Wednesday, April 29, 2015

Do larger wine glasses contribute to overdrinking and obesity? Alcohol nutrition labeling debated

The UK’s Royal Society for Public Health recently issued a warning that “the insidious increase in the size of wine glasses in bars and restaurants in the past decade” has led many of us to have “unwittingly increased the number of invisible calories we consume in alcohol.” They called for food labeling laws to include calorie content in alcoholic beverages, which are exempt. Writing in the British Medical Journal, RSPH chair Professor Fiona Sim cites a survey which found that 80% of adults did not know the calorie content of their drinks, and speculates that in addition to gargantuan glasses, this may be contributing to the obesity epidemic in the UK. According to the Professor, the average portion served is a whopping 250 ml. (8 ½ ounces!) If that’s true I can’t wait for my trip to the UK this October.
 While public health officials are right to be concerned with rising obesity rates and abuse of alcohol, in this case they have missed the mark. For one thing, if larger glasses have become fashionable it is likely because they are believed to enhance the flavors and aesthetic appreciation of the wine, in part because of the space above the pour within the glass. It seems to me that would have the effect of slowing the pace of drinking, not increasing overall drinking. I would further venture that wines ordered by the bottle are typically shared between two diners regardless of glass size, and by-the-glass pours are unlikely to be a third of a bottle – the unit economics of that don’t pencil out. On this side of the pond, I am more likely to get too small of a pour in too small of a glass.
Professor Sim goes on to compare two glasses of wine to the caloric content of a McDonald’s order of fries, and notes that it exceeds recommended daily alcohol allowance for women.  She points out that most women “do not realise that two large glasses of wine, containing 370 calories, comprise almost a fifth of their daily recommended energy intake.” But 17 ounces is a lot of wine under most circumstances, and two of the more typical 5 ounce pour of red wine contains around 250 calories, close to half of the number cited in the article.
The article justifies inclusion of alcohol calories in food labeling because “there is no reason why calories in alcohol should be treated any differently from those in food.” It does not provide evidence that labeling laws have had any influence for other foods however. Indeed, the increasing rates of obesity despite nutritional labeling mandates suggest otherwise. It would be interesting to know if the survey subjects could accurately estimate the calories in their fries any better than in their vino (I doubt it.)

On the question, of labeling, we may have an answer soon. As of this year, in the U.S. all restaurant chains with more than 20 outlets will have to provide calorie counts for alcoholic beverages in addition to food items.  So if McDonald’s decides to offer wine to augment their fine dining experience (happy meal for mom and dad?), you will be able to make an informed decision. I expect you will find wine a more nutritional choice than a 17-ounce cola.

Saturday, March 21, 2015

Hangover-free wine from engineered yeast? Good wine is already hangover-free.

The promise of hangover-free wine has been in the news this week, based on new gene splicing techniques to manipulate the yeast used in fermentation. Using an enzyme called a “genome knife” researchers have been able to remove redundant copies of certain genes that produce compounds associated with hangovers, and what’s more, add in copies of genes that code for resveratrol.  All of this assumes of course that you don’t mind genetically modified yeast in your wine, and that these compounds are the main culprit in wine hangovers.
To the second point, there is a long tradition of wine consumption in moderation with food. This in turn leads to slower consumption, less intoxication, and less propensity for hangovers. The real issue is compounds called biogenic amines which are associated with headaches and allergic –type symptoms. (Histamine is a biogenic amine for example, which is why you take anti-histamines for allergies.) Biogenic amines typically develop in wine during malolactic fermentation, a secondary stage. Malolactic fermentation is driven by bacteria, because the yeast typically die off as alcohol levels rise; so the price winemakers pay for smoother wines is sometimes higher levels of headache-causing compounds. A fewyears ago a genetically modified yeast was developed that spliced the gene for catalyzing malolactic fermentation into the yeast, giving greater control over the process and promising an era of headache-free and delicious wines.

For some reason, the idea never took off. People became suspicious of GMO foods even if, in this case, they would be healthier. This latest development tinkers with the yeast genome even further, with possibly even healthier and tastier wines as a result. The role of different yeast strains in making wines with identifiable terroir and specific characteristics is vitally important (the same applies for beer and really any fermented food.) Will this new super yeast lead to an era of cleaner, headache-free, and hangover-free wines? Only if traditions hold, and we continue to see wine as a part of a healthy diet.

Thursday, February 26, 2015

Remember to drink your wine: It’s good for memory

Did you remember to have a glass of wine last night? If not, it may be because you didn't have a glass of wine to help you remember. The association of wine consumption and better memory has long been suspected, especially as it relates to cognitive decline with advancing age. Studies consistently find a correlation between long term moderate wine consumption and better mental function in older populations, but clinical studies – where one group is prospectively compared to another – are still hard to come by.
One such study comes from the Max Planck Institute for Human Cognitive and Brain Sciences in Berlin. They compared 23 older adults given resveratrol for 26 weeks to an equal number given placebo. Before and after the study period, subjects underwent memory tasks and neuroimaging to assess volume and functional neural connectivity of the hippocampus, a key region implicated in memory. The resveratrol group had improvements in memory retention and increased neural connectivity over the placebo group.
These findings corroborate a study in rats, also evaluating the effects of resveratrol on the hippocampus. (Rats also suffer from declining memory with age, due to deterioration of hippocampal function.) After 4 weeks of either resveratrol or placebo, middle-aged rats showed improved learning and memory function with resveratrol but impairments in the control group animals. Resveratrol-treated animals also displayed increased neurogenesis and microvasculature.
But is it just resveratrol? A study from Columbia University compared drinking patterns in a multiethnic group of nearly 600 New Yorkers over age 65 to actual brain volume using MRI scans. Light-to-moderate drinkers, particularly wine, had significantly larger average brain volume than nondrinkers. This fits with the several population studies where wine drinkers have comparatively better cognitive performance (and not with what we were told about alcohol killing brain cells!)

One person who would not have been surprised by all this is the 13th century court physician Arnoldo da Villanova, one of the earliest to recommend wine as medicine. He published a special “wine for memory” recipe purported to be good for forgetfulness along with other beneficial properties.

Monday, December 1, 2014

A glass of red wine is worth an hour of exercise. Red wine compound resveratrol may negate health benefits of exercise. Or both. Or neither.

Once again we have dueling headlines about the effects of red wine and resveratrol: Does it enhance the effects of exercise or negate them? A study from the University of Alberta in Canada found that resveratrol supplementation in animals improved muscle and heart functions in the same way as an hour of exercise would, leading the study’s lead author Jason Dyck to postulate that “We could conceivably create an improved exercise performance in a pill." Supplement marketers already label resveratrol as an “exercise mimic,” while bloggers and wine lovers conclude that a glass of red wine would therefore do the same.
Meanwhile, at Queen’s University a few provinces over in Ontario, researchers were finding that resveratrol supplementation blunted the benefits of high-intensity interval exercise, a seemingly opposite effect. In a four-week placebo-controlled clinical trial, the data “clearly demonstrates that RSV supplementation doesn't augment training, but may impair the affect it has on the body" according to the authors.
The implications from these studies are not so opposite as they may seem, however. For one thing, the study that found resveratrol enhanced exercise results was in animals, not a human clinical trial, and animal studies frequently do not produce the same results as clinical trials. Another key difference is that the clinical study was measuring whether resveratrol could enhance the effects of intensive exercise, while the animal study was looking at whether it could replace exercise. And all studies on resveratrol are potentially confounded by the fact that it may have completely different and even opposing effects at different doses, a phenomenon known as hormesis. For all of these reasons we are still a ways off from knowing the answer to the question of resveratrol as an exercise mimic.

One thing we can say (again) is that a glass of red wine is not the same as a resveratrol pill. The doses are different, and wine has a multitude of compounds that may interact synergistically with the small amount of resveratrol in wine. Wine drinkers are healthier in part because they tend to have healthier lifestyles including regular exercise.

Wednesday, October 22, 2014

Don’t get soaked: The truth about red wine and resveratrol

Much has been made recently about pro basketballer Amar’e Stoudemire’s “vinotherapy” rehab program, which involves soaking in red wine baths. I tried it myself a few years ago at the Caudalie spa in Bordeaux, and while it was a fabulous experience I would put it more into the pampering category than physical rehab. But the practice does raise a lot of questions, and as with so many issues about wine and health there is a kernel of truth shrouded by a layer of hype.

Dr. Richard Baxter and Mathilde Thomas
For deep healing to happen, something would have to be absorbed from the wine in significant enough amounts to have an effect, and there is scant evidence that this occurs. A more realistic concept is rejuvenation of the skin, which can absorb certain compounds found in wine. Resveratrol, a powerful antioxidant, has received much attention both as a supplement and a skin care product. But just as there is not enough resveratrol in wine to explain wine’s health benefits alone, there isn’t enough in baths either.

Credit goes to Mathilde Thomas, founder of Caudalie, for connecting skin care to resveratrol. Science has backed this up too; resveratrol can be absorbed into the skin, where it provides an array of anti-aging benefits. Several large brands have now jumped on the resveratrol bandwagon, including SkinCeuticals.

The hype of the story stems from the increasingly common mistake of equating red wine’s benefits to resveratrol.  (For examples, see my recent posts here.) The reasoning goes like this: The French Paradox or some other study associates red wine with longevity, or lower rates of heart disease, or diabetes, or something else; resveratrol has been shown in lab studies to provide an explanation for these benefits; but in order to achieve levels of resveratrol  high enough for the same effect, one would have to consume dozens of bottles; so red wine must not be good for you after all. The correct interpretation of course is that it must be something other than resveratrol, or in addition to it.

Three amigos: Me, Professor Joseph Vercauteren, and David Sinclair
It’s partly my fault. In my book I set out to identify a plausible cause-and-effect relationship for each of the known benefits of moderate wine consumption, and resveratrol fits the bill. But I also emphasized that it is only one of many antioxidant polyphenols compounds in wine, and that they often work synergistically. I also pointed out the relationship of red wine consumption in moderation as a marker for many other healthy lifestyle habits. The ability to relax is probably one of those, and if soaking in a tub of wine helps, I am all for it.

Tuesday, August 19, 2014

Ten things your doctor won’t tell you about wine and health

A recent column in MarketWatch called “10 things your winemaker won’t tell you” has provoked considerable controversy, and the way I see it the statements about wine and health are particularly off base. So my response is a list of what your doctor probably won’t tell you; part of this will refute the MarketWatch piece, part of it will get at the misconceptions that underlie the problem. Author Catey Hill does make some interesting and valid points, but the question of healthy drinking is just too big to be distilled into a paragraph or two. I do know this though: it isn’t the winemaker’s job to tell you about its health benefits, and in fact the feds take a pretty dim view of that idea.

       1.       Hill states “Scan any health website these days and you’re likely to find at least one article touting the health benefits of wine, among them heart health and longevity—all the more so since the recent discovery of the antioxidant resveratrol in red wine. But some studies suggest there are more risks to wine consumption—or at least fewer rewards—than recent headlines might suggest. ” We must first point out that the discovery of resveratrol is not especially recent; a PubMed search returns nearly 6,700 articles in the biomedical literature on resveratrol, hardly qualifying it as an incompletely studied novelty. The issue is whether resveratrol is actually the reason for wine’s health benefits. Evidence seems to point elsewhere, given the low amounts of resveratrol in wine or any other dietary source. Resveratrol is clearly not “all the benefits of wine without the alcohol” as touted in supplement ads.
2.       Despite this understanding that researchers familiar with wine and health have had for years, the fallacy repeated in Hill’s article (and many others) is equating resveratrol and wine as the same thing. She cites an article much ballyhooed this year in the Journal of the American Medical Association in which researchers tracked a population of men over nine years, measuring resveratrol levels in their urine as a marker for dietary resveratrol intake. The more wine and vegetables in the diet, the hypothesis went, the more resveratrol and therefore lower mortality and disease. The lack of any correlation was interpreted as meaning that wine wasn’t so good after all, despite the fact that those in the know had abandoned the idea years before the study was completed.
3.       So how did the claims to health and longevity get started in the first place? What it boils down to is this: moderate wine drinkers live longer on average than nondrinkers, they have lower rates of degenerative diseases such as diabetes, osteoporosis, and cancer; and they have higher quality of life by standard measures. Statistically, it doesn’t matter whether it is the resveratrol, the alcohol, or anything else. Individual studies looking at individual disease conditions can therefore give a false view of the bigger issue. An example of this is another study (albeit a large one) cited by Hill, which showed that alcohol consumption even in moderation was associated with an increased risk of atrial fibrillation, a marker for heart disease. But the preponderance of data, from even larger studies such as Framingham, indicates that moderate wine consumption is the single lifestyle factor most protective against heart disease other than not smoking.
4.       Red wine drinking makes for healthy teeth. On the other hand, white wine may erode tooth enamel, according to an article cited by Hill. But the polyphenols in red wine – the things that make red wine red – are potent inhibitors of the bacteria that cause plaque and cavities.
5.       What your doctor really doesn’t want to tell you is that they don’t trust you to understand what moderate drinking is. Hill cites physician and author John La Puma, who points out (correctly) that the standard measure of a glass of wine on medical studies is 5 ounces, yet most wine glasses hold more. This leads to what is known as the under-reporting bias, meaning that people drink more than they think they do (or report that they do.) But the logical conclusion of this is that wine is actually better for you than we thought; if the healthiest level of drinking (lowest point on the J-shaped curve) is two 5 ounce glasses, what that really means that it is more, because the data is based on self-reporting.
6.       Alcohol is part of the health benefit equation. Claims that you get the same benefits from grape juice are dubious, and there are several reasons why it would be so: For starters, grape juice is full of sugar, and alcohol calories are metabolized in less deleterious ways. Perhaps more importantly though, the polyphenols in the skin of the grape occur in higher concentrations in wine grapes, and are extracted and concentrated during fermentation. But alcohol in the right amounts has specific health-promoting properties, which I outline in a chapter in my book.
7.       Sulfites in wine are not the reason for allergic reactions. Hill mentions sulfites only in passing, but it is commonly believed that flushing and other symptoms relate to the sulfites in wine that are added as preservatives. But they occur naturally, and when added are still in much lower concentrations than many common foods such as dried fruit. The reactions are usually attributable to histamine-like compounds that develop during malolactic fermentation, a type of secondary fermentation mediated by bacteria rather than yeast.
8.       Wine is more than heart healthy. Because the French paradox highlighted cardiovascular disease, early research focused on that. But as knowledge of wine chemistry expanded, research extended into several areas of anti-aging health issues. But focusing on only one condition (for example atrial fibrillation in the article referenced above) can obscure the larger benefit across a range of benefits to health and longevity.
9.       Wine is good for the brain. Every major epidemiologic study of Alzheimer’s disease and age-related cognitive decline has found a strong correlation of moderate wine consumption with higher mental function during aging. [references in my book]
10.   Research on wine and health is comprehensive. A recent summary called “Mapping the scientific research on wine and health” noted that the field is highly interdisciplinary, with publications in more than 500 different scientific and biomedical journals. There are few if any aspects of health research more thoroughly investigated.

Wednesday, May 14, 2014

Yes Red Wine is Still Good for You

Recent reports that “red wine is not great for health after all” and that “no amount of alcohol is safe” are just plain wrong. This type of misguided reporting and misinterpretation of scientific studies is one of the reasons for my book Age Gets Better with Wine. How is it that the story is still so confused?
Kicking off the latest round of hype was a report issued bythe World Health Organization’s International Agency for Research on Cancer. Noting that the risk is dose-dependent, meaning that heavy drinking has a stronger correlation with some types of cancer, the authors of the report concluded that even moderate drinking carries some degree of risk. This was followed by release of a study in Italy that looked at dietary levels of resveratrol and incidence of diseases of aging. Since the most well-known source of resveratrol is red wine, the lack of a benefit from higher resveratrol consumption was reported as casting doubt on the benefits of red wine.
So here we go again: It is well-documented that people who consume red wine in moderation, on a daily basis, live longer, have lower rates of cancer and other diseases of aging, and have better mental function and higher quality of life as compared to nondrinkers. They are also healthier than heavy drinkers, so the relationship of wine consumption and disease risk is not a linear dose-response but a J-shaped curve. One reason why this is not recognized is what is called “self-reporting bias,” which means that heavy drinkers tend to under-report their true consumption and so are categorized as moderate drinkers. Another reason is that there are comparatively few true consumers of red wine in moderation and they are hard to isolate statistically. Most people tend to drink in more erratic patterns as compared to the more traditional habitual glass of wine with dinner. These types of things confound data but lumping this group in with all drinkers and declaring alcohol a carcinogen is sloppy science and wrongheaded.
The bigger problem with this report is that it looks only at cancer risk, not overall health and longevity. Even if we ignored the evidence that moderate wine drinkers actually have lower cancer risk and assumed it was a linear dose-response relationship, the major cause of mortality is heart disease. Since moderate drinkers have a larger benefit of reduced heart disease risk than potential increase in cancer, the net result is still clearly positive. Add to that the benefits of wine on Alzheimer’s, diabetes, osteoporosis, etc. etc. and you will see my point.
But the big C is a scary thing, and a major point of emphasis in the report is breast cancer. The widely held view, based on the many studies that have been done, is that a drink a day increases risk of breast cancer by 10%; 2 drinks, 20% and so on. Lifetime risk of breast cancer is around 12%, but the risk of a daily drink (if any) would not increase risk to 22%, but rather 10% of the 12%, so the net is just over 13% -  hardly measureable by statistical standards. Add to that the self-reporting bias and it is easy to see why alarmist reporting is unjustified. And as I have pointed out many times before, in populations where women drink primarily red wine, the incidence of breast cancer is substantially lower.
Which brings us to the question of whether red wine really is different. A study 783 elderly men in the Chianti region of Italy attemptedto answer this question by measuring resveratrol metabolites in the urine, and looking for a relationship of resveratrol to observed rates of cancer and longevity. The reasoning was that red wine’s benefits are due to resveratrol, which also occurs in other foods, so total resveratrol from all dietary sources should correlate to improved health. However, the study found no such correlation.

I could have told them that before they started the study, because there is not much resveratrol in any naturally occurring food including wine, so it was never the primary reason for red wine’s benefits. Remember the whole reason for doing the study was to try to find what it is about wine that would explain why wine drinkers fare so well; but it always comes back to just drinking the wine.