WINE OR WELCH’S? Guiding Your Employees to Informed

Decisions

By Monika Fischer, MN, RN, ANP, CCM, COHN-S

Wine Educator and President

Grasp of the Grape & Taste with me

DISCLAIMER

This talk will be presenting scientific findings associated with the consumption of wine/alcohol. At no time am I encouraging anyone to start drinking,

increase their consumption of alcohol or go against any religious or moral beliefs related to alcohol

consumption.

WHAT STARTED ALL THIS HOOPLA ABOUT WINE

•  “Sixty Minutes” segment focusing on the potential benefits of red wine.

AND •  Renaud and de Lorgeril published their

article re French Paradox in Lancet June 20, 1992

“FRENCH PARADOX”

Which is the phenomenon that the diet of people in Southern France includes high fatty and cholesterol-laden foods. A diet that would seem to promote HD, but the rate there is much lower than America. Therefore paradoxical.

WHY?

It is believed that the drinking of red wine has been attributed with the low incidence of CHD in France.

Probably a result of both the alcohol content and the polyphenols found in red wine.

The French Wine Study

S. Renaud & M De Lorgeril 1992 •  Found that French had lower HD even though ate rich diets.   Emphasized that alcohol is a drug & should be regularly taken in

moderate doses •  Sources of Information for them

•  Wales study shows due to platelet aggregation •  Pilot studies showed platelet reactivity lower in France than

Scotland •  MONICA project

•  France mortality rate from CHD closer to Japan or China than US or UK

  May be due to fact wine consumed during meals & absorbed slowly   Now believed related to lowering of homocystiene levels.

  Amino acid derivative naturally found in body

Other Possible Reasons for the French Paradox

•  Consume more vegetables & fruit •  Salads •  Legumes •  Wheat •  Olives

•  Different sources of fat •  Dairy fat from cheese not milk •  Use of EVOO

•  Meals more relaxed & longer •  Effect shown in other countries who eat Mediterranean diet

USDA 2005

What Constitutes A Drink & What is Moderate

Drink size: •  5 oz serving of wine •  12 oz of beer •  Shot of spirits (1.5 oz) •  Standard drink =

12gm pure alcohol Moderate

•  No more than 2 drinks/day for men •  No more than 1 drink/day for women

Total Mortality Rate Compared to Alcohol Consumption

Drinks Per Day

Ten-year Mortality rate (per 1000)

Positive Affects of Wine

•  Reduce risk of MI •  Reduce risk of CHF •  Raise HDL while grapes don’t •  Potential in helping to avoid a second MI (red wine ) •  Protects against Lung CA •  Non-steroidal anti-inflammatory activity •  Help protect against Alzheimer’s disease •  Work against food-borne illness

•  H. pylori •  E. coli •  Salmonella Typhemurum •  Listeria monocytogenes

Kabagambe, E.K., et al. Am. J Clin Nutr 2005

Alcohol Intake and Risk of Nonfatal MI

Drinking Patterns and Risk of Nonfatal MI

Negative Effects of Drinking

•  Addiction •  Seizures •  Intracranial

hemorrhage •  Cardiac Disorders

•  Cardiomyopathy •  Arrhythmias

•  Cirrhosis •  Gastrointestinal

disorders

•  Falls & fractures •  Malignancy

•  Oral & pharyngeal •  Esophageal •  Stomach •  Breast

•  Suicide risk increases •  Sleep disturbance •  Sexual dysfunction •  Accidents & injury (to

self & others)

Reasons to Never Drink

•  At risk for alcohol related problems •  Pregnant or nursing women •  Taking medications with alcohol

contraindications •  Family hx of alcoholism •  History of alcohol or drug abuse. •  Selected medical conditions. •  Ethical or religious prohibitions to drinking. •  Don’t like the taste of liquor.

Positive Affects of Grape Juice

•  Reduces the risk of blood clots •  Reduces LDL cholesterol •  Improves function of cells in blood vessel

linings –alcohol doesn’t do this •  Lessens the risk of clogged arteries •  Prevents damage to blood vessels in heart •  Helps maintain healthy BP •  Lowers blood clotting •  Antioxidants in this lingers longer in body

Studies on Topic

•  John Folts, Ph.D. –University of Wisconsin •  Found purple grape juice associated with

lower blood clotting & less risk of HD •  Stated that in order to consume enough

wine to do this would be legally drunk •  Felt 10-12 oz per day of juice enough •  Cumulative effect.

•  Researchers in Germany found 28% higher anthocyanin levels in grape juice compared to wine

Studies on Topic (con’t)

•  UC Davis—9 volunteers drank Cab with alcohol removed and catechin remained 4hrs. Those that had full strength Cab it lasted 3.2 hrs—felt that ETOH hastens breakdown of antioxidant in blood steam

•  Japanese researchers found while grape did have antioxidative benefits, it did not significantly lower LDL compared to wine

Studies on Topic (con’t)

•  Study from Journal of Nutrition—24 pre & 20 postmenopausal women consumed drink of 36g of powder made from dried grapes for 4 weeks •  Results

•  Blood levels of LDL and apolipoproteins B & E dropped significantly

•  Triglycerides dropped 15% and 6% in pre-and postmenopausal women, respectively

•  Cholesterol ester transfer protein activity dropped 15% •  Levels of urinary F(2)-isoprostanes & TNF-alpha dropped

significantly

National Institute on Alcohol Abuse & Alcoholism Report (1999)

•  Long term data (max 24 yrs) from 20 countries (No. America, Europe, Asia & Australia)

•  Total population more than 1 million men & women—various ethnicities

•  20%-40% reduction in CHD incidence in drinkers •  Large scale prospective studies confirmed moderate

drinking associated with reduced CHD risk •  Found one study from Scotland disputing this

NIAAA Conclusions

•  No causal relationship •  Abstainers could share other traits than not using

alcohol that could be detrimental •  Found few studies adjusted for levels of physical

activity •  Is wine better?

•  Concept that ingredients other than alcohol in it are beneficial produced conflicting results •  Those elements only tested on animals or cells

not humans

Physicians’ Health Study I

•  21,601 participants free of HF followed from 1982-2005

•  Findings •  904 incident case of HF •  Hazard ratios per drinks/week

•  1.0 for alcohol category <1 (reference)

•  0.90 for alcohol category 1 to 4 •  0.84 for alcohol category 5 to 7 •  0.62 per for alcohol category >7

•  Data indicates moderate drinking may lower risk of HF

Circulation 2007; 115:34-39

Population-based Case-Control Study (Type of Beverage)

Schroder, H. et.al. (2007)

•  Purpose •  Association of non-fatal MI with total alcohol consumption & type of

beverage •  244 subjects & 1270 controls •  Males ages 25-74 yrs with a first MI •  Total alcohol consumption—30g/day (adjusted for lifestyle & CV

risk factors) •  Results

•  Inverse association with risk of non-fatal MI (odds ratio 0.14) •  Multivariate logistical regression analysis for consumption

>0g & < 20g/d showed reduced risk of MI •  Wine – 78% •  Beer – 76% •  Spirits – 79%

*Values adjusted for variables

Odds Ratio of MI By Type of Alcoholic Beverage* (Schroder, H. et.al. (2007)

Hypertension 2008

Association Between Alcohol Intake and Risk of Developing Hypertension

Multivariate Risk of Hypertension Development In Women By Beverage Type

Risk of Stroke Studies

Concord Grapes

•  Concord grape juice is believed to have the most health benefits

•  More antioxidants than red wine or cranberry juice.

•  However, Muscadine grapes can have 40X more resveratrol than red grapes

Antioxidants Present

•  Wine •  Flavonoids

• Quercitin • Resveratrol

•  Phenolic Acid •  Saponins •  Catechin •  Epicatechin

•  Grape Juice •  Flavonoids

• Quercitin • Resveratrol

•  Phenolic Acid •  Catechin > •  Epicatechin> •  Pterostilbene

Saponins

•  Found in grapes waxy skin •  Dissolves during fermentation •  Alcohol makes them more soluble and available •  Binds to and prevents absorption of cholesterol •  Settles down inflammation pathways •  Red wine had 3-10X more than whites •  Strong wine with high ETOH levels have more •  Best are Zinfandel (16%) •  Then Syrah, Pinot Noir and Cabernet Sauvignon •  Beneficial dietary amt is 15mg -1 glass of wine 7.5mg.

ETHANOL

Vascular Smooth Muscle Cells Sympathetic Activity Cardiac Muscle Cells

Brain

Coronary Flow

Coronary Vasodilation

Heart Rate

Cardiac Contraction

Cardiac Contraction

CARDIOPROTECTION

Proposed Events for Ethanol-Induced Cardioprotection

Das, S. et. al., Exp Clin Cardiol 2007

Klatsky, A. et al. Am. J. Epidemiol 2003

Adjusted Risk of Death From All Causes By Exclusive Beverage Type

Pterostilbene

•  Fights cancer •  Lowers cholesterol •  Works better than resveratrol in

metabolism of lipids •  Also in cranberries and blueberries

What Flavonoids Do

•  Give wine bitterness and astringency •  Are the foundations of ability to have

long aging (antioxidant) •  Inhibits platelet aggregation •  Believed to be due to inhibiting

oxgenase enzymes

Resveratrol

Properties •  Naturally occurring

fungicide & part of defense system against disease

•  Found in skins & seeds of grapes

In Vitro Findings: •  Cardioprotective

•  Inhibits platelet aggregation •  Neutralizes free radicals •  Inhibits LDL oxidation •  Inhibits proliferation of

vacular smooth muscle cells •  Cancer prevention

•  Potential to act as both estrogen agonist or antagonist

•  Induces apoptosis •  Inhibits angiogenesis

•  Antiviral effects •  Anti-inflammatory effects •  Longevity-possibly through

mimicking calorie restriction

Amount of Resveratrol In Skins

•  Dependent on: •  Variety of grape •  Where cultivated •  Geographical origin •  Exposure to fungal infection •  The amount of fermentation time wine spends in

contact with skins •  Ripeness when picked •  If pesticides were used •  How long wine aged •  Process by which wine bottled

Catechin

•  Actions: •  Inc. plasma antioxidant

activity •  Dec. platelet

aggregation •  Dec. plasma conc. of

lipid peroxide & thiobarbituric acid-reactive substance

•  Dec. susceptibility of LDL to oxidation

•  Inc. plasma ascorbate conc.

•  Dec. nonheme iron absorption

•  Possibly translates to: •  Reduced atherosclerotic

plaques •  “Free-radical” prevention

from doing cellular damage

•  Reduced carcinogenesis •  Reduced risk for stroke,

heart failure, CA & diabetes

•  Skin protection from UV radiation-induced damage

•  Inc. HDL conc •  More in grapes than wine

Quercitin •  Most active of flavonoids •  Potent antioxidant activity •  Vitamin C-sparing action •  Anti inflammatory

•  Direct inhibition of initial process •  Inhibits both manufacture & release of

histamine & other mediators •  Anti-tumor properties •  Positive affects on:

•  Heart Disease •  Cataracts •  Respiratory Diseases

•  Contraindicated with antibiotics •  Fluoroquinolones

Antioxidant Content in Grapes

Product Country of Origin

Content mmol/100g

Blue Chiquita, Chile 0.69 Blue Carmel, Israel 2.42 Blue Del Monte-

Norway 0.90

Blue Italy 0.78-.80 Green USA 0.13 Green Italy 0.24-41 Red USA 0.32 Red Italy 0.47

Comparison of Antioxidant Content of Various Beverages

Beverage Min Max Apple juice 0.12 0.60

Black tea 0.75 1.21

Coffee 1.24 4.20

Espresso 12.64 15.83 Green tea 0.57 2.62

Orange juice 0.47 0.81

Red wine 1.78 3.66 Grape juice 0.69 1.74

WHY RED NOT WHITE?

•  RED WINE = 1,800 – 3,000 MG/l

•  WHITE WINE = 90 – 150 MG/l

•  Also flavonoids (resveratrol & epicatechin) are found in red not white.

ARE ALL RED WINE CREATED EQUAL?

•  Highest in phytochemicals • Cabernet Sauvignon

•  Others also high in flavonoids •  Petit Syrah •  Pinot Noir

OHN’s Role in Guiding Employees

•  Assess situation • Current drinking patterns •  Past hx & family hx • Co-morbidity or current treatments

•  Discuss pros & cons of each •  If decides on wine, stress that there is a

narrow window from help to harm.

FINAL THOUGHTS So if your employees want all the heart health benefits of red wine without the hangover? Raise a cup of Concord grape juice.

No one needs to drink to lead a healthy and happy, rewarding life, but if drinking wine adds pleasure remember moderation! Also remember wine is like a lover no one ever has exactly the same taste in them, but we all know what we like.

Monika Fischer, Wine Educator