Is wine re­ally good for your heart?

The Mercury - - NEWS - Adrian Baranchuk, Bryce Alexan­der and So­haib Haseeb

OUR re­la­tion­ship with wine has a long his­tory. The old­est known win­ery, dat­ing back to 4100 BC, was dis­cov­ered in 2010 by ar­chae­ol­o­gists in an Ar­me­nian cave.

Wine was used in cer­e­monies by the Egyp­tians, traded by the Phoeni­cians, hon­oured by the Greek god Diony­sus and the Ro­man god Bac­chus.

By 2014, hu­man­ity was con­sum­ing more than 24 mil­lion litres of wine every year glob­ally. Now there is some fear that ex­treme weather events in western Europe this year have re­duced pro­duc­tion sub­stan­tially, and prices of this high-de­mand com­mod­ity are set to rise. Why is wine so pop­u­lar? Aside from its flavours, and ca­pac­ity to help peo­ple re­lax, wine has gained some­thing of a rep­u­ta­tion as a “healthy” al­co­hol – with re­searchers in the past not­ing as­so­ci­a­tions be­tween red wine drink­ing in France, and lower in­ci­dence of heart dis­ease.

How­ever, wine drink­ing is also known to in­crease risks of se­ri­ous health is­sues, in­clud­ing liver cir­rho­sis, sud­den cardiac death, al­co­holic car­diomy­opathies and cardiac rhythm dis­or­ders.

Ex­ces­sive con­sump­tion and chronic mis­use of al­co­hol are risk fac­tors con­tribut­ing to an in­crease in global dis­ease.

How does the av­er­age drinker know what to be­lieve? And how much wine is safe?

As med­i­cal re­searchers, we re­cently pub­lished an in-depth anal­y­sis of the anatomy of wine. This in­cluded anal­y­sis of the risks and ben­e­fits of con­sump­tion, com­par­isons with other al­co­holic bev­er­ages and a dis­cus­sion around wine’s much-pub­li­cised health ben­e­fits.

Mod­ern sci­en­tific in­trigue sur­round­ing wine has grown im­mensely since the 1970s, when large, in­ter­na­tional stud­ies first re­ported a link be­tween light-to-mod­er­ate con­sump­tion of al­co­hol and lower rates of is­chemic heart dis­ease (IHD) oc­cur­rence and as­so­ci­ated deaths.

IHDs are a group of dis­eases char­ac­terised by a re­duced blood flow to the heart, and ac­count for sig­nif­i­cant deaths world­wide.

Sim­i­lar re­sults have been re­ported in­di­vid­u­ally for wine, specif­i­cally red wine. This phe­nom­e­non was even­tu­ally coined “the French para­dox” af­ter Re­naud and De Lorg­eril, two sci­en­tists who be­came known for this work, ob­served a rel­a­tively low risk of IHD-as­so­ci­ated mor­tal­ity in red wine drinkers de­spite the con­sump­tion of a diet rich in sat­u­rated fat.

Does this mean red wine is good for the heart? This is a com­plex ques­tion and as yet there is no con­sen­sus on the an­swer.

More than one fac­tor needs to be con­sid­ered in or­der to ex­plain this sit­u­a­tion. Drink­ing pat­terns, life­style char­ac­ter­is­tics and di­etary in­take are all im­por­tant for in­di­vid­u­als to ob­tain a healthy car­dio­vas­cu­lar pro­file.

The Mediter­ranean diet has been put for­ward as one ex­pla­na­tion. This diet em­pha­sises con­sump­tion of plant-based foods in ad­di­tion to the mod­er­ate con­sump­tion of red wine and has been la­belled as ben­e­fi­cial by sci­en­tific ad­vi­sory com­mit­tees.

In the Mediter­ranean diet, the low con­sump­tion of sat­u­rated fat, em­pha­sis on a healthy life­style, and more in­de­pen­dently, al­pha-linoleic acid (an es­sen­tial fatty acid) and red wine, may al­low this diet to con­fer the much-re­searched car­dio-pro­tec­tive ben­e­fits.

Red wine con­tains more than 500 dif­fer­ent chem­i­cal sub­stances.

One class, called “polyphe­nols”, has been widely in­ves­ti­gated for imparting the ap­par­ent an­tiox­i­dant and anti-in­flam­ma­tory ef­fects of red wine.

Al­co­hol and polyphe­nols are thought to have sev­eral pos­i­tive health im­pacts.

One is a con­tri­bu­tion to an in­crease in HDL-choles­terol, or “good chole­strol”, and a de­crease in LDL-ox­i­da­tion, or “bad choles­terol”.

They also con­trib­ute to a de­crease in in­flam­ma­tion. They are thought to in­crease in­sulin sen­si­tiv­ity. And they are un­der­stood to im­prove blood pres­sure.

Mediter­ranean di­ets have long been touted as hearthealthy, based on ob­ser­va­tional stud­ies. There is no con­sis­tent pat­tern when wine is com­pared with beer and spir­its.

Some re­port wine’s su­pe­ri­or­ity in a re­duc­tion from IHD and mor­tal­ity. Oth­ers re­port it for beer and spir­its. Oth­ers sug­gest there is no dif­fer­ence.

This sug­gests that al­co­hol and polyphe­nols both con­trib­ute to ex­plain­ing the French para­dox, in ad­di­tion to life­style fac­tors.

De­spite the ben­e­fi­cial ef­fects of wine and al­co­hol con­sump­tion, drink­ing is still a po­ten­tial risk-fac­tor for atrial fib­ril­la­tion, the most-com­mon “rhythm al­ter­ation” of the heart.

In much of the re­search, ad­verse ef­fects were in­creas­ingly ob­served with ex­ces­sive or binge-con­sump­tion of wine, while low-to-mod­er­ate in­takes low­ered IHD and mor­tal­ity risks.

In re­sponse, var­i­ous gov­ern­ing bod­ies have come forth with guide­lines for al­co­hol con­sump­tion.

Th­ese fol­low sim­i­lar pat­terns, but vary re­mark­ably by coun­try and source.

And the def­i­ni­tion of “one stan­dard drink” used in each guide­line is highly vari­able, and dis­crepant be­tween coun­try bor­ders. This causes great con­fu­sion. Read­ers should be wary of this when in­ter­pret­ing al­co­hol con­sump­tion guide­lines.

The World Health Or­gan­i­sa­tion rec­om­mends lowrisk al­co­hol con­sump­tion of no more than two stan­dard drinks per day, with at least two non-drink­ing days dur­ing the week. Here one stan­dard drink is de­fined as 10g of pure ethanol.

The Amer­i­can Heart As­so­ci­a­tion rec­om­mends al­co­hol in mod­er­a­tion – less than or equal to one to two drinks per day for men and one drink per day for women. 55ml of beer, 120ml of wine, 45ml of 80-proof spir­its, or 30ml of 100proof spir­its.

The Di­etary Guide­lines for Amer­i­cans 2015-2020 de­vel­oped by the United States Depart­ment of Agri­cul­ture rec­om­mends a mod­er­ate con­sump­tion of al­co­hol. This equates to up to two stan­dard drinks per day for men and one for women.

Here, one stan­dard drink is de­fined as 14g of pure ethanol.

The Cana­dian Cen­tre for Ad­dic­tion and Men­tal Health guide­lines rec­om­mend lowrisk al­co­hol con­sump­tion – up to three drinks per day for men and two for women.

One drink is de­fined as 355ml of 5% beer, 150ml of 12%, and 45ml of 40% spir­its.

Ob­ser­va­tional data around al­co­hol con­sump­tion and heart health sug­gests that a light-to-mod­er­ate in­take, in reg­u­lar amounts, ap­pears to be healthy.

How­ever, when math­e­mat­i­cal mod­els have been ap­plied to de­ter­mine cau­sa­tion (an ap­proach known as Men­delian ran­domi­sa­tion), the re­sults have been mixed.

Some stud­ies have found light-to-mod­er­ate drink­ing ben­e­fi­cial, while oth­ers have re­ported long-term al­co­hol con­sump­tion to be harm­ful for the heart.

For doc­tors, it is quite clear what to rec­om­mend to pa­tients when it comes to diet, ex­er­cise and smok­ing.

Given the in­con­sis­ten­cies in the find­ings re­lat­ing to al­co­hol, and wine specif­i­cally, rec­om­men­da­tions for con­sump­tion are less ob­vi­ous.

For wine drinkers, too, de­fin­i­tive an­swers on wine and health re­main elu­sive. There is, how­ever, im­mense re­search po­ten­tial in this area for the fu­ture.

And as all the guide­lines say, one or two glasses of red wine tonight will be just fine. – The Con­ver­sa­tion

Baranchuk is Pro­fes­sor of Medicine, Queen’s Univer­sity, On­tario

Alexan­der is Med­i­cal Stu­dent, Queen’s Univer­sity, On­tario

Haseeb is Stu­dent, Queen’s Univer­sity, On­tario


Serge Re­naud, the French sci­en­tist who be­came known for his work on ‘the French para­dox’, drink­ing wine in Paris in 1998.

Most guide­lines sug­gest a mod­er­ate con­sump­tion of no more than one or two al­co­holic drinks per day. But is yours a 120ml or an 240ml glass?

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