One of the top lifestyle questions I get from patients is about alcohol - more specifically, is red wine good for your heart? We’ve long heard about the possible benefits of red wine and resveratrol (what is that any way?). Yet, some research also indicates that alcohol consumption may be detrimental to our health by increasing risks to certain diseases like liver problems and cancer. So, what's the verdict? 

What is the French Paradox?

The idea that there may be health benefits from consuming red wine originates from an observation made about heart disease rates in France in the early 1980s. Despite a relatively high consumption of saturated fat and the use of cigarettes, there seemed to be relatively less death from heart disease - this became known as the French Paradox. It was postulated that the lower risk of heart disease was due to a higher intake of red wine, which was thought to have some protective effects on the heart. Moderate alcohol consumption is also a component of many long-living Blue Zones diets, most notably in the Mediterranean diet.

What does the rest of the evidence say about red wine and heart disease risk?

Beyond the French Paradox, several epidemiologic studies investigating the relationship between alcohol consumption and heart disease have found an association with low to moderate alcohol intake and lower risk of heart disease. Studies have found this relationship to be mirrored in a J-shaped curve, such that light-moderate alcohol intake is associated with the lowest mortality rate - even lower than complete alcohol abstinence. However, it’s important to note that many non-drinkers are prior drinkers who have a much higher rate of chronic diseases impacting morbidity and mortality compared with occasional or light drinkers. Also importantly to note, high levels of alcohol intake are associated with the highest rates of death.  

Why might red wine be cardioprotective? 

Red wine might be cardioprotective because it contains some amount of resveratrol and antioxidants. Resveratrol, a natural phenol and common supplement, may lower blood pressure and body fat when consumed in large quantities. Red wine also contains some anti-inflammatory and anti-thrombotic agents, which means it may be able to reduce inflammation and decrease the risk of blood clots. However, it’s important to note that the amount of resveratrol found in red wine is found in very small amounts and may not even survive in the bottle long enough to actually be consumed! 

So red wine is heart healthy then?

It’s important to realize that there has been no randomized controlled trial data that has directly tested red wine’s role in cardioprotection. This is the gold standard type of a test that can definitively determine if red wine is cardioprotective or not. Epidemiologic data cannot prove cause and effect, it simply shows a relationship between the two, which may or may not be directly related.

Furthermore, there have been several other epidemiological studies that link alcohol consumption to an increase in triglycerides, as well as higher rates of high blood pressure, heart failure, atrial fibrillation, liver disease, breast cancer, and stroke. Given this data, the optimal amount of alcohol consumption that maximizes health may be closer to zero.

Studies have also shown that many are drinking much more than recommended, with an increased risk of death that goes along with it. Excessive alcohol use remains a leading preventable cause of death, and it is estimated that around one in 6 US adults binge drinks (which is defined as more than 4 drinks in one sitting for women and 5 for men).

The red wine conclusion 

In the context of a healthy diet, occasional moderate wine intake may be reasonable, with some major caveats.

“Moderate consumption” is key here, and notably may be a lot less than most of us are used to. As defined by the Dietary Guidelines for Americans, moderate alcohol consumption is defined as no more than 1 drink a day for women and 2 for men - with one alcoholic drink consisting of 5 fluid ounces of wine.

If you already consume alcohol and enjoy drinking wine, it can be a part of your heart healthy diet when consumed responsibility. It’s clearly important to watch your intake and avoid binge drinking, or consuming more than several drinks in one sitting. Consider mixing it up with sparkling water, mocktails, tea, or non-alcoholic wine.

That said, if you don’t already enjoy wine or alcohol, there’s no solid evidence you should start drinking for your heart (and more than enough reason to avoid). Beyond red wine, engaging in a healthy diet, regular exercise, and other lifestyle modifications remain the best practices for cardioprotection and good health. 

Interested in working with Dr. Harkin to optimize your heart health?