Mediterranean Diet: Alcohol
I get questions from patients almost every day about whether it's safe or healthy for them drink alcohol. It goes without saying that drinking too much alcohol is bad for you. Even so, the best research we have now shows that those drinking between 2 and 3 drinks per day for men or 1 to 2 per day for women live longer and live healthier.
The key is moderation.
The earliest meaningful research was done by a cardiologist named Arthur Klatsky. He noticed that many of his patients with heart disease were not drinkers. This led him to do a retrospective study of over 80,000 patients and he discovered those who drank more had a much lower risk of dying from a heart attack. Dr. Klatsky's research has since been repeatedly confirmed. For instance, an early population study of Mediterranean countries showed the lowest risks of death from heart disease in those consuming the most alcohol. The important point is that research on Mediterranean Diet shows that alcohol is generally consumed with meals.
In another study, women drinking red wine at least once per week were 16% less likely to get diabetes than those women who didn't drink regularly. When researchers in that study looked at other alcoholic drinks, such as beer and spirits, they found similar results.
It may be the antioxidants in wine that offer benefits beyond just grapes or grape juice. One study had a group drank 400ml of wine each day while avoiding grapes and grape products. The other group avoided alcohol of all kinds, grapes and grape products for two weeks. For the following two weeks all of the volunteers returned to their normal diets in what is known as a "washout period." In the next two weeks the groups switched. Blood tests showed that those who drank the red wine each day had higher levels of antioxidants in their bloodstream and decreased levels of a substance used to measure the damage that free radicals do to cells. In theory, older volunteers would see greater benefits from the antioxidants in red wine, but that was not the case. The positive effects of drinking red wine was about the same regardless of age.
It does appear that wine may be the healthier choice over beer or spirits. Researchers in Spain recruited 20 healthy men between the ages of 25 and 50 to participate in a crossover study comparing cava (a sparkling wine containing a medium level of polyphenols) to gin (practically no polyphenols). Each man consumed a specified amount of wine daily for a month, then switched to gin for a month, with a two-week period of abstaining from alcohol before and after each month of alcohol consumption. The subjects were directed to refrain from foods with high levels of polyphenols (such as onions, virgin olive oil, and teas) but were given an otherwise Mediterranean-style diet designed to maintain their weight throughout the study.
The scientists performed blood tests on the subjects at the beginning and end of each period of alcohol consumption and found that although both gin and sparkling wine helped reduce the biomarkers of inflammation that indicate artherosclerosis, the effects of cava consumption were significantly greater than those seen for gin.
Even though cava is a white wine, the speculation is that the antioxidants in wine, especially red wine, offer protection from heart disease. Research on the substance resveratrol has grown out of this. In spite of some believing that this antioxidant is the miracle cure for everything, we don't really know exactly why red wine or drinking alcohol reduces the risk of heart disease. It may be that moderate daily consumption increases the HDL (good) cholesterol and reduces the LDL (bad) cholesterol. It is clear that this isn't true of binge drinking, though. Saving up those 2 drinks a day and having 14 on the weekends has been shown to be more harmful than not drinking at all.
What makes up a drink? This depends on what you are drinking. There's a difference between the amount of alcohol in each serving of wine, beer or spirits. Most research uses the measure of a "drink" as 5 ounces of wine, 12 ounces of beer or 1 -1.2 ounces of liquor. Keep in mind that that alcohol contains calories. There's about 125 calories in a five ounce glass of wine, 150 calories in each 12 ounce can of beer and around 75 calories in a fluid ounce of spirits, such as whiskey or vodka.
I don't tell my patients who don't drink to start drinking. But for those who do drink, I caution them to imbibe in moderation and to do as folks who live around the Mediterranean do: have a glass of wine or two with dinner.