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Red Wine and Diabetes Health: Getting Skin in the Game

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Red Wine and Diabetes Health: Getting Skin in the Game Diabetes Volume 63, January 2014 31 R. Paul Robertson Red Wine and Diabetes Health: Getting Skin in the Game Diabetes 2014;63:31–38 | DOI: 10.2337/db13-1318 It was an unexpected pleasure to be invited to write opinion and in keeping with the fashion of the day, it seems a Perspectives in Diabetes article considering the propo- appropriate at the outset of this Perspectives in Diabetes sition that moderate consumption of red wine provides and in the spirit of full disclosure to state that my mother, health benefits for people with diabetes. At the outset, a full-blooded Italian from Vinchiaturo in Molise, always I want to make clear that since Perspectives in Diabetes told her sons that a day without wine is a day without PERSPECTIVES IN DIABETES are not review articles in the conventional sense, this one sunshine. Being a Seattle resident, I relish a sunny day. does not exhaustively analyze the effects of beer, hard In preparing to write, I submitted three topics to liquor, or alcohol per se on health. This one is all about PubMed: wine and diabetes, wine and mental health, and wine, especially red wine. This is an important point wine and social health. Note that I purposely did not in- because of the intrinsic psychic influences of wine. Beer is clude beer, liquor, or alcohol in my search. These searches associated with boisterous behavior at sporting events. garnered 265 references from 1963–2013, 58 references Hard liquor is associated with serious drinking and dark from 1967–2013, and 200 references from 1970–2013, moods. Wine, on the other hand, is associated with re- respectively. After reading titles and abstracts, I excluded laxation, reflection, celebration, conviviality, toasting, articles that were not peer reviewed or original work, did and a certain amount of dry humor. So, in this spirit, not specifically address drinking wine in moderate quan- I will lace this article with a modicum of these wine- tities in humans, or did not consider the impacts on health related characteristics. in people with diabetes or cardiovascular disease. I read the Archeologists tell us that humans made and drank full manuscripts for the remainder. This Perspectives in wine in the Middle East (Fig. 1) beginning in ~7000 Diabetes is organized to consider 1) epidemiologic and BCE—well before recorded time. During its 9,000-year metabolic studies of the consequences of red wine drinking history, wine has been used for many purposes, including for people with type 2 diabetes (T2D), 2) the question of religious (Fig. 2) and medical ones. The scientific litera- whether the health effects of wine are intrinsic to grapes or ture over the past half century does not explicitly warn a function of the alcohol in wine, and 3) potential mech- against drinking wine in moderate amounts, except anism(s) of action for the beneficial effects of red wine. during pregnancy. Yet, in the U.S. there continues to be a lurking hesitancy in some social circles about its use for EPIDEMIOLOGICAL STUDIES relaxation or recreational purposes. Some religious faiths specifically proscribe wine, which also makes it in- French Paradox, Cardiovascular Disease, and T2D teresting that some other religious faiths include wine in The term French paradox appears to have been popu- their services. Beyond use of moderate amounts, it is larized in the early 1990s by 60 Minutes, the CBS news clear that drinking wine excessively leads to inebriation and magazine (1), and an epidemiological article in The Lancet likely endangerment of self and others, just as with any (2), which point out that high intake of saturated fat is alcohol-containing beverage.Inviewofthisspectrumof positively related to high mortality from coronary heart Pacific Northwest Diabetes Research Institute and the Division of Metabolism, Corresponding author: R. Paul Robertson, [email protected]. Endocrinology, and Nutrition, Departments of Medicine and Pharmacology, Received 26 August 2013 and accepted 15 October 2013. University of Washington, Seattle, WA © 2014 by the American Diabetes Association. See http://creativecommons .org/licenses/by-nc-nd/3.0/ for details. 32 Red Wine and Diabetes Health Diabetes Volume 63, January 2014 Figure 2—A monk cellarer keeping track of the progress of his sacramental wine (probably white) in the Middle Ages (late 13th century, France). Source: From Li Livres dou Santé by Aldobrandino of Siena. Figure 1—A Persian woman pouring a Persian red wine (mey)in moderate alcohol consumption. However, decreases in the ancient world (17th century, Persia). From a wall painting inside body weight were also associated with increasing alcohol the Chehel Sotoun palace, Isfahan, Iran. Photo by Zereshk. use. The authors concluded that there was no support for the notion that moderate alcohol intake independent of weight loss increases or decreases the risk of T2D. Four large epidemiological studies were reported from disease (CHD) except in France, where there is high wine Australia (5), Sweden (6), a European consortium (7), consumption. This observation was made as early as and Denmark (8) in the past decade (Table 1). Hodge 1979 by St. Leger et al. (3). CHD has important linkage to et al. (5) studied 36,527 adults aged 40–69 years at the issue of the effects of wine use on T2D because of the baseline, and incident cases of T2D were identified by marked increased risk for CHD in people with T2D. questionnaire 4 years later. Eighty-seven and eighty-five A steady accumulation of articles reporting an association percent of the women and men, respectively, responded of moderate alcohol use and protection against CHD in- to the questionnaires. Of women, 44% consumed no dependent of T2D has appeared over the past few decades. alcohol. Women with the highest consumption were At the current time, a PubMed search for the terms younger, leaner, more active, and more educated, smoked “alcohol” and “coronary heart disease” yields 11,980 cita- more, and were less likely to have a family history of tions. Rather than trying to digest this unwieldy number, diabetes. Of men, 15% consumed no alcohol. Men with I will concentrate on a more refined and more manageable the highest consumption consumed less fat and were group of reports focused on the impact of red wine more likely to have gained weight. A total of 454 par- drinking on the health of people with T2D (4–23). ticipants reported a diagnosis of diabetes after baseline. Not so long ago, there was concern that drinking al- Of 397 who followed up with doctors, 76% were con- cohol might raise blood glucose levels. Stampfer et al. (4) firmed to have T2D. For women and men, after adjust- (Table 1) evaluated this hypothesis in 1988 by examining ment for BMI and waist-to-hip ratio, there were no the status of 85,051 women participating in the Nurses’ associations between general alcohol consumption and Health Study who were 34–59 years of age in 1980 with a diagnosis of T2D. However, particularly pertinent for no history of diabetes. A dietary questionnaire was used to this Perspectives in Diabetes, wine was the most com- gather information about the consumption of beer, wine, monly consumed beverage (92% of total alcohol intake and liquor. Follow-up questionnaires were sent in 1982 for women and 57% for men), and it was associated and 1984. Ninety-eight percent responded to at least one with lower risk of T2D for both women and men. follow-up. A total of 526 incident cases of T2D were Cullmann et al. (6) used oral glucose tolerance tests at confirmed. The risk of diabetes decreased with increasing baseline 8–10 years later to study the development of diabetes.diabetesjournals.org Robertson 33 Table 1—Epidemiologic studies of the association between moderate alcohol consumption and the development of T2D Association between all alcohol drinking Association between wine vs. beer/spirits drinking Author (ref.) and risk of T2D and risk of T2D Stampfer et al. (4) Wine equally associated with weight loss and less T2D Hodge et al. (5) All alcohol associated with loss of weight Wine more strongly associated with weight loss and less T2D and less T2D Cullmann et al. (6) All alcohol associated with less T20 Wine associated with less T20 in women only in women only All alcohol associated with less prediabetes Wine associated with less prediabetes in women only in women only Beulens et al. (7) All alcohol associated with less T2D Wine most strongly associated with less T2D Rasouli et al. (8) All alcohol associated with less T2D in men Wine most strongly associated with less T2D prediabetes or T2D in a group of 2,070 men and 3,058 associated with protection against the development of women with normal glucose tolerance. The devel- T2D. Àvotresanté! opment of T2D was determined in this same group after enrichment with other subjects who had pre- METABOLIC STUDIES diabetes, yielding groups of 2,217 men and 3,176 As we know, epidemiology is the study of associations women with either normal glucose tolerance or pre- and not ascertainment of cause-effect relationships. diabetes. Of the group with normal glucose tolerance, However, these associations have stimulated prospective 105menand57womendevelopedT2Dand240men metabolic research in humans. Dietary and metabolic and 174 women developed prediabetes. Data were ex- approaches were used to ascertain whether consumption amined before and after adjustment for confounding of alcohol and wine causes deterioration of carbohydrate variables (age, BMI, tobacco use, physical activity, tolerance (Table 2). Compared with epidemiologic stud- family history of diabetes, and education). Wine con- ies, the metabolic studies I found were comprised of sumption by men was not associated with either pre- much smaller groups of subjects.
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