Letters to the Editor
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Materia-non-Medica - "Wine and Doctors - An Age-Old Affinity"
"Excess alcohol is very bad for public health, for individual health, but moderate amounts will most likely prevent heart disease."
The strong affinity between the medical profession and
wine goes back some 6,000 years. In the time of the Pharoahs for instance, ear infection
was treated by a mixture of mouse dung and wine! And in the oldest pharmacopoeia dating
from 2,200 BC, wine was listed as a medicine. Wine was used as an antiseptic, an
anaesthetic, a hypnotic, a sedative, a tonic, as treatment for anaemia, an appetite
stimulant, a diuretic, as treatment for diarrhoea, to purify water and as a mixing medium
for other less palatable medicines (Norrie, P A, 1997).
Hippocrates (450 - 370 BC) used wine in almost every one of his recorded remedies. "He used it for cooling fevers, as a diuretic, a general antiseptic, and to help convalescence. But he was completely specific, occasionally advising against wine at all, and always recommending a particular wine for a particular case." (Hugh Johnson, "Vintage, the Story of Wine" 1989). He had a good understanding of the human body and how it worked as shown by his advice: "Soft dark wines are moister; they are flatulent and pass better by stool .... Harsh white wines heat without drying, and they pass better by urine than by stool. New wines pass by stool better than other wines because they are nearer the must, and more nourishing .... Must causes wind, disturbs the bowels and empties them ...." (Hugh Johnson, 1989).
His use of wine as part of his dietary therapy "Wine is fit for man in a wonderful way provided that it is taken with good sense by the sick as well as the healthy" could easily and well apply today in the light of the mass of evidence from epidemiological studies in the past few decades.
The wheel has come full circle today as we now have enough epidemiological data to accept that moderate consumption of wine exerts a protective influence against coronary heart diseases. There are also suggestions that wine may have a similar protective influence against malignant diseases and even Alzheimers disease.
The "French Paradox" has now passed into the daily vocabulary even amongst the lay public. Its introduction into the popular vocabulary almost certainly dates from CBSs 60 Minutes on 7th November 1991, when it was the subject of an interview with two medical scientists, Dr Curt Ellison, Chief of Epidemiology, Boston University and Dr Serve Renaud, French scientist and pioneer in alcohol research from Frances health research agency INSERM. The key
factor which Ellison and Renaud believed responsible for this phenomenon was the French habit of taking wine together with meals. Ellison even went further to say that the secret of the French Paradox lies in their life-style, food and wine. Renaud was more emphatic. "It is well documented that a moderate intake of alcohol prevents coronary heart diseases by as much as 50%".
What is little known is that as far back as 1926 an American biologist named Raymond Pearl had reported that people who drank moderate amounts of alcohol lived longer than people who did not drink at all.
One of the most important of the earlier work on this subject was the paper by A S St Leger, A L Cochrane and F Moore of the Epidemiological Department of the Medical Research Council of England (Lancet 12th May 1979), reporting the findings of their epidemiological study on cardiac mortality in developed countries. Their conclusion? "A strong and specific negative association between ischaemic heart-disease deaths and alcohol consumption. This is shown to be wholly attributable to wine consumption."
On 5 November 1995, four years after the original programme, CBS-TV revisited the French Paradox interviewing not only the same two scientists, Ellison and Renaud, but also Dr Martin Gronbaek, of the Institute of Preventive Medicine, Copenhagen Health Services and the University of Copenhagen, and principal author of two recent reports from a new Danish study published in the highly reputable British Medical Journal.
The message that they sent out and which has since been supported by other numerous epidemiological studies was that "Excess alcohol is very bad for public health, for individual health, but moderate amounts will most likely prevent heart disease." According to Renaud, antioxidants (substances such as tannins and flavonoids) as well as alcohol found in wine were likely to be responsible for wines beneficial effects.
Morten Gronbaek discussed the findings of the Copenhagen City Heart Study recently published in the Lancet, a report based on the study of a group of 13,000 men and women aged 30 to 70 followed over a twelve-year period from 1976 to 1988. The first report, January 1994, concluded "alcohol intake showed a U-shaped relation to mortality with the nadir at one to six beverages a week." Gender, age, body mass index or smoking did not modify the risk function which remained stable over the 12-year study period.
Their second article in May 1995 reported the results of their examination of mortality associated with moderate intakes of wine, beer, or spirits. The conclusion reached was "Low to moderate intake of wine is associated with lower mortality from cardiovascular and cerebrovascular disease and other causes. Similar intake of spirits implied an increased risk while beer drinking did not affect mortality."
According to Gronbaek "Now we drink 30 percent more wine than we did 20 years ago ... and heart disease has decreased by 30 percent accordingly." Among the 13,000 men and women wine consumers had half the risk of dying of those who never drank wine.
The Danish study has been one of the most important and most widely quoted of recent studies because of the long period (12 years) of monitoring and the large number (13,000) of subjects involved. The sufficiently substantiated epidemiological data serves to contradict the official line taken by the World Health Organisation. "There is no minimum threshold below which alcohol can be consumed without risk... The less you drink the better."
A further report from the Copenhagen City Heart Study (Truelsen T; Gronbaek M; Schnorh P; and Boysen G, Stroke, 29 (12) 2467 - 72, 1998) found indications of a "U-shaped relation between intake of alcohol and risk of stroke." Their conclusions: "The differences in the effects of beer, wine and spirits on the risk of stroke suggest that compounds in the wine in addition to ethanol are responsible for the protective effect on risk of stroke."
The weight of evidence, though still mainly epidemiological, has led to official recommendations from both the United Kingdom and the United States.
In December 1995 Britains Health Minister Stephen Dorrell announced that the recommended drinking limits had been increased as follows: for men, the previously recommended limit of an equivalent of three glasses a day was increased to four; for women the previous limit of two glasses was increased to three a day.
The new 1995 Dietary Guidelines for Americans, Fourth Edition, in a major departure from the 1990 Guidelines, noted that current evidence suggests moderate drinking "to be associated with a lower risk for coronary heart disease." The concluding "Advice for Today" recommends that food accompany alcohol, that moderation should be exercised and when consumption did not cause risk to the drinker or others.
Two years ago the influential American Heart Association accepted officially that moderate consumption of wine could reduce the mortality risk from Coronary Heart Disease. Has the time come for doctors to recommend to their patients that the sensible consumption of a few glasses of wine a day (three to four for men, two to three for women) is good for their health? I believe it is timely and I know this is shared by many of my colleagues in other countries, but the profession by and large (not only here but all over the world) is still regrettably steeped in the religious, almost Calvinistic, moralistic attitude towards alcohol and thus lacks the courage of its convictions.
There is no question that the beneficial effects of wine on health, in particular the protective effect on heart disease constitute today THE most important factor in the extraordinary increase in wine consumption all over the world - all the way from the karaoke bars of Guangzhou to a coffeeshop eating house in Geylang! We can see it almost everywhere and on almost every occasion here in Singapore. At the many wedding dinners I have been to in recent years, the standard bottles of XO cognac and black label Scotch have been replaced with wine. And numerous small groups have got together to form their own tasting clubs, quite apart from the more formalised groups such as the International Wine & Food Society Singapore and the Commanderie de Bordeaux.
But the strong affinity between the medical profession and wine extends beyond and antedates the current interest in the health benefits of wine. Doctors have for a long time been amongst the most famous collectors of wine - neurosurgeon Marvin Overton in Texas, dermatologist Lou Skinner in Miami, dermatologist Cary Feibleman in Los Angeles, Barney Rhodes in Napa Valley, to name a few of the most prominent. And they have not only been collectors, they have also been amongst the most famous of wine growers.
Examples include the late ophthalmologist Dr George Mugneret in Burgundy whose Clos Vougeot was one of the best of that Grand Cru, and Dr Barney Rhodes whose wife Belle owns the famous Bella Oaks vineyard from which Heitz Cellars gets its grapes for its Bella Oaks wine. Australia can perhaps boast of the largest number of wineries started by or associated with doctors - Lindemans Penfolds, Hardy, Houghton, Mount Mary, Moss Wood - the list goes on.
What fascination does wine have for the medical profession that doctors should number prominently amongst the great collectors and wine growers?
There are many factors at work here. Increased social opportunities and exposure leading to growing real appreciation and enjoyment of the taste of wine especially with food, the professions ingrained curiosity and quest for knowledge, increased leisure time, increasing affluence (a necessary pre-requisite for building up a collection), and finally the appreciation of a different, and perceptibly better life-style, more gracious, more sane and more satisfying.
Unfortunately there is also the hollow association of snobbery and elitism with wine collecting and drinking, which is mentioned here only to be deplored.
A passionate wine-maker, Jean-Marie Guffens who owns the negotiant firm of Verget said to me last October "The more I know about wine making, the less I know about wine." The technology is there, the elements which go to make a great wine are understood, but there is still an unknown factor which defies analysis and dissection, and which the wine maker cannot control or even influence. In wine, as in Medicine, you never stop learning. There is always something new - a new vintage, new types of wines, new styles. Perhaps that is the key to the affinity between wine and the medical profession.
Wine mirrors life and love, changing, growing, developing, maturing, yet at the same time frustratingly elusive in its definition, always new and yet always old, haunting in its memories, and always fascinating.
DR N K YONG