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Regarding Wine & Health
By Rebecca Murphy
Jun 15, 2020
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In 1989 the U.S. Government mandated a health warning label to appear on all containers of alcoholic beverages.  I'd guess most readers of Wine Review Online have seen it many, many times, but just to be sure, it reads, in "all caps":

GOVERNMENT WARNING: (1) ACCORDING TO THE SURGEON GENERAL WOMEN SHOULD NOT DRINK ALCOHOLIC BEVERAGES DURING PREGNANCY BECAUSE OF THE RISK OF BIRTH DEFECTS. (2) CONSUMPTION OF ALCOHOLIC BEVERAGES IMPAIRS YOUR ABILITY TO DRIVE A CAR OR OPERATE MACHINERY, AND MAY CAUSE HEALTH PROBLEMS.

Also in 1989, I attended a meeting in San Francisco with a group of winemakers, wine grape growers, wine writers and physicians to discuss the creation of an organization that might provide the public with information about the health effects of moderate wine consumption.  While attendees did not necessarily disagree with parts of the message, they were also aware of medical research studies which found that—when alcohol is consumed in moderation—most people enjoy health benefits.  The group was concerned that the warning labels were only one side of the story and would disproportionally frighten consumers.

The result of this meeting was the creation of a 501(c3) non-profit organization called the American Wine Alliance for Research and Education, or AWARE.  Initially I was a volunteer, but after a couple of years I became an employee and got a major education on the topic of alcohol and health in general, and wine and health in particular.  I met my fellow WRO columnist, Dr. Michael Apstein as well as my future husband, Dr. Keith Marton.  They were both essential for my introduction to, and education in, wine and health.

While I was a wine professional and a strong supporter of U.S. wine producers, I must admit I was a bit skeptical that perhaps the enthusiasm about wine and health might be a marketing ploy.  After reading reams of medical research papers, with translation from Drs. Apstein and Marton as well as other physician advisors for AWARE, I realized that for most people, moderate alcohol consumption is healthy.  At the time, the bulk of medical studies looked at alcohol in general.  As Dr. Marton often pointed out, it’s difficult to find people who only drink wine, or beer, or liquor. 

In 1979 researchers published in The Lancet, a British medical journal, that heart disease was inversely correlated with wine consumption, a study that lead to public awareness of the so-called French Paradox.  That paradox is that the French consume more dietary fats and smoke more than Americans, but have half the number of deaths from heart disease and live longer than Americans.  Possibly concerned that someone might turn the active element into a pill, the researchers concluded, “If wine is found to contain a constituent protective against I.H.D. [ischemic heart disease] then we consider it almost a sacrilege that this constituent should be isolated.  The medicine is already in a highly palatable form.”

I think it is safe to say that the first wine and health report that got America’s attention was the French Paradox as reported to Morley Safer by Dr. Curtis Ellison on 60 Minutes, November 17, 1991.  According to The Wine Spectator, in 1992, sales of red wine in the U.S. rose 39 percent. 
          
I recently found a new book, Wine & Health: Making Sense of the New Science and What It Means for Wine Lovers (Board and Bench Publishing, 2019, $20, paper) by Richard Baxter, M.D.  He is a plastic surgeon in Seattle particularly interested in anti-aging medicine, or the slowing, preventing, or reversing the aging process.  In his Introduction, he notes that this quest for knowledge led him to wine science because “…it is revealing the answers to why and how we age and what we can do about it.”  He notes that his only connection to the business of wine is as a consumer.  He covers the research that I learned about and that we reported on at AWARE, as well as the research on wine components, particularly resveratrol, that has exploded since the AWARE days.

It can be difficult to understand medical research reports without a medical education, but Dr. Baxter does a great job of explaining complicated topics in layman’s terms.  If you want to dig deeper, he has included an extensive listing of references for each chapter.  His gives the following “skeptic’s checklist” for considering the results of scientific research, noting that one study has little meaning by itself. 

-    Is there epidemiologic evidence (population surveys) showing a correlation?
-    Do studies of different types reach the same conclusion?
-    Is there a plausible cause-and-effect explanation?
-    Is there evidence from clinical studies showing a measurable health benefit?

The research we were interested in at AWARE was about the health effects of the consumption of alcohol in general and wine in particular.  Studies that have looked at health outcomes based on levels of alcohol consumption show a “J-shaped curve.”  When the data are plotted in a graph, it is shaped like the letter J lying on its side.  The deepest part of the curve represents moderate consumers of alcohol, usually considered 2-3 drinks per day for men and 1-2 drinks per day for women, who have the lowest incidence of heart disease or in some studies all-cause mortality.  The short part of the J on the left side of the graph represents non-drinkers and the tall part of the J represents those who drink more than 3 drinks a day.  Baker builds the case for the reliability of these findings by taking the reader through the skeptic’s checklist with the various studies.  He points out the “…importance of distinguishing between regular consumption of wine with meals and the destructive behaviors associated with alcohol abuse.  They are not the same and do not overlap.”  

Chapters of the book are devoted to the relationship of wine and cancer, wine and the brain, and wine as a food, among others.  Baxter addresses issues such as allergic reactions to wine, the genetic aspects of taste.  He discusses polyphenols, components that contribute the color, aromas and flavors of grapes.  The role of some polyphenols like resveratrol is to defend the fruit against environmental threats like fungal infections or sun damage.  Polyphenols are in grape skins and seeds.  Red wine is made with extended skin contact, so red wines have more polyphenols.  Generally, white wine is made by separating the skins and seeds from the juice and have fewer polyphenols.

Dr. Baxter takes on a study that purports to show that the bulk of the studies showing a health benefit for moderate drinkers are wrong.  In Chapter 2, under the subheading of “The J-curve is dead…Long live the J curve,” he dissects the results of the EPIC study from 2014 that included over 400,000 subjects from 23 research centers in 10 countries, which concluded that “alcohol was positively associated with overall mortality, alcohol-related cancers and injuries, but marginally to CVD/CHD (cardiovascular disease).”  Basically, the J-shaped curve was wrong.  His review of the data showed that the J curve still exists, and notes their statement “moderate drinkers have a substantial cumulative survival advantage over extreme drinkers throughout the adult lifespan.”      
          
Dr. Baxter relates a fun story of Joseph Vercauteren who was a Professor of Pharmacy at the University of Montpelier and possibly the first to look for resveratrol in wine.  In his search for sources to work with he met Daniel and Florence Cathiard, owners of Chateau Smith Haut-Lafitte in Bordeaux.  He found a treasure trove of resveratrol in the pomace of pressed red grape and in the vines the Cathiards were pulling up to replant the vineyards.  An unanticipated outcome of this project was the Cathiard’s daughter’s creation of Caudalie, a company that produces and markets wine derived, antioxidant skincare products.
   
This is a comprehensive review of the research on wine and its effect on human health.  It is well written and often funny.  It can be a bit daunting at times for the non-medically educated reader, because, well…it is complicated.  Perhaps the best takeaway is that, for those who can drink alcohol, wine is important component of a healthy lifestyle along with fresh fruits and vegetables and regular exercise.
 
In the words of Herman “Jackrabbit” Smith Johansen, who, when asked at the age 103 if he had any advice on how to live to be over 100, replied, “The secret to a long life is to stay busy, get plenty of exercise, and don’t drink too much.  Then again, don’t drink too little.”  



Read more by Rebecca:   Rebecca Murphy

Connect with him on Twitter at  @RebeccaOnWine