In 1991, the widely popular CBS television news show, 60 Minutes, featured a story that attributed the lower risk of heart disease in France to drinking red wine. Since the original story aired, red wine sales skyrocketed1 along with the public’s consumption of the beverage and thirst for evidence about this proposed cardioprotective effect. Seemingly everyone attempted to “cash in” on the phenomenon, particularly red wine producers2 and nutrition “experts” who marketed the nutritional value in books like the New York Times Bestseller, French Women Don’t Get Fat by Mireille Guiliano (2004 hardcover; 2007 paperback). Earlier this year CBS followed-up on the 1991 story with additional information about the so-called French Paradox.3 The “French Paradox” refers to the low rate of cardiovascular mortality in France compared to the United States despite a high fat diet.4-6 The term “French Paradox” comes from the work of an Irish physician, Dr. Samuel Black (1891), interested in the observed differences in angina pectoris in Irish patients compared to the lack of discussion about coronary diseases in French patients.7 More than a century after Dr. Black’s query, evidence of biological mechanisms for cardioprotective effects continues to emerge – slowly; yet, the momentum has not died down in the popular media where the focus is primarily the medium of ethyl alcohol (ethanol) and red wine.
The truth is epidemiologic data demonstrates an association between heart disease, health and nutritional benefits, and alcohol and red wine consumption5, 6 but the association has been misinterpreted as causally related to heart disease. While biomedical research systematically explores the relationship between red wine and heart disease by exploring the biological pathways associated with cardiovascular risk factors (e.g., obesity, diabetes, blood pressure) as well as outcomes (e.g., heart attack or myocardial infarction, death), conclusive evidence for human benefit is lacking. Yet, a lack of evidence has not stopped the paucity of marketing campaigns postulating the benefits of red wine or the benefits of resveratrol (as a nutritional supplement or pharmacologic agent) for a healthy heart, anti-aging, or to combat cancer (all types of cancer).5, 8
Resveratrol is a polyphenol found on the skin of red grapes which protects the grape from bacteria and fungi. The compound is available in detectable quantities of red wine because skins of grapes are not fermented in the production process. In vitro data for resveratrol in human tissue and in vivo mice models of obesity, cardiovascular disease, and anti-aging effects is positive;9 however, its effects are the subject of ongoing clinical investigation in humans (see clinical trials.gov for a list of 10 active trials studying resveratrol). Numerous academic institutions and pharmaceutical companies such as Sitris, a Glaxo-Smith Kline (GSK) company, have jumped on the resveratrol-anti-aging/anti-cancer/anti-obesity/decreased-heart-disease-band wagon. As such, resveratrol has been isolated and marketed as a dietary constituent despite repeated warnings from the FDA to cease selling the product as a pharmacologic agent since there are no definitive results from clinical trials.8 In fact, there are warnings against purchasing resveratrol on many sites linked to Google.
Although alcohol has a well documented cardiovascular pathway, its pathway is independent of beverage type (i.e., wine, beer, or other alcoholic spirit).10, 11 The cardioprotective effects of alcohol includes increased high-density lipoprotein (HDL), antithrombotic effects, improved endolethial function, and decreased insulin resistance.5, 6, 10, 11 These effects, however, are confounded by individual characteristics such as gender, race, age, quantity, and type of alcohol (e.g., beer may be more beneficial for men while wine or a distilled spirit may be more beneficial for women).
Established risk factors for heart diseases include smoking, systemic hypertension, type II diabetes, blood lipids, atherogenic lesions, and thrombosis damage.6, 7 Both alcohol and red wine polyphenols antioxidant properties have antithrombotic and antiatherogenic action as well as significant impact on blood lipids (HDL and LDL); however, their association to other risk factors is confounded by intake and lifestyle variables. Alcohols’ positive impact on acute physiologic events (such as high blood pressure and heart rate) is a plausible explanation for the heightened interest in the association between alcohol, red wine, and heart disease. These findings excite nutrition proponents who fail to understand that red wine and alcohol independently impact heart disease risk factors; in fact, the non-alcohol related benefits (e.g., resveratrol) can be found in non-alcoholic beverages such as grape juice, other fruits and vegetables. Furthermore, the amount of property relates significantly to the benefit such that alcohol in large quantities has equally harmful consequences.
Fortunately, biomedical researchers, pharmaceutical companies, and legitimate organizations such as the American Heart Association are not marketing red wine or alcohol as beneficial mechanisms to decrease heart disease. In fact, it appears that only independently owned organizations such as Nutra-Smart.net by Stuart Adams or Bio-Medicine.org use evidence of an association between moderate alcohol consumption and acute cardioprotective benefit as explanations for the French Paradox while purporting causal relationships. Therefore, in light of the complex evidence for mechanisms of heart disease as well as the multiple pathways for alcohol and non-alcohol benefits people should be leery of the hypothesis that red wine decreases heart disease. Since alcohol consumption to the point of abuse represents a problem for a significant portion of American adults,12 it is not wise for popular news to continue promoting red wine consumption as a legitimate benefit for a healthy heart. Instead, promoting a low-fat diet with fruits and vegetables and exercise is a much more responsible message.
Holly Tomlin
Blog 8
References
1. McGraw A. Wine drinkers spark up sales. Central Penn Business Journal. 1995;11(5).
2. Dolan C. Marketing: Wineries and Government Clash over Ads that Toast Health Benefits of Drinking. The Wall Street Journal, 1992.
3. Fountain of Youth in Wine Rx. Jan 25, 2009, 2009.
4. Opie LH, Lecour S. The red wine hypothesis: from concepts to protective signalling molecules. Eur Heart J. 2007;28(14):1683-1693. Epub 2007 Jun 1687.
5. Saiko P, Szakmary A, Jaeger W, Szekeres T. Resveratrol and its analogs: defense against cancer, coronary disease and neurodegenerative maladies or just a fad? Mutat Res. 2008;658(1-2):68-94. Epub 2007 Aug 2017.
6. Saremi A, Arora R. The cardiovascular implications of alcohol and red wine. Am J Ther. 2008;15(3):265-277.
7. Klatsky AL. Alcohol, wine, and vascular diseases: an abundance of paradoxes. Am J Physiol Heart Circ Physiol. 2008;294(2):H582-583. Epub 2007 Dec 2014.
8. FDA. Warning Letter (09-ATL-01). In: Services DoHaH, ed; 2008.
9. Baur JA, Sinclair DA. Therapeutic potential of resveratrol: the in vivo evidence. Nat Rev Drug Discov. 2006;5(6):493-506. Epub 2006 May 2026.
10. Pearson TA. Alcohol and heart disease. Circulation. 1996;94(11):3023-3025.
11. Sato M, Maulik N, Das DK. Cardioprotection with alcohol: role of both alcohol and polyphenolic antioxidants. Ann N Y Acad Sci. 2002;957:122-135.
12. CDC/NCHS, Survey NHI. Figure 31. Cigarette smoking and alcohol use among young adults 18-29 years of age, by sex: United States, 1997-2006. In: Health US, ed: CDC; 2008.
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