Ep. 142: Dr. WHO? w/ Dr. Laura Catena & Miles Hassell, MD

Martín Reyes, MW is back, and he’s brought some friends. With their help, we get into misleading claims from the W.H.O, the health effects of wine, and how moderation may just be good for you. Joining us this week are Dr. Laura Catena, a Harvard and Stanford trained biologist and physician, fourth generation vintner, and the managing director of Bodega Catena Zapata in Argentina; and Dr. Miles Hassell, a specialist in Internal Medicine, the author of Good Food, Great Medicine, and a professor at Pacific University.

[00:00:45] Martín Reyes, MW: I am back and we are recording this right in the middle of Premiere Napa Valley 2024. And I’ve got winemakers visiting from overseas, from España, but this conversation is so important that I have dropped everything to be here.

[00:00:57] Katherine Cole: Yes, this is really a life or death conversation.

[00:01:00] Martín Reyes, MW: because wine could either kill us or it could make us live longer. And misleading blanket declarations about wine and health could damage the wine industry if we don’t speak up in defense of it and clear things up.

[00:01:15] Katherine Cole: That’s right, Martín. And this has been the theme of some conversations you and I’ve been having on The Four Top recently. And listeners, you can tune in to episode 130 or 134 to get up to speed on the World Health Organization’s declaration that, quote: “No level of alcohol is safe for our health.

[00:01:33] Martín Reyes, MW: Man, that statement came out more than a year ago, and it’s finally starting to really hit the wine industry pretty hard. And in episode 134, we talked a bit about how The WHO, the World Health Organization didn’t quite tell the whole story and arguably misrepresented the research.

[00:01:51] Katherine Cole: Yes. And I know that since then, Martin, you have been devouring books, you have been sending me articles and excerpts and all sorts of reading material about what alcohol actually does to our bodies.

[00:02:02] Martín Reyes, MW: It’s fascinating to look at how our bodies process alcohol. Part of the mystery around why health studies seem equivocal lies in the pace of wine consumption. AKA how fast we consume it changes how it flows in our body and that changes its impact on us. But I should be clear. I am not…I’m an interested citizen. I am not a scientist or a doctor.

[00:02:23] Katherine Cole: But guess what? Since we last spoke, Martín, I wrote a column for Decanter magazine on this subject and folks, you can see that in the March issue. And I was able to interview a couple of physicians about this subject. They’re from very different backgrounds and they have so much interesting expertise around this issue and they’re both able to join us today. So I’m thrilled.

[00:02:45] Martín Reyes, MW: When I spoke at a recent global wine symposium in Portugal, that’s when I first heard friend and respected wine figure, Dr. Laura Catena, her keynote speech about wine and health last year. Those of us in the wine industry know Laura, as I’ll pronounce her name, uh, as the head of Bodega Catena Zapata in Argentina, But Dr. Catena or Laura is also a Harvard and Stanford educated doctor and was an emergency room physician in San Francisco for 25 years. And for the past year, she’s been touring and talking about wine and health. Welcome Laura.

[00:03:20] Laura Catena, MD: Muchas gracias. Muchas gracias.

[00:03:22] Katherine Cole: And, you know, Martín, I always try to pronounce your name properly and I probably butcher it, but I’m all in favor of proper pronunciation.

[00:03:30] Laura Catena, MD: You say it …

[00:03:31] Martín Reyes, MW: Laura will give us permission to say Laura if you want. 

[00:03:33] Laura Catena, MD: Martín, is very good, you say it perfectly.

[00:03:40] Katherine Cole: Our other distinguished guest, Dr. Miles Hassell, is a physician who was very much ahead of the curve when it came to identifying the health benefits of the Mediterranean Diet. Dr. Hassel’s book, Good Food, Great Medicine, A Mediterranean Diet and Lifestyle Guide, came out before the famous Blue Zones book that Martín and I were talking about, I believe in episode 134. This was more than two decades ago and Miles, I understand you’re now working on the fifth edition. And Miles, you are a physician specializing in comprehensive risk reduction and you treat patients in their seventies, eighties, nineties, and even a hundreds, right?

[00:04:16] Miles Hassell, MD: Yep, that’s me. And we have a we have a practice in Portland, Oregon, which is internally. So it’s a conventional internal medicine practice with an emphasis on using lifestyle as a tool that is superior in most aspects to pharmaceutical medicine for most illnesses. Now, that’s not to say we don’t use plenty of pharmaceutical medicine and surgery and, and everything else as well. We put together what’s best for the patient, but what’s best for the patient usually starts with lifestyle. And we have patients, you know, in our teaching hospital here. I teach the residents and we also teach at one of the local universities. I’m a professor there. But trying to wrap up this whole idea that your lifestyle counts for more than anything else you choose in terms of your health outcomes.

[00:05:00] Katherine Cole: Oh, I cannot wait for this conversation.  

[00:05:07] Martín Reyes, MW: All right. Well, part one, the studies, Laura, let’s start with you. You’ve been lecturing around the world on the wine and health connection and misinterpretation of the data and about that data. We know we don’t have randomized control studies on alcohol for a few different reasons. Logistically, iy would be nearly impossible to cordon off a large population, feed them the same diet, get them on the same exercise regime, and then do a third on a fixed volume of alcohol, a third placebo, and a third of them on an unlimited supply of alcohol, correct?

[00:05:38] Laura Catena, MD: Well, actually, the reason why the study hasn’t been done is that there was a plan to do this and there was a sort of political opinion against it, but there was a randomized control study like they do for medication. So for example, if you want to test if Tylenol is good for pain, you get, like you said, a group of people that’s the same as another group of people. You give one Tylenol for pain. The other one, you give placebo and actually placebo itself improves pain by about 20%. So for Tylenol to get approved, it has to make your pain minus 30 percent, you know, so it really has to work and I don’t think it would be impossible to do such a study, but it’s hard to get it approved. I do understand that it’s now happening in Europe, which would be fantastic, but we do have hundreds of studies, population studies, which, you know, are kind of second best, but can still be pretty great because you can get controlled groups. You can get a huge database of people and say, okay, all the people with diabetes are going to be compared with other people with diabetes.

All the people of this age, men will be compared to men of that same age. All the smokers will be compared to smokers. So there’s actually pretty, you know, good criteria to do population studies based on, you know, patients that come in, you do a survey, you ask them questions, and then you look at their outcome over the next couple of years. That would be called a perspective study. And those studies, you know, are not the gold, gold standard, but they can be quite good. And there’s hundreds of such studies showing that alcohol in moderation and wine, in my opinion, is a little better, but again, this is biased mostly because the culture of wine is moderation. So most people who drink wine are used to just having a little bit with dinner, whereas with other, you know, spirits, people often binge drink. So alcohol in moderation, which can be defined as up to one glass per day, five ounce glass of wine for women. And there’s other measurements for beer and spirits.

Up to two glasses for men. Uh, there’s, there’s some new criterias that, that say skip a couple days a week. I kind of agree with some of that, but, but the actual data shows that in those doses, you know, one glass up to one glass per day for women, two for men. Actually, you have a reduction in cardiovascular disease. You know, you have lesser strokes, lesser heart attacks, less heart failure, greater lifespan. And so these studies are quite powerful. And I am actually really shocked that the WHO has come out with that declaration.

[00:08:16] Miles Hassell, MD: And it seems like you could also look back, at the historical precedent, because if we go back to the oldest recorded history of humankind. Wine is there. This is not a new thing. And I think it could be said that there is not a single major epidemiologic study that does not show that the lifestyle that includes wine is not superior to all others in terms of the outcomes. I think of Nurses’ Health Study from your Harvard, for example. 

[00:08:41] Laura Catena, MD: Yeah. 

[00:08:42] Miles Hassell, MD: Where they, um, 20, 30 year follow up, 130,000 patients maybe, and consistently has shown that the group of people that included those that had a moderate amount of alcohol had better outcomes in terms of cancer, heart disease, diabetes, and total mortality than any of the other groups studied.

[00:08:59] Laura Catena, MD: Yeah, no, I mean, the data is huge. Like, though, the people who are talking against alcohol do have a few points that I think are valid in terms of the studies. So, in some of the studies, non drinkers were put together with ex-heavy drinkers. That’s not a good control because ex-heavy drinkers will have some negative outcomes from, let’s say, they drank for 30 years a lot and then they stopped. Well, that person is less healthy than somebody who didn’t drink at all or, or than somebody who had alcohol in moderation. Now what researchers have done is they’ve gone back to these studies. And they’ve re-looked at the data, taking out the control group of ex-heavy drinkers as a control for non drinkers. So they’ve actually fixed that mistake in the data, and the results are still showing that alcohol in moderation improves cardiovascular disease. So some of the critics are saying these blanket statements the criticisms have been addressed, yet the critics are still repeating the same message. The other thing that they will say is, oh, the reason why people who drink wine, particularly in moderation, are healthier is because you’re already picking healthier people. People who drink wine maybe have a higher income. That has been controlled for as well. So actually, these negative arguments, are not valid because the data has been looked at again and the results are still showing cardiovascular benefits.

[00:10:34] Miles Hassell, MD: No, I think that’s absolutely correct and the data are so wide and so deep in the sense that, you know, whether you look at Nurses’ Health physician follow up study, INTERHEART, INTERSTROKE, PURE, EPIC studies, these are all gigantic, well done international studies, and they all give the same result.

[00:10:53] Laura Catena, MD: They’ve done them in Europe, over the Americas and Asia. I mean, there’s just so much data and there’s actually a really cool recent study done at Harvard where they looked at PET scans of, you know, thousands of people that had had PET scans for other reasons. And they found that the amygdala in people who drank alcohol in moderation were less hyperactive. And they have some really good data that shows that a more hyperactive amygdala is associated with more heart attacks. So, this is a new explanation in addition to the blood thinner effect, the fiber analytic effect of alcohol and the HDL increase from alcohol. Now, we see some less hyperactivity in the amygdala as a potential reason why people who drink in moderation might have fewer heart attacks. And even the 2018 Lancet study, that’s one of the studies that the W. H. O. uses. Even that study shows dramatic decreases in heart attacks from people who drink in moderation, yet they don’t acknowledge it in their conclusions, which is very strange to me. So, I have a hard time understanding why the W. H. O. is saying this.

[00:12:07] Martín Reyes, MW: You know, it occurs to me that, Laura, I think that, from what I understand, there’s a way to cherry pick through the data and interpret it in such a way that bolsters those who are, uh, you know, this neo-prohibitionist movement. Is that an accurate statement to say that there are studies that could be cherry picked?

[00:12:26] Laura Catena, MD: Yes, I think that, you know, a bad researcher could, you know, look at the data and, uh, manipulate it. You could also exclude studies for technicalities that maybe shouldn’t have been excluded. However, even in the study that claims that alcohol is not good for you, when you really look at their data, you see that the cardiovascular benefits are huge. So, that’s even stranger because it’s a study showing something and then not writing about it in the abstract and the conclusion. And most people will read the abstract and the conclusion and not necessarily look at all the data. So, it’s a rare person, right? It’s the headline. So, yeah, but you can certainly cherry pick, but you know, a real study has a result and you should be able to look at that data and come to a conclusion. And these articles are peer reviewed. All these hundreds of articles. So that’s the main criteria. Is it published in a peer reviewed journal? And the peer reviewed journal will actually look at the data and make sure that you’re reaching the correct conclusions. So, that’s why it’s so shocking that, you know, there’s this new statement that is ignoring hundreds of research in peer reviewed journals from the past and even present. There’s an article actually in Dr. Hassell’s book, there’s a reference from a study from 2023, again, showing these results, the positive results for better cardiovascular health. So, you know, there’s very few studies showing negative effects. 

[00:14:09] Martín Reyes, MW: One of the points that I’m mulling in my mind is that, whoever’s changed the direction of the conversation at the W.H.O. and otherwise who’ve now wanted to come out forcefully on this, I think, if any of them are listening, I think it would be beneficial if we built a bridge with them and to understand where they’re coming from. I don’t want to vilify them. I like to understand it from a point of view of: they believe that alcohol is a public health risk because they’ve either been affected by some, by drunk driving or by something around the behavioral changes of excessive consumption or binge drinking, which none of us are talking in favor of. And in doing so, I think that they gloss over the nuance.

[00:14:51] Laura Catena, MD: Well, I would agree with that. Yeah. I think that, as you said, excess consumption is bad and my advice to people is if you can’t stick to the guidelines, most likely you should stop drinking because, you know, if you’ve tried for a couple of years, many people try to cut down and they’re able to a large percentage. Give it a try. If you’re unable, you should probably stop. And I think that instead of that, there’s a group that’s saying, don’t drink at all. And there’s obviously some kind of an agenda, but I’ll tell you what my, my son who, I have a son who’s doing a PhD in chemistry, and he told me, mom, you need to stick to the science. Don’t try to understand why people are doing stuff, just stick to the science. I don’t know what you think, Miles, about all this.

[00:15:43] Miles Hassell, MD: They have their own, obviously, biases, depending on their own personal experience, as Martín was mentioning. But also, they hate nuanced messages. They hate nuance because it’s really hard to sell nuance, and yet that’s where these kinds of issues require, you require it. And you simply can’t do an honest job as a public health authority without dealing with the nuance on issues of this nature, just like with red meat or any, any number of issues that we could discuss. And so therefore they default to what’s easy. Add then, depending on who’s on the committee, and I would, I hope I’m not going to be offensive to anyone here but, you could liken it to the Harvard nutritionists in the 80s and 90s that were telling us that margarine is good for us. And these guys were, there was nothing wrong with their brains. There was something really wrong with their analysis. But it’s so easy, I think, for these people to just go along with, with a crowd, whoever the loudest voices are in the room, no matter who you are, you get influenced by this stuff and they hate nuance.

[00:16:48] Laura Catena, MD: Yeah.

[00:16:49] Katherine Cole: So true. I do have a little pet theory, which is that the W.H.O. is based in Geneva. And if you look at world alcohol consumption, there is very dangerous, heavy levels of drinking in Europe. It’s really concentrated in Europe. And so, I think part of what we’re grappling with here in the U.S. is a lot of hand-wringing is going on about an issue that obviously affects every population, but culturally it is a huge problem. And it’s very close to home for the W.H.O., but I digress. I’m guilty of digressing and I’m the one who’s in charge of not letting us digress. And I would like to move on to the second part of this conversation. Part two. Miles, I wanted to talk to you because so much of your practice is focused on keeping, you know, older patients healthy. You have patients who are centenarians, even, and I interviewed you earlier for Decanter magazine and you were telling me that many of your healthy older patients are, are people who enjoy wine and enjoy alcohol. Lifelong drinkers who have been ingesting what is apparently a toxin, alcohol, for decades, but seem to be healthier for it. So maybe you can talk us through like, how are their aging bodies processing alcohol? Is it maybe not a toxin if they’re consuming it in the right way?

[00:18:09] Miles Hassell, MD: Certainly I think as, as we’ve already referred to, the vast majority of the data on the subject show that you actually live longer if you have a small amount of alcohol in your diet. I think that’s almost universal in the literature. So then you look at these old people and certainly I have some older people in their 90s who don’t drink, then, you know, it’s not a requirement to reach your 90s, but I certainly have 95 and 100 year olds and they tend to be mostly Greek oddly enough, and they certainly, continue to drink alcohol, especially wine.

[00:18:38] Katherine Cole: You said Greek. Is that… 

[00:18:39] Miles Hassell, MD:: Yeah, I think it’s just the region I’m in. I have a lot of Greek patients,

ethnically Greek, ethnically Greek.

[00:18:45] Katherine Cole: But so interesting because your book is about the Mediterranean Diet and they, I’m assuming, they’re all having the Mediterranean diet and wine.

[00:18:53] Miles Hassell, MD: Yeah, but my practice tends to accumulate foodies. But if you look at the plausibility of the issue, we’ve already talked a little bit about the historical precedent. We talked about, certainly, the epidemiologic and observational data. But there’s a lot of plausibility, let’s take diabetes, for example, which isn’t often discussed in the way I think it should be in terms of alcohol, but alcohol is strongly related to reduction in diabetes. And type two diabetes influences your risk of just about every disease. It increases your risk of cancer, of heart disease, of stroke, of dementia, of joint disease, of joint replacements. And so when you look at this vast spectrum of morbidity that’s caused by type two diabetes, if you see something that consistently reduces the risk of that, then you say, wow! That gives you some plausibility why people who drink, alcohol, especially wine, live longer. You can also see that it improves the gut microbiome, for example, that, you know, the, the tradition in, in lifestyle medicine is, it’s all about the gut. We have a healthy gut, the rest of us are healthy. And I don’t think that’s a bad way…I can’t prove it, but I think that’s not a bad model to think about. And so we see that especially wine improves the gut microbiome biodiversity there, which we know is associated with better health outcomes in terms of less obesity, less type 2 diabetes, less heart disease, less cancer, better immunity, blah, blah, blah. And so, it’s very plausible on numerous different levels that old people indeed would be drinkers because drinkers live longer. 

[00:20:21] Martín Reyes, MW: I’ve got one data point. Just one. I recently got an additional life insurance policy, because of my new business. And I had blood drawn. I’m 47 years old and I was shocked when they said, oh, you know, nobody gets the top two, nobody gets the five, 10%, you know, the blood work you’re going to get around 30 or 40, if you’re healthy. And I came back as, as, the top 2 percent of the rate of insurance largely driven by the zero factor of diabetes, whatever the baselines are. I’m not a, obviously you can’t speak in those terms, but your level of diabetes is like a young fit 21 year old male. And I’m like, hmm, maybe that’s because of all the wine I drink in moderation.

[00:21:06] Miles Hassell, MD: It’s not impossible. 

[00:21:08] Martín Reyes, MW: Not impossible. Yeah.

[00:21:10] Laura Catena, MD: Yeah, and one of my other points, is this whole epidemic of loneliness that we’re seeing, you know, there’s this, this angst after the pandemic. A lot of people sort of, you know, started socializing less, maybe going out in nature less. And it’s well proven that a little bit of alcohol, you know, in a gathering, in a family gathering with food improves the mood, you know, gathering with friends. I mean, again, an n of one, you know, in medicine, we always say, don’t use your personal example or, you know, medical students, usually they see a patient with pneumonia and then they think everybody has pneumonia. You know, this is classic. But, you know, if I’m going out with my husband and it’s one of our wine nights, because I like to do a few nights without alcohol, I’m a lot happier to go out with my husband and we have a much better time.

And I once asked my husband this question. We always go to this little Italian restaurant and get, um, a bottle of Chianti Classico when we go to the same Italian restaurant. Usually every Friday that we’re in San Francisco. And I said to my husband, wow, we had such a great time. And I was like, I would rate this a nine out of 10. You know, I just didn’t give it a 10 because I don’t want him to think too highly of himself. He already does. Uh, and, and I say, and I said to him, he’s wonderful. My husband’s amazing. He’s also a doctor. And I said, if we had not had the Chianti Classico, because I’ve been reading all this alcohol literature. I said, what, what would you rate our evening? And he said, a three. And every time I tell this story, people are like, oh my God, your husband’s horrible. And I said, and I said, no, I agreed with my husband. You know, I said Dan, I said, I totally agree with you. It was a nine because we were having the bottle of Chianti Classico and we were excited and the food was fantastic and the conversation was fantastic. And we had such a wonderful time and without the wine, it would have maybe not a three, maybe a five, but it would not have been a nine. And I think that, that if there’s something that is not bad for you, in moderation, and that creates this kind of experience and companionship, why would we get rid of it? It would seem absolutely absurd.

[00:23:32] Miles Hassell, MD: As my mother says, it oils the wheels of sociability.

[00:23:36] Laura Catena, MD: Oh, I love that. That’s a good, that’s a good phrase.

[00:23:40] Miles Hassell, MD: Yeah, yeah. And, you know, it’s, the data are less certain, but you can see this effect on anxiety, for example, that wine reduces anxiety. People who chronically drink moderate amounts of alcohol seem to have less depression. The dementia literature certainly seems to be giving us a signal that it reduces dementia. And so, there’s lots of stuff in terms of the bioactive components on the brain that once again lend plausibility to that being healthy.

[00:24:06] Laura Catena, MD: But the, the big thing is then you look at if you drink too much and then all the things are bad. So if you drink too much, more depression, more dementia, more bleeding strokes, more heart attacks. And you…

[00:24:19] Miles Hassell, MD: More being thrown out of restaurants.

[00:24:21] Laura Catena, MD: More, yeah, more not having a great time with your husband, getting into a fight, you know?

[00:24:26] Martín Reyes, MW: That nine goes back down to a three.

[00:24:28] Laura Catena, MD: Yeah, exactly. It goes… 

[00:24:29] Miles Hassell, MD: To a two… 

[00:24:29] Laura Catena, MD: To a one , to a one. But, you know, I was, I was talking to my son at his college, you know, a bunch of over 21 year olds. And I was saying, you know, would you ever think of going home with a bottle of Tylenol and taking the whole bottle? No, because it would harm your liver because Tylenol is metabolized by the liver just like alcohol, and you would potentially need a liver transplant. So why do people think that they can have, you know, ten shots or drink a whole bottle of wine in one day, one person, you know? So I think that it is true yhat we do not talk enough about how bad non-moderation is, how bad excess is. And, I do think that if there’s one good result from this whole W.H.O. thing that I’m perplexed by, if the result is that we re-examine the data. And that we really repeat over and over, you know, with doctors to their patients, family members to their family members, you know, that moderation is, you know, this one glass for women, two glasses for me. Don’t drink more than three glasses in one day. So I always tell people, listen, if you’re going to share a bottle of wine with your spouse one Friday night, well, then probably don’t have anything to drink Tuesday, Wednesday, Thursday, because you just used up, you know, half your allocation for the week. So you really do need to measure it. And, and one piece of advice that I heard at this panel from Harvard public health was, you know, the same theory as for the small plate. If you want to eat less, use a small glass, you know, buy small glasses because big glasses…My husband, who I think drinks too much, you know, I’m telling him all the time, and I hope he doesn’t mind that I’m live telling this and he does listen to me and drinks less. But he can fit a whole half a bottle into one glass. I think that’s a terrible idea. You know, use a smaller glass.

[00:26:24] Miles Hassell, MD: And would this be a good time to talk about the concept of hormesis? 

[00:26:28] Laura Catena, MD: Yes. Yes. Please talk about it. 

[00:26:29] Miles Hassell, MD: I think if, if it’s a public health message, I think if, if they could wrap their mind around the fact that these things aren’t simplistic, that there are nuances, but the nuance is reliably defined with the concept of hormesis, which says too little of something is bad, just right is enough, like Goldilocks, and too much is bad, and that this model applies to almost every biological component. And so if you have, take water, Martín, earlier had used example of water, if you don’t have any water at all, you obviously die, if you have just the right amount of water, you do really well, and if you have too much, you actually drink yourself to death with water. Potomania, it’s got a term. 

[00:27:11] Laura Catena, MD: Okay. Yes.

[00:27:39] Miles Hassell, MD:: And so, this actually really does happen. I’ve had two patients in my practice over time make themselves crazy. Fortunately we found out what was going on: they had drank their sodium down to 115, 120, and indeed they went crazy. So this concept really makes everything make, in my opinion, around the alcohol discussion, make sense. We’re not saying any amount is okay. We’re saying: a little bit’s great for you, and that we have reliable data for that, and we have plausible biological mechanisms to explain it.

[00:27:43] Laura Catena, MD: Absolutely. Okay. 

[00:27:44] Martín Reyes, MW: I wanted to ask you generally, my understanding of this is correct where the body processes the alcohol in a way in which there’s a specific pace that the liver is able to to break it down into a two step process that then makes it inert and we metabolize it outside, but if it spills over, Miles, if it spills over, being too much too soon, whether we drink, you know a glass, two, three, too fast too quickly that’s where the body can’t keep up and the toxic effects take over because the body can’t keep up with that metabolism, or rather the liver itself. And then the alcohol goes into parts of your body, into your brain, or other areas, and affects your mood, some of it, some of it positive, some of the endorphins, serotonin levels increase, but some of it, of course, cognitively we suffer if we drink too much too soon. Is that, Is that an accurate thing to say that alcohol is, a can be a toxin or a tonic, depending on the dose and the pace?

[00:28:53] Miles Hassell, MD: Oh, absolutely, yeah, yeah, because, in excess, alcohol poisons every system in the body. There is, I think it’s fair to say that there’s no system that is free of damage from alcohol excess used chronically. What’s interesting is the body has incredible resilience with respect to short term excess. I’m not promoting that because people make really dumb decisions when they have an excess in the short term. So yes, so I think the fact that the body can process so much, but not too much, is critical. And that’s where Laura earlier on mentioned the idea of one glass a day of wine for women and two for men as a reasonable historical level that continues to be supported in the literature. Makes a lot of sense. The other issue is that when we’re talking about wine in particular, we’ve got all these other compounds within wine, phenolics, non-phenolics, all these different compounds that, that have other health benefits that I think are hard because we’re not just talking about ethanol. I think part of the danger when we’re talking about wine is if we concentrate too much on ethanol alone without recognizing that there’s all these other nutritional components that we understand very poorly that also are part of the benefit.

[00:30:03] Laura Catena, MD: Yeah we have all the polyphenols that are also present in fruits. And we know that eating fruits and vegetables as part of the Mediterranean Diet and other diets is highly correlated with decrease in cancer risk and cardiovascular risk. So yeah, I totally second what Miles says and I want to make one more point about metabolism is that the reason why we tell people have a wine with food is that if you’re eating, the wine will be metabolized more slowly…in the sense it will be metabolized more rapidly, so the level will go up more slowly. So just think about it. You know, when, if you have a glass of wine on an empty stomach, you feel drunk, right? If you drink wine with a meal, you don’t feel anything or you just feel a little happy. And that’s because it’s metabolized more gradually and it’s not absorbed as quickly because the stomach is metabolizing the food with the, with the wine. So it’s being absorbed through the stomach little by little. And so if you’re drinking with a meal, you get a little bit of alcohol in your system. You feel a little happy, but you don’t feel drunk. If you have, you know, even a glass of wine or an empty stomach, you might actually feel a little tipsy. And so that’s less optimal because of what you said about the liver. The liver is metabolizing and it can metabolize a lot more quickly a small dose than a big dose.

[00:31:23] Miles Hassell, MD: And if you look at the literature on diabetes in particular, then numerous studies have shown that if you drink wine with a meal, the beneficial effects are much stronger.

[00:31:33] Laura Catena, MD: Oh, I didn’t know about those studies. That’s really cool.  

[00:31:35] Miles Hassell, MD: Two or three studies, yeah..

[00:31:36] Laura Catena, MD: Really, interesting. 

[00:31:37] Miles Hassell, MD: …have shown that and it’s kind of intriguing because it fits also with what we have seen historically in terms of historical precedent. We often say around my practice that a Greek grandmother is worth a dozen physicians. And in that degree…what we’re really applying there is that…what we’re referring to there is that it’s really foolish not to look at what humans have done historically and still be here, right? We’re still here. And so, historically, humans have primarily had their wine with food in, in a social setting. Then we say, you know, that’s not a bad precedent. Unless we have information to the contrary, maybe that’s the way we should do it, simply because what has worked for humans for a long time might be a lot smarter than our August health professionals.

[00:32:26] Katherine Cole: For 10,000 years, 

[00:32:28] Laura Catena, MD: Right. 

[00:32:39] Miles Hassell, MD:: Yeah, yeah. At least. So, the other issue that that comes to is if we’re having wine with meals, with other people, we’re perhaps far less likely to drink too much. You’re in a social setting. And so one of the things I do with my patients, I tell them, especially those, well, all of them, but especially those who are prone to drink too much, is I say, just don’t drink alone.  Always drink with somebody, be accountable, which is not a bad rule of everywhere in life. Accountability is a good thing.

[00:32:59] Martín Reyes, MW: You know, that’s true that, bottles of wine, right? 750. They’re designed almost consciously to be shared. You shouldn’t drink a whole bottle of wine by yourself. One can, but it’s made for four, maybe five glasses. That is a, that’s a dinner party. That’s a family gathering. And obviously we’ve underscored this multiple times in this episode, but there’s plenty of evidence that stress reduction and social networks and the lifestyle, Miles, I think you said that was more medicinal than medicine.

[00:33:29] Miles Hassell, MD: Yeah, so take the Nurses’ Health Study and the Health Professionals Follow-up Study out of Harvard, there’s numerous other studies that say the same thing. So I’m just using that because it’s pretty clean data, it’s been followed for 30 years. It’s got, I think, approaching…between those two studies, a couple of hundred thousand people in it now. And these are people that are followed very carefully over time. And we see a pattern of a decent diet, nothing, nothing extreme, not vegan, not, carnivore, just what we call a normal omnivorous diet, small amount of alcohol, 30 minutes of exercise a day, not being too chubby, body mass indexes of 25 or less, and not smoking. Those five characteristics, including the alcohol, are associated with about, over the period of the study, significantly less total mortality, about 12 years longer life on average, about 90 percent less cancer, about 80 percent less, uh, excuse me, 90 percent less diabetes, about 80 percent less heart disease and stroke, and about 60 percent less cancer. Now, this is a pattern that we cannot give those kind of results with anything else that we do in conventional medicine. There’s no pill I can give you that extends your life by 12 years. There’s no fancy set of supplements that I can give you that some, longevity expert would propose that can give you this kind of results. But every time we see this alcohol in these kind of studies, it’s always in this setting of prudent health practices. And that is actually one of the criticisms that some of the people use is they say, well, it’s because these people are doing these other things as well. And that would be reasonable if by dropping out the alcohol component, you saw the same or better results, but that’s not the case. The healthiest cohort in each of these studies is always the people that drink a small amount of alcohol as well.

[00:35:16] Katherine Cole: As we like to say on The Four Top: Wine: It does a body good.

[00:35:20] Miles Hassell, MD: Yeah.

[00:35:21] Laura Catena, MD: In moderation, we have to put the word moderation all the time. That’s important too.

[00:35:26] Miles Hassell, MD: Yeah. Yeah.

[00:35:27] Martín Reyes, MW: That’s pretty powerful, powerful stuff, Miles.

[00:35:33] Miles Hassell, MD: And as I, as I might’ve said earlier, and, slap me down if I’m repeating myself, but it’s not just Nurses’ Health Study and Health Professionals Follow-up Study, but INTERSTROKE, PURE, EPIC studies. These are all reliable, well done, peer reviewed studies that all say roughly the same thing.

[00:35:49] Laura Catena, MD: Absolutely. 

[00:35:50] Martín Reyes, MW: I want to bring up something that might be controversial and then we’ll wind, we’ll wind up, Katherine, but it just occurred to me that Lancet study, Laura, you referenced this. The one that the W.H.O. pointed to as the definitive alcohol is no good for you. If I recall, I read somewhere in the Harvard School of Medicine website that was trying to parse out the equivocal nature of these studies from their perspective that they mentioned the Lancet study, which had positive results that were ignored by the W.H.O. A lot of that, if I heard correctly, a lot of the people that funded the Lancet study, a lot of them were actually leaders in the biopharmaceutical industry, aka medicine, aka potentially competitive.

[00:36:37] Laura Catena, MD: I feel, I feel like the study I saw was funded by Bill and Melinda Gates Foundation. One of the big studies, but, actually one thing that I do wanna say about the W.H.O. is that they, one of their claims is that many of the studies that show cardiovascular benefits were funded by the alcohol industry. And when I looked carefully at their opinion paper, they make a reference to an article and it says “2,” right? You look at that article that they’re referencing and it’s a study of over 300 studies that showed cardiovascular benefits for alcohol in moderation, and they looked at those studies. They found that 5.4 percent were funded by the alcohol industry, which, in my opinion, 5.4% is not many. And what they showed was that the results were very similar between the studies that have been funded by the alcohol industry and the studies that had not been funded by the alcohol industry. There weren’t, it wasn’t like the ones funded by the alcohol industry showed much better results. So the conclusion of this literature review, and it was a very substantial literature review, was that there was no bias and that there were not many studies funded by the alcohol industry. All these studies that Miles has been talking about, with hundreds of thousands of patients, were not funded by the alcohol industry. They’re funded by the government. So it’s a minimal percentage. And both the W.H.O. and the New York Times, which has quoted the WHO, are saying that there’s this industry funding, in my opinion, to make it look like the cigarette industry or like the narcotics industry, and this is not the case. So, it’s very strange in my opinion.

[00:38:21] Katherine Cole: Laura, I just want to jump in as the sometimes journalist in this group and say, I’m a little embarrassed on behalf of the journalists who’ve been reporting this because the biopharmaceutical industry actually provides 75 percent of the food and drug administration’s drug review budget. I mean, the way studies get funded is money coming from interest. I mean, there’s, this is the only way that scientific studies are funded. And so the fact that only 4 percent of these studies were, had any sort of any connection to the alcohol industry is actually quite impressive and shows that we should be paying attention.

[00:38:56] Miles Hassell, MD: Because people don’t realize how Big Pharma is involved in funding, not necessarily directly. So for example, most of the people who work for the FDA, who are part of the major decision-making bodies within the FDA and so on, have strong connections to the Big Pharma. They might have come from Big Pharma and so on. Secondly, Big Pharma often funds things through indirect channels. Like when I’m speaking at a conference, that conference might be supported by an indirect grant from Merck, or Pfizer or something like that. And they of course claim that they have no direct impact on the content of that conference. But anybody who’s being paid to go to that conference knows if they don’t say something appropriate, they’re probably not going to be invited back to go to the big island and speak next year. And so Big Pharma has a very long tentacles that are not necessarily direct. And if I could just address, for example, that Lancet article, if it’s, if it’s the Wood article from 2018, that I think is what you’re… 

[00:39:54] Laura Catena, MD: Yeah. That’s the one. 

[00:39:56] Miles Hassell, MD: It’s interesting because they said the lowest rate of all cause mortality was in the patients who drank about 100 grams of alcohol a week. That’s somewhere around 10 drinks a week, somewhere in that region. Now that should, that’s in the abstract. Any journalist reporting this should notice that, wow, if the lowest mortality is in the alcohol drinkers, then we can’t give a strict anti-alcohol message because the lowest mortality is in the 100 grams a wee drinkers. And that means that they live longer. And that means it can’t be a bad thing. You know, you’d think that they would, they would not be able to escape that.

[00:40:29] Laura Catena, MD: No, instead they focused on the results on the higher drinker because they defined limited moderate as higher. So you know, Martín to go to what you were saying, that they’re kind of misrepresenting the data. Yes, that is happening and it’s shocking. And Katherine, I agree with you. I, you know, I’m somebody who really respects journalists and I’m a bit surprised. On the other hand, I feel like if you’re a journalist and the W.H.O. says something, you normally trust it. So I feel like the fault is more with the W.H.O. actually

[00:41:07] Miles Hassell, MD: I think the fault is more with physicians because if physicians were doing their

job and giving their patients good advice, we wouldn’t have to worry about these other organizations.

[00:41:15] Martín Reyes, MW: There’s doctors and physicians that we wanted to come on, right, Katherine and, and your experience has been that there’s resistance there

[00:41:22] Katherine Cole: I did. I wanted to quote a hepatologist, a well known hepatologist who, I read this hepatologist also happens to be a wine collector. So I was like, oh, perfect. Wouldn’t speak to me. And then posted an article on Twitter or X, right after responding to say that they would not be able to speak with me.

And the article basically came to the conclusion, it was the journal of the American Medical Association, that basically poorer populations tend to be dying of alcohol-related cancers. Whereas this is kind of, sort of mortifying to say, but people who have a little more money to spend on fine wine are actually healthier and living longer. So there is sort of a class, we could go off on a whole tangent about this, a class element to this, as well. But folks, I would love to just keep listening to you all for hours, but we do need to wrap it up and it’s been such a pleasure to listen to you.Thank you so much, Laura and Miles, for sharing your insights. This has been fascinating.

[00:42:20] Martín Reyes, MW: It has been fascinating. 

[00:42:21] Miles Hassell, MD: Yeah, thank you.

[00:42:22] Laura Catena, MD: Absolutely. So much fun. I wish we had been sitting in a restaurant eating delicious Mediterranean food and, some wine, right?  

[00:42:31] Miles Hassell, MD: With a bottle of chianti, yeah.

[00:42:32] Laura Catena, MD: Or a bottle of Gambier Argentinian Malbec as well.

[00:42:35] Katherine Cole: Yes. 

[00:42:36] Martín Reyes, MW: Right? 

[00:42:37] Miles Hassell, MD: My wife prefers Malbec. So, I’ll tell her, I’ll tell her that we spoke to you. Yeah. Well, thank you.

[00:42:43] Laura Catena, MD: Please do. Wonderful. 

[00:42:44] Martín Reyes, MW: Yeah, Miles, Miles, you’re talking to one of the world’s most famous Malbec producers. I’m sure you, if you didn’t know that now, now you do. 

[00:42:51] Miles Hassell, MD: I did not know that. Oh, thank you.

[00:42:55] Martín Reyes, MW: One, one of the most famous in the world, from Argentina is, Laura’s Bodega Catena Zapata. 

[00:43:00] Miles Hassell, MD: Wow. Thank you. Well, glad to meet you, Laura.

[00:43:04] Laura Catena, MD: Nice to meet you here. 

[00:43:06] Katherine Cole: This has been The Four Top podcast. I am our executive producer, Katherine Cole.

[00:43:12] Martín Reyes, MW: And I am Martín Reyes, Master of WIne. And we were joined today by Dr. Laura Catena, whom you can read about at CatenaZapata.com. 

[00:43:20] Katherine Cole: And Dr. Miles Hassell, whom you can find at goodfoodgreatmedicine.com. And I understand you have a new project, greatmed.org. Thank you for joining us, Dr. Laura Catena and Dr. Miles Hassell. Kielen King is our sound supervisor and the composer and performer of our theme music.

[00:43:41] Martín Reyes, MW: Please visit our website, thefourtop.org to learn more about us and listen to back episodes such as episode 130 and 134, in which we talked more about this issue. And if you have not already subscribed to The Four Top on iTunes or Spotify, please do so. And please give us a rating.

[00:43:59] Katherine Cole: That’s right. And from Portland, this is Katherine Cole signing out.

[00:44:03] Martín Reyes, MW: And from Benicia, normally, but today, Napa Valley, this is Martín Reyes signing out. Stay safe out there. And hey, if it means having a glass of wine, just one glass tonight, do that. And thanks for listening.

[00:44:15] Katherine Cole: Thanks everybody. 


Sources & Citations

Citations reference first appearance, without repeating for subsequent usage:

[00:01:28] World Health Organization: No level of alcohol consumption is safe for our health

[00:08:39] Bringham and Women’s Hospital | Harvard T.H. Chan School of Public Health: Nurses’ Health Study

[00:11:47] Robyn Burton, Nick Sheron | The Lancet: No level of alcohol consumption improves health

[00:33:24] Harvard T.H. Chan School of Public Health: Health Professionals Follow-up Study

[00:39:51] Angela M Wood, PhD, Stephen Kaptoge, PhD, Adam S Butterworth, PhD, Peter Willeit, MD, Samantha Warnakula, PhD, Thomas Bolton, MMath, et al | The Lancet: Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies