Our collective ancestral consciousness has long suspected that
wine, in addition to enriching life, enhances health and prolongs
life. In this age of sceptical and exacting science, we must have
objective data to support such a contention, else we shall lose
credibility.Wine has powerful enemies spreading disinformation.We
must not fall into the easy trap of viewing wine as panacea or
as a medicine.
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
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
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