It may be useful to begin with the conclusions: Moderate consumption of wine improves health and prolongs life, as scientifically demonstrated by hundreds of reported studies. Prolonged abuse of alcohol is dangerous, impairing health and shortening life. Abstention is a risk factor to health and longevity. All this is succinctly illustrated by the J-shaped curve (see figure left - click to enlarge), based on the revelation known dramatically as the French paradox*.

Epidemiologic studies all through the developed world have demonstrated repetitively that moderate drinkers live longer and healthier (and probably happier) than do those who do not drink, and that both of these groups are much better off than those who drink too much. Identical results are found in Western Europe, Canada, the United States, Japan, Australia, New Zealand, Israel, Iceland, and elsewhere, in people of various ages, in both sexes, in blacks and whites. (The benefits of wine, however, are lessened in smokers, and may be increased for those who take aspirin prophylactically.) The major benefit is the reduction of heart attacks, our most common killer.

This phenomenon was termed "the French paradox" because researchers studied middle-aged and older Frenchmen, who, because they smoked too many cigarettes, ate foie gras and other supposedly unhealthy foods, and limited their exercise to bending their elbows, were expected to have a higher-than-average risk of heart attack.

They were found, instead, when they drank moderately (chiefly red wine), to be more protected than similar populations of non-drinkers. Perhaps they were protected by what their elbow flexion brought to their mouths. In fact, this protection extends to arterial blood vessels other than those of the heart — vessels that supply the brain and other organs. (The common form of stroke is also reduced by moderate drinking.)

Alcohol is a two-edged sword. Excessive drinking for many years causes many life-threatening ills, among them heart disease, hemorrhagic stroke, cancers of the liver and, especially in the company of smoking, of the mouth, throat, larynx, and oesophagus. It is not clear whether drinking is associated with small increases in the risks of breast and colorectal cancers. (Alcohol is the only component of wine that may be harmful, but only in excess.)

The liver is the limiting organ, the canary of drinking, in setting safe limits. It is the organ to which the first damage of too much alcohol occurs. Continued abuse may lead to cirrhosis, often fatal. What are safe limits of drinking? Figuring on the liver as the safety alarm, one may estimate that a man may very safely consume an average of fourteen ounces of wine daily all his adult life. (I am referring to the medical safety of the drinker, not necessarily to his performance abilities, which vary widely.) He should not save his week's allotment for weekends, thereby exceeding thresholds of defense.

Sex counts. Women are safe at only half the quatity of alcohol as men, probably because they possess ony half as much of the neutralising enzyme, alcohol dehydrogenase, in their stomachs as do men. So, when my wife and I dine, I get two-thirds of the bottle. Individuals vary.

Let's look at the likely mechanisms by which wine may enhance health, particularly cardiovascular health. Alcohol is thought to contribute about half the benefits. Wine also possess special attributes, not much shared with other potables, contained in the dozens of compounds we may call polyphenolic flavonoids. Several function as antioxidants, as we'll see of great significance in coronary protection, and thus far mainly theoretically in offering of protection against cancer. In protecting against cardiovascular disease, the alcohol and the phenolics work together. The phenolics (resveratrol and quercetin are the two best known) are largely derived from grape skins, so are in maximum concentration in red wines, which are fermented on the skins.

Atherosclerosis, the disease of the normally smooth inner lining of arteries (the intima or endothelium), may begin at relatively early age, but usually doesn't become apparent for years. Its engenderment depends on heredity, diet, smoking, metabolic disorders (e.g., elevated cholesterol, diabetes mellitus), and other factors, possibly including arterial infection. Low-density lipoprotein (LDL), the "bad cholesterol" , is deposited in the intima, leading to degeneration, inflammation, roughening and narrowing. Blood flow slows. The coup de grâce is blood-clot formation, obstructing the artery that had contracted to supply oxygen and nutrients to heart muscle or other tissue, resulting in death of the tissue, the heart attack or stroke.

Here is what wine does to help the poor blood vessels. It (mainly its alcohol) causes the liver to produce more high-density lipoproteins (HDLs), the "good cholesterol." HDLs are like trash collectors: they cart off the LDLs from sites in the walls of arteries, where they do their evil, and carry them to the liver for disposal via the bile. Because it is the oxidized form of LDLs that does the damage, the antioxidant properties of wine (mainly the phenolics) mollify the LDL attack. Wine's alcohol and phenolics, especially when drunk with dinner, inhibit damaging blood clotting by several routes. Early but growing evidence suggests that wine may also abnormal growth of the muscular walls. (We certainly don't want up-tight, muscle-bound blood vessels.)

It had naturally been assumed that the damage to various organs associated with abusive drinking was due directly to the toxicity of alcohol. New data, however, suggests that at least a significant portion of the malign effects of wretched excess is exerted through alcohol's direct descendant, acetaldehyde. The first step in the breakdown of alcohol, mediated by alcohol dehydrogenase, converts the alcohol to acetaldehyde, a highly toxic material that promotes damaging oxidation and other adverse effects leading to diseases of the liver, brain, heart, and other organs, and to cancer. Ordinarily, acetaldehyde is neutralized very quickly, but, due to genetic variations in a portion of certain populations (east Asians, Puerto Ricans), many people accumulate acetaldehyde, so that they may be intolerant of any alcohol or at risk for the damages listed. Here, again, is a possible beneficial role for antioxidants.

Evidence is accruing that potables, wine in particular, may help prevent and eliminate a number of infections, notably those of the gastrointestinal tract. Of great recent interest are reports that wine counters infections of the stomach with Helicobacter pylori (H pylori), a bacterium that causes much of chronic gastritis, the majority of ulcers, and a number of stomach cancers. Like so many of these implications, it is too soon for solid conclusions. A more detailed discussion has been recently published — Finkel H: Wine for thy stomach's sake. Wine News 24:16 (Aug/Sep) 1998. Of even more stunning potential importance is the growing suspicion that the disease of blood vessels that leads to millions of deaths and an enormous range of disability via heart attacks, strokes, amputations, and other catastrophes is contributed to by the same H pylori or other bacteria.

In an arena of similarly dramatic importance, evidence continues to appear suggesting that wine's polyphenolic antioxidants may help to prevent and counter cancers. It has been reported that our friendly phenolics might protect against cancer by:

~Shielding DNA from oxidative damage (perhaps the oxidation is sometimes promoted by acetaldehyde);
~Inducing enzymes that protect against malignant mutation;
~Modulating carcinogenic inflammatory reactions;
~Promoting normal cellular differentiation and maturation;
~Inhibiting growth of cancer cells;
~Enhancing the effects of chemotherapy.

We are in the early days of understanding these mechanisms.An exciting report published by Clúmont, et al., in the highly reliable and critical journal, Blood, on August 1, 1998 (92:996-1002), demonstrated that resveratrol triggered a death cascade of cancer cells, while not harming normal cells.

Myriad other effects of wine consumption are incompletely explored. Some seem beneficial, some adverse, some just the stuff of jokes and epigrams.

I will close with our take-home lesson. With rare exception, mounting evidence indicates that moderate, regular consumption of wine, especially with meals, is beneficial to health and longevity. Abuse of alcohol is clearly damaging to the drinker, often to others. Absention is a likely risk factor. There is no substitute for individual assessment by one's knowledgeable physician.

Do not make the mistake of using wine as therapy. We should use it to enrich life, not to medicate it.

*The basic information is comprehensively reviewed and fully referenced in Finkel HE: Wine and Health: a review and perspective. Journal of Wine Research 1996; 7:157-196 and in Finkel HE: In Vino Sanitas? Savage, MD: Society of Wine Educators, 1998.Tel: (301)7768569 Fax: (301) 776 8578

Dr. Finkel, award-winning wine writer and educator and chairman of the Committee on Health of the Society of Wine Educators, is Clinical Professor of Medicine at the Boston University Medical Center, specializing in hematology and oncology. He writes and lectures internationally on the interrelationships of wine and health.