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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