Saturday, November 30, 2013

100-200ml Red Wine Per Day Improve HDL and the LDL/HDL Ratio With & Without Mediterranean Diet & Exercise

Good for him, good for her, good for everyone? Is it really possible that red wine can help even those who don't want to the necessary lifestyle changes?
You all know about the limitations of epidemiological studies and the fallacy of the over-generalization of associations between health parameters and red wine consumption in the mainstream media. For me this *bs* is so annoying that I usually don't even take a look at "red wine studies". Luckily, a recent paper by Dirk W. Dorste and his colleagues did still catch my attention: It's about to be published in the December issue of Nutrition Journal and is not based on epidemiological data.

The Luxembourgian scientists gathered their data in the course of a randomized unblinded 2-year trial that involved 108 patients with carotid atherosclerosis and >30% reduced blood flow (65% of the patients were on statin therapy).

122 patients, 4 intervention groups, red wine and/or lifestyle changes

While half of the patients did nothing to improve their health and fitness, the other half of the patients, the lifestyle change group, had to follow a modified Mediterranean diet and perform moderate physical exercise during 30 min/day for 20 weeks. In both of these groups half of the patients were randomized either to no alcohol or red wine groups (100ml/day for women, 200ml/day for men). The end results of this process was a 2 x 2 design that looked like this:
  • Med. diet + exercise only
  • Med. diet + exercise + red wine
  • regular diet + laziness only
  • regular diet + laziness + red wine
While the subjects in the groups in the left "regular diet + laziness" column did not receive any dietary advice and were not encouraged to work out, the participants in the "Med. diet + exercise groups" had five 30 min sessions with a registered dietitian "giving advice on healthy eating based on a modified Mediterranean diet and physical exercise" - the cornerstones of this advice were:

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    eat 5 portions of fruit/vegetables per day, 
  • consume a diet low in absolute fat, 
  • prefer vegetable oil (olive or canola oil), 
  • eat whole grain products, poultry, low fat dairy products, 
  • consume a fat and a lean fish meal per week,
  • reduce your consumption of red meat, 
  • avoid pork and ready made-meals,
  • stay away from sugar and excessive amounts of salt,
  • drink 1.5-2 l plain water every day,
  • eat the occasional 25g of dark (70%) chocolate,
  • include tomatoes and walnuts in your diet,
  • get at least 30 min of moderate daily physical activity
Yes, I know, not all of these points are exactly in line with what you (and even I) believe to be cornerstones of a healthy diet, but I do not write about this study, because it was an awesome example for highly beneficial lifestyle changes - quite the contrary: I picked it because the booze worked even without lifestyle changes:
Figure 1: Relative changes (in %) in total cholesterol, LDL, HDL, LDL/HDL and triglycerides after 4 and 20 weeks on one of the four "interventions" (Droste. 2013)
If you compare the red wine only and lifestyle only data from the end of week 20, it is not easy to tell the difference between the two - the greater improvements in HDL cholesterol, and higher reductions in LDL actually give the impression that simply guzzling red wine would be more effective than reinventing your diet and exercise habits

If we take a closer look at the data we do yet (luckily) have to acknowledge that the the subjects who did reinvent their lives were the only ones with lasting beneficial effects on total cholesterol, HDL, the LDL/HDL ratio and the total amount of triglycerides after 20 weeks - and that irrespective of the missing dietary and exercise / training control and despite the disputable dietary advice they received!
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Bottom Line: This is not the experiment to confirm the hilarious mainstream media hype about the health benefits of red wine, but the results of this prospective study are still intriguing. They do after all support the hypothesis that the literal glass of wine can actually be a crutch that helps you to take a first baby step towards a healthier life. It does not hamper, but improve the beneficial effects of lifestyle interventions on CVD-relevant plasma markers and it's stand-alone effect on the HDL/LDL ratio is - I have to admit that - downright surprising.

  • Droste, Dirk W., et al. "A daily glass of red wine associated with lifestyle changes independently improves blood lipids in patients with carotid arteriosclerosis: results from a randomized controlled trial." Nutrition journal 12.1 (2013): 147.