Assessment and Plan: Red wine
- Red wine may carry exceptional benefits as described. However, a patient must compare the risks with the benefits of drinking red wine. In brief, the special patient populations who should abstain from alcohol use include: patients with hypertension, breast cancer or increased risk of breast cancer, pregnancy, sexually active without contraception, attempting to become pregnant, patients with psoriasis, with a history of or increased risk of esophageal or gastric cancer, with high risk of or history of stroke, patients with liver disease or hepatitis, heart failure, atrial fibrillation or other arrhythmias, patients with addiction, dependence or abuse behaviors, and other various cancers. Please see the “Risks and Benefits of Alcohol” section for further information.
- Red wine, cholesterol, and cardiovascular disease: Consumption of red wine reduces cardiovascular disease risk by increasing HDL (high density lipoprotein or “good” cholesterol) (2,3,4), by reducing LDL (low density lipoprotein or “bad” cholesterol) (2,3), and by reducing fibrinogen levels (4) which may reduce the tendency of the blood to form clots in the coronary arteries resulting in a heart attack.
- Red wine and mortality risk: Gronbaek M et al in Denmark initially studied over 13,000 subjects in 1995 for mortality risk and determined that the relative risk of cardiovascular and cerebrovascular mortality was significantly less for those who had a low to moderate intake of wine (5). Beer intake did not change mortality risk much and drinking spirits increased mortality (5). The same author evaluated 24,000 subjects 5 years later and found that moderate drinkers of wine were found to have a 20% lower mortality due to all causes compared to those who drank other types of alcohol beverages (6).
- Regarding red wine and kidney stones: For each daily 8-ounce serving of the following, risk of kidney stone formation was reduce by the following percentages: coffee with or without caffeine, 10%; tea, 14%; beer, 21%; and wine, 39% (7). A similar study design looked at kidney stone formation in women and found a 59% reduced risk of kidney stones with each 8-ounce serving of wine daily (8).
- Gammon et al found that red wine can reduce the risk of some gastrointestinal cancers and confirmed that smoking will significantly increase this risk. Drinking red wine was associated with a lower risk of esophageal and gastric cancer with an odds ratio of 0.6 with a 95% confidence interval. This translated to 40% lower odds of these cancers occurring in wine drinkers over odds of developing these cancers in controls. Beer drinkers and liquor drinkers were not found to have an association to esophageal and gastric cancer. Of note, smoking significantly contributed to esophageal and gastric adenocarcinoma and the authors of the study expressed that smoking causes about 40% of these cancers. (9)
- Consumption of up to 3 servings of wine daily was associated with a lower AD risk, but did not protect those subjects with a APOE-epsilon 4 allele gene (a genotype established as a risk factor for both sporadic and familial Alzheimer’s disease) (10).
- Sato et al. demonstrated that an ethanol-free red wine extract and trans-resveratrol are cardio-protective against ischemia (restriction in blood supply to tissues) by functioning as a strong antioxidant (11). These findings support the benefits of red wine on heart health which may be a much safer way of obtaining the benefit of resveratrol rather than resveratrol supplements due to safety concerns of lack of regulation, unknown effective dose, and lack of standardization.
References:
1.De Lorimier AA. Alcohol, wine, and health. Am J Surg. 2000;180:357–61. http://www.ncbi.nlm.nih.gov/pubmed/11137687