From two glasses of wine a day to an advice not to drink at all. How we changed our mind about the dangers of alcohol.

Long-term health outcomes of regular, moderate red wine consumption

Studies that are conducted to assess alcohol’s long-term health outcomes generally report the results as a pooled analysis across all types of alcohol. Questions have been raised regarding potential health differences between types of alcohol, such as beer, wine, or spirits. While these three share the same alcohol in the form of ethanol, they differ in the other compounds they contain that are particular to each type of alcohol, specifically the polyphenols in red wine. The generalizability of pooled results may be limited due to the differences in health outcomes that may exist between different types of alcohol and lead to overall conclusions that differ from the subset analysis by type of alcohol that is often reported in the data tables of an article.

The objective of this systematic review was to specifically address the assessment of the long-term health outcomes of regular, moderate, red wine consumption.
PubMed was searched from 1987 through June 2023. Studies were included if they met all the following criteria: adult participants, red wine consumption and its frequency (close to daily), volume in moderation (1 glass/day for women, 2 glasses/day for men), and measurement of long-term (> 2 years) health outcomes.

Nonclinical animal studies, or studies with an endpoint as a marker or biomarker, without a health outcome, of short duration (< 2 years), small size (< 25 subjects), a focus on binge drinking, no wine analysis performed, review articles, meta-analysis, or editorial/commentary were excluded.

A total of 74 studies met the inclusion/exclusion criteria. Of these, 27 (36%) evaluated cancer outcomes, 14 (19%) evaluated cardiovascular outcomes, 10 (14%) evaluated mortality, 7 (9%) evaluated weight gain, 5 (7%) evaluated dementia, and the remaining 11 evaluated a variety of health outcomes.

There were no studies that demonstrated an association between red wine consumption and negative health outcomes. Forty-seven studies demonstrated an association between red wine consumption and positive health outcomes, whereas 26 studies were neutral, and one had mixed results where women had a positive health outcome and men were neutral. All studies on mortality and dementia showed positive health outcomes.

From this systematic review of the literature, there is no evidence of an association between moderate red wine consumption and negative health outcomes. Across the various outcomes assessed, a beneficial effect of moderate red wine consumption was consistently seen for mortality and dementia, along with certain cancers (i.e., non-Hodgkin lymphoma) and cardiovascular conditions (i.e., metabolic syndrome). For other health outcomes, the association was neutral, i.e., neither harmful nor beneficial, or a mix of positive and neutral.

While this review does not intend to encourage red wine consumption for health outcomes, it does hope to prevent the discouragement of moderate red wine consumption based on broad conclusions drawn from data pooled across all types of alcohol. It must be emphasized that these conclusions are based on moderate consumption levels since health outcomes from red wine tend to follow a J-shaped curve where moderate consumption may offer benefits over abstinence. Beyond-moderate consumption of red wine leads to a potential loss of benefits, and health outcomes become negative with increased consumption.

Even if moderate consumption of red wine is only neutral on health outcomes, the potential positive psychosocial benefits should not be ignored.

How red wine lost its health halo

How our understanding of alcohol and health has evolved

The possibility that a glass or two of red wine could benefit the heart was “a lovely idea” that researchers “embraced,” Dr. Stockwell said. It fit in with the larger body of evidence in the 1990s that linked alcohol to good health.
In one 1997 study that tracked 490,000 adults in the United States for nine years, for example, researchers found that those who reported having at least one alcoholic drink per day were 30 to 40 percent less likely to die from cardiovascular disease than those who didn’t drink. They were also about 20 percent less likely to die from any cause.

By the year 2000, hundreds of studies had reached similar conclusions, Dr. Stockwell said. “I thought the science was in,” he said.
But some researchers had been pointing out problems with these kinds of studies since the 1980s, and questioning if the alcohol was responsible for the benefits they saw.

Perhaps moderate drinkers were healthier than non-drinkers, they said, because they were more likely to be educated, wealthy and physically active, and more likely to have health insurance and eat more vegetables. Or maybe, these researchers added, it was because many of the “non-drinkers” in the studies were actually ex-drinkers who had quit because they had developed health issues.

Kaye Middleton Fillmore, a researcher at the University of California, San Francisco, was among those urging more scrutiny of the research. “It is incumbent on the scientific community to assess this evidence carefully,” she wrote in an editorial published in 2000.
In 2001, Dr. Fillmore persuaded Dr. Stockwell and other scientists to help her sift through the previous studies and reanalyze them in ways that could account for some of these biases.
“I’ll work with you on this,” Dr. Stockwell remembered telling Dr. Fillmore, who died in 2013. But “I was really skeptical of the whole thing,” he said.

As it turned out, the team found a surprising result: In their new analysis, the previously observed benefits of moderate drinking had vanished. Their findings, published in 2006, made headlines for contradicting the prevailing wisdom: “Study Puts a Cork in Belief That a Little Wine Helps the Heart,” The Los Angeles Times reported.

“It upset an awful lot of people,” Dr. Stockwell said. “The alcohol industry took huge steps and spent a lot of money to counteract this rather awkward message that was coming out,” he added. Within months, an industry-funded group had organized a symposium to debate the research, and they invited Dr. Fillmore.
In notes Dr. Stockwell saved, Dr. Fillmore wrote that the discussion was “hot and heavy, such that I felt like I needed to get my shoe off, banging it on the table.”
And when two conference organizers published a summary of the symposium that said that “the consensus of the conference” was that moderate alcohol consumption was associated with better health, Dr. Stockwell said that Dr. Fillmore “was furious” that her views weren’t represented.

Since then, many more studies, including one Dr. Stockwell and his colleagues published in 2023, have confirmed that alcohol is not the health drink it was once believed to be.
In 2022, researchers reported graver news: Not only was there no cardiovascular benefit to drinking alcohol, it could even increase the risk of heart issues, said Dr. Leslie Cho, a cardiologist at the Cleveland Clinic.
Today, more and more research shows that even one drink per day can increase your chances of developing conditions like high blood pressure and an irregular heart rhythm, both of which can lead to stroke, heart failure or other health consequences, she said.

And alcohol’s links to cancer are clear — something the World Health Organization has been stating since 1988.
That’s a very different message from the one patients might have heard from their doctors for years, Dr. Cho acknowledged. But the consensus has shifted.
No amount of alcohol is safe, the W.H.O. and other health agencies have said, regardless of whether you’re drinking wine, beer or liquor.

So, is wine out?

Health halo has faded