Saturday, March 10, 2012

The J-shaped Curve

I thought it was worth revisiting the question of the J-shaped curve as it applies to alcohol intake, not so much because I thought it was a stumper, but because I wanted to ensure that we all have a common base of knowledge from which to work.  As caring providers, we want to know as much as possible about health topics, and when we ask about healthy lifestyles, we want to ensure the patients aren't ignorant about the negative effects of teetotalling or the overconsumption of alcohol.  

I think of it as cholesterol medicine (which it really isn't, but it works for the illustration).  We wouldn't advise the patients who need it NOT to take their cholesterol medicine, nor would we advise them to take too much of it, nor would we say "if you don't take your medicine daily, just take a lot of it on the weekends". The right dose (1-2 glasses of alcohol) on a daily basis is good for the patients, and that is that.

There are always confounding variables in our lives, such as smoking, exercise and other lifestyle risks, but if we factor those confounding variables out, the data regarding moderate intake of EtOH still stands alone as a positive effect on longevity, on health, on cardiovascular status and on maintenance of intellect into the later years.  

There are several proposed mechanisms for the positive effects of red wine, in particular, and some of them bear mentioning.  Although the polyphenols from red wine in vivo exert no significant antioxidant effects (Vitamin C, vitamin E, glutathione, etc. have far greater effects) they do decrease inflammation, decrease endothelial cell adhesion, increase nitric oxide production and decrease platelet aggregation.  Other sources of polyphenols such as black tea, cocoa and its derivative dark chocolate also exert similar effects.

For those who really want to hone in on red wine with the highest polyphenol content, the tannat and sacramentino grapes seem to have the highest levels, and coincidentally seem to coincide with local populations where these grapes are derived that seem to be unusually long-lived.  

Fun quotes regarding wine and health:

"Drink a glass of wine a day, and steal a ruble from the doctor"- Old Russian Proverb
"Wine is the foremost of all medicines; where there is no wine, medicines become necessary" The Talmud
"It's not the use of a bad thing, but the abuse of a very good thing" that causes harm.  Abraham Lincoln

Finally, for those wine nerds among you, I went to a lecture by Matt Kramer, The Wine Spectator's great critic and explainer, and he had some tips for finding great wine without spending a bundle:

1. Australia: Look for wines from Clare Valley; it has the best reds and whites from Oz.  Margaret River also serves up some great Cabs and Merlots.
2. New Zealand: Pinot noirs from the Central Otago Valley
3. Italy:  Mount Aetna-grown wines from Sicily, Barbera d'Alba and Nebbiolo d'Alba are good buys
4. Argentian: Malbecs from Salta
5. Hungary: Tokajs
6. Champagne: Ask for "grower champagnes" rather than the more well known negociant champagnes such as Veuve Cliquot, Dom Perignon, Mumms and the like.
7. Loire Valley:  Ask for Muscadets, Chinons (Cabernet Franc)
8.  Ask for "mountain wine" from California.  Those wines made from vines that had to work to survive are, in his opinion, superior to those valley grown wines that had an easier life.

Everyone got the correct answers, so very nice work!

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