I have heard that drinking red wine lowers the risk of heart disease. Is this correct?

This answer is brought to you by many of the Australian nutrition professionals who regularly contribute to a nutrition email discussion group.

The idea that wine may be helpful in combating heart disease started with the observation that people in the Burgundy area of France experience a lower rate of heart disease than do people in Western countries (such as Australia) where wine is not the major alcoholic beverage. This is despite the observation that Burgundians generally eat a diet that is rich in cheese, cream and 'pate de foie gras' (pate derived from fatty goose or duck livers), among other foods rich in saturated fat and cholesterol.

The low incidence of heart disease in the presence of a high saturated fat diet (which normally promotes heart disease) has come to be known as the 'French Paradox'. This observation led to the suggestion that drinking wine may be protective against heart disease. Subsequent research provided strong circumstantial evidence that drinking wine (especially red wine) is associated with a significant reduction in the risk of developing heart disease. 

However, an 'association' doesn't prove 'cause and effect'. For example, people who carry matches or a cigarette lighter in their pocket are far more likely to contract lung cancer than those who don't. Of course it is cigarette smoking that leads to lung cancer; carrying a lighter is not the cause of the disease, it is simply statistically associated with it.  With respect to heart disease in France it may be, for example, that fruit and vegetable consumption (also quite high in France) is the factor that is protective. If so, wine consumption may be merely associated with, but not the cause of, the observed lower rates of heart disease. Similarly, in countries like Australia, the US and the UK, wine drinkers are believed to smoke less, exercise more and generally lead 'healthier' lifestyles than most beer drinkers. It could therefore be that healthy lifestyles associated with wine drinking are protective against heart disease, rather than wine drinking itself.  However, there are sound theoretical arguments supporting the belief that wine drinking may actually be protective. Recent studies have shown the presence of powerful 'antioxidants' in wine. Red wine may be especially beneficial because it has additional antioxidants - not present in white wine - that are derived from the skins of the grapes. Different grape antioxidants have different effects. One (found only in red wine) increases the level of the 'good cholesterol' (HDL) in the blood, while simultaneously lowering the level of 'bad cholesterol' (LDL). Other antioxidants (present in red and white wine) help to protect LDL in the blood from being oxidised. (Oxidation of LDL is believed to be a critical step in the process leading to heart disease). Still another antioxidant helps to dilate blood vessels, thereby reducing the risk of abnormal blood clotting (the immediate cause of most heart attacks).

Although more research is needed to clarify the situation, the scientific consensus seems to be that wine, and especially red wine, is the most 'heart friendly' alcoholic beverage.

But even if wine, and especially red wine, do offer some protection against heart disease, this is not the only cause of illness, injury or death that alcohol has the potential to affect. Accidents (on the road, at home and at work), cancer, liver disease, domestic violence and crime are all influenced by alcohol intake. The question arises: at what level of intake is the protection against heart disease outweighed by increased rates of illness, injury and death from other causes?

It has been found that the relationship between alcohol consumption and illness/death follows a 'J curve'. That is, those people who drink no alcohol suffer more from illness or die younger, on average, than those who have a low-to-moderate intake of alcohol. But as alcohol intake increases, the relative risks of illness and early death start to rise above those for the non-drinkers. As alcohol intake increases further, rates of illness, death and injury start to accelerate rapidly.

So how many drinks of alcohol per day would be considered both protective against heart disease AND safe (with respect to other causes of death)? This is a question that is still being hotly debated. In 1986 the National Health and Medical Research Council considered a daily alcohol intake of up to about four 'standard' drinks' (defined at the end of this answer*) as safe for men, while up to two standard drinks was regarded as a safe level of intake for women. The different levels of 'safe drinking' for men and women are due to differences between the genders in body size, body composition and metabolism (even 'Mother Nature' is sexist sometimes!). Of course, if you are going to drive, use machinery or engage in similar potentially dangerous activities, zero alcohol intake beforehand is the only safe level.

Other authorities have suggested more recently that up to two drinks per day for men and only one drink for women represent the 'best of both worlds': minimising both risk of heart disease and illness/injury/death from other causes. Virtually all authorities agree that if a woman is pregnant, breastfeeding, or even 'at risk' of becoming pregnant, she should avoid drinking alcohol.

A bottle of wine usually contains between seven and eight standard drinks, so the maximum 'safe' daily levels of intake of wine are 1/4 to 1/2 bottle (men) and 1/8 to 1/4 bottle (women). It should also be pointed out the probable benefits of low/moderate consumption of  wine, while significant, are not massive. If you do not already drink alcohol, or for any reason should not drink alcohol, this FAQ does NOT recommend that you start to do so. The advice here applies only to those people who are, or intend to become, social wine drinkers. 

Summary: There is good reason to believe that drinking moderate quantities of wine, and particularly red wine, help to protect against heart disease. In fact, moderate alcohol consumption generally is associated with reduced risk of heart disease. But there is also overwhelming evidence that more than moderate levels of alcohol consumption (greater than 2-4 standard drinks per day for men, 1-2 drinks for women), lead to increased risk of disease, injury and death. 

*Definition of a standard drink: One standard drink contains about 10 grams of alcohol. Examples of one standard drink are one 285 mL (10 ounce) glass of normal strength beer; 2 x 285 mL glasses of 2% alcohol beer; 100 mL (small glass) of table wine, 60 mL of port or other fortified wine; 30 mL (one nip) of spirit or liqueur. 

For more information Nutrition Australia recommends:

• Eat Less Fat

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[Date issued: October 1999]

Disclaimer: This material is provided on the basis that it constitutes advice of a general nature only. It is not intended to replace the advice of a physician or a dietitian.