Health effects of wine

Wine has a long history of use in the world of medicine and health.

The issue of wine and health is a topic of considerable discussion and research. Wine has a long history of use as an early form of medication, being recommended variously as a safe alternative to drinking water, an antiseptic for treating wounds and a digestive aid, as well as a cure for a wide range of ailments from lethargy and diarrhea to easing the pain of child birth. Ancient Egyptian Papyri and Sumerian tablets dating back to 2200 BC detail the medicinal role of wine, making it the world's oldest documented man-made medicine. Wine continued to play a major role in medicine until the late 19th and early 20th century, when changing opinions and medical research on alcohol and alcoholism cast doubt on the role of wine as part of a healthy lifestyle and diet. In the late 20th and early 21st century, fueled in part by public interest in reports by the U.S. news broadcast 60 Minutes on the so-called "French Paradox", the medical establishment began to re-evaluate the role of moderate wine consumption in health. Studies have since shown positive benefits of the phenolic compound resveratrol with continued research attempting to better understand its functions in wine and the body.

Historical role of wine in medicine

See also: History of medicine

Early medicine was intimately tied with religion and the supernatural, with early practitioners often being priests and magicians. Wine's close association with made it a logical tool for these early medical practices. Tablets from Sumerian culture and papyri from Ancient Egypt dating to 2200 BC include recipes for wine based medicines, making wine the oldest documented man made medicine.

Early history

Hippocrates, the father of modern medicine, prescribed wine for a variety of ailments include lethargy and diarrhea.

When the ancient Greeks introduced a more systematized approach to medicine, wine still retained its prominent role. The Greek physician Hippocrates recommended wine as a part of a healthy diet and advocated it uses a disinfectant for wounds as well as a medium to mix other drugs in for easier consumption by the patient. He also prescribed wine as a cure for various ailments ranging from diarrhea to lethargy to pain during childbirth. The medical practices of the ancient Romans used wine in a similar fashion. In his 1st century work De Medicina, the Roman encyclopedist Aulus Cornelius Celsus detailed a long list of Greek and Roman wine that were used in medical practices. While treating gladiators in Asia Minor, the Roman physician Galen would use wine as a disinfectant for all types of wounds, even soaking the exposed bowels and stomach content before returning them to the body. During his four years tending to the gladiators only five deaths occurred, compared to sixty deaths under the watch of the physician before him.

Religion still played a significant role in promoting wine's use for health benefit. The Talmud noted "Wine is the foremost of all medicines: wherever wine is lacking, medicines become necessary.". In his first epistle to Timothy, Paul the Apostle recommended that his young colleague drink a little wine every now and then for the benefit of his stomach and digestion. While the Islamic Koran contained restrictions on all alcohol, Islamic doctors such as Avicenna in the 11th century AD noted that wine was an efficient digestive aid but because of Islamic laws were limited only in using it as a disinfectant while dressing wounds. Catholic monasteries during the Middle Ages would also regularly use wine for various medical treatments. So closely tied was the role of wine and medicine that the first printed book on the subject of wine was written by a physician, Arnaldus de Villa Nova, in the 14th century which included lengthy writings on wine's treatment of various medical illnesses such dementia and sinus troubles.

Changing views highlight the risks of consumption

The lack of safe drinking water for much of history may have been one reason for wine's popularity in medicine. Wine was still being used to sterilize water as late as the 1892 cholera epidemic of Hamburg in order to control the disease's spread. However the late 19th century and early 20th century ushered in a period of changing views on the role of alcohol (and by extension) wine in health and society. The Temperance movement started to gain steam by touting the ills of alcoholism, which was eventually defined by the medical establishment as a disease. Studies regarding the long and short-term effects of alcohol caused many in the medical community to reconsider wine's role in medicine and diet. Public opinion against consumption of alcohol in all forms lead to Prohibition in the United States and other countries. In some areas wine was able to maintain a limited role, such as an exemption in the United States for "therapeutic wines" that were sold legally in drug stores. These wines were marketed for their medicinal benefits but some wineries used this measure as a loophole to sell large quantities of wine for normal consumption. In response, the United State government issued a mandate requiring producers to include an emetic additive that would induce vomiting above the consumption of a certain dosage level.

Throughout the mid to early 20th century, health advocates touted the risk of alcoholic consumption and the role it played in a variety of ailments such as blood disorders, high blood pressure, cancer, infertility, liver damage, muscle atrophy, psoriasis, skin infections, strokes, and long term brain damage. Studies showed a connection between alcohol consumption of pregnant mothers and an increased risk of mental retardation and physical abnormalities for their fetus in what became known as fetal alcohol syndrome. The use of warning labels on alcohol products began in several countries warning of these dangers.

1990s: French Paradox and renewed interest in the benefits of consumption

Despite having a diet that features high fat dairy products such as cheeses, the French have lower rates of heart diseases. One explanation for this "paradox" is the regular consumption of red wine.

The 1990s and early 21st century saw a renewed interest in the health benefits of wine, ushered in by increasing research suggesting that moderate wine drinkers have lower mortality rates than heavy or non-drinkers. In November 1991, the U.S. news program 60 Minutes aired a broadcast on the so-called "French Paradox". Featuring the research work of Bordeaux scientist Serge Renaud, the broadcast dealt with the seemingly paradoxical relationship between the high fat/high dairy diets of French people and the low occurrence of cardiovascular disease among them. The broadcast drew parallels to the American and British diets which also featured high levels of fat and dairy and lead to high numbers of heart disease related deaths among Americans. One of the theories proposed by Renaud in the broadcast was that moderate consumption of red wine was a risk-reducing factor for the French and that wine could have more positive health benefits yet to be studied. Following the 60 Minutes broadcast, sales of red wine in the United States jumped 44% over previous years.

This changing view of wine can be seen in the evolution of language in the U.S. Food and Drug Administration Dietary Guidelines. The 1990 edition of the guidelines contained the blanket statement that "wine has no net health benefit". By 1995, the wording had been changed to allow moderate consumption with meals providing the individual had no other alcohol related health risk. From a research perspective, scientists began distinguishing alcohol consumption among the different classes of beverages-wine, beer and spirits. This distinction allowed studies to highlight the positive medical benefits of wine apart from just the presence of alcohol. However, wine drinkers tend to share similar lifestyle habitats-such as better diets, more exercise and non-smoking-that can differ from the lifestyles of beer, spirits and non-drinkers which may be a factor in itself for the possible positive health benefits of moderate wine consumption.

What is moderate consumption?

See also: Recommended maximum intake of alcoholic beverages

Some doctors define "moderate" consumption as one 5oz glass of wine per day for women and two glasses per day for men.

Nearly all research into the positive medical benefits of wine consumptions make a distinction between moderate consumption, heavy and binge drinking. What constitutes a moderate, healthy level of consumption will vary by individual according to age, gender, genetics, weight and body stature as well as the situation-i.e. is food being consumed as well, are any other drugs currently in the individual's system, etc. Women, in general, tend to absorb alcohol quicker than men due to their lower body water content and difference in levels of stomach enzyme so their moderate levels of consumption tend to be lower than a male of equal age and weight. Some doctors define "moderate consumption" as one 5 US fluid ounces (15 cl) glass of wine per day for women and two glasses per day for men.

The view of consuming wine in moderation has a history almost as long as that of wine's role in medicine. The Greek poet Eubulus believed that three bowls (kylix) were the ideal amount of wine to consume. The number of three bowls for moderation is a common theme throughout Greek writing; today the standard 750 mL wine bottle contains roughly the amount of three glasses for two people. In his circa 375 BC play Semele or Dionysus, Eubulus has Dionysus say:

Three bowls do I mix for the temperate: one to health, which they empty first, the second to love and pleasure, the third to sleep. When this bowl is drunk up, wise guests go home. The fourth bowl is ours no longer, but belongs to violence; the fifth to uproar, the sixth to drunken revel, the seventh to black eyes, the eight is the policeman's, the ninth belong to biliousness, and the tenth to madness and hurling the furniture.

Resveratrol

File:Chehalem pinot noir grapes.jpg

Grapes like Pinot noir grown in cool climates such as Oregon and Burgundy tend to have higher concentrations of resveratrol than grapes grown in warmer regions like California and Australia.

Resveratrol is a non-flavonoid phenolic compound found in wine, present largely because of its high concentration in grape skin. It has received a lot of attention in both the media and medical research community for its potential health benefits. Belonging to a class of compounds known as stilbenoid, resveratrol is also found outside of the Vitis grapevine family in plants such as eucalyptus and peanuts. It is part of the defence mechanism in grapevines, used as a phytoalexin produced in the leaves and berry skins in response to a microbial attack by fungus or grape disease. In a controlled setting, this reaction can be artificially induced by exposure to ultraviolet radiation. The build up of resveratrol slows and sometimes will stop the spreading infection. According to NC State University researchers, Muscadines contain a unique blend of several natural antioxidants that can reduce the risk factors associated with degenerative diseases.

The production and concentration of resveratrol is not equal among all the varieties of wine grapes. Differences in clones, rootstock, Vitis species as well as climate conditions can affect the production of resveratrol. The degree of exposure to greater risk of fungal infection and grape diseases also appear to play a role. The Muscadinia family of vines, which has adapted over time through exposure to North American grape diseases such as phylloxera, has some of the highest concentrations of resveratrol among wine grapes. Among the European Vitis vinifera, grapes derived from the Burgundian Pinot family tend to have substantially higher amounts of resveratrol than grapes derived from the Cabernet family of Bordeaux. Wine regions with cooler, wetter climates that are more prone to grape disease and fungal attacks (such as Oregon, New York) tend to produce grapes with higher concentrations of resveratrol than warmer, dry climates like California and Australia.

Red wine tends to have a significantly higher concentration of resveratrol than white wine, even though white wine grape varieties produce similar amounts in the vineyards. This is because during winemaking white wine spends very little if any time in contact with the resveratrol-rich grape skins. This maceration period not only gives red wine its color but allows for the extraction of phenolic compounds such as resveratrol into the resulting wine. Other winemaking techniques, such as the use of certain strains of yeast during fermentation or lactic acid bacteria during malolactic fermentation, can have an influence on the amount of resveratrol left in the resulting wines. Similarly the use of certain fining agents during the clarification and stabilization of wine can strip the wine of some resveratrol molecules.

The prominence of resveratrol in the news and its association with positive health benefits has encouraged some wineries to highlight it in their marketing. In the early 21st century, the Oregon producer Willamette Valley Vineyards sought approval from the Alcohol and Tobacco Tax and Trade Bureau (TTB) to state on their wine labels the resveratrol levels of their wines which ranged from 19 to 71 molecules per liter (higher than the average 10 molecules per liter in most red wines). The TTB gave preliminary approval to the winery, making it the first to use such information on its labels. While resveratrol is the most widely publicized, there are other components in wine that have been the focus of medical research into potential health benefits. These include the compounds catechin and quercetin.

Wine's effect on the body

Bones

Heavy alcohol consumption has been shown to have a damaging effect on the cellular process that create bone tissue. Long term alcoholic consumption at high levels increases the frequency of fractures. Studies from St. Thomas' Hospital in London and the Epidimiologie de l'Ostioporose (EPIDOS) medical group in France suggest that moderate wine consumption may offer positive benefits to women, particularly elderly women, in retaining bone density and reducing the risk of developing osteoporosis. While consuming more than three glasses of wine a day was shown to reduce bone density, the French study showed that women who drank moderately (1 to 3 glasses a day) had more overall increases in bone density over the two year study period. However, the physicians who took part in the French study noted that other factors could be in play apart from wine consumption with moderate drinkers being more likely to live active lifestyles that included physical activity which also benefits bone density.

Cancer

See also: Alcohol and cancer

Alcohol is a toxin and has the potential to damage cells. The International Agency for Research on Cancer of the World Health Organization has classified alcohol as a Group 1 carcinogen. Studies have linked even moderate consumption of alcohol to increase risk for a variety of cancers including breast, colon, esophageal and stomach cancer. Focus on wine's positive benefits regarding cancer has centered on the antioxidant properties of resveratrol which some laboratory results showing protective quality that inhibit cancerous changes in cells. The research is ongoing with no conclusive results though some studies suggest that moderate wine consumption may lower the risk for lung, ovarian and prostate cancer.

While alcohol is a known carcinogen that can increase the risk of developing breast cancer, recent studies suggest that resveratrol, which can be found in wine, may be able to decrease production of estrogen metabolites which promote the development of cancerous tumors (example shown right) in the breast.

In early 2009, three independent studies published in the medical journal of Gastroenterology suggest that moderate wine consumption may reduce the risk of certain forms of esophageal cancers such as esophageal adenocarcinoma and the precancerous condition Barrett's esophagus. In one study, conducted by Kaiser Permanente in California, respondents who reported drinking no more than 1 glass of wine a day had a 56% decrease in the risk for developing Barrett's esophagus-a rate lower than that of heavy and non-drinkers. While heavy alcohol consumption has been proven to increase the risk of esophageal, these studies suggest that antioxidants in wine may offer some benefit if consumed in moderation but there is not a conclusive link. In response to these studies, Dr Prateek Sharma, MD, of the University of Kansas School of Medicine, notes that there maybe other links such as people who drink wine leading generally healthier lifestyles with consuming less fats and eating more fruits and vegetables.

Research conducted at the Yale School of Public Health in 2009, suggest that wine may have some protective benefits against some forms of cancer. Women diagnosed with non-Hodgkin's lymphoma were questioned about their alcohol consumption patterns and followed for an 8 to 12 year period. Compared to non-drinkers, women who had drinking wine for at least 25 years prior were 33% less likely to die over the five-year period following diagnosis and 26% less likely to experience a relapse or develop a secondary cancer during that same five year period. Of all the women in the study, 75% of those who drank at least 12 glasses of wine over the course of their lifetime were alive after 5 years compared to 66% of the women who never drank any wine. Women who drank beer and alcohol spirits showed no differences.

While alcohol itself has been linked as increasing the risk of breast cancer in women, a 2008 study by researchers at the University of Nebraska suggest that resveratrol may have some preventative benefits against breast cancer. Prolong exposure of breast cells to estrogen has long been suspected as to be a major risk factor for breast cancer. This exposure can cause toxic estrogen metabolites to appear that react with DNA in the body to promote the development of tumors. Researchers at the University of Nebraska exposed human breast cells grown in the laboratory to low doses of resveratrol and found that it created numerous positive outcomes. The exposure to resveratrol not only decreased the production of estrogen metabolites but it also increased production of an enzyme that destroys these metabolites. It also appeared to limit interaction between these metabolites and DNA, limiting the promotion of tumor development. The amount of resveratrol used in the study was a low dose concentration of 10 micromoles per liter. A typical glass of wine has a concentration between 9 to 28 micromoles per liter. However, this laboratory study does not suggest that consuming wine will produce the necessary concentration of resveratrol in the blood stream to have these cancer fighting properties.

Cardiovascular system

See also: Alcohol and cardiovascular disease

The anticoagulant properties of wine may have the potential benefits of reducing the risk of blood clots that can lead to heart disease.

Studies have shown that heavy drinkers put themselves at greater risk for heart disease and developing potentially fatal cardiac arrhythmias. Excessive alcohol consumption can cause higher blood pressure, increase cholesterol levels and weakened heart muscles. For moderate drinkers, medical research indicates moderate wine consumption may lower the mortality rate and risk of heart of disease. Studies have shown that moderate wine drinker can improve the balance of low-density lipoprotein (LDL or "bad" cholesterol) to high-density lipoprotein (HDL "good" cholesterol), which has been theorized as to clean up or remove LDL from blocking arteries. The main cause of heart attacks and the pain of angina is the lack of oxygen caused by blood clots and atheromatous plaque build up in the arteries. The alcohol in wine has anticoagulant properties that limits blood clotting by making the platelets in the blood less prone to stick together and reducing the levels of fibrin protein that binds them together. However these anticoagulant properties of wine only stay in the system for a maximum of 24 hours after consumption. While having a glass of wine the night before may lower the risk of having a heart attack the next day, there is still the potential of long-term effects of alcohol. These anticoagulant properties can also be amplified adversely by binge drinking, with the individual becoming over-anticoagulated and at increase risk of a stroke or heart attack.

Additional studies have focused on the benefits of the phenolic compound resveratrol to cardiovascular health. Some studies suggest that the antioxidant properties of resveratrol inhibits the oxidative reaction that for LDL cholesterol and decreases the "stickiness" of platelets that form blood clots.

Dementia and mental functions

See also: Alcohol dementia

One of the short-term effects of alcohol is impaired mental function, which can cause behavioral changes and memory impairment. Long term effects of heavy drinking can inhibits new brain cell development and increase the risk for developing major depressive disorders. Studies have linked moderate alcohol consumption to lower risk of developing Alzheimer's and dementia though wine's role in this link is not yet fully understood. A 2009 study by Wake Forest University School of Medicine suggest that moderate alcohol consumption may help healthy adults ward off the risks of developing dementia but can accelerate declining memory for those already suffering from cognitive impairment. The reason for the potential positive benefit of moderate consumption is not yet identified and may even be unrelated to the alcohol but rather other shared lifestyle factors of moderate drinkers (such as exercise or diets). If it is the moderate consumption, researchers theorize that it maybe alcohol's role in promoting the production of "good cholesterol" which prevents blood platelets from sticking together. Another potential role of alcohol in the body maybe in stimulating the release of the chemical acetylcholine which influences brain function and memory.

Diabetes

Research has shown that moderate levels of alcohol consumed with meals does not have a substantial impact on blood sugar levels. A 2005 study presented to the American Diabetes Association suggest that moderate consumption may lower the risk of developing Type 2 diabetes.

Digestive system

The anti-bacterial nature of alcohol may reduce the risk of infection by the Helicobacter pylori bacterium that has been associated with stomach cancer as well as gastritis and peptic ulcers.

The anti-bacterial nature of alcohol has long been associated with soothing stomach irritations and ailments like traveler's diarrhea where it was a preferred treatment to the less palatable bismuth treatments. The risk of infection from the bacterium Helicobacter pylori, strongly associated with causing gastritis and peptic ulcers as well as being closely linked to stomach cancer, appears to lessen with moderate alcohol consumption. A German study conducted in the late 1990s showed that non-drinkers had slightly higher infection rates of Helicobacter pylori then moderate wine and beer drinkers.

Wine positive effects on the metabolism of cholesterol has been suggested as a link to lower occurrences of gallstones among moderate drinkers since cholesterol is a major component of gallstones.

Headaches

See also: Red wine headache

There are several potential causes of so called "red wine headaches", including histamines/tyramines and the breakdown of some phenolic compounds in wine that carry the chemical messenger for serotonin. One culprit that is regularly dismissed by allergist as an unlikely cause of red wine headaches is sulfites which are used as a preservative in wine. Wine, like other alcoholic beverages, is a diuretic which promotes dehydration that can lead to headaches (such as the case often experienced with hangovers). In 2006, researchers from the University of California, Davis announced finding from genetic mapping that amino acids in wine that have been slightly modified by the fermentation process maybe the cause of wine related headaches. The research suggest changes in fermentation techniques may help alleviate the risk for wine drinkers sensitive to these amino acids.

Vision

The anti-oxidant and anticoagulant properties of wine may have a positive benefit in slowing the effects of macular degeneration that causes vision to decline as people age. An American study from the late 1990s showed that vision of moderate wine drinkers suffered less macular degeneration than non-drinkers

Weight management

See also: Alcohol and weight

Wine has a long history of being paired with food and may help in weight management by encouraging less food to be consumed.

Arthur Agatston, co-creator of the South Beach diet believes that wine can offer some positive benefit for weight management if it is consumed with food.

Alcohol can stimulate the appetite so it is better to drink it with food. When alcohol is mixed with food, it can slow the stomach's emptying time and potentially decrease the amount of food consumed at the meal.

Compared to many beers and non-diet sodas, a serving of wine has a moderate amount of calories. A standard 5 oz serving of red wine (based on an average alcohol content of 13%) contains approximately 106 calories and 2.51 g of carbohydrates. A similar serving of white wine contains approximately 100 calories and 1.18g of carbohydrates.

Heavy metals in wine

In 2008, researchers from Kingston University in London discovered that a number of European wines contained high levels of heavy metals-including chromium, copper, lead, manganese, nickel, vanadium and zinc. The "target hazard quotients" (THQ) of the wines in the study ranged from 50 to over 350. A THQ over 1 represents a health concern with, by comparison, seafood mercury levels typically raising concerns with THQs between 1 to 5. While the research suggest that a single glass of wine will not lead to metal poisoning, there is concerns about long term daily wine consumption particularly in regards to the high manganese levels which has been linked to Parkinson's disease. There is current explanation for how the metals got into the wine but some theories suggestion that they may come from metals in the vineyard soils, the use of pesticides and fungicides on the grapevines or yeast contamination during fermentation.

The countries producing wines with the highest level of heavy metals include Hungary and Slovakia with THQ levels that surpassed 350. Other countries with significantly high THQ levels over 100 include Austria, France, Germany, Spain and Portugal. Wines from New World Wine regions such as the United States, Australia, New Zealand and South Africa were not included. In response to this study some scientist speculated on the benefits of including heavy metal levels on wine labels.

External links

• Dr. Philip Norrie "Chronology of wine as a medicine" The Wine Doctor