It seems that the more studies we see on the relationship between wine and health, and the larger they are, the more contradictory the results. Headlines summarizing comprehensive international studies declare the French paradox dead, and all alcoholic beverages are equally detrimental. I think there is an overlooked explanation for this: over the past several decades, convergence of drinking patterns around the world has separated wine from its role as a daily part of a meal. Globalization has commoditized our views about drink, toppling it from its role as a culturally specific emblem.
Global convergence of drinking
There are several recent reports summarizing the trend,[i],[ii], [iii]and it applies for both developed and developing countries. Since the early 1960s, wine’s share of global alcohol consumption has more than halved, declining from 35% to 15%. Beer and spirits have taken up the slack, with beer gaining 42% and spirits adding 43%, both large gains. The bigger story however is convergence; Nordic countries for example have reduced consumption of distilled spirits in favor of wine and beer, while the ratio of wine versus beer consumption on a per capita basis in France has fallen from around 6:1 to less than 2:1. Countries historically favoring beer drink more wine and vice-versa. Consumers in developing countries are moving their preferences upscale, while in developed nations traditional practices are discarded as quaint artifacts. The resulting pattern is not particularly healthful.
How does this relate to the French paradox and wine’s privileged position as a healthy drink? Recall that it all came to light when the French had a strong affiliation with wine and an ingrained pattern of daily drinking. A now iconic 1979 paper in Lancet[iv]laid out the case, well before the “French paradox” was even a thing. Comparing per capita wine consumption by country to mortality from heart disease, a tight inverse correlation appeared. Italy, France and Switzerland occupied the high end of wine consumers, enjoying the lowest rates of heart disease, while countries such as the U.S. were not so big on wine but suffered dramatically higher rates of heart attack. What’s clear from studies like this and others that followed is that it is the wine-centric life that makes the difference. It needs to be almost the exclusive beverage and consumed with regularity. Wine is still mainly consumed with meals nowadays, but spirits and beer usually not, so a move away from wine represents a profound shift in how alcohol is consumed.
Why the French paradox is no longer French
The convergence of drinking patterns implies several things important to epidemiologic research on drinking and health. An important feature is that populations who consume wine in this strictly traditional way become difficult to isolate. This could explain much of the disparity between modern studies and earlier ones, with breast cancer being an enlightening case in point: Studies generally (but not always) find now that any level of drinking, of any type, carries some increased risk. But one of the few studies evaluating breast cancer and alcohol that looked at traditional wine consumers in a southern French population found a clear J-shaped curve[v]. Comparing several hundred breast cancer cases to matched population controls, the researchers found that “Women who had an average consumption of less than 1.5 drinks per day had a lower risk when compared with nondrinkers.” They noted “This protective effect was due substantially to wine consumption since the proportion of regular wine drinkers is predominant in our study population. Furthermore, women who consumed between 10 and 12 g/d of wine had a lower risk when compared with non-wine drinkers.” The odds ratio, a measure of relative risk, was 0.58 in the light drinking cohort and 0.51 in the moderate drinkers – half that of nondrinkers.
With wine and health studies, then, bigger is not always better. Analysis of tens of thousands of people yields limited information when their drinking habits are not consistent and ritually specific. Researchers try to get around the issue by categorizing people according to their stated preference of beverage, but convergence shows that these preferences are increasingly fungible. The French paradox is alive and well, you’re just more likely to find it at your neighborhood bistro rather than TGI Friday’s.
[i] Holmes AJ, Anderson K. Convergence in national alcohol consumption patterns: New global indicators. Journal of Wine Economics 2017; 12(2): 117–148.
[ii] Bentson J, Smith V. Structural changes in the consumption of beer, wine and spirits in OECD countries from 1961 to 2014. Beverages 2018; 4(8).
[iii] Smith DE, Skalnik JR,”Changing Patterns in the Consumption of Alcoholic Beverages in Europe and the United States”, in E – European Advances in Consumer Research Volume 2, eds. Flemming Hansen, Provo, UT : Association for Consumer Research 1995; 343-355.
[iv] St. Leger AS, Cochrane AL, Moore F. Factors associated with cardiac mortality in developed countries with particular reference to the consumption of wine. Lancet 1979 May 12;1017.
[v] Bessaoud F, Daures JP. Patterns of alcohol (especially wine) consumption and breast cancer risk: a case-control study among a population in Southern France. Ann Epidemiol. 2008 Jun;18(6):467-75. Case-control study finding lower risk of breast cancer in moderate wine drinkers.