Most of us are more interested in the effects of moderate drinking
on the risks of getting various diseases, and we have become aware
that risks are often reduced thereby. It is surprising, however,
to come across evidence that moderate consumption of wine may
reduce the risks of upper gastrointestinal inflammation, ulceration,
and even cancer, apparently by combating infection. One more surprise
will complete the setting, one that virtually no one in the medical
profession had suspected; much of gastritits, the large majority
of peptic ulcers, and a substantial proportion of cancers of the
stomach, both the more common and especially deadly carcinomas
and the far less common lymphomas, are caused by chronic infection
by the bacterium Helicobacter pylori (H pylori).
Let us consider the credentials of alcohol as an anti-infective
agent. Although abuse may impair immunity, moderate consumption
of alcohol, particularly as wine, may help protect against infection,
supported first by lore, then by observation, finally by science.
The first notation of a J-shaped curve reported that moderate
drinking appeared to offer protection against tuberculosis. Drinking
has been shown by controlled experiment to reduce susceptibility
to the common cold.
It is in the gastrointestinal tract that wine is most salubrious
in protection from infections, largely, in the tropics, as substitute
for contaminated water carrying the agents of infectious diarrheas.
Claret was drunk in British army messes in India as "sovereign
preventative against the prevalent cholera". Alois Pick demonstrated
in Paris a century ago during a raging cholera epidemic that diluted
wine killed the offending bacteria in 15 minutes. Wine and spirits
(not beer) were reported to protect against hepatitis carried
by raw oysters.Undiluted wine proved superior to other solutions,
including alcohol, tequila, and is a widely used diarrheal remedy
in quickly reducing the bacterial counts of Escherichia coli,
Salmonella typhimurium, and Shigella sonnei, causes of "traveller’s
diarrhea," typhoid-like disease, and bacillary dysentery.The researchers
believed that the antibacterial agent in wine is a polyphenol
liberated during fermentation, that it is most active in the acid
conditions found in the stomach, and that the antimicrobial properties
increase with the age of the wine, peaking at about ten years,
then falling off gradually. We should recall that some polyphenols
function in the vine to protect it from infection.
Getting back to our villain, H Pylori,, we find increasing evidence
that this bacterium, not alcohol, causes the chronic gastritis
that distresses so many, especially alcoholics. In a study of
alcoholic patients with dyspepsia due to chronic gastritis, neither
abstinence (in the hospital) nor anti-acids relieved the condition,
but antibacterial treatment to eliminate H pylori led to significant
improvement.
Uninfected alcoholics are not unduly susceptible to gastritis.
Alcoholics are more likely than average to be infected with H
pylori, probably more because of their background and lifestyle
than the alcohol abuse directly. Many millions are infected with
this bacterium, more likely amidst crowded and imperfectly sanitary
conditions. It is believed that most infections begin during childhood,
and persist until treated. H pylori can grow and multiply in water
and soft drinks, and spread from one person to another easily,
especially in families, by, say, the sharing of drink containers.
Among adults living in decent conditions, however, moderate or
higher consumption of alcohol has recently been reported as protective
against H pylori, more likely by eliminating infection than by
preventing it. (Coffee is associated with increased risk of infection)
There is a glimmer of suspicion about H pylori’s role in cardiovascular
disease. While we know that wine may aggravate heartburn, a very
large study has shown no increase of risk of duodenal ulcer associated
with alcohol, coffee, or even smoking. It is now believed that
the vast majority of ulcers are caused by H pylori.
What of cancer? Frank and prolonged abuse of alcohol increases
risk of certain upper gastrointestinal cancers, particularly when
combined with smoking. H pylori is a cause of gastric cancers,
so moderation of consumption and abstinence from smoking should
reduce this cancer risk. Now we are presented evidence that the
risk of carcinomas of the upper stomach and lower esophagus is
decreased by drinking wine. (Beer and spirits, however, offer
no such help.) Hundreds of residents of Connecticut, New Jersey,
and Washington state were studied, along with suitable controls.
Those who had only drunk wine had only 60 percent as much risk
of developing adenocarcinoma of the esophagus or upper stomach
(cardia) as those who had not. Another type of cancer of the esophagus,
squamous cell carcinoma, was also at the same reduced risk in
wine drinkers, but a considerably higher risk for beer drinkers
(double abstainers’) and liquor drinkers (triple).Even after adjusting
for other variables, the investigators found increasing levels
of education and income associated with reduced cancer risk. The
mechanism of risk reduction, via H pylori elimination or others,
is unknown.
Shall we get our take-home lesson from Paul? Drink no longer water,
but use a little wine for thy stomach’s sake and thine often infirmities.–I
Timothy 5:23
Dr. Harvey E. Finkel is clinical professor of medicine at the
Boston University Medical Center, and chairman of the Committee
on Health of the Society of Wine Educators. He writes regularly
on the inter-relationships of alcohol and health.
