Wine and Health
In recent years, work in epidemiology has shown that wine is not bad for your health to the extent that we consume in moderation.
It would lend itself particularly beneficial properties in the prevention of cardiovascular disease.
Professors Andre Vacheron, Pr Ludovic Drouet and Professor David Khayat we are part of the latest studies and observations on moderate wine consumption and health.
Wine and Cardiovascular Disease
Prof. Andre Vacheron: Member of the Academy of Moral and Political Sciences and former president of the Academy of Medicine
Wine is a wonderful drink since we find mention 4000 years before Christ, in the tombs of pharaohs. Hippocrates was the first to boast its medicinal virtues four centuries before Christ, and said that "like love, wine excess could have effects quite deleterious to health." In Ecclesiastes, chapter 40, it says: "Vinum Bonum lactificat cor hominis. "However, it was not until the twentieth century to have work on the beneficial effects of wine, despite the media hype that has befallen the sugar, fat, salt, overweight, wine does not escape.
In recent years, work in epidemiology has shown that wine is not bad for your health to the extent that we consume in moderation. In 1979, St. Leger, in The Lancet, reported an inverse relationship between wine and cardiovascular mortality in 18 countries taking up the death certificates and the concepts of wine consumption. The study is supported by the American Keys in 1980, which shows that wine consumption reduces cardiovascular mortality compared to people who do not consume.
But it's Serge Renaud, a scientist at INSERM in Lyon, which really showed in his study Lyons in The Lancet in 1994, and in Circulation in 1999, the wine was interesting in arterial disease. He studied in 605 coronary mean age of 53 years and having had a myocardial infarction, the effects of a Mediterranean diet based on fruits and vegetables and rich in alpha-linolenic acid margarine, supplemented with a few glasses of wine. He observed the prevention of reinfarction in these survivors by comparing the half who received coronary Mediterranean diet with a little wine and margarine to 300 others who were fed normally.
It was found that, regardless of margarine and other components of the diet, there was a wine and by preventing a reduction in mortality from 73% to 72% and 27 months to 46 months. The study was stopped at 46 months for ethical reasons. However it was the basis of the French paradox. In 1991, Serge Renaud was invited to the United States on CBS and was questioned about his Lyon study. Americans have concluded that the French, despite their diet rich enough in calories and saturated fat, were the people with the lowest blood mortality rate after Japan, thanks in part to the wine consumed.
A large epidemiological study led by the World Health Organization (WHO), the MONICA study, was the subject of several reports between 1994 and 1999, but showed a decrease in cardiovascular mortality among moderate drinkers of wine - one to three drinks per day. Denmark, Copenhagen, Morten Gronbaek conducted a prospective study of 13,285 men between 30 and 70 years followed for 10 to 12 years. For wine drinkers, the risk of dying from a heart attack was significantly lower than among those who never drank wine, but also lower than among drinkers of beer and spirits drinkers. This latest study therefore showed a relative risk of cardiovascular mortality and a decreased risk of overall mortality decreased by 50% among wine drinkers, but increased among drinkers of beer and spirits.
Another epidemiological study was conducted by Serge Renaud in Lorraine. He studied about 34,000 men the effect of moderate wine consumption on cancer mortality by general cause and cardiovascular disease. With moderate consumption of wine, 2 to 4 glasses per day, cardiovascular mortality proves weaker than among abstainers. The beneficial effect also operates in mortality from cancers.
To return to the MONICA study, it also showed a decrease in the prevalence of coronary disease from north to southern Europe with a gradient true north / south. Coronary heart disease are much less common among wine consumers, at the same time that there is a decrease in consumption of distilled liquor, drank more in the countries of northern Europe. Therefore, rather than "French paradox", it would be better to speak of Mediterranean paradox, because the wine is certainly not the only nutrient that is involved in the improvement of cardiovascular risk. The presence of fruit and vegetables participates greatly and we find this Mediterranean paradox in France, Italy, Spain, Greece and Crete.
The wine is superior to beer and other alcohols in cardiovascular protection. Indeed, it is more rich in polyphenols, including resveratrol and quercetin. The latter appears to be the most beneficial polyphenol, red wine containing 5 mg / liter. Resveratrol is an antioxidant LDL, that is to say of low density lipoproteins. There are indeed good and bad cholesterol and it will be deposited in the arterial wall. If the individual does not have enough HDL, that is to say, high-density, bad cholesterol will penetrate tissues and constitute a molehill of fat that will protect in a fibrous shell. Resveratrol is going to prevent these bad proteins go create molehills cholesterol. But resveratrol is also vasorelaxant, that is to say, it relaxes the arterial wall, antiplatelet, anti-inflammatory and anti-atherogenic.
The anti-atherogenic action of resveratrol has been verified in a study of a Chinese working in the United States, Dr. Wang Z. He made hypercholesterolemic rabbits by giving them a diet rich in saturated fatty acids and butter. He then fed red wine without alcohol, but with resveratrol. He observed that there was no development of molehills in these rabbits receiving resveratrol after eating too much butter.
Outside of this action on the arterial wall and the coronary, wine slows and increases durability aging. One study named PAQUID, implementation and Dartiques Orgozozo, focused on 4,000 people over 65, followed between 1988 and 1997, they found that in these moderate wine drinkers and older, the disease of Alzheimer occur so much less common.
Mechanisms of non-wine aging are discussed. Some molecules, sirtuins are activated by the polyphenol. These are from a family of molecules which one of them, the SIRT 1, the active energy producers in cells. In cells that are aging, the SIRT 1 reactive energy battery. Other mechanisms have been invoked as the inhibition of endothelin; activation of the estrogen receptor by a delphinidin which stimulate vasodilation.
In this beneficial effect of wine, the two main mechanisms are decreased atherogenesis, decreased molehills and prevention of thrombosis. These qualities are mostly found in red wine fermentation with several weeks in oak barrels. This will reap rich tannins polyphenols. The wine should be consumed in moderation because a glass provides 100 kcal and 10 g of alcohol on average.
A diet high in wine with chronic excess promotes hypertension. John Steinbeck said thus: "Good wine is like love, too much of one or the other can make a sick man. "
The fatty streaks are deposits of LDL cholesterol which have no deleterious effect on blood flow. But molehills, because of the bad cholesterol, can occur in the arteries open. LDL cholesterol that builds up in the past will grow and thicken and obstruct the flow of blood from upstream to downstream. When the dam is large enough, angina appears. It is due to poor oxygenation of the heart muscle.
Myocardial infarction occurs when a molehill plate forms a blood clot. The crack of the molehill will cause platelet aggregation, which will complete clog the coronary artery. When it is blocked, which was irrigated cardiac muscle necrosis.
These two diseases are the consequences of atherothrombosis and thrombosis. This is why we believe that cardiac drink a little wine may be beneficial in reducing these risks.
Wine and atherothrombosis
Professor Ludovic Drouet: Head of angio-hematology department at the hospital Lariboisière
I take after André Vacheron for you to understand how we can carry out research on this subject. First, we need funding. There are about ten years, the Ministry of Agriculture launched an action named ONIVINS, which was based on a state funding to question the beneficial effects of wine on health, and more particularly cardiovascular disease. Work has been carried out with several French groups from Dijon, Bordeaux, INRA and CNRS in Strasbourg.
In the early 2000s, when the results were regarded, from an epidemiological point of view, studies on the link between wine consumption and cardiovascular disease, all the data proved very consistent: around February-March glasses of wine per day, the risk reduction was 30 to 40%.
An Italian group has recently published an update of these results and showed that when we consume wine, we see a reduction in cardiovascular mortality. However, the curve rises as consumption becomes too strong. The group has also shown a benefit, though smaller and sustainable consumption of beer, reflecting the influence of alcohol in general.
When an artery is cut through, one can observe atherosclerotic plaques - or molehill - that fill the wall and make a lesion ruptures. The latter is breaking, causes coagulation reaction called atherothrombosis mixture of thrombosis and atherosclerosis. Overall, epidemiological studies show a reduction of atherothrombotic events associated with moderate consumption of wine. However, it remains unclear whether this consumption has beneficial effects on the game "thrombosis" or the "athero" section.
Among the animals that we have available to us in our work, the mouse is the most manipulated. By studying the behavior of naturally hypercholesterolemic mice and giving them a wine-enriched diet, the researchers found that there was no effect on atherosclerosis. However, it has effects on the so-called thrombotic component. We have the impression that the wine has an antithrombotic effect and antiathérosclérose.
Other mice with a mutation in the LDL were used and we found that there was no effect on athéroclérose short term, but again an effect on thrombosis. But in the long term, the effect on thrombosis tended to disappear.
We also conducted other experiments with pigs - because the pig is the animal with the most similarities with humans and naturally develops atherosclerotic lesions - and we watched the action on the wine last. But the wine is alcohol and polyphenols and we asked which item was beneficial to health.
We have started our study by looking at the short and long term action in which wine would have removed alcohol. However, we found that there was no effect on atherothrombosis. Yet if we look at the benefits of wine on health, we conclude that a large part comes from polyphenols. After several years of experience, we have found on atherosclerosis that there was no effect on lesion size, but their severity, with a decrease in calcification.
In pursuing the study, we tried to make the much more heterogeneous animals by giving them different diets. But in these conditions, we found that the action of wine phenols was inoperative.
We continued our work truly giving alcohol to our animals. A new study has been conducted using animals for 2 years. We spotted a small effect on atherosclerosis in periphery. We also found a reduction in thrombotic response. The regime in blood sugar and wine limit does not increase the risk of diabetes. We also identified a small antithrombotic effect on a type of platelet aggregation.
As I said, the wine is alcohol and polyphenols. Alcohol has effects on lipoproteins and vascular wall. The wine phenols cause stimulation of the production of nitrogen monoxide. So we watched the vascular reactivity of our animals: wine produces vasodilation of peripheral arteries. Student individually in our animals, we realized that the older animals that have not had the chance to drink wine have arteries dilate hurt as aging. But among those who have had the chance to consume wine in their entire life, vasodilation appears much stronger.
Currently, researchers are trying to understand what happens in the cells to allow protection of the vascular walls. The system of sirtuins will play a role in the maintenance and survival of these cells. A recent study on hypercholesterolemic pigs showed that only wine consumption compared to consumption of vodka or abstinence, resulted in vasodilatation.
I hope I could show you how to search, with its current resources, moves forward in understanding the effects of wine. The most important consequence is the antithrombotic action. Under these conditions, with moderate wine consumption, we find a benefit the cardiovascular system.
I now give the floor to David Khayat, who will speak to us about the relationship between wine and cancer.
Wine and Cancer: Myths and Realities
Professor David Khayat: Chief of Medical Oncology at the Hospital Pitié-Salpêtrière
After cardiovascular diseases, we thought it was good to deal with the other major cause of death in developed and developing countries, namely cancer. It currently affects one in two men and one in three women. In 2012, there were 8,000,000 deaths related to cancer in the world. In 2020, the World Health Organization (WHO) expects 10 million, after the declaration of 20 million new cases this year. The incidence rate of doubling every twenty years cancer in the world, even if it heals better and if the mortality rate remains stable. It represents 150,000 deaths each year, while we record 350,000 new cases in the same time.
Wine is another important issue, it made sense to treat the link between these two items. I will address this topic in a simple way through three channels. The first will deal with the increased risk of cancer among heavy drinkers compared to moderate drinkers. Moderate consumption is estimated at about two to three glasses of wine on average for men, and one to two drinks for women.
For most of the studies that have been done on this subject, more specifically to cancers of the mouth, esophagus, colon, liver, lung or breast, the problem is that 90% of them do not address the link between excessive consumption or moderate wine and increased risk of cancer, but between excessive consumption of alcohol or moderate. But we must understand that they have cases of people that have been followed for decades, and 70% of them were made in the United States, that is to say in a country where alcohol is distilled greatly consumes. These studies are not transferable to countries with strong wine tradition. Indeed, all alcoholic beverages are not good for health, while I think the wine consumed in moderation, has been rather beneficial.
I will not discuss all of the cancer, but I will take emblematic cases such as cancer of the mouth. For this type of cancer, we have studies that examined the relationship between wine and pathology. When I started my classes, I learned that cancer is caused by alcohol and tobacco. There is thus 22 studies published worldwide on the potential increased risk of cancer among heavy users ENT wine and moderate drinkers. However, everyone, including top international experts, consensus that only 14 studies are valid. Some are simply too small or were interrupted hurriedly. Of these 14 studies, nine conclude that excessive consumption of wine increases the risk of head and neck cancer.
However, 5 say, instead, that excessive consumption of wine reduces the risk of cancer compared with moderate consumption. Scientists do in these circumstances? They include the data to create what is called a meta-analysis. The world body, the World Cancer Research Fund, and its experts came to the conclusion that, in heavy wine drinkers compared with moderate drinkers, the increased risk was multiplied by 1.02, which means that increased risk was 2%. But in science, we know that there is a degree of uncertainty in this kind of work, which is called "confidence interval", and in which lies the scientific truth. That is why the 1.02 is between 1 and 1.03, and the increased risk is 1%.
To understand this, we need to revisit the methodology of epidemiological studies. For a study, we follow a procedure called "case-control". We take cases - 1,000 patients who contracted cancer of the mouth, for example - we will compare to controls. The general rule is 1 in 5 for witnesses, that is to say five men to one man, one woman for 5 women, 1 for 5 young young to balance according to the same social, economic criteria, etc. All individuals participating in the work will be asked about the factors related to the study, over a long period.
Indeed, for a cancer spreads in an organization, it takes about 25 to 30 years, because for a cancer cell to become a tumor of one centimeter in diameter comprising 1 billion of these cells, it is necessary that it is divided 33 times, whereby the fact of dividing it takes about 3 to 6 months. To understand the origin of cancer patients, we must ask what they drank there 30 years - 33 times 3 to about 6 months - resulting in inevitable imprecision, because no one is able to remember what he was drinking there so long. Therefore, the finding of the study reveals lapses.
The other problem of this work is that they were all made before 2006, however, this year, a study, since confirmed by others, showed that 70% of oral cancers were caused by papillomavirus ( or HPV), which also give the cervical cancer in women, cancer of the penis in men and cancer of the anus in both. The virus grows in the first oropharyngeal contact. On cancers of the head and neck, excessive or moderate consumption of wine does not increase the risk of disease.
Moreover, doctors agree that there is no increased risk to the consumer or to moderate liver cancer, or cancer of the colon, as it does not exceed 30 40 grams of ethanol per day, that is to say glasses 3-4.
I now turn to my second part: there are two or three years, a study has claimed that alcohol is carcinogenic in the first glass, which strikes the right direction. Another study showed that people drinking 4-5 glasses of alcohol per day had 60% increased risk of skin cancer. However, the researchers did not test the degree of sun exposure of these individuals. This work will therefore reveal little valid.
The question of carcinogenicity of first drink consumed is the work of a great American scholar, Arthur Klatsky, which followed 129,987 volunteers in California between 1978 and 1985 to 2008 and grouped them among abstainers moderate drinkers and heavy drinkers, and sought to understand whether the act of drinking a glass or more resulted in an increased risk of developing a "big cancer" - breast, colon, lung, etc. - About the fact not to drink at all. After publishing his results, all doctors had to recognize that alcohol consumption seemed dangerous from the first drink. But in October 2012, the same researcher found that the study was flawed.
Indeed, an article published in the American Journal of Epidemiology showed that over 50% of returns on wine consumption volunteers for the studies were under-reported. Arthur Klatsky has taken over the files of the 129,987 volunteers and found that among the abstainers over a third had been arrested for driving while intoxicated, assault under the influence of alcohol, ethyl comas, etc. So he rebuilt his study by classifying people between suspects and non-suspects. He then came to apologize to the Congress of Vienna Cancer and explained that removing the suspects, there was no increased risk from the first drink. However, this information was relatively relayed to the public.
Finally, we not only heal more cancer, but, as regards breast cancer, two beautiful studies have established the beneficial link between moderate wine consumption and disease. The first is on 25,000 women with breast cancer followed for 11 years, the second on 13,525 women with breast cancer and followed for 15 years. When doctors looked when, after cancer, is drinking wine increases the risk of relapse and mortality, two studies have shown that drinking 1-2 glasses reduced the risk of dying from 15-16%.
Therefore, drinking wine in moderation or not at all increase the risk of cancer or the risk, when it had a to die faster.
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