THE FRENCH PARADOX
‘French’ and ‘Paradox’, the two commonly used words brought a sea change in the way wine is looked at, when coined as ‘French Paradox’ on Sunday, the 10th November 1991, on the CBS featured ’60 Minutes’ viewed by over 20 million Americans. Evidence was produced by Dr. Serge Renaud, Research Director, Segalen University in Bordeaux that the French who eat a lot more butter, cheese, eggs and sauces in their food than the Americans, smoke more cigarettes and barely exercise have only one third the incidence of cardiac heart disease (CHD). They are the second highest drinkers of wine and have the second lowest rate of heart diseases in the world. The studies had linked this paradox to the French habit of regular, moderate wine drinking with food. After the programme was aired the sale of wine spurted by 400%. Red wine stocks were diminished fast and most red wine went on allocation.
Also Read: Father of French Paradox gets Highest Honour
BEFORE THE PARADOX
The French Paradox was not a discovery for the first time. There is evidence that for centuries, wine had been used as medicine. The scientific discovery was made as far back as in 1940, that wine contains vitamins A, B, C and 13 minerals essential to human life.
Framingham Heart Study conducted in early seventies in Boston had demonstrated that moderate drinkers had 50% fewer deaths than abstainers. However, the conservative officials at the U.S National institute of Health panicked at the reference to the strong protection by alcohol against CHD in the draft report and insisted that reference to this aspect must be eliminated from the final publication.
Dr. Arthur Klatsky, a well-known cardiologist from California and a pioneer in several important studies in alcohol and heart published an Article as early as 1974 that reported an inverse relationship between alcohol drinking and CHD.
IMPACT OF THE PARADOX
The French Paradox had universal repercussions and forced scientists, doctors and ecologists to look at the health aspects of wine and alcohol at an accelerated pace, resulting in over a hundred studies in the USA, UK, Denmark, France, Chile, south Africa etc.
An International Wine and Heart Health Summit organized in 2001 by the Desert Heart Foundation, Arizona to share the latest findings was followed by the Second Summit from 15-17 February 2003 in Napa Valley, California. Over a hundred doctors and several researchers, wine connoisseurs and important thought leaders including Dr. Renaud, Dr. Arthur Klatsky, James Laube, Senior Editor of the Wine Spectator, attended ‘Beyond the French Paradox’. Topics like Biology of Wine, How wine alters the Pathophysiology of Atherosclerosis, Managing Coronary Artery Disease, Linking wine to Cardiovascular Health, were discussed by famous enologists, heart specialists, wine masters and physician winemakers- a growing breed of doctors who have combined pleasure with business and set up their own wineries. My observations are based on the Findings at this Summit.
WINE AND HEART
According to Dr. Klatsky, “abstinence can be hazardous to some person’s health” His group at the Kaiser Permanente Medical Centre in Oakland analyzed the different studies done on a total of 1.3 lakh (103,000) patients between 1978-85 and their status, in 1998. He concluded that those who had one or two alcoholic drinkers a day had 32% less risk of dying from CHD than non- drinkers. He feels, however, that no one should drink as primary means to protect oneself against heart disease.
Copenhagen Heart study, released in 1995, reported that those who consumed three to five glasses of wine per week over the 12- year span of the study had only half of the mortality risk of those who did not drink at all. Beer and hard alcohol did not provide such protection.
Dr. Serge Reynaud also concludes from a study of middle aged man in Nancy (East France) that a moderate daily intake of wine resulted in a lower risk of death due to CHD (40%), cancer (22%), and all causes (33%). A moderate intake of alcohol from beer also lowered the risk from CHD but not cancer. However, he cautions against using the results as an incentive to start drinking.
Also Read: Wine-An Affair Of The Heart
WINE AND BLOOD PRESSURE
Another critical factor involved in the healthy functioning of blood vessels is the control of blood pressure and the avoidance of blood clots, which affect blood flow in the vessels. polyphenols possess the capacity to relax and smooth the muscles of these blood vessels. This could be important factor in reducing blood pressure and the risk of clotting. Number of drinks and their effect on the blood pressure follows a J or U shaped curve. With one glass of wine the blood pressure actually goes down, with 2 glasses it is about the same. But increases significantly with more than 2 glasses. Therefore, if you have high blood pressure, you need to be careful with the extra amounts.
WINE AND CHOLESTEROL
Dr. R. Curtis Ellison, Director, Institute of Lifestyle & Health, Boston University indicated from one of his studies that alcohol was the only lifestyle factor, increasing the HDL cholesterol by 10- 20% when taken in moderation regularly. ‘Regularly’ is the keyword because the effect of increasing HDL lasts for a few hours only. Wine also has a favourable effect on blood coagulation and fibrinolysis, lowering the risk of thrombosis occluding an artery narrowed by atherosclerosis. In simple terms, it acts as a blood thinner and needs to be taken regularly. He cautions, however, against irresponsible drinking which includes drinking on empty stomach and binge drinking.
Clogging of arteries is basically due to the oxidation of LDL. The anti-oxidants in the phenolic compounds also inhibit this oxidation process, thus slowing down the formation of arterial plaque.
WINE AND WOMEN
While some studies have shown a fall in cancer with wine drinking, one type of cancer that may relate even to a moderate alcohol consumption is breast cancer among women. Though 25- 50 years of follow – up in the case of 5,000 women of the Framingham Study indicate no increase in the risk of breast cancer, other studies do suggest a slight increase. In fact, 2 major studies reported in 2002 that the increase in risk is 6% for one glass of wine daily and can go up to 46% for 4 glasses or more. But studies have also shown that adequate intake of folates blocks any increase in the risk of breast cancer (and perhaps colon cancer). Folates are found in leafy greens, fruits and whole grains. You can also take them in the pill from. But a word of caution – you must also take vitamin B12 with it to avoid any neurological problems.
WINE AND PREGNANT WOMEN
Although there has been no evidence so far to suggest that moderate alcohol drinking is harmful to the pregnant mother, no doctor is willing to make any statement. In private though, there seems to be a consensus that an occasional glass of wine is not harmful. This seems to be consistent with the latest guidelines issued by the Danish National Board of Health, which recommends avoidance of alcohol in pregnancy but advises up to one drink a day, occasionally.
Dr. Tedd Goldfinger, Senior Cardiologist at the Desert Cardiology of Tucson Heart Centre and also the Programme Chairman of the Summit, has quoted various studies which prove that alcoholic beverages, particularly wine, exert many favourable influences on human vascular biology that afford it protective actions against atherosclerosis. But it has been difficult to show a consistent benefit for wine over beer or spirits. Alcohol also reduces the risk of CHD by decreasing the risk of type 2 diabetes that is a powerful predictor of CHD among adults.
According to Dr. Deanfield, Professor of Cardiology at the University of London, there has been a shift in emphasis to prevention rather than invasive surgery with better understanding of CHD. There has been growing evidence during the last few years that inflammation of the arteries contributes to CHD and the alcohol’s anti – CHD power may be related to the anti– inflammatory action on the endothelial tissues that line the blood vessels. He also attributed this factor to the lower rate of CHD even for non-regular drinkers of alcohol where HDL, he good cholesterol level may not increase.
WINE AND DIFFERENT GRAPES
Although no studies have been done to directly co-relate the declogging of arteries with the amount of alcohol consumed, the anti-aging effect of different grapes does indicate that polyphenols present in different red grapes have as varying impact on this process. Studies done so far indicate that the best results are achieved from Chateauneuf-du–Pape, followed by Bordeaux, Barolo, Burgundy and Valpolicella. Dr. Deanfield recommends moderate drinking of wine as, ‘investing in your arteries just like your retirement pension plan.’
Also Read: DWC organizes Conference on Wine & Health in the Capital
WINE AND PHENOLICS
Dr. Roger Boulton, Professor of Enology at the University of California- Davis, had a very interesting observation relating the presence of polyphenols in wine to the French Paradox. The anti- oxidants present in the red wine grapes like cabernet sauvignon having a high amount of anthocyanin, which give colour to the grapes and are one of the phenolic compounds. Red wine consists of more than 50 such compounds. Well known to enologists for their sensory properties, they give wine its bitterness and astringency. They have anti-oxidant properties and are thus foundation for long ageing.
As the wine ages, the level of anthocyanins falls dramatically, from 600 mg/I to 100 mg/I within one year. This explains the initial bitterness and puckering in such wines and consequent softening of taste. Since the French mostly drink their wines young, they consume higher anti-aging compounds. This comes as good news since most of us in India may not be able to afford the expensive older vintages and the findings suggest that the young red wines may be better for the healthy anti-aging compounds.
WINE AND DEMENTIA
A new prospective study of alcohol consumption and risk of dementia in older adults conducted at Harvard concludes that compared with abstention, consumption of 1 to 6 drink weekly is associated with a lower risk of incident dementia among older adults. “The results are drawn from the Cardiovascular Health Study, a prospective, population-based cohort study in four US communities of 5,888 adults aged 65 and older. Those who consumed one to six drinks a week had a 54 percent lower risk of developing various type of dementia including Alzheimer’s disease, than abstainers.
However, those who drank less than one drink a week also had a reduction (35 percent) as did those who drank seven to 13 drinks a week (31 percent). At the same time lead author Dr. Kenneth Mukamal from Harvard Medical School and colleagues also found that drinking of 14 or more drinks a week actually increased the risk of developing dementia by 22 percent. The study also showed that people who carried the Apolipoprotein gene E4 had a higher risk of developing Alzheimer’s. Those individuals who had this trait and drank up to six drinks a week had about 40 percent risk reduction compared with non-drinkers with that trait. However, those with the trait who consumed 7 to 13 drinks a week had a 49 percent greater risk and those who drank more than 14 drinks increased their risk up to 337 percent.
Experts have described the Harvard study as “strongly suggestive” rather than “definitive.” They caution that people should not be encouraged to binge drinking but that those who are at greater risk of dementia should discuss the matter with their doctor.
WINE AND WAIST CIRCUMFERANCE: A Copenhagen City Heart Study
In this latest study Danish researchers examined the long-term association between the amount and type of alcohol consumed and subsequent waist circumferences. A large waist circumference was defined as more than 40 inches in men and 34.6 inches in women. The authors concluded, “Moderate-to-high consumption of alcohol and of beer and spirits was associated with later high waist circumference, whereas moderate- to-high wine consumption may have the opposite effect.”
The odds ratios of having a high waist circumference after ten years showed a linear increase in both men and women. They were 65% higher in men and 116% higher in women who drank more than 4 drinks a day total alcohol compared to those who drank an average of less than one a day. There were significant linear increases for men and women who drank only beer or spirits but no linear trend was found for wine in either men or women.
At the same time the investigators point to some potential study shortcomings and the need for further clarifications on the subject, especially as waist circumference was not measured at baseline. Moreover, this could also be due to the dietary and exercise difference between the wine and other-alcohol drinkers.
Also Read: Wine & Heart Health Summit in USA
WINE AND HEALTHY LIFESTYLE:
Based on two major studies completed recently, the investigators from Harvard have defined a ‘Health Lifestyle’ which has 5 components, namely:
(1) Don’t smoke
(2) Stay lean
(3) Eat a diet low on animal fats with lots of leafy green vegetables, fruits and whole grains
(4) Exercise regularly and
(5) Have half a glass of wine daily.
While these seem to be very obvious rules, it is only recently that wine had been included as regular component for good health. Good news is that the risk of heart disease had gone down by 80% and diabetes by 90% for diabetes. Also, the emphasis is on moderate drinking on a regular basis.
It is also worth mentioning here that some studies have pointed out that the effects of wine may not be due to wine itself but due to other lifestyle factors of the people who drink wine. For instance, Klatsky has pointed out that in the USA wine drinking correlates with higher income, which is also related to lower mortality rate. Similarly, the latest Danish Study that linked wine with lower CHD risk also pointed out that the wine drinking subjects were better educated, professionals and with higher incomes which made them conscious about a healthier lifestyle. Therefore, it is important for the researchers to establish if there is a molecular mechanism by which could affect CHD.
PROOF OF THE PUDDING:
One of the cardiologists attending the Conference from South Australia, Dr. Justin Ardell is a passionate believer in the therapeutic value of red wine for heart. The 40-year old doctor bought a 24- acre vineyard 9 years ago in Clare Valley, adjoining the famous Barossa Valley. His boutique winery, Reilly Wines, makes 7,000 cases annually of excellent red wine and some Riesling every year. His 3 – year old daughter, Jaclin can not only tell the difference between his Shiraz and Cabernet Sauvignon, but actually prefers Shiraz.
CONCLUSION:
· The Scientific data presented indicates a strong case for benefits of controlled drinking.
All- cause mortality rates clearly indicate that moderate drinkers live longer than abstainers. However, more randomized clinical studies need to be done to come to a statistical conclusion.
· Women should be extremely careful about excessive drinking because of the risk of breast cancer. In case they do they must eat plenty of whole grains, fruits and leafy vegetables and take folate pills under doctor’s advice.
· Maximum recommended daily drink is 1-2 for women and 2-3 for men.
· Though any alcoholic beverage is beneficial for heart, it is better to stick to beer or even wine for additional benefits against cancer.
· Do not Drink rapidly or on an empty stomach.
· Pregnant women should avoid drinking wine or any alcohol but can have an occasional glass of wine only.
· Drink moderately AND regularly, avoid binge drinking, i.e. Drinking 5-7 glasses over the weekend and not on other days.
· Do not start drinking wine or alcohol just to derive its health benefits. Drink for the pleasure of it, the good effects being just the side effects.
· Former abusers of alcohol and drugs, people with religious or moral contraindications to alcohol and people with severe liver disease and perhaps a few other medical indications should avoid wine and alcohol.
· If you are very particular about drinking wine only because of the health benefits, drink red wine with grapes having higher phenolic content, viz., Cabernet Sauvignon, Shiraz, Nebbiolo, Grenache – darker and with higher tannic content.
Also Read: Taking it to heart
Friends, I know listening about wine is a lot less enjoyable than drinking wine. But wine-lovers you all, may be interested to know that I sought out and went to Napa specifically to attend this 3-day conference, and Bacchus willing shall attend the next one too in February 2005.
Thank you for listening and CHEERS!
Subhash Arora
The Speaker is the President of the Delhi Wine Club and has recently attended the International Heart and Wine Summit in Napa, USA. He can be contacted at arora@delhiwineclub.com For more information on the subject visit www.delhiwineclub.com . Indian Wine Academy had also not been founded yet and delWine came later in 2006
Although the Talk was in 2003, it is interesting that most Studies after this Conference have corroborated the findings and the Article is still very relevant in 2021-editor.