Controversy in Wine

Major new well designed study confirms health benefits of wine consumption on risk of death and heart disease

couple with wine hi res.jpeg

After the controversy caused by the news analysis by Stockwell in 2016 "Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality" it was inevitable that more research in this subject would be started.

The systematic review and meta-regression analysis of studies investigating alcohol use and mortality risk after controlling for quality-related study characteristics was conducted in a population of 3,998,626 individuals, among whom 367,103 deaths were recorded. A total of 87 studies were examined and the paper concluded that when his team corrected for abstainer "biases" and certain other study-design issues, moderate drinkers no longer showed a longevity advantage.

Stockwell's paper concluded that "Estimates of mortality risk from alcohol are significantly altered by study design and characteristics. Meta-analyses adjusting for these factors find that low-volume alcohol consumption has no net mortality benefit compared with lifetime abstention or occasional drinking. These findings have implications for public policy, the formulation of low-risk drinking guidelines, and future research on alcohol and health.

A blog by The Stats Guy relating to the subsequent change to the U.K.'s alcohol drinking limits is enlightening and gives an indication that Stockwell and others like the Sheffield group may have been overzealous on their interpretations of data. 

Di Castelnuovo paper December 2006 and the J-shaped curve

Stockwell's view was contrary to the previous large meta-analysis by Di Castelnuovo et al in 2006 "Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies". Di Castelnuovo used a meta analysis technique where the results of 34 studies were collated and reviewed and published in the Archives of Internal Medicine. The study looked at the link between the amount of alcohol drunk and death rates in men & women in clinical trials conducted before the end of 2005 with over 1 million subjects. 

A J-shaped relationship between alcohol and total mortality was confirmed in both men and women. Consumption of alcohol, up to 4 drinks per day in men and 2 drinks per day in women, was inversely associated with total mortality or the chance of dying, maximum protection being 18% in women and 17% in men. Higher consumption of alcohol was detrimental. The results were consistent with studies by other research including Sir Richard Doll's 1994 study "Mortality in relation to consumption of alcohol: 13 years' observations on male British doctors". 

The Journal of the American College of Cardiology paper August 2017

Now a brand new study published aimed to tackle the controverisal issue of wine and health yet again. In mid-August 2017, a new and large study was published in the Journal of the American College of Cardiology, "Relationship of Alcohol Consumption to All-Cause, Cardiovascular, and Cancer-Related Mortality in U.S. Adults" by Bo Xi, Sreenivas P. et al.

The study in 333,247 people found that light-to-moderate drinkers (less than 14 drinks in men and 7 drinks in women) did have a lower risk of dying from cardiovascular disease.

Individuals were followed between 1997 and 2009 and around 34,000 died sometime during this period. Throughout the length of the study, 34,754 participants died from all-causes. Of these, 8,947 deaths were cardiovascular disease-specific (6,944 heart disease-related and 2,003 cerebrovascular-related deaths) and 8,427 mortalities were cancer-specific.

The results of the study showed that men and women who were moderate drinkers had a 13 percent and 25 percent decreased risk of all-cause mortality, and 21 and 34 percent decreased risk of cardiovascular disease mortality, respectively.

Men who are heavy drinkers have a 25 percent increased risk of mortality due to all-causes and a 67 percent increase in mortality from cancer; however, these results were not significant in women. There were similar findings for light drinking for both men and women.

This is the key point. Bo Xi and his team were careful to address the supposed flaws in previous studies on alcohol and health. So the non-drinker group only included lifetime nondrinkers, so "sick quitters",  former heavy drinkers and those who gave up alcohol because they got sick were excluded.

The paper also controls for smoking, Body Mass Index (BMI) and physical activity, Some academics still believe that total lifetime abstainers are rare and could share other, unforeseen traits that impact their health, whereas moderate drinkers might have an overall healthier lifestyle. Causation is almost impossible to identify and this will always be a flaw.

But this new observational study tries its hardest to be large, well designed and lasted for 12 years.

National Institute of Health study results due 2023

A new study costing $100 million by the U.S. based National Institutes of Health will aim to finally answer the question whether daily alcohol drinking can help lower your risk for heart attacks, strokes and death.

8,000 volunteers will be recruited that fit very specific criteria from 16 areas around the world. Half will randomly be selected to have one drink per day, while the other half will have to abstain from drinking during the course of the study. These two groups will be followed for six years (poor abstainers!). The clinical trial will be run by notable researchers from around the world in Boston, Baltimore, Amsterdam, Copenhagen and Barcelona to cover all regions of the world.

Regular wine drinking and parenting - controversial antidotes to civilisation

parents drinking wine

I came across an article on the Vinepair website called "Why wine is essential to being a good mother". A very good article which sums up the dilemma facing mothers, and fathers for that matter, whether to hit the bottle of wine or abstain with that glass of sparkling water. The latter being particularly dull after a day with a screaming toddler, difficult teenager or hell commute and office politics.

"Wine o'clock" is a much used phrase when it comes to many families these days. After an exhausting day either looking after kids or battling corporate life in the office, there is nothing more relaxing than a glass or two of wine (even better a bottle shared between two parents). 

As a father, the stresses and strains of dealing with work and family life is obvious and frankly parenting is exhausting.  You move from nappies and no sleep to more sophisticated stresses, rewarding it may be, but not easy. 

In decades past alcohol and tobacco were the mainstay of the so called "antidotes to civilisation". Before smoking was considered dangerous, parents would relax smoking a few Malboro's to chill out and reflect on their days. Now with smoking a no go, many resort to alcohol to unwind. As smoking rates have fallen in Western Europe and the U.S. , drinking of alcohol has shot up. No coincidence I think and why not....

Some in the health community are obsessed with the notion that there is no level of safe alcohol drinking. For example the United Kingdom chief medical officer, Dame Sally Davies, famously said that women should “do as I do” and think about the risks of breast cancer every time they reach for a glass of wine.

However, I reassure myself that in France and the Mediterranean  countries, where smoking rates are still sky high (and supposed bad habits like eating processed meats such as Salami),  life expectancy is still at very high levels. The consistent things in countries like France, Spain and the Greek islands is Olive oil, fresh fruit and vegetables and of course regular consumption of alcohol, particularly red wine. This means people living in these countries have low rates of stroke and heart disease. This so called "French Paradox" seems to be rather reassuring and lets face it several aspects of French life aren't seen as healthy (particularly smoking, ingestion of fatty foods such as duck, pates and cheese). 

prescription wine

Then look at the significant and positive clinical data involving tens of thousands of drinkers and the advice to abstain or drink only occasionally seems off the mark.

The Vinepair article says "in fact, the promise of wine at the end of a particularly challenging day of motherhood is like a beacon in the darkest of nights. It is the reward for a job well done. It is the spoils of war, if you will. I genuinely look forward to it and how consuming a single glass slows me down and transports me to a state of calm, after a day that is chock full of crazy. I don’t look at my nightly glass of cheer as a form of stress management or self medication and I certainly don’t need it (well, “need” is probably debatable). I, like a lot of mothers I know, consume that glass of wine at the end of the day because we truly enjoy relishing the time it takes to enjoy it, time that isn’t being interrupted to get someone a juice box or explain why painting the family dog isn’t a good idea.

After seven years of being in the parenting trenches, this is what I know for sure: Parenting is hard and mothering is exhausting. At the end of each full and moderately productive day, a glass of perfectly chilled Riesling can restore your sanity and leave you prepared to suit up and do battle the next day."

Risk of death is higher for tee totalers than those drinking 2-3 3 glasses per day

Back to the "Antidotes of civilisation" which now can safely include coffee, tea and alcohol. The establishment may advise lettuce leaves, meat once a week, no cheese or salami, not living in a city, regular exercise, 1-2 drinks of alcohol a week at most but life would be awfully boring. More boredom equals more stress equals faster mortality!

Perhaps it would suit someone like Teresa May but for the rest of us, balance is key. I drink red wine, but I exercise regularly, eat healthily and I have my Milk Thistle and think positively about all the resveratrol (from the grape skins) coursing through my body and protecting me against all those nasties like heart diease and furred arteries.

See further information:

Regular Champagne drinker? Pesticide levels now at toxic levels in ground water caused by drought and excessive usage

Soil and hands

For regular wine drinkers like myself, the presence of chemicals like herbicides and pesticides in the vineyard and production process is a concern.  Who wants chemicals in their bodies from nasties like glyphosate after opening a fine wine? The new world, particularly New Zealand, has been more notable in the move by many winemakers to use organic or biodynamic practices to limit chemicals and this is to be applauded.

Old world wine winers have been slower to ban chemicals on the vines, worried by the impact on yields and potential rampant disease on the grapes.  Its been great to see sparkling wine producers in the U.K. such as Sedlescombe in Kent adopting organic as well as biodynamic in their products. Bravo!

Champagne region around Reims in France, North East of Paris

It has been of particular note to read reports in recent weeks about the the hot, dry summer in Champagne that has left pesticide levels in its groundwater at dangerous levels. Too many chemicals are clearly being used in the vineyards to maintain quality with heavy handed application of insecticides, herbicides and fungicides.

Ongoing studies by the Champagne region's water agency, Eau Seine et Normandie, found chemical residues both in the surface and ground water regularly exceed European authorised levels. This is partly explained by the fact that the Seine river has one of the smallest water flows of all French rivers, yet the water used by the region is extremely high at around 3 billion cubic metres per year and this limits dilution capacity of chemicals.

This has meant that for the French living in areas such as Champagne, pollution levels have reached alarming levels and it is estimated that nearly 3 million citizens in areas such as Bordeaux, South West France as well as Champagne are drinking polluted tap water as a result of pesticides and nitrates leaching into the water table. 

Studies in 2016 show that pesticides remain the most important threat to ground water quality, especially the herbicide glyphosate. It can take years for these chemicals to completely disappear from the groundwater because they bind to the chalk present in the soil in the region. 

champagne vineyards

In 2008, the French government put in place a first EcoPhyto plan with 1900 agricultural producers to limit chemical use and this has been followed by Ecophyto II in 2015 with 30,000 producers aiming to reduce the use of pesticides by 50 percent by 2025.

The Comité Interprofesionnel du Vin de Champagne (CIVC) has already championed the eradication of insecticides in Champagne and  is now signed up to the EcoPhyto II plan to deal with the areas excssive heribicide use. Two-thirds of the region's vineyards were still blanket-sprayed with herbicides, and almost 90 percent of the vineyards used herbicides to weed under the rows. Veuve Clicquot is one of the few Champagne producers that have have eliminiated herbicides in its vineyards due tot he concerns about the impact on water quality despite impacting yields and making life more difficult for its workers.

In July 2017 the CIVC will vote whether to accept a ban on the blanket spraying of herbicides from the following. The decision seems a no brainer, especially for those millions of people around the world who enjoy that regular glass of Champagne. Come on winemakers, we don't want chemicals in our wine and Champagne! 

Why are alcohol levels in wine rising - climate, winemaker or consumer?

wine glasses splashed wine

Too much alcohol in wine?

Consumers and wine experts now expect not to be served thin, flabby wines with unripe tannins. To avoid these characteristics a wine needs alcohol. But if you're feeling a little too worse for wear after a night out, many wine drinkers are now concerned that alcohol levels have gone up too far - particularly from wines produced in hotter climates such as Australia.

Many top winemakers are of the view that wines with 15-16% alcohol are unbalanced and when drunk can produce a hot, burning sensation on the palate which can be unpleasant. 

Critically, someone drinking two 175ml glasses of wine with 10-12% alcohol would be likely to be under the legal drink drive in many countries but the same amount of wine with 14-16% alcohol could put you over the legal limit and facing serious trouble!

Why are alcohol levels in wine rising - climate or the consumer?

15% alcohol australian wine label

Alcohol levels in wine can range from as little as 5% for some dessert wines, e.g. Moscato d'Asti, to more than 20% for a port whose natural alcohol level has been increased by adding spirit. Two or three decades ago alcohol levels in wine were rarely more than 14%. Now is common to be drinking red wine at 15-16% especially from warmer climates like Australia, California and South Africa. 

Higher alcohol can mean higher risk of drink drive offences as well as nasty hangovers the next morning. 

An easy explanation could be global warming causing an increase in average temperature  and lower rainfall in the vineyard resulting in greater ripeness, more sugar in grapes and hence more alcohol during fermentation. But research has shown that the increase in average alcohol levels are much greater than could be explained by any change in climate.

AAWM logo

In a working paper published in May 2011 by the American Association of Wine Economists (AAWE),  alcohol levels for wines imported between 1992 and 2007 by the LCBO, the large and important liquor monopoly of Ontario that buys wines from all over the world, were analysed and compared with actual temperature increases in their regions of origin. 

"SPLENDIDE MENDAX: FALSE LABEL CLAIMS ABOUT HIGH AND RISING ALCOHOL CONTENT OF WINE by JM. Alston, KB Fuller, JT Lapsley et al"

It was concluded by the research team that "our findings lead us to think that the rise in alcohol content of wine is primarily man-made" with the main causes being "evolving consumer preferences and expert ratings" as more likely to have driven up alcohol levels. So wine producers have noted that experts and consumers desire and consume wines that taste "bigger" and in particular have softer tannins and lower acidity (acid levels fall as grapes ripen) and have deliberately chosen to have grapes picked later than they once were.

bad wine

To lessen the potential for super high alcohol wines when they are not desired, winemakers are choosing  lighter grape varieties, leaf removal, experimenting with pruning times and irrigation to reduce the time between sugar and phenolic ripeness. Phenolic ripeness (also referred to as physiological ripeness) refers to the changes in the tannins that occur in grape skins, seeds and stems. Sugar ripeness refers to the breakdown of acids and accumulation of sugars. In the classic northern hemisphere regions, grapes are typically harvested by sugar ripeness. Some producers are also employing biodynamic viticulture to increase flavour grapes are picked earlier.

Achieving more regularly greater phenolic ripeness is not just to achieve higher sugar levels and so higher potential alcohol levels, but also, crucially, riper and finer tannins. Winemakers choose the date of picking of the grapes based on tasting of the grapes and lab analysis of polyphenols and IPTs (total phenolics), which usually indicate the optimum phenolic ripeness a few days after sugar levels.

In the AAWE study, mean actual alcohol levels over 1992-2007 were highest in US, Argentine, Australian and Chilean wines (13.9, 13.8, 13.8 and 13.7% respectively). The average for New World countries analysed was 13.7%,  whilst the European average was 13.0% (with Spain highest at 13.4%).

In addition the researchers found an alarming difference between the alcohol information appearing on wine bottle labels and the actual alcohol levels as analysed by the Canadian LCBO. It was found by the researchers that labels "understate the true alcohol content by about 0.39% alcohol for Old World wine and about 0.45% for New World wine".

Average alcohol percentage for French wines analysed was 13.0% but wines produced in hotter areas such as the southern Rhône's Châteauneuf-du-Pape can have alcohol in excess of 15% and even 16%.

Star trek choking

Stated alcohol levels can be up to 1.5% less (or more) than the actual alcohol in wines up to 14% in the US where the tolerance for wines over 14% is still a full percentage point whereas wines sold in the EU have to be labelled with an alcohol percentage no more than 0.5% different from the actual level. The study found that the countries with the most notable understatements of the alcohol content were Chile, Argentina, Spain and the US.

One wonders if some unscrupulous winemakers with a wine of 15%, cheekily declares 13.5 or 14%.

Alcohol levels in wine and mis-labelling are a huge concern for many drinkers and an area where the industry and government must take a pragmatic but stringent view.

The controversy of Dr. Dipak Das and resveratrol research manipulation

Doctor Dipak K. Das continues to be a controversial figure in alcohol and wine health research. His work and the allegations against him have added fuel to the fire when trying to resolve the question of whether resveratrol is truly beneficial to human health and how important it is compared to alcohol when reducing cardiovascular events.

In 2012, after a three year investigation by the University of Connecticut, the one time director of its Cardiovascular Research Centre was accused of falsifying and fabricated data at least 145 times, in some cases digitally manipulating images using PhotoShop.  

The investigation examined more than seven years of activity in Das’s lab, and centred on Western blot results that had been manipulated and used in published papers.  The western blot (sometimes called the protein immunoblot) is a widely used analytical technique used to detect specific proteins in a sample of tissue homogenate or extract.The investigation into Das was started after an anonymous allegation of research irregularities in 2008.The University subsequently dismissed Das. 

Das who died shortly after the accusations were published in September 2013 was best known for his work on resveratrol, a compound present in grapes and wine and the subject of continued speculation as to its benefits in cardiovascular health.

In a 60,000 pages long report the University alleged that

  • Das was “intimately involved in the generation of figures that were determined to have been manipulated (either by fabrication or falsification).”
  • Others in his laboratory may have also been involved in wrongdoing. DeFrancesco, the spokesman, said an investigation into who else might have been involved is continuing.
  • The data manipulation, investigators concluded, was “intentional” and “designed to deceive.”

Das responded to the allegations in a letter of July 2010 blaming racial discrimination saying "Thus, careful analysis of the entire issue leads to the conclusion that it is an entirely racial issue – war against Indian community and unfortunately I am also an Indian. I have been working in the Health Center since 1983 [almost 28 years] under three different administrations and all adorned me. Why? Because they honored the equal opportunity employer policy. In fact, former Dean Dr. Peter Deckers was my good friend and under his term, we flourished. The problem started from the DAY NEW ADMINISTRATION took over from Peter Deckers. I became the Devil for the Health Center, and so did all the Indians working with me. " 

Das also posted a video defending himself on YouTube:

Whether Das was truly the victim of racial discrimination or a disgruntled ex-colleague or was really fiddling data for personal financial gain, the evidence behind resveratrol and its benefit in human health are suggestive of being positive.