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
What Constitutes A Drink & What is Drink size: 5 oz serving of wine 12 oz of beer Shot of spirits (1.5 oz) Standard drink = Moderate 12gm pure alcohol Moderate No more than 2 drinks/day for men No more than 1 drink/day for women USDA 2005
Total Mortality Rate Compared to Alcohol Consumption Ten-year Mortality rate (per 1000) Drinks Per Day
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
Alcohol Intake and Risk of Nonfatal MI Kabagambe, E.K., et al. Am. J Clin Nutr 2005
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%
Odds Ratio of MI By Type of Alcoholic Beverage* (Schroder, H. et.al. (2007) *Values adjusted for variables
Association Between Alcohol Intake and Risk of Developing Hypertension Hypertension 2008
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.
Proposed Events for Ethanol-Induced Cardioprotection ETHANOL Brain Vascular Smooth Muscle Cells Sympathetic Activity Cardiac Muscle Cells Coronary Flow Coronary Vasodilation Heart Rate Cardiac Contraction Cardiac Contraction CARDIOPROTECTION Das, S. et. al., Exp Clin Cardiol 2007
Adjusted Risk of Death From All Causes By Exclusive Beverage Type Klatsky, A. et al. Am. J. Epidemiol 2003
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 acidreactive 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 Blue Chiquita, Chile 0.69 Blue Carmel, Israel 2.42 Blue Del Monte- Norway Content mmol/ 100g 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