Thursday, March 29, 2012

Wine and breast cancer: Here we go again

Yet another article about a possible link between wine and breast cancer is in the news, and as usual it is being widely quoted without any critical analysis or perspective. The article in question, a review of previously published studies, estimates that even a glass of wine per day increases risk of breast cancer and estimates that 1-2% of all breast cancer cases are attributable to light drinking alone. Rather than pick apart the article item by item, which would take all day since there are so many issues, I will highlight a few important things.

First, there are fundamental problems with the way that these types of studies are done, and reviewing them simply magnifies the underlying mistakes. Here’s the thing: in order to know if for example a glass of wine per day affected breast cancer risk, you would have to follow a large population of women who drink only wine, only a glass per day, every day, rarely more, rarely anything other than wine, and rarely not having a drink; this would need to be compared to a similar population who never drink, another who only drink beer, and so forth. But most people have mixed drinking patterns, they under-report their true level of drinking, and there is simply no reliable way to get any meaningful information. All we really know is that heavy drinking is bad.

Secondly, there are some populations of women in France who have traditionally consumed wine in moderate amounts and in a regular pattern. Their incidence breast cancer is dramatically lower than that of nondrinkers.

Third, breast cancer is nowhere near the leading cause of premature death in women; heart disease is far and away the biggest threat. It is well established that moderate wine consumption lowers heart disease risk, the net effect being overall reduction in risk of premature death.

Moderate wine consumption is also associated with lower odds of Alzheimer’s disease, osteoporosis, diabetes, and measurably improves quality of life and well-being. Wine drinkers outlive nondrinkers by about 5 years on average, and for most even if there is a fractional increase in breast cancer risk, the smart choice favors having a glass of wine with dinner and not stressing over it.

Monday, March 19, 2012

Wine and civilization: we wouldn’t be here without it

As a physician I go to a lot of symposia, the term often used for meetings where exchange if ideas is the goal. It is interesting to note that the word “symposium” actually derives from classical Greek, meaning  “to drink together.” The tradition was that following dinner, the men would retire to a special room dedicated to the purpose of drinking and philosophical discussions. There would be toasts to the gods, ancestors, and fallen heroes, then the revelry would truly begin, often lasting until the early hours of the morning. Here’s an excerpt from Plato: “Socrates took his seat then they turned their attention to drinking. “ A member of the party named Pausanius said “Well gentlemen, how can we arrange to drink less tonight? To be honest, I still have a hangover from yesterday. “ Hard to believe that the canons of Greek philosophy, the underpinnings of modern civilization, had such origins as this.

But going back even further, wine is what civilized our nomadic hunter-gatherer ancestors. Other crops could be re-sown each year in a new place, but vines require year-round maintenance. Pruning, shaping, harvesting, fermenting –all depended on settling in one place. But doing so posed new challenges, such as keeping drinking water sanitary when the source was in proximity to “bathroom” facilities. Here again wine played a role by countering water-borne pathogens, and the tradition of adding wine to water became a necessary tradition in seafaring, voyages of exploration, trading, and military campaigns. Wine both civilized mankind and fueled some of our less laudable actions, and we are still conflicted today.

So what of wine in the modern era? The great tendency now is to treat wine as a pharmaceutical, whether deliberating the evils of alcohol or trying to tease out the secret components that explain why it is so good for us. But doing so misses the point on both counts; alcohol in the right amounts can be a healthy thing, and many of the known health benefits attribute to the lifestyle pattern that defines healthy drinking. So while the science of resveratrol and the long list of polyphenol antioxidants in wine is impressive, it isn’t the whole story and likely never will be.