drinking wine for your health, and who doesn’t, it is actually quite important to define the term “moderation” if we are to get the maximum benefit. If you drink for purely aesthetic reasons, or anesthetic reasons for that matter, then you have other considerations to deal with. But here’s the deal on moderation:
Studies on wine drinking and health in populations often use weekly alcohol consumption as a convenient measure. From data like that we get the familiar J-shaped curve, showing that maximum health benefits are associated with about 2-3 glasses of wine a day for men and half that for women, and disease risk about equal to that of nondrinkers at about double that level of consumption (the bottom loop of the “J”.) But we also know that binge drinking is particularly bad, so the pattern of daily drinking is critical. You can’t do all your drinking on the weekend and expect any health benefit, despite the inconveniences that can occur during a busy workweek.
Integrating your wine consumption with meals seems to be important as well. This slows the absorption of alcohol, but also provides antioxidant capacity to counteract many of the harmful compounds that are found in the modern diet. There have been some interesting clinical studies on this point and it seems to have scientific validity. Perhaps just as important is that drinking with meals sets an example of wine as food rather than alcohol as a drug, reinforcing the concept of healthy drinking.
So how big are these glasses of wine? I know what you are thinking, if I have to limit myself to only 2 glasses, I’ll just get bigger glasses. But for purposes of research, a drink has to be defined so for wine it is a 5-oz. pour. Unfortunately, that makes a standard 750 ml bottle a bit much for a man and a woman to split. On the other hand, the half-bottles (375) don’t really fill the bill either; any winemakers out there want to do a 500 ml bottle?

Wine and Chocolate: a not-so-silly Valentine

2010-02-08T08:30:00.000-08:00

Silly me, I thought I could write up a simple blog post about the health effects of wine and chocolate, just in time for Valentine’s Day. So I go online to search the recent medical literature on the health effects on cocoa, and find that there are now more than 2000 articles on the subject. Needless to say, my comments here are based on a selected list. (You should know by now that wine and chocolate contain many of the same antioxidant molecules that have proven to be so beneficial, and that it has to be in the form of dark chocolate. There are a lot of studies now on how cocoa polyphenols lower blood pressure and help keep arteries clean, and the latest ones provide confirmation of the earlier reports.)

One article out just last month caught my eye. It turns out that simply smelling dark chocolate can provide a sense of satisfaction. The researchers proved this by comparing blood levels of insulin and the satiety hormone ghrelin in volunteers who either ate or just smelled dark chocolate, and both had a similar response. It reminds me of how enticing the “bouquet” of a great wine can be; sometimes I just want to enjoy that for a while before drinking it. Of course we already knew that wine and chocolate make for a sensory experience but it’s good to know that science is on the job here.

We also know that chocolate helps put one in the mood, so to speak, but now we have confirmation from a different study that cocoa not only makes us smarter but improves mood in scientifically verifiable ways. Using standardized assessments and cognitive performance testing, researchers documented significant improvements following ingestion of dark chocolate, along with measures of mood. Similar results have been found for red wine polyphenols, so it makes sense.

This last item is a bit more obscure, but I had to include it because I love the terminology used to describe the category of things like chocolate: “hedonic foods.” I’m not sure having a glass of wine or a piece of chocolate fully qualifies as hedonism, but they definitely give pleasure so we’ll accept the term. Researchers from the Department of Neurobiology at the University of Chicago observed that animals experiencing pain react often by eating rather than avoidance, a phenomenon called “ingestion analgesia.” Through a series of experiments on rats they were able to show that the behavior is controlled at the level of the brain stem, meaning that it is a primitive reflex not subject to motivation, and powerful enough to overcome strong incentives to not eat. Major implications for obesity and eating disorders here.

All I know is that wine and chocolate are health foods of the first order, regardless of whatever part of my brain is telling me so, and I am not about to try and get by with a sniff instead of a sip.

No Sir thing with wine-derived drugs

2010-02-01T08:53:00.000-08:00

Pharmaceutical giant Glaxo made headlines two years ago with their purchase of biomedical startup Sirtris for $720 million, following reports that Sirtris was making progress with resveratrol-based compounds that might extend lifespan. But doubts are now being cast on the question of whether wine-derived molecules even work for anti-aging the way that scientists at Sirtris believe. It’s an important story for consumers as well as investors, given that use of resveratrol supplements continues to rise. (Consumer Lab reports that resveratrol use by consumers surged some 66% last year.)

If you have been following the wine and health story, you know why resveratrol is such an exciting compound. It has impressive anti-cancer properties (in lab studies), fights heart disease (again, not clinically proven), diabetes (if you happen to be a lab rat), and the list goes on. What is really interesting is that it appears to activate enzymes called sirtuins (the corresponding genes are called Sir1-7), which trigger a metabolic change that prolongs the lifespan of laboratory organisms such as yeast and fruitflies. If the effect could be replicated in humans, we could perhaps expect to live well into our 150’s.

The problem is, it might not work that way, either in humans or primitive organisms. Concerns about an artifact of the testing method that leads to false-positive results have been expressed by skeptics such as Matt Kaeberlein here in Seattle (at the University of Washington), and now studies from Glaxo’s rivals cast further doubts. Amgen published a report this past fall provocatively titled “Resveratrol is not a direct activator of SIRT1 activity.” Pfizer has weighed in with a similar sentiment. So given the lack of clinical data supporting the use of resveratrol supplements, it is fair to say that a lot of work remains to be done.

It’s pretty complicated stuff, but there are some simple truths in which we can take comfort. One is that wine drinkers outlive teetotalers, enjoy better health, and have a higher quality of life according to published studies. The sentiment was aptly expressed in one of the iconic wine & health studies published in 1979. In considering the possibility that wine’s benefits might be attributable to some as-yet unidentified compound, the authors observed that “The medicine is already in a highly palatable form.” (St. Leger, Cochrane, and Moore)

American Heart Association drops the bottle on lifestyle recommendations

2010-01-26T08:50:00.000-08:00

In a drastic lurch back to Victorian era temperance, the American Heart Association came out this month with lifestyle recommendations intended to promote “ideal cardiovascular health.” Their list of “Life’s Simple Seven” includes:
• Never smoked or quit more than one year ago;
• Body mass index less than 25 kg/m2 (I.e., not overweight)
• Physical activity of at least 150 minutes (moderate intensity) or 75 minutes (vigorous intensity) each week;
• Four to five of the key components of a healthy diet consistent with current American Heart Association guideline recommendations;
• Total cholesterol of less than 200;
• Blood pressure below 120/80;
• Fasting blood glucose less than 100.

Not much to quibble with there it would seem, but as always the devil is in the details. Let’s look more closely at the “healthy diet” components:

• Vegetables and fruits are high in vitamins, minerals and fiber — and they’re low in calories. Eating a variety of fruits and vegetables may help you control your weight and your blood pressure.
• Unrefined whole-grain foods contain fiber that can help lower your blood cholesterol and help you feel full, which may help you manage your weight.
• Eat fish at least twice a week. Recent research shows that eating oily fish containing omega-3 fatty acids (for example, salmon, trout, and herring).

So far, so good, we have heard all that before. But as we approach the twentieth anniversary of the French Paradox, where does the AHA stand on wine?

• If you drink alcohol, drink in moderation. That means one drink per day if you’re a woman and two drinks per day if you’re a man.

That’s it? With the thousands of research paper attesting to the cardiovascular benefits of red wine consumption, nary a mention other than be careful not to drink too much? It’s not like there is a lack of data upon which to base a recommendation. According to the widely recognized expert Dr. R. Curtis Ellison, 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.” This recommendation is supported by the prestigious Framingham study, the bedrock of research on the lifestyle factors in cardiovascular disease. But the Framingham scientists have been studiously neglecting the data about drinking and health since the 1970’s when the role of alcohol was first evaluated. One of the scientists involved in the study, Dr. Carl Seltzer, revealed later that the senior staff at the National Institutes of Health demanded that the data be altered to remove any suggestion of a beneficial effect from alcohol, citing concerns that it would be “socially undesirable.” To this day the official Framingham website omits any reference to the alcohol studies. This is what they call science?

The thing is, most of know better and so the “updated” recommendations from the AHA lose credibility. It reinforces perceptions of the medical establishment as paternalistic. Time to start treating us like adults.

For more including detailed references check out my book Age Gets better with Wine.

Wine and the Happiness Connection

2010-01-18T08:12:00.000-08:00

One of the more interesting things I came across when I was researching the factors influencing longevity for Age Gets Better with Wine was the fact that happy, connected people live longer. It makes sense intuitively of course, but what makes it particularly encouraging is that nurturing our connections to community and friends, something we can simply decide to do, has a large influence on lifespan. Throw in a little wine, some exercise, and healthy eating and you’ve got it made.

It turns out that connectedness is linked to happiness too. In their book Connected: The Surprising Power of Social Networks and How They Shape Our Lives, researchers Nicholas Christakis and James Fowler reveal that networks wield more control over our lives than we realize. Through our social networks, even beyond our circles of friends, we tend to be either overweight, happy, sad, successful or not in measurable ways. Knowing happy people increases the odds of you being happy by 9%, while having unhappy people around lowers it by 7%. Being geographically close helps too, upping the odds of contagious happiness by as much as 25% if they live within a mile or so. What is interesting is that the people you don’t know, but those with whom you associate do, also measurably impact your sense of well being.

What we can’t seem to escape entirely is our genetically determined happiness “set point.” Apparently this is the most important factor, contributing half of whatever it is that gives our spirits a lift. Another 40% relates to our choices; what we choose to do and how we decide to live our lives (This is where wine and friends come in; see also my post on Dec. 21 about how wine might combat depression.) A mere 10% apparently relates to circumstances, such as wealth and health.

So big surprise, money can’t buy happiness. But deciding to have happy people in your life gets it for free.

Resveratrol clinical trials: What’s the evidence?

2010-01-12T09:47:00.000-08:00

If you are interested in anti-aging, or just the science behind healthy wine drinking, you must have seen the ads for resveratrol supplements. “All the benefits of wine without the alcohol” they might say, implying that the science is in and the matter decided. There is an impressive dossier of resveratrol research, now totaling some 3,000 research papers, and the beneficial effects of this wine-derived molecule are myriad. There is good reason why I dubbed resveratrol the “miracle molecule” in my book Age Gets Better with Wine.
In the book I also introduced what I call the “skeptic’s checklist,” a useful tool for evaluating claims about medical interventions and miracle supplements. The reason this is important is that while data from laboratory studies can reveal interesting properties and lines of research, what happens in a test tube is meaningless unless the effect can be documented in a clinical trial in humans. In order to obtain FDA clearance, for example, clinical trials need to document both safety and objectively measured effectiveness. But since herbal supplements do not fall under the FDA’s purview, there is wide leeway for frequently misleading often outrageous and claims. So without evidence from clinical trials (not the same thing as "clinically tested"), there is no way of knowing whether the product is doing any good or if it is in fact harmful.
There are a few clinical trials underway for resveratrol, and a very small number of published reports. Of the 12 papers that I found on a Medline search using “clinical trial” and “resveratrol,” 3 were not actual clinical trials but studies on blood or tissue in a lab. Another 3 used a wine extract with resveratrol along with the whole family of wine polyphenols, and the rest were what are called pharmacokinetics studies. These types of studies evaluate what is called “bioavailability” or the absorption and distribution of resveratrol after oral ingestion. Without exception they all found low but variable levels, even at high doses.
So it doesn’t appear that resveratrol alone explains the benefits of drinking wine. Synthetic derivatives, up to a thousand times more potent, are being developed so it may turn out that resveratrol opened the door to a new and powerful anti-aging products even if it isn’t the answer alone. For now, a skeptical approach seems the way to go.

What causes those wine headaches? Hope for a solution

2010-01-05T13:16:00.000-08:00

It seems like every time I give a talk about wine and health there is at least one person in the audience who asks about headaches. They would like to drink wine, they say, but sometimes it gives them a headache. Or another frequent question relates to why they didn’t get headaches drinking wine in Europe but domestic wines do; is it the sulfites?

The good news is that scientists are developing a good understanding of what triggers headaches for some people, and it doesn’t seem to be sulfites; all wines contain them. It probably isn’t the alcohol, unless you are prone to migraines or to imbibing too much. The culprit for most people is a class of compounds called biogenic amines, the most familiar of which is histamine. These are not products of the wine itself, but of bacterial contaminants. Fortunately there are fairly quick tests that can be done do measure the levels of biogenic amines, though these aren’t routinely done.

But without testing, the inherent variability of amine production during wine fermentation makes it difficult to predict which wines will be a problem for people susceptible to them. There aren’t any sensory clues, since they tend to have little effect on the taste or smell of the wine. Why there should be a difference between European and domestic wines remains a matter of speculation. Perhaps it relates to the long history of winemaking, with traditional methods naturally sorting out the processes that make drinkable wine and environments naturally free of the offending bacteria. Or maybe it’s just that domestic wines have a higher alcohol content.

In any case, a solution should be achievable now that the cause of the problem is known. It is up to the industry to invest in the technology.

A toast to health with champagne?

2009-12-29T11:05:00.000-08:00

Red wine is usually credited with providing the health benefits of drinking, because so many of the compounds associated with specific biochemical properties come from the skins and seeds of the vinifera grape. Since red wine is made by fermenting the whole berry, skins, seeds and all, these molecules are extracted into the nascent wine. Resveratrol in particular is increasingly touted as the explanation for the French Paradox, despite mounting evidence that it is the combination of substances in wine working together synergistically that best fits the data. In any case, white wines and champagne get short shrift in the health story, but new evidence suggests we should take another look.

It is true that champagne contains relatively little resveratrol, the miracle molecule. But it does contain two other potent antioxidants, tyrosol and hydroxytyrosol. If you are a student of the Mediterranean diet, you may have heard of these as being the principal antioxidants in olive oil. Since wine and olive oil are both primary components of the Mediterranean diet, it is likely that these compounds play a much larger role than resveratrol, which is present in only small quantities even in red wine. This was confirmed in a recent study from the University of Connecticut, in which rats were given either red or white wine and then induced to heart attack. Both types of wine conferred equal protection against damage to the heart, via antioxidant reactions.

So let’s toast to the New Year with champagne, to health, long life, to friends and family, and to the poor rats who unwittingly devoted their lives to science.

What’s red and white and fights the blues?

2009-12-21T10:43:00.000-08:00

Although the holidays are a festive time of year, for some it can be depressing. Those with drinking problems have a particularly difficult time, and I cannot in good conscience recommend alcohol as a therapy for the seasonal blues. There is some intriguing evidence however that substances in wine can help fight depression.

Two studies from the same lab at the University of Santiago in Spain looked at the activity of the wine-derived compound resveratrol, and a cousin molecule called “trans-epsilon viniferin” (which is 2 resveratrol molecules linked together) on release of the neurotransmitter serotonin. This is the same molecule that many prescription antidepressants target, and with both wine substances the levels of serotonin were elevated in the same way. Another target of antidepressants called MAO inhibitors, were similarly found to have a parallel effect from the wine derivatives. A limiting factor is that these studies were in brain tissue from rats, so it is a big leap to conclude that it will have the same effect in humans. However, we do know that resveratrol gets into the brain and has other positive effects so it certainly merits further research.

Although resveratrol levels are generally higher in red wines, white wines may have a beneficial effect as well. A study done a few years ago at a French laboratory evaluated the effects of champagne consumption in a set of human subjects. Interestingly, they observed that people tend to either have high or low baseline serotonin levels. In those with low levels (who may be at higher risk for depression) the serotonin levels were increased by more than 50% after moderate consumption of the bubbly. They also observed increases in another neurotransmitter molecule called dopamine, which may also have salutary effects.

In any case, the evidence suggests that if you don’t have a problem with alcohol, you should consider getting in the mood for some wine this season. Here’s wishing everyone a happy and healthy holiday.

of wine and chocolate

2009-12-15T10:09:00.000-08:00

What a treat to meet and have dinner with Fran Bigelow, founder of the famous Fran’s Chocolates here in Seattle last night. She is of course the creator of President Obama’s favorite chocolates, and her gray salt caramels are renowned. She is truly gracious, talented, and smart.

I enjoyed talking with her about the similarities of wine and chocolate, and learned a few things. I knew that dark chocolate and wine contain many of the same polyphenols, the antioxidants that explain why they are both good for us. There is a lot of scientific literature supporting the healthful properties of both chocolate and red wine. But what I didn’t know was that chocolate, like wine, is the product of fermentation. The polyphenols aren’t present in significant quantities until the beans undergo fermentation, before roasting and processing. They do however vary in taste by place of origin, just as wines are known to express what is called terroir.

Appreciation of fine chocolate has similarities to wine also, in that all of the senses are used. It has aromas, textures (wine aficionados call it “mouth feel”), and of course complex tastes. But winemakers are done when the wine goes into the bottle, whereas the chocolatier then goes on to create visually appealing creations. Both are of course best thought of as foods, and health foods at that, but wine frames the meal as chocolate completes it.

Why wine should be part of your healthy holiday diet

2009-12-07T07:59:00.000-08:00

The holidays are always a tricky time of year for those concerned about healthy eating, which of course should be all of us. We gather around food and drink, celebrate all that is good in our lives, and toast to friendship and goodwill. And we hit the buffet, usually not featuring low-cal and low fat options, so it is no wonder that average weight gain this time of year in the range of 10-15 pounds is the norm. Fortunately, there is one sacrifice that we don’t have to make. Red wine might actually help minimize the weight gain and other adverse effects of high fat meals.

First the general advice: Scan the buffet first, before getting in line, so you can save room on your plate for healthier choices. Make portion control your mantra, and try for a mix of carbohydrates and proteins along with higher fat foods. Don’t deprive yourself of what you like, just don’t have as much of it. Another helpful suggestion is replace sweet with spicy.

Standard advice usually also includes a caution to keep alcohol consumption in check. This can’t be argued with, but several lines of evidence point to the beneficial reasons to make red wine your holiday beverage of choice. For one, compounds in red wine tend to help moderate blood sugar levels, a major culprit in weight gain. Wine drinkers tend to have less trouble with weight gain overall, and some recent research shows that it actually works at a cellular level to control fat metabolism. Fatty foods also do a lot of their damage by releasing free radicals into the blood stream, and wine works to counter this as well. And finally, while wine may not count as a low-calorie drink, it is better than mixed drinks both in terms of sugar content (none in dry red wine) and the way the calories are processed.

So enjoy yourself this holiday season and share some good red wine with family and/or friends. And come to think of it, Age Gets Better with Wine makes a great present.

Big Thank-you to the Indian Wine Academy

2009-12-04T07:36:00.000-08:00

I'm just back from my trip to India for an international plastic surgery conference where I was presenting a paper, but I must say that one of the highlights was the opportunity to speak about my book Age Gets Better with Wine at a dinner meeeting of the Indian Wine Academy. A very big thank-you to Subhash Arora for the invitation and the wonderful dinner at Ciro Restaurant in New Delhi this past Monday evening. There is very sophisticated group of wine lovers in India to be sure. One member, Arun Varma, who heads a marketing and travel service company, even had me convinced that wine drinking could be incorporated into Ayurvedic medicine. Why not?
So what about Indian wine? It is a young industry, and there is a lot of potential. Growing regions in the north, where the climate is more temperate, are largely undeveloped but I wouldn't be surprised to see some really good wines in the not-too-distant future.

more on the new French Paradox

2009-11-16T07:46:00.000-08:00

I know we have covered the new French paradox recently but I came across a fact that put it into sharp focus: No country in the world has cut its alcohol consumption more over the past 4 decades than France except the United Arab Emirates, where even possession of alcohol is banned.* Even more surprising is that beer and spirits consumption has held steady, so what has vintners really seeing red is that the reduction is entirely in wine. Talk about a paradox!

Chalk it up to the disappearance of the leisurely meal. A key to healthy drinking is to consider wine as a part of a meal – in fact I have an entire chapter in Age Gets Better with Wine titled “Wine is a Food.” The average French meal is now said to be down to 38 minutes, barely an appetizer and aperitif before. And the French apparently frequent McDonald’s more than any other country in Europe. But others are taking up the slack: Spain formally classified wine as a food in 2003. And Spain has become not only one of the world’s great food and wine destinations, but a leader in the science of wine & health.

*From a chapter in Mark J. Penn's excellent book Microtrends.

The problem with resveratrol

2009-11-11T07:51:00.000-08:00

We continue to hear a lot about resveratrol these days. If you follow news releases on wine and health topics (which I do so you don’t have to) it seems that all of the goodness of wine can be attributed to this miracle molecule from wine grape skins. It is a pretty compelling story when you look at all of the basic science research on the subject, which offers tantalizing prospects of a cure for Alzheimer’s disease, cancer, heart disease, diabetes, even the common cold (see below). But there’s a problem.

To begin with, scientists first looked to wine-derived compounds because of all of the data showing a correlation between moderate drinking and lowered chances of having any of the above-mentioned diseases. When researchers discovered that resveratrol activates enzymes called sirtuins that extend lifespan in certain organisms, the door to a whole new area of scientific inquiry was opened. What resveratrol does in a Petri dish seemed to explain the benefits of drinking wine, and so now dozens of manufacturers are offering resveratrol supplements as a way to get wine’s goodness without the alcohol. So what’s the problem?

The thing is, there isn’t enough resveratrol in wine to explain why wine drinkers are so much healthier and live longer than teetotalers on average. It has been calculated that some 200 bottles would be required to get the daily dose required to cause the same effect in people as it does in lab rats. And, as we have pointed out here before, resveratrol isn’t very well absorbed after oral ingestion anyway. So clearly there must be something else going on. Several papers do offer a possible explanation: when resveratrol is given in combination with other wine polyphenols, the effects are often multiplied. And alcohol in the right amounts has specific heart-health benefits too.

A similar thing happened with vitamins. Their discovery a hundred years ago was the biggest advance in nutritional science of the 20th century, as I believe polyphenol science will be for the 21st. But when vitamins were extracted out their natural sources (usually fruits and vegetables) and given as supplements, no benefits in terms of age-related diseases were found. That bears repeating: No benefits to taking antioxidant vitamins, period. The same may turn out to be true for wine. So just eat your vegetables and drink your wine.

Cold & flu season ahead: Got wine?

2009-11-03T08:12:00.000-08:00

By all accounts, the coming flu season is going to be a doozy unless we all get our H1N1 vaccination soon. There’s always the plain old cold too of course. I can never remember whether we are supposed to starve a cold and feed a fever or the other way around, but new findings suggest that regardless of the symptoms, respiratory viruses can be kept at bay by drinking wine.

It’s not as farfetched as it sounds. A few years ago, researchers in Spain looked into the question of how wine drinking habits relate to the risk of colds. Their subjects were 4000 faculty members of five universities across the country, who were tracked during cold & flu season for the number and severity of illnesses. When the data was cross-referenced to drinking patterns, they found that consumers of at least 2 glasses of wine a day were only half as likely to contract a viral illness as nondrinkers, and the correlation was stronger for red wine drinkers than for white. What’s more, the duration of illness was shorter for those who did contract a cold or flu.

There are a couple of explanations for this. One of course is that wine drinkers may have other healthy habits that put them at less risk (researchers call these “confounding variables”) but well designed studies such as the Spanish one take these into account. A more interesting possibility is that compounds in red wine have a direct effect on cold and influenza viruses, and there is good evidence to support that. One red wine compound called quercetin was tested against flu viruses and found to be more potent than oseltamivir (Tamiflu®), at least in the laboratory. It appears that the effect is quite specific, by interfering with viral replication. A more familiar wine extract, resveratrol, has also been fairly well tested against cold and flu viruses and found to be effective (again in a laboratory setting.)

What hasn’t been demonstrated is whether these compounds have any effect in supplement form. Resveratrol in particular is better-absorbed from wine in the mouth than pill form in the stomach. So my advice is wash your hands frequently, stay home if you are ill, and by all means have a glass or two of red wine with dinner.

And look for my book Age Gets Better with Wine in bookstores soon, or on Amazon.com or barnesandnoble.com now!

Age Gets Better with Wine has arrived!

2009-10-27T09:00:00.000-07:00

Napoleon is credited with saying that champagne is deserved in victory, and necessary in defeat. I say it is time to celebrate because the second edition of Age Gets Better with Wine is here! The timing couldn't be better, with all of the controversy about resveratrol and so many companies trying to convince us that we just need to take a pill with "all of wine's benefits" and skip the part about drinking wine. If that's your view, you really need to read the book. It is availablke at http://www.amazon.com/ and http://www.barnesandnoble.com/. Check out the cool cover design.

The new paradox: why does France discourage wine drinking?

2009-09-29T14:39:00.000-07:00

Although my book Age Gets Better with Wine is focused mostly on the science of healthy wine drinking, in the course of researching wine and health the topic of social policy about drinking is unavoidable. Frankly, regulators in the U.S. have made a mess of it over the years, but the French? It’s the French after all who demonstrated to the world that a habit of red wine with meals is not only a key to enjoying life, but to a healthier one too. But in recent years signs have appeared that even as Americans increase their consumption of wine, the French are slipping. And their government is all for it, or so it appeared.
Earlier this year France’s National Cancer Institute, a branch of the health ministry, released a report indicating that any level of consumption of alcohol increases cancer risk, and so abstinence is to be recommended. As one would expect, there was widespread concern that such a policy sent the wrong message. Winegrowers were frankly outraged, and members of the medical establishment began coming forward with a more broad-based view. Even if the findings regarding cancer risk were valid (there is plenty of evidence that it may not be entirely so), an abstinence recommendation fails to take into consideration all of the other benefits of wine, such as with cardiovascular disease (the original French paradox), Alzheimer’s, diabetes, and on and on. The net benefit of healthy wine drinking most certainly outweighs a narrowly defined cancer risk.
Fortunately, it appears that common sense will prevail at the highest levels of French government, at least on this issue. According to a report in Decanter.com, the French High Council for Public Health has now officially disavowed the Cancer Institute’s report. And French president Sarkozy recently announced that new, stricter regulations on advertising alcoholic beverages were to be relaxed. The French may have banned indoor smoking (hard to believe but true), but surely someone must have known that a program of national abstinence just wasn’t going to fly. It may be flattering to see the French emulating America, but trust me, the prohibition thing didn’t really work.

Reason #101 to drink wine

2009-09-23T08:22:00.000-07:00

We arrive at last at number 101 of the healthy reasons to drink wine, and I should point out that they have been in no particular order. Trying to decide the most important reasons would be pointless, and even the decision to limit the list to 101 is arbitrary. So with a toast, here we go:
101. In my book Age Gets Better with Wine, I review the science of aging and how wine has revealed secrets that have eluded kings and philosophers seeking the key to life extension for millennia. We have shown how wine drinkers live longer on average, and have lower rates of the diseases that plague us as we get older. But ultimately, it isn't just being healthy and living long, it's a matter of quality of life. Now we have evidence from an Italian study that wine drinkers do indeed have higher scores on quality of life measures as they age. So it turns out that age really does get better with wine.

Almost there: Reason #100 of 101 healthy reasons to drink wine

2009-09-21T09:14:00.000-07:00

100. Jeanne Calment of Provence lived longer than anyone else on record, some 122 years, 8 months and 3 days. She was born before the telephone was invented and her death was a global news story broadcast over the internet. Throughout her life she enjoyed red wine on a daily basis and was fond of dark chocolate. Coincidence? Maybe, but why take a chance?

Don't lose your SIRT: resveratrol and the promise of lifespan extension

2009-09-16T08:28:00.000-07:00

We are closing in on the list of 101 healthy reasons to drink wine, and my book "Age Gets Better with Wine" will be on bookshelves soon. (You can pre-order it at any of the major retailers now.) So we turn now to one of the most exciting aspects of wine, one which has opened a new frontier in anti-aging research. Resveratrol from red wine was identified a few years ago as the only significant natural activator of a family of enzymes called sirtuins, coded by the SIRT gene (hence the name). A long list of specific benefits are being discovered for sirtuins, beyond what resveratrol and other polyphenols do independently, and we will list only a few of them here.
96. It has been known for many years that caloric restriction - reducing an organism's caloric intake by around 40% of what it would normally consume - will extend its life by a similar percentage. Sirtuins were found to be the key to this effect, and when researchers discovered that by feeding the subject resveratrol the effect could be replicated without caolric restriction it made headline news worldwide. So far this has only been demonstrated in fairly primirive creatures, however, and it remains to be seen whether it works in people.
97. Sirtuins are responsible for maintaining metabolic balance. Activation of sirtuins by resveratrol may be one of the ways by which wine drinkers tend to be healthier overall.
98. As a separate but related phenomenon, sirtuins appear to mitigate the diseases of insulin resistance (the most recognizable being type 2 diabetes.) This is in addition to the independent effects of wine polyphenols on diabetes.
99. The growth of new blood vessels is called angiogenesis, and it is important to maintain the vitality of muscles and other organs that are in constant metabolic use. Failure of angiogenesis is one of the ways the heart muscle weakens with aging, and sirtuins appear to promote heart health by facilitating new channels of blood supply. Anything we can do to encourage this is obviously beneficial.

Wine as an antibiotic: #95 of 101 healthy reasons to drink wine

2009-09-10T13:45:00.000-07:00

95. Every few years there is a news story about an outbreak of E. coli infection, which is a bacteria that can cause significant illness. But just as wine drinkers tended to be better protected against typhus in the old days, there is evidence that red wine is an effective antibacterial agent for E. coli. In this case, the active compounds are quercetin and an aromatic called caffeic acid, according to another paper from Argentina. Again, more reason to drink whole wine.

ACE your high blood pressure test with wine

2009-09-10T13:29:00.000-07:00

94. Resveratrol gets all the attention but it is far from the only healthy thing in wine (in fact it is a relatively minor component.) Another class of compounds call oligomeric proanthocyanidins (let's just call them OPC's) have a unique mechanism for lowering blood pressure. Researchers at the University of Buenos Aires found that they inhibit an enzyme called Angiotensin Converting Enzyme which contributes to hypertension in many people. Prescription ACE inhibitors are available as well, but who wouldn't rather drink a glass of red wine? It does have to be red, and it does have to be wine, because OPC's come almost exclusively from the seeds and alcoholic fermentation is required for extraction.

More wine on the brain: healthy reason #93 to drink wine

2009-09-08T08:30:00.000-07:00

93. We continue to hear about all of the ways by which wine might be good for the brain: activating memory and learning enzymes, untangling the plaques associated with Alzheimer's disease, and so on. But some have cautiously pointed out that the polyphenols that mediate these effects might not actually get into the brain tissue. Our central circuitry is protected by what is called the "blood-brain barrier" so that toxic molecules can't wander in at will. This of course also creates difficulties in getting medications and helpful nutrients across. Indeed, studies have shown that after oral ingestion, wine polyphenols might not get in to any great degree, suggesting that what we see in a test tube might not be happening inside the brain.
But recent findings from Purdue University show that with regular daily consumption, levels do begin to accumulate in about a week to 10 days. So all of the things we have been saying about regular moderate consumption find more support here.

Now hear this: wine prevents hearing loss

2009-09-06T13:34:00.000-07:00

92. Loss of hearing is no laughing matter, and it can occur from either age-related decline or acoustic trauma (loud noise.) A few years ago, a group or researchers decide to see if resveratrol could play a role. Ealry indications were that becaue oxidative damage contributes to hearing loss, antioxidants such as resveratrol could be helpful. However, a more direct way to test it is with noise-induced hearing loss. A group of rats (hard rock fans, no doubt) were recruited to test whether resveratrol could prevent hearing loss induced by standardized noise exposure. It turns out that indeed it does, as if we are surprised.

Where there is no wine, love perishes

2009-09-02T11:24:00.000-07:00

Publication of the second edition of Age Gets Better with Wine is almost here, and so we are closing in on completing the list of 101 healthy reasons to drink wine. A few more thoughts from our ancestors before we get to the cutting edge science that has caused such a stir.
90. The Greek playwright Euripedes penned Where there is no wine, love perishes, and everything else that is pleasant to man. A bit dramatic perhaps but that was then the whole idea of drama and comedy was invented by the Greeks, in order to show the benefits and the hazards of moderate vs. excessive wine consumption.
91. The Roman romantic poet Ovid wrote It warms the blood, adds luster to the eyes, and wine and love have ever been allies. Some 2 thousand years later, Italian researchers indeed proved scientifically that women who drink wine have healthier sex lives.

Wine and civilization: more reasons to drink wine

2009-08-31T08:26:00.000-07:00

87. Ernest Hemingway wrote that "wine is one of the most civilized things in the world." I say that not only is that true, but wine may have made civilization as we know it possible. When hunter-gatherer societies first congregated into villages and cities, the notion of septic systems hadn't been worked out so water supplies became of questionable safety. The practice of adding wine to water made it safer to drink, as Louis Pasteur observed a few thousand years later.
88. Wine became further entrenched in civilization during the golden age of Greece. Plato, who articulated so many of the tenets on which modern societies are organized, brought great thinkers together in what were called "symposia" which derives from the words "to drink together." Many of our most cherished institutions were conceived during these drinking sessions.
89. The notion of moderation is also an ancient one. The Roman orator Pliny the Elder noted "Nothing is more useful than wine for strengthening the body, and also more detrimental to our pleasure if moderation is lacking." Wine was firmly entrenched in Roman society, and in fact the expansion of the Roman Empire was possible because of the fact that the Romans has worked out the necessity of wine added to water to ensure potability.

Something else to digest about wine: good for the GI tract

2009-08-27T08:53:00.001-07:00

85. When I was in my general surgery residency before training in plastic surgery, we did a lot of surgery for peptic ulcers, which are prone to bleeding and causing major problems. Advice for dealing with ulcers always included things like avoiding spicy foods and alcohol. some years later, it was determined that most ulcers are associated with a particular type of bacteria, not simply excess acid. As it turns out, wine polyphenols inhibit this bacteria (called Helicobacter pylorii), so better advice is to drink wine. Another one of those counterintuitive things about healthy drinking.
86. In the same vein, another problem is refulux of gastric acids into the esophagus, which over time causes changes in the esophageal lining leading to a particularly nasty type of cancer. Interestingly, red wine seems to thwart these changes, another counterintuitive finding.

Something to smile about

2009-08-26T16:51:00.000-07:00

84. Wine contains compounds that inhibit the toxins from bacteria in the mouth that form plaques leading to cavities. Who know purple teeth were healthy teeth?

More on wine and the brain: surviving stroke

2009-08-25T11:12:00.000-07:00

83. Wine drinkers are less likely to have the most common type of stroke, which is caused by blood clotting in the arteries to the brain as with heart attack. Since stroke is a major cause of disability and death, any benefit here is worth celebrating.
84. When the clot causing a stroke (or a heart attack) is dissolved, blood rushes in bringing oxygen to the cells that have been suffering for lack of it. Some of these cells will have already died, but many are capable of surviving if blood flow is restored soon enough. Paradoxically though, the toxins that have been building up are released with the restoration of blood flow, causing further damage. (This is know as ischemia-reperfusion injury.) Resveratrol and other wine polyphenols have been shown to dramatically improve cell survival after ischemia-reperfusion.

Wine and Alzheimer's disease: drink for brain health

2009-08-21T07:59:00.000-07:00

In this section we consider one of the major epidemics of our times, Alzheimer's disease. With the baby boom generation graying, the millions of new cases of this debilitating problem loom ominously. Drug therapies to date have had disappointing results. Fortunately, there is some evidence that wine drinking and other lifestyle factors can have an effect. So our count of 101 healthy reasons to drink wine continues with:
79. The Canadian Study of Health and Aging found that wine, coffee, regular exercise, and anti-inflammatories like ibuprofen were associated with the lowest risk of Alzheimer's.
80. The Copenhagen City Heart Study, a 15-year follow-up of more than 1700 subjects, found that wine consumption but not beer or spirits correlated with lower risk of Alzheimer's.
81. The Catholic University of Rome multicenter study found that drinking up to 2 bottles of wine per day for men and one for women correlated with higher scores on standardized testing of mental acuity and lower risk of Alzheimer's. (It must be pointed out that this level of consumption would have a range of detrimental effects in other categories, but it is a testament to the beneficial effects of wine on the brain nonetheless.)
82. The Bordeaux study, with perhaps the most dramatic findings of all, found that wine drinkers had an 80% lower risk of developing Alzheimer's disease in a population age 65 and older.

Winning the rat race with wine

2009-08-19T10:54:00.000-07:00

78. How does wine help the brain? One answer might be the ingredient quercetin, which may help with spatial learning and memory. Researchers at Nanjing University in China reported that mice given quercetin did a much better job at remembering how to navigate a maze. It was attributed to activation of enzymes in a part of the brain called the hippocampus, one of the key areas for memory.

Is alcohol good for the brain?

2009-08-18T09:05:00.000-07:00

77. Continuing our line of thought on wine and the brain, we turn to the question of alcohol's effects. Haven't we always assumed that alcohol kills brain cells, and so any positive aspects of drinking must be weighed against this? True, at high doses alcohol (as with anything for that matter) is toxic, but a recent review from Loyola University pointed to experimental evidence that moderate alcohol levels exert direct "neuroprotective" actions; that is, in addition to promoting healthy blood vessels that improve blood flow to the brain, the direct effects of alcohol on nerve cells are protective, at least in moderate amounts.
Add this to the list of healthy effects of alcohol in moderation where cardiovascular disease is concerned, and keep it in mind the next time you see an ad for some supplement touting "all the benefits of wine without the alcohol" because that is of course not possible.

Are wine drinkers smarter?

2009-08-13T08:56:00.000-07:00

76. Sure, wine drinkers may think they are smarter, but before you write it off as smugness, consider that there is actually a documented correlation between IQ and preference for wine. In the Netherlands, all young men are required to register for the draft, a process which includes an extensive battery of physical and mental tests. One well-known study cross-referenced the IQ results with beverage preference, finding a clear linear relationship with wine; the smarter you are, the more likely you are to be a wine drinker. The results held up when repeated at intervals several years later. So either wine makes you smart (which is possible based on effects of wine polyphenols in the brain) or smart people are attracted more to wine (a better explanation of the data from this study). Either way, it's a win-win.

Just sip it: #75 of 101 healthy reasons to drink wine

2009-08-12T08:08:00.000-07:00

75. Many of the benefits of drinking wine have been attributed to resveratrol and the other polyphenols, and with good reason. The list of beneficial properties of resveratrol could probably fill our list of 101 reasons to drink wine by itself. And to judge by the number of companies marketing resveratrol supplements, you would think that drinking wine has become a quaint custom of a bygone age since it seems no longer necessary in order to reap the benefits. But not so fast! As I have pointed out, there is a lack of clinical studies confirming resveratrol's usefulness as an oral supplement, and one of the reasons may be that it is very poorly absorbed from the digestive tract. It is however taken up quite well through the lining of the mouth, so by sipping your wine, swirling it around to get the full flavor essence, you are actually getting more resveratrol in your system than by swallowing quickly. So those expensive pills are probably just making a more expensive end product of digestion, if you catch my drift.

wine is a food

2009-08-08T08:45:00.000-07:00

The new movie "Julia and Julia" which highlights the life of Julia Child, reminds me of what an incredible contribution to food and wine that she made. In an interview with the Wine Spectator, she once said "Life is too short to drink bad wine." She famously ended each of her cooking shows with a cheerful "bon appetit" taost holding a glass of wine, at a time when wine with meals was not part of the American lifestyle. In my book Age Gets Better with Wine I have a chapter called Wine is a Food, which I belive to be absolutely true. It is a healthful, nutritious part of a meal, and better for you that most of what passes for food these days. So item #74 in our list of 101 healthy reasons to drink wine: Wine is a Food.

the inflammation age

2009-08-04T11:24:00.000-07:00

Over the past couple of decades, the importance of chronic inflammation as a mediator of aging has become clear. All those antioxidants we hear so much about are ultimately targeted at inflammation. One dramatic example is the case of cardiovascular disease, where the process of plaque buildup in arteries is now known to relate more to inflammatory processes than simple buildup of cholesterol sludge. So the role of wine as a potential means of controlling inflammation may provide an explanation for some of its anti-aging properties.
71. There are several "markers" of inflammation in the blood, one of the more useful being c-reactive protein. High levels of this correlate to an inflammatory state and premature aging. Diets high in flavonoids such as quercetin (in red wine) result in lower c-reactive protein levels.
72. Research out just this month demonstrates the potent anti-inflammatory capabilities of resveratrol. Scientists in Scotland gave a group of mice a potent inflammatory trigger, to mimic the effects of septic shock. A second group pre-treated with resveratrol had a much diminished response, by blocking the production of two molecules known to be particularly destructive.
73. A diet study from Chile found that adding wine produced a much greater effect at reducing inflammation than adding vegetables, though the two together was best.

wine and skin

2009-08-03T08:13:00.000-07:00

I am just back from giving a lecture on wine and health at the meeting of the Society of Wine Educators, a convenient excuse to escape the record 103 degree heat in Seattle! So thoughts turn to fun in the sun. Conveniently, wine plays a role in skin health which I will enumerate as we continue through the list of 101 healthy reasons to drink wine:
69. A study from Australia, where skin cancer is a major issue, found that those who drink wine have a lower incidence of precancerous skin lesions called actinic keratoses (AK's). Only a half glass per day, on average, lowered the incidence by 27%.
70. Wine polyphenols have been put to good use in skin care. Several studies have documented that resveratrol and other wine compounds can reduce the damage caused by UV exposure, the major cause of premature aging of the skin.

wine and women

2009-07-27T10:43:00.000-07:00

Someone famously once said "Who loves not wine, women and song remains a fool his whole life long." So in our count of 101 healthy reasons to drink wine, leading up to the release of the second edition of Age Gets Better with Wine, we turn our attention to wine and women.
66. According to a recent study from the University of Florence, Italy, women who drink wine have better sexual health than nondrinkers or mixed beverage drinkers. Using a study tool known as the Female Sexual Function Index, they studied more than 700 women from Tuscany. (Women consuming more than 2 glasses a day were excluded due to the possible confounding effect of alcohol on libido.) Women who drank wine had the highest overall scores on this comprehensive test of sexual health. No surprise there if you ask me, but these things have to be proven I suppose.
67. Postmenopausal women who have a high flavonoid intake (these are the polyphenol compounds from red wine and some vegetables) have a lower risk of cardiovascular disease. While this may seem obvious, given all that is known about heart health and wine, the problem had not been previously addressed specifically for postmenopausal women in much detail.
68. Some wine-derived compounds have estrogen-like properties. (Plant-derived chemicals with estrogenic effects are called phytoestrogens, a familiar one being soy.) The trick is to mimic the favorable actions of estrogen in post-menopausal women (lower osteoporosis, heart disease, healthier skin, etc) while minimizing the adverse effects (possible increased risk of breast cancer.) Such compounds are called selective estrogen receptor modulators, or SERMS. One recent study found that wine-derived phyoestrogens activated longevity genes. The fact that estrogens have this capability may explain why women live longer than men on average.

Is wine good for the liver?

2009-07-20T13:36:00.000-07:00

65. While it is common knowledge that alcohol abuse leads to cirrhosis of the liver, this next item on our count up to 101 healthy reasons to drink wine reveals that in the right amounts wine is actually a good thing for liver health. A condition know as "Non-Alcoholic Fatty Liver Disease" or NAFLD is becoming more prevalent and is one of a spectrum of conditions that may lead to cirrhosis. Doctors used to assume that NAFLD patients were simply concealing their heavy drinking. It turns out that the incidence of NAFLD is lowest among wine drinkers, being equal in nondrinkers and spirits drinkers.