For years people and groups have been pushing to make wine out to be some sort of health elixir. It is not. What we do know is that the active ingredient in wine — alcohol — is highly addictive, can kill when consumed in excessive quantities, is associated with some cancers, is involved in 31% of all auto accidents, is a factor in many domestic abuse situations, increases risky behavior, can lead to dependency and can harm a fetus. Alcoholism wreaks havoc on millions of lives

To be clear, I drink wine and the occasional cocktail. I’ve also made and sold wine. I believe an occasional glass of well-made wine adds to an adult celebration. In the past, I also touted the healthy benefits of drinking modest daily amounts of wine as an element of healthy living. That ended when I dug into the data.

Although mine is not a popular position to take in the Napa Valley, I am not alone when it comes to being concerned over the continued attempt to link alcohol consumption to positive health outcomes.

Wine is just one of many alcohols

Studies show little or no difference between wine, beer or spirits when it comes to correlative evidence indicating that moderate consumption of any of them is loosely associated with a reduced risk of heart disease and ischemic stroke (caused by a clot in the blood vessel).

Negative correlations with the consumption of these alcohols, however, include high blood pressure, hemorrhagic stroke (where a blood vessel breaks open) and cancers such as colorectal, breast, esophageal and stomach.

The data are not clear on how many might benefit from modest consumption of alcohol, but the Centers for Disease Control and Prevention estimates that 88,000 people die from alcohol-related causes annually in the United States.

A 2018 report from the World Health Organization (WHO) highlighted that 3 million people died globally from harmful alcohol use in 2016, three-quarters of whom were men. In that report the WHO called for more taxes to pay for alcohol-related health costs and consumption-reduction efforts.

A month before leaving office, the Trump administration rejected an advisory committee’s recommendation that men should cut their daily alcohol consumption from two drinks to one.

The result is that the recently released “Dietary Guidelines for Americans, 2020-2025,” still contains the suggestion that men can “safely” drink two glasses of wine per day, whereas women should continue to limit their intake to one.

But the report goes on to state that “Emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease. Alcohol has been found to increase risk for cancer, and for some types of cancer the risk increases even at low levels of alcohol consumption -- less than one drink a day. Caution, therefore, is recommended.”

They define a “drink” as containing 0.6 ounces of pure alcohol, which is the equivalent of 5 ounces of a wine labeled as having 12% alcohol. Relatively few Napa Valley wines contain less than 12% alcohol -- even the whites -- and many of the red wines top 15%. This means that the 5-ounce rule depends on the type of wine consumed.

The French Paradox

In the late 1980s the catchphrase “the French Paradox” summarized a dilemma: The French diet was higher in saturated fats than that of Americans, but their death rate from cardiovascular disease was lower.

This seemed to contradict the idea that high-fat diets were the culprits behind everything from heart attacks to strokes and even cancer. One hypothesis explored was that because the French consumed more wine than Americans maybe this discrepancy was linked to alcohol consumption -- and wine consumption, in particular.

Everyone from “60 Minutes” to wine-brand public relations agencies embraced this newfound “therapy,” often implying that wine might be akin to medicine. All such claims were based on correlative data.

Causation vs. correlation

Confusing causation with correlation is, well, confusing. The classic example is increased ice-cream sales correlated with increased drowning deaths. Ice cream doesn’t cause people to drown, but these are correlated because both happen more often during the hot summer months.

Anyone who says wine is associated with healthy outcomes means that wine has been correlated with some people who live longer than average or have fewer heart attacks than those who don’t imbibe. No causative studies of which I am aware show a direct link between alcohol consumption and positive health outcomes.

“It's unclear whether red wine is directly associated with [health] benefits or whether other factors are at play,” Robert Kloner, chief science officer and director of cardiovascular research at Huntington Medical Research Institutes and a professor of medicine at the University of Southern California, reported to the American Heart Association.

When someone tells you about a person who drank wine every day of their lives and lived to be 100, they are using correlative arguments to make their point. If you looked into the history of that 100-year-old, you would likely find a host of other correlative factors — wealth, diseases kept in check by advanced medical care, plant-based diets, worked outside, had a dietitian and the like.

Sowing seeds of confusion — breast cancer as a case study

The National Cancer Institute warns: “More than 100 epidemiological studies have looked at the association between alcohol consumption and the risk of breast cancer in women. These studies have consistently found an increased risk of breast cancer associated with increasing alcohol intake. The Million Women Study in the United Kingdom (which included more than 28,000 women with breast cancer) found that even 10 grams of alcohol (slightly less than one drink) was associated with a 12% increase in the risk of breast cancer.

In 2018, the world-renowned breast cancer physician Susan Love — whose foundation is dedicated to researching the causes and prevention of breast cancer as well as patient advocacy and education — pointed to study methodology as a source of confusion.

“The studies are large epidemiological studies which suggest that women who drink alcohol have a higher risk of breast cancer than women who don't,” Love said. “However, it is impossible to tell from these studies whether the alcohol is the culprit or whether they are also less likely to exercise or eat a healthy diet or are overweight. You cannot prove cause and effect from these kinds of studies. In general, moderation is a good idea as well as living a healthy lifestyle. I think we should stay away from giving strict advice.”

The use of percentages in recommendations can also lead to confusion.

In her July 5, 2017, Chicago Sun-Times article, “Wine’s link to breast cancer: scary or just a scare?” Froma Harrop quotes Cornelia Dean, the New York Times science writer and author of “Making Sense of Science: Separating Substance From Spin”:

“People who want to scare us typically give us relative risk figures. Raising a risk that starts off small can result in a risk that’s higher but still very small in absolute terms. This is best shown in an example. ‘Something that raises your risk of heart attack by 30% (relative risk) could be no scarier than raising your odds from 6 in 1,000 to 8 in 1,000 (absolute risk). When we hear that a small glass of wine a day may raise a premenopausal woman’s breast cancer risk by 5% and a postmenopausal woman’s by 9%, remember, those are relative risks.”

So what do we know about women and drinking? [Harrop] asked Dean.

“We know drinking modestly raises the risk of breast cancer,” she said. “But it is widely believed that moderate drinking is associated with better heart health and longer life expectancy. And we know that almost half of American women die of heart/vascular causes, whereas about 3% die of breast cancer.”

It is true that statistics can be used in a sloppy manner; however, the comment “widely believed” in Dean’s statement also points to a favored tool of those touting wine as a health elixir: Whether or not she is aware, she is perpetuating unproven assumptions.

Non-alcoholic “wine” reduces blood pressure

Lost in the noise of correlative health claims about wine is a 2012 causation study that found non-alcoholic red “wine” actually does lower blood pressure.

As reported in the Harvard Health Publishing Medical School journal, 67 men between the ages of 55 and 75 with cardiovascular risk factors or diabetes were evaluated. Each subject consumed 10 grams (slightly less than one drink) of red wine for four weeks, then 10 grams of non-alcoholic red “wine” for the next four weeks, followed by 4 grams of gin for the final four-week period.

The results: drinking non-alcoholic red “wine” lowered the systolic blood pressure of the participants by an average of six points — enough to reduce heart disease by 14% and lower stroke risk by 2%, according to the report. Drinking gin had no impact, and drinking normal wine reduced blood pressure only slightly.

As the above study suggests, there might be something in wine sans alcohol that is beneficial, but as of yet that substance remains elusive.

Resveratrol

Researchers and the wine industry have looked for a magical chemical in wine that might support wine’s health claims. Many thought they had it with a compound found in the skins of grapes called resveratrol.

One hopeful study showed mice on high-fat diets, given high-dose injections of resveratrol, had improved metabolisms compared with those that were not injected. The problem with that study was that for humans to obtain the equivalent levels of resveratrol they’d need to consume more than 250 gallons of red wine at a time to reach the levels injected into the test mice.

In 2012 UConn Today reported that a University of Connecticut investigation had concluded that one of the leading resveratrol researchers — Dipak K. Das in the Department of Surgery and director of the Cardiovascular Research Center — was guilty of more than 100 counts of fabrication and falsification of data. Das had gained global attention for his reports on the alleged benefits of resveratrol, but much of his work has now been discredited.

Alcohol is toxic

Although there might be something healthy within the wine itself, the associated alcohol is not. It increases the levels of circulating estrogen in the bloodstream, and estrogen is a hormone linked to breast cancer. It also appears to interfere with the absorption of nutrients such as folate that may protect against cancer.

And when the body metabolizes ethanol in alcoholic drinks, the most common pathway involves two enzymes — alcohol dehydrogenase and aldehyde dehydrogenase.

These enzymes help break down the alcohol molecule so it can be eliminated from the body. The first step metabolizes alcohol to acetaldehyde, a toxic substance known to be a carcinogen. In the second step acetaldehyde is further broken down into a less active byproduct called acetate, which is subsequently metabolized into water and carbon dioxide.

Enjoy the wine but avoid the snake-oil

Unfounded health claims are nothing new for selling a product and getting the public to buy-in.

In 1863 a Parisian chemist, Angelo Mariani, mixed wine with cocaine, called it “Vin Marian,” and promoted the addictive and intoxicating concoction as an elixir for “good health.”

Not surprisingly, it was hugely popular and even used by Arthur Conan Doyle and Jules Verne, who repeated the false health claims.

Building on Mariani’s success, an American, Dr. John Pemberton of Atlanta, created his own version that he initially called Pemberton’s French Wine Coca. This, too, was touted as a health tonic, curing everything from headaches to melancholy.

Because of the growing anti-alcohol movement in the United States at the time, in 1886 the wine was replaced by extra amounts of sugar, and Pemberton changed the name of his drink to “Coca-Cola, the temperance drink.”

In 1903 the cocaine in Coca-Cola was replaced with caffeine, but for decades the health claims of the beverage remained. Scientists now believe such sugary drinks are associated with 180,000 deaths per year.

At present we know what makes for a healthy life: daily exercise, eating a plant-centric diet that is low in sugar, staying hydrated, and enjoying plenty of laughter with friends and family. In the end, having an occasional glass of wine will not kill you, but drinking more than one glass a day is more likely to have more negative outcomes than not drinking wine at all.