For this post I decided to address what I see as a neo-prohibitionist
and paternalistic trend in medical advice about drinking, with a
point-counterpoint on a blog that appeared recently on self.com. I believe the author
made a sincere attempt to get the story right but was misinformed by the
physicians she quotes. What was not disclosed is that the meta-analysis that
this story references was done under the auspices of the Centre for Addictions
Research of British Columbia, University of Victoria, an institution with a
presumed anti-alcohol bias. An invited commentary with the original publication came from the Alcohol Research Group in
Emeryville, CA, whose mission “seeks to reduce alcohol-related harms.” They lauded
the findings, saying that it could help fight back against “renewed calls from
certain medical commentators to prescribe moderate drinking.” Disclosure: I
count myself among those medical commentators.
By Korin Miller
The Truth About Whether Red Wine Actually Helps Your
Heart Health
This isn't the most delightful news ever.
People love to talk about how red wine is good for your
heart—and they usually do it while they’re drinking red wine, which is only
natural. But research on the subject has been mixed, and even most positive
findings have stopped short of actually recommending that people go out of
their way to have a glass to prevent heart disease. Now, a large new
meta-analysis is adding to the conversation, concluding that there's not
much to support the idea that you should be drinking red wine to benefit your
heart health.
For the analysis, which was published in the Journal of
Studies on Alcohol and Drugs on May 21, scientists examined 45 studies on
alcohol and heart health and found the conclusion that alcohol—especially red
wine—is good for your heart are misleading.
Previous individual studies have suggested that moderate
drinkers, defined as having at most one drink a day for women and two drinks
for men, have lower heart disease rates than people who don’t drink. But
researchers in this meta-analysis point out that a good portion of the people
who don’t drink are teetotalers either because they have a problematic history
with alcohol or have health problems that prevent them from drinking—not just
because they choose not to drink for no reason. So, although healthiness and
moderate drinking have been linked in past research, these studies have usually
compared drinkers with people who already had health issues of some sort. When the
researchers behind this new meta-analysis addressed this by controlling for
heart health, they found no significant evidence that drinking moderate amounts
of alcohol protects your heart.
RAB: This is known as the “abstainer bias” or the “sick quitter”
hypothesis. In order to determine the validity of a hypothesis, it needs to be
tested; additional observational data does not answer the question. The way to do this is to ask “What happens to lifelong abstainers who
start drinking, and what happens to healthy moderate drinkers who quit?” This
was addressed in a largestudy from Australia that followed 13,000 female subjects for 12
years. They found that when healthy moderate drinkers either increased or quit
drinking, their health status declined. They further found that the health of
recent abstainers and lifelong abstainers was the same, disproving the sick
quitter hypothesis.
There's historically been a lot of confusion around the idea
of red wine being healthy for your heart.
As you can see, it’s complicated, and somewhere along the
line, the message got muddled. "The American Heart Association and other
organizers have never recommended that a person has a daily allotment of
alcohol," Richard Becker, M.D., director and physician-in-chief of the
University of Cincinnati Heart, Lung and Vascular Institute, tells SELF.
"If a person [stays within the moderate-drinking recommendations], that
may be acceptable, but there's never been a recommendation to consume alcohol
for heart health."
While the American Heart Association acknowledges that some
research has shown that there may be a benefit to drinking wine due to
components like flavonoids and other antioxidants that can help lower your
heart disease risk, they also point out that these can be found in other foods,
like grapes, and that the wine is likely not the key component here. “The
[health and drinking] linkage reported in many of these studies may be due to
other lifestyle factors rather than alcohol,” the organization states. “Such
factors may include increased physical activity, and a diet high in fruits and
vegetables and lower in saturated fats.” And, the American Heart Association
notes, there have been no direct comparison trials to determine the specific
effect of wine or other forms of alcohol on the risk of developing heart
disease or stroke.
RAB: There should be no confusion. It would be more accurate to say that a substantial body of
research supports a connection between moderate wine drinking and overall good
health and longevity. Additional research documents an independent association
of moderate alcohol consumption and heart health specifically. What is important
to recognize is that the relationship is nonlinear, but follows a J-shaped curve: lower
risk with moderate consumption, increased risk with heavy drinking compared to
nondrinking. Moderate regular wine consumption is associated with other healthy
lifestyle factors but these do not fully account for the observed benefits.
George S. Abela, M.D., chief of the division of cardiology
at Michigan State University, tells SELF that alcohol and heart health can be a
“double-edged sword.” On the one hand, moderate alcohol intake can raise your
levels of HDL ("good") cholesterol, which is great for your heart
health, he says. It also may help you de-stress here and there, and stress is a
risk factor for heart disease.
On the other, when you drink in extreme excess or if you
have a genetic condition, alcohol can damage your heart muscle and cause an abnormal
heartbeat. It can also increase your blood pressure. “I’ve had patients that
I’ve had to get off of alcohol completely to control their blood pressure,”
Abela says. And, if you have a strong family history of high blood pressure,
stroke, or weakening of the heart, Becker points out that you should talk to
your doctor—they may advise that you shouldn't be drinking alcohol at all.
RAB: Again, the relationship is a J-shaped curve. Stating that heavy
drinking is bad does not discredit the benefits of moderate drinking.
There's also the nutritional aspect to think about. “I’m not
a big supporter of alcohol being cardio-protective,” Nicole Weinberg, M.D., a
cardiologist at Providence Saint John's Health Center in Santa Monica,
California, tells SELF. “When I look at wine, I think it’s just a big glass of
sugar." While indulging is a huge part of what makes life great,
overdoing it on alcohol can lead to inflammation, weight gain, and an increased
risk of diabetes—all of which are risk factors for heart disease, she says.
RAB: The statement that wine is the same as a “big glass of sugar” is
nonsense. In wine, the sugar has fermented into alcohol, which is metabolized
in a way that avoids the spike in blood sugar levels that sugary drinks such as
grape juice have. The high sugar content and lower antioxidant polyphenols
levels are among the reasons that grapes and grape juice do not have the same
benefits as wine. Sugar is a notorious pro-inflammatory substance and
responsible for much more cardiovascular disease than alcohol. Wine drinkers
have lower markers of inflammation, are less likely to be overweight, and have
a lower incidence of diabetes.
It's understandable that this "double-edged sword"
concept can be frustrating, Malissa Wood, M.D., co-director of the Corrigan
Women's Heart Health Program at Massachusetts General Hospital, tells SELF. But
one of the main problems with alcohol, she says, is that people often drink
more than they say they do—and drinking more than a moderate amount clearly
isn’t great for your heart.
RAB: This points out a primary weakness in the studies on which the
meta-analysis was done and a fault in how they are interpreted. Since people
tend to under-report their actual drinking, what this actually means is that
the benefits of moderate drinking apply to higher levels of consumption.
Luckily, this doesn’t mean you have to choose between pinot
noir and your heart if you're healthy.
You can still drink alcohol and live a healthy life. “It’s a
complicated situation, and I don’t think there’s a clear message that small
amounts of alcohol are bad for your heart,” Wood says. Instead, experts
recommend keeping your drinking in check. “A glass of wine here and there is
perfectly reasonable, and so is going out on the weekend and having a few
drinks with dinner,” Weinberg says. “But when it starts to become regular or
heavy use, I tell people to dial back.”
Also, know this: If you prefer beer or cocktails, you don’t
have to become a wine person to be “healthier.” “At the end of the day, the
body only sees alcohol,” Abela says.
RAB: This is demonstrably false. Multiple studies document an
association of regular, moderate wine consumption with improved health and
longevity that are not observed with other drinks. The pattern of drinking is
important; wine with dinner on a regular basis has the strongest benefit,
limiting drinking to weekends or drinking different forms of alcohol and in
varying amounts is associated with increased risk.
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