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The Heart of the Story
"A meal without wine is like a day without sunshine." - Anthelme Brillat-Savarin
Louis Pasture once said, “Wine gives strength, pleasure and joy in living.” With recent findings on the consumption of red wine and its possible health benefits, many health magazines, medical websites and news broadcasts are claiming this phrase may prove to be scientifically true. Red wine has often been associated with fine dining, entertaining family and friends, and relaxation; now it may be implicated in decreasing the risk of coronary heart disease. As journalist Steve Koelher said, the phrase “drink to one’s health” may slowly be changing to “drink for one’s health.” But don’t start toasting just yet; there’s more to the story than simply drinking more red wine.
Hundreds of sources on the web all advertise the same, striking claim: drinking more red wine will improve your health. Specifically, red wine has been said to protect against heart disease. This exciting and surprising finding stemmed from a large scale study which found that even though the French eat “inexcusable amounts of heart-stopping, artery-clogging saturated fats” such as high fat cheese, salami and paté, they have one of the lowest heart attack rates in the world (http://www.askmen.com/sports/health/14_mens_health.html). Their daily and moderate consumption of red wine was determined to be the reason for this phenomenon. News of the “French Paradox,” a name coined by 60 minutes in 1992, led to increased sales of red wine; within weeks, sales of red wine shot up 40% and the following year sales were still up by 39% (http://www.askmen.com/sports/health/14_mens_health.html). Apparently Plato knew what he was talking about when he said, “Nothing more excellent or valuable than wine was ever granted by the Gods to man.” But are the assertions that drinking red wine decreases your chance of developing heart disease scientifically correct? To answer this question we must first look at the claims being made: what is the media telling us about the health benefits of red wine?
Moderate consumption of red wine (one drink a day for women and two drinks a day for men) supposedly lowers the risk of heart attack for people in their middle ages by 30-50%, raises HDL cholesterol (the good cholesterol) and prevents the formation of LDL, the bad cholesterol (http://www.healthcastle.com/redwine-heart.shtml). Red wine contains antioxidants, the compound found in red wine that is “responsible for its healing powers,” and which functions as protection and prevention of disease (http://www.red-wine-and-health.com/). Also, although many of the benefits of wine consumption have been attributed to the alcohol itself, wine contains other components that help protect heart disease, which are not found in either beer or hard liquor (http://wine.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=wine&zu=http%3A%2F%2Fwww.thewinenews.com%2Faprmay00%2Fcomment.html). There must be something special about red wine, then, that accounts for its myriad benefits on cardiovascular health. Red wine contains poly-phenolic flavenoids, which are a form of antioxidant. Flavenoids are found mainly in the skins of grapes, and their concentration tends to be higher in red wines than in white wine, beer, and hard liquor. This is because the skins of grapes are included in fermentation only in red wine; the fermentation of white wine proceeds without grape skins (http://wine.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=wine&zu=http%3A%2F%2Fwww.thewinenews.com%2Faprmay00%2Fcomment.html). The antioxidants in wine and grape juice help reduce blood clotting and inhibit the oxidation of the bad cholesterol, LDL, to its dangerous form; without antioxidant protection, blood clots and oxidation of LDL may eventually result in a heart attack (http://wine.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=wine&zu=http%3A%2F%2Fwww.thewinenews.com%2Faprmay00%2Fcomment.html). So why not just eat a lot of grapes and avoid the alcohol? Apparently, the ethanol in wine accounts for much of red wine’s cardiovascular benefits and may even “enhance the desired actions of the antioxidants in the enriching form of wine” (http://wine.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=wine&zu=http%3A%2F%2Fwww.thewinenews.com%2Faprmay00%2Fcomment.html).
What They Don’t Tell You
Is red wine sounding pretty good right about now? Don’t say “bottom’s up” just yet. The thought that the more red wine you drink, the healthier your heart is an intoxicating idea, almost as intoxicating as the alcohol itself. However, the importance of drinking in moderation can’t be stressed enough. Although there is gathering evidence that red wine does improve cardiovascular health, experts caution that “those health benefits can quickly turn to health risks” if higher than moderate amounts of alcohol are consumed (http://wine.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=wine&zu=http%3A%2F%2Fcbs2chicago.com%2Fhealth%2Flocal_story_326165813.html).
First of all, once you get up to four glasses or more of wine (or the equivalent of that, depending on how much you weigh), blood pressure rises and increases heart risk, which outweighs the initial benefits of red wine (http://wine.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=wine&zu=http%3A%2F%2Fcbs2chicago.com%2Fhealth%2Flocal_story_326165813.html). Also, alcohol addiction is a very real and serious problem. It’s very easy for people to go overboard with their alcohol, and when done on a consistent basis, can lead to serious health problems (http://wine.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=wine&zu=http%3A%2F%2Fcbs2chicago.com%2Fhealth%2Flocal_story_326165813.html). Higher than normal alcohol intake has been said to increase the risk of several types of cancer, damage the liver, cause depression, anxiety and insomnia. Thus, it may be dangerous to encourage red wine consumption as a means to improve cardiovascular health.
The American Heart Association “stops short” of recommending red wine as a way to prevent heart disease. Red wine and other types of alcohol are high in calories, and due to the problem of obesity in our society, using alcohol consumption as a way to improve cardiovascular health should not be encouraged. Walking 30 minutes a day, cutting a few high-fat foods out of your diet and giving up smoking are all excellent ways to lower your risk for heart disease (http://wine.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=wine&zu=http%3A%2F%2Fcbs2chicago.com%2Fhealth%2Flocal_story_326165813.html). As long as red wine is consumed in moderation, it may also contribute to your cardiovascular health, just as long as you aren’t always supplementing your glass of wine with a Big Mac and fries.
Collectively, the literature on health benefits of red wine increases our understanding of how this alcoholic beverage and its components affect the health of our population. The majority of studies, both experimental and epidemiologic, associate moderate consumption of red wine with a protective effect against the development of cardiovascular disease. Although the exact nature of this protective effect still must be established, mechanisms such as LDL oxidation and the effects of both phenolic compounds and alcohol are being recognized as contributory (Wollin, 2001).
Results from a review of 51 epidemiological studies showed that the risk of coronary heart disease decreased by about 20% when 1 to 2 alcoholic drinks were consumed per day in healthy individuals. Those who appeared to benefit from the alcoholic beverages included healthy adults, patients with diabetes, and patients with a history of heart attack (Wollin, 2001). A large Health Professionals Follow-Up Study, which included 38,077 male health professionals who were free of cardiovascular disease, showed that the risk of having a heart attack was decreased by as much as 32% after having 1 to 2 drinks per day, 3 to 4 days per week (Szmitko, 2001). There are problems with these types of studies, however, that may cloud data interpretation (Poikolainen, 1995). Epidemiological research is good for observing trends within a large population but does not necessarily establish whether the trends are representative of what is occurring within the population (Poikolainen, 1995). Therefore, just because some populations who drink more red wine may show lower rates of heart disease, red wine is not necessarily what accounts for the decreased levels of cardiovascular disesase.
A study looking at mortality rates associated with moderate intake of wine, beer and spirits collected observational data in which individual intake of alcohol could directly be linked to cardiovascular disease. This prospective population study followed 6051 men and 7234 women aged 30-70 years. The number and time of cause-specific deaths from 1976-1988 was recorded. The results showed an inverse relationship between red wine consumption and cardiovascular disease mortality rates; increasing intake of red wine decreased the risk of dying. Interestingly, consuming beer and spirits was not associated with a reduced mortality risk. Therefore, the study concluded that low to moderate intake of wine is associated with lower mortality from cardiovascular disease (Gronbaek, 1995).
There are a few problems with this study, however. First of all, the possible different drinking patterns and lifestyle choices made by people who regularly chose a certain drink were not taken into account. For example, in the study, people who chose to drink wine within the population normally consumed a healthy range of 1-2 drinks/day. Also, those who chose red wine as their drink of choice may have been making other lifestyle choices that positively affected the outcome of cardiovascular disease rates. Secondly, differences in consumption patterns were also not taken into account, such as what time of day or how irregularly throughout the day drinks were consumed. Not considering these factors may have affected the observed health benefits (Wollin, 2001). However, the results of this study should not be totally discredited, because red wine has been proven to improve heart health.
Effect of Red Wine on Atherosclerosis
Atherosclerosis, or the hardening of the arteries, is partly due to the amount of LDL cholesterol available for fatty plaque formation in the blood. If oxidation of low-density lipoprotein (LDL) is prevented, the chance of getting atherosclerosis is decreased. A study conducted by Frankel et al. examined whether red wine inhibited the oxidation of LDL in humans. Red wine contains phenolic compounds, and by conducting an in-vitro study of phenolic substances in red wine and their effects on normal human LDL, it was found that red wine inhibits the oxidation of LDL. Therefore, the authors concluded that regular consumption of these antioxidant phenols in red wine caused a reduction in the oxidation of lipoproteins and thus decreases the morbidity and mortality of atherosclerosis (Frankel, 2003). However, this study did not take into account all the possible confounders such as diet, physical activity and other environmental factors that may have also affected LDL properties when comparing subjects. Therefore, the validity of these results must be questioned (Wollin, 2001).
Red Wine or Grape Juice?
Flavonoids are polyphenolic compounds that come from grapes and appear to be the major antioxidant components of red wine. The majority of grape polyphenols are present in the skins and seeds, but the processing of grapes into wine actually increases the available polyphenol content (Wollin, 2001). The question remains, if flavonoids come from grapes and have been shown to protect against cardiovascular disease, then why not just drink grape juice? What’s so special about wine? A study by Miyagi et al. compared the effects of flavonoids from both red wine and grape juice. By comparing LDL oxidation levels in groups that consumed either red wine or grape juice, the authors found that both groups showed inhibited LDL oxidation. Two conclusions were made from this study. First of all, the biological activity of flavonoids, but not ethanol, was determined to contribute to the antioxidant properties of both red wine and grape juice in vitro (outside the body). Secondly, it was also reported that only red wine consumption resulted in LDL resistance to oxidation in vivo (in the body), suggesting that flavonoids in red wine can be absorbed in the intestines more easily than those in grape juice. Ultimately, this study proposes that the consumption of red wine may be better at protecting cardiovascular disease simply because the body can better absorb flavonoids in red wine than in grape juice, which means enhanced protection from heart disease (Miyagi et al., 1997).
Effects of Ethanol
Moderate consumption of ethanol (one to two drinks per day) acts to raise the “good cholesterol,” high-density lipoprotein (HDL) cholesterol. HDL serves as a protective factor against atherosclerotic cardiovascular disease by removing some of the LDL from circulation. This lessens the amount of material available for plaque formation, ultimately decreasing the chance for a heart attack. This was proven by Rakic et al. in a controlled trial involving 55 healthy male drinkers who were recruited on the basis of regular alcohol intake. After randomly assigning subjects to consume varying amounts of alcohol for 4 weeks, and then switching their drinking habits after 4 weeks, it was discovered that moderate ethanol intake produced a significant increase in HDL cholesterol. Drinking more alcohol than average, however, sharply increased the chance for cardiovascular disease (Rakic, 1998). So the protective effects of red wine may have to do, in part, with the ethanol composition in wine.
The Bottom Line
Much of the existing research on the health benefits of alcohol establishes a clear understanding that some benefits exist from both the phenolic compounds and alcohol of red wine itself. Many factors contribute, however, to the prevention of cardiovascular disease and cannot be substituted by simply drinking red wine. Although drinking moderate amounts of red wine may show some protective effects of the heart, lifestyle choices such as exercise and low fat diet also play significant roles in lowering the risk of heart disease. The existing information given by the media on the health benefits of red wine is slightly misleading. Although scientific studies do prove the effectiveness of red wine’s influence on antioxidant levels and inhibition of LDL oxidation, this is only part of the big picture; consumption of red wine alone will not inhibit the development of cardiovascular disease. Further research is warranted on the health benefits of red wine before scientists will admit to any conclusive results regarding its effects on cardiovascular disease. In the mean time, do as the French and enjoy your wine- just don’t overdo it. In the words of Charles Dickens, ". . . fan the sinking flame of hilarity with the wing of friendship; and pass the rosy wine."
Finkel, H. (n.d.). Wine's antioxidant assets. Retrieved Sep. 20, 2005, from Wine News Web site: http://wine.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=wine&zu=http%3A%2F%2Fwww.thewinenews.com%2Faprmay00%2Fcomment.html.
Frankel, E. (1993). Inhibition of oxidation of human low-density lipoprotein by phenolic substances in red wine. Lancet, 341, 454-457.
Gronbaek, M. (1995). Mortality associated with moderate intakes of wine, beer, or spirits.. British Medical Journal, 310, 1165-1169.
Levine, J. (n.d.). Is alcohol good for you?. Retrieved Sep. 20, 2005, from AskMen.com Web site: http://www.askmen.com/sports/health/14_mens_health.html.
Miyagi, Y. (1997). Inhibition of low-density lipoprotein oxidation by flavonoids in red wine and grape juice. American Journal of Cardiology, 80, 1627-1631.
NCERx, (2005). Red wine in moderation can have a positive effect on health. Retrieved Sep. 20, 2005, from Red Wine and Health Web site: http://www.red-wine-and-health.com/
Poikolainen, K. (1995). Alcohol and mortality: a review. Journal of Clinical Epidemiology, 48, 455-465.
Rakic, V. (1998). A controlled trial of the effects of pattern of alcohol intake on serum lipid levels in regular drinkers. Atherosclerosis, 137, 243-252.
Szmitko, P. (2005). Red wine and your heart. Circulation, (111), e10-e11.
Tsang, G. (n.d.). Red wine- heart health benefits?. Retrieved Sep. 20, 2005, from HealthCastle.com Web site: http://www.healthcastle.com/redwine-heart.shtml.
Wollin, S. (2001). Alcohol, red wine and cardiovascular disease. Journal of Nutrition, 131, 1401-1404.
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