Category Archives: Alcohol

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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Filed under Alcohol, Diabetes Complications

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

Alcohol Long-Term May Impair Vision in Diabetics

MedPage Today yesterday reported that chronic 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. 

Glasses, contacts, or Lasik?

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.

Steve Parker, M.D.

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Red Wine Improves Circulation

Red wine’s beneficial health effects may be related to improved circulation, according to a recent study by Israeli researchers.

Red wine is a time-honored component of the healthy Mediterranean diet.  Consumption is associated with longer lifespan and less cardiovascular disease such as heart attacks. 

Israeli investigators had 14 young healthy volunteers drink 250 cc of red wine daily for 21 days, while monitoring markers of circulatory function.  Endothelial progenitor cells may be particularly important in maintenance, repair, and formation of the arterial circulatory system.

Here’s their conclusion:

The results of the present study indicate that red wine exerts its effect through the up-regulation of CXCR4 expression and activation of the SDF1/CXCR4/Pi3K/Akt/eNOS signaling pathway, which results in increased [endothelial progenitor cell] migration and proliferation and decreased extent of apoptosis. Our findings suggest that these effects could be linked to the mechanism of cardiovascular protection that is associated with the regular consumption of red wine.

I’m not going to tell you I understand all that.  Don’t feel bad if you don’t, either.  My point is to illustrate one way that Science makes progress.  An observant person notices, “Hey, people who drink judicious amounts of red wine seem to live longer and have fewer heart attacks.  I wonder how that works.”  Perhaps a plausible mechanism is identified.  That might lead to isolation of a specific component in red wine that yields the benefit.  Then that component is produced and disseminated, leading to the health benefits, without the risks of alcohol consumption.

It’s an expensive, time-consuming enterprise with many blind alleys.

Steve Parker, M.D.

Reference:  Hamed, Saher, et al.  Red wine consumption improves the in vitro migration of endothelial progenitor cells in young, healthy individuals.  American Journal of Clinical Nutrition, April 14, 2010.    doi:10.3945/ajcn.2009.28408

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Longevity Components of the Mediterranean Diet

According to Greek researchers, the components of the Mediterranean diet that contribute to longer lifespan are:

  • moderate alcohol consumption
  • low consumption of meat
  • high consumption of vegetables, fruits, nuts, olive oil, and legumes

The following didn’t seem to contribute much, if any:

  • cereals (the grain of a grass such as wheat, corn, oats)
  • dairy products
  • fish and seafood

Investigators at the University of Athens examined the Greek portion of the European Prospective Investigation into Cancer (EPIC) and Nutrition, which included 23,349 men and women free of diabetes, cancer, and coronary heart disease at the outset.  Food habits were documented by questionnaire. 

The focus of this particular study was death rates over an average follow-up of 8.5 years.  Adherence to the traditional Mediterranean diet ranged from minimal to high, as would be expected. 

As with numerous other studies of the Mediterranean diet, higher adherence to the Mediterranean diet was associated with lower chance of death. 

My Comments

The lack of benefit from fish is unexpected.  I have no explanation.  A preponderance of evidence elsewhere suggests fish consumption helps prolong life via lowered rates of heart disease.

Alcohol can be dangerous, of course.  Some people should not partake, ever.     

For people with diabetes who wish to avoid the carbohydrate load in cereals and dairy products, you don’t need to worry much about cutting those out of an otherwise Mediterranean-style diet.

Steve Parker, M.D. 

Reference:  Trichopoulou, Antonia, et al.  Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort studyBritish Medical Journal, 338 (2009): b2337.  DOI: 10.1136/bmj.b2337.

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Filed under Alcohol, Dairy Products, Fish, Fruits, Grains, Health Benefits, legumes, Mediterranean Diet, nuts, olive oil, Vegetables

Alcohol Habit (Especially Wine) Started in Middle-Age Reduces Heart Attack and Stroke

Jesus turned water into wine at a wedding.  His mother asked him to do it.  Of all the miracles he performed and could have performed, I wonder why this is the first one recorded in the Holy Bible.

We have known for years that low or moderate alcohol consumption tends to lower the risk of cardiovascular disease such as heart attack and stroke, and prolongs life span.  Physicians have been hesitant to suggest that nondrinkers take up the habit.  We don’t want to be responsible for, or even accused of, turning someone into an alcoholic.  We don’t want to be held accountable for someone else’s drunken acts.  Every well-trained physician is quite aware of the ravages of alcohol use and abuse.  We see them up close and personal in our patients.

A scientific study published in 2008, however, lends support to a middle-aged individual’s decision to start consuming moderate amounts of alcohol on a regular basis.  It even provides a positive defense if a doctor recommends it to carefully selected patients.

This research, by the way, was supported by a grant from the National Heart, Lung, and Blood Institute, not the wine/alcohol industry.

Methodology

Researchers at the Medical University of South Carolina examined data on 15,637 participants in the Atherosclerosis Risk in Communities (ARIC) study over a 10-year period.  These men and women were 45 to 64 years old at the time of enrollment, living in four communities across the U.S.  Of the participants, 27% were black, 73% nonblack, 28% were smokers, and 80% of them had high blood pressure, high cholesterol, or diabetes.

Out of 15,637 participants at the time of enrollment, 7,359 indicated that they didn’t drink alcohol.  At baseline, these 7,359 had no cardiovascular disease except for some with high blood pressure.    Subsequent interviews with them found that six percent of the nondrinkers – 442 people – decided independently to become moderate alcohol drinkers.  Or at least they identified themselves as such.

“Moderate” intake was defined as 1-14 drinks per week for men, and 1-7 drinks a week for women.  Incidentally, 0.4% of the initial non-drinking cohort – 21 people – became self-identified heavy drinkers.

93.6% of the 7,359 non-drinkers said that they continued to be non-drinkers.  These 6,917 people are the “persistent nondrinkers.”

Type of alcohol consumed was also surveyed and broken down into 1) wine-only drinkers, or 2) mixed drinkers: beer, liquor, wine.

Researchers then monitored health outcomes for an average of 4 years, comparing the “new moderate drinkers” with the “persistent nondrinkers.”

Results

  •  Over 4 years, 6.9% of the new moderate drinkers suffered a cardiovascular event, defined as a heart attack, stroke, a coronary heart disease procedure (e.g, angioplasty), or death from cardiovascular disease.
  • Over 4 years, 10% of the persistent nondrinkers suffered a cardiovascular event.
  • The new moderate drinkers were 38% less likely than persistent nondrinkers to suffer a new cardiovascular event (P = 0.008, which is a very strong association).  The difference persisted even after adjustment for demographic and cardiovascular risk factors.
  • There was no difference in all-cause mortality (death rate) between the new moderate drinkers and the persistent nondrinkers.
  • New  drinkers had modest but statistically significant improvements in HDL and LDL cholesterol and mean blood pressure compared with persistent nondrinkers.
  • 133 new moderate drinkers consumed only wine
  • 234 new moderate drinkers consumed mixed types of alcohol
  • Wine-only drinkers were 68% less likely than nondrinkers to suffer a cardiovascular event.
  • “Consumers of moderate amounts of beer/liquor/mixed (which includes some wine) tended to also be less likely to have had a subsequent cardiovascular event than nondrinkers…but the difference was not significant.”

A Few Study Limitations

  • Four years is a relatively brief follow-up, especially for cancer outcomes.  Alcohol consumption is associated with certain types of cancer.
  • If moderate alcohol consumption indeed lowers death rates as suggested by several other studies, this study may not have lasted long enough to see it.
  • The alcohol data depended on self-reports.

Take-Home Points

The study authors cite four other studies that support a slight advantage to wine over other alcohol types.  It’s a mystery to me why they fail to stress the apparent superiority of wine in the current study.  Several other studies that found improved longevity or cardiovascular outcomes in low-to-moderate drinkers suggest that the type of alcohol does not matter.  Perhaps “the jury is still out.”  In the study at hand, however, it is clear that the reduced cardiovascular disease rate in new moderate drinkers is associated with wine.

In all fairness, other studies show no beneficial health or longevity benefit to alcohol consumption.  But at this point, the majority of published studies support a beneficial effect.

Wine is a component of the traditional healthy Mediterranean diet.  The Mediterranean diet is associated with prolonged life span and reduced cardiovascular disease.  This study strongly suggests that wine is one of the health-promoting components of the Mediterranean diet.

Starting a judicious wine habit in middle age is relatively safe for selected people and may, in fact, improve cardiovascular health, if not longevity.

Now the question is, red or white.  Or grape juice?

Steve Parker, M.D.

Reference:  King, Dana E., et al.  Adopting Moderate Alchohol Consumption in Middle Age: Subsequent Cardiovascular Events.  American Journal of Medicine, 121 (2008): 201-206.

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Red Wine With Meaty Meals Possibly Healthier Than Wine and Meat Alone

Meaty meal in the making
Meaty meal in the making

 Wine is a time-honored component of the healthy Mediterranean diet and, traditionally, is consumed with meals.

For science and food geeks, Bix at the Fanatic Cook blog has a post outlining how red wine consumption with meals might be healthy: it reduces blood levels of cytotoxic lipid peroxidation products like malondialdehyde.

By no means is Fanatic Cook always this esoteric.  Check out some of the other topics there.

Steve Parker, M.D.

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Lower My Risk of Diabetes? I’ll Drink to That!

Beautiful woman smiling as she is wine tasting on a summer day.
How many grams of alcohol are in this wine?

Judicious alcohol consumption is linked to lower risk of developing type 2 diabetes: 40% lower risk in women, 13% lower in men. 

The latest issue of Diabetes Care reports the comparison of lifetime abstainers with alcohol drinkers.  The protective “dose” of alcohol is 22–24 grams a day.  I’ll leave it to you to figure out how much alcohol that is.  Prior studies looking at overall health benefits of alcohol indicate that judicious consumption is ≤ one drink daily, on average,  for women, and  ≤ 2 drinks a day for men.

Of course, many people shouldn’t drink any alcohol.  

Steve Parker, M.D.  

Reference:  Baliunas, D., et al.  Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysisDiabetes Care, 32 (2009): 2,123-2,132.

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Do Grape Products Other Than Wine Affect Heart Disease Risk?

"Grapes may be just as healthful as wine"

"Grapes may be just as healthful as wine"

Grape products favorably affect four risk factors for heart disease, according to a scientific review published last year.

The “French Paradox” refers to the fact that certain regions of France have low levels of heart disease despite high consumption of saturated fats that supposedly cause heart disease.  Some have explained away the paradox by noting high consumption of red wine in those areas, which could counteract the adverse effects of saturated fats.  Others have used the paradox to indict the Diet-Heart Hypothesis itself

Wine, especially red wine, is an integral part of the Ketogenic Mediterranean Diet.  However, many people just don’t like wine, and others shouldn’t be drinking it.  So, I’ve been wondering if grape products other than wine might have the healthy effects of wine.

The reference article below reviewed grape product trials published over the previous 13 years: 34 studies in animals, 41 in humans.  In addition to wine, grape products included grape juice, grape seed, grape skin, grape pomace, and polyphenol-rich extracts.  The authors conclude that grape products have the following beneficial effects on cardiovascular risk factors:

  • lower blood pressure, mainly due to release of nitric oxide from cells lining the arteries
  • reduced levels of total cholesterol, LDL cholesterol (“bad cholesterol”), and trigylcerides, especially if these values are high at baseline
  • reduced development of early-stage atherosclerosis (less LDL oxidation and plaque formation)
  • improved antioxidant status

Here are some grape product “fun facts” from the article:

  • healthy effects are primarily attributed to polyphenols, which are strong antioxidants that disable free radicals and chelate metals
  • major grape polyphenols are anthocyanins in red grapes, flavon-3-ols in white grapes
  • red grapes have more total polyphenols than white grapes
  • the main polyphenols in wine are resveratrol, tannins, flavan-3-ols, flavan-3,4-diols, anthocyanins, flavonols, flavones, anthocyanins, and anthocyanidins
  • red wine has a much higher phenolic content than white wine

Unfortunately, the authors never make any specific recommendations for people wanting to substitute alcohol-free grape products for wine.  

But I bet if you went down to your local vitamin or health food store, you could find some grape extracts or other grape products to try.  Anyone on a very low-carb diet would want to be sure the grape product wouldn’t supply more than 3-4 grams of digestible carbohydrate per day.  For those not on such a diet, purple grape juice like Welch’s—4 to 8 fl oz a day—is a good alternative to wine.  Welch’s has 42 g of carbohydrate per 8 fl oz. 

Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

Reference:  Perez-Jimenez, Jara and Saura-Calixto, Fulgencio.  Grape products and cardiovascular disease risk factors.  Nutrition Research Reviews, 21 (2008): 158-173.

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