Category Archives: Alcohol

Is It Time to Freak-Out About Arsenic In Wine?

Is the arsenic in the irrigation water, pesticides, or introduced during processsing?

Is the arsenic in the irrigation water, pesticides, or introduced during processsing?

A class-action lawsuit in California claims that certain wines have dangerously high levels of arsenic that could cause cancer, cardiovascular disease, or diabetes. USA Today has one of the ubiquitous stories outlining the few details we know at this point.

Furthermore, chronic low-dose arsenic exposure can cause skin changes (e.g., scaly thick skin, darkening, lightening), peripheral neuropathy (numbness, pain, weakness, typically starting in the feet, then hands), peripheral vascular disease, and liver disease. The cancers linked to arsenic are mostly skin, bladder, lung, and liver. The increased cancer risk persists even after the end of exposure.

How Do You Know If You’ve Been Poisoned With Arsenic?

Comments here refer to chronic low-dose exposure; acute high dose poisoning is another can o’ worms.

First, see your doctor for a history and physical exam and let her know you’re worried about arsenic. If arsenic poisoning remains a possibility, lab testing is usually a 24-hour urine collection for arsenic, or spot urine for arsenic and creatinine. “Spot” in this context means a random single specimen, not a 24-hour collection. For the 48 to 72 hours before either of those tests, don’t eat fish, seaweed, or shellfish.

What about testing hair for arsenic? In general, it’s not accurate.

Bottom Line

At this point, if you or someone you love drinks wine, I suggest simply keeping an eye on this story as it develops. We need more facts. The whole thing could blow over, with nothing coming of it. One of the brands mentioned is Sutter Home, one of my favorites.

Remember a few years ago when we had the vapors over arsenic in rice?

Steve Parker, M.D.

PS: Wine is a time-honored component of the traditional Mediterranean diet, but see my books for alternatives to wine. You don’t have to drink wine to live long and prosper.

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Wine Ratings: Legitimate or Malarkey?

"Is the room spinning, or is it just me?"

“Is the room spinning, or is it just me?”

Wine is a time-honored component of the healthy Mediterranean diet and probably contributes to the longevity seen with Mediterranean-style eating. That’s why wine is an option on my Advanced Mediterranean Diet, Ketogenic Mediterranean Diet, and Low-Carb Mediterranean Diet. Folks new to wine-drinking are confused by the myriad wine varieties and don’t know which kind to get. This post should help separate the wheat from the chaff. Wine snobs typically think “the more expensive the wine, the better.” But are they right?

A couple years ago, someone gave me an expensive bottle of champagne that I’d never had before. I won’t mention the brand because I’m not looking for trouble. The brand is iconic and a bottle costs $150-200 (USD). The more you pay, the better it should be, right?

I’m no expert on champagne, but this stuff was awful. Had the bottle simply gone bad? Too old? My wife had drunk this champagne several times before in business settings, and said this flavor was typical. It was a real eye-opener for me.

Robert T. Gonzalez has an article on wine-tasting at IO9. A quote:

 In 2001, researcher Frédéric Brochet invited 54 wine experts to give their opinions on what were ostensibly two glasses of different wine: one red, and one white. In actuality, the two wines were identical, with one exception: the “red” wine had been dyed with food coloring.

The experts described the “red” wine in language typically reserved for characterizing reds. They called it “jammy,” for example, and noted the flavors imparted by its “crushed red fruit.” Not one of the 54 experts surveyed noticed that it was, in fact a white wine.

David McRaney has a more nuanced article on the same issue at The Atlantic. For instance:

In blind taste tests, long-time smokers can’t tell their brand from any of the competitors and wine connoisseurs have a hard time telling $200 bottles from $20 ones. When presented microwaved food from the frozen food section in the setting of a fine restaurant, most people never notice. Taste is subjective, which is another way of saying you are not so smart when it comes to choosing one product over another. All things equal, you refer back to the advertising or the packaging or conformity with your friends and family. Presentation is everything.

If you have more time, check out Calvin Trillin’s article on white-red differentiation in The New Yorker. His suspicion is that “…experienced wine drinkers can tell red from white by taste about seventy per cent of the time, as long as the test is being administered by someone who isn’t interested in trying to fool them.”

The take-home points for me after reading all these are:

  • the more expensive wines are by no means better tasting; I’m sticking with cheaper
  • when you hear someone waxing eloquent about the various flavors in a particular wine, they’re most likely full-of-it (FOS); in other words, it’s malarkey
  • you’re as good a wine judge as anyone else; satisfy your own palate

Steve Parker, M.D.

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Wine May Ward Off Depression

…according to an article in The Guardian. This finding is from the PREDIMED study of Spaniards aged 50 to 88. Those who drank between two and seven glasses of wine per week were less prone to develop depression.

She looks happy!

She looks happy!

Wine is allowed on my Advanced Mediterranean Diet, Conquer Diabetes and Prediabetes plan, and the Ketogenic Mediterranean Diet. Of course, some folks should never drink alcohol.

Steve Parker, M.D.

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Experts Debate Composition of the Mediterranean Diet

…but they have some good ideas as to the healthy components, according to a report in MedPageToday. A sample:

Through a subtractive statistical technique, the EPIC investigators calculated that the biggest chunk of the health advantage—24%—came from moderate alcohol consumption (predominantly wine).

The other relative contributions were:

  • 17% from low consumption of meat and meat products
  • 16% from high vegetable consumption
  • 11% from high fruit and nut consumption
  • 11% from high monounsaturated-to-saturated lipid ratio (largely due to olive oil consumption)
  • 10% from high legume consumption

Here’s my definition of the Mediterranean diet.

Steve Parker, M.D.

Reference:
Sofi F, et al “Ideal consumption for each food group composing Mediterranean diet score for preventing total and cardiovascular mortality” EuroPRevent 2013; Abstract P106.

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Filed under Alcohol, Fruits, legumes, Mediterranean Diet, nuts, olive oil, Vegetables

Chronic Alcohol May Impair Vision in Diabetics

MedPage Today reported that long-term consumption of alcohol may impair vision in diabetics.  Drinkers performed less well on vision chart tests than non-drinkers. It’s not a diabetic retinopathy issue.

Beer and distilled spirits were riskier than wine.

The MedPage Today article didn’t comment on the potential health benefits of alcohol consumption. You can bet I’ll keep an eye on this.  (Did you get the pun?)

Steve Parker, M.D.

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Finally Settled: Alcohol Consumption Linked to Lower Rates of Death and Heart Attack

Canadian and U.S. researchers report that moderate alcohol consumption seems to reduce 1) the incidence of coronary heart disease, 2) deaths from coronary heart disease, and 3) deaths from all causes.  Reduction of death from all causes is a good counter-argument to those who say alcohol is too dangerous because of deaths from drunk driving, alcoholic cirrhosis, and alcohol-related cancers such as many in the esophagus. 

Remember, we’re talking here about low to moderate consumption: one drink a day or less for women, two drinks or less a day for men.  That’s a max of 12.5 grams of alcohol for women, 25 g for men.  No doubt, alcohol can be extremely dangerous, even lethal.  I deal with that in my patients almost every day.  Some people should never drink alcohol.

The recent meta-analysis in the British Medical Journal, which the authors say is the most comprehensive ever done, reviewed all pertinent studies done between 1950 and 2009, finally including 84 of the best studies on this issue.  Thirty-one of these looked at deaths from all causes.

Compared with non-drinkers, drinkers had a 25% lower risk of developing coronary heart disease (CHD) and death from CHD.  CHD is the leading cause of death in develop societies.

Stroke is also considered a cardiovascular disease.  Overall, alcohol is not linked to stroke incidence or death from stroke.  The researchers did see strong trends toward fewer ischemic strokes  and more hemorrhagic strokes (bleeding in the brain) in the drinkers.  So the net effect was zero. 

Compared with non-drinkers, the lowest risk of death from any cause was seen in those consuming 2.5 to 14.9 g per day (one drink or less per day), whose risk was 17% lower.  On the other hand, heavy drinkers (>60 g/day) had 30% higher risk of death. 

In case you’re wondering, the authors didn’t try to compare the effects of beer versus wine versus distilled spirits. 

On a related note, scientists at the Medical University of South Carolina found that middle-aged people who took up the alcohol habit had a lower risk of stroke and heart attack.  Wine seemed to be more effective than other alcohol types.  They found no differences in overall death rates between new drinkers persistent non-drinkers, perhaps because the study lasted only four years and they were following only 442 new drinkers.  

This doesn’t prove that judicious alcohol consumption prevents heart attacks, cardiac deaths, and overall deaths.  But it’s kinda lookin’ that way.

Steve Parker, M.D.

 References:  Ronksley, Paul, et al.  Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysisBritish Medical Journal, 2011;342:d671    doi: 10.1136/bmj.d671

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Filed under Alcohol, coronary heart disease

Heart Patients: Mediterranean Diet to the Rescue!

The Mediterranean diet preserves heart muscle performance and reduces future heart disease events, according to Greek researchers reporting in the American Journal of Clinical Nutrition, May 19, 2010.

Reuters and other news services have covered the story.

The Mediterranean diet is well-established as an eating pattern that reduces the risk of death or illness related to cardiovascular disease—mostly heart attacks and strokes. Most of the studies in support of the heart-healthy diet looked at development of disease in general populations. The study at hand examined whether the diet had any effect on patients with known heart disease, which has not been studied much.

How Was the Study Done?

The study population was 1,000 consecutive patients admitted with heart disease to a Greek hospital between 2006 and 2009. In this context, heart disease refers to a first or recurrent heart attack (70-80% of participants) or unstable angina pectoris. Acute heart attacks and unstable angina are “acute coronary syndromes.” Average age was 64. Sixty percent had a prior diagnosis of cardiovascular disease (coronary heart disease or stroke). Thirty percent had diabetes. At the time of hospitalization, half had diminished function of the main heart pumping chamber (the left ventricle), half had normal pump function. Men totalled 788; women 212.

On the third hospital day, participants were given a 75-item food frequency questionnaire asking about consumption over the prior year. If a potential enrollee died in the first two hospital days, he was not included in the study. A Mediterranean diet score was calculated to determine adherence to the Mediterranean diet. Mediterranean diet items were nonrefined cereals and products, fruits, nuts, vegetables, potatoes, dairy products, fish and seafood, poultry, red meats and meat products, olive oil, and alcohol.

Left ventricle function was determined by echocardiogram (ultrasound) at the time of study entry, at the time of hospital discharge, and three months after discharge. Systolic dysfunction was defined as an ejection fraction of under 40%. [Normal is 65%: when the left ventricle is full of blood, and then squeezes on that blood to pump it into the aorta, 65% of the blood squirts out.]

Participants were then divided into two groups: preserved (normal) systolic left ventricular function, or diminished left ventricular function.

They were followed over the next two years, with attention to cardiovascular disease events (not clearly defined in the article, but I assume including heart attacks, strokes, unstable angina, coronary revascularization, heart failure, arrhythmia, and death from heart disease or stroke.

Results

  • Four percent of participants died during the initial hospitalization.
  • At the three month follow-up visit, those with greater adherence to the Mediterranean diet (a high Mediterranean diet score) had higher left ventricular performance (P=0.02).
  • At the time of hospital admission, higher ejection fractions were associated with greater adherence to the Mediterranean diet (P<0.001).
  • Those who developed diminished left ventricular dysfunction had a lower Mediterranean diet score (P<0.001)
  • During the hospital stay, those in the highest third of Mediterranean diet score had lower in-hospital deaths (compared with the lower third scores) (P=0.009).
  • Among those who survived the initial hospitalization, there was no differences in fatal cardiovascular outcomes based on Mediterranean diet score.
  • Food-specific analysis tended to favor better cardiovascular health (at two-year follow-up) for those with higher “vegetable and salad” and nut consumption. No significant effect was found for other components of the Mediterranean diet score.
  • Of those in the highest third of Mediterranean adherence, 75% had avoided additional fatal and nonfatal cardiovasclar disease events as measured at two years. Of those in the lowest third of Mediterranean diet score, only 53% avoided additional cardiovascular disease events.

The Authors’ Conclusion

Greater adherence to the Mediterranean diet seems to preserve left ventricular systolic function and is associated with better long-term prognosis of patients who have had an acute coronary syndrome.

My Comments

I agree with the authors’ conclusion.

We’re assuming these patients didn’t change their way of eating after the initial hospitalization. We don’t know that. No information is given regarding dietary instruction of these patients while they were hospitalized. In the U.S., such instruction is usually given, and it varies quite a bit.

In this study, lower risk of cardiovascular death was linked to the Mediterranean diet only during the initial hospital stay. Most experts on the Mediterranean diet would have predicted lower cardiovascular death rates over the subsequent two years. Mysteriously, the authors don’t bother to discuss this finding.

For those who don’t enjoy red wine or other alcoholic beverages, this study suggests that the Mediterranean diet may be just as heart-healthy without alcohol. A 2009 study by Trichopoulou et al suggests otherwise.

Steve Parker, M.D.

Reference:  Chrysohoou, C., et al. The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event.  American Journal of Clinical Nutrition 2010.  DOI: 10.3945/ajcn.2009.28982

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Filed under Alcohol, coronary heart disease, Health Benefits, Mediterranean Diet