Wine Health

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.

New $100 million study will aim to finally answer question - "Can drinking alcohol daily help lower your risk for heart attacks, strokes and death?”

lady drinking red wine

There has been so much debate in the health community about whether regular and moderate alcohol drinking is good or bad for your health. It is a hugely controversial subject with some national health bodies like the UK advocating that there is no safe level of alcohol consumption whilst others cite strong clinical evidence from large meta-analysis studies as well as the "French Paradox" that 2-3 glasses of alcohol (and more so wine) is healthy for you and reduces your risk of premature death as well as heart attacks and strokes.

Many media reports and studies from the medical community are contradictory. One minute the press says that alcohol causes cancer, the next day there's another story saying regular drinking prevent Alzheimer's disease and so on.

National institutes of health logo

But new research costing $100 million is hoping to get to the bottom of the moderate drinking debate once and for all. 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.

But the study has already been mired in controversy as it has emerged that Heineken, Anheuser-Busch InBev, Diageo, Pernod Ricard and Carlsberg have all contributed to the costs with a total investment of $68 million, given to a foundation raising money for the National Institutes of Health. In addition some have questioned the credentials of some of  the researchers behind the study given they have been involved previously in alcohol manufacturer related studies. But without industry funding, the study will be unlikely to get off the ground given the significant cost.

George F. Koop from the National Institutes of Health said “The study could completely backfire on the alcoholic beverage industry, and they’re going to have to live with it,” ,“The money from the Foundation for the N.I.H. has no string attached. Whoever donates to that fund has no leverage whatsoever – no contribution to the study, no input to the study, no say whatsoever.”

Pernod Ricard, one of the alcohol companies funding the study, said the company funded the the research because of its scale, “We’ve never seen a study of such scope or calibre,” a spokesperson told the NYT and confirmed that the companies will “have no say” in the research.“We’re hoping the results nevertheless are going to be good. And we’re optimistic they will be.”

All this controversy seems unwarranted given the NIH is a reputable body and any subsequent publications will be peer reviewed by independent scientists. But industry involvement in any health trials are always questioned, most times, unnecessarily after the questionable practices of the tobacco industry in the last century.

A very interesting piece of research indeed. Shame we need to wait 6-7 years for the results and it only looks at drinking at 1 glass per day.

More and more alcohol in Californian Napa Valley wines - too much?

Average Napa valley Cabernet Sauvignon alcohol levels 1976 - 2016

Average alcohol levels in California's Napa Valley Cabernet Sauvignon has risen from 13.6% in 1976 to 15.4% in 2016. Not great if you're concerned about the amount of alcohol that you consume when you drink wine. The reasons - changes in the Californian climate, later picking and hence riper and hence more alcoholic grapes and finally changes in vineyard practices.

Fake news? - Telegraph article claims that "Glass of wine a day enough to damage brain and could increase Alzheimer's risk "

Healthy and advanced Alzheimer's brain

On the 6th June 2017 the Telegraph.co.uk reported on an apparent damning new link between alcohol and Alzheimer's disease risk. But is it as clearcut as the article suggests? The study cited is "Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study. BMJ 2017". It was also reported in the Guardian in a similar way, "Even moderate drinking can damage the brain, claim researchers".

The BMJ paper contradicts several large meta-analysis studies published over the last 20 years. In a study published in 2008, researchers at Imperial College London found that "low to moderate alcohol use is associated with a 38 per cent reduced risk of unspecified incident dementia." and they noted that wine, at an intake of up to half a litre a day, significantly reduces the risk of Alzheimer's in particular.

In 2009, an Australian group's meta-analysis found that 'compared with non-drinkers, drinkers had a 34 per cent reduced risk of Alzheimer's disease and a 47 per cent reduction of any dementia type'. Heavy drinkers didn't benefit, but they were found to be at no greater risk of dementia than non-drinkers.

In 2011, a meta-analysis by U.S. researchers concluded that there is 'a real and beneficial effect of light to moderate drinking that reduces the risk of dementia, cognitive impairment, and cognitive decline in older adults by 20 to 25 per cent'.

In 2001, Harvard University neurologists decided to use MRI scanners to examine the inside of drinkers' and non-drinkers' skulls. They found that 'moderate drinkers' had healthier-looking brains than non-drinkers, with 'a lower prevalence of infarcts [damage from mini-strokes] . . . and white matter abnormalities [defects in the tissue that transmits messages between brain cells]' - two classic precursors of dementia.

Even the Telegraph article states " But others questioned the findings, saying the changes in brain matter appeared to have had little impact on brain function, with only one measure of language fluency showing changes, while heavy drinkers appeared to have greater fluency than others at the start of the study.

Prof Sir David Spiegelhalter, Winton Professor for the Public Understanding of Risk, University of Cambridge, said: “In spite of conducting repeated large batteries of tests of cognitive function, a possible relationship with alcohol was only found with one measure of language fluency, and this seems to have been due to a decline in the initially higher scores of drinkers.  So the changes in brain matter seem to have had little impact on brain function.”

Naughty reporting from Laura Donnelly and an exaggerated headline at best. A nice example of fake news when it comes to the controversial subject of alcohol and health.

See the Telegraph article in full:

Stockwell paper attempts to cast doubt on benefits of moderate alcohol drinking

Tim Stockwell, University of Victoria, BC

Tim Stockwell, University of Victoria, BC

Stockwell and his team in Canada has published a new study in the March 2016 issue of the Journal of Studies on Alcohol and Drugs, "Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality."

The new study was a 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.

Tim Stockwell, Ph.D., the lead researcher on the analysis and director of the University of Victoria's Centre for Addictions Research in British Columbia, Canada said that "Most often, studies have compared moderate drinkers (people who have up to two drinks per day) with "current" abstainers. The problem is that this abstainer group can include people in poor health who've cut out alcohol. A fundamental question is, who are these moderate drinkers being compared against?"

The paper concluded that when his team corrected for those abstainer "biases" and certain other study-design issues, moderate drinkers no longer showed a longevity advantage. Further, only 13 of the 87 studies avoided biasing the abstainer comparison group--and these showed no health benefits. It stated 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."

Stockwell's dismissive attitude to many previous studies citing these study biases and poor design is not universally accepted. Some academics saying that his team's negative opinion of clinical studies with a positive association of moderate drinking with alcohol is an over zealous attempt to portray a prohibitionist stance to alcohol. Given that Stockwell is based at the University of Victoria's Centre for Addictions Research in British Columbia, the title of the department may give underlying motivations away when it comes to funding and the desired outcome to be sceptical of any positive benefits of alcohol or wine.