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Showing posts from 2017

Healthy drinking for the holidays

The holiday season is a time of conviviality, and nothing is more celebratory than wine. As we raise our glasses to toast friendships and family, we remember that wine symbolizes health and happiness. But it is all too easy to fall out of the habits that define healthy drinking, and moderation hardly seems a festive theme. With that in mind, here are a few (science-based) tips for healthy drinking: 1.Stick with wine. Peak blood alcohol levels are lower after wine consumption as opposed to spirits, even when the amount of alcohol is the same. (The same applies for beer, but beer lacks the beneficial polyphenols of wine.) Mixed drinks also tend to contain more calories from sugar, while calories from alcohol avoid spikes in blood sugar levels. 2.Whenever possible have food with wine. Alcohol is absorbed much more rapidly on an empty stomach, even for wine. What’s more, wine with meals dampens down what is called “oxidative stress” from certain foods such as red meat. Wine with food actual…

Why Age Gets Stronger with Wine

Because physical fitness and good health go hand in hand, muscle mass and strength are markers of resistance to frailty with aging. There are important behavioral associations such as regular exercise (no surprise there) and moderate regular consumption of alcohol, especially wine (only a surprise if you haven’t been reading this blog!) Studies on the subject are numerous and from many countries, suggesting that more than cultural factors are involved. A great example is this study[1] from Spain, which prospectively evaluated more than 2000 community-dwelling adults aged 60 and older at enrolment. The researchers were specifically interested in the Mediterranean drinking pattern, defined as moderate alcohol intake, with ≥80% of alcohol intake from wine, and drinking only with meals.  The subjects were followed regularly, with measures of muscle mass, walking speed, and endurance, and other factors. Using validated criteria, the subjects were classified as “frail” if they had low fun…

Update on wine and breast cancer

With breast cancer awareness month upon us again, it’s fair to ask what we have learned about prevention and treatment, and for wine drinkers, it remains a confusing picture. It’s clear that heavy alcohol consumption increases risk, not so certain whether moderation – especially wine – is all that bad; it might even be good. On one hand, the message from the medical community is unambiguous: any level of drinking increases the odds of developing breast cancer. On the other hand, at moderate levels of drinking, cancer risk is extremely difficult to measure with confidence, even more so with wine. Here’s why I think a daily glass or two of red wine with dinner is still a healthy choice: A recent study from the University of California San Diego[1] looked at survival and recurrence after breast cancer treatment, finding that light drinking had no correlation. Moderate alcohol intake was “protective against all-cause mortality” in non-obese women.There appears to be no breast cancer risk …

Is wine a probiotic? More than a gut feeling

That “gut feeling” you sometimes get may be more literal than you think: research continues to reveal the importance of the bacteria in our digestive tract, called the “gut microbiome.”  This symbiotic population of microbes affects health and well-being in often unexpected ways. The microbiome sends signals to the central nervous system, regulates inflammation, even influences cardiovascular health. Wine’s impact on health appears to depend significantly on the microbiome, and we are now learning that it may not actually be the constituents of wine that make it healthy for us; it is the things that the microbiome transforms them into. How wine promotes a healthy microbiome Wine’s relationship with the microbiome is a two-way street: Recent studies[1]  demonstrate how wine consumption influences the composition of the various bacteria, while other research demonstrates how the microbiome metabolizes wine into components that boost the immune system.[2] The idea that wine’s health be…

Alcohol and skin cancer: When the devil is ignoring the details

Summer has me thinking about skin cancer (I am a plastic surgeon after all) and recent reports that drinking alcohol increases the risk of skin cancer are not helping to ease my mind. "Drinking just one glass of beer or wine a day could give you skin cancer, scientists have warned," reports Britain’s Mail Online.  Researchers reached this conclusion by analyzing pooled results from previous studies (the notorious meta-analysis; see last month’s post.) It seems that every drink increases your odds of developing non-melanoma skin cancer by around 10 percent. But just as blending random wines together may produce something drinkable but lacking nuance, pooling results of different types of studies may obscure crucial details. With the specific question of wine consumption and skin cancer risk, the details are especially important. Is skin cancer risk the same with all types of alcohol? Granted, some of the studies are very well done and should not be dismissed out of hand. These…

Will the NIH trial on alcohol and health answer the question once and for all? Maybe not

What used to be accepted as gospel – that moderate drinkers are healthier than nondrinkers or heavy drinkers – has been challenged in recent years, and a new study to be conducted by the National Institutes of Health aims to settle the question once and for all. The study plans to enroll about 8,000 volunteers aged 50 or older from around the world, who will be assigned to avoid drinking or have one drink per day for 6 years. The lack of such large scale prospective studies is one reason why the question of alcohol’s influence on health and longevity remains subject to debate. However I am not sure the study will yield the answers it seeks to, but not for the reasons others are already finding to criticize the project.  It’s an ambitious undertaking, with an equally ambitious price tag of US$100 million. The plan is for most of the money to come from the alcoholic beverage industry through grants, and $68 million has reportedly already been pledged. Skeptics point out that many of the…

The whole truth about wine and heart health: Point-counterpoint

For this post I decided to address what I see as a neo-prohibitionist and paternalistic trend in medical advice about drinking, with a point-counterpoint on a blog that appeared recently on self.com. I believe the author made a sincere attempt to get the story right but was misinformed by the physicians she quotes. What was not disclosed is that the meta-analysis that this story references was done under the auspices of the Centre for Addictions Research of British Columbia, University of Victoria, an institution with a presumed anti-alcohol bias. An invited commentary with the original publication  came from the Alcohol Research Group in Emeryville, CA, whose mission “seeks to reduce alcohol-related harms.” They lauded the findings, saying that it could help fight back against “renewed calls from certain medical commentators to prescribe moderate drinking.” Disclosure: I count myself among those medical commentators. http://www.self.com/story/red-wine-heart-health-analysis
Health|May …

Understanding the risk of drinking (or not drinking) wine: Meet micromort

Whether we are talking about driving a car, drinking wine, or any other routine activity, most of us are not very good at calculating risk. Life insurance company actuaries devote careers to these sorts of calculations, but even they will tell you it gets really muddled when assessing small risks of prematurely dying from everyday endeavors. With nutrition and lifestyle choices it’s practically impossible. That doesn’t stop us from trying though, and one approach is unit of measurement called the micromort. A micromort is a one in a million chance of dying (mort from mortality.) If nothing else, it is useful in placing things in perspective; there’s even an app for tracking your micromorts as you consider lifestyle choices. Take scuba diving, for example:  5 micromorts. It is said that 3 glasses of wine equals eating 100 char-broiled steaks or spending an hour in a coal mine, for a micromort each. Really? That sounds bad, and frankly didn’t make sense to me when I heard the term rece…

Of Wine, Charity and Health

Although wine has been associated with health since the dawn of civilization, the relationship was consummated in 1859 with the founding of the Hospices de Beaune annual charity wine auction. Built in 1443 as an almshouse and hospital for the poor, the Hospice was and is to this day supported by vineyard holdings. The auction serves to create a market for the wines, and has become a huge annual event in Burgundy. Following this lead, charity wine auctions are now held throughout the world, benefiting health care and a range of worthy causes. Some wineries now devote their profits directly to health care charities, and I would like to highlight a few of them here. Napa Valley winery Ehlers Estate is actually owned by a charitable trust, Fondation Leducq. The vineyard dates to the 1880’s, and produces 100% organic wines. The foundation, based in France, sponsors internationally collaborative research in cardiovascular and neurovascular disease.  Their grants have gone to more than 100 in…

The J-curve is dead. Long live the J-curve!

There is a resurgence of debate about the validity of the J-curve, especially as it relates to alcohol and cancer. A 2014 report determined that “alcohol use was positively associated with overall mortality, alcohol-related cancers, and violent death and injuries, but marginally to CVD/CHD” (cardiovascular disease). In other words, there was little benefit if any in terms of heart disease but a big upside risk for cancer and accidental or violent demise. Gone was the French Paradox! The J curve is dead! Or not. Though that statement may be technically true, I looked at look at the data myself and found something different: a strong confirmation of the J-curve for overall mortality, overall cancer deaths, cardiovascular disease, and all “other causes.” This held for both men and women:
    Used under creative commons license from Ferrari P, Licaj I,Muller DC, et al. Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nu…

Quality of life is better with wine

Wine appreciation is an icon of “the good life,” but can it really be true that something as simple as a glass of wine with dinner measurably improves quality of life? There’s good evidence that it does. Quality of life (QoL) may seem a subjective concept, impossible to quantify, as irreproducible as numerical wine scores, but QoL has become a vital concept in clinical research. Everything from cancer treatments to plastic surgery can be appraised in terms of impact on quality of life. Wine drinking is no different. Quality of Life is more than good health The concept first appeared in the medical literature in the 1970’s, as medical and surgical treatments advanced in terms of their ability to save lives, but sometimes at the expense of significant side effects.  In a similar vein, scholarly investigations about wine consumption tended to focus on its detrimental effects until recently. Only when it became apparent that wine drinkers actually lived longer and enjoyed better health o…

Lost in translation: Why most reports on health and wine are erroneous

In an era of fake news, alternative facts, and conflicting advice on healthy drinking from even the most reliable sources, it is important to understand where reporting on clinical science can go awry. Does a glass of wine before bed help you to lose weight? A widely reported study last year seemed to suggest just that, at least if you only looked at the headlines. How about a glass of wine a day is as good as an hour at the gym? Both of these might be true - if you are a mouse - and substituting resveratrol for wine. Of mice and men - and medicine The journey from the research lab to the clinic is known as translational medicine, and the process can be long and unpredictable. Take for example the hypothesis that resveratrol alters metabolism in a way that mimics exercise (and ignore for the moment the separate idea that resveratrol supplementation is the same as drinking wine.)  There are limits on what sort of interventional studies you can do to test this idea on humans, before you…

The J Curve explained

In order to make sense of the seemingly conflicting reports about wine and health there’s one essential thing to understand: the J-shaped curve. It’s a simple concept, universal, in plain sight, and often ignored. It goes like this: Take “nondrinking” as the baseline and plot increased or decreased relative risk of a health issue with increasing levels of daily consumption. Nondrinkers have a certain risk of, say heart attacks, moderate drinkers a lower risk, heavy drinkers a relatively higher risk. Not too complicated. The tricky parts are separating wine drinkers from drinkers in general, and daily moderate drinkers from occasional drinkers. The J-curve is not just about wine The J-shaped curve is too universal to ignore once you see it. Even dietary salt intake has a J-curve; consuming too little in your diet can be as harmful as too much. For years, the American Heart Association has endorsed a 1.5 gram per day limit on sodium intake (salt is about 40% sodium), about what you ge…