to drink or not to drink? that is the question samer kanaan, m.d
TRANSCRIPT
To Drink or Not to Drink? To Drink or Not to Drink? That Is the QuestionThat Is the Question
Samer Kanaan, M.D.Samer Kanaan, M.D.
GoalsGoals
Review Briefly my credentials and backgroundReview Briefly my credentials and background
Heart Disease Heart Disease – The Problem– The Problem
The The French ParadoxFrench Paradox
Review Heart-Health Benefits of Review Heart-Health Benefits of Red Wine Red Wine BiologyBiology
Recommendations on Recommendations on Red Wine Red Wine ConsumptionConsumption
Estimated Estimated 80 million 80 million Americans have one or Americans have one or
more type of more type of Cardiovascular Disease Cardiovascular Disease
1 in 3 American Adults1 in 3 American Adults
Cardiovascular Disease accounts for 35.3% of all deaths in 2005, or one of Cardiovascular Disease accounts for 35.3% of all deaths in 2005, or one of every 2.8 deaths in the United States.every 2.8 deaths in the United States.
2,400 Americans die of CVD each day 2,400 Americans die of CVD each day one death every 37 seconds one death every 37 seconds
In every year since 1900 except 1918, CVD accounted for more deaths than In every year since 1900 except 1918, CVD accounted for more deaths than any other cause.any other cause.
Cardiovascular Disease Cardiovascular Disease claims claims moremore lives each year than lives each year than
CancerCancer, , ChronicChronic Lower Respiratory Lower Respiratory
DiseasesDiseases, , AccidentsAccidents, and , and
Diabetes Mellitus Diabetes Mellitus COMBINEDCOMBINED!!
History of Alcohol and HealthHistory of Alcohol and Health HippocratesHippocrates
Illustrated the value of wine as a medicine and vital to a healthy diet.Illustrated the value of wine as a medicine and vital to a healthy diet.
Paracelsus (German physician 16Paracelsus (German physician 16thth century) century) ““Whether wine is nourishment, medicine, or poison is a matter of Whether wine is nourishment, medicine, or poison is a matter of
dosage.”dosage.”
Thomas JeffersonThomas Jefferson ““wine of long habit has become indispensable to my health”wine of long habit has become indispensable to my health” ““I think it a great error to consider a heavy tax on wine as a tax on I think it a great error to consider a heavy tax on wine as a tax on
luxury. On the contrary, it is a tax on the health of our citizens.”luxury. On the contrary, it is a tax on the health of our citizens.”
Louis PasteurLouis Pasteur ““wine to be the most healthful and hygienic of beverages.”wine to be the most healthful and hygienic of beverages.”
William Heberden – 1786 described angina pectorisWilliam Heberden – 1786 described angina pectoris ““wines and spirituous liquors afford considerable relief”wines and spirituous liquors afford considerable relief”
Renaud and DeLongerilRenaud and DeLongeril
Wine, alcohol, platelets, and the French paradox for coronary heart Wine, alcohol, platelets, and the French paradox for coronary heart disease. disease. LancetLancet 1992. 1992.
Mortality rate for coronary heart disease in France was paradoxical and Mortality rate for coronary heart disease in France was paradoxical and unexpectedly lower than other industrialized countries, such as the unexpectedly lower than other industrialized countries, such as the United States and the United Kingdom, despite similarly high dietary United States and the United Kingdom, despite similarly high dietary intake of saturated fat and the prevalence of other risk factors, such as intake of saturated fat and the prevalence of other risk factors, such as smoking.smoking.
The untoward effects of saturated fats are counteracted by the intake The untoward effects of saturated fats are counteracted by the intake of wine. of wine.
““Epidemiological studies indicate that consumption of alcohol at the Epidemiological studies indicate that consumption of alcohol at the level of intake in France (20-30 g per day) can reduce risk of CH D by at level of intake in France (20-30 g per day) can reduce risk of CH D by at least 40%”least 40%”
““J Curve”J Curve”
““J Curve”J Curve”
EpidemiologyEpidemiology
Red Wine Red Wine BiologyBiology
Red Wine PolyphenolsRed Wine Polyphenols
ColourColour
BitternessBitterness
Astringent TasteAstringent Taste
Act as PreservativesAct as Preservatives
AntioxidantsAntioxidants
Found in the skin and seedsFound in the skin and seeds
Two typesTwo types::
FlavinoidsFlavinoids
NonFlavinoidsNonFlavinoids
ResveratrolResveratrol
Red Wine Red Wine produced by produced by fermenting grape juice with fermenting grape juice with the pulpthe pulp
VsVs
White Wine produced by White Wine produced by fermenting without the pulpfermenting without the pulp
Therefore:Therefore:
Red Wine Red Wine has much higher has much higher polyphenol content and polyphenol content and higher level antioxidant higher level antioxidant activityactivity
Red Wine Red Wine BiologyBiology
Red Wine Red Wine BiologyBiology
Red Wine Red Wine BiologyBiology
Red Wine Red Wine BiologyBiology
CautionCaution Increase TriglyceridesIncrease Triglycerides
Result in Weight Gain Result in Weight Gain – empty calories– empty calories
Cancer RiskCancer Risk
Pregnancy – Pregnancy – NO!NO!
GoutGout Red wine increases blood uric acid levels.Red wine increases blood uric acid levels.
Alcoholic Cardiomyopathy / Heart Failure / Cardiac Arrhythmias / Sudden Cardiac DeathAlcoholic Cardiomyopathy / Heart Failure / Cardiac Arrhythmias / Sudden Cardiac Death
Atrial FibrillationAtrial Fibrillation Limit to less than 35 drinks / weekLimit to less than 35 drinks / week
HypertensionHypertension Limit to two drinks / day for malesLimit to two drinks / day for males Limit to one drink / day for femalesLimit to one drink / day for females
Drug interactionsDrug interactions Nitroglycerin, anxiolytics, neuroleptics, and oral contraceptives.Nitroglycerin, anxiolytics, neuroleptics, and oral contraceptives.
SummarySummary Red Wine Red Wine Benefits:Benefits:
Antioxidant Antioxidant CardioprotectiveCardioprotective Lowers risk of heart attack – Lowers risk of heart attack – by 30-50%by 30-50% Raises Raises HDLHDL cholesterol (good one) cholesterol (good one) Prevents Prevents LDLLDL cholesterol from forming (bad one) cholesterol from forming (bad one) Prevents blood clotsPrevents blood clots Reduces blood vessel damage caused by fat depositsReduces blood vessel damage caused by fat deposits
AHA RecommendationsAHA Recommendations NOTNOT to start drinking if you do not already drink to start drinking if you do not already drink
alcoholalcohol
If you drink already, Drink in If you drink already, Drink in MODERATIONMODERATION 2 drinks a day for men2 drinks a day for men 1 drink a day for women1 drink a day for women
Alcohol use should be an item of discussion Alcohol use should be an item of discussion
between physician and patientbetween physician and patient