It's a recurring topic, and one we rarely reach an agreement on when we're with friends and family, especially during these times of family gatherings and meals. The repeated phrase is " a glass of wine with a meal is good and won't hurt ," and it might be an excuse to feel less guilty, or perhaps we genuinely want to believe it, or we're part of an indirect form of advertising in a country with a great winemaking tradition and history: "wine gives us pleasure and perhaps protects our hearts because it has antioxidants..." or so we think.
The relationship between alcohol consumption and the Mediterranean diet remains a controversial issue. A 2013 study published in The Lancet indicated that people following this diet with moderate red wine consumption had a lower risk of death from cardiovascular disease , stroke, and Alzheimer's. However, in 2018, the same journal published a study with estimates for 195 countries from 1990 to 2016, which concluded that there is no single healthy minimum alcohol consumption level.
Along the same lines, the WHO emphasizes that there is no safe threshold that guarantees the absence of risk in alcohol consumption and the cognitive consequences for adolescents with the "botellón" phenomenon are clear.
The Carlos III Health Institute provided evidence that alcohol consumption is not beneficial to health , and that the risk increases as the amounts consumed increase; even with low amounts of alcohol there is no lower risk of dying from all causes, so that glass of wine with food doesn't seem to be as good as we thought.
Up to six types of alcoholic beverages were studied : wine, beer, vermouth, liqueurs, mixed drinks and cider, recording the frequency and quantity of consumption, and subsequently calculating the ethanol content according to the percentage of alcohol that each beverage contains.
Starting at 20 grams/day (the equivalent of two glasses of wine or two beers), the risk increases with higher alcohol consumption. However, consumption below 20 grams/day does not appear to increase the risk of mortality, but neither does it decrease it. Those who drink small amounts of alcohol do not have a lower risk of dying.
Despite its polyphenols, wine is no better than other liquors when it comes to mortality ; no differences were found between different types of alcohol.
The association with all-cause mortality was studied ; however, the effect of alcohol is different depending on the diseases studied.
Excessive consumption is linked to more than 200 diseases, including obesity, since alcohol consumption involves the intake of empty calories, up to 120 per glass of wine or beer, and up to 450 if they are high-proof drinks, without providing any valuable nutrients to the body, in addition to being associated with other negative health and social effects.
According to the WHO, 3 million deaths occur worldwide each year due to harmful alcohol consumption.
But is there a low-risk consumption?
Low-risk consumption for health is one beer or one glass of wine per day for women and two for men, although that does not mean it is harmless, any alcohol consumption can be harmful to health.
In the case of cancer mortality , the risk increases even with very small amounts, even less than 5 grams of alcohol, and there is no safe threshold for consumption. Alcohol is the direct cause of 4% of all cancers diagnosed in 2020.
As expected, high-risk alcohol consumption (20 to 60 grams daily) and excessive consumption (above 60 grams) resulted in the highest proportion of cancer cases at 39% and 47% respectively.
There is no safe consumption in relation to cancer.
However, in relation to ischemic heart disease , this effect may be different, and small amounts of alcohol are probably not as harmful as in the case of cancer. Therefore, the recommended message should be: the less alcohol, the better.
A ray of hope for wine lovers
New data suggest that moderate wine consumption reduces cardiovascular risk in people at high cardiovascular risk, with reductions of around 50% when they drink between half and one glass of wine a day and follow a Mediterranean diet, according to research published in the European Heart Journal , carried out by researchers from the University of Barcelona, the Hospital Clínic and the August Pi i Sunyer Biomedical Research Institute (IDIBAPS), in Barcelona, the Biomedical Research Center in Network of Physiopathology of Obesity and Nutrition (CIBEROBN) and the University of Navarra (UNAV).
It is based on the urinary analysis of a biomarker, tartaric acid—a substance present in grapes. Specifically, it indicates that light to moderate wine consumption, measured through this objective biomarker, was prospectively associated with a lower rate of cardiovascular events in a Mediterranean population at high cardiovascular risk.
The inconsistent results of previous studies may be partly due to the fact that research often relies on people reporting how much wine they drink; whereas in this work, the researchers measured the amount of a chemical in urine, an objective and reliable measure of wine consumption.
So what is the importance of moderate wine consumption within a healthy dietary pattern? With a Mediterranean diet, we previously believed that 20% of the beneficial effects could be attributed to moderate wine consumption; however, in light of these results, the effect may be even greater.
Finally, are there differences based on age and sex ? The protective effects of wine consumption are observed from the age of 35 to 40, and moderate consumption in women should always be half that of men and preferably consumed with meals.
By Dr. Alejandro Saez , Cardiology specialist at Quironsalud Valle del Henares Hospital.