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According to the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and many other health organizations, not drinking alcohol at all is the safest option for health. If, however, you’re looking for a healthy reason to drink wine, a new report may have found the perfect heart-healthy excuse — but is the science trustworthy?
Ramon Estruch, MD, PhD, from the University of Barcelona in Spain, has found that drinking a moderate amount of wine maintains a protective effect against cardiovascular disease. Recently published in the European Heart Journal, Estruch’s team stands by their findings despite the recommendations of the CDC and WHO.
The research team claims that light to moderate wine drinking is tied to a lower risk of long-term cardiovascular disease – which includes suffering from heart failure, stroke, heart attack, and cardiac death. They reported that this correlated to the amount of tartaric acid measured in study participants’ urine, indicating that each person consumed 12 to 35 glasses of wine per month. Those with tartaric acid in their urine indicating 3 to 12 glasses of wine consumed per month had a milder cardioprotective effect. For those drinking more than 35 glasses of wine per month, the team reports that the cardioprotective effect disappears.
Despite the promising results, I found numerous issues with the validity of the research and the report.
Diet
The report states that numerous epidemiological studies have suggested a relationship between higher adherence to the Mediterranean diet and a lower risk of developing CVDs. Within the diet’s framework, moderate consumption of alcohol, particularly wine, with meals, is thought to be one of several factors contributing to the cardioprotective effects of this dietary pattern.
Urinary tartaric acid
The study measured a chemical in urine called tartaric acid to determine how much wine was consumed. Estruch claims that measuring tartaric acid in urine is a method to objectively assess an individual’s alcohol intake because it comes from metabolizing grapes and eliminates the need for study participants to self-report wine drinking. Self-reports are often inaccurate, and intake is often under-reported.
“Tartaric acid is primarily produced in grapes and is synthesized very rarely by other plant species,” Estruch writes in the study.
It is true that grapes have the greatest concentration of tartaric acid, but it is also in bananas, avocados, cranberries, citrus fruits, baking powder, cream of tartar, tamarinds, and prickly pears. Many of these foods are also part of the Mediterranean diet, without the associated health risks of alcohol. When these foods are consumed, urinary tartaric acid cannot be assumed to solely reflect wine or grape consumption.
“Thus, tartaric acid emerges as a valuable short-term biomarker (several days to a week) for assessing wine consumption, provided that the intake of grapes and their derivatives is excluded. Indeed, prior studies from our laboratory have confirmed its usefulness as a reliable and objective biomarker of wine consumption,” Estruch continues.
The researcher admits that the urinary tartaric acid reflects wine intake only for the last seven days, but the study reports wine intake as a monthly amount. The tartaric acid results also do not adjust for the human tendency to drink less wine before needing to give a urine sample, with greater consumption prior to the preceding seven days.
Polyphenols
The report speculates that polyphenols are the compounds in wine that may be responsible for its cardioprotective effect. However, polyphenols are available in other foods, including berries, apples, cherries, plums, spinach, onions, broccoli, nuts and seeds, tea, coffee, spices, cocoa, and dark chocolate. All do not carry the risks associated with alcohol.
Alcohol-associated diseases
Alcohol consumption is associated with an increased risk of many health conditions and is the main and sufficient cause of several disorders, including alcohol dependence, liver cirrhosis, and several other non-communicable diseases and mental health conditions. This makes alcohol among the leading risk factors for premature death and disability because it has a cause-and-effect relationship with multiple health conditions, including injuries and suicides. Alcohol use is estimated to cause approximately 178,000 deaths each year. The height of the COVID-19 pandemic saw an average of 488 deaths per day due to excessive alcohol use.
“Alcohol use is among the leading risk factors for premature mortality and disability because of its causal relationship with multiple health conditions, which also include non-intentional injuries and suicides. Younger people are disproportionately affected by alcohol compared with older people, and 13·5% of all deaths among those aged 20–39 years are attributed to alcohol. Disadvantaged and vulnerable populations have increased rates of alcohol-related death and hospitalization,” writes Benjamin O. Anderson from WHO’s Department of Noncommunicable Diseases in The Lancet.
The International Agency for Research on Cancer classifies alcohol as a toxic, psychoactive, dependence-producing substance and a Group 1 carcinogen that is causally linked to seven types of cancer, including esophagus, liver, colorectal, and breast cancers. Alcohol consumption is associated with 740,000 new cancer cases each year globally.
Increasing levels of alcohol use are associated with increasing levels of risk of illness and mortality, leading to the question of whether a safe level of alcohol consumption that leads to zero health risks even exists.
Some, but not all, studies have suggested that light drinking could have a small health benefit, as measured by the risk of some cardiovascular diseases or Type 2 diabetes. Some studies show that the hearts of middle-aged and older people show signs of benefitting from light drinking. However, several reviews have also found that the protective effects of moderate consumption disappear with heavy episodic drinking, which increases the risk of any form of heart disease.
Overall, no alcohol studies have shown that the potential protective effects for cardiovascular diseases or Type 2 diabetes carry over to a drinker’s risk for cancer. The evidence does not show the existence of a particular threshold at which the cancer-causing effects of alcohol start to manifest in the human body. Simply put, there is no safe amount of alcohol when it comes to developing various cancers. Drinkers should be objectively informed by their doctor about the risks of cancer and other health conditions associated with consuming alcohol.
This editorial raises several concerns with Estruch’s study:
1. To what degree is the cardioprotective effect due to the Mediterranean diet, and to what degree is it attributable to wine consumption? Without following this diet, would the wine still demonstrate a cardioprotective effect?
2. Does urinary tartaric acid accurately assess an individual’s wine consumption? It is known that urinary tartaric acid reflects no than seven days previous intake, although the report claims it reflects monthly intake.
3. The report suggests that polyphenols in wine are responsible for the cardioprotective effect. Polyphenols can be consumed in many other foods and beverages without the health risks associated with alcohol consumption.
4. The study ignores the numerous and potentially deadly health risks associated with alcohol intake, including seven cancers known to be caused by alcohol. No safe amount of alcohol has been established as a threshold before the carcinogenic effects are active.
In summation, this study added nothing to the bodies of knowledge of medicine and science that was not already known. When deciding to drink alcohol, individuals should be informed of all risks associated with its consumption.
