Introduction:
Red wine is made from dark red-colored grapes that contains antioxidants called polyphenols. In moderation, red wine may help protect against heart disease by increasing levels of ‘good’ cholesterol and protecting against artery damage. A lower incidence of heart disease is seen among wine drinkers in France, a phenomenon known as “The French Paradox.” Red wine may also be beneficial against kidney stones, gastrointestinal cancers and lower mortality rates. The benefits of red wine are two-tiered, which are due to both the polyphenols and the alcohol content. The ideal amount of alcohol consumption to obtain benefits of reduced risk for a number of disease states appears to be 2-4 drinks per day for men and 1-2 drinks per day for women. (1)
Red wine, cholesterol, and cardiovascular disease:
The relation between red wine (polyphenolic extracts) and risk factors associated with cardiovascular disease was examined as part of a review by de Gaetano G, et al in a European project FAIR CT 97 3261″Wine & Cardiovascular Disease”. Results from a study of 40 healthy volunteers in Barcelona showed a significant increase in HDL (“good”) cholesterol levels and a decreased oxidation of LDL (“bad”) cholesterol after red wine consumption (30 g alcohol daily for 4 weeks) as compared to the same amount of alcohol given as spirit such as vodka, whiskey, gin, tequila, and rum. Additionally, a meta-analysis indicated a significant negative relationship between moderate wine drinking of 150-300 ml daily and the risk of cardiovascular events. In conclusion, moderate wine consumption is linked with prevention of cardiovascular disease. (2)
The effects of dealcoholized red wine (DRW) and regular red wine (RW) on risk factors associated with cardiovascular disease (CVD) in 45 hypercholesterolemic (high cholesterol level) postmenopausal women were analyzed. Participants were randomized to 400 mL/day of either water, DRW or RW for 6 weeks on a controlled diet following a 4-week washout. At the end of the study period, concentrations of fasting lipids, lipoproteins, insulin and glucose were unaffected by DRW intake. However, chronic consumption of RW significantly decreased LDL (“bad”) cholesterol concentrations by 8% and increased HDL (“good”) cholesterol concentrations by 17%. In summary, regular consumption of red wine reduces CVD risk by improving fasting LDL and HDL levels in hypercholesterolemic postmenopausal women. (3)
The present parallel four-armed intervention studied the relationship between cardiovascular disease (CVD) and wine drinkers. Sixty-nine men and women aged 38-74 years old were randomized to either 1: red wine (males: 300 ml/day, 38.3 g alcohol/day, female subjects: 200 ml/day, 25.5 g alcohol/day), 2: water + red grape extract tablets (wine-equivalent dose), 3: water + red grape extract tablets (half dose), or 4: water + placebo tablets. At the end of the 4-week study period, results showed that drinking red wine in moderation increased HDL (“good”) cholesterol by 11–16% and decreased fibrinogen (a protein that plays a key role in blood clotting) by 8–15% compared with drinking water with or without red fermented grape extract. The findings suggested that it was the alcohol component of red wine that is causing these beneficial effects. In conclusion, moderate alcohol consumption in the form of red wine and other beverages is associated with beneficial changes in blood lipids and fibrinogen that may help to reduce the risk of CVD. (4)
Sato et al. demonstrated that an ethanol-free red wine extract as well as trans-resveratrol, one of the major antioxidants found in red wines, protected the hearts from the negative effects of ischemia (a restriction in blood supply to tissues). This was seen after an improvement in post-ischemic ventricular function and reduction of myocardial infarction occurred. Rats were treated with 10 μM trans-resveratrol (RVT), with 0.07% ethanol, or with 0.07% ethanol plus 10 mμM RVT. An hour after reperfusion or blood restoration, the findings suggested that the cardio-protective effects of the red wine were comparable to those provided by trans-resveratrol. (11)
Red wine, cardiovascular and cerebrovascular mortality:
A study done in Copenhagen, Denmark followed 6051 men and 7234 women between 30 and 70 years old. The relative risk of cardiovascular and cerebrovascular mortality was significantly less for those who had a low to moderate intake of wine. It was found that beer intake did not change mortality risk much and that drinking spirits increased mortality. (5)
Wine drinking and all-cause mortality:
Gronbaek et al studied a large group of over 24,000 subjects including men and women age 20 to 98 for a duration of 11 years. Although the types of wine consumed were not clear, 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)
Red wine and kidney stone risk in men:
45,289 men without previous renal stones were followed in the Health Professionals Follow-up Study for formation of stones. Increasing intake of fluid reduced kidney stone formation. Specific types of beverages were found to decrease risk of stone formation. For each 8 ounce serving daily of the following beverages consumed per day, stone formation risk decreased by the following amounts on average: coffee with or without caffeine, 10%; tea, 14%; beer, 21%; and wine, 39%. Also, for each 8 ounce serving of apple juice, stone formation risk increased by 35%, and grapefruit juice increased risk by 37%. (7)
Red wine and kidney stone risk in women:
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)
Red wine and esophageal, gastric cancer risk:
Gammon et al performed a population-based case-control study on 1,143 patients with esophageal and gastric adenocarcinoma and compared them to controls to determine the risk factors of these cancers. The authors found that esophageal and gastric cancer odds ratio was 0.6 with a 95% confidence interval in drinkers of wine which translated to 40% lower odds of these cancers occurring in wine drinkers over controls. Beer drinkers and liquor drinkers were not found to be related to esophageal and gastric cancer. Of note, smoking significantly contributed to esophageal and gastric adenocarcinoma and was believed by the authors to cause about 40% of these cancers (9)
Red wine and Alzheimer’s disease:
The relationship between alcohol consumption and risk of Alzheimer’s disease (AD) and dementia associated with stroke (DAS) was analyzed within a cohort study of 980 participants aged 65 and older. Dementia was diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and classified as AD or DAS. After 4 years of follow-up, 260 individuals developed dementia (199 AD, 61 DAS). Consumption of up to 3 servings of wine daily was associated with a lower AD risk (Hazard ratio = 0.55). Liquor, beer, and total alcohol were not associated with a lower risk of AD. In this study, red wine did not appear to protect those with the APOE-epsilon 4 allele, which is a genotype established as a risk factor for both sporadic and familial Alzheimer’s disease. The relationship between wine consumption and lower risk of AD was seen only in individuals without the APOE-epsilon 4 allele. (10)
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
2.de Gaetano G, Cerletti C. Wine and cardiovascular disease. Nutr Metab Cardiovasc Dis. 2001 Aug;11(4 Suppl):47-50. http://www.ncbi.nlm.nih.gov/pubmed/11894753
3.Naissides M, Mamo JC, James AP, Pal S. The effect of chronic consumption of red wine on cardiovascular disease risk factors in postmenopausal women. Atherosclerosis. 2006 Apr;185(2):438-45. http://www.ncbi.nlm.nih.gov/pubmed/16095600
4.Hansen AS, Marckmann P, Dragsted LO, Finne Nielsen IL, Nielsen SE, Gronbaek M. Effect of red wine and red grape extract on blood lipids, haemostatic factors, and other risk factors for cardiovascular disease. Eur J Clin Nutr. 2005 Mar;59(3):449-455. http://www.ncbi.nlm.nih.gov/pubmed/15674304
5.Gronbaek M, Deis A, Sorensen TI, Beker U, Schnoh P, Jensen G. Mortality associated with moderate intakes of wine, beer, or spirits. Br Med J. 1995;310:1165–9. http://www.ncbi.nlm.nih.gov/pubmed/7767150
6.Gronbaek M, Becker U, Johansen D, et al. Type of alcohol consumed and mortality from all causes, coronary heart disease, and cancer. Ann Intern Med. 2000;133:411–9. http://www.ncbi.nlm.nih.gov/pubmed/10975958
7.Curhan GC, Willett WC, Rimm EB, Spiegelman D, Stampfer MJ. Prospective study of beverage use and the risk of kidney stones. Am J Epidemiol. 1996;143:240–7. http://www.ncbi.nlm.nih.gov/pubmed/8561157
8.Curhan GC, Willett WC, Speizer FE, et al. Beverage use and risk for kidney stones in women. Ann Intern Med. 1998;128:534–40. http://www.ncbi.nlm.nih.gov/pubmed/9518397
9.Gammon MD, Schoenberg JB, Ahsan H, et al. Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst. 1997;45:273–6. http://www.ncbi.nlm.nih.gov/pubmed/9293918
10.Luchsinger JA, Tang MX, Siddiqui M, Shea S, Mayeux R. Alcohol intake and risk of dementia. J Am Geriatr Soc. 2004 Apr;52(4):540-6. http://www.ncbi.nlm.nih.gov/pubmed/15066068
11.Sato M, Ray PS, Maulik G, Maulik N, Engelman RM, Bertelli AA, Bertelli A, Das DK. Myocardial protection with red wine extract. J Cardiovasc Pharmacol. 2000 Feb; 35(2): 263–268. http://www.ncbi.nlm.nih.gov/pubmed/10672859