Grape Expectations - Could wine really be the best medicine?

Grape Expectations

Could wine really be the best medicine?

By Dr Edward Fitzgerald

“In vino sanitas” – In wine there is health. Pliny the Elder (AD 23-70)

Imagine a day when the British National Formulary contains a chapter on wine prescriptions. Sounds a little far-fetched? Or perhaps too good to be true! For over 5,000 years wine has been one of mankind’s oldest medicines, a fact sometimes overlooked in today’s high-tech world of medical intervention. Indeed, the strength of the anti-alcohol lobby together with the damages of excess we witness every week serves to remind us of its constant harm; rather ironic given that, after publicans, doctors are by far the most alcoholic profession. Yet recently the Department of Health increased their recommended maximum weekly alcohol limits. Why? A burgeoning mountain of evidence now supports the centuries old notion that sensible alcohol intake actually improves health. In a 1997 BMJ review Sir Richard Doll recalled prescribing an ounce of whisky in the 1930’s for a patient with lobar pneumonia. With credible scientific evidence that alcohol (particularly wine) can ward off a variety of ills, might this day come again?

“Drink no longer water, but use a little wine for thy stomach’s sake and thine often infirmities” 1 Timothy 5:23

Recipes for wine-based medicines appear in Egyptian papyri dating back to 2200BC. Better documented is the work of Hippocrates in ancient Greece, who used wine as a disinfectant for wounds, for sedation, intestinal disease and as part of a healthy diet. Wine was regularly added to water in Roman times to improve hygiene. In medieval Europe, monasteries, schools, universities and hospitals all recognised the benefits of wine, still seen in their ownership of vineyards today. More recently the development of the American “temperance movement” during the 1800 & 1900’s led to a re-evaluation of alcohol in society and its gradual fall from favour as medical treatment – except, perhaps, for doctors themselves!

Thankfully the past 20 years have seen a snowballing of research into the positive health benefits of wine consumption. Since the era of prohibition the idea that alcohol is only harmful has been firmly ingrained in western minds. The late 1970’s saw a turning point with the publication in the Lancet of an epidemiological study by Selwyn St Leger et al. This examined a variety of factors associated with deaths from ischaemic heart disease, and the surprise discovery was a strong negative association between deaths from ischaemic heart disease and alcohol consumption. Interest in this area slowly picked up, culminating in the publication of the now famous “French Paradox” paper in 1992 by Dr. Serge Renaud from the French Health Research agency, INSERM. This highlighted an infuriating fact: the French can stuff themselves silly with saturated fatty foods, smoke 10 Gauloises a day and still have a lower rate of coronary heart disease than other western countries. Again, the main difference between French data and that for other countries was the average wine consumption. This story went on to become international news when the prime-time American NBC televison program “60 Minutes” aired its story of the “French Paradox”. American wine sales went through the roof overnight. Never let it be said that the American public is easily persuaded…

“Wine is the most healthy and hygienic of beverages” Louis Pasteur (1822-1895)

Any study to correlate alcohol consumption and health benefit is extremely difficult. Differentiating between the drinker and the drink poses many problems. In America wine drinking correlates with increased income, itself strongly correlated with increased life expectancy. The wine-rich French diet also contains more fresh fruit, already shown to have a beneficial effect on health. Control non-drinkers may be abstaining for reasons of poor health or conversely to maintain a supposed healthy, fitness-driven lifestyle, both of which can potentially skew results. The addition of the Copenhagen Study to this debate (Gronbaek et al, BMJ, 1995) provided further supporting evidence. This attempted to control many of these variables and followed 13,000 thirty to seventy year-olds over 10-12 years. Their results showed a relative risk reduction in death from 1.00 for subjects who never drank to 0.51 (95% CI 0.32 to 0.81) for those who drank three to five glasses of alcohol a day. With the addition of other epidemiological studies the shear weight of supporting evidence is now sufficient to persuade the most ardent abstainer that a tipple might just tip the balance in their favour.

A pattern has gradually begun to emerge, revealing a U-shaped mortality curve. The risk of death from all causes decreases from subjects who never drink to subjects who drink up to three or four glasses of wine a day, with the risk of death from vascular disease and stroke in these subjects reduced by up to a third. Beyond three to four glasses a day the risks begin to rapidly rise again. Further research has shown that hypertension, kidney stones and peptic ulcer occurrence all follow the same U-shaped curve with a significant benefit for light drinkers. This has prompted far more questions than there are answers. Could alcohol once again be a panacea for our ills? How does it bring about these positive effects? Does it matter what type of alcohol we drink?

The last question has been the subject of much debate mainly due to vested commercial interests. Sales of wines have risen greatly since the it’s health benefits were first promoted and wine makers are all keen to sell their drink as the healthiest. Sir Richard Doll’s review of literature in this area argues that the characteristics of the drink do not change the beneficial effects; these are merely due to the content of ethanol. Studies have shown that ethanol increases levels of HDL cholesterol, reduces blood viscosity by moderating cytokines involved in blood clotting and promotes fibrinolysis. However, several papers now reveal even greater health benefits for wine drinkers. Over recent decades the scientific study of wine, known as oenology, has become an academic subject in its own right. Chemists have started to investigate the thousands of natural chemicals squashed out of grapes to form a glass of wine. Many of these are phenolics, aromatic compounds from grape skins that give wines their distinctive taste and smell. These are more concentrated in red wine, giving it bitterness and astringency and acting as strong antioxidants to give wine its aging potential. It now appears that wine contains many non-alcoholic compounds such as these that confer its extra health benefits.

In 1993 the first evidence came to light that phenolic antioxidant action may work inside the human body and a mechanism for the health benefits of wine began to be formed. Frankel et al showed that that the antioxidants in wine could significantly reduce oxidation of LDL, slowing the development of arterial plaque. Resveratol, epicatechin and quercetin, the newly discovered antioxidant chemicals in wine, are far stronger antioxidants than vitamin E. Attention has focused on the strongest of these, reveratol, perhaps unwisely so. Whilst one study published last year in Cardiovascular Research hailed it as a potent cardioprotective chemical and antiarrhythmic agent, no-one has yet addressed whether it can ever reach physiologically active concentrations in the blood stream. At only 1-2 mg/L, the amount of wine that may have to be consumed to see positive effects could well be harmful in other ways. The body’s absorption of these chemicals is far from understood.

Meanwhile, a vast number of other papers have been published proclaiming the benefits of moderate wine consumption. The vasodilator and antithrombic effects are now thought to be due to quercitin and other potent nitric oxide donors. Animal models show that inhibition of platelet aggregation can be achieved with much lower blood alcohol concentration in dogs receiving red wine than pure alcohol. The historical benefits of wine on digestion and as an antimicrobial were given a scientific basis by Weisse et al in the BMJ, who showed that red table wine could reduce the number of viable salmonella, shigella and Escherishia coli organisms in suspensions by 10⁵ – 10⁶ colony forming units. Finally, a dash of current controversy. The common premise assumes that alcohol is associated with a decrease in bone density. Laboratory based work has shown that alcohol has a damaging effect on bone forming mechanisms. However, population based studies have begun to show otherwise. The Framingham Study suggested that an alcohol intake of two or three daily glasses of wine is actually related to an increased bone density in post-menopausal women. The Rotterdam Study in 1998, whilst not showing a positive benefit to wine consumption, did show that chronic alcohol intake was not adversely related to the rate of bone loss for any category of alcohol intake. Clearly an area for further study.

So the message from research is that light drinkers actually enjoy better health than abstainers. Of course, the beneficial effects cannot be applied across the board – they are dependent on each individual’s risk of developing CHD, vascular disease, etc. in relation to the causes of death aggravated by alcohol. Many of the positive effects of drinking only protect against diseases of the middle-aged or elderly. It must therefore be highlighted that regular alcohol intake during our younger years may actually cause harm before the age where beneficial effects begin. So while our consultants sit back and enjoy a fine 1989 Cornas, medical students may be better off with a 2001 Cola.

“There are more old wine drinkers than old doctors” An old German proverb.

This article makes no attempt to cover up the huge harm alcohol abuse can cause – from liver damage to brain damage, accidents to assaults - the toxic effects of ethanol would render it a controlled substance had it recently been discovered. Many a medical student can testify to the deep psychological trauma alcohol can cause the morning after an Osler House bop when they realise beauty is very much in the eye of the beer-holder.

Seriously, it is well known that the proportion of alcohol abusers is a function of the number of drinkers in society as a whole. The positive health message regarding alcohol must therefore be conveyed with care, as the important point that only moderate consumption brings health benefits can easily be overlooked. Put simply, this article hopes to promote a favourable view of moderate wine consumption and the health benefits it confers. At the end of a hard day, uncorking a nice bottle of wine is in itself relaxing – good food and company adds to the enjoyment. Regardless of biochemical evidence and physiological proof this must surely be good for your health. In the words of Alexander Flemming: “Penicillin can cure the ill, but only wine will make them happy”.

Acknowledgments

My thanks to Oxford University Wine Society (www.oxforduniversitywinesociety.com) for the loan of materials referenced in this article and the provision of copious wine to aid its flow.

 

References

1.    St Leger AS, Cochrane AL, Moore F. Factors associated with cardiac mortality in developed countries with particular reference to the consumption of wine. Lancet 1979 12;1:1017-20

2.    Renaud S, de Lorgeril M. Wine, alcohol, platelets and the French paradox for coronary heart disease. Lancet 1992 20;339:1523-6.

3.    Waterhouse AL. Wine and heart disease. Chemistry & Industry 1995 May;338-341.

4.    Gronbaek, M et al. Mortality associated with moderate intake of wine, beer or spirits. BMJ 1995;310:1165-1169.

5.    Doll R. One for the heart. BMJ 1997;315:1664-1668.

6.    de Lorimier, AA. Alcohol, wine and health. American Journal of Surgery 2000; 180:357-361.

7.    Hung LM, Chen JK, Huang SS, Lee RS, Su MJ. Cardioprotective effect of resveratrol, a natural antioxidant derived from grapes. Cardiovascular Research 2000; 47:549-555.

8.    Frankel EN, Kanner J, German JB, Parks E, Kinsella JE. Inhibition of human low-density lipoprotein by phenolic substances in red wine. Lancet 1993;341:454-7.

9.    Demrow HS et al. Administration of wine and grape juice inhibits in vivo platelet activity and thrombosis in stenosed canine arteries. Circulation 1995;91:182-8.

10. Gronbaek M et al. Population based cohort study of the association between alcohol intake and cancer of the upper digestive tract. BMJ 1998;317:844-8.

11. Weisse ME, Eberly B, Person DA. Wine as a digestive aid: comparative effects of bismuth salicylate and red and white wine. BMJ 1995;311:1657-1660.

12. Felson DT et al. Alcohol intake and bone mineral density in elderly men and women. The Framingham study. Am J Epidemiol. 1995;142:485-92.

This paper was previously published in Oxford Medical Gazette volume 52(2).

Dr JEF Fitzgerald - Copyright 2008 (ISSN: 0030-7661)