Should Doctors Recommend Wine To Patients?

by | Jan 15, 2009

Today I have an article out in Synapse called “Wine May Increase Heart Healthy Fats in the Blood.” I am making an executive decision that it is too science-y for this blog, so instead I would like to open a discussion about how doctors should treat information like this.

For you uber-nerds (like me), here is the PubMed link to the original paper.

Let’s start with some excerpts from my article:

  • Moderate alcohol consumption has long been known to be protective against mortality from coronary heart disease, but the biological mechanism of this effect is unknown. A new analysis suggests that drinking wine may alter the composition of healthy fats in the blood, mimicking the beneficial effects of seafood consumption and conferring protection against heart disease.”
  • “The beauty of this finding is that the improvement in fatty acid profile from wine consumption seems to be clinically relevant. Based on the current consensus, small dietary changes in fatty acid consumption have a large clinical effect, so a 38% to 50% increase in EPA levels among moderate wine drinkers is noteworthy. Similar levels of improvement in lipid profiles from studies of fish consumption have shown considerable benefit for cardiovascular outcome.”
  • “Thus, the present finding may offer dietary intervention as a possible method of cardiovascular protection, particularly when combined with increased omega-3 consumption.”
  • “In the present study, the difference between participants in the low fatty acid group who did not drink and those in the high fatty acid group who drank the most was an 83% increase in blood EPA, a change associated with a 50% to 75% reduced risk of heart attack. Such a dramatic difference represents a useful alternative to fish consumption for those who may not have access to seafood for whatever reason.”
  • “Thus, increasing both dietary omega-3 fatty acids and wine consumption may be helpful to protect against cardiovascular events. Plant-derived omega-3 fatty acids are abundant in walnuts, soy, flax and canola oils, and one gram per day is the current recommendation for heart protection. “Moderate” alcohol intake is one glass per day for women and two for men.”

From a clinical perspective, the evidence that alcohol provides a tremendous protection against mortality from heart disease is undeniable. It is thought to work by both raising good HDL cholesterol and reducing blood clotting.

This effect is not limited to red wine, all spirits elicit substantial protection.

Despite these benefits, there are also a number of obvious reasons to avoid alcohol, particularly excessive consumption. Excessive alcohol consumption is associated with addiction, liver disease, stroke and can cause accidents and other behavioral problems.

Notably, benefits similar to those seen with alcohol can be conferred by increasing exercise amount or intensity.

If you want to experience the benefits of alcohol you need to use it in moderation, which is 1 drink per day for women and 2 for men, or possibly slightly more. More than one drink per day for women is associated with an increased risk of breast cancer, however this effect is attenuated by sufficient folate intake.

Doctors have been recommending increasing exercise for decades, but only a small percentage of the population makes an effort to get enough to make it as valuable against heart disease as alcohol. Also, there is a large population of individuals that have physical ailments that prevent them from performing vigorous cardiovascular exercise.

But to this day the American Heart Association–the same agency that recommended the low-fat, high-carb diet that many argue actually promotes heart disease–refuses to recommend moderate alcohol consumption. The basic tenet of their argument is that alcohol is not necessary because heart protection can be achieved in other ways, and the risks outweigh the benefits.

Is this right? I’m not so convinced.

Do you think doctors should discuss the potential benefits of alcohol with their patients? Should the AHA change their recommendation?

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10 Responses to “Should Doctors Recommend Wine To Patients?”

  1. Mike says:

    It sounds like the AHA, like most other organizations probably want to stay on the safe side when it comes to alcohol. There are obviously advantages and disadvantages to any health or food choice, and since alcohol is still taboo in the US copping out of the health implications is the easiest and safest thing for the AHA to do.
    Personally, if I was unhealthy and went to the doctor, and he/she with-held the benefits of alcohol from me I would probably be upset.

  2. Matt Shook says:

    Alcohol is fairly prevalent in American society…so it’s not like people or organizations are unaccustomed to it. I believe the AHA, like most large organizations have shifted their focus from “making recommendations that will be beneficial for people” towards “making recommendations that will not get them sued”…ie. making sure their asses are covered.

    I believe that often it is not what is said, but rather what is not said, that can be the most disturbing. In this case the doctors/health organizations will leave it to the individuals to discover the health benefits of alcohol on their own. Perhaps doctors/health organizations are afraid of how the media and wine conglomerates will promote the health benefits…usually in some dumbed down method that will leave the consumer with: “Alcohol is good.” In turn the consumer can’t see anything wrong with having more of something that’s “good for you” and drink more wine…and the wine companies watch their profits grow.

    This very thing seemed to happen with dark chocolate…all of a sudden the chocolate companies(Hersheys for one) started putting little blurbs on their “dark” chocolate that it is actually healthy for you. Maybe a small disclaimer in .5 point font the words: “when used in moderation”

    This response may sound extremely cynical, but from my experience it these cases usually fall under:
    1)drs/orgs protecting themselves from legal issues
    2)drs/orgs not trusting the intelligence/self-control of their patients.

    Do I think it’s right the AHA hasn’t recommended alcohol in moderate consumption? No. However, I can understand why they haven’t…and may never do so.

  3. Katie says:

    Its actually ironic that anybody actually would take advice from the AHA, which seems to be wrong about more things than it is right. I’ve been registered with the AHA for BLS CPR for many years, but it seems like each time I go in for re-certification the AHA has changed their recommendations for the technique of delivering CPR. Of course they would argue that as information becomes better they adapt to the better info, but it just shows how far, far from infallibility the organization is.

  4. Anonymous says:

    What does folate have to do with alcohol?

  5. Steve Parker, M.D. says:

    Doctors are hesitant to recommend alcohol because it could put them at risk for lawsuits if anything goes wrong: drunk driving, accidents that occur when alcohol is in the blood stream, drug interactions, liver damage, etc. It’s easier for doctors to simply ignore the issue, so that is frequently done.

    A clinical study last year indicated that middle-aged people who start an alcohol habit have lower incidence of heart attacks and strokes. This would provide a positive defense for a physician who indeed recommeded alcohol consumption to carefully selected people.

    For details, see my blog post:
    http://advancedmediterraneandiet.com/blog/?p=69

    -Steve

  6. Darya Pino says:

    Sounds like everyone agrees the AHA is playing it safe (for themselves) for legal reasons. I personally find this annoying, and think public health should come first for this kind of organization.

    Too bad we aren’t all PhDs who can effectively read and interpret the appropriate data. In the meantime I will do my best to translate for you.

    @Steve

    Great article, thanks for the reference.

  7. Scott says:

    Are these studies funded by the wine industry? Imagine how happy the wine industry would be if doctors decided they needed to tell all of their patients to drink wine every day to be healthy! Apple a day keeps the dr. away…….Milk does a body good…..those industry people will do/say anything.

  8. Darya Pino says:

    @Mike

    Great question! Probably, but I didn’t check.

    :D

  9. Robbert_A says:

    Sorry but Daryo I think you are letting your own bias influence your judgment. I realize you enjoy drinking with friends but as a 3rd year MD student I wholly support the AHA’s position.

    I don’t argue with the facts about the mortality protection of alcohol its known well as the J shaped curve in terms of concentration of alcohol consume (you know im sure). But I do think the studies on moderate drinking leading to excess are very strong and I totally endorse the concept of improving health in other ways.

    Exercise is of course an obvious substitute but as you said some may not be able to exercise hard. In that case what about a very good diet and instead of slamming some bears how about making fresh juice everyday with a nice blend of veggies and fresh fruit? Sure it takes effort but the health benefits of juicing I think are quite clear given research into nutrition about fresh fruits and vegetables. I also think behavioral modifications are important. Trying to deal with life more calmly and meditating regularly which also show benefits in neurology and cardiology if you do some searching.

    You might say but you can do all that PLUS drink. Well by then will drinking still give even a further boost to cardiovascular health? I don’t know. But I’m still not comfortable with MD’s or AHA recommending alcohol because of the negative aspects of drinking both too much and even in moderation (such as acetaldehyde related GI cancers).

  10. Robbert_A says:

    In regards to Katie’s comment. The AHA does not invent BLS CPR. The entire world uses certain sets of practices that anyone from around world found to be effective such as any medical modality (vaccines, drugs, surgical techniques). When 1 group improves the modality through accidental finding or focused effort the results often are published and then with careful scrutiny are then updated and practiced by countries all over the world. These updated practices are then adapted and approved by organizations (such as AHA) which often have their own bodies to verify independently the improvements of a certain technique.

    The documentary by Dr. Sanjay Gupta on delivering fast chest thrusts instead of mouth to mouth improving CPR results comes to mind.

    You seem to understand the basics of my point above with your comment but I thought you might benefit if it was better explained.
    Please consider this because your comment has no real merit as evidence that the AHA is a bad organization as you seem to subtly imply.

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