The red wine paradox: Supposedly the French, in spite of eating a diet high in fat, tended to have a low rate of heart disease. Why? Back in the 1990s the thinking was it was the consumption of red wine which was responsible — but is that true? And, if you don’t drink red wine regularly, should you start in order to protect your heart?

I’ll start off with the answer. No. If you don’t already drink red wine with your meals, don’t start now in the hope that it will protect you from a heart attack or a stroke. It might, but the risks of alcohol consumption probably outweigh the benefits for most of us. Now let’s dive into the details.

The supposed French paradox is really a function of a number of factors that we’ve teased out over the last 30 years.

First, fat isn’t always bad for you so the ‘bad‘ French diet (heavy in cheese etc.) really wasn’t all that nasty. Notice that in the last while we’ve added eggs and poly- and mono-unsaturated fats back into the North American diet recommendations. Olive oil is okay. Butter is back, but in moderation. Processed foods are not good for you at all.

There are a lot of healthful compounds found in red wine: resveratrol, quercetin and a host of other antioxidants, flavonoids and polyphenol compounds that could help protect your heart by making your blood vessels smoother, keeping platelets from clogging them up with clots and have other effects throughout the body. However, no one substance taken by itself — and the classic example is the famous resveratrol — has been shown to have the beneficial effects we’d hoped for.

So, all the studies looking at supplementing with just it or any other flavonoid or polyphenol have failed to live up to expectations. It‘s possible that these different compounds work their magic by working together, but we don‘t know that for certain.

There are other components to this possible red wine benefit. Wine drinkers tend to drink in social gatherings or at meals and we know that social connections are important for our general health and well being. Wine drinkers tend to eat differently than non-wine drinkers and they shop for different foods. That may also be part of what we’re seeing. Also, the French who drank their wine at supper by and large limited themselves to only a single glass or two, and that also was important. Binge drinking (or drinking more than a few glasses of alcohol at a time) has been shown to be bad for you. There’s even a heart rhythm disorder, atrial fibrillation, that’s more common in drinkers especially in they drink a lot at one sitting.

There was an excellent world-wide review published in 2018 in the respected journal, The Lancet, which reminded us about all the bad things that are associated with alcohol consumption — from dangerous behaviour, to accidents, to cancer, to the risk of addiction and liver cirrhosis.

So, if you drink a glass or two of wine with dinner, you need not stop, but if you don’t, don’t start now just because it might protect your heart. The evidence isn’t there to support that.

By the way, it’s possible that white wine and other alcoholic drinks might fall under the exact same analysis. The other warning is that certain groups should not consume wine or alcohol under any circumstances. For example, pregnant and breast-feeding women, people with underlying liver disease or on certain medications and people with a personal or strong family history of problems with addiction or difficulty controlling their intake of alcohol.

Dr. Mitch Shulman is an Assistant Professor, Dept. of Surgery, McGill Medical School and an Attending Physician, Emergency Department, McGill University Health Centre. He’s also the CJAD AM 800 Medical Consultant.

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