Wine Wisdom
Ellen Mack, M.D., M.P.H. - Russian Hill Winery
Wine and your Heart
Part I: More than just Enjoyment!

Could a glass of wine a day, keep the doctor away? This philosophy, cultivated by ancient Chinese, Egyptian, and Mesopotamian societies, is today enjoying a re-emergence thanks to scientific scrutiny. Let’s look at some of the evidence.

In the 1950’s, it became apparent that Americans were having heart attacks at unprecedented rates and coronary heart disease had become the number one killer of Americans. Unfortunately, coronary heart disease carries this distinction to this day.

To better understand this problem, and therefore effectively combat it, the medical profession undertook large scale studies in the 1960’s to investigate the association between heart disease, diet and lifestyle. Such studies, including the widely publicized Framingham Study, taught us that a lifestyle consisting of a low fat diet, regular exercise, no smoking, and weight loss lowers our risk of death from heart disease. What these early studies also revealed, but which was not publicized, was that persons who regularly consumed moderate amounts of alcohol also had a lower risk of dying from heart attacks.

The general public and, I might sadly say, much of the medical profession did not become aware of this knowledge until the 1990’s when 60 Minutes aired ‘The French Paradox’ episode in 1991. The paradox is that the French, who eat more fat than the Americans, have similar cholesterol levels, and smoke more, would be expected to have similar, or even higher, rates of heart disease than Americans. However, the French have only one third the number of fatal heart attacks and less than half the rate of coronary heart disease of Americans.

How could this be? The researchers of the French Paradox suggested that the large difference in the rates of heart disease between French and American populations is partially based on their different levels of alcohol consumption. Although the Americans and French differ in many respects, the researchers focused on wine consumption. They took their clues from earlier studies examining worldwide dietary habits and mortality. These studies found that only a population’s consumption of fat and wine was correlated with its overall survival. Wine consumption had a positive correlation with survival, i.e. populations who consumed alcohol tended to live longer, whereas fat consumption was negatively correlated with survival.

The French Paradox researchers concluded their publication with a prediction that consuming 20 to 30 grams of alcohol a day could lower the rate of coronary heart disease by 40%, making alcohol one of the most efficient agents for protection against heart disease.

The findings of the French Paradox study helped explain why Americans, who had by now largely heeded the advice of their doctors to exercise more, stop smoking and eat less fat, had decreased their risk of dying from heart disease but were still lagging far behind the French. Obviously, a critical factor was still missing.

More scientific studies began to substantiate the finding that people who consumed alcohol regularly had a lower risk of dying from heart disease and of dying in general. Fueled by the mounting scientific evidence that moderate alcohol consumption could be good for your health, 60 Minutes aired a second segment on this topic in 1995.

This telecast featured Dr. Morton Gronbaek, author of the Copenhagen City Heart Study as published in the British Medical Journal. The Copenhagen Study followed 13,000 Danish citizens over a thirteen year period and controlled for factors which could affect mortality such as gender, age, education level, income level and smoking. The findings of this study are substantial and warrant a careful review.

First of all, the Copenhagen study confirmed what was now becoming known as the U-shaped relationship between alcohol consumption and heart disease. Namely, people who consume moderate amounts of alcohol (the users) have a lower mortality than those who consume either no alcohol at all (the abstainers) or those who consume larger amounts of alcohol (the abusers). If these data are plotted on a graph of level of alcohol consumption versus mortality, a U-shaped curve results. Therefore, alcohol has both harmful and beneficial effects and it is the rate and amount of alcohol consumption that are key to its beneficial effects.

Secondly, this Danish study showed that it was not just the French who, perhaps by way of other features of their Mediterranean diet and lifestyle, had less heart disease, but rather that any population who drank moderate amounts of alcohol could benefit from the so-called French Paradox. The implications are important and have since been confirmed in studies on Chinese, Japanese, Korean, German, Dutch, Polish, Italian, Israeli and American populations, all of whom have shown decreased mortality with the regular consumption of moderate amounts of alcohol.

The Copenhagen study was also very revealing in that it looked at the pattern, not just amount, of alcohol consumption. Did enrollees in the study drink wine, beer, or spirits? Did they drink daily, weekly, or less regularly and how much did they drink at one time? The Copenhagen study found that daily, moderate consumption, as opposed to occasional binges, was an important factor in the beneficial effects of alcohol.

A final conclusion of the Copenhagen study was that the health benefits of alcohol consumption can be largely attributed to the consumption of wine. This study found a lesser reduction of mortality from beer consumption and little decrease in mortality from the consumption of distilled spirits. It is worth stating that this finding is in conflict with many other studies which have found similar benefits from the consumption of beer, wine and spirits. The possibility that wine has preferential benefits is currently an area of intense debate and research and I, personally, feel that the jury is still out. Nonetheless, if this finding is true, it implies that there is more to the benefit of wine than merely its alcohol content.

How much did wine drinkers in Denmark benefit from consuming wine? In this study, consumers of one to two glasses of wine a day had a 53% lower risk of dying from strokes and heart disease and a 20% lower risk of dying from other causes.

Such reductions in mortality are substantial! The Danish government has listened carefully to the results of this study and attributes a 30% overall decline in the country’s coronary heart disease mortality over the past two decades to a change in drinking patterns. Over this time period, the Danes did not significantly change their overall level of alcohol consumption but, with the opening of the European market, they doubled their consumption of wine.

The findings of the French Paradox and Copenhagen studies are impressive. Furthermore, every major epidemiological study to date has shown a positive benefit to moderate, regular consumption of alcohol. In part two of this three part series entitled Wine and your Heart, we will look at some of the specific ways in which alcohol can lower your risk of dying from a heart attack.

Part II: Preventing Heart Attacks >