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“Wine is the greatest of medicines.  Where wine is lacking, drugs are necessary.”   -The Talmud

That is the question posed to physicians in the Journal of the American Medical Association Journal in its May 26 online issue.  (May 26, 2010; Vol. 303, No. 2065-73)

The response, written by an accomplished physician, is reflective of the widespread void in applying nutritional medicine in cases such as this one.  The doctor is a bit ambiguous in his answer to this question and can never fully explain why the wine-drinking French exhibit far greater longevity and lean body mass compared to North Americans.

Recognize the mortality rate for coronary artery disease is 240 per 100,000 in the U.S. and just 91 per 100,000 in France.  Lives are being lost while doctors quibble whether to drink red wine or not.  The reviewing doctor leans toward slamming the door on wine drinking and overlooks an obvious alternative – a red wine pill that would provide the polyphenolic wine solids without undesirable alcohol, sugars or sulfite preservatives.

While the patient desires to drink wine for health reasons, his primary care doctor warns about a newly recognized side effect of alcohol consumption — brain shrinkage.  Wine is no exception to this potential problem versus other alcohol beverages.

A more thorough examination regarding brain atrophy (shrinkage) and alcohol consumption reveals an overlooked linkage to alcohol-induced vitamin B1 (thiamine) deficiency.  Actually a link between brain atrophy and alcohol consumption was reported in 1985 and was reported to occur long before alcohol-related liver damage, which suggests universal vitamin B1 supplementation among all regular consumers of alcoholic beverages.

The preferred form of thiamine in supplements should be benfotiamine, a fat-soluble form of vitamin B1 which is more readily absorbed.  The alcohol-thiamine deficiency is completely overlooked by the reviewing physician and by modern medicine at large.

Should this patient be advised to continue drinking red wine in moderation, or should he be advised to back away?  Let’s assume the brain atrophy problem is completely countered by vitamin B1 supplementation.  The doctor is asked “To what degree do you attribute the lower cardiovascular mortality to drinking French wine regularly?

The doctor’s answer:  “It is difficult to know with certainty how much of their lower cardiovascular risk is attributable to drinking alcohol, but it is easy to speculate that regular, limited alcohol intake may have been at least part of the explanation for those observations.”

I don’t think doctors in France have the same reticent opinion.  Wine is medicine in France.  Wine was even prescribed to patients in France and it reduced the risk cardiac complications by a remarkable 59% over a period of 4 years following their initial heart attack.   Among men in Italy who were in involved in hard physical labor and drank 1-4 glasses of wine a day, they experienced a whopping 9-year survival advantage over men who were sedentary, occasional wine drinkers.

Country	Deaths per 100,000 men due to heart disease	Average cholesterol level	Fats consumed as percentage of diet
USA	240	2.09 grams/liter	46%
France	91	2.33 grams/liter	45%
Source: World Health Organization 1990

The primary reason the reviewing doctor diminishes any beneficial effect from red wine is that he has been misled by erroneous information about resveratrol and other similar molecules found in red wine.

The reviewing doctor says:  “Mr. Q primarily drinks red wine, presumably for resveratrol and its other nonalcoholic constituents. However, the concentrations of such constituents even in red wine are much lower than the concentration of ethanol and, given their limited bioavailability, are unlikely to have substantial physiological effects at the modest doses consumed by most Americans.”

Unfortunately, the doctor has been misled by some faulty science here.  Red wine polyphenols are bioavailable despite reports to the contrary.  The misunderstanding emanates from studies which mistakenly indicate resveratrol and other polyphenols in red wine are not provided in sufficient quantity nor are they delivered to tissues in an available form.  While these molecules are attached to detoxification molecules (sulfate and glucuronate) as they pass through the liver, rendering them too large to pass through cells walls and influence cellular or genetic machinery, an enzyme called glucuronidase that is abundant at sites of inflammation, infection and malignancy frees resveratrol so it is delivered at the right time and place as an unbound molecule.

How doctors fall for this erroneous information is beyond comprehension since resveratrol exhibits striking system-wide health benefits (brain, heart, kidneys, liver, lung, etc.), which suggests either unbound resveratrol or its liver metabolites are biologically active.

Professor Roger Corder of the William Harvey Research Institute sets the record straight in his book, The Red Wine Diet.  Dr. Corder explains that while resveratrol represents only a small amount of the total polyphenols in a glass of red wine (~ 1 mg in a 5-oz glass), about 60 milligrams of total polyphenols are provided in a glass of dark, aged red wine.  There is a synergistic effect when these molecules are combined in a relatively low dose, beyond what resveratrol alone can accomplish.

About 3-to-5 glasses of dark red wine produce optimal health benefits.  Three-to-five glasses of dark red wine provide about 180-300 milligrams of polyphenols which can also be consumed without the alcohol in the form of a red wine pill, which may provide a healthier option to this male patient.  The patient can probably reduce wine intake to 1 glass a day, limiting any potential drawbacks posed by the alcohol in wine.

It should not be overlooked that this patient has other indicators of nutritionally-related health problems.  Bilateral hernias that were surgically repaired and some joint aches and pains suggest weak collagen, a problem that is addressed by the provision of vitamin C plus amino acids proline and lysine which are precursors for connective tissue.  ©2010 Bill Sardi, Resveratrol News

Addendum: A 42-Year-Old Man Considering Whether to Drink Alcohol for His Health

Kenneth J. Mukamal, MD, MPH, Discussant

Journal American Medical Assn. 2010;303(20):2065-2073.

ABSTRACT

Alcohol consumption is widespread and, in excess, a leading cause of morbidity and mortality worldwide. At the same time, a consistent body of observational evidence has found that individuals who consume alcohol within recommended limits have a lower risk of coronary heart disease than do abstainers. These observations have led many to consider small amounts of alcohol as a cardioprotective strategy. Mr Q, a 42-year-old man who has consistently sought ways to preserve his health, is at a crossroads in his discussions with his physicians about the health effects of his regular, limited alcohol intake. The discussion reviews the epidemiology of drinking in the United States, the established effects of moderate alcohol intake on key pathophysiological biomarkers and pathways, the strengths and limitations of observational evidence linking alcohol intake to lower risk of coronary heart disease, other chronic diseases linked to moderate alcohol intake, and a framework in which Mr Q can discuss the potential risks and benefits of alcohol consumption with his physicians.

INTRODUCTION

DR SHIP: Mr Q is a 42-year-old man who works as a health care consultant. He lives in the greater Boston area and has preferred provider organization insurance.

Mr Q drank socially in college and found he didn’t have much tolerance for alcohol. About 10 years ago, he read some popular literature about the potential benefits of drinking red wine for cardiovascular health. Soon afterward, he found out that his cholesterol level was high and began a regimen of drinking 3 to 4 oz of red wine nightly. He occasionally substitutes or adds a martini.

His comfort with drinking alcohol for his health was stable until about 4 months ago, when he saw a consultant for an unrelated medical issue. That physician queried him about his alcohol intake and suggested that regular use might be associated with long-term damaging effects. Mr Q now wonders whether the benefits outweigh the risks.

In addition to red wine, Mr Q regularly drinks yerba maté tea and eats dark chocolate in small amounts, both for their antioxidant benefits. He exercises about 4 days a week, does not smoke, and is attentive to his diet, watching his calorie intake and weight carefully.

His medical history is significant for childhood obesity. He lost a significant amount of weight with diet and exercise and subsequently underwent abdominoplasty in 2000 for removal of redundant skin. He has had bilateral inguinal hernia repairs. He had a positive skin test result for tuberculosis in 1992 and took isoniazid at that time. He has recurrent temporomandibular joint pain. He has no family history of premature cardiovascular disease or alcoholism.

His medications include finasteride, 1 mg/d, for hair loss andzolpidem, 5 mg nightly, as needed for insomnia. He takes a multivitamin daily. He has no allergies to any medications.

MR Q: HIS VIEW

About 10 or 15 years ago, there seemed to be a lot of literature coming out on the benefits of drinking alcohol, specifically red wine. I read some of the research on alcohol and found other resources that talked about the benefits of other kinds of beverages—green tea, grape juice, red wine, etc. Also, right around this time, my primary care doctor noticed that my cholesterol level was starting to eke up a little bit.

As a result of my cholesterol, my doctor said, “Well, why don’t you enjoy a little bit more red wine?” And I said, “Why don’t I? Sounds good to me! I like red wine!” And so, since that time, I’ve really been going out of my way to drink more red wine—maybe 3 or 4 oz an evening.

Then, about a month ago, I saw a specialist for a follow-up appointment. During the regular health history, the doctor asked me, “Do you drink alcohol?” I said, “Yes,” and explained that I have about 3 or 4 oz of wine about 5 nights a week. She gave me the feedback that I might want to rethink that. She cited a particular study—and I really think it was only 1 study—where some of the findings suggested that alcohol may accelerate the rate of brain size shrinkage as you age. Though I certainly enjoy alcohol, I’ve been drinking it for medicinal reasons. Now, suddenly, I have to rethink my decision—maybe this isn’t the right thing to do.

I already use a different kind of antioxidant drink, yerba maté, which is basically a South American equivalent to coffee but a lot better for you than coffee. I think it has some of the benefits of green tea. I also make a point of having 2 dark chocolate squares a day, but only 2, because I watch my weight very carefully as well. Sometimes the alcohol presents a problem because when I’m drinking it, despite the moderate amount I’m drinking, I notice that I tend to eat more. Because maintaining my weight is of great concern to me, I sometimes think that I should find an alternative to red wine.

I would like to know more about the “shrinking brain” study. I would also like to know a bit more about the vetting process that goes on between scientific literature and the information that actually makes it into a conversation with a patient. I was a little surprised and thrown off by the way 1 small piece of preliminary evidence—the “shrinking brain” study—could suddenly change a decision I had contracted with my primary care physician 10 years ago.

AT THE CROSSROADS: QUESTIONS FOR DR MUKAMAL

What is known about the benefits and harms of moderate alcohol intake? Do they vary by type and frequency of alcohol intake or by sex? Are there end points (eg, cholesterol values) that should be monitored? Should any laboratory measures be monitored? What medications or diseases would argue against drinking therapeutically? What should patients understand when interpreting medical studies related to alcohol? What do you recommend for Mr Q?

DR MUKAMAL: Mr Q, a 42-year-old executive concerned with preserving his good health, presents with a deceptively simple question: should he drink alcohol? The simplicity of the question belies a complex answer. Although alcohol has long been part of both mammalian and human diets and social and religious activities,¹ it has been ranked the third most important preventable cause of death in the United States.