The French Paradox at 20
IN THE OLD TESTAMENT, Timothy, on the advice of his mentor, St. Paul, instructed, "Drink no longer water, but use a little wine for thy stomach's sake and thine often infirmities." The Bible, as well as far more ancient civil and religious texts, is replete with references to the healing properties of wine and its place in spiritual life and practice. The ancients knew that wine—in moderation—was an aid to health, and so encouraged, even celebrated, its use as a daily beverage.
More than 200 years ago, Thomas Jefferson, our third president and an ardent lover of wines, spoke in support of wine as a national beverage. Jefferson said, "No nation is drunken where wine is cheap; and none sober, where the dearness of wine substitutes ardent spirits as the common beverage. It is, in truth, the only antidote to the bane of whiskey... Who will not prefer it? Its extended use will carry health and comfort to a much enlarged circle."
In the modern world, Timothy's dictum and Tom's declaration have been accepted as gospel by many, but questioned or rejected by many more. Nearly the entire Moslem world eschews the consumption of alcohol (alcohol is Arabic for "like a monster," certainly not a linguistic incentive to imbibe), and other religions wail against the evils of drink. Even in those societies where alcohol is not banned, the secular consumption of alcohol—including wine—is often viewed as a negative societal trait.
Although much of the Mediterranean is populated by Moslems, the European Mediterranean countries—Italy, Spain, southern France, Greece are the major nations—have, for centuries, embraced wine as a part of a healthy daily diet. These countries have rich wine histories and wine cultures, and produce more wine than any other area of the world. Wine consumed with meals is part of daily life in the European Mediterranean, coupled with the world's highest per capita consumption of fruits, grains and vegetables, with most fat calories coming from virtually unrestricted intake of olive oil, a largely monounsaturated fat.
Americans have become interested in healthy patterns of eating and drinking, and have looked to the traditional Mediterranean diet as a model. We know the benefits of fruits, vegetables, and grains, and consumption of olive oil is at an all-time high in the United States. In our homes, red meat consumption is down, even as we eat more fish and poultry. Of course, wine is part of the Mediterranean diet—it is widely seen as what it always has been (when consumed in moderation): a healthy beverage.
The French Paradox
France is often thought to be the land of artery-clogging, heart-stopping foie gras, rich cheeses, buttery croissants and Gauloises. Why, then, does France, along with the other Mediterranean nations, have some of the lowest rates of coronary heart disease—America's number one killer—in the industrialized western world? The answer may lie in a glass of wine.
Dr. Serge Renaud, who was director of the nutrition and cardiology department of the French National Institute of Health Research, studied the relationships between alcohol and health for 40 years. Renaud posited that the moderate consumption of wine (red wine in particular) is an important element in overall health. He observed that the French consume the same amount or more dairy fat—a definite link to heart disease—than the British and the Americans do, yet the French are 66 percent less likely to develop coronary heart disease or suffer fatal heart attacks. Renaud claimed that moderate consumption of wine with meals coupled with an absolute prohibition against binge drinking is a prescription for a healthy heart, lower rates of cancer and stroke, and even accidents.
How much is moderate? Renaud had a surprising answer. "For every 18 milliliters of red wine you drink in a week, you decrease your risk of heart disease by one percent. It's only a drop of wine, just a taste, almost an empty glass. You don't have to drink it, just sniffing it is enough."
Renaud's research was amplified and affirmed by physicians and research scientists in the United States, and it found particularly eloquent support in the detailed and long-term work of R. Curtis Ellison, MD, Chief of Preventive Medicine and Epidemiology and Professor of Medicine and Public Health at Boston University School of Medicine, as well as Arthur Klatsky, MD, Chief of the Division of Cardiology at Kaiser Permanente Medical Center in Oakland, California.
It was not a scientist, however, who captured the attention of the health-conscious, wine-drinking American public. In November 1991—almost 20 years ago—the "French Paradox" was revealed to the masses by Morley Safer, wine-loving co-anchor of 60 Minutes. In a 13-minute segment featuring a groundbreaking interview with Serge Renaud, Safer posed this question to Americans:
Why is it that the French, who eat 30 percent more fat than we do, suffer fewer heart attacks, even though they smoke more and exercise less? All you have to do is look at the numbers: If you're a middle-aged American man, your chances of dying of a heart attack are three times greater than a Frenchman of the same age.
Safer seemed almost messianic in his answer. While he did mention that the French diet included more fruits, vegetables, and bread than the American diet, he reserved his greatest enthusiasm for red wine when he reported there has been for years the belief by doctors in many countries that alcohol, in particular red wine, reduces the risk of heart disease. Now it's been all but confirmed.
Well over 33 million people watched 60 Minutes that evening, making it the highest-rated television show broadcast that week. The effect of the "French Paradox" report on the American wine-buying public was dramatic and measurable. The very next day, all US airlines ran out of red wine, and sales of red wine began to skyrocket. For the month following the report, red wine sales were up 44 percent (about 2.5 million bottles) over the same month of the previous year. In July 1992, the same show was re-broadcast, and sales of red wine went up 49 percent for that month. Sales of red wine for the entire year following the initial broadcast were up by a factor of about 39 percent. It seemed like a portion of the American public embraced red wine as the newest health food—the oat bran of the 1990s. Since then, Americans have never turned back.
Most wine drinkers in this country have no idea what the term "French Paradox" means; they drink wine—red and white and sparkling—because they like it and because enjoying wine with food is one of life's pleasures. Although we may bemoan the lack of historical and cultural perspective of younger friends and colleagues (many of today's American wine drinkers were children or teenagers at the time Safer made his pronouncement), it's best to think of wine as one of life's small pleasures, certainly not as medicine, no matter what age we are.
The French Paradox was full of good news, and the American wine industry was reborn, as were restaurant wine lists, which used to feature lots of white wines and a smattering of reds unless the restaurant was a steak house. Today it is not unusual to find fish restaurants with as many reds on the wine list as whites, sometimes more. Cabernet became king, and for a while Merlot appeared to be the Queen, until so much of it was relegated to the role of Court Jester. The 2004 film Sideways kindled a still-growing interest in Pinot Noir, as Americans continue their love affair with the media as arbiter of what's "in" and what's "out."
As the public began to look deeper into the research on red wine, some buzzwords emerged—resveratrol, quercetin and catechin—the primary antioxidants found in red wine. There's evidence that red wine could have a positive impact on high-density lipoproteins (HDL, the "good" cholesterol), and that it could help to dissolve the artery-clogging platelets in the bloodstream.
Recently I had a procedure known as a cardiac catheterization—a fiber optic probe of the arteries that pump blood to the heart. Happily, my results were good; my arteries are clean as a whistle. I must admit that I credit my moderate consumption of red wine (and olive oil) for the positive outcome of this scary procedure.
So, I am not immune to thinking of wine as medicine—it's one prescription I will be happy to take for life. If we live longer, we get to experience more of life's pleasures, and perhaps the wine-as-medicine model is not without merits. Perhaps. But to be honest, unless Morley Safer can prove on next week's 60 Minutes that wine will permanently and irrevocably wreck our health, most of us, I think, will continue to enjoy the gift of nature that delivers so much pleasure and just happens to be good for us, too.
Wine—For Your Health
As we look at life and lifestyle in the early twenty-first century, here is what we find about the links between moderate wine consumption and health, based on the most reliable scientific data, as of late 2009.
— Moderate intake of alcohol, especially wine, is associated with improved cardiovascular health. Alcohol exerts protective effects on the heart by raising high-density lipoprotein (HDL) cholesterol, lowering low-density lipoprotein (LDL) cholesterol, and inhibiting blood clotting. Antioxidant properties of the phenolic compounds in red wine—the compounds that give wine its color, aroma and taste—reduce the risk of atherosclerosis and heart attack by as much as 60 percent.
— Moderate drinking reduces the risk of both ischemic strokes and hemorrhagic strokes. People who abstain from alcohol and heavy drinkers may be at almost twice the risk for ischemic stroke than moderate drinkers.
— Researchers have found that starting to drink a moderate amount of wine during midlife, even after not drinking during younger years, is beneficial to the heart. In one study, wine drinkers were found to have a 68 percent lower chance of having cardiovascular illness. Also, antioxidants in red wine help to improve blood circulation and improve cholesterol levels in people of all ages.
— Excessive alcohol consumption is associated with hypertension, but low to moderate consumption (one to two drinks per day) may actually assist in lowering blood pressure, and, among men, lower the risk of heart attack by 30 percent.
— Because of its antioxidants (specifically resveratrol in red wine and quercetin in red grapes), wine may be helpful in cancer prevention and suppression. It is also useful in lowering stress in cancer patients.
— Moderate alcohol consumption leads to higher levels of cognition and memory, and the moderate daily intake of wine, tea and dark chocolate by elderly men and women can lead to enhanced cognition and memory. In several studies, light to moderate wine drinking has been shown to be highly effective in helping to reduce dementia by as much as 56 percent compared to those who do not consume wine. Results improved when light to moderate wine drinking was part of a traditional Mediterranean diet.
— Red wine (and tea) have shown promising results in helping patients with type 2 diabetes to properly metabolize sugars and starches. Also, resveratrol may help to prevent type 2 diabetes.
— Dry red wines made from particular grapes—Cabernet Sauvignon, Merlot, Pinot Noir, and Syrah—have been found to assist in killing harmful bacteria, including E. coli and Salmonella strains, while not killing off beneficial bacteria (probiotics). Wine consumption inhibits the growth of Helicobacter pylori, the bacterium that causes ulcers, with best results (30 percent less bacteria) shown among those who consumed three glasses of wine per day.
— Both white and red wine can kill streptococci, the bacteria that can cause sore throats ("strep throat"), as well as tooth decay. Scientists found that the acids present in grapes and wine are able to kill the harmful bacteria. Antioxidants in grape pomace (skins, pits and stems) have been shown to inhibit the growth of bacteria that cause plaque in teeth and gums.
— Drinking a glass or two of wine per day on a regular basis can cut the risk of catching a cold by as much as 50 percent, compared to adults who abstain from wine, or drink beer and/or spirits.
— Quercetin, an anti-inflammatory polyphenol found in red wine, has been shown to reduce the growth of prostate cancer and the replication of the influenza virus.
— Moderate daily wine consumption is actually beneficial to liver health, lowering by 50 percent the incidence of nonalcoholic fatty liver disease (NAFLD).
— Light to moderate wine consumption—one to two glasses per day—results in a lower risk of kidney failure and kidney cancer than abstaining from alcohol.
— Moderate wine consumption may reduce the risk of rheumatoid arthritis.
— Resveratrol inhibits the growth of tumors in the prostate and has been found to suppress the ravages of aging, including keeping the heart, eyes, kidney, and bones healthier. Resveratrol has been shown to be a useful tool in obesity research—it prevents the development of fat cells, which can be linked to type 2 diabetes and clogged arteries. This antioxidant shows potential in attacking cancer-including pancreatic cancer, which is particularly resistant to chemotherapy—thus making chemotherapy more effective for cancer patients. Researchers are beginning to develop resveratrol-based dietary supplements, medicines and patches, as a promising new niche of the pharmaceutical industry.
— The research dealing specifically with wine consumption by women, who metabolize alcohol somewhat differently from men, is not all good news, especially when it comes to risk for breast cancer. For women who consume one glass of wine per day with healthy meals the risk for breast cancer was 40 percent lower than for women who are nondrinkers. However, drinking two glasses of wine per day increases the risk for breast cancer by 10 to 20 percent. (A 10 percent increase is the same level associated with women who smoke a pack of cigarettes every day.) If a woman consumes more than three glasses of wine per day, her increased risk for breast cancer may rise as high as 41 percent.