Article By: Harvey Finkel, MD
A mountain of evidence based upon sound medical science indicates that abstinence can be considered a health risk, that heavy drinking dangerously damages health and shortens life, and that moderate drinking improves health and lengthens life. The J-shaped curve rules. It illustrates that moderate drinking is associated with a lower death rate than is abstinence and a much lower rate than is heavy drinking. Maybe life is a J-shaped curve. Alcohol itself appears to supply at least half these benefits. Those beverages, red wine in particular, that are imbued with polyphenolic antioxidants are especially salutary. We are just beginning to understand the remarkably complex mechanisms at work.
The so-called French paradox graphically calls attention to drinking as possibly healthy. Behold the stereotypical Frenchman: overweight and indolent, sated with butter, cream and fois gras, Gauloise ever hanging from lips, shunning vegetables and exercise, save for flexion of elbow. The paradox is the low coronary death rate in France compared to, say, America with its healthier lifestyle. Perhaps what the elbow flexion is conveying to the Frenchman's mouth, red wine, makes the difference.
I have written overviews of wine's influences upon health from time to time, when it seemed updates were needed. The current piece will review significant developments mainly during the past couple of years.
Most qualified observers continue to believe that the healthiest drinking is moderate in quantity, say two glasses of wine daily for men, one for women, regularly with meals. The stomachs of women contain only half as much of the enzyme that neutralizes alcohol as those of men's. All agree that spreading out consumption in modest doses is far better than concentrating one's drinking. (One well-done study concluded, however, that only the frequency of doses counts, within reasonable limits of quantity, not what one drinks, nor whether with meals.) We must continue to support research, and to demand that conclusions are based upon objective scientific data. The roles of genetic factors and of various enzymes must be clarified.
Cardiovascular disease (atherosclerosis), the most frequent cause of death and disability in the developed world, is the most studied and carries the greatest weight of evidence of the beneficial effects of moderate drinking: dramatic reductions of risk of heart attack, ischemic stroke (due to obstruction of a diseased artery supplying the brain), and of obstruction of arteries elsewhere in the body. (It takes very prolonged and heavy drinking to damage the heart.) Most of such benefits can be demonstrated only in those over 4O years of age, but neither the disease nor its alleviation would be apparent in young people. We know that the atherosclerotic process begins early in life, and we all hope to attain older age with healthy hearts and blood vessels. Many studies report that moderate drinking is associated with a reduction of greater than 4O percent in coronary risk.
It is worth reviewing the now numerous cardiovascular risk factors known to be affected by moderate drinking.
Blood fat (lipid) deposition into the walls of arteries in the heart and elsewhere is a prime step in the development of atherosclerosis. Alcohol stimulates the liver to increase production of high-density lipoprotein (HDL) cholesterol, the "good cholesterol", which purges arteries of low-density lipoprotein (LDL) cholesterol, "bad cholesterol", and carts it back to the liver for excretion in the bile. Other potentially noxious fats, such as triglyceride and lipoprotein (a), may also be favorably impacted by drinking. LDL cholesterol is particularly toxic only after it is oxidized. Antioxidant polyphenols of wine, and perhaps HDLs, coat LDLs, protecting them from oxidation.
A blood clot is the coup de grace of a heart attack or ischemic stroke, obstructing the flow of blood with its oxygen and nourishment to the unfortunate tissue beyond. Both alcohol and wine's polyphenols beneficially modulate several facets of an overactive coagulation (clotting) cascade. (The risk of much less frequent hemorrhagic strokes is increased by drinking.)
Homocysteine, an amino acid, when overabundant due to genetic factors or lifestyle, encourages harmful blood clotting, and may directly injure arterial walls. Abusers of alcohol are often deficient in the important vitamin folic acid. This deficiency and perhaps alcohol itself may raise the homocysteine level. Supplemental folic acid or vitamins B12 or B6 protect against homocysteine excess.
The inner endothelial layer of the blood vessel wall is a vital working tissue. Nitric oxide elaborated by endothelial cells relaxes vessel walls, allowing freer blood flow, reduces aggregation of platelets, decreasing clot risk, and inhibits excessive muscle growth within the vessel wall. Polyphenols of wine stimulate production of nitric oxide.
Abnormal arterial stiffness and thickening appear to obey the J-shaped curve.
A red-wine polyphenol extract strongly inhibits production of endothelin-1, a human peptide that may play a role in the development of coronary disease.
The inflammatory process initiated by endothelial injury is thought to perpetuate the atherosclerotic process. Drinking reduces blood concentrations of C-reactive protein and other signs of inflammation correlating with coronary risk. Gallic acid, a polyphenol of wine, was recently reported to inhibit inflammation, and perhaps thrombosis and cancer.
Wine polyphenols appear to protect against Helicobacter pylori and Chlamydia pneumoniae, bacteria suspected of provoking athersclerosis. They both make other mischief.
Diabetes mellitus, a common and dangerous disorder, renders its sufferers highly susceptible to atherosclerosis, often at unusually young ages. Moderate drinking protects diabetics at least as much as others, and improves insulin sensitivity, thus enhancing control and reducing cardiovascular risk and the risk of developing type 2 diabetes to begin with. Both alcohol and polyphenols are operative. Benefits may be greater among those who drink wine or beer than for spirit drinkers. Dry wine contains almost no carbohydrate and few calories. Diabetics must eat when drinking to avoid hypoglycemia.
Elevated blood pressure (hypertension) a stealthy, potentially disabling and lethal disorder, may be ameliorated by moderate drinking and, in keeping with the J-shaped curve, exacerbated by excessive drinking.
Excessive weight, another well-recognized cardiovascular risk, may be lost with the aid of moderate consumption, but see the liver paragraph.
The production of antioxidant polyphenols in the vine, where they act in fungal protection and likely in other ways, is stimulated by various stresses. They help protect wine from premature senility, and contribute to color, flavor and texture. Abundant in grape skins, they are found abundantly in red wines, our main source, also to a lesser extent in white wine, beer, especially the darker types, cask-aged spirits, hard cider and fruits, nuts, and vegetables. Resveratrol, quercetin and the catechins are among the most familiar and most biologically active. Specific beneficial effects of these compounds continue to be elucidated. Oxidative reactions, part of normal living, additionally incited by smoking, noxious chemicals, radiation, and acetaldehyde, a breakdown product of alcohol, lie at the core of most of the damaging sequences leading to aging, cancer, dementia (including Alzheimer's disease), immune dysfunction, inflammation, cataract formation, and other degenerative disorders. It is hoped that the antioxidants can diminish these pathological processes.
Mimicking severe calorie restriction, polyphenols activate sirtuin genes, thus stabilizing DNA and preventing lethal accumulation of toxic products in older cells, in this manner increasing maximum life span. Resveratrol extends yeast life span by 7O percent. The sirtuins are operative in roundworm, insect and in mammalian cells, where they play a favorable role in fat metabolism. Research continues.
In addition to anti-inflammatory effects, wine has been found to combat a number of infections. Contrary to what one might assume, it is mostly the polyphenols, not the alcohol, that do the job. Wine effectively inhibits growth of bacterial terrors of the gastrointestinal tract, including H. pylori, implicated in causing gastritis, ulcers, stomach cancer, and perhaps atherosclerosis. It likewise retards the virus of hepatitis A and of C. pneumoniae, a bacterium which causes upper and lower respiratory infections of varying severity and duration, and which also may provoke atherosclerosis. Recent research suggests, however, that the old notion implicating alcohol in virulence of infection may be true.
We know that prolonged excessive consumption of alcohol increases the risk of several cancers. Alcohol can stimulate the growth of blood vessels in tumors, thereby promoting the spread of cancer. There are reasons to believe that antioxidants may help protect against cancer. Still unresolved is the question of whether moderate drinking might increase the risk of breast cancer, perhaps of colorectal cancer. If increase there be, it must be very small, and it would appear submerged by the cardiovascular benefits. (Remember that heart disease is also women's most frequent cause of death.) Dietary folate may protect drinkers against breast cancer. Individualized risk assessment can be provided only by one's own physician. A recent study found a substantial reduction of prostate cancer, particularly of the more aggressive types, associated with red wine consumption. (Might the wine's contribution of boron have played a role?) Risk of other cancers, including lymphoma and those of lung and ovary, may also be reduced.
Evidence continues to come in suggesting that even modest drinking may be a bad idea for those trying to conceive and during early pregnancy. Both male and female alcohol intakes of ten or more drinks during the week of conception increased the risk of early pregnancy loss. Women who drank four or more drinks per week had increased risk of preterm delivery, especially those who drank seven or more drinks per week. The female offspring of rats fed low to moderate amounts of alcohol during pregnancy developed more breast tumors than those of abstinent pregnancies. Some adolescent children of human mothers who had averaged even fewer than one drink per day during pregnancy continued to exhibit growth deficit.
At the other end of life, mental function is of great concern. Studies continue to demonstrate an association between moderate drinking and a substantial reduction in risk of dementia. Of course, heavy drinking is well known to damage the brain and nerves.
The liver, the canary of the body in its sensitivity to alcohol, surprisingly, in one study of rats, regenerated more briskly after injury if the rats partook of light libation. A study of mice suggested that obesity might increase risk of liver damage from drinking. Cirrhosis of the liver remains the chief fatal consequence of prolonged excessive drinking.
Isolated reports on miscellanea continually appear, then await, hopefully, confirmation, or, fearfully, denial or silence. Although of interest, they should not arouse credence. Moderate drinking has been reported to reduce risk of visual loss from macular degeneration, preserve hearing of the elderly and kidney function, both impair and improve lung function and bone strength. The acidity of wine can erode dental enamel in those who must have wine in their mouths for long periods (e.g., winemakers, buyers, judges). The carbon dioxide of Champagne enhances absorption of alcohol. Extract of a cactus plant suppresses some of the symptoms of hangover.
Finally, I'll offer a general prescription that is largely common sense and mostly heart healthful, but which cannot be taken as individual advice. If no contraindication and you are so inclined, enjoy wine moderately: say two glasses per day for men, one for non-pregnant women. Drinking regularly with meals is probably best. A Russian proverb advises, "Drink a glass of wine after your soup, and you steal a ruble from the doctor." Red wine, with its higher content of polyphenols, is likely more beneficial than white. Do not binge. Drinking excessively risks damage to your liver, brain, heart, and neighbor's automobile. Wine should be used to enrich life, not to medicate it.