Tuesday, January 26, 2010

American Heart Association drops the bottle on lifestyle recommendations

In a drastic lurch back to Victorian era temperance, the American Heart Association came out this month with lifestyle recommendations intended to promote “ideal cardiovascular health.” Their list of “Life’s Simple Seven” includes:
• Never smoked or quit more than one year ago;
• Body mass index less than 25 kg/m2 (I.e., not overweight)
• Physical activity of at least 150 minutes (moderate intensity) or 75 minutes (vigorous intensity) each week;
• Four to five of the key components of a healthy diet consistent with current American Heart Association guideline recommendations;
• Total cholesterol of less than 200;
• Blood pressure below 120/80;
• Fasting blood glucose less than 100.

Not much to quibble with there it would seem, but as always the devil is in the details. Let’s look more closely at the “healthy diet” components:

• Vegetables and fruits are high in vitamins, minerals and fiber — and they’re low in calories. Eating a variety of fruits and vegetables may help you control your weight and your blood pressure.
• Unrefined whole-grain foods contain fiber that can help lower your blood cholesterol and help you feel full, which may help you manage your weight.
• Eat fish at least twice a week. Recent research shows that eating oily fish containing omega-3 fatty acids (for example, salmon, trout, and herring).

So far, so good, we have heard all that before. But as we approach the twentieth anniversary of the French Paradox, where does the AHA stand on wine?

• If you drink alcohol, drink in moderation. That means one drink per day if you’re a woman and two drinks per day if you’re a man.

That’s it? With the thousands of research paper attesting to the cardiovascular benefits of red wine consumption, nary a mention other than be careful not to drink too much? It’s not like there is a lack of data upon which to base a recommendation. According to the widely recognized expert Dr. R. Curtis Ellison, professor of Medicine and Public Health at Boston University, “ ... only stopping smoking would have a larger beneficial effect on heart disease than for a nondrinker to begin having a drink or two each day.” This recommendation is supported by the prestigious Framingham study, the bedrock of research on the lifestyle factors in cardiovascular disease. But the Framingham scientists have been studiously neglecting the data about drinking and health since the 1970’s when the role of alcohol was first evaluated. One of the scientists involved in the study, Dr. Carl Seltzer, revealed later that the senior staff at the National Institutes of Health demanded that the data be altered to remove any suggestion of a beneficial effect from alcohol, citing concerns that it would be “socially undesirable.” To this day the official Framingham website omits any reference to the alcohol studies. This is what they call science?

The thing is, most of know better and so the “updated” recommendations from the AHA lose credibility. It reinforces perceptions of the medical establishment as paternalistic. Time to start treating us like adults.

For more including detailed references check out my book Age Gets better with Wine.

Monday, January 18, 2010

Wine and the Happiness Connection

One of the more interesting things I came across when I was researching the factors influencing longevity for Age Gets Better with Wine was the fact that happy, connected people live longer. It makes sense intuitively of course, but what makes it particularly encouraging is that nurturing our connections to community and friends, something we can simply decide to do, has a large influence on lifespan. Throw in a little wine, some exercise, and healthy eating and you’ve got it made.


It turns out that connectedness is linked to happiness too. In their book Connected: The Surprising Power of Social Networks and How They Shape Our Lives, researchers Nicholas Christakis and James Fowler reveal that networks wield more control over our lives than we realize. Through our social networks, even beyond our circles of friends, we tend to be either overweight, happy, sad, successful or not in measurable ways. Knowing happy people increases the odds of you being happy by 9%, while having unhappy people around lowers it by 7%. Being geographically close helps too, upping the odds of contagious happiness by as much as 25% if they live within a mile or so. What is interesting is that the people you don’t know, but those with whom you associate do, also measurably impact your sense of well being.

What we can’t seem to escape entirely is our genetically determined happiness “set point.” Apparently this is the most important factor, contributing half of whatever it is that gives our spirits a lift. Another 40% relates to our choices; what we choose to do and how we decide to live our lives (This is where wine and friends come in; see also my post on Dec. 21 about how wine might combat depression.) A mere 10% apparently relates to circumstances, such as wealth and health.

So big surprise, money can’t buy happiness. But deciding to have happy people in your life gets it for free.

Tuesday, January 12, 2010

Resveratrol clinical trials: What’s the evidence?

If you are interested in anti-aging, or just the science behind healthy wine drinking, you must have seen the ads for resveratrol supplements. “All the benefits of wine without the alcohol” they might say, implying that the science is in and the matter decided. There is an impressive dossier of resveratrol research, now totaling some 3,000 research papers, and the beneficial effects of this wine-derived molecule are myriad. There is good reason why I dubbed resveratrol the “miracle molecule” in my book Age Gets Better with Wine.
In the book I also introduced what I call the “skeptic’s checklist,” a useful tool for evaluating claims about medical interventions and miracle supplements. The reason this is important is that while data from laboratory studies can reveal interesting properties and lines of research, what happens in a test tube is meaningless unless the effect can be documented in a clinical trial in humans. In order to obtain FDA clearance, for example, clinical trials need to document both safety and objectively measured effectiveness. But since herbal supplements do not fall under the FDA’s purview, there is wide leeway for frequently misleading often outrageous and claims. So without evidence from clinical trials (not the same thing as "clinically tested"), there is no way of knowing whether the product is doing any good or if it is in fact harmful.
There are a few clinical trials underway for resveratrol, and a very small number of published reports. Of the 12 papers that I found on a Medline search using “clinical trial” and “resveratrol,” 3 were not actual clinical trials but studies on blood or tissue in a lab. Another 3 used a wine extract with resveratrol along with the whole family of wine polyphenols, and the rest were what are called pharmacokinetics studies. These types of studies evaluate what is called “bioavailability” or the absorption and distribution of resveratrol after oral ingestion. Without exception they all found low but variable levels, even at high doses.
So it doesn’t appear that resveratrol alone explains the benefits of drinking wine. Synthetic derivatives, up to a thousand times more potent, are being developed so it may turn out that resveratrol opened the door to a new and powerful anti-aging products even if it isn’t the answer alone. For now, a skeptical approach seems the way to go.

Tuesday, January 5, 2010

What causes those wine headaches? Hope for a solution

It seems like every time I give a talk about wine and health there is at least one person in the audience who asks about headaches. They would like to drink wine, they say, but sometimes it gives them a headache. Or another frequent question relates to why they didn’t get headaches drinking wine in Europe but domestic wines do; is it the sulfites?

The good news is that scientists are developing a good understanding of what triggers headaches for some people, and it doesn’t seem to be sulfites; all wines contain them. It probably isn’t the alcohol, unless you are prone to migraines or to imbibing too much. The culprit for most people is a class of compounds called biogenic amines, the most familiar of which is histamine. These are not products of the wine itself, but of bacterial contaminants. Fortunately there are fairly quick tests that can be done do measure the levels of biogenic amines, though these aren’t routinely done.

But without testing, the inherent variability of amine production during wine fermentation makes it difficult to predict which wines will be a problem for people susceptible to them. There aren’t any sensory clues, since they tend to have little effect on the taste or smell of the wine. Why there should be a difference between European and domestic wines remains a matter of speculation. Perhaps it relates to the long history of winemaking, with traditional methods naturally sorting out the processes that make drinkable wine and environments naturally free of the offending bacteria. Or maybe it’s just that domestic wines have a higher alcohol content.

In any case, a solution should be achievable now that the cause of the problem is known. It is up to the industry to invest in the technology.