HB 490 Introduction to Wine
Lesson 1:
Wine and Health, Wine in History,
Wine and Culture, and Serving
Alcohol Safely

In Vino Sanitas?
Wine (and other alcohols) and Health

The French Paradox
60 Minutes segment in 1991
Mounting epidemiological evidence that moderate consumption of alcohol is associated with
Reduced risk of death
 Particularly by coronary disease
 Red Wine was apparently most beneficial

The “J” shaped curve

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Societal Attitudes
 The French Paradox report came in the midst of a resurgent prohibitionist sentiment
 This sentiment has not disappeared, but is somewhat less prevalent or obvious today Societal Attitudes
 To drink or Not to drink?
 Some believe the healthiest choice is NOT to consume alcohol, while others tout the purported health benefits of alcohol consumption
 Others, yet, acknowledge the apparent health benefits of moderate alcohol consumption, but hesitate to discuss them as they fear this may lead some may become alcohol dependent to start consuming alcohol

Societal Attitudes
Much (dis)information on the issue of alcohol and health!
You must consider the data critically
Interpretations may vary
Research is never fully conclusive
Scientist not always “value free”
Some agencies/authorities have
“agendas”

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Agenda?
 Visit the websites of these organizations and see if you can establish if they have an agenda relative to wine and health Epidemiology
Epidemiology is the scientific study of factors affecting the health and illness of individuals and populations, and, in this capacity, it serves as the foundation and logic of interventions made in the interest of the public’s health

Epidemiology
 Epidemiologist have studied if and how wine and other alcohols affects health.
 Large populations have been studied
 Epidemiological studies are by nature usually not controlled studies
 Many populations have been studied:
 Europe, North America, Japan, Australia, Israel, Iceland,
...
 Great demographic variety

 The studies point to the J-shaped curve!

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Safe Limits
Moderate versus excessive
Often poorly/ill defined

Many variables influence tolerance
Size, gender, habit, medication, food, pregnancy, nursing and diseases
Safe limits
Are defined as per medical concerns
Not as per performance or social concerns

Safe Limits
 Safe upper limits moderation) is determined by the threshold for liver damage
 Healthy men: 40 grams of ethanol/day
 Healthy women: 24 grams of ethanol/day
 Not in the form of binge drinking
 Protective effects come from the spread!
 B.t.w.: Ethanol is a.k.a. ethyl alcohol

Safe Limits
One regular bottle of wine contains 75 cl (0.75 liter) which is just over 25 ounces While there is significant variation in the alcohol content of wine, a typical bottle of table wine will contain about 72 grams of alcohol 2.8 gr./oz.

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Safe Limits
14 ounces of wine is the safe daily potable portion for men
Which is the same as
3.25 ounces of 80 proof (40 percent) liquor
32 ounces (1 quart) of 4-6% alcohol beer
 Or about three servings

Safe Limits
The average man can metabolize 1.753.5 ounces of wine per hour
Women on average experience liver damage at 60% of mens' volume.

Safe Limits
Food helps metabolize
Even if eating takes place after drinking

Food
Less subjective intoxication
Lower peak BAC
Speedier metabolizing

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Metabolizing Alcohol
Alcohol dehydrogenase
Is an enzyme that detoxifies alcohol and assists in the metabolizing of alcohol
Women have roughly 60% of the alcohol dehydrogenase levels of men

http://www.rcsb.org/pdb/molecules/pdb13_1.html

Metabolizing Alcohol
Levels of alcohol dehydrogenase
Are reduced by
Fasting
Anti-histamines
Ulcer medicines that reduce gastric flows
Aspirins and other analgesics

What is Moderation?

How Many Drinks?

In the US, drinking in moderation means one glass for women, and one to two glasses for men. The definition of moderation is different in the United Kingdom and European Union, however. The "sensible limits" in the UK and
EU are two to three glasses of red wine per day for women and three to four glasses for men.

By now you may be wondering how many drinks is considered safe! For healthy men 1-2(3) drinks per day
Ideally with food

For healthy women 1-1.5 (2) drinks per day
Ideally with food

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How Many Drinks?
Men and women 65 and older shouldn't drink more than one drink a day
Age-related changes make older adults process alcohol more slowly, leading them to become intoxicated more quickly and increasing alcohol's damaging effects.

What is a Drink?
A drink is defined as
12 fluid ounces of beer
5 fl. oz. of wine
1.5 fl. oz. of 80-proof distilled spirits
or

1.0 fl. oz. of 100-proof distilled spirits

Safe Limits?
Considering that 10-14% of the population are potentially future alcohol dependents, is there such a thing as a safe amount?

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French Paradox
Let’s look closer at the French paradox
Some would suggest the French are less health conscious than Americans.
They generally eat fattier foods, smoke more, and exercise less!

French Paradox
Compared to the US, the French consume much more wine per capita.
According to The Wine Institute, in 2002 the French consumed on average 57.17 liters of wine, while we in the US consumed on average 8.77 liters of wine. French Paradox
 While the average French person in 2002 consumed about 6.5 time the amount of wine that the average American did, you should know that French per capita consumption is declining, while US consumption is increasing.  At the time of the initial French paradox research, the French consumed about 14 times the US level.
 In terms of other alcohols, the French consume a tad less beer and about the same amount of liquor.

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French Paradox
French/American mortality per 100,000 in the 1990s:
Coronary mortality
France 80
USA 185

Cirrhosis mortality
France 40
USA 30

Total mortality:
France 780
USA 900

French Paradox
 Dairy fat consumption is highly correlated with coronary heart disease (CHD)
 Yet researchers found that some French cities with very high dairy fat consumption had lower CHD rates than others
 On closer examination they found wine consumption to be a negative correlate with CHD and to be higher in these French cities
 Thus the “French Paradox”

French Paradox
 Further research has confirmed that wine consumption is a negative CHD correlate
 Note: The same body of research established that fruit consumption lowers CHD
 Keep in mind that your total mortality may not be reduced
 You may die from other causes!

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French Paradox
 Studies that considered consumption rates found the lowest total mortality was among those that consumed moderate amounts of alcohol  J-curve again!

 Both wine consumption and overall alcohol consumption are negative CHD correlates
 Wine r = -.66
 Overall alcohol r = -.39

 Wine appears to be particularly beneficial

Cardiovascular Disease
Heart Attacks
Blood clots (thrombosis)
Most common cause of cardiovascular death

While thrombosis may appear suddenly, it often has a prolonged genesis
Heredity, gender, habits, other disease
(diabetes), lipids (fat), cholesterol (LDL) deposits, aging, arteriosclerosis, . .

Cardiovascular Disease
 How does wine protect?
 Alcohol
 Alters the balance of fat in the blood
 Inhibits coagulation and clotting

 Polyphenols/flavonoids of wine (bitter and astringent elements)
 Are antioxidants (help wine age well)
 Inhibit LDL
 Inhibit clotting
 Reduce the narrowing of blood vessels by relaxing the blood vessel wall

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Cardiovascular Disease
Blood Fats: Good and Bad Cholesterol
Fats are carried in the blood by water soluble lipoproteins
LDL (low density lipoproteins) a.k.a. “bad: cholesterol form deposits in blood vessels
HDL (high density lipoproteins) a.k.a. “good” cholesterol leach out the lipids from the blood vessels walls and takes them to the liver for excretion; protects against arteriosclerosis

Cardiovascular Disease
Alcohol
Increases HDL production
Increased HDL is associated with cardiac health Appears to
Increase lipase production
 Lipase an enzyme that removes lipids

Decrease LDL production
Decreases triglyceride (blood fat) levels


A naturally occurring ester of three fatty acids and glycerol that is the chief constituent of fats and oils.

Relax blood vessels; decrease constriction

Cardiovascular Disease
Antioxidants
Compounds that neutralize oxidation Phenols/Flavonoid

Limited, but increasing, knowledge
Antioxidants prevent LDL production/deposits
 LDL deposits are oxidized cholesterol

Some evidence suggests that phenols
 Increase HDL production
 Relax blood vessels; decrease constriction

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Cardiovascular Disease
Most phenols are in the grape skin
Red wine has the most
(Cabernet in particular!)

White wine less
 Beer trivial amounts
 Spirits none

Other sources of phenols include
Allium vegetables (onions), broccoli, tea

Cardiovascular Disease
Blood clots are an integral part of heart attacks (myocardial infarction)
If we can reduce blood’s clotting tendency without inviting a hemorrhage we are likely to reduce cardiovascular risks (Source: American Heart Association)

Cardiovascular Disease
Wine (and aspirin) may be helpful in reducing blood clots
Get your physicians advice!

Wine
Inhibits blood platelet functions
Inhibition was NOT found when non-alcoholic wine was used

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Cardiovascular Disease
Fibrinogen
A blood protein that enhances coagulation
Used as a measure of coronary risk

Alcohol
Reduces fibrinogen activity
One study suggested that wine taken with the evening meal will increase the fibrinolytic activity (de-coagulation) the following morning
 Most heart attacks take place in the morning

Cardiovascular Disease
Alcohol can damage the heart muscle
If alcohol is consumed consistently at or above a level of 80 grams per day (28 ounces of wine, 6.5 ounces of liquor, 2 quarts of beer)

For alcoholics cardiomyopathy can occur much sooner

Cardiovascular Disease
Blood pressure
Follows the “J” shaped curve

Stroke
Ischemic strokes (85%)
Blood supply is obstructed by an arteriosclerotic clot or embolus (travelling clot)

Hemorrhagic stroke (15%)
Rupture of diseased blood vessel

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Cardiovascular Disease
Ischemic strokes
Follows the “J” shaped curve
Moderate alcohol consumption reduced ischemic stroke risk 20% over no-consumption

Hemorrhagic stroke
Induced by excessive drinking

Intracerebral hemorrhage

The Blood Itself
 Red cells transport oxygen and waste, white cells fight infections and the platelets are part of the clotting process
 The cells are produced in the bone marrow

 Excessive drinking
 Damages the bone marrow
 Weakness and cardiac stress through anemia
 Impaired infection defense

Illustration by Gilles/Photo
Researchers.

 Leukopenia

 Not enough platelet production; severe bleeding

Infections and Immunity
The data are ambiguous
It is clear that excessive drinking leads to immune deficiencies and increased infections Newer research suggests
While alcohol consumption generally is associated with immune system suppression, moderate consumption of red wine has no suppressive effect

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Cancer
Alcohol is a carcinogen
Heavy drinking is clearly associated with cancer of
The mouth, pharynx, larynx, esophagus, stomach, liver, and colon

Cancer
Breast cancer and alcohol
Knowledge is still fragmentary
Many conflicting studies
Some find negative associations
Some find no association
Some find a positive association

Check out >>>>>>>> , and >>>>>>>> for current in-depth perspectives

Cancer
All women are at some risk for breast cancer: 11-12%
2-3 glasses of wine per day may increase risk to 14-15%
Perspectives on interpretation:
3-4% increase
36% increase over initial risk percentage

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Cancer
Cancer of the large intestine may be linked to alcohol consumption
Inconclusive
Beer has been indicted

Cancer of the pancreas
Most often fatal
Typically a result of Pancreatitis
Pancreatitis is often the result of alcohol abuse Cancer
Is wine beneficial?
Some studies have suggested that wine’s antioxidant properties may protect against cancer Still inconclusive

Mothers and Babies
 Emotionally charged
 Servers have denied wine to pregnant women

 Heavy drinking, or binge drinking, is clearly related to fetal alcohol syndrome
 Low amounts have been found related to less severe effects known as fetal alcohol effects
 Symptoms persist after birth

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Mothers and Babies
FAS and FAE
10-20% of mental deficiencies
1/6 of cerebral palsy

One (1) study found an inverted “J”
Moderate alcohol consumption provided the best birth weight

To be safe, don’t drink when pregnant
Beer most culpritious

Mothers and Babies
Smoking exasperates negative alcohol effects
Moderate drinking when nursing seems benign if the mother allows the wine to clear her system before breast feeding

The Elderly
Defined as those over 65
Restraint may be prudent
Smaller margins of error
Interactions with medication
Don’t start now

The “J” curve applies

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The Elderly
Moderate consumption
Increased neuromuscular function relative to abstainers
Better mental function than abstainers or heavy drinkers
Less development of dementia

Greater pleasure

The Brain and Nervous
System

Intoxication

For non-alcoholics
 BAC above 0.03% may be associated with mild intoxication
 Altered mood, impaired reasoning and coordination

At BAC 0.06% motor (vehicle) performance is impaired BAC 0.1%-0.08% is legal intoxication in most states BAC above 0.64% leads to respiratory depression and death

The Brain and Nervous
System

Mellanby effect

Acquired tolerance

Blackout
Occurs from rapid consumption of large volumes of alcohol

Alcohol withdrawal
Tremor, vomiting, insomnia, agitation, confusion, hallucination, seizure, delirium tremens 18

The Brain and Nervous
System
A wide range of illnesses impact the chronic abuser

Other Toxins in Wine?
Sulfites
Naturally occurring
Anti-microbial compound
Anti-oxidant

Up to 350 parts per million are considered safe 0.5% have severe reactions to sulfites
Anaphylaxis, asthma

Other Toxins in Wine
Lead
Lead salts after lead capsules
Lead-crystal decanters
Are not good for long term storage!
Lead effects
 From behavioral problems and learning disabilities, to seizures and death.

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Other Health Effects
 Macular degeneration
 The visual cells of moderate wine drinkers have been found to be 20% better preserved than those of non-drinkers or drinkers of other alcoholic beverages  Bone density
 Heavy drinkers are prone to fracture
 Moderate drinking has been associated with increased density

 Diabetes
 Moderate consumption has been associated with a decrease in diabetes developing in adults (Noninsulin dependent diabetes)

Drug Interactions!
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Antibiotics
Anticoagulants
Antidepressants
Anti-diabetes
medications
Antihistamines
Anti-seizure medications Beta blockers
Pain relievers
Sleeping pills

 Alcohol and aspirin
 Increased risk of gastrointestinal bleeding.

 Alcohol and acetaminophen (Tylenol, others)

 Increased risk of liver damage. Alcohol and Health Summary
 Pros
 Moderate alcohol consumption may provide some health benefits. It can:
 Reduce your risk of developing heart disease, peripheral vascular disease and intermittent claudication
 Reduce your risk of dying of a heart attack
 Reduce your risk of strokes, particularly ischemic strokes
 Lower your risk of gallstones
 Possibly reduce your risk of diabetes
 Maintain eyesight and bone density

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Alcohol and Health Summary
 Cons
 Excess alcohol consumption can lead to serious health problems, such as:
 Cancer, such as gastrointestinal, oral, pharynx, larynx, esophageal and liver cancers, as well as breast cancer in women  Chronic Pancreatitis, especially in people with high levels of triglycerides in their blood
 Elevated levels of triglycerides in the blood
 High blood pressure
 Miscarriage
 Injuries due to impaired motor skills
 Sudden death in people with cardiovascular disease;
 Heart failure; Stroke
 Alcoholic cirrhosis of the liver
 Fetal alcohol syndrome in an unborn child, including slow growth and nervous system problems
 Suicide

Some Wine and Health resources in addition to your text:
 Finkel H. E. (1998) In Vino
Sanitas? Savage, MD:
Society of Wine Educators.
 Robinson, J. (ed.) (1999),
The Oxford Companion to
Wine (1999).
 Waterhouse, A.L. (1995),
Wine and Heart Disease,
Chemistry & Industry, 1 May,
338-341.

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

www.MayoClinic.com http://wine.about.com http://www.intowine.com http://heart.bmjjournals.com/cgi/ content/full/90/1/107 http://winemag.wineenthusiast.c om/ISSUES/FEB03/FRENCHP
ARADOX.HTM
http://www.drinkingandyou.com/ site/uk/health/doctor.htm http://www.annalsnyas.org/cont ent/vol957/issue1 http://209.209.34.25/webdocs/W ine%20and%20health%20webp age

Wine in History
A bit about early winemaking

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Wine in History
• Wine is older than recorded history
• It may be as old as humanity
– Apes seek out fermenting fruits
– Is there any reason to think our ancestors were less adept?

Wine in History
• Wine was not invented by mankind
• All that is needed is for a ripe grape to encounter – Yeast
• Minimal amounts on the grape skins
• Copious amounts are airborne

First Wine?
• While it is impossible to date the first wine, we infer from historical records/artifacts: – 6000-5000 BC
• Wine was made in Sumeria/Mesopotamia and in the Caucasus near the Black Sea

– About 3000 BC
• Wine was used in Egypt and Phoenicia

.

Early Dynastic "wine jar" and stopper from a royal tomb at Abydos, Egypt

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First Wine?
– In 2000 BC wine was made in Greece
– By 1000 BC wine making had reached
Italy, Sicily and North Africa
– By 500 BC wine making spread to Spain,
Portugal, France and Southern Russia
– By 100 AD the Romans brought wine making throughout Europe even as far as
Britain

Wine in History
• Code of Hammurabi (King of Babylonia) in 1780 BC

Wine in History
• The Dark Ages
– From the fall of Rome in the fifth century
A.D. to the restoration of relative political stability around the year 1000. The earliest part of the Middle Ages
– Wine making was kept alive mainly through the efforts of Christian monasteries.
• The Benedictines and The Cistercians

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Wine in History
• During the Middle Ages wine was still considered to be a staple of the daily diet. – Safest to drink and fairly stable
• While beers were being made, they were not as stable (no hops yet).

Wine in History
• Charlemagne,
King of the Franks (768-814) was crowned Holy Emperor of Rome in AD
800.
– Seen as most influential in returning civilization to order and prosperity.
– He decreed that in making wine, grapes should not be stomped by foot nor should wine be stored in animal skins

USA Wine History
• Earliest documented:
– French Huguenots
• 1500s
• Jacksonville, Florida

– Brought Vitis Vinifera
• Failed:
– Phylloxera Vastatrix

– Tried to make wine from Vitis Rotundifolia
• a.k.a. Muscadine or Scuppernong
– “Virginia Dare”

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USA Wine History
• 990-1000 A.D.
– Leif Ericson and friends
• “Vinland” (New Foundland?)
– German onboard

• Early British documents
– Lured settlers
• Native and European vines

USA Wine History
• Thomas Jefferson & William Penn
– Promoted Winery establishments

• Early Spanish vineyards?
– Vineyards planted in CA in 1769

• First commercial winery:
– The Pennsylvania Vine Company (1793)
• Used a Vitis Labrusca: Alexander

– The Ohio River Valley followed
• Sparkling wines from native vines

USA: Dark Ages
• Prohibitionist Party 1869
• Kansas 1880s
• The 18th amendment
– Prohibition
• 1919 to 1933

– Many counties are still dry
– State and Federal bureaucracies

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USA: “Better” Years
• Until the 1960s
– Wine a “suspect” beverage

• In the 60s and 70s
– East Coast held sway:
• Simple wines appeal to simple tasters
• 85% from CA, mostly plonk
– In Europe too?
» Most popular: Mateus and Blue Nun

USA Wine History
• The Paris Tastings of 1976
– Steven Spurrier

• Fourth largest producer (2005)
• Current wine consumption
– The Wine Institute calculates wine consumption to be
• 2.3 gallons per head in 2001

– 2.43 gallons in 1985/6

Wine and Culture

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Wine and Culture
• Wine connects us with Mediterranean culture and traditions
• Wine was first the drink of the Priesthood
• Subsequently the wealthy also partook
– To come “closer to the gods”

• Medical uses
– Solvent, cleaning agent, antiseptic, purifier, therapeutic value, . . .

Wine and Culture
• Wine a part of everyday life
– Particularly in Europe
– Increasingly important elsewhere

• Wine and parenting
– Less abuse

• Wine and the Good Life

Wine and Culture
• Wine knowledge in business and social settings demonstrates savoir faire
• Wine a social lubricant
• Peynaud: “. . . wine demands attention and contemplation . . .”
• Tasting and appreciation encourages moderation 27

Wine and Culture
.
 Offers the following research observations:
 Research has revealed low incidence of alcoholism or alcohol abuse among cultural groups who use alcohol as part of their daily lives. As a rule these groups have developed attitudes and habits to foster responsible drinking within their culture. Some of these attitudes follow:  1. Children are exposed to alcohol early in life, within an established family or religious context. Whatever the beverage, it is served diluted and in small quantities, with consequent low blood-alcohol levels.
 2. The beverages used are commonly those containing large amounts of non-alcoholic components (wines or beers), which help to retain low blood-alcohol levels.
 3. The beverage is considered mainly as a food and is usually consumed with meals.

Wine and Culture
.
 Offers the following research observations:
 4. Parents present a constant example of moderate drinking.  5. No moral importance is attached to drinking. It is considered neither a virtue nor a sin.
 6. Drinking is not viewed as proof of adulthood or virility.
 7. Abstinence is socially acceptable. It is no more rude or ungracious to decline a drink than to decline a piece of cake.  8. Excessive drinking or intoxication is not socially acceptable and is not considered stylish, comic, or tolerable.  9. Alcohol is not a prime focus for any activity.
 10. Finally, and perhaps most importantly, there is wide and usually complete agreement among members of the group on the ground rules of drinking.

Serving Alcohol Safely

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Serving Alcohol Safely
Remember our earlier discussion regarding the rates at which we metabolize alcohol.
These rates suggest that different people will feel the impact of alcohol differently
Peak alcohol levels vary:
Fasting: 30 minutes to 2 hours
Non-fasting: 1 hour to 6 hours

Serving Alcohol Safely
Most of us feel the maximum relaxation when our BAC is at 0.05%
Most states have BAC limits for driving or operating machinery at 0.1% or 0.08%
Some countries have limits as low as 0.03%, or tolerate NO blood alcohol at all when operating machinery or vehicles!

Commercial drivers are often held to higher
(lower BAC) standards

Serving Alcohol Safely
With this in mind, what is your responsibility? As a host in your home?
As a “host” in a commercial establishment?
If you serve alcohol, are you responsible for the safety of a) your guests, b) anyone they may encounter while driving or operating machinery,
c) your home or establishment, d) your staff, e) your family, or f) yourself?

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Serving Alcohol Safely
I believe you need to ensure that you serve alcohol with care, remembering that different people have different metabolic rates
ROT: Most people will be able to dispose of one drink per hour

Serving Alcohol Safely
 The U.S. Department of Human Health and their Substance Abuse and Mental Health
Services Administration provide the following
BAC charts that can be used as guidelines.
 http://www.health.org/nongovpubs/bac-chart/
 How few drinks would you need to consume to reach a
BAC of 0.05%?

Serving Alcohol Safely
Whether serving alcohol in the privacy of your home, or as an employee of a hospitality company, the following are some suggestions that will help keep all happy and safe.

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Serving Alcohol Safely
 Serve Food
 Roughly 20-25% of alcohol is absorbed in the stomach while 75-80% is absorbed in the small intestine. Food slows down the absorption of alcohol by delaying gastric emptying and leads to a delayed and lowered peak BAC
 Harder to digest foods, such as proteins, may increase this effect
 Volume is more important

 Salty foods increase beverage consumption

Serving Alcohol Safely
Serve Water
Non-alcoholic alternatives, such as water, are ideal for quenching thirst. In addition, as they provide an alternate to the alcohol, and alcohol consumption may decline.

Avoid carbonated beverages or mixers
Carbonated beverages speed up alcohol absorption

Serving Alcohol Safely
Offer low-alcohol alternatives
Alcohol content varies greatly!

Stop serving alcohol before the party is over and people are leaving
Offer non-alcohol alternatives
Coffee and Tea

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Serving Alcohol Safely
Keep an eye on your guests
Watch for signs of intoxication and slow or stop service as needed
If you know your guests you can tell when they start to act differently
If you do not know the folks you are serving its is good advice to spend some time with them as they arrive to establish a behavioral baseline

Support designated drivers

Signs of Intoxication
 Slurred speech
 Staggering, swaying, stumbling, clumsiness
 Sudden behavioral changes  Increases in drink size
 Careless handling of money  If smoking
 Multiple lit cigarettes
 Unattended cigarettes
 Cigarettes lit by the wrong end


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Rambling
Lack of concentration
Spilling drinks
What else?

Stopping Service?
If you find you need to stop serving alcohol to someone, in a commercial or private setting, the following may be helpful 32

Stopping Service?
 Be polite, courteous, yet firm
 Do not label the guest
 Make use of his/her friends
 Have back-up, and if in a commercial setting, alert the manager first
 Get the person home safely.
Provide/find transportation.
 Point to your own liability and responsibility
 If the guest is uncooperative, you may need the help of police

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