Benefits of red wine—health or hype?

By Naveed Saleh, MD, MS, for MDLinx
Published December 18, 2018

Key Takeaways

You’ve heard that moderate consumption of red wine is good for you. But is it? Equally important, should you advise your patients that moderate consumption of red wine is healthy? Debate over whether limited alcohol consumption is in fact healthy has grown in recent years.

People have been drinking alcoholic beverages for eons. After the Neolithic era, which occurred circa 10,000 BCE, the cultivation of crops led to the earliest forms of wine and beer. But alcohol was very likely tippled even earlier. In fact, fruits, grains, and even honey were fermented to create alcoholic beverages, which is believed to be a key part of the early hunter-gatherer diet.

In modern times, the French diet consists of cheese and other high-fat foods. Yet, French people exhibit a lower incidence of heart disease. The “French paradox” has largely been attributed to red wine and has led to the discovery of numerous healthy compounds in red wine, including antioxidants called polyphenols. Polyphenols are found in the skin of red and purple grapes and could help explain wine’s potential cardioprotective effects.

But other factors may also explain the lower rates of heart disease reported among the French. This, includes eating patterns, such as adherence to the Mediterranean diet, and underreporting of heart disease by French physicians.

Moderate consumption of alcohol—one glass per day for women or two glasses per day for men—is safe for most adults.

But, despite the presence of polyphenols and other healthy plant-based compounds in red wine, little data actually support the health benefit of red wine consumption—or any other type of alcohol, for that matter. Specifically, the data suggesting that people who drink moderate amounts of alcohol exhibit lower rates of heart disease is merely observational. Randomized-controlled trials need to be done to further suss out any relationships.

In these observational studies, alcohol of all types (not just red wine) was associated with increased high-density lipoprotein cholesterol levels, decreased blood clot formation, decreased blood vessel damage due to low-density lipoprotein cholesterol (LDL-C) levels, and improved endothelial function in blood vessels.

Revisiting resveratrol

Resveratrol is a polyphenol found in red wine that has been touted as anti-aging and heart protective. Higher levels of resveratrol are found in red wine than in white wine because red wine is fermented longer with grape skins, which promotes the release of this compound. In prior studies, researchers found that resveratrol was associated with reduced LDL-C levels, inflammatory risk, and blood clots that result in heart disease.

In other studies, researchers found no direct link between resveratrol consumption (via resveratrol-rich diet or supplements) and decreased rates of heart disease. In one study involving older Italian individuals who consumed a lot of red wine as part of their diets, investigators found no evidence of an association of resveratrol intake with heart disease, cancer, or mortality risk. Furthermore, you would have to drink between 100 and 1,000 glasses of red wine daily to experience the health benefits observed in animal models.

Even if resveratrol were cardioprotective (which remains to be determined), there are non-alcoholic options that also contain this polyphenol. Such foods include peanuts, blueberries, cranberries, and purple grape juice.

Don’t drink and thrive

Considering how little is known about any potential health benefits of red wine or alcohol, spirits should not be promoted as healthful. Both the American Heart Association and the National Heart, Lung, and Blood Institute advise against drinking alcohol solely to prevent heart disease.

Instead, when discussing the consumption of red wine and other types of alcohol with your patients, be sure to stress moderation for those who desire to drink. Specifically, one drink of red wine should be limited to 5 ounces (148 mL). Be aware that 5 ounces appears to be a smaller volume when poured into a larger glass. Finally, men aged 65 years or older should limit consumption of alcohol to one glass per day (not two) because individuals in this age group often have trouble metabolizing alcohol regardless of sex, thus potentiating its effects.

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