Wine Advisor: One drink healthy, two not so much?

[Robin Garr]

One drink healthy, two not so much?

A new Canadian study of the heart-healthy benefits of beverage alcohol suggests that this medicine may be best taken in small doses.

Many previous studies have suggested that the beneficial effects of alcohol, particularly red wine, on cardiovascular health increase with dosage.

This intriguing finding - which has kicked up world sales of red wine since it was first publicized as "The French Paradox" during the 1990s - is complicated by the undeniable health hazards associated with over-consumption. Drinking to excess to protect your heart offers cold comfort if you poison your liver or lose your life in a drunken-driving accident in the process.

As it turns out, the issue may be moot, if researchers at the Peter Munk Cardiac Centre of the Toronto General Hospital are on track in a study published this month in the American Journal of Physiology, Heart and Circulatory Physiology and summarized in a press release from University Health Network.

"After one drink of either red wine or alcohol, blood vessels were more 'relaxed' or dilated, which reduced the amount of work the heart had to do," according to the summary report. "But, after two drinks, the heart rate, amount of blood pumped out of the heart, and action of the sympathetic nervous system all increased. At the same time, the ability of the blood vessels to expand in response to an increase in blood flow diminished. This counteracted the beneficial effect of one drink of red wine or alcohol."

What's more, those who love Pinot Noir, Cabernet Sauvignon or Shiraz will be further disheartened to learn that the Canadian group found no difference in the effects of red wine or any other form of beverage alcohol.

"We had anticipated that many of the effects of one ethanol drink would be enhanced by red wine," reported Dr. John Floras, director of cardiology research at the Peter Munk center. "What was most surprising was how similar the effects were of red wine and ethanol. Any benefits that we found were not specific to red wine."

Participants attended three morning sessions, each two weeks apart, in which they consumed random samples of water, 1.5-ounce glasses of ethanol and 4-ounce glasses of a moderately priced Pinot Noir selected by the Liquor Control Board of Ontario for its high content of resveratrol, an anti-oxidant found in red wine.

Researchers found that one sample of either red wine or alcohol had no effect on heart rate, brachial artery dilation or sympathetic nerve activity. A second drink of either beverage, however, did increase sympathetic nerve activity, heart rate and the amount of blood the heart pumps out, and also blunted the ability of the brachial artery to expand further in response to blood flow. These responses, researchers said, "are recognized markers for high blood pressure, heart failure and sudden death."

Floras concluded: "Our findings point to a slight beneficial effect of one drink – be it alcohol or red wine – on the heart and blood vessels, whereas two or more drinks would seem to turn on systems that stress the circulation. If these actions are repeated frequently because of high alcohol consumption, these effects may expose individuals to a higher risk of heart attacks, stroke or chronic high blood pressure."

I'm not panicking just yet. Before you make any lifestyle decisions based on the Canadian finding, it should be noted that the study was limited to 13 volunteers - seven men and six women, ranging in age from 24 to 47, described as "healthy, non-smoking adults who were not heavy drinkers or total alcohol abstainers." Indeed, Floras pointed out, " ... this study measured the effects of these drinks on one occasion only. The effects of daily wine or alcohol intake may be quite different."

My advice remains, as it has since the first appearance of the French Paradox: Wine consumed in moderation by non-alcoholic adults is certainly benign and may be beneficial. If you choose to enjoy wine, do so moderately as part of a healthy lifestyle of sensible diet and exercise. But it's silly to take it as medicine.

If you'd like to evaluate this report for yourself from primary and secondary sources, here are some useful links:

* The news release on University Health Network:
http://www.uhn.ca/news/Index.asp?ID=5092&category=8

* The abstract of the full study in the American Journal of Physiology, Heart and Circulatory Physiology:
http://ajpheart.physiology.org/cgi/content/abstract/294/2/H605
(The abstract is free. Should you wish to purchase the complete report, it's available in text or PDF format for $8. Click the links This Article, Full Text or Full Text (PDF) on the right-hand side of the abstract page.

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One of the most disturbing pieces of evidence in the debate about the health effects of wine is the suggestion that the benefits of wine may be the same as the benefits of drinking (unfermented) grape juice!
If there is ever a justification for suppressing scientific knowledge, this must be something to keep quiet about.
Heaven knows what the tea-totallers would do with such information.

The paper in question also compared a solution (diluted) of alcohol, and found similar effects. However like all studies its not perfect. I've posted a few comments on my blog here. The study was set up so that the first drink (of 155 mls) was consumed in 5 minutes; that's pretty fast - at least for me. Both drinks were consumed in about an hour, which seems reasonable consumption, although that is 310 mls or close to half a 750 ml bottle. The other thing for which I am trying to get clarification is the amount of alcohol consumed. They state that each drink contained 18.6 grams of alcohol. This was based on calculations using 12% ABV. Now 155mls at 12% ABV equals 18.6 mls of ethanol but not 18.6 grams because the density of ethanol is 0.789g/ml. So 155 mls is 14.7 grams of alcohol. That means that for two drinks the study subjects would have consumed 29.4 grams rather than the 37.2 implied in the study.

The other thing I had trouble with was what defines a “drink”? The definition of a standard drink varies widely from country to country. For example in the UK its 7.9 grams of alcohol while in Japan its 19.75 grams. That is a 2.5 fold difference. And that is reflected in the drinking guidelines for the same countries. I’ve also made some comments on this on my blog here.

What is the take home message? Its quite simple. When you see a report proclaiming the good (or bad) health effects of wine (or alcohol) consumption make sure you check how much alcohol (weight or volume) was involved. Don’t just rely on information about how many drinks are recommended.

When I hear back from Dr. Spaak about the amount of alcohol used in the study I’ll post that information.

Mike

One of the most disturbing pieces of evidence in the debate about the health effects of wine is the suggestion that the benefits of wine may be the same as the benefits of drinking (unfermented) grape juice!
If there is ever a justification for suppressing scientific knowledge, this must be something to keep quiet about.
Heaven knows what the tea-totallers would do with such information.

Citation, Paul? Everything I've read in the scientific and biomedical literature suggests otherwise. Beyond the demonstrated health benefits of moderate alcohol consumption, the amounts of resveratrol and polyphenolics in unfermented grape juice are paltry compared to that found in wine, since alcohol assists in the extraction of those molecules from the grape skins during fermentation.

Mark Lipton

Robin, a few thoughts:

1. This study is principally concerned with vasodilation, a known effect of alcohol that is also responsible for the warm feeling and flushing associated with alcohol consumption. However, vasodilation is only one of a myriad of effects produced by wine.

2. The use of "drink" as a unit of measure worries me. How much alcohol in a drink and how quickly was it consumed? People's abilility to absorb and metabolize alcohol differ considerably -- was this factored in to the study?

3. The proposed health benefits of wine go well beyond cardiovascular health. There is also substantial evidence for activity against cancer, Alzheimer's, Parkinson's, diabetes and perhaps even life prolongation. In these cases, there is plenty of evidence to suggest a marked difference between wine and grain alcohol.

4. A recently published Danish study shows that alcohol consumption was as beneficial for cardiac health as exercise and that the amount consumed was largely irrelevant.

Mark Lipton

[Robin Garr]

2. The use of "drink" as a unit of measure worries me. How much alcohol in a drink and how quickly was it consumed? People's abilility to absorb and metabolize alcohol differ considerably -- was this factored in to the study?

Mark (and Mike) ... I'm almost certain (without looking back - on deadline now) that the abstract and news release specifically defined "drink" as 4 ounces for the wine and 1.5 ounces for the ethanol.

I may be naive here, but I thought the standard unit for a "drink" was pretty generally agreed upon in the research community for beverage alcohol studies. There's plenty of room for weasel wording in this arena, but I don't think drink size is one of them.

Until the size of the study group (which was ONLY 13 people) equals or exceeds the size of the healthy adult population of France that consumes a moderate amount of wine, I'll take no credance in the results..................

abstract and news release specifically defined "drink" as 4 ounces for the wine and 1.5 ounces for the ethanol.
.

I thought for most studies they consider 5 ounces of wine a drink (and if 155 ml as cited that is about 5 ounces using in my head math). In which case the ethanol should be diluted to about 40% alcohol to be equivalent- 1.5 ounces of Everclear™ is way more than a glass of wine.

I'm not giving up my second glass of wine, though medical benefits has never been my reason for wine. This study (very small) examines just one potential way that alcohol can help health (see Mark's points 1, 3, and 4)

2. The use of "drink" as a unit of measure worries me. How much alcohol in a drink and how quickly was it consumed? People's abilility to absorb and metabolize alcohol differ considerably -- was this factored in to the study?

Mark (and Mike) ... I'm almost certain (without looking back - on deadline now) that the abstract and news release specifically defined "drink" as 4 ounces for the wine and 1.5 ounces for the ethanol.

I may be naive here, but I thought the standard unit for a "drink" was pretty generally agreed upon in the research community for beverage alcohol studies. There's plenty of room for weasel wording in this arena, but I don't think drink size is one of them.

Robin,

Yes, in the intro to the paper they state “In this context, because they contain a comparable amount of alcohol (15–18 g), each of a 12-oz bottle of beer (355 ml), a 4-oz glass of wine (120 ml), and a 1.5-oz (44 ml) shot of spirits is considered one standard “drink”.”” But this is simply used to compare alcohol between the different types of alcoholic drinks. This makes it easier for someone who mixes their drinks to work out how many drinks they have had. But there is no such thing as an internationally accepted definition of a standard drink. Drinking guidleines come closer a standard because they inclued daily/weekly consumption. But even here there can be wide differences. In Spain the Basque Country: Department of Health and Social Security recommends that you not exceed 70g/day - that would be a complete no-no in Australia where they say 20-40 grams per day but never more than 6 standard drinks (60g) in one day! (See here).

The problem I have with the paper using the term drink is simply because the term is not that useful (e.g in Australia one drink is 10 grams of alcohol, in the USA 14, in Japan 20). Another concern is that the study made one drink equal to 18.6 grams of alcohol (by their calculation). That is higher than most countries, except Japan. So if you are someone who sticks to the definition of a drink as 120 ml of wine (12% ABV) and you see the press on this study then you might think that you are better off not having a second drink. But this study did not look at the effect of 14.4 ml (or 11.4 grams) of alcohol (the alcohol in 120 ml of a 12% ABV wine); its also possible that two drinks or 22.8 grams might do the same as their one drink. The problem as I see it is that they (including the press) should not be talking about how many drinks but about how much alcohol.

Mike

Unfortunately science is always flip flopping on these studies, or rather, new studies come out to disprove older ones. I think worrying about whether you should have a second glass is worse than just having it .

If ever a topic was sure to inspire wishful arguments ...

However! Thanks Robin for posting. As a rank layman in the health sciences I'm not qualified for much opinion here, whereas I believe Mark L does research related to some of those

resveratrol and polyphenolic

substances in wine. A couple second-hand observations though:

1. A regular blind-wine-tasting friend who's a high-profile academic biologist (and amateur winemaker for decades) follows this literature more than most journalists do. He has said for a few years that, much as he might wish otherwise, health benefits of alcoholic beverages reported in the literature on the whole have correlated consistently only with alcohol content, not beverage type.

2. Various things we do (exercise, coffee, foods) affect blood pressure, with characteristic time "footprints," e.g., coffee has a BP-raising footprint of some hours that (interestingly) has different onset and longer duration than its stimulant effect on the nervous system. Vigorous exercise tends to work the (soft-muscle) blood-vessel tissues, and leave a residual BP reduction for a day or two, I've measured this many times myself. (Side note: Serene social activities such as card-playing or taste-and-spit wine tasting also reduce BP, at least in the short term!) Cheeses and red wines are among the foods I've read about with a BP-increasing effect of intermediate (like 12-18 hour) duration. Maybe someone has collected the food and drink BP-footprint data in consistent form; if not, it would be very useful.

3 [Afterthought]: My regular physician, a cardiologist and wine geek, has remarked for years a professional rule of thumb that a little wine lowers your BP, and a larger amount raises it.

Unfortunately science is always flip flopping on these studies, or rather, new studies come out to disprove older ones. I think worrying about whether you should have a second glass is worse than just having it .

Hello Peter, and welcome to the forum. I hope you find us interesting and that you stay around and talk wine and other subjects with us.

i saw this topic the other day and wanted to rejoin to comment (I was a member a while ago but got lazy)
Anyway, this is a common topic in my wine job...

this study sounds bogus, because of the technique - a drink in 5 minutes? Huh?

I never believed wine had special health powers of any kind - I've always thought it was just that the type of person who enjoys wine with their meals and drinks in moderation is just a healthier person, mentally and physically - it's a symptom not a cause

I don't trust drinking and health studies, at least I've never seen one I trusted

I think that casual drinking of a glass of wine every hour to one hour and a half over an evening is a lot different from chugging a glass or a shot of booze then testing your BP, then doing it again.

Peter's comment about worrying about a second glass is bang on.

I drink wine (and beer and spirits) as part of my life and I don't generally count. But I do watch my health, get regular liver and blood tests, I exercise, etc.

I don't know anyone who seriously loves wine who doesn't finish at least a bottle between 2 people (and often 2 bottles) when staying home and enjoying a nice dinner and evening with their spouse or friends. Any doctors I know are the same...

No one is getting stinking drunk. it is not binge drinking by MY definition

i think the people conducting these studies mistakenly try to extrapolate from moderate drinkers to drunks. Moderate drinkers may have a drink or two over a relaxing lunch (or not), and may drink a whole bottle at night (from 5-midnight, say) - possibly never getting legally impaired (depending on the laws where you live -- I'm talking 0.08 here).

A "drunk" might have a few drinks in them by breakfast, and some are constantly impaired.

You can't draw a line between these groups, so don't try. They should not be included in studies together.

And another problem with any booze studies is that people always lie about consumption.

I would only trust a study where there was absolute control over consumption,and they looked at specific effects on the body (liver, mainly) from 0 drinks per day up to maybe 10, but consumed gradually, with no binging. And there would need to be a tonne of data to make any differences significant (I'm a stats guy).

THAT would be an interesting study.

has anything like that been done?

One of the most disturbing pieces of evidence in the debate about the health effects of wine is the suggestion that the benefits of wine may be the same as the benefits of drinking (unfermented) grape juice!
If there is ever a justification for suppressing scientific knowledge, this must be something to keep quiet about.
Heaven knows what the tea-totallers would do with such information.

Citation, Paul? Everything I've read in the scientific and biomedical literature suggests otherwise. Beyond the demonstrated health benefits of moderate alcohol consumption, the amounts of resveratrol and polyphenolics in unfermented grape juice are paltry compared to that found in wine, since alcohol assists in the extraction of those molecules from the grape skins during fermentation.

Mark Lipton

Mark, Here is a citation. Not to be taken too seriously!

Willett WC.
Ask the doctor.
For the health of my heart and arteries, how does regular consumption of red wine
compare with grape juice or the equivalent in grapes?.
[Journal Article] Harvard Heart Letter. 17(7):7, 2007 Mar.
UI: 17378077
Paul.

So much to do about nothing. I have known tons of people who drink way more wine than recommended by health professionals who live long, engaging lives. For those who were born more recently, just look at Michael Broadbent.

Before worrying about how much wine one drinks, it would be lots more beneficial to bring body weight into the recommended range, refrain from any smoking, stay away from too much saturated fat, get enough exercise, and stay off the street after midnight.

I have completed all this and expect to live to 90 while drinking at least a bottle of wine at any wine sitting. To help dial myself into the best possible (while still drinking wine) shape, I enlisted the help of a cardiovascular internist. And for a mere $200 (health insurance won’t pay for this of course) you can get a CAT scan of your coronary artery plaque from which you can adjust your diet. From my efforts, I have zero.

The doctor asked how much, if anything, I drank. When I told him, he said I was not drinking properly for my health. I said I wasn’t drinking for my health; I don’t have to, and neither does anybody else, if they take the proper responsibility.

..................The other thing for which I am trying to get clarification is the amount of alcohol consumed. They state that each drink contained 18.6 grams of alcohol. This was based on calculations using 12% ABV. Now 155mls at 12% ABV equals 18.6 mls of ethanol but not 18.6 grams because the density of ethanol is 0.789g/ml. So 155 mls is 14.7 grams of alcohol. That means that for two drinks the study subjects would have consumed 29.4 grams rather than the 37.2 implied in the study.

When I hear back from Dr. Spaak about the amount of alcohol used in the study I’ll post that information.

Mike

AN UPDATE: Dr Spaak has confirmed that the calculation of alcohol content used was in error, and will be corrected.

Mike

This study, as noted above, only looked at vasodilation. Alcohol (not specific for type) use raises "good" cholesterol. This is particularly important for people who might not have an overall high cholesterol count, but who have bad "good cholesterol/bad cholesterol" ratios. Link- http://www.bidmc.harvard.edu/display.asp?node_id=4951

This study, as noted above, only looked at vasodilation. Alcohol (not specific for type) use raises "good" cholesterol. This is particularly important for people who might not have an overall high cholesterol count, but who have bad "good cholesterol/bad cholesterol" ratios. Link- http://www.bidmc.harvard.edu/display.asp?node_id=4951

I opined earlier that to live to 90 or beyond (save those who are dealt a bad gene or two) you only need to watch your weight, don't smoke, exercise, and watch your cholesterol via saturated fat. After posting this, I read a study citation in today's NYT that adds blood pressure maintenance and keeping from getting diabetes (stay thin and don't guzzle sugar) to the regimen for longevity, but suggests that cholesterol is not a problem - ostensibly if you stay thin. Doctors have told me, and I pretty much accept it, that if you are thin you can virtually eat what you like, as long as you eat enough good things to get vitamins, etc. The study could not confirm that alcohol helps anything. The idea of drinking for your health seems like something a person prone to BSing himself might talk about to rationalize drinking - until after the second glass, at which time the person would have to change the subject.

I opined earlier that to live to 90 or beyond (save those who are dealt a bad gene or two) you only need to watch your weight, don't smoke, exercise, and watch your cholesterol via saturated fat. After posting this, I read a study citation in today's NYT that adds blood pressure maintenance and keeping from getting diabetes (stay thin and don't guzzle sugar) to the regimen for longevity, but suggests that cholesterol is not a problem - ostensibly if you stay thin. Doctors have told me, and I pretty much accept it, that if you are thin you can virtually eat what you like, as long as you eat enough good things to get vitamins, etc. The study could not confirm that alcohol helps anything. The idea of drinking for your health seems like something a person prone to BSing himself might talk about to rationalize drinking - until after the second glass, at which time the person would have to change the subject.

I lack the expertise to opine. However, my doctor has a pretty strong opinion, and it is that I should keep drinking (in moderation). I have low cholesterol (low as in 2 digit cholesterol) but a TERRIBLE good/bad ratio. The statins don't help with that. The two things that do are Niaspan and alcohol. The only real problem I'm having is getting my insurance to pay 80% for a nice '82 Bordeaux.

4. A recently published Danish study shows that alcohol consumption was as beneficial for cardiac health as exercise and that the amount consumed was largely irrelevant.

Mark Lipton

Mark
I agreed with all your points until this last one which, having read the original Danish study [which was extensively discussed in another forum], seems to be way off what was concluded. I can find no reference to anything which indicated that 'the amount [of alcohol] consumed was largely irrelevant'.

The main conclusions appeared to be 'Drink moderately and exercise - up to 2 drinks per day - and live longer' and 'Drink a lot and don't exercise and die early'.

However, my doctor has a pretty strong opinion, and it is that I should keep drinking (in moderation). I have low cholesterol (low as in 2 digit cholesterol) but a TERRIBLE good/bad ratio. The statins don't help with that. The two things that do are Niaspan and alcohol. The only real problem I'm having is getting my insurance to pay 80% for a nice '82 Bordeaux.

I don't know what to believe about the cholesterol issue. Studies seem to condradict one another with regard to it. The ratio could be a problem. Are you of normal weight? I think the issues might get confused. The truth might be that if you are thin you have less chance of having a cholesterol problem, even if you eat a lot of fat. But maybe if you are thin and still have a cholesterol problem, possibly from genetics, maybe that is a problem. If you are heavy and have a cholesterol problem, it might be lessened by losing weight. In my case, just by going from 195 to 175 lbs. brought moderately poor cholesterol numbers into line. Blood pressure came down nicely, too. I eat lots of lamb, skin on my chicken, cheese, etc., but if the scales go up even to 177, I scale back.

But even if drinking a bottle of '82 Bordeaux at a rip might slightly increase the chances of certain diseases, such as liver problems, the increase in quality of life probably justifies the practice.

I agreed with all your points until this last one which, having read the original Danish study [which was extensively discussed in another forum], seems to be way off what was concluded. I can find no reference to anything which indicated that 'the amount [of alcohol] consumed was largely irrelevant'.

The main conclusions appeared to be 'Drink moderately and exercise - up to 2 drinks per day - and live longer' and 'Drink a lot and don't exercise and die early'.

Well, as they defined "moderate consumption" it was 1-14 drinks per week, which is a fairly big spread, but you're right that they draw a big distinction between moderate and heavy consumption.

Mark Lipton

However, my doctor has a pretty strong opinion, and it is that I should keep drinking (in moderation). I have low cholesterol (low as in 2 digit cholesterol) but a TERRIBLE good/bad ratio. The statins don't help with that. The two things that do are Niaspan and alcohol. The only real problem I'm having is getting my insurance to pay 80% for a nice '82 Bordeaux.

I don't know what to believe about the cholesterol issue. Studies seem to condradict one another with regard to it. The ratio could be a problem. Are you of normal weight? I think the issues might get confused. The truth might be that if you are thin you have less chance of having a cholesterol problem, even if you eat a lot of fat. But maybe if you are thin and still have a cholesterol problem, possibly from genetics, maybe that is a problem. If you are heavy and have a cholesterol problem, it might be lessened by losing weight. In my case, just by going from 195 to 175 lbs. brought moderately poor cholesterol numbers into line. Blood pressure came down nicely, too. I eat lots of lamb, skin on my chicken, cheese, etc., but if the scales go up even to 177, I scale back.

But even if drinking a bottle of '82 Bordeaux at a rip might slightly increase the chances of certain diseases, such as liver problems, the increase in quality of life probably justifies the practice.

No question I'm heavier than I should be, but the primary problem is genetics. My father had a sextuple bypass with a total cholesterol count of 150.

As for the Bordeaux, heck, the doctor prescribes it and I'm perfectly willing to take on the 20% copay. Doesn't that seem reasonable?

No question I'm heavier than I should be, but the primary problem is genetics. My father had a sextuple bypass with a total cholesterol count of 150.

Yikes. You might want to get that CAT scan of your coronary arteries that I mentioned. That will tell you if you have a potential problem coming.