the doctors are in
Diabetics who drink moderately PDF Print E-mail

JB stated, "I'm glad my son doesn't drink alcohol because he is a diabetic."  The WineDoctors would like to explore this statement.  To start, let's assume that JB's son is more than 21 years of age and that alcohol, particularly wine was not part of their family's daily routine of sharing meals and fellowship.   Several recent studies show that moderate alcohol consumption helps regulate blood sugar levels in diabetics.  (Remember, moderate alcohol consumption is 5 ounces of a 12% wine a day for women and twice that for men.).  This is counter to the prevailing misconception that alcohol is contraindicated in diabetics.  The WineDoctors do not advocate that diabetics start to drink alcohol in order to help modulate blood sugar control.  We do, however, want to make it clear that diabetics who moderately consume alcohol seem to have improved blood sugar control compared to their non-drinking counterparts.

 
Information for cancer survivors? PDF Print E-mail

Question : LG writes: I am interested in info. pertaining to the health effects on wine for Women who have had Mastectomy due to breast tumors.

Answer : The scientific literature on this subject is very limited. The question of whether breast cancer recurrence in women with advance disease is effected by alcohol consumption is not well studied. Epidemiologic data shows a weak association (i.e., relative risk of approximately 1.2) between alcohol consumption and the diagnosis of breast cancer. The literature appears to indicate that women diagnosed with early stage breast cancer are more likely to die from other causes, while women with advanced disease are likely to succumb to complications of breast cancer. The data with regard to moderate consumption and effects on all cause morbidity and mortality would therefore appear to be applicable to the subset of breast cancer patients diagnosed early. The decision to drink moderately is clearly individualized based on all medical and health issues, as well as perceived quality of life.

 
What are the benefits of complimenting wine with a high antioxidant pure chocolate? PDF Print E-mail

Question : JB asks, What are the benefits of complimenting wine with a high antioxidant pure chocolate?

Answer : This is a very complex question. Let's start with some definitions. Cocoa is the non-fat component of cocoa liquor (finely ground cocoa beans). Chocolate is a combination of cocoa, cocoa butter, sugar, etc., into a solid food product. Cocoa beans, along with red wine, represent two of the most concentrated food sources of the cocoa polyphenols, flavanols and procyanidins. Resveratrol, a stilbene and potent anti-oxidant found in red wine is also found in cocoa powder at about 50% the amount by weight. There is a large body of evidence that supports a favorable effect of red wine or even alcohol in moderation on all cause mortality and cardiovascular disease. Chocolate and cocoa may also promote cardiovascular health by decreasing or inhibiting LDL-oxidation and platelet activation or function, enhancing serum lipid profiles, favorably modifying eicosanoid synthesis, lowering blood pressure, promoting endothelial-dependent relaxation or dilation, and inhibiting free-radical induced erythrocyte hemolysis. Additionally, they may act by modulating immune responses. Most of these hypotheses are based on epidemiologic and in vitro data. Future study design recommendations include: (1) specifying the full characterization of the chocolate or cocoa used and the calculated dose; (2) identification of the specific flavanol components found in both cocoa and wine and; (3) using biologic markers to assess responses to these products. The concentration of cocoa polyphenols is higher in dark chocolate than milk chocolate. White chocolate contains no polyphenols. Milk proteins found in milk chocolate may inhibit absorption of flavenoids. Resveratrol levels are highest in cocoa powder followed by unsweetened baking chocolates, semisweet chocolate baking chips, dark chocolates, milk chocolates, and chocolate syrups. Synergy of consumption of red wine with a chocolate has not been studied. Nonetheless, come Halloween night, we shall be pairing 5 ounces of a 12% red wine with a Xocai Chocolate, high in cocoa polyphenols and resveratrol! Cooper KA et al. Cocoa and health: a decade of research. B J Nut. 2008, 99: 1-11. Hurst WJ et al. Survey of the trans-Resveratrol and trans-Piceid Content of Cocoa-containing and Chocolate Products. J Agric Food Chem. 2008, 56: 8374-8. Lippi G et al. Dark chocolate: consumption for pleasure or for therapy? J Thromb Thrombolysis, 2008. Crews Jr, WD et al. A double-blind, placebo-controlled, randomized trial of the effects of dark chocolate and coca on variables associated with neuropsychological functioning and cardiovascular health clinical findings from a sample of healthy, cognitively intact older adults. Am J Clin Nutr 2008. 87:872-80. Corder R. Red wine, chocolate and vascular health: developing the evidence base. Heart. July 2008. 94:7;821-3. Allen RR et al. Daily Consumption of a Dark Chocolate Containing Flavanols and Added Sterol Esters Affects Cardiovascular Risk Factors in a Normotensive Population with Elevated Cholesterol. J Nutr. 2008. 138:725-31.

 
I had a Roux-en-Y gastric bypass surgery last year PDF Print E-mail

Question : JM writes “I had a Roux-en-Y gastric bypass surgery last year... My surgeon … advises his patients to not drink alcohol after the surgery. I understand that there are higher-than-average risks for addiction, but I've never been much of a drinker. Also I understand that the alcohol has a faster initial impact on post bariatric surgery patients. I would only drink wine at home in the evenings so I don't think there would be a risk for driving, etc. What are your thoughts about whether I could benefit from wine? Should I abstain altogether or are the health benefits enough that I should consider it?

Answer : JM- Believe it or not, there are only 2 studies in the medical literature that address alcohol metabolism in patients after bariatric (weight loss or gastric bypass) surgery. One study evaluated blood alcohol concentration (BAC) in 12 women who underwent bariatric surgery 3 years or more prior vs. a control group of 12 women of similar age and body mass index (BMI). Women who had undergone bariatric surgery were found to have statistically significantly higher maximum BAC as well as BAC at 10 and 20 minutes after ingesting the same amount of alcohol per kg of body weight (pure ethanol that was mixed with orange juice). There were no differences in the groups at 30 minutes and at subsequent 10-minute intervals up to 3.5 hours after ingestion. The authors concluded that alcohol is more rapidly absorbed and has a higher maximum BAC in women who underwent bariatric surgery. Note that 20% of ethanol is metabolized in the stomach but this is decreased in patients after bariatric surgery. This is due to the absence of normal gastric emptying, smaller stomach mucosa surface area, and less alcohol dehydrogenase (the major enzyme responsible for alcohol metabolism). Limitations of this study include: small numbers; subjects were fasting (This increases the studied parameters.) and; pure ethanol (not wine) was consumed. Our colleague and friend, Dr. John Morton et al. at Stanford University Medical Center, performed the second study. They looked at 17 control and 19 post-gastric bypass subjects who consumed 5 oz. of red wine each (same varietal, vintage, alcohol content). They measured alcohol breath levels and found that gastric bypass patients had greater peak alcohol levels and longer time intervals needed to clear alcohol but no difference in subjective symptoms. Limitations of this study include small numbers. Although the above data is compelling that alcohol metabolism is altered in patients after bariatric surgery, we think more studies with greater power need to be done to confirm this hypothesis and explore the mechanism(s) of action. It is unclear if there are higher than average risks of ethanol addiction in patients who have undergone bariatric surgery. In one study that analyzed the charts of 298 women in a weight management program undergoing a pre-bariatric surgery evaluation, researchers concluded that there was an inverse relationship between BMI and alcohol consumption, i.e., the more obese a patient was, the less alcohol she consumed. Researchers postulated that overeating might compete with alcohol for brain reward sites. In a recent abstract (The WineDoctors are awaiting publication of the entire journal article for analysis.), researchers from the University of North Dakota sent patients who had undergone bariatric surgery (numbers of patients unspecified) the Post-Bariatric Surgery Appearance Questionnaire. Results indicated that a small (again, number not specified) number of respondents developed alcohol abuse or dependence since the surgery. Therefore, in our opinion, there is very limited, if any data that addresses whether or not post-gastric bypass surgery patients are at increased risk of developing alcohol addiction or dependence. Lastly, although moderate (Please see “The Doctors are in: How much can I drink? Dated Nov 10, 2007) alcohol (not just wine, it seems) consumption has cardiovascular health benefits and appears to decrease all-cause mortality and may incur other health benefits, we do not recommend initiating alcohol (wine) consumption for its health benefits.

 

 

 
How much wine can a woman drink? PDF Print E-mail

Question : JH Writes: Hello, I'm a 5'8, 138 lb., very active female who enjoys wine. I've always felt that the 1 glass/day max should not apply to me, when a male, who might be unfit and smaller than me, gets the ok to imbibe 2 glasses. What do you say to this? Thank you.

Answer : Your question is intriguing on many levels. We presume that your question refers to level of ethanol clearance and metabolism, and not what the preferred level of consumption is to achieve maximal health benefit. Of course there is no way of measuring your level/concentration and type of alcohol dehydrogenase receptor status or your liver volume at the time of this question. Federal nutritional guidelines are based on a woman who is 5 ft.4in. 125 lbs. consuming five ounces of 12% ethanol wine/day. As your question implies, several factors effect alcohol metabolism including: - EtOH concentration - Carbonation (I.e., champagne, soda) - Food - Gender - Liver size - Body weight - Variations in enzymes which break down EtOH There are also gender and ethnically based differences based on different subcategories of alcohol dehydrogenase and liver metabolism. As a result, there will be individual variation on alcohol metabolism (and therefore how much you can drink without feeling the effects of intoxication). Studies suggest that acute exercise enhances ethanol clearance in humans but are limited and unclear about the impact of chronic exercise on ethanol metabolism. The majority of studies focus on the effect of acute alcohol consumption and or intoxication and their effects on exercise and exercise efficiency.

 
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