by HARVEY FINKEL, MD
THE SEMINAL WORK of Serge Renaud, R. Curtis Ellison, and many others during the last 3O years has made the health effects of drinking a perennially hot topic, developing the iconic concepts of the French paradox and the J-shaped curve. Of course, some of our wisest thinkers had been observing and speculating long before, though without the same scientific tools: Drink a glass of wine after your soup, and you steal a ruble from the doctor. (Russian proverb)
We have had left to us similar wisdom by the Psalmist, Hippocrates, the Talmud, St. Chrysostom, Paracelsus, Shakespeare, Pasteur, and others. It has become clear that moderate drinking is associated with enhanced health and fewer deaths, which infuriates some, and that excessive drinking leads to the opposite: . . . problems with alcohol relate not to the use of a bad thing, but to the abuse of a good thing. (Abraham Lincoln)
Analyses of published data derived from both observational epidemiological studies, especially, and controlled laboratory experiments raise questions that cannot be answered by seeking confounders or factors intrinsic to the subjects. There is not always a neat direct relationship between how much one drinks and the resultant effects therefrom. Most studies have neglected to attend to what and how their subjects drink, potentially vital lapses.
Although we have covered some of this ground before, the publication in July, 2O16, of the review, “Drinking patterns of wine and effects on human health: why should we drink moderately and with meals?” by Mladen Boban, Creina Stockley, Pierre-Louis Teissedre, et al., in food & function, a journal of the Royal Society of Chemistry, stimulated me to revisit and expand on the subject. This cogent, well-referenced article is a model of good sense and unbiased reportage dealing with the health benefits of moderate drinking as well as the dire medical and social consequences of abuse. It confronts important aspects of drinking too often passed over. It is truly an international endeavor: authors are from Croatia, Australia, France, Italy, and Germany. was initiated under the auspices of the health-expert group of the International Organization of Vine and Wine (OIV). I became aware of the article soon after its publication when, as a member of the International Scientific Forum on Alcohol Research, I participated in a critique. The Forum, acknowledging that the science isn’t newly revelatory, unanimously approved of the review. I thought it should be made widely available to the general consuming public.
The damage that can be inflicted by alcohol abuse is discussed, and preventive measures suggested. But it is the health effects of moderate drinking on which I want to focus, for there should be no argument or surprise that excessive drinking is, to say the least, unhealthy for the drinker, the drinker’s family, and society. In contrast to abusers and to abstainers, moderate drinkers have a lower risk of heart attack and stroke, of death from all causes, of diabetes and its complications, dementia, and osteoporosis. Most studies estimate the quantity of alcohol their subjects consume, but few have documented the form it comes in or the pattern of its consumption. The Boban review deals with three potentially vital variables, in addition to gross quantity: choice of beverage, time frame of drinking, whether food is consumed while drinking.
The understanding of the influence of beverage choice needs more work, but indications are that wine, particularly red wine, is more healthful than other potables. This is likely due in part to wine’s complement of polyphenolic antioxidants, chiefly derived from grape skins, contained in higher concentration than in other beverages. Perhaps our pattern of use of wine, in smaller allotments with meals, plays a role, as may the general lifestyle of wine drinkers as compared to others.
Consumption of 14 drinks per week may be consistent with good health if, say, the drinker has two glasses with dinner each day, but such a quantity would be dangerous were it all to be consumed in one or two sessions on a weekend. Quantity alone does not determine whether drinking is healthy or not. Binge drinking is always a bad practice, even when the total consumed falls within “safe limits” for the surrounding period of time. The recommended safe range of daily wine intake is, according to the review, 7-1O ounces for men (about 2O-3O grams of ethyl alcohol), 3-7 ounces for non-pregnant women (1O-2O grams).
Finally, the when of drinking. Abundant data support multiple mechanisms strongly favoring the Mediterranean tradition of drinking with meals. Highly oxidative, and therefore damaging, hydroperoxides formed during the digestive period attack the vital vascular endothelium, the inner lining of blood vessels, especially following meals of high fat content – the ones that taste best. Consumption of wine with these meals reduces oxidative damage, activation of blood clotting, and conversion of LDL-cholesterol to its most toxic oxidized form, and protects diabetics from vascular complications. Mealtime drinkers, especially when the drink is wine, are at reduced risk of heart attack. These favorable effects are less pronounced after consumption of well-balanced meals (those lower in fat).
The improvement of the blood’s antioxidant activity after mealtime wine consumption is abetted by the moderately increased plasma uric acid concentration stimulated by wine, which helps neutralize the postprandial oxidative stress. Even unabsorbed phenolic compounds in the intestine after a wine-containing meal contribute to antioxidant effect by scavenging free radicals and absorbing toxic lipid-peroxidation products.
Blood pressure may rise undesirably from drinking outside of meals, while remaining in bounds after mealtime quaffing. Wine appears to stimulate less rise in blood pressure than beer or liquor.
Eating while drinking lowers the blood alcohol concentration and accelerates the rate of elimination of alcohol, a favor to the drinker’s liver and other tissues, perhaps reducing the risks of cirrhosis and cancers of the liver and aerodigestive organs in heavy drinkers.
Wine consumed with food has been shown to protect against infection by food-borne pathogens, both viral and bacterial. Eat your oysters with peace of mind.
LET US SUM UP THE HEALTHIEST WAY TO DRINK FOR THE AVERAGE ADULT:
Limit quantity to the safe range,
recognizing the sex difference.
Drink in regular allotments, not in binges.
Prefer wine, perhaps red more than white.
Drink with meals.
Avoid tobacco while drinking,
and while not drinking.