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Thursday, March 15, 2007

Red, Red Wine

I am a believer in the value of a modest intake of alcohol in the form of red wine.

Some people cannot drink alcohol because they have addiction or other medical/ideological reasons for abstinence. For the rest of us the evidence is becoming fairly clear that a moderate regular intake of alcohol is beneficial, particularly for type 2 diabetics. The benefits appear to be enhanced if the alcohol of choice is dry red wine.

At the foot of this post I have given a brief sample of a search on HighWire using the following terms: "red wine" diabetes "type 2". Even I was surprised at the result, particularly with the findings of more recent research. So I've included the links for those who are interested, as well as some excerpts from some selected papers.

I usually drink dry red wine. I have found that many people don’t understand the term "dry". It simply means "not sweet". Fortified wines such as port, or dessert wines such as sherry or tokay, or sweet fruity wines such as lambrusco or most white wines, aren’t suitable for me because the sugars in them raise my blood glucose. The only white wines I can drink are the very dry Sauvignons Blanc or Chablis styles.

In essence I drink dry red wine for the following reasons:

1. I like it. That’s important. If you don't like wine, don't start. I shudder at the thought of having to "take it as a medicine".
2. It appears to assist in blood glucose control when taken with meals.
3. It appears to improve my cardiovascular health, based on my own lab reports since I added it to my menu after diagnosis.
4. Red wines include some specific benefits over other alcoholic drinks and white wines because of their unique resveratrols and flavinoids.

The studies I’ve included in the links below tend to support the possibility that I’m not unique in seeing those benefits.

Any proposed changes in your alcohol consumption should be discussed with your doctor first. There may be other reasons for abstinence, apart from addiction, that your doctor is aware of. However, don’t automatically accept warnings against alcohol on medication packets - metformin is just one example – discuss those with your doctor to see if it applies in your individual situation.

The various studies aren't in agreement on "moderation". The definition appears to lie between one and three "standard" glasses daily for a male and half that for a female; personally I imbibe about a half-bottle of dry red daily which equates to 300-400ml. If in doubt your doctor will advise on that.

Cheers Alan, T2, Australia.

A PS, added 24th April '07.

I also have CLL, a type of leukemia. I became aware of this report today:
“Antioxidant found in many foods and red wine is potent and selective killer of leukemia cells
A naturally occurring compound found in many fruits and vegetables as well as red wine, selectively kills leukemia cells in culture while showing no discernible toxicity against healthy cells, according to a study by researchers at the University of Pittsburgh School of Medicine.”
I believe that this is the original study:
“These results indicate that cyanidin-3-rutinoside have the promising potential to be used in leukemia therapy with the advantages of being wildly available and being selective against tumors.”

PPS, added 20th March 2013: The Relationship Between Alcohol Consumption and Vascular Complications and Mortality in Individuals With Type 2 Diabetes Mellitus 

"RESULTS During a median of 5 years of follow-up, 1,031 (9%) patients died, 1,147 (10%) experienced a cardiovascular event, and 1,136 (10%) experienced a microvascular complication. Compared with patients who reported no alcohol consumption, those who reported moderate consumption had fewer cardiovascular events (adjusted hazard ratio [aHR] 0.83; 95% CI 0.72–0.95; P = 0.008), less microvascular complications (aHR 0.85; 95% CI 0.73–0.99; P = 0.03), and lower all-cause mortality (aHR 0.87; 96% CI 0.75–1.00; P = 0.05). The benefits were particularly evident in participants who drank predominantly wine (cardiovascular events aHR 0.78, 95% CI 0.63–0.95, P = 0.01; all-cause mortality aHR 0.77, 95% CI 0.62–0.95, P = 0.02). Compared with patients who reported no alcohol consumption, those who reported heavy consumption had dose-dependent higher risks of cardiovascular events and all-cause mortality. 

CONCLUSION In patients with type 2 diabetes, moderate alcohol use, particularly wine consumption, is associated with reduced risks of cardiovascular events and all-cause mortality"

Once again moderation is the key.

Further reading:

HighWire Red Wine Search

Links to papers and articles for those who want to read further:

Am J Physiol Heart Circ Physiol 288: H2023-H2030, 2005.
First published January 14, 2005; doi:10.1152/ajpheart.00868.2004
Antiatherogenic potential of red wine: clinician update
"Complications of atherosclerosis remain the leading cause of morbidity and mortality in industrialized countries. Epidemiological studies have repeatedly demonstrated that
moderate alcohol intake has a beneficial effect on cardiovascular disease. The purpose of this review is to examine the epidemiological and biological evidence supporting the intake of red wine as a means of reducing atherosclerosis. On the basis of epidemiological studies,
moderate intake of alcoholic beverages, including red wine, reduces the risk of cardiovascular, cerebrovascular, and peripheral vascular disease in populations. In addition to the favorable biological effects of alcohol on the lipid profile, on hemostatic factors, and in reducing insulin
resistance, the phenolic compounds in red wine appear to interfere with the molecular processes underlying the initiation, progression, and rupture of atherosclerotic plaques. Whether red wine is more beneficial than other types of alcohol remains unclear. Definitive data from a
large-scale, randomized clinical end-point trial of red wine intake would be required before physicians can advise patients to use wine as part of preventative or medical

Diabetes Care 28:2933-2938, 2005
Alcohol Consumption and Risk of Type 2 Diabetes Among Older Women
"CONCLUSIONS-Our findings support the evidence of a decreased risk of type 2 diabetes with moderate alcohol consumption and expand this to a population of older women."

Diabetes Care 27:1369-1374, 2004
Acute Alcohol Consumption Improves Insulin Action Without Affecting Insulin Secretion in Type 2 Diabetic Subjects
"CONCLUSIONS-Acute alcohol consumption improves insulin action without affecting ß-cell secretion. This effect may be partly due to the inhibitory effect of alcohol on lipolysis. Alcohol intake increases insulin sensitivity and may partly explain both the J-shaped relationship between the prevalence of diabetes and the amount of alcohol consumption and the decreased mortality for myocardial infarction."

The Journal of Clinical Endocrinology & Metabolism Vol. 90, No. 2 661-672 doi:10.1210/jc.2004-1511
Beneficial Postprandial Effect of a Small Amount of Alcohol on Diabetes and Cardiovascular Risk Factors: Modification by Insulin Resistance
"Alcohol enhanced the postprandial increase in energy
expenditure 30-60 min after the LC meal (increase, 373 ± 49 vs. 236 ± 32 kcal/d; P = 0.02) and HC meal (increase, 362 ± 36 vs. 205 ± 34 kcal/d; P = 0.0009), but suppressed fat and
carbohydrate oxidation. Some of our findings may be mechanisms for lower diabetes and cardiovascular risks in moderate drinkers."

Diabetes 50:2390-2395, 2001
A Prospective Study of Drinking Patterns in Relation to Risk of Type 2 Diabetes Among Men
"Using data from a 12-year prospective study, we determined the importance of the pattern of alcohol consumption as a risk factor for type 2 diabetes in a cohort of 46,892 U.S. male health professionals who completed biennial postal questionnaires. Overall, 1,571 new cases of type 2 diabetes were documented. Compared with zero alcohol consumption, consumption of 15-29 g/day of alcohol was associated with a 36% lower risk of diabetes (RR = 0.64; 95% CI 0.53-0.77).

This inverse association between moderate consumption and diabetes remained if light drinkers rather than abstainers were used as the reference group (RR = 0.60, CI 0.50-0.73). There were few heavy drinkers, but the inverse association persisted to those drinking >=50 g/day of alcohol (RR = 0.60, CI 0.43-0.84). Frequency of consumption was inversely associated with diabetes. Consumption of alcohol on at least 5 days/week provided the greatest protection, even when less than one drink per drinking day was consumed (RR = 0.48, CI 0.27-0.86). Compared with infrequent drinkers, for each additional day per week that alcohol was consumed, risk was
reduced by 7% (95% CI 3-10%) after controlling for average daily consumption. There were similar and independent inverse associations for beer, liquor, and white wine. Our findings suggested that frequent alcohol consumption conveys the greatest protection against type 2 diabetes, even if the level of consumption per drinking day is low. Beverage choice did not alter risk."

(Circulation. 2000;102:494.)
Moderate Alcohol Consumption and Risk of Coronary Heart Disease Among Women With Type 2 Diabetes Mellitus
"Conclusions-Although potential risks of alcohol consumption must be considered, these data suggest that moderate alcohol consumption is associated with reduced CHD risk in women with diabetes and should not be routinely discouraged."

Diabetes Care, Vol 15, Issue 4 546-548, Copyright (c) 1992 by American Diabetes Association
Short-term effect of red wine (consumed during meals) on insulin requirement and glucose tolerance in diabetic patients
"CONCLUSIONS--Moderate prandial wine consumption has no adverse effect on the glycemic control of diabetic patients. Thus, it appears unnecessary to proscribe the consumption of
red wine in moderation with meals to diabetic patients. Wine contains tannins and phytates that can explain its action."

Meal-Generated Oxidative Stress in Diabetes
The protective effect of red wine
"Our data show that red wine is able to preserve plasma from meal-induced oxidative stress in diabetes, suggesting that moderate consumption of red wine during meals may have a beneficial effect in decreasing the risk of cardiovascular disease in diabetic patients."

JAMA Vol. 282 No. 3, July 21, 1999
Alcohol Intake and the Risk of Coronary Heart Disease Mortality in Persons With Older-Onset Diabetes Mellitus
"Conclusion. Our results suggest an overall beneficial effect of alcohol consumption in decreasing the risk of death due to CHD in people with older-onset diabetes."

"Am J Physiol Heart Circ Physiol 288: H2023-H2030, 2005.
First published January 14, 2005; doi:10.1152/ajpheart.00868.2004
Antiatherogenic potential of red wine: clinician update
"Complications of atherosclerosis remain the leading cause of morbidity and mortality in industrialized countries. Epidemiological studies have repeatedly demonstrated that moderate alcohol intake has a beneficial effect on cardiovascular disease."

Finally, an interesting one specifically on resveratrol, a red wine component, and the insulin system.
Am J Physiol Endocrinol Metab 290: E1339-E1346, 2006. First
published January 24, 2006; doi:10.1152/ajpendo.00487.2005
Resveratrol, a red wine antioxidant, possesses an insulin-like effect in streptozotocin-induced diabetic rats
"Aberrant energy metabolism is one characteristic of diabetes mellitus (DM). Two types of DM have been identified, type 1 and type 2. Most of type 2 DM patients eventually become insulin dependent because insulin secretion by the islets of Langerhans becomes exhausted. In the present study, we show that resveratrol (3,5,4'-trihydroxylstilbene) possesses hypoglycemic and hypolipidemic effects in streptozotocin-induced DM (STZ-DM) rats."

Note that I prefer to wait for the human trials confirmation - but it is the first time I've seen this effect of resveratrol noted anywhere.


Robin said...

Don't you know, coffee and red wine have to be bad for you. Everyone will as the first thing, regardless of your health problem, wisely advise you to reduce coffee and alcohol consumption. And so you can quote studies not supporting this advice, as soon as they do the right one, I know it will say, no coffee, no red wine.

ps favorite place in house is visit to wine cellar, second only to coffee maker

Venkat said...

Alan, Thanks for posting this article on Dry Red Wine and its benefecial effects on your Type II diabetes.

Personally for me being a Type II diabetic, I am considering taking wine to get my Glucose into control. My A1c is 5.0 as of Apr 2009.

Can you let me know what was the benefit in terms of Blood Glucose control? Did you see any reduction in A1c values? If so by how many points?

Though I am ideologically against consuming alcohol, I am ok if that need to be consumed as a medicine.

Thanks and expecting your reply.


Alan said...

Venkat, I would urge you NOT to consider adding red wine to your menu.

Your ideological reasons are sufficient to counsel against it. I can think of nothing worse than having to drink wine as a medicine.

I have not done any consistent research into wine's affect on A1c; there are too many other variables in my menu to single it out.

Your A1c is excellent, far better than most type 2s. Continue to do whatever you are doing now.

Cheers, Alan

Venkat said...

Thanks for your diligent reply Alan. I follow a low carb diet (40g of net carbs excluding Fiber) and that has kept my A1c at 5.0. I do workout at Gym thrice a week.

Anyway Thanks for your advice and time.

Best Regards,


Christina said...

I am totally clueless about wine in general - although I know a few brands and types I like (naturally, the sweet ones !). What specifically are "dry" red wines ? I am in the US and I have seen Australian wines here - is there a brand you particularly like ? What do you recommend for someone who likes sweet drinks ?

Alan said...

You asked: "What specifically are "dry" red wines?"

Basically, not sweet. In the whites styles such as Chablis or Sauvignon Blanc, in reds styles such as Merlot, Cabernet Sauvignon, Shiraz/Syrah and many others. If in doubt ask your wine merchant.

"I am in the US and I have seen Australian wines here - is there a brand you particularly like?"

There are too many to list. As I'm a cheapskate with champagne tastes on a beer budget I tend to buy cleanskins. I usually only get the more expensive wines by dropping hints around Christmas and Birthdays. If I had to choose only one brand then it would probably be Penfolds. Their range is enormous, from quite a few at the lower end (quite drinkable) to stars like Bin 389, Bin 707 and Grange Hermitage if you are extemely well-heeled.

"What do you recommend for someone who likes sweet drinks?"

Don't drink wine :-)

If you must have a sweet wine, such as sauternes or other sweet whites, or a red dolcetta, treat it like any other food the first few times. Have a glass, then test about 30 minutes later to see what it did to your blood glucose levels.

Anonymous said...

Good article Thank you so much

niru said...

thanks i bought a red dry wine and im diabete my friends alwaz drinks wine but i was scared so knw i can also drink wine after reading your article no matter if i have diabetes 2.thanks.

Anonymous said...

Mark asks:
Lately I have tried 1 or 2 oz of dry red wine with meals. Would a nite cap of 1 or 2 oz add any benefit to the prandial 1 or 2 oz?

whde villiers said...

This case series documents three patients referred to the Intensive Dietary Management clinic in Toronto, Canada, for insulin-dependent type 2 diabetes.