Can the many studies reporting a health and longevity benefit to moderate drinking be squared with mounting reports showing none? Is wine good for health or bad? Yes. No. It depends. In order to get at the truth, you have to ask the right questions:
1. Do the effects of alcohol consumption depend on the type of beverage? The heart of this question is whether wine drinkers have better health outcomes compared to those who consume alcohol from other sources. If so, then broad measures of drinking and disease correlation that don’t account separately for wine drinkers are missing the mark; if not, then the J-curve of the French Paradox is an illusion. At one time, it wasn’t so hard to figure out, but it has become more difficult for several reasons. One is that archetypical wine drinkers – those who enjoy wine regularly, with meals, pretty much exclusively, and in moderation – are becoming an ever-smaller subset of the population of drinkers. Even in France, consumers are becoming more diverse in the variety of beverages they drink and more irregular in their drinking patterns. Binge drinking is on the rise, moderation falling out of favor.
There is still plenty of evidence that those who prefer wine in moderation are healthier, but this benefit is obscured when they are lumped together with all forms of drinking.
2. Why do nondrinkers appear less healthy than moderate drinkers (and are they really)? At issue here is the fact that not all nondrinkers are the same, and moderate drinkers may appear to fare comparatively better for reasons not related to any health benefits of wine. Critics point to what is called the “sick quitter” hypothesis, which holds that the health status of nondrinkers is skewed by including former drinkers who had to quit for health reasons. For this to be true, their poor health must (a) remain after quitting, and (b) the effect has to be large enough to bring the average health status in the nondrinker category down overall even if they are a minority compared to lifetime abstainers. If these are true, excluding sick quitters would make the apparent comparative benefit to moderate drinkers illusory.
Research papers in recent years seem to increasingly assume that this applies. But if it doesn’t, or if the effect is not in fact enough to offset any apparent benefit to moderate drinking, then every conclusion that follows is invalid. And there is reason to question the degree to which influence of sick quitters skew the data; one study of >9000 subjects tracked over 10 years found that “Former drinkers did not show significantly worse health than people who at baseline were lifetime abstainers.”[1] This echoes results of an earlier analysis of 34 studies that referenced the category of “no alcohol intake” excluding former drinkers, in which a slightly shallower but nonetheless clear J-curve was found. [2] (Thank you Stats Guy for an insightful summary.) And this was for all drinkers, not just wine lovers.
3. Is alcohol truly an independent variable for health outcomes? One way to simplify the data on wine and health is to assume that all other variables can be accounted for and the true effects of alcohol on health can be separately measured. Strip away context, adjust for sick quitters, put in a fudge factor for under-reporting, do some modelling to account for different study methods, stack as many studies as you can find together, and perhaps the true signal will emerge from what is very noisy data. It is a compelling pursuit; see for example the Gates Foundation’s 25-year study of 195 countries on alcohol and the global burden of disease [3]. It’s a quixotic quest though. There is simply too much variation in what and how people drink around the world, how they metabolize alcohol, and too many linked behaviors.
But if we do consider the question globally, there is one pattern that should jump out but doesn’t: If lifetime abstainers truly fare better than even moderate drinkers in terms of health outcomes, life expectancy in Muslim countries where alcohol is banned should be greater than in countries where drink is embedded culturally. But of 198 countries where life expectancy has been tabulated, the highest Muslim countries are Oman at number 50 and United Arab Emirates at 51 (2022 data). [4] The French, Italians, and Irish have a good 5 years on them. Are there other factors involved? Of course – that’s the point.
The way I see it, the answer isn’t going to be found by ever more massive studies, meta-analyses, and data grinding. We need smaller studies, on specific populations with specific lifestyles and drinking habits. The French Paradox was never about alcohol; it was about wine as part of a Mediterranean diet and way of living. A global survey of alcohol and health outcomes tells us nothing about individual risks and benefits of our favorite tipple. The French Paradox correlates most tightly to local regions where red wine consumption is favored, as pointed out by Roger Corder MD, author of the Red Wine Diet. [5] It is often pointed out that other lifestyle factors -eating more slowly for example – also contribute to health and longevity (nevermind that the original French Paradoxers also smoked more and ate a fattier diet). It’s not the wine, critics say. But if wine is such an integral part of this way of living long and well, it is also not not the wine.
- Park JE, Ryu Y, Cho SI. The Association Between Health Changes and Cessation of Alcohol Consumption. Alcohol Alcohol. 2017 May 1;52(3):344-350. doi: 10.1093/alcalc/agw089. PMID: 28430927; PMCID: PMC5397877.
- Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G. Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med. 2006 Dec 11-25;166(22):2437-45. doi: 10.1001/archinte.166.22.2437. PMID: 17159008.
- GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018 Sep 22;392(10152):1015-1035. doi: 10.1016/S0140-6736(18)31310-2. Epub 2018 Aug 23. Erratum in: Lancet. 2018 Sep 29;392(10153):1116. Erratum in: Lancet. 2019 Jun 22;393(10190):e44. PMID: 30146330; PMCID: PMC6148333.
- https://www.worldometers.info/demographics/life-expectancy/
- Corder R, Mullen W, Khan NQ, Marks SC, Wood EG, Carrier MJ, Crozier A. Oenology: red wine procyanidins and vascular health. Nature. 2006 Nov 30;444(7119):566. doi: 10.1038/444566a. PMID: 17136085.
Age Gets Better With Wine 