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The J-curve is dead. Long live the J-curve!

 There is a resurgence of debate about the validity of the J-curve, especially as it relates to alcohol and cancer. A 2014 report determined that “alcohol use was positively associated with overall mortality, alcohol-related cancers, and violent death and injuries, but marginally to CVD/CHD” (cardiovascular disease). In other words, there was little benefit if any in terms of heart disease but a big upside risk for cancer and accidental or violent demise. Gone was the French Paradox!  The J curve is dead! Or not. Though that statement may be technically true, I looked at look at the data myself and found something different: a strong confirmation of the J-curve for overall mortality, overall cancer deaths, cardiovascular disease, and all “other causes.” This held for both men and women:     Used under creative commons license from Ferrari P, Licaj I,Muller DC, et al. Lifetime alcohol use and overall and cause-specific mortality in the European Prospec...

Quality of life is better with wine

Wine appreciation is an icon of “the good life,” but can it really be true that something as simple as a glass of wine with dinner measurably improves quality of life? There’s good evidence that it does. Quality of life (QoL) may seem a subjective concept, impossible to quantify, as irreproducible as numerical wine scores, but QoL has become a vital concept in clinical research. Everything from cancer treatments to plastic surgery can be appraised in terms of impact on quality of life. Wine drinking is no different. Quality of Life is more than good health The concept first appeared in the medical literature in the 1970’s, as medical and surgical treatments advanced in terms of their ability to save lives, but sometimes at the expense of significant side effects.  In a similar vein, scholarly investigations about wine consumption tended to focus on its detrimental effects until recently. Only when it became apparent that wine drinkers actually lived longer and enjoyed better...

Lost in translation: Why most reports on health and wine are erroneous

In an era of fake news, alternative facts, and conflicting advice on healthy drinking from even the most reliable sources, it is important to understand where reporting on clinical science can go awry. Does a glass of wine before bed help you to lose weight? A widely reported study last year seemed to suggest just that, at least if you only looked at the headlines. How about a glass of wine a day is as good as an hour at the gym? Both of these might be true - if you are a mouse - and substituting resveratrol for wine. Of mice and men - and medicine The journey from the research lab to the clinic is known as translational medicine, and the process can be long and unpredictable. Take for example the hypothesis that resveratrol alters metabolism in a way that mimics exercise (and ignore for the moment the separate idea that resveratrol supplementation is the same as drinking wine.)  There are limits on what sort of interventional studies you can do to test this idea on humans, ...

The J Curve explained

In order to make sense of the seemingly conflicting reports about wine and health there’s one essential thing to understand: the J-shaped curve. It’s a simple concept, universal, in plain sight, and often ignored. It goes like this: Take “nondrinking” as the baseline and plot increased or decreased relative risk of a health issue with increasing levels of daily consumption. Nondrinkers have a certain risk of, say heart attacks, moderate drinkers a lower risk, heavy drinkers a relatively higher risk. Not too complicated. The tricky parts are separating wine drinkers from drinkers in general, and daily moderate drinkers from occasional drinkers. The J-curve is not just about wine The J-shaped curve is too universal to ignore once you see it. Even dietary salt intake has a J-curve; consuming too little in your diet can be as harmful as too much. For years, the American Heart Association has endorsed a 1.5 gram per day limit on sodium intake (salt is about 40% sodium), about what ...

Wine is a food group

Why are wine’s maximal health benefits related to consuming it with meals? It’s well known that wine with dinner on a regular basis is best, and understanding the role of wine as a food can help illuminate wine’s larger role in health. A central puzzle about wine and health is how much is due to biochemical substances such as resveratrol.  On the other hand, to what degree wine drinkers do other healthy things that can either compensate for the detrimental effects or amplify the good ones? People who regularly have a glass of wine with dinner more often eat in moderation, prefer healthier foods, and deal better with stress. Wine with meals is associated with other healthy habits A few recent studies bring clarification to the issue. One from the University of Helsinki in Finland reported the results of a long term population study evaluating drinking patterns and subjective well-being. Although a comparatively small percent of Finns have wine with dinner on a regular basis, th...

The French paradox at 25

  November 17 2016 will mark twenty-five years since the CBS television show  60 Minutes christenedthe 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. It still has its naysayers; as recently as 2015, England’s chief medical officer Sally Davies scorned the idea and proclaimed it an “old wives’ tale.” (She suggested a cup of tea instead, presumably with pinky finger raised.) Then 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? Why the French Paradox is still true As with many questions in the realm of lifestyle and health, the answers are often nuanced and conditional. Government authorities in both America and Europ...

Should colleges teach drinking 101?

A quick glance at statistics on alcohol abuse in American colleges and universities reveals a huge problem, and I believe that tackling the issue will require a new and perhaps controversial strategy. Various approaches have failed, so in this “back to school” edition I take a look at the question and offer a sensible, if counterintuitive, alternative. The majority of young people who choose to drink need to be taught that there is such a thing as healthy drinking. The drinking 101 curriculum has to include “how drinking can be healthy” and not just “don’t drink.” First the numbers: According to the National Institute on Alcohol Abuse and Alcoholism, as many as 1800 students die each year from alcohol-related causes. More than a half million more are injured while drunk, and tens of thousands become victims of sexual assault attributable to alcohol.  Tellingly, more than half of the 80% of students who consume alcohol engage in binge drinking, and this lies at the heart of most ...