May 14, 2007
Wine and Health
Ernest H. Rosenbaum, MD
There's been a lot of interest and publicity about the role of wine (grapes) in promoting better health. When used in moderation, health can be enhanced, but when used in excess, it is toxic and deleterious to health.
It has been shown that procyanidin-rich red wines can help reduce the risk of heart attacks and mortality through a red wine ingredient resveratrol. Alzheimer's disease is believed to have a lower risk through the use of Cabernet Sauvignon red wine.
A Kaiser Permanente study showed benefits for red wine.1
In 2003, Klatsky also showed that those who were light drinkers had a 30% lower coronary artery disease mortality risk and a 10% lower total mortality risk. Thus, it is believed that there is a protective effect from modest drinking, less than three drinks per day. Unfortunately, there are not many randomized control studies.
It is believed that wine may help elevate the high-density lipoprotein (HDL) cholesterol, which is believed to have up to a 50% benefit. It's also believed to have an antithrombotic effect and an antioxidant effect, and it's believed that oxidation of the low-density lipoprotein (LDL) cholesterol helps prevent atherosclerotic plaques. 2
There are several studies by Keil, et. al., 1997, in Demark, where there was a decrease not only of heart disease but of cancer and strokes for those who drank wine rather than beer and liquor. The Danes were health conscious and ate a healthier diet, exercised more and smoked less, which would also be contributing factors for better health.
There is some evidence that white wines may be as beneficial as red wines.
There is also some suggestion that red wine can help promote longevity, but this concept requires more intense studies. It is believed that coronary disease benefits, in part, are derived from ethyl alcohol, and it's possible that beer, liquor, and white wine may all have similar benefits, as well as the relaxation effects.
A simple way to identify harmful effects from hazardous drinking has been devised by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which created a single question screening for those drinking more than five drinks a day for men or four for women.
Counseling has been found to be helpful in helping hazardous drinkers understand their problems through diagnosis and providing treatment for alcohol abuse.
The safe recommended amount of drinking is two for men and one for women. An excess of this can be hazardous even for moderate drinkers and especially for those who are drinking more than fourteen drinks per week or more than five on any occasion
- There are many problems involved with alcohol abuse, such as:
- 1. Injuries
2. Legal problems
3. Adverse side effects on both personal and professional relationships
5. Atrial fibrillation, fatal arrhythmias and cardiomyopathies
6. Gastrointestinal problems, such as cirrhosis and end-stage liver disease
7. An additional hazard from excessive wine or alcohol drinking is peripheral neuropathy (peripheral nerve damage).
- Early detection is very important, as it may help reduce the risks involved with alcohol abuse, and encouraging safe levels of alcohol intake can promote better health in many instances.
Several questions that may be of help in diagnosing alcohol abuse:
- 1. Do people annoy you by criticizing your drinking?
2. Have you had feelings that you should cut down your drinking?
3. Do you feel guilty about overdrinking?
4. Do you sometimes have a drink in the morning (an eye-opener) to help steady your nerves or to try to get over a hangover?
- A good resource from the NIH is their website: http://pubs/niaaa.nih.gov/publications/practitioner/CliniciansGuide2005/guide.pdf
It is of note that college students have been found to be at increased risk - 33% had a history of alcohol abuse in one survey.
There are many co-morbidities with alcohol abuse, including psychiatric disorders, especially in those who have a family history of substance abuse or acute or chronic liver disease.
Often, co-morbidities are treated by gastroenterologists, hepatologists, or neurologists.
It is helpful to provide information for those who abuse alcohol, as well as family and friends, on the adverse effects of alcohol consumption, as well as ways to help reduce excessive drinking. This material can be obtained from the NIAAA.
- Using brief interventions, as well as a combination of psychosocial counseling, cognitive behavior therapy and/or motivational enhancement therapy, can be helpful in curbing excessive drinking.
Alcoholics Anonymous can also play a major role in helping to keep excessive drinkers sober and functional. These non-drug therapies benefit not only the person who abuses alcohol but families and friends.
Drug therapy such as benzodiazepines are very helpful, especially for alcohol withdrawal symptoms, and other agents such as diazepam (Valium) or lorazepam (Ativan) can be helpful in controlling symptoms and are aids in helping to support those with alcohol dependency. They are also helpful in the detoxification process.
Physician guidance is vital. Sometimes intravenous infusions of benzodiazepines can be helpful for short-term treatments.
Naltrexone has been very helpful for patients with alcohol abuse and dependence in conjunction with psychosocial counseling and other non-drug therapies.
Disulfiram (Antabuse) is another drug therapy used for highly motivated patients. For problem alcohol abusers, hospitalization or specialty clinics have also been of value, especially for those with mild or moderate symptoms. Hospitalizations are especially helpful when there are alcohol withdrawal problems.
Educational programs, such as recommended by the NIAAA, provide an excellent guide to assist patients in becoming abstinent or moderate drinkers. Patients who can sustain a five-year period of abstinence are unlikely to relapse.
- Alcohol abuse is a chronic problem, and it's wise for physicians to try to elicit whether this is a problem through questions and then give guidance and directions to help lead patients to abstinence or at least to a moderate controlled drinking habit.
Simple questions are:
- 1. Do you drink alcohol?
2. How often do you drink?
3. How much do you consume?
4. Are there times when you drink more than is tolerable or have an abuse problem?
- During the physical examination, laboratory tests and guidance can be very helpful in controlling or averting alcohol abuse.
- 1.Klatsky, et. al. The Permanente Journal, 2007, 11(2): 86-8.)
2.Arthur Klatsky, M.D., "Abstinence from Red Wine, Is Abstaining Hazardous to Your Health?" San Francisco Medicine, Journal of the San Francisco Medical Society, vol. 80, no. 3, April 2007.
- Reprinted by permission CancerSupportiveCare.com