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Tsoupras, A.; Ni, V.L.J.; O’mahony, �.; Karali, M. Health Benefits and Detrimental Effects of Wine Consumption. Encyclopedia. Available online: https://encyclopedia.pub/entry/50235 (accessed on 03 July 2024).
Tsoupras A, Ni VLJ, O’mahony �, Karali M. Health Benefits and Detrimental Effects of Wine Consumption. Encyclopedia. Available at: https://encyclopedia.pub/entry/50235. Accessed July 03, 2024.
Tsoupras, Alexandros, Victoria Ling Jun Ni, Éimhín O’mahony, Maria Karali. "Health Benefits and Detrimental Effects of Wine Consumption" Encyclopedia, https://encyclopedia.pub/entry/50235 (accessed July 03, 2024).
Tsoupras, A., Ni, V.L.J., O’mahony, �., & Karali, M. (2023, October 13). Health Benefits and Detrimental Effects of Wine Consumption. In Encyclopedia. https://encyclopedia.pub/entry/50235
Tsoupras, Alexandros, et al. "Health Benefits and Detrimental Effects of Wine Consumption." Encyclopedia. Web. 13 October, 2023.
Health Benefits and Detrimental Effects of Wine Consumption
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This entry is adapted from the peer-reviewed paper 10.3390/fermentation9090838

Wine contains a large quantity of several phenolic compounds and this distinguishes it from other alcoholic beverages, while several microbiota metabolites that are formed after wine consumption by digestion of all wine polyphenols (except stilbenes), further increase the diversity of bioactive phenolic compounds.

wine grape pomace grape seed by-products bioactives phenolics polar lipids anti-inflammatory antioxidant

1. Health-Promoting Effects of Incorporating Moderate Wine Consumption in Diet

The life expectancy in developing countries is continuously increasing, however, there is a resulting rise in the burden of chronic diseases related to age and lifestyle, such as diabetes mellitus, cancer, atherosclerosis and cardiovascular diseases (CVD), neurodegenerative disorders and amyloid diseases, notably Parkinson’s and Alzheimer’s diseases, among others. Numerous studies support that adherence to Mediterranean diet, or to other healthy dietary patterns, can protect against such disorders [1][2]. In recent years, extensive epidemiological studies, for instance, the Health Professionals Study, the Nurses’ Health Study (NHS) and the European Prospective Investigation into Cancer and Nutrition (EPIC) study, as well as their follow-ups, have highlighted the health benefits associated with adherence to healthy diets and the detrimental effects linked to unhealthy dietary habits.
The light to moderate consumption of red wine has been characterised as one of the main characteristics of the Mediterranean diet and is proven to provide protective effects against CVD. Since the Lyon Diet Heart Study, the health benefits of wine consumption, mostly red wine, were initially attributed to the antioxidant protection of lipoproteins and cell membranes due to wine’s rich content in phenolics, as presented by the main PIs of the study, Drs. Michel de Lorgeril and Serge Renaud, on the “60 Min” CBS show in the 1990s. During this show, they also talked about the “French paradox”, the observation of an unusually low rate of heart disease among southern French people who drink a lot of red wine, despite a high-saturated-fat diet, and the theoretically inhibitory effects of wine consumption against lipid peroxidation [3][4][5]. Subsequently, the focus on the benefits of wine consumption was mainly given to its antioxidant potency and cardiovascular protection [3][4][6][7][8][9][10]. Nevertheless, as outlined in the Lyon Diet Heart Study, the components of food and alcoholic beverages included in the Mediterranean diet not only exhibit beneficial properties against lipid peroxidation but they also have an inhibitory effect against platelets’ activation and aggregation [4], which was unfortunately not emphasised during that show and thus was initially neglected by many.
Since inflammation and thrombo-inflammation have been characterised as the main causes of the onset and development of CVD, as well as of several other inflammation-related chronic disorders [1][2][11], it is now well established that, apart from the antioxidant protection, the effects of moderate wine consumption that promote health benefits include mainly 1. beneficial moderation of lipid metabolism, 2. protection against oxidative stress, inflammation, platelet activation–aggregation and thrombo-inflammation, 3. improvement of endothelial function and 4. the modulatory effect on the gut microbiota.
The beneficial effects of moderate wine consumption have been extensively researched, mainly in several epidemiological studies. Recently, several interventions in animal models and humans, including randomised clinical trials, have evidenced that moderate wine consumption with meals based on a Mediterranean diet setting, or as part of other healthy diets, has exhibited health benefits against not only atherosclerosis and CVD [4][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] but also against several other pathologies and all-cause mortality [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65].
Several characteristic studies, interventions and clinical trials are outlined with respect to the benefits of moderate consumption of wine and its bio-functional compounds against inflammation, thrombosis, vascular inflammatory activation and adhesion of leukocytes, endothelial dysfunction, atherosclerosis and CVD [4][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Moreover, other characteristic studies, interventions and clinical trials with respect to the benefits of moderate consumption of wine and its biofunctional compounds against other inflammatory and thrombotic manifestations and inflammation-related chronic disorders, including cancer, metabolic syndrome and diabetes mellitus, gastrointestinal disorders, pulmonary diseases, stroke, neurodegenerative diseases and depression, as well as all-cause mortality, are also presented.
There is vast evidence demonstrating the anti-inflammatory protective effects and health benefits of moderate wine consumption. The most recent epidemiological studies are partly in agreement with the reported outcomes of the benefits of wine consumption, firstly presented in the Lyon Diet Heart study, while numerous clinical studies have now outlined the beneficial effects of wine consumption on inflammatory factors and endothelial function, which are paramount in the manifestation of chronic disorders.
A range of clinical studies have exhibited that the chemical composition of wine, with respect to its bio-functional components and their potential synergism(s), is the main contributor to the health benefits associated with moderate wine consumption. More specifically, the potent anti-inflammatory and antioxidant effects of wine and its bioactive components are major contributors to beneficial health outcomes. Moderate red wine consumption has exhibited anti-inflammatory properties by reducing markers of inflammation and, thus, preventing the likelihood of chronic inflammation. Such benefits are also provided by the positive interactions of wine and its compounds with gut microbiota.
In addition to the anti-inflammatory and antioxidant effects associated with wine and its bio-functional components, the moderate intake of wine can also provide protective effects against the pathogenesis of a range of chronic disorders. The most prominent mechanisms mediating the beneficial effects of moderate wine consumption are the induced enhancement of endothelial function and the counterbalance of inflammation by the synergistic activities of wine bioactives and/or their metabolites against inflammatory biomarkers, mediators and associated thrombo-inflammatory signaling pathways. This includes the reduction of the activities and levels of PAF and of other inflammatory chemokines and cytokines, as well as the down-regulation of monocyte adhesion to endothelial cells and the reduced expression of adhesion molecules. Once these mechanistic pathways are improved by the presence of wine bioactives and/or their metabolites during or just after moderate wine consumption, then all the other mechanisms are also beneficially affected with an overall health benefit against the risk for atherosclerosis, CVD and other inflammation-related chronic disorders.
There are also studies like the Hoorn Study, in which the anti-inflammatory and endothelial protective health benefits of red wine consumption were emphasised in comparison to the other components of the Mediterranean diet. It was suggested that red wine consumption, but not fruit, vegetables, fish or dairy products, was the component that mainly protected against factors involved in the pathogenesis of CVD and other diseases, as it was associated with less endothelial dysfunction and less low-grade inflammation [66].

2. Alcohol-Containing Wine, Quantity Consumed and Detrimental/Beneficial Effects on Health: Is It Really a Debate or Is It a Matter of Re-Definitions and Re-Education?

With respect to the associations of wine consumption and several detrimental effects on health, including cancer, an intense scientific debate exists. Huge epidemiological studies like the Health Professionals Study, the Nurses’ Health Study (NHS) and the European Prospective Investigation into Cancer and Nutrition (EPIC) study and their follow-ups have outlined that alcohol intake is associated with the presence and development of several types of cancers in both women and men, such as cutaneous basal cell carcinoma and colorectal, skin, pancreatic and, mainly, breast cancer [67][68][69][70][71][72]. However, whether an increase in the incidence of cancer is also observed in association with moderate consumption levels has not yet been definitively ascertained.
Based on the findings of such studies that alcohol is a leading risk factor for cancer, it has been observed in other studies that awareness about an alcohol–cancer link is low. Awareness may be influenced by perceptions of potential health benefits of alcohol consumption or certain alcoholic beverage types. A study based on data from the 2020 Health Information National Trends Survey, a nationally representative survey of US adults, estimated awareness of the alcohol–cancer link by beverage type and examined the relationship between this awareness and concomitant beliefs about alcohol and heart disease risk [73]. It was observed that low levels of accurate awareness exist on the cancer harms associated with alcohol use, including wine, beer and liquor consumption. Awareness of the alcohol–cancer link was higher among those recognising that alcohol use increased heart disease risk.
Based on these observations, it has been proposed that the “health halo” surrounding consumption of wine and other forms of alcohol as reducing heart disease risk has lead the public to overgeneralise alcohol’s health benefits to other diseases, including cancer, and this increases the need to address high levels of perceived risk uncertainty to help the public distinguish between the impact of alcohol on heart disease versus cancer and to overcome other barriers to including alcohol use reduction as a cancer prevention strategy [74]. Given recent increases in US population drinking rates, as well as morbidity and mortality associated with alcohol use, it was also proposed that there is a need to educate US adults about the alcohol–cancer link, including raising awareness that drinking all alcoholic beverage types increases cancer risk [73][74].
Although it is clearly established that the abuse of alcohol is seriously harmful to health, much epidemiological and clinical evidence seems to underline the protective role of moderate quantities of alcohol and in particular of wine in health [9]. Wine differs from other alcoholic beverages and its moderate consumption not only does not increase the risk of chronic degenerative diseases but is also associated with health benefits particularly when included in a Mediterranean diet model. Moreover, it is worth mentioning that follow-ups of such epidemiological studies [36][75][76][77] and several other studies and especially interventions and clinical trials have outlined that adherence to a moderate wine consumption pattern provides antitumour protection against several types of cancer.
For example, only heavy (but not light or moderate) consumption of alcohol at baseline is associated with intestinal-type non-cardia gastric cancer risk in men from the EPIC cohort, while such a positive association was not observed specifically for wine consumption [75]. In addition, in a follow-up of the Health Professionals Study on the effects of alcohol consumption on prostate cancer, it was observed that cancer-free men who consumed alcohol had a slightly lower risk of lethal prostate cancer compared with abstainers, and, especially among men with prostate cancer, red wine was associated with a lower risk of progression to lethal disease. It was proposed that these observed associations seem to provide assurance that moderate alcohol consumption is safe for patients with prostate cancer [36]. Moreover, in another follow-up of the Nurses’ Health Study, Nurses’ Health Study II and Health Professionals Follow-Up Study, it was also proposed that in these three prospective cohorts, alcohol consumption was associated with reduced risk of pituitary adenoma, compared to almost no consumption of alcohol [76]. In another very recent follow-up study of the Nurses’ Health Study and the Health Professionals Follow-Up Study, it was also proposed that encouraging an increased intake of specific flavonoid-rich foods and beverages, including tea and red wine, even in middle age, may lower early mortality risk [77]
However, all these effects seem primarily to be associated with the amount of alcohol consumed, while the role of the different alcoholic beverages and of their minor components in this regard is in fact not clearly defined. It seems that the effect of alcohol consumption on cancer and health in general is far more complex, while the type of alcoholic beverage, the quantity consumed and the frequency of consumption, as well as the type of cancer and the overall personalised health status and genetic profile of each individual, seem to also play a significant role in these contradictory associations.
It should be mentioned, however, that wine and wine-derived compounds are promising chemoprotective and chemotherapeutic agents for cancer, as they have been shown to participate in several mechanisms against cancers, including deoxyribonucleic acid damage, oxidative stress, cell proliferation, cell cycle arrest, cell apoptosis, autophagy, inflammation-related cell invasion and metastasis, immunity and metabolism, as well as regulation of multiple signaling molecules and gene expression [1][78].
Due to the presence of such beneficial for health bioactives in wine, it has been proposed that the light to moderate consumption of alcohol in the form of wine (≤1 drink/day for women and 1 to 2 drinks/day for men) is associated with a lower risk of inflammation-related disorders, such as atherosclerosis and CVD, stroke, cancer and type 2 diabetes mellitus and all-cause mortality [1][2][3][4][8][9][10][14][16][17][18][19][22][23][24][25][26][27][28][29][30][31][32][33][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][75][76][77][79][80][81][82][83][84][85][86][87]. Conversely, heavy drinking (>4 drinks/day) is closely correlated with detrimental effects on health and associated with an increased risk of developing cancer, CVD and stroke (both ischaemic and haemorrhagic), among others [67][68][69][70][71][72][73][74][75][76][77][84][85][86]. Among males aged 15 to 59 years, alcohol abuse is perhaps the leading cause of premature death. Excessive alcohol intake trails behind only smoking and obesity and they are the three leading causes of premature death in westernised societies. As such, the risk-to-benefit ratio of drinking is less favourable in younger individuals.
Because of the opposite direction of the association between alcohol consumption and cardiovascular and cancer events, the association with all-cause mortality is complex and J-shaped [84][85][86], with a consumption window theoretically associated with a reduction in all-cause mortality of up to 25 g alcohol per day. The J-shaped curve indicates that light to moderate alcohol consumption leads to lesser risk of chronic disorders than for abstainers and heavy consumers of alcohol, with the latter being at the most risk in terms of health. Most of the studies on alcohol and health are observational, and correlation does not prove causation [67][68][69][70][71][72][73][74][75][76][77], while the recent increase in interventions and trials conducted on wine consumption have provided more robust evidence for the health benefits of wine consumption in moderation. A daily habit of light to moderate drinking is ideal for those who choose to consume alcohol regularly. Red wine before or during the evening meal is linked with the best long-term health outcomes. Subsequently, health care professionals need to advise non-drinkers to begin drinking with caution because of the paucity of randomised outcome data coupled with the potential for alcohol abuse even among seemingly low-risk individuals and the possible interaction(s) of wine bioactives with specific drugs and therapies of elderly people. Moreover, every effort must be made to promote behavioural education to prevent abuse, especially among young people. Additional research is required to evaluate and clarify the doubts that still exist.
For example, in all type of studies, including epidemiological studies, interventions and trials, the abuse of alcoholic beverages has been associated with an increased risk of chronic–degenerative diseases, including diabetes mellitus, so there is a general diffidence towards the low/moderate consumption of wine by individuals with type 2 diabetes or those at risk of developing it. Whether wine/grape derivatives must be excluded or if their low/moderate consumption could be part of the daily diet of individuals with type 2 diabetes is still being studied. Although further intervention studies on the consumption of alcoholic beverages and the development or control of type 2 diabetes are needed, the burden of evidence suggests that, especially for wine, low/moderate consumption seems to provide beneficial effects. It has also been proposed that for older adult drinkers, registered dietitians and physicians may find benefit in inquiring about the specific alcohol types consumed, as opposed to inquiring merely about holistic alcohol intake, as part of patient consultations or routine visits, while they should also encourage older adult alcohol drinkers to consume alcohol in moderation and to consume mainly red wine as part of total alcohol intake in order to help reduce the risk of weight gain, metabolic syndrome, adiposity-associated health risks and diabetes.

3. Concluding Remarks on the Health-Promoting Effects of Wine Consumption in Moderation: From Ancient Times (Religion, Philosophy and Scientific Approaches) to Recent Scientific Evaluation

Wine is actually a mixture of bioactives with unique properties, with a rich and unique composition in terms of polyphenols and other phenolic and non-phenolic bioactive components, such as the wine polar lipid bioactives and UFA, which may contribute to the alleged health effects and to a protective association between low to moderate wine consumption and inflammation-related chronic diseases like CVD, type 2 diabetes and neurodegenerative disorders, while it does not appreciably influence the overall risk of cancer. There is therefore strong scientific evidence from Mediterranean and non-Mediterranean countries that moderate wine consumption as part of a healthy diet can provide protection against all-cause mortality and thus increase longevity.
Bioactive components are not the only reason for the beneficial effects associated with wine consumption; social factors also matter. The Mediterranean diet is a dietary model that is considered healthy because it suggests consuming wine in moderation (up to 1–2 glasses/day for men and 0.5–1 glass/day for women) during meals, especially in the presence of company and during socialising. When consumed during meals with others, wine tends to be sipped more slowly than other alcoholic beverages and this may provide metabolic benefits. In addition, the concomitant presence of food in the stomach slows the absorption of ethanol, aiding metabolism and hepatic clearance and lowering the peak blood alcohol concentration. The concomitant presence of food may also reduce the amount of alcohol available to the oral microbiota, which has the ability to metabolise ethanol to acetaldehyde and thus reduces the produced levels of this compound that, if increased, are associated with the tumour-inducing effects of ethanol in the upper gastrointestinal tract. In addition, the presence of alcohol may improve the bioavailability of wine bioactives in the food bolus, making them more assimilable and possibly reducing glucose bioaccessibility, which is consistent with the hypoglycaemic effects observed in intervention and observational studies of moderate wine consumption [9].
Wine has always accompanied humanity, for religion or for health. For example, wine is mentioned in the Bible, where it is written that Jesus Christ himself chose wine for his Last Supper, and subsequently Christians also use wine for the re-enactment of the “Holy Communion”. The wise King-Prophet David had also emphasised in several of his psalms the benefits of food with wine and oil, with characteristic examples being the 4th (8th verse; “ἔδωκας εὐφροσύνην εἰς τὴν καρδίαν μου· ἀπὸ καρποῦ σίτου, οἴνου καὶ ἐλαίου αὐτῶν ἐπληθύνθησαν”) and 103rd psalms (15th verse; “καὶ οἶνος εὐφραίνει καρδίαν ἀνθρώπου τοῦ ἱλαρῦναι πρόσωπον ἐν ἐλαίῳ, καὶ ἄρτος καρδίαν ἀνθρώπου στηρίζει”). The reason why the original Greek versions of these psalms are presented here is because, unfortunately, the most common English translations of the original Greek phrases used in such important ancient scripts like these psalms, such as “εὐφροσύνην εἰς τὴν καρδίαν μου” and “εὐφραίνει καρδίαν ανθρώπου”, are usually based on simple phrases like “gladdens the heart” in this case.
However, we should not neglect that the Greek language and thus several Greek words, phrases and quotes like the aforementioned ones are conceptual and thus they usually provide a deeper meaning derived from the synthesis of their root words (“εὐ-φροσύνην” and “εὐ-φραίνει” from the origin word “εὐ-”, which means “in a good way (καλώς)”, and the verb “φρονώ”, which means “wisely taking care”). Subsequently, the phrases mentioned in these psalms seem to have a more proper meaning like, for example, “consumption of food with wine and oil wisely takes care and gladdens men’s heart”.
All the above further indicate an in-depth Greek-based philosophy of the Mediterranean diet principles, which is usually characterised by the famous Greek quote “Μέτρον Άριστον” (simply translated as “all things in moderation”, while its more in-depth translation indicates that “using all things in moderation is the best and just way to deal with anything”), first mentioned by the Greek poet Cleobulus of Lindos in the 6th century BC. It has been engulfed since then by all Mediterranean civilizations as a way of life. Moving from religion and philosophy towards a more scientific way of studying such effects, it should also not be neglected that the Greek physician Hippocrates, who incorporated scientific approaches for therapy and thus is now usually characterised as the “father of modern medicine”, had also highlighted that, in one of his quotes, “Wine is a thing wonderfully appropriate to man if, in health as in disease, it is administered with appropriate and just measure according to the individual constitution” [87]. Within the same quote, apart from an appropriate and wise measure of wine administration, Hippocrates also insightfully introduced us to recommendations in a personalised approach to each patient, taking into account other factors too, such as individual constitution and contraindications with other medications.
Since then, and as science moved on, apart from industrialising the winemaking process, only recently has a lot of research been carried out to study wine and its bioactives in order to solve the mystery of its benefits, making wine responsible for the lot of ink that has been spilled to explain the French and/or the Crete paradox. Beyond its cardiovascular effects, there are also beneficial effects of wine on longevity, metabolism, cancer prevention and neuroprotection, when it is consumed in moderation, and the list goes on. Wine acts mostly as an alcoholic solution and is a reserve of antioxidants and anti-inflammatory compounds, especially for the winter, when there usually are no grapes available. Even though several epidemiological studies have suggested an association of alcohol, including alcoholic wine, with cancer and other diseases [67][68][69][70][71][72][73][74][75][76][77], such studies only bring up associations but not evidence. There are also studies proposing health benefits from alcohol-free wines [65], while the plethora of recent interventions and trials have provided more robust evidence for the health benefits of wine consumption in moderation, making researchers suggest that a wine without alcohol is not really wine, rather a “pure heresy” [87].
Wine is the elixir that by design, over millennia, has acted as a pharmacopoeia that has enabled man to heal and prosper on the planet [87]. From Hippocrates to Michel de Lorgeril and Serge Renaud, nutrition has now been considered the key to health and longevity and, whether considering the Cretan, Ikarian or Okinawa diets of the Blue Zones, it seems that small doses of alcohol (either in wine or sake) as a part of such healthy diets allow the appropriate beneficial interaction(s) of the other wine components with gut microbiota and the bioavailability of their bioactive compounds and bio-functional metabolites. Moderate drinking provides protection against diseases and the potential of longevity. In conclusion, as Prof. Poli has suggested, let us drink fewer, but drink better, to live older [87].

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