Fashion (even fad) and health are the motivations ruling attempts at weight control. I fear that fashion is usually more effective than the desire for good health. Just watch television commercials for the huge industry of weight-loss programs. Fashions change. These days, anorexic models are the standards for adolescent girls who want to look like zombies toofrightening. But visit your art museum to see how Rubens, for example, a supreme artist of another age, depicts a previous fleshy ideal of beauty.
Abnormalities of weight, only recently being recognized as illnesses, not just passing cosmetic deviations, are exceedingly difficult to correct and may be part of a complex of disorders. Obesity leads to considerably increased susceptibility to cardiovascular disease (heart attack, stroke, and the like), to diabetes, with all of its dire complications, to wearing down of bones and joints, and on and on. Anorexia is likewise dangerous: witness the tragically premature death of the young, talented, and successful singer Karen Carpenter a few years ago.
Weight gain, especially, and loss continue to be mysteries that science has only begun to understand. To make matters worse for us, bad information abounds. Wine is often characterized as a cause of corpulence, a kiss of death these days for any consumablenot so. Drinking, even moderately, has been accused of causing wastingnot so too. Let’s see just how wine may tend to influence weight, as far as we know thus far.
First, we should review the nutritional makeup of wine. Is it really loaded with calories, with carbohydrates? Is wine a source of vitamins, minerals, other good stuff? No, in both cases. Dry wine provides few calories, about 80 per four-ounce glass, virtually all from its twelve percent alcohol. (Such wine contains about 2.8 grams of alcohol per ounce. Each gram yields seven calories.) Sweet wine and those with more alcohol provide more calories, but not as many as one might fear. Worst case: Port, with 20 percent alcohol and 10 percent residual sugar, would sock us with 178 calories per four-ounce glass, still far less than the rich dessert you were eager to order. As always, moderation rules.
Dry wine contains virtually no carbohydrates (sugars, starches), so is safe for diabetics as long as they eat when drinking (else they may risk dangerous plummeting of blood sugar). Freedom from “carbs” is all the rage now among weight-loss dieters, who must number in the millions. Wine contains no appreciable protein, nor fat. It is a source of only negligible quantities of vitamins and minerals: don’t rely on wine as a nutritional supplement. (Abusers who drink all their calories are doubly endangered, from the alcohol load and from malnutrition.) For those who must restrict their intake of, say, sodium, wine is no threat.
So what is wine? A typical dry wine is 86 or 87 percent water and 12 percent ethyl alcohol (ethanol). Much of the rest is composed of those intriguing polyphenolic antioxidants that color, flavor, and preserve wine, and, along with alcohol, may so enhance health and lengthen life, esters and acids important to smell and taste, and many trace materials. Alcohol is the only component that is harmful if taken in excess, other than in extremely rare cases of specific allergies.
The relationship of drinking to weight seem even more complex and murky than the values and liabilities of various diets. We are well advised to stick to what’s been established by research.
Men and women differ in how they handle calories, especially the calories of alcohol. Men preferentially deposit excess calories as fat on their bellies. Equal calories of wine are less likely than those of beer to give one a “beer belly.” I don’t know why. This is, of course, old news. Women are more likely to pad their posteriors. The difference may be more than cosmetic, for a fat belly has been shown to be a coronary risk factoralso old news.
The weight wiles of women go further. They, more than men, especially when drinking immoderately or compressing their intakes in a short time, are often able to hide calories: they gain less weight than would be calculated for the number of calories consumed. Some observations have suggested that alcohol may have a weight-lowering effect, particularly on women. “The case of the missing calories” remains a mystery. Perhaps alcohol promotes some sort of energy wastage or impairs some metabolic process. Alcohol does not tend to make lean people obese, but it may cause the obese to become more so. Part of the mystery likely reflects contrasting individual differences in handling alcohol.
In general, moderate wine consumption does not lead to weight gain or undesirable changes in body chemistry. On the happy contrary, moderate drinking usually helps correct weight excess and reduce the risks of diabetes and cardiovascular disease by several means. With heavy drinking, particularly when accompanied by a high fat intake, satiety may be difficult to reach, so excessive caloric intake may lead to excessive weight gain in the unfulfilled pursuit of satisfaction. A five-year study from London of 7,608 middle-aged men (Wannamethee SG, Shaper AG: Am J Clin Nutr 2003; 77:1312-1317) reports that consumption of one to three drinks per day did not lead to alcohol-related weight gain. More than three drinks per day, however, “contributes directly to weight gain and obesity, irrespective of the type of alcohol consumed.” Spirit drinkers tended to be heavier than wine and beer drinkers.
As a doctor, I have personally witnessed impressive desired weight loss resulting from dietary restraint enabled by the satisfaction of a modicum of good wine. Seemingly paradoxical is the confirmed observation that elderly people suffering loss of appetite eat with gusto after being given wine. (Their overall health and spirits also improve.) Anorexia in young women may respond in part to small doses of wine. While we have no definitive explanation for the apparently opposing actions of wine, some of what it does is likely influenced by the condition and metabolic idiosyncrasies of who is drinking and by alcohol’s relaxation of emotional tension and depression. This should also raise a caution against the risk of falling into dependency.
Reports of weight-loss programs for the severely obese are pleasant surprises. Those patients drinking between seven and 36 ounces of wine per week lost significantly more weight than those who did not drink or who consumed negligible quantities. Those who drank more than 36 ounces did even better (but that is a borderline or higher quantity than moderate drinking for women). All the wine drinkers sustained additional health benefits during the duration of the study (Dixon JB, Dixon ME, O’Brien PE: Obes Res 2002; 10:245-252). Is this an example of the mysterious wasting of alcohol-associated calories?
Liver disease, ultimately progressing to cirrhosis, is the major fatal medical complication of long-term alcohol abuse. An intermediate stage of liver disease has been observed in heavy drinkers before the progression to cirrhosis and in obese humans who do not drink to excess. Research from Baltimore (Cope K, Risby T, Diehl AM: Gastroenterology 2000; 119:1340-1347) in obese mice may have given us an explanation and a warning. These abstentious mice suffer from liver disease that appears identical to that cited above, the result of alcohol produced by bacteria lolling about in the mice’s guts rendered lazy by obesity. Normally motile intestines are able to propel bacteria to a more innocent fate. Alcohol and weight excess may, therefore, be dangerous companions in some individuals.
The weight of evidence supports moderate drinking as beneficial to the obese, providing the same health benefits others derive, plus possibly easing weight loss. I would be wary of more than moderate quantities for a prolonged period. Those truly needing to put on weight may also find help in moderate drinking. As always, individual medical advice should be sought, but if you’re blaming the wine instead of the whipped cream, it’s time to recalculate your bottom line!
Harvey Finkel, M.D is clinical professor at Boston University Medical Center and a valued member of the AIM Council