Wine Wisdom
Ellen Mack, M.D., M.P.H. - Russian Hill Winery
Wine and your Heart
Part III: To the Heart of the Matter

The first two parts (see Part 1 &Part 2) of the series Wine and your Heart examined some of the vast epidemiological and scientific evidence that moderate consumption of wine is associated with decreased cardiac mortality. Is this information being put to good use?

Some would say that it is not. Dr. Curtis Ellison, Chief of Preventive Medicine of the Boston School of Medicine, argues that despite the fact that epidemiological studies have shown for decades that moderate alcohol consumption is associated with lower cardiac mortality, the fact has not been widely publicized. Obviously this is because of concerns that such positive statements could lead to higher rates of alcohol abuse.

Dr. Ellison argues, however, that for those with existing heart disease, moderate drinking has more health benefits that other measures usually recommended by physicians, such as exercise, weight reduction, and changing to a low fat diet. Only quitting smoking can have a more positive influence on the health of your heart.

Dr. Ellison clearly states that “abstinence from alcohol is a major risk factor for coronary heart disease” and that moderate alcohol consumption could reduce the rate of cardiac mortality by 20%. He feels this information should be considered a major public health breakthrough.

Others are beginning to agree with this preventive medicine specialist.

The first to join the ranks were public health groups who, in 1993, began to acknowledge and publicize the health benefits of moderate wine consumption. One such group is the Oldways Preservation & Exchange Trust, a Boston-based nonprofit educational organization dedicated to improving public health and the environment through the promotion of healthful and sustainable dietary patterns traditional to various cultures.

The Oldways Trust has released food guide pyramids as alternatives to the food pyramid proposed by the United States Department of Agriculture (USDA). The USDA food pyramid, well known to many of us from our primary school days, could easily be criticized as being outmoded. It does not distinguish between proteins derived from plants and those derived from animals and does not suggest the restriction of animal-based proteins known to be high in saturated fats. It also does not include regular physical activity as part of a healthy lifestyle.

The food pyramid proposed by the Oldways Trust differs from that of the traditional American diet as reflected by the USDA pyramid in several important ways. It emphasizes the restriction of animal-based proteins, and includes regular exercise and the option of daily wine consumption as part of a healthy lifestyle. The Oldways group has included the daily use of wine in each of their food pyramids, as proposed for Mediterranean, Asian, Latin American and vegetarian diets. Each food pyramid stresses that wine consumption should be at moderate levels, by adults, occur primarily at meals, and be avoided during pregnancy or when it would put the individual or others at risk.

The Dietary Guidelines for Americans, considered the foundation of American nutritional policy, also takes a more modern view of what constitutes a healthy diet. These Guidelines are produced by a joint committee formed by the USDA and the U.S. Department of Health and Human Services (DHHS).

Until recently, the Dietary Guidelines for Americans stated that alcohol consumption had no net health benefit and was not recommended. In 1996, however, the guidelines were changed to state that  “alcoholic beverages have been used to enhance the enjoyment of meals by many societies throughout human history” and advises that “if you drink alcoholic beverages, do so in moderation, with meals, and when consumption does not put you or others at risk”. These changes to the Guidelines result from the acknowledgment of recent scientific work and reflect a major change in our government’s public policy with respect to alcohol consumption.

Soon after the change in the Dietary Guidelines, the American Heart Association published a “Science Advisory” on alcohol and heart disease acknowledging alcohol’s potentially sizable health benefit. For those individuals not opposed to alcohol consumption, the American Heart Association’s Advisory recommended consulting a physician for an assessment of the benefits and risks of alcohol consumption. This is the first public health organization to make such a recommendation.

Some medical organizations have also redefined their public policy with respect to the consumption of alcohol. The American College of Cardiology has boldly added ‘no alcohol consumption’ to the list of preventable risk factors for cardiovascular disease. This means, that in addition to factors such as smoking, sedentary lifestyle, and high cholesterol levels, cardiologists feel that not consuming moderate amounts of alcohol is one of the factors under an individual’s control which places him or her at higher risk for heart disease.

Perhaps most telling of our changing perception of moderate alcohol consumption as part of a normal, healthy lifestyle comes from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). This organization, as the name implies, is dedicated to researching the effects of abusive alcohol consumption.

However, in 1996, the NIAAA published a monograph acknowledging that “numerous well-designed studies have concluded that moderate drinking is associated with improved cardiovascular health”. They furthermore implemented a program to award grants for researchers to examine the effects of moderate, rather than abusive, consumption of alcohol. By 1997, the NIAAA had allocated over $3 million to research on moderate alcohol consumption and health. These grants are the result of 1996 Congressional appropriations encouraging the DHHS and USDA to study moderate drinking and health.

From health groups to Congress, the message seems to be that moderate consumption of alcohol is good for many but, certainly, not all people.

But what is moderate consumption? This depends on whom you talk to. Our government has defined moderate as one drink per day for women and one to two drinks per day for men. A drink is defined as one 12 oz glass of beer, one 4 oz glass of wine, or a one ounce shot of distilled liquor. Some European governments, such as the British, have set higher limits for moderate consumption. The American policy, perhaps somewhat conservative, seems reasonable since the majority of epidemiological studies have shown the lowest mortality in those who consume one to two drinks a day.

Should one drink to be healthy? Dr. David Whitten, physician and noted wine writer, replies “don’t drink wine to be healthy, but drink wine as part of a healthy lifestyle”. This seems like reasonable advice for a society that associates guilt with such a simple pleasure.

Part I: More than just Enjoyment! • Part II: Preventing Heart Attacks