Wine health evidence

New large and well designed study helps resolve confusion about the health benefits of alcohol and wine with up to 25% cut in heart disease and mortality risk

Femme Fatale beautiful lady drinking wine

The whole issue of whether drinking a glass or two of wine a day is good or bad for you has raged in the health community for years. One study seems to say one thing, then another comes out and is contradictory. Some researchers have dismissed some studies because drink companies have fully or partially funded them, though in many cases there observations are perfectly valid. In the face of this ambiguity, some health bodies have advocated strict and low limits on weekly drinking e.g. UK 14 units per week in both men and women.

For years, moderate drinking was linked to many health benefits, including a lowered risk of developing heart disease and longer life expectancy. But more recently, these assumptions were been called into question by a 2016 meta-analysis of 87 long-term studies which concluded that many of these health benefits could be explained by apparent flaws in study design. Some studies compared moderate drinkers to current abstainers, this "sick quitter"  group included former heavy drinkers and those who were tee-totallers because of health conditions. After correcting for these factors, the study’s authors found no evidence that moderate drinking had protective health benefits in most groups.

However, the study was criticised because the number of studies with design flaws was relatively low and trying to extrapolotate data from this relatively low number of sick quitters was like trying to slice a tiny piece of salami with a blunt knife. 

So it was concluded in the health community that more analysis is needed on the long term effects of alcohol consumption and health and in the meantime they advocated caution especially as alcohol is linked with raising the risk of some cancers e.g. breast (relative risk higher by 8%, but moderate exercise reduces relative risk by 15%). Doesn't sound like too much fun.

healthy and happy.jpeg

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.

Dr. Sreenivas Veeranki, one of the study’s authors said “Our conclusions definitively show there is a J relationship” between drinking and heart health(as alcohol consumption goes up, at first the risk of dying from cardiovascular disease decreases slightly—the bottom of the J—before increasing once intake exceeds around 10 drinks per week) The curve illustrates “moderate drinking has a protective effect, while heavy drinking or binge drinking is harmful.”

The authors concluded "Light and moderate alcohol intake might have a protective effect on all-cause and CVD-specific mortality in U.S. adults. Heavy or binge drinking was associated with increased risk of all-cause and cancer-specific mortality."

Link to full paper

Clinical paper abstract

Relationship of Alcohol Consumption to All-Cause, Cardiovascular, and Cancer-Related Mortalityin U.S. Adults.

Am Coll Cardiol. 2017 Aug 22;70(8):913-922. doi: 10.1016/j.jacc.2017.06.054.

Xi B, Veeranki SP, Zhao M, Ma C, Yan Y, Mi J.

BACKGROUND:

Previous studies have revealed inconsistent findings regarding the association of light to moderate alcohol consumption with cardiovascular disease (CVD) and cancer mortality.

OBJECTIVES:

The aim of this study was to examine the association between alcohol consumption and risk of mortality from all causes, cancer, and CVD in U.S. adults.

METHODS:

Data were obtained by linking 13 waves of the National Health Interview Surveys (1997 to 2009) to the National Death Index records through December 31, 2011. A total of 333,247 participants ≥18 years of age were included. Self-reported alcohol consumptionpatterns were categorized into 6 groups: lifetime abstainers; lifetime infrequent drinkers; former drinkers; and current light, moderate, or heavy drinkers. Secondary exposure included participants' binge-drinking status. The main outcome was all-cause, cancer, or CVD mortality.

RESULTS:

After a median follow-up of 8.2 years (2.7 million person-years), 34,754 participants died of all causes (including 8,947 CVD deaths and 8,427 cancer deaths). Compared with lifetime abstainers, those who were light or moderate alcohol consumers were at a reduced risk of mortality for all causes (light-hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.76 to 0.82; moderate-HR: 0.78; 95% CI: 0.74 to 0.82) and CVD (light-HR: 0.74; 95% CI: 0.69 to 0.80; moderate-HR: 0.71; 95% CI: 0.64 to 0.78), respectively. In contrast, there was a significantly increased risk of mortality for all causes (HR: 1.11; 95% CI: 1.04 to 1.19) and cancer (HR: 1.27; 95% CI: 1.13 to 1.42) in adultswith heavy alcohol consumption. Binge drinking ≥1 d/week was also associated with an increased risk of mortality for all causes (HR: 1.13; 95% CI: 1.04 to 1.23) and cancer (HR: 1.22; 95% CI: 1.05 to 1.41).

CONCLUSIONS:

Light and moderate alcohol intake might have a protective effect on all-cause and CVD-specific mortality in U.S. adults. Heavy or binge drinking was associated with increased risk of all-cause and cancer-specific mortality.

The press release from the American College of Cardiology

Men and women who engage in light-to-moderate alcohol consumption have a decreased risk of mortality from all-causes and cardiovascular disease, according to a study published August 14 in the Journal of the American College of Cardiology.

Bo Xi, MD, et al., looked at the relationship between all-cause, cardiovascular disease and cancer mortality risks and current alcohol consumption patterns. The researchers used data from 333,247 participants obtained through the National Health Interview Surveys from 1997 to 2009. Alcohol consumption patterns were divided into six categories: lifetime abstainers, lifetime infrequent drinkers, former drinkers, and current light (less than three drinks per week), moderate (more than three drinks per week to less than 14 drinks per week for men or less than seven drinks per week for women) or heavy drinkers (more than 14 drinks per week for men or seven drinks per week for women).

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 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. Men and women who engaged in moderate drinking 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. There were similar findings for light drinking for both men and women.

Light-to-moderate drinking may have protective factors for either all-cause or cardiovascular disease mortality, write the authors. To decrease all-cause, cardiovascular disease and cancer mortality risks, the researchers emphasize that a balance needs to be considered when looking at individual patient recommendations, however reducing high alcohol consumption is necessary.

In an accompanying editorial, Giovanni de Gaetano, MD, PhD, said that while younger adults should not expect considerable benefit from moderate drinking, "for most older persons, the overall benefits of light drinking, especially the reduced cardiovascular disease risk, clearly outweigh possible cancer risk." He concluded by noting that those who do not drink should not start, but rather focus on adopting a healthy lifestyle surrounding "regular physical activity, no smoking, weight control and dietary habits."

Want to be brainy and avoid dementia? Become a wine expert as Sommeliers brains are larger, including parts of the brain responsible for memory

A year ago or so I was watching a fascinating documentary on the BBC by David Eagleman, "The Brain", and subsequently read his excellent books. It amazing that we take our brain for granted but experience from those experiencing a starvation of input and sensory information e.g. "the Hole" dark punishment cells in prisons such as Alcatraz and lack of developmental input e.g. kids in Romanian orphanages shows what can happen.

When we are born we have roughly the same number of brain cells as in later life but it is the way these cells are wired together is the key. The importance of nurturing the brain during childhood and teenage years helps the brain sort out what is important and what isn't.

Mental gymnastics, a rewarding job and rich social life all seem to delay or prevent dementia. Importantly we can  adapt our brains because of something called "plasticity" through what we do and for example specialists like a London Taxi driver, a concert piannist or even a wine expert all have important structural changes in their brains because of what they do, learn and practice.

Eagleman uses the analogy of the toolbox when overcoming deterioration in the brain and discusses a phenomenon to prevent dementia/Alzheimers called "celebral reserve". He says even if the wrench is broken, we can use a different spanner in the box to do the same task. So elderly sisters in a convent in the United States had physical signs of Alzheimer's disease in the brain when they died e.g. protein anomalies but exhibited no obvious symptoms since they led an active mental life and their brains were able to adapt and "use a different spanner".

Eagleman discusses the basis of reality and the fact that we see, feel, hear, smell is the brain's perception of reality called the "internal model". This brain simulation is like the movie the Matrix as it evokes its perception of the outside world.

The big lesson is that the more you put into your brain, just like training your muscles in a gym, the better the condition and resilience of your brain.

More on brain or "cerebral reserve"

cross word puzzle

The concept of brain or cebrealreserve refers to the ability to tolerate the age-related changes and the disease related changes in the brain without developing clear clinical symptoms or signs of dementia. A considerable amount of biological research has documented that a number of factors including education, work complexity, social network, and leisure activities may contribute to this reserve allowing cognitive brain function to be maintained in old age.  Epidemiological studies have suggest that intellectual challenges experienced across the whole life span may increase the brain reserve and be crucial for preventing the occurrence of dementia symptoms in late life.

The factors that can help boost your brain or cerebral reserve are high education, adult-life occupational work complexity, as well as a mentally and socially integrated lifestyle in late life. All these factors could postpone the onset of clinical dementia and Alzheimers Disease.

The relevance of physical activity itself remains in debate, as most physical activities include also social and mental stimulation. Leisure activities with all three components--physical, mental and social--seem to have the most beneficial effect. 

The Sommelier and brain study in detail

Several studies have assessed the development of new skills in adulthood and associated changes in brain structure. Areas of expertise such as taxi driving and hippocampal volume , juggling and visual and motor regions of the cortex, musicians and the auditory cortex and more recently expertise in perfume has been associated with olfactory regions of the frontal lobe

Similarly, there have been studies looking at distinct functional activation patterns in experts. For example, musicians show a distinct pattern of prefrontal activity compared with non-musicians when listening to different rhythms and sommeliers, or wine experts, showed enhanced regions of the memory network when tasting wines.

Sommeliers’ brains are of particular interest since their expertise is focused on the smell (olfaction ) and taste (gustation), and associated with multiple other functions including memory, judgement, and the amalgamation of this with other senses.

The olfactory regions of the brain are relevant to diseases such as Alzheimer’s and Parkinson’s, where initial degeneration of the brain cells called neurones are isolated to regions important in smell. Furthermore, given that sommeliers are experts not just in a single domain but combine these in an integrating sensory information system.

MRI scanner

In 2016, researchers from the University of Las Vegas in Nevada conducted MRI scans on Masters of Wine to access structural changes in their brain.

This was published in Front. Hum. Neurosci., 22 August 2016

Structural and Functional MRI Differences in Master Sommeliers: A Pilot Study on Expertise in the Brain

Sarah J. Banks*, Karthik R. Sreenivasan, David M. Weintraub, Deanna Baldock, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA

What does the Sommelier brain study show?

This study identified enhanced structural and functional patterns in the smell or olfactory network of sommeliers. These findings are consistent with the learning they undergo in achieving the status of Master Sommelier. Furthermore, the volume of a region of the brain involved in olfactory memory was associated with experience, suggesting that the continued training results in morphological changes of the brain. These results speak to the plasticity of the adult brain in response to sensory expertise. Future research into therapeutic sensory-cognitive training in individuals at risk from neurodegenerative diseases, such as Alzheimer’s or Parkinson’s, which impact the same regions of the limbic system and entorhinal cortex, might provide an important clinical application of these results.

Changes to the brain in sommeliers

Enhanced Volume of the Right Insula

The dorsal subregion of the insula was found to be larger in volume in sommeliers. This is thought to be due to the importance of this region in combining multisensory and higher order cognitive processes, activities that sommeliers practice throughout their training and work. 

Enhanced Activation in Sommeliers Compared with Controls

Multiple regions showed an interaction between group and task, that appeared to be driven by more activity in sommeliers than controls, specifically during the olfactory judgment task.

We assume that the enhanced, more widespread, activation in sommeliers implies more complex processing of the same information. Overall, there was somewhat more activation in the right hemisphere of sommeliers compared with controls. This is consistent with earlier studies that suggest right hemispheric dominance for olfaction and olfactory memory (Jones-Gotman and Zatorre, 1993). 

The visual region enhancements both in the main effect of group (sommeliers more than controls) and in the interaction are interesting, this could be due to training of master sommeliers to use multiple senses while learning about wine, and to use imagery (e.g., of the fruit and vegetable section of a grocery store) when blind tasting5. This might explain the apparently enhanced activation of these regions in sommeliers during the olfactory task.

There was no relationship between enhanced functional activation and years of experience. The regions that were different were more specifically related to olfactory memory and cross modal integration, and it might be that these are the particular strengths that are enhanced in sommeliers.

More about the Sommelier brain study for those interested

Design

After Institutional Review Board (IRB) approval from the University of Nevada Las Vegas (UNLV), a preliminary selection of possible stimuli was conducted with UNLV students. Twelve male participants between the ages of 21–33 were recruited to participate. Following informed consent, participants were given the wine knowledge test. For this pilot study, only participants scoring below 70% were included. Eight non-wine blends were made by mixing varying amounts of vodka, cognac, Fusion brand versus (a non-alcoholic grape juice made from the same grapes as many wines), fruit essences and in some cases water-soaked oak chips. Participants were blindfolded using a cloth sleep mask. The researcher held a glass jar containing either wine or a non-wine underneath the participant’s nose and instructed the participant to inhale through their nostrils. During the first task, participants were asked to tell the researcher if they smelled a wine or a non-wine.

During the second task, participants were asked to tell the researcher if they smelled a white or a red wine. Four white wines and four red wines were included. All jars during both tasks were chosen at random. Immediately following the olfaction tasks, participants were led to a computer and asked to rapidly categorise variably pixilated pictures of zebra patterns or fingerprints to allow the researchers to match this visual task with the olfactory tasks on difficulty of identification.

Participant Selection and Recruitment

Master Sommeliers were recruited with the assistance of JJ, Master Sommelier and extensively involved in both training of sommeliers and in the local community. After being approached informally by him and allowing their contact details to be shared, they were contacted by DB or SB to ascertain interest. All Master Sommeliers were considered eligible. The Court of Master Sommeliers provides a diploma to those who pass their four-stage examination process2. There are only 219 Master Sommeliers worldwide, all of whom have passed this process that takes several years. By including only individuals with this distinction, we could be assured that we were assessing true experts. However, this restriction did limit the number of sommeliers who we could include, and hence posed a limit to the potential sample size.

Results - Non scanner

Scores on the wine knowledge quiz ranged from 20 to 70% with a mean of 45%. Participants were able to distinguish between wines and non-wines with accuracy, ranging from 58 to 100%. Accuracy in distinguishing white wines from red wines varied from 25 to 91%. Accuracy at distinguishing between zebra patterns and fingerprints varied from 93 to 100%. Stimuli were selected based on participant accuracy. 

Interesting that for the UPSIT control and Sommelier scores were similar

Interesting that for the UPSIT control and Sommelier scores were similar

General olfactory ability was evaluated using the University of Pennsylvania Smell Identification Test (UPSIT; Doty et al., 1984). The test consists of a booklet containing a series of standardized microencapsulated odorants. Scratching the paper releases each odor, which must then be identified by the participant (i.e., “scratch and sniff”). Results of this test indicate the degree to which individuals can identify smells in a forced-choice scenario.

Wine knowledge was assessed using the wine quiz. The wine quiz is a 10-item questionnaire developed for this project by MEP. The quiz contains questions about varietals, terroir, origin and tasting techniques.

Results - MRI

Enhanced Volume of the Entorhinal Cortex

Given the importance of the region to olfactory memory, this finding was expected. Sommeliers spend years learning about the olfactory qualities and other aspects of wine, and no doubt draw on that memory whenever they make a judgment about wine. We further found a relationship between years of experience and cortical thickness of the right entorhinal cortex. In many ways, this finding echoes that of Maguire et al. (2000) in taxi drivers who show enlargement of hippocampal regions with driving experience. It is also similar to the earlier finding of Delon-Martin et al. (2013) in perfumers, who showed increased size of the piriform cortex, a region of olfactory cortex directly adjacent to the entorhinal cortex. Furthermore, although we larger volume of this region bilaterally, compared with controls, the volume of the right hemisphere was larger than the left, consistent with early research on hemispheric lateralization of olfactory memory (Jones-Gotman and Zatorre, 1993). The entorhinal cortex may additionally be involved in more primary odor perception or identification tasks in addition (Wilson et al., 2014), which would also be highly relevant to a sommelier’s experience and skills. Given this region’s sensitivity to aging and neurodegenerative disease, it is especially interesting that we found this result comparing an older group of sommeliers with younger controls.

Enhanced Volume of the Right Insula

The dorsal subregion of the insula was found to be larger in volume in sommeliers. This is thought to be due to the importance of this region in combining multisensory and higher order cognitive processes, activities that sommeliers practice throughout their training and work. The cortical thickness of this region had no relationship with experience, however, which is interesting in comparison to the finding with the entorhinal cortex. It may be that this region changes early in the training process and then plateaus, or that only part of this heterogeneous region responds to cross-modal sensory expertise. Longitudinal studies would be needed to further explore the relative impact of training on different regions. Further study regarding the particular role of subregions of the insula in cross-modal expertise would also be of interest.

Enhanced Activation in Sommeliers Compared with Controls

Multiple regions showed an interaction between group and task, that appeared to be driven by more activity in sommeliers than controls, specifically during the olfactory judgment task. Importantly, task performance was similar between the two groups, making us more confident in the activation differences. We made the tasks similar enough to sommeliers’ work to be meaningful, but also wanted the tasks to require a similar amount of attention in both groups, thus made the tasks entirely novel (i.e., not discriminating types of wine, but rather wine from non-wine). These regions included olfactory, limbic, visual imagery, and multimodal regions. They are similar to those reported in an earlier study with fewer subjects comparing the taste and after-taste of wine and water in sommeliers compared with controls (Delon-Martin et al., 2013; Pazart et al., 2014). We assume that the enhanced, more widespread, activation in sommeliers implies more complex processing of the same information. Overall, there was somewhat more activation in the right hemisphere of sommeliers compared with controls. This is consistent with earlier studies that suggest right hemispheric dominance for olfaction and olfactory memory (Jones-Gotman and Zatorre, 1993). There were some left hemisphere differences in the interaction, always with analogous differences in the right hemisphere, specifically, in the hippocampus, lingual gyrus and precuneus. Previous fMRI studies of taste in sommeliers have also shown mixed lateralization: one study comparing tasting of wine vs. glucose showed more left insula activity compared with controls during the after-taste period (Castriota-Scanderbeg et al., 2005), while the study by Pazart et al. (2014) showed enhanced right but not left anterior insula activation during tasting but not during aftertaste.

The visual region enhancements both in the main effect of group (sommeliers more than controls) and in the interaction are interesting, this could be due to training of master sommeliers to use multiple senses while learning about wine, and to use imagery (e.g., of the fruit and vegetable section of a grocery store) when blind tasting5. This might explain the apparently enhanced activation of these regions in sommeliers during the olfactory task.

We did not demonstrate a difference in activation over the piriform [which we consider to be part of the olfactory cortex (Zatorre et al., 1992) although one cluster extended into the olfactory cortex though only by a few voxels.] in the interaction. Others have noted the inconsistency of imaging studies in olfaction to specifically demonstrate piriform involvement (Zald and Pardo, 2000) although an alternative explanation here might be that this primary olfactory cortex is equally activated by both groups.

From its comparison to activation during a complex visual discrimination task, our results support the specificity of the enhanced activation seen during the olfactory discrimination tasks, and particularly so in sommeliers. While the olfactory network enhancement makes intuitive sense, the result of the current study point to the specificity of this finding. Had we not included this visual control task, one could argue that the Master Sommeliers attended more to perceptual judgment tasks in general, and that this was not specific to tasks involving olfactory stimuli. Our use of a visual judgment task as a comparison provides evidence for the specificity of enhanced cortical activation during processes involving chemical senses in sommeliers.

There was no relationship between enhanced functional activation and years of experience. Future longitudinal studies will be important in learning more about the interrelationship between activation intensity and experience. There may be a causal relationship with those regions that show enhanced activity early in the training process showing enhanced volume or thickness over time. Similarly, we did not find any significant differences in certain parts of the olfactory network including the orbitofrontal cortex. The regions that were different were more specifically related to olfactory memory and cross modal integration, and it might be that these are the particular strengths that are enhanced in sommeliers, however, future research and direct comparison with other olfactory experts such as perfumers might be important to further disentangle the regions that could be specifically enhanced in one expert group over another.

 

 

Fake news alert: Express "Bowel and gullet cancer: Just two beers or glasses of wine raises your risk"

Fake news

Fake news alert

Another piece of exaggerated reporting from the British media when it comes to alcohol and cancer. 

On  July 4th, the UK's Express newspaper reported that "Bowel and gullet cancer: Just two beers or glasses of wine 'raises your risk'" - TWO beers or glasses of wine a day raises the risk of bowel and gullet cancer by more than a fifth, according to new research

Reporting that:

Britons down an average of 2.1 drinks daily, placing them among the most vulnerable to two of the deadliest forms of the disease. And anyone having four or more drinks a day is at increased risk of liver, gastric and pancreatic cancer three more particularly lethal types.

The five cancers are the most common digestive cancers across the world, causing almost three million deaths a year, says the report by medical group United European Gastroenterology.

“Heavy” drinkers who get through more than four daily were more likely to develop pancreatic, liver and gastric cancer.

Drinking across the region is higher than in any other area in the world, with over one fifth of the European population over the age of 15 drinking heavily at least once a week. As a result, the continent suffers from the highest proportion of ill health and premature death directly linked to alcohol.

So what are the facts about Bowel and gullet cancer and alcohol?

When you do drink moderate amounts of alcohol, studies have shown that the risk of some cancers increase, yet others decrease. There is much debate about this but overall the health benefits of moderate alcohol drinking are such that your risk of dying is reduced. See more at:

WCRF Report Alcohol and risk of Colorectal Cancer

The most recent WCRF (World Cancer Research Fund) report states that "The evidence that consumption of alcohol of more than 30g/day of ethanol from alcoholic drinks is a cause of colorectal cancer in men is convincing, and probably also in women."

So when you read the summary the WCRF seems damning, but the devil is in the detail and things aren't what they seem at first read! It is a very mixed picture.

A wine at 12.5 % vol contains 12.5ml of alcohol/100ml of wine x 0.8 g/ml = 10g of alcohol/100 ml of wine. So 30g is 300ml, around half a bottle a day (A drinking unit can vary from 8-14g of alcohol depending on the country). For example, 125 ml of wine (12.5% vol), will translate into 1.25 drinking units and 175ml of wine (12.5% vol), will translate into 1.75 drinking units.

Your lifetime Risk of Developing colon and rectum cancer is approximately 4.3 percent of men and women (diagnosed with  at some point during their lifetime, based on 2012-2014 data).

Relative risk, your additional chance of getting bowel cancer, has been reported as follows and summarised by the WCRF in their report. If relative risk is 1.25, your lifetime risk is 5.4%. If relative risk is 1 your lifetime risk is unchanged at 4.3%.

Kato 1999 (1 = no additional risk), Ford 1997 (0.97 =slightly reduced risk, Schoen 1999 (1.24 = 24% higher chance), Chen 2001 (1.26), Flood 2002 (1.02 = no increased risk), Pedersen 2003 (1.0).

The summary estimate is 1.01 according to WCRF= no increased risk of colorectal cancer with Alcohol! 

Somewhat different to the summary, "The evidence that consumption of alcohol of more than 30g/day of ethanol from alcoholic drinks is a cause of colorectal cancer in men is convincing, and probably also in women." Hardly convincing evidence of increased risk. I would say no risk increased risk based on the data!

Summary: Is it true Bowel and gullet cancer: Just two beers or glasses of wine 'raises your risk'?

The most respected cancer reporting charity the WCRF has concluded that the the relative risk is the same for drinkers as non drinkers. So the Express newspapers claims that "just two beers or glasses of wine raises your risk" is untrue. Fake news! 

Further information: Detailed summary of bowel cancer studies

See more at: 

Cho et al in 2004 in their paper "Alcohol intake and colorectal cancer: a pooled analysis of 8 cohort studies" saw that "In categorical analyses, increased risk for colorectal cancer was limited to persons with an alcohol intake of 30 g/d or greater (approximately > or =2 drinks/d), a consumption level reported by 4% of women and 13% of men. "

In 2007, Ferrari et al reported on the link between rectal and colon cancers in Europe concluding that "In this large European cohort, both lifetime and baseline alcohol consumption increase colon and rectum cancer risk, with more apparent risk increases for alcohol intakes greater than 30 g/day."

The 2009 Park JY et al with participants from Norfolk concluded that "Total alcohol consumption was not associated with CRC risk before or after adjustment for age, sex, weight, height, and smoking status . No significant associations were observed between consumption of specific alcoholic beverages (beer, sherry, or spirits) and CRC risk when compared with non-drinkers after adjustment for lifestyle and dietary factors. Daily consumption of > or =1 unit of wine appeared inversely related to CRC risk (HR: 0.61, 95% CI: 0.40-0.94). No evidence was found for sex-specific relationships, and further exclusion of cases incident within 3 years of baseline did not change the associations observed. In this population-based UK cohort, we did not find any significant adverse effect of alcohol over the moderate range of intake on colorectal cancer risk.". So a 40% lower risk with daily consumption of wine!

In the 2010 UK study by Park et al, which looked at alcohol intake and risk of colorectal cancer (CRC) concluded that "No clear associations were observed between site-specific CRC risk and alcohol intake in either sex. " (up to 30g/day).

Hjartaker et al in 2013 looked at "subsite specific dietary risk factors for Colorectal cancer: A review of cohort studies" . The paper stated that "Ten articles were included in the review. Three analyses for both sexes combined consistently showed a higher risk of rectal cancer with increasing alcohol consumption and no significant associations for any of the colon subsites . In the EPIC studyan increased risk was reported both for rectal and distal colon cancer, whereas in the UK dietary cohort consortium (part of which is included in the EPIC study) a significantly increased risk was found for distal colon cancer only."

Is drinking wine good or bad for you?

If you love to drink wine you are probably concerned when you read the endless negative headlines in the newspapers about alcohol and its effect on your health. Most governments, public health organisations and even charities advise not drinking or very limited drinking of alcohol. This review aims to discuss the balance of evidence to help you decide whether alcohol and wine is good or bad for you.

Background to the debate on alcohol, wine and health

The dangers of excessive drinking and the benefits of moderate amounts of alcohol have been part of a continued debate within the health community for decades. For example, a World Health Organisation (WHO) study published in October 2015 ranked ethanol in alcoholic beverages as definitely carcinogenic in common with processed meats like salami and bacon. In January 2016, the U.K.'s Chief Medical officer (CMO), Dame Sally Davies reduced "safe" drinking guidelines to 14 units a week for both men and women. See CMO Alcohol report.

In March 2016 Stockwell et al published a new study in 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 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 stating 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."

However other academics dispute Stockwell's analysis contesting strongly his assertion that abstainers were biased because many abstainer groups include people in poor health whod cut out alcohol and that his approach to dismiss many studies because of his group's reservations about design was over zealous.

Yet, whilst drinking too much wine is certainly not good for you and even with the debate about abstainer biases and "flawed design" raised by Stockwell and other academics, some major clinical studies with many hundreds of thousands of participants give strong evidence that moderate consumption (2-3 glasses of alcohol per day) has a beneficial impact on your overall health, reduce your risk of premature death and lower your chances of having a life threatening event like a heart attack. These studies were pioneered by scientists like Sir Richard Doll, noted for being one of the first to conclusively link smoking tobacco and lung cancer.

Clinical evidence in these large scale human studies is clear that total abstainers from alcohol are likely to die younger than those drinking a glass or two a day on average of alcohol. Conversely "binge drinking" or heavy daily consumption of any alcohol is not healthy, predominantly because of negative effects on the liver and increasing the risk of cancer. A moderate approach to wine consumption is therefore to be recommended for a happier, healthier and longer life!

In addition, certain types of wine may have a more beneficial effect on health than others. Laboratory studies confirm that red wines made from grapes with thick skins (e.g. Tannat & Malbec) have higher levels of a molecule called resveratrol which appears to have positive effects on the body. However some studies show an equal positive impact for both red and white wines leading some academics to suggest that it is alcohol itself which benefits health rather than any specific compound in wine or other drinks. 

Unpicking facts from fiction is a large task given the controversy and this review attempts to link the substantial human data relating to alcohol use and give a conclusion to the regular alcohol or wine drinker as to whether wine is good or bad for your health. 

Gene Ford in his 2003 book "The Science of Healthy Drinking" points out that antipathy to drinking became the norm in medicine when the American Medical Association passed a resolution in June 1917 which stated "alcohol as a beverage is detrimental to the human economy...or as a stimulant or as a food has no scientific basis...the use of alcohol as a therapeutic agent should be discouraged." This was followed by Prohibition in the United States between 1920 and 1933, a nationwide constitutional ban on the sale, production, importation, and transportation of alcoholic beverages.

Prohibition may have gone but temperance is a societal normal in many countries with a pattern of government sponsored bodies omitting drink positive research in disease articles and with a tendency to overstate the risks of abuse and addiction. Many highly regarded but conservative doctors still believe in a prohibitionary agenda despite the evidence that moderate consumption has a positive impact on health outcomes. Yet most doctors themselves are not abstainers!

Many drinkers worry about addiction but the evidence is substantial in the medical literature that only a very small percentage of alcohol drinkers will become addicted. Alcohol abusers tend to have underlying psychological or social problems which is linked to the addiction and certain genetic factors are key.

Positive studies associated with alcohol are explained away by some physicians by so called "confounding factors". They will argue that those who apparently had a lower risk of heart attacks or other negative health events may have been drinking more alcohol than abstainers but focus on the potential of better lifestyle in the alcohol drinking group. Others quote the 'sick quitter' hypothesis, an argument that the risks of not drinking were magnified as some people stop consuming alcohol because of problems with their health and therefore only lifelong abstainers should be studied.

Authors like Tony Edwards in "The Good news about Booze" summarise the picture that moderate drinking - or by today's puritanical standards, even relatively heavy drinking - reduces not only heart disease risk but overall mortality risk and the relationship is causal.

Dr Kari Poikolainen, a doctor of medical science and adjunct professor in public health (since 1983) at the University of Helsinki in Finland and Research Director at the Finnish Foundation for Alcohol Studies before he retired. In 2014 he published a very good book for those interested in alcohol and health called "Perfect Drinking and its enemies".

Dr Kari Poikolainen

Dr Kari Poikolainen

Poikolainen says "To sum up, the most likely estimate for increased health risk (from alcohol), compared with that of abstaining, is somewhat between 90 and 150g/day. Respectively, the optimal level might be 14-22g/day" (120 ml of wine, half a large glass = 12g of 100% alcohol). Furthermore he states that "Careful participant observations have found that many alcoholics consume much more, typically between 350 to 470g/day".

Those with a negative view of the alcohol benefit talk about "Even if moderate drinking does confer health benefits, which it probably does, they are rather modest - certainly not stronger than the effect of small daily doses of aspirin on heart health...the effect may be more in line with the apparent cardio-protective benefits of eating a modest portion of nuts each day" (Time magazine 2003). Yet clinical evidence from major studies indicates that drinking moderate amounts of alcohol has a more than "modest" benefit on risk of cardiovascular disease and overall mortality and in populations who are abstainers and are already eating healthily and perhaps using measures such as Aspirin the comparative benefit of drinking 2-3 glasses of alcoholic drinks are incrementally beneficial.

In 2006 Di Castelnuovo et al 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. Yes over 1 million people!

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". 

Abigail Zuger wrote in the NYT in 2002 in the article "The case for drinking (All Together Now in Moderation), "Thirty years of research has convinced many experts of the health benefits of moderate drinking for some people. A drink or two of wine, beer or liquor is, experts say, often the single best non-prescription way to prevent heart attacks, better than a low fat diet or weight loss, better even than vigorous exercise. Moderate drinking can help prevent stokes, amputated limbs and dementia."

Zuger's view may be over eager but examples like the French Paradox (where despite a high fat diet and heavy smoking the people of several regions of France live a long life) show that moderate alcohol together with regular exercise, a good diet with olive oil/fish/nuts (in a regular, relaxed setting ideally non rushed eating) and not smoking is a key to long and healthy life. 

Do we need to drink wine - no! But life without wine would be a lot duller and wine is certainly an "antidote to civilisation". What do I mean by this? Well after a stressful or boring day at work, a rough day with the children, bad or good news, human beings sometimes need a reward. In earlier generations they may have smoked a few cigarettes to wind down and now in the modern world we need something else since we now know that the TAR in cigarettes isn't exactly positive (the risks certainly outweigh the benefits). The alclohol prohibitionists may say you don't need anything, "a glass of water will do", but we know that this suggestion isn't the same and the clinical evidence is there for all to see that less than half a bottle of wine a night is a lot better for you than smoking tobacco or cannabis or eating too much as comfort food - the benefits of moderate wine drinking certainly outweigh the risks. If you can do it with exercise and healthy eating even better! 

The evidence for Aspirin and Statins in reducing mortality plus risk of heart attack & stroke are substantial but given side effect concerns (e.g. gastrointestinal bleeds with Aspirin) the case for consuming 2-3 glasses of wine a day look equally compelling.

In the end it is all down to relative risk. Certain behaviours and environmental factors increase your risk of an event like cancer or heart attack. Although certain cancers such as Breast may rise in alcohol drinkers, the increase in risk is tiny compared with the absolute risk of dying in a car accident. Given the risk of dying prematurely in moderate drinkers seems convincingly lower, I for one am continuing my love of the fermented grape.

The debate and the controversy amongst academics will continue!

Negative effects of alcoholic drinks

  • Alcohol: high alcohol consumption (half a bottle of wine a day and over) results in a higher blood pressure and may cause hypertension at very high levels of drinking. It has a positive correlation with mouth, throat and gullet (oesophageal) cancer and under certain circumstances with liver cancer and liver cirrhosis. Some studies suggest a positive relationship between alcohol and breast & gastric cancer, though there is evidence that it may reduce the risk of kidney cancer. The relative risk of lung cancer for men who smoke is 2,300 percent higher than it is for men who don't smoke, whereas some studies show that alcohol may have a relative risk of around 100%, i.e. doubles your chance of getting cancer, which in many cases have a small absolute lifetime risk e.g. oesophageal (1 in 112) or liver (1 in 193). The most prevalent cancers are lung (most caused by smoking), prostate and breast.
  • Tannin: these compounds are plant polyphenols and may cause headaches. Tannins tend to bind starches while being digested. 
  • Sulfites / Sulphites: The term ‘sulfites’ is an inclusive term for sulphur dioxide (SO2). SO2 is a preservative and widely used in wine making because of its antioxidant and antibacterial properties. SO2 plays a very important role in preventing oxidisation and maintaining a wine’s freshness but some people seem to be sensitive to it and many higher quality wine makers are now trying to limit the addition of sulphite or eliminate it entirely.

Positive effects of alcoholic drinks

Risk of premature death

  • Risk of dying early up to 40% lower in drinkers than abstainers, with lower benefit for women and Asians
  • Moderate drinking increases longevity for all causes by about 3%

Reducing coronary heart disease

Epidemiological studies confirm that wine changes body fat levels with total cholesterol lower, bad LDL cholesterol and higher good high density lipoprotein (HDL) levels in drinkers than abstainers.

  • Alcohol significantly reduces incidence of cardiovascular disease, total mortality with lower incidence of angina pain and heart attacks
  • Daily alcohol intake reduces atherosclerotic plaque build up (arteriosclerosis), key in reducing the risk of strokes and heart attacks
  • Nearly a 50% reduction in heart attack risk amongst moderate daily alcohol drinkers has been reported with superior benefits to using daily Aspirin

High blood pressure

  • Light drinkers show favourable blood pressure profiles and less blood pressure induced strokes

Strokes 

  • Light alcohol consumption reduces risk of stroke, whilst lifelong abstention increases risk

Cancer

  • Two to three alcoholic drinks per day reduce some cancer rates e.g. prostate and kidney

Alzheimer's disease and dementia

  • The Polyphenols in wine have an antioxidant and free radical scavenging action which may explain their positive benefit in reducing the risks of dementia. High doses of resveratrol which is found in wine has been shown to reduce the level of amyloid beta protein in blood (where it probably accumulates in the brain causing the classic symptoms of dementia). 

Diabetes

  • Detrimental metabolic factors are reduced in diabetics who consumer moderate amount of alcohol e.g. LDL cholesterol

Colds and Flu

  • Moderate daily drinking has been shown to reduce the risk of catching the common cold

Why is wine probably healthier than other alcoholic drinks?

In Arranz S 2011 "Wine, Beer, Alcohol and Polyphenols on Cardiovascular Disease and Cancer" they said that "The mechanisms responsible for the healthy effects of wine are extremely complex due to the many different pathways involved. Both alcohol and polyphenolic compounds have been extensively studied, despite the continued controversy as to which component is the most active. The underlying mechanisms to explain these protective effects against CHD include an increase in high-density lipoprotein (HDL) cholesterol, a decrease in platelet aggregation, a reduction in the levels of fibrinogen and an increase in insulin sensitivity, which have been attributed to the ethanol content in wine. Other studies have provided evidence that wine exhibits beneficial properties which are independent of the presence of alcohol, and should be attributed to their polyphenolic content.".

They conclude that "Wine consumption should not replace a healthy lifestyle. However, light-to-moderate wine drinkers, without medical complications, may be assured that their wine consumption is a healthy habit."

Cordova AC 2009 in "Polyphenols are medicine: Is it time to prescribe red wine for our patients?" states that "The habit of having one or two drinks of red wine every day with meals may translate to a longer, healthier and better quality of life."

Are certain wines better for you than others?

Red wine polyphenols are a complex mixture of flavonoids (such as anthocyanins and flavan-3-ols) and nonflavonoids (such as resveratrol, cinnamates and gallic acid). Flavan-3-ols are the most abundant, with polymeric procyanidins (condensed tannins) composing up to 50% of the total phenolic constituents. These compounds act as potent antioxidants as they reduce low-density lipoprotein (LDL) cholesterol oxidation, modulate cell signaling pathways, and reduce platelet aggregation. Red wine contains more polyphenols than white wine (around 10-fold) because during the wine making process, red wine, unlike white wine, is macerated for weeks with the skin which is one of the parts of the grape with the highest concentrations of phenolic compounds. The concentrations in red wine range from around 1.2 to 3.0 g/L.

Certain wines seem to be more healthy than others and one theory is those with the healthiest credentials have the highest amount of procyanidins (proanthocyanidins) - proC, which is a polyphenol.  

The effects of proC include anti oxidant and free radical neutralisation, reducing blood fat, and inhibiting destruction of collagen, the most abundant protein in the body. They may also prevent cardiovascular disease by reducing the negative effects of high cholesterol on the blood vessels. These effects explain their apparent benefits in reducing the incidence of cardiovascular disorders. 

The amount of polyphenols varies from wine to wine, country to country and grape to grape.  The method of production can also significantly impact the amount of procyanidins.

In N Gall 2001 "Is wine good for your heart? A critical review" he says " Is there evidence to enable us to advise what to drink? Although the epidemiological evidence suggests not, there are at least theoretical reasons why red wines rich in flavonoids and resveratrol may hold extra benefit. Flavonoids, being found particularly in grape skins, occur in the highest concentrations in grape varieties with thick skins grown in hot climates.Cabernet sauvignon based wines from Australia, South America, and the southern Mediterranean are particularly rich sources. Syrah (shiraz) and merlot are good too. Fungal vine infection is more common in cooler, damper regions and occurs in significant quantities in pinot noir. Wines from this grape form Burgundy, Sancerre, New Zealand, and the north west United States are particularly rich in resveratrol. Merlot, gammay, syrah, zinfandel, and pinotage wines may also be too. May I advise: Nuits-St-Georges Premier Cru, Clos des Porrets, 1997, one nocte. As the French say, Salut."

What is Resveratrol and why is it important?

 

Other evidence points to the importance of the concentration of a stilbenoid, a type of natural phenol, called resveratrol in wine and some producers have sought to exploit higher concentrations of this chemical in their wines. 

Resveratrol is found in the skin of red grapes. For example, the Malbec grape, used extensively in Argentina and the Tannat grape found in Uruguay, have thick skins and contains high levels of resveratrol. Vine grapes grown in cooler climates have higher resveratrol levels than those from warmer climates such as Australia.

However, the science behind healthy wine is controversial with some scientists arguing that polyphenols are unimportant, and that factors such as the pips used or manufacturing process are more significant.For example,  see http://www.bbc.co.uk/news/health-23985540, "Red wine - what's behind its healthy reputation?"

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Tannat - seemingly the grape with the highest health benefits

It is said that the tannat grape is the grape with the greatest health benefits. Tannat is used extensively in Madiran wine from SW France (not to be confused with Madeira Wine, a fortified Portuguese wine made in the Madeira Islands) and in Uruguay.

tannat grape vines

More recently wine makers in the Central Coast Region of California are beginning to grow the grape in larger quantities.

The other main factor in the health benefits of a Red Wine may be the method of duration of fermentation and maceration (which is the process of soaking crushed grapes, seeds, and stems in a wine must to extract coluor and aroma compounds as well as tannins). The long fermentation and maceration times that go into the production of Madiran Red Wine may be important factors in its apparent healthiness. The more mass produced Red Wines wines generally don’t conform to these criteria and usually have very low levels of procyanidins.

Procyanidin levels around the world (reds):

Dr. Roger Corder is an author of many scientific papers detailing his research into the flavonoids of foods, but wine in particular. He summarised his findings in "The Red Wine Diet, 2007". 

roger.jpeg

Among the important observations Corder makes is that regions of the world with the greatest longevity also correspond to regions with the highest procyanidin flavonoids in their wines. 

"Although differences in the amount of procyanidins in red wine clearly occur because of the grape variety and the vineyard environment, the winemaker holds the key to what ends up in the bottle. The most important aspect of the winemaking process for ensuring high procyanidins in red wines is the contact time between the liquid and the grape seeds during fermentation when the alcohol concentration reaches about 6 percent. Depending on the fermentation temperature, it may be two to three days or more before this extraction process starts. Grape skins float and seeds sink, so the number of times they are pushed down and stirred into the fermenting wine also increases extraction of procyanidins. Even so, extraction is a slow process and, after fermentation is complete, many red wines are left to macerate with their seeds and skins for days or even weeks in order to extract all the color, flavor, and tannins. Wines that have a contact time of less than seven days will have a relatively low level of procyanidins. Wines with a contact time of 10 to 14 days have decent levels, and those with contact times of three weeks or more have the highest."

He points out that deeply-coloured reds are more likely to be richer in procyanidins. Wines rich in procyanidins provide several-fold more, such that a single glass can provide the same purported health benefit as several glasses of a procyanidin-poor wine.

  • Australian: on average, low levels, except Cabernet Sauvignon which is moderate.
  • Argentine: Argentinian Malbec have some of the highest levels of procyanidins 
  • Californian: Those with the Tannat grape variety have the highest levels, but Cabernet Sauvignon has also a high content.
  • Chile: Cabernet Sauvignon stands out, then only moderate in content.
  • French: Bordeaux is moderate for procyanidins, Burgundy wines are low to moderate; Languedoc-Roussillon red wines moderate to high levels; Côtes du Rhône red Wines moderate to high. South-West France is a region with superior longevity of its residents. Wine of the Cahors appellation is mainly made from the Malbec grape. The wine with the highest procyanidin content is a wine grown in the Gers region of southwest France. The wines here are made with the tannat grape within the Madiran appellation; wines labeled "Madiran" must contain 40% or more tannat to be so labeled.
madiran.jpeg
  • Italian:The southern Italian wines from Sicily, Sardinia, and the mainland have high levels of procyanidins while most northern varieties are moderate.
  • Spanish: Moderate levels 
  • United States: Cabernet Sauvignon is the standout for procyanidin content, with the Napa Valley a major production area.

Resveratrol concentrations in wine

Media coverage of wine health controversy

Prescription wine? - Horizon - Do I drink too much?

In this BBC documentary Dr William McCrea prescribes red wine to his patients in the Cardiac Ward of Scotland's Great Western Hospital.

William McCrea is now consultant cardiologist at the Great Western Hospital in Swindon, 58. He says

"There's a great deal of evidence that in moderation, alcohol is not harmful. And in people who've always had it in moderation, it's actually healthy. Two small glasses of red wine a day are good for you in terms of preventing heart disease. I personally have this every night at home, unless I'm on call or driving somewhere. 

And I prescribe red wine to mycardiac patients, apart from those with obvious contra-indications, such as liver or stomach disease or a history of addiction. 

Look at the French paradox: there is a far lower death rate from cardiovascular disease in France compared with the U.S. - that's not because of the cheese or the Gauloises cigarettes, is it? 

I occasionally have a cider, too - scrumpy has good antioxidants, which stop your blood clotting and keeps the inside of your blood vessels smooth. 

Antioxidants are good in general, but moderation is key: while two units a day gives you the optimal benefits, if you go up to four, it's bad news. 

The French Wine Paradox - CBS 60 Minutes

The ground breaking CBS feature on wine which changed the mindset of many an American when it comes to alcohol consumption and the impact on their health.

Eat well, Drink Wisely, Live Longer - Wine Spectator

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The French Paradox

The term "French paradox" was coined by Serge Renaud, a scientist from Bordeaux University in France, and has been in use since the early 1990s. His paper was published in 1992 "Wine, alcohol, platelets, and the French paradox for coronary heart disease".

Renaud et al based on the MONItoring system for CArdiovascular disease (MONICA) project which included seven million men and women between 35 and 64 years of age from 37 European, American and Asian populations, including the US, Canada, United Kingdom, France and China, among others. The World Health Organisation followed the subjects over a period of 10 years, from the mid-1980s to the mid-1990s. France presented a markedly lower annual mortality from CAD (coronary artery disease) compared with other industrialised nations, despite the fact that cardiovascular risk factors such as cigarette smoking, blood pressure, body mass index and serum cholesterol concentration were similar among these countries; furthermore, it had a three-fold higher intake of saturated fats than that of the US and the United Kingdom, which are not well known for their healthy eating .

Renaud's observations regarding the apparent disconnect between French patterns of high saturated fat consumption and their low rates of cardiovascular disease can be quantified using data from the Food and Agriculture Organisation of the United Nations. In 2002, the average French person consumed 108 grams per day of fat from animal sources, while the average American consumed only 72 grams. The French eat four times as much butter, 60 percent more cheese and nearly three times as much pork. Although the French consume only slightly more total fat (171 g/d vs 157 g/d), they consume much more saturated fat because Americans consume a much larger proportion of fat in the form of vegetable oil, with most of that being soybean oil. However, according to data from the British Heart Foundation, in 1999, rates of death from coronary heart disease among males aged 35–74 years were 115 per 100,000 people in the U.S. but only 83 per 100,000 in France.

Possible explanations for the French Paradox:

  • High per capita consumption and appreciation of wine in France, particularly red table wine - Resveratrol, Procyanidins and polyphenols
  • Aspects of the French diet - The French diet is rich in vitamin K2, it is rich in short-chain saturated fatty acids and low in trans fats despite dishes like Fois Gras, Confit de Canard etc.  
  • Whole diet - Higher fruit and vegetable intake, more fish, Early life nutrition
  • Generally don't tend to over eat and don't eat quickly - quality over quantity, portion control and lack of over consumption
  • Limited processed and packaged ready meal type foods (many of which are high in sugar and salt)
  • Less snacking and more moderate exercise
CardiovascularDeathsAHA.jpg

American Heart Association - This shows rates of death from cardiovascular diseases (heart attack and strokes combined) for men in several countries, ranked from worst to best.

France stands out as a country with a high wine consumption but with a correspondingly low level of death caused by heart attacks and strokes.

Detailed clinical evidence - the health effects of alcohol consumption

For more detailed information on the health effects of alcohol and wine consumption on health outcomes such as heart disease and death with key clinical studies please see the link below: