The Responsibilities Series – Episode Two: Wine & Health

The Responsibilities Series allow us to explore the specific responsibilities of those who work in fine wine, as we strongly believe that fine wine can no longer be defined solely by its taste or its terroir, but also by its leadership values and ethos. This very special series has been possible thanks to the support of Moët Hennessy and their programme Living Soils, Living Together.

In this second episode, we are exploring one of the most serious issues facing wine: the question of wine and health, and the growing movement challenging even the moderate consumption of wine and alcohol.

Could wine lose its social license to operate? That once unthinkable possibility now seems to be a real threat, as the health lobby declares that there is no safe level of alcohol.

In late October, a Congress on wine and health — the Lifestyle, Diet, Wine & Health Congress — was held in Toledo, Spain. It brought together a number of prominent doctors, scientists and other researchers, to look at what the evidence says about the impact of wine on health. Areni’s Editorial Director Felicity Carter was there, and in this special podcast, she explains what was discussed.

The Responsibilities Series – Episode Two: Wine & Health, recorded November 2023

The below is an edited and shortened version of the conversation, which also included excerpts from the Congress. To hear the full episode, click here.

This podcast is an independent production, our partners do not influence our content. The views expressed on that podcast are our own.

Pauline Vicard: Felicity, could you start by talking about the Congress and who organized it and what did they talk about?

Felicity Carter: The Congress was organised by two European bodies, the Wine Information Council, and, the Foundation for Wine and Nutrition Research. The organisers brought together some of the world’s major researchers into wine and health to give presentations over two days.

And why did they organise it?

The wine trade has been blindsided by new drinking guidelines that were issued by the World Health Organization (WHO) in February this year. They said there is no safe level of alcohol consumption and what the WHO says informs many countries’ policies. We know that people are already drinking less, partly because they see alcohol as unhealthy. This new public messaging is going to accelerate the move away from wine drinking. If you want to put this in context, a recent Gallup poll showed 39% of Americans now see consuming any amount of alcohol as unhealthy. If a respected body like the WHO comes out and says, alcohol is just bad for you in every way, there are a lot of people who will listen. These public messages really resonate as we saw 30 years ago with the famous 60 Minutes French Paradox program.

Can you explain what that was and how it impacted the wine world?

In 1991, CBS television in America ran a segment on 60 Minutes where the presenter went to France to try and uncover why the rate of heart disease was lower in France than in the US even though the French was supposedly doing everything wrong,

They were eating lots of fat, they were cooking with butter, they were eating unbelievable amounts of cheese, and most of all, they never went jogging. The main conclusion was it was because the French consume red wine. The very next day, sales of red wine began to boom and this really marks the expansion of wine drinking in the United States.

What’s changed? Was the 60 Minutes program wrong?

The population is getting older and sicker. Governments are panicking about how they’re going to pay to treat the growing number of diseases like cancer, diabetes, and heart disease that come along with older and sick populations. So there’s a study called the Global Burden of Disease that tracks global movements in health, and in 2018 they came out and said that not only does alcohol not have any health benefits, but it was contributing to the global rising in cancer.

The word ‘cancer’ is the key here because wine has always been seen as good for cardiovascular health and maybe for diabetes. But what the WHO are now saying is that even if that were true — and they’ve cast doubt on the cardiovascular benefit hypothesis — it doesn’t matter, because what you gain in heart benefits you might lose by getting cancer.

Felicity Carter

So is drinking wine in moderation good for you? Neutral, bad? What did they say at the Congress?

It turns out the answer is complicated. Let me see if I can summarize some of the presentations and you’ll see the problem. The key thing that we have to talk about is something called the J-curve. Now the J-curve is a graph that’s shaped like a tick or like the Nike swoop.

The tick part of it represents moderate drinkers and moderate drinkers have lower death rates from all causes. Alcohol is dose dependent, so as people drink more, the graph moves sharply upwards. The more alcohol people consume, the sicker they get. What’s always been fascinating is the J curve also shows that non-drinkers are more likely to have worse health outcomes than moderate drinkers.

People have known about the J curve for about 50 or so years, but it’s always been challenged. Some criticisms include the idea that maybe moderate drinkers are more likely to be upper class people who take better care of their health. Another is that maybe people who don’t drink are what they call “sick quitters”, meaning people who were in such poor health, they were forced to give up drinking.

I am not sure the J curve is even true because it’s been challenged by many scientists and it’s been questioned quite a lot in the recent years.

The J curve is alive and well. A number of scientists and doctors talked about it, including the star of the Congress, Dr Curtis Ellison, who was featured on the original 60 Minutes program. He said the current health messaging is not based on science. It’s based on paternalism.

I just want to go back to the Global Burden of Disease, who said the J curve doesn’t exist. They did this in 2018 and the WHO guidelines changed in 2020. But they went back and reviewed the same data and said, “Oh yes, the J curve exists”, but although they changed their story, it didn’t change the WHO guidelines.

If we drink moderately, we can get better health outcomes for our hearts. Right?

Well, yes and no. First, what are we talking about when we talk about moderation? It turns out moderation is pretty moderate. Professor Ken Mukamal from Harvard said a standard drink is about 11 to 15 grams of alcohol. The average serving size in a British pub for a woman is way over what is drinking moderately.

Now here’s something interesting. A lot of the research that’s being used to say that wine drinking or alcohol drinking in general has poor outcomes, is based on looking at people how they drink over a week, not per day. This is really important. If you’ve got a man who can drink two glasses a day and get some benefit for his heart, that’s great, but if he drinks seven glasses on Friday and seven on Saturday, he’s now binge drinking and that has terrible health consequences. And so sometimes the research is showing that what’s supposed moderate drinking has terrible health consequences, but it’s because they’re evaluating based on the week rather than on the day.

It turns out moderation is pretty moderate. Professor Ken Mukamal from Harvard said a standard drink is about 11 to 15 grams of alcohol. The average serving size in a British pub for a woman is way over what is drinking moderately.

Felicity Carter

Is some of the research saying alcoholic is toxic wrong?

Yes. One problem they said is too many of these studies put different cohorts of drinkers into one study. So they’ll put in young people. Now young people don’t get any benefit from moderate drinking. It’s only once you get past 40 and your heart starts to get a bit dicky that the benefits start to accrue. So putting young people in is hopeless. It skews the data, but then if you put binge drinkers in, it also skews the data. So you need to be very careful about who you put into a study.

The other thing they said is that too many studies don’t enroll patients who already have heart disease or diabetes because they say these diseases will confound the results and they want a nice simple study. But moderate drinking is most helpful to people have diabetes and heart disease.

And the big problem is that too many studies of alcohol depend on people telling the truth about how much they consume. Most people will lie. And that means that many, many studies, you just can’t rely on the results.

How do they even do those studies? Do they lock people in rooms and give their wine and monitor their health?

This comes to the heart of the whole issue. There was a study that was done of the UK Biobank, for example, where they used a natural language program to crawl the data looking for words that had to do with alcohol. It was all anonymized data, but they put different patients into different categories depending on what the patients had said about their drinking. And so the results came up that moderate drinking didn’t have these benefits, but when they examined the data later, it turned out that people had lied. Some of the people who said they were moderate drinkers were later admitted to hospital for alcoholism.

There was a study that was going to be done, which was going to be led by Dr Ken Mukamal from Harvard looking at this. They were going to do what’s called a randomized control study where they literally took people and were able to monitor their intake. The alcohol industry put, I think it was something like a $100m into it, but there was an enormous outcry about it. There was outrage that the alcohol industry were funding something that was going to make them look good. And so the whole thing was dropped. So we don’t have a way of evaluating this, but what we do have is we do have some animal studies.

You mean they make animals drink wine with dinner?

That’s exactly what they do because animals can’t lie about their alcohol intake. So Professor Mladen Boban from Croatia did exactly this. He got a bunch of rats and he gave them heart attacks. I don’t how he did it and it’s probably best not to ask. And then he split them into different groups for four weeks. So these were rats that had damaged hearts. Some rats got water to drink and some got white wine.

About half of the water drinking rats died. And among the wine drinkers, some rats turned into alcoholics. They drank twice as much as the moderate rats. And pretty much all of the rats that were drinking too much died. But here’s the interesting thing: none of the moderate drinking rats did, which suggests that white wine has some sort of cardioprotective effect.

Well, that’s what we’ve been told, at least that’s what I’ve heard, that polyphenols in wine are good for you and they’ve got that protective effect.

A lot of the Congress was given over to presentations about the Mediterranean diet. It looks like it’s not wine by itself that’s heart healthy, though it can be, but where it really pays dividends is when it’s drunk with foods. The Mediterranean diet has many foods and many of them have polyphenols, particularly olive oil. And these have what’s called a synergistic effect, which means the polyphenols in wine and olive oil and tomatoes are all boosting one another. The olive oil is key.

So is it just the Mediterranean diet or did they talk about all the cuisine as well? What about Japan?

Somebody actually asked that question. And Greg Drescher of the Culinary Institute of America was on hand and he said, it’s important to understand that the Japanese diet isn’t just about the food, but also the way that the Japanese eat. They eat until they’re 80% full and then they walk away. Could other people eat like this? Probably not. So maybe they wouldn’t be getting the same health benefits.

When we talk about moderation, it’s the fact that people drink in moderation who are in better health. But they tend to do everything in moderation.

Tamara Haspel in the Washington Post actually wrote about this. Maybe it’s not moderate drinking, that is the key. Maybe it’s the fact that you can drink moderately, given that alcohol is addictive. I was very persuaded by that until I went to the Congress. And I think the evidence that wine is moderation is good for you is very robust. Just to go back to the question of the Mediterranean diet; the other diet Greg Drescher brought up was India. He said you’d expect the Indian diet would be the healthiest in the world because so much of it is based on pulses and vegetables, but actually, India has a big problem with diabetes.

The Mediterranean diet is probably is the best in the world because of how rich it is in polyphenols and antioxidants. Even then, the effects come from how you consume it. In the Mediterranean world, family is still very important. People eat with each other at the dinner table. And when you do that, you’re typically consuming less food, and you’re digesting it over a longer period of time, because you’re sitting there socialising and talking.

So, does wine give you cancer?

Alcohol is dose dependent. Wine is particularly toxic in high doses for women.

They had a very interesting researcher on stage, Dr Justus Apffelstaedt, an oncologist who specializes in breast cancer and works in Stellenbosch. And he got very interested in this question of wine and cancer because, of course, he lives in a wine region and a lot of his patients work in the wine industry and they wanted to keep drinking wine.

He took apart a study that was done in the United States from Kaiser Permanente, a health insurance company. They said that drinkers had a worse mortality than people who weren’t drinking. And he said he looked at the data and first of all, what they hadn’t teased out was the fact that it was very heavy drinkers that had the worst outcome. And secondly, the worst outcomes were people who were also obese and postmenopausal.

But he said something else as well, which was that there is actually evidence that alcohol can be protective of some things like kidney cancers and lymphomas, though he said he wouldn’t recommend anybody start taking it up.

So are we really at risk of losing our seated, is wine really at risk of losing its place on the table?

Yes. I can’t emphasize this enough. That didn’t come up in the presentations themselves because the presentations were about the science. But when I listened to people speaking privately in the break, one executive said to me, “if we don’t deal with this, we’ve got six years.”

You would think that an institution that is as ancient and important as wine would be invulnerable. But as people kept saying, this is a denormalization project, you don’t have to ban it, you don’t have to do anything. You just have to tell people that it’s a terrible thing for their health. And as people get more health conscious, they will choose not to touch it.

You would think that an institution that is as ancient and important as wine would be invulnerable. But as people kept saying, this is a denormalization project, you don’t have to ban it, you don’t have to do anything. You just have to tell people that it’s a terrible thing for their health. And as people get more health conscious, they will choose not to touch it.

Felicity Carter

Should we even try to communicate about wine and health?

There were a lot of executives who I spoke to during the break and they’re very worried about this. And some of them were kind of exultant at what they were hearing and how clear the evidence is for cardiovascular benefits and saying, “We just need to tell people.” I think that’s going to be a problem. It’s complex and if you’re going to politically lobby, you’ve got to have a simple slogan. This research just doesn’t lend itself to that.

Another problem is the wine industry itself doesn’t have many people who can communicate it effectively. I’ve been a wine editor for 15 years and I’ve only met a small handful of wine journalists or communicators who are capable of reading scientific papers and understanding the differences between absolute and relative risk. To do this effectively, there has to be proper science communication.

What’s your vision on how it’s going to evolve? Are we going to be able to find a common ground and something that we all agree on when it comes to wine consumption?

No, absolutely not. First of all, I should state my own position. I went to this conference being very skeptical that there would be any benefits of wine. I’ve taken a huge interest in this and I’ve read the Lancet studies, I’ve read the meta-analyses. I thought people were kidding themselves, that it was just wishful thinking that wine could be healthy. I sat through the presentations and afterwards I went and looked up all of the papers they were referencing and now I’m convinced. I think it does have the benefits that they’re saying, but it’s not healthy for everybody and it’s only healthy in moderation. And moderation is a very small amount.

Wine does have the benefits that they’re saying, but it’s not healthy for everybody and it’s only healthy in moderation. And moderation is a very small amount.

Felicity Carter

Did they talk about mental health at all and the rule that wine and socializing?

They did, actually. They had a wonderful psychiatrist from Vienna – Dr Michael Musalak —who talked about conviviality and the importance of how you live your life.

So we can’t communicate about wine and health. What if we just communicate about culture and history?

That’s not going to be enough. When I talk to people privately, they’re calling this a monster. That’s the word that’s being used.

The forces of neo-Prohibitionism are enormous. It isn’t just the World Health Organisation. There are very powerful temperance movements, particularly from the United States, that are funding lobbying against alcohol. And I don’t think people who work in wine have even begun to understand the level of funding and the level of passion that is ranged against alcohol.

I don’t think people who work in wine have even begun to understand the level of funding and the level of passion that is ranged against alcohol.

Felicity Carter

People tend to compare alcohol and wine to tobacco. Is it true that we are the tobacco of tomorrow and we’re going to end up being treated the same?

Yes.  That was talked about a lot. First of all, I do think that the wine trade needs to take on the argument about science, medicine, and health. But it has to be done by responsible professionals, not by your average influencer or your average wine writer. It has to be done by science communicators. Also, there are EU governments that are on the side of wine in this. So for example, Ireland has done some measures around health warnings and the Italians are suing them, because they see that Italy’s wine exports are at risk.

There were representatives from the Spanish government there and they were saying, “This is an attack on our way of life”. Our way of life isn’t just alcohol, it, it’s a whole culture of sitting around and eating and enjoying ourselves.

Is there a way that the wine industry can organize a collective answer without being seen as the devil that just wants to sell more alcohol?

Some of this has to happen at a political level. There is some lobbying happening in Europe, but it’s done very quietly. I also think the media needs to slow down on some of its wine and health reporting. I’ve been appalled over the years at some of the really reckless, irresponsible articles I’ve read.

What would that message be and who are the best to carry?

If anyone’s in a wine region, they need to start pestering their local Member. This is an extremely valuable industry and if it were to go down — and there’s a very real possibility that it might — it would rip the guts out of lots of rural regions. People in Europe need to be louder about what this sector of the economy is worth, not just in money terms, but also in terms of rural regeneration, conviviality and wellbeing.

People in Europe need to be louder about what this sector of the economy is worth, not just in money terms, but also in terms of rural regeneration, conviviality and wellbeing.

Felicity Carter

Does fine wine need to separate ourselves from the rest?

No, I would find that very unfair. Beer is as ancient a beverage as wine. It’s played an incredibly important role in human history. And again, look at distilling, at something like whiskey or rum. These are also products that have a very important history and heritage. I think we could all agree there’s a lot of really bad alcohol out there and none of us should be defending the bad stuff or drinking too much, but I don’t think we should throw everybody else under a bus either. My partner drinks whiskey and he loves it. He has a real appreciation for high quality whiskey — and why shouldn’t he have it, if he’s drinking in moderation?

What was your own personal takeaway after hearing all of this and maybe changing your mind slightly about your belief around wine and health?

First of all, I was surprised at how robust the evidence is about drinking wine in moderation and its benefits.

And can I leave you with one final thought that I took away from the Congress? Olive oil. Everyone should be eating lots and lots of olive oil. I had no idea.

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