Square meals and bottled benefits: don’t abandon chocolate and red wine just yet
Practising medicine in modern times, doctors must be wary of becoming part of the “health police”
“That living has become so difficult is peculiar, for even the experts manage to die in the simplest of ways” – Erwin Chargaff
Practising medicine in modern times, doctors must be wary of becoming part of the “health police”. There is a growing industry around “negative” health advice. By negative I mean bombarding people with a constant diet of health don’ts. And depending on how they are delivered, health dos can become a little tiresome also.
Luckily, some of us were exposed to teachers in medical school who were well aware of the risks posed for doctors of becoming over-identified with the nanny state.Two professors in particular were advocates of hedonism, arguing that individual patients had a right to harm themselves in the pursuit of happiness, provided they did not harm others in the process.
Noting the growing evidence for the protective effect of a moderate alcohol intake in the prevention of coronary heart disease in the 1980s, Prof Petr Skrabanek and Prof James McCormick wrote: “What is perhaps surprising is that those who are enthusiasts for prevention and health promotion have never encouraged people to drink, presumably because of the danger that we would all become drunks.”
So I have veered towards the mantra “a little of what you fancy does you good” in lifestyle advice I give to patients. It has always given me particular joy to mention the health benefits of dark chocolate and wine, and, indeed, to write about them in this column.
In this context, the publication of research in Jama Internal Medicine last week looked like a blow.
A study of Italians who consume a diet rich in resveratrol – a compound found in red wine, dark chocolate and berries – found they live no longer than, and are just as likely to develop cardiovascular disease or cancer as those who eat or drink smaller amounts of the antioxidant.
For 15 years, researchers from Spain, Italy and the US have studied the effects of ageing in a group of people who live in the Chianti region of Italy.
For the current study, the researchers analysed 24-hour urine samples from 783 people over the age of 65 for metabolites of resveratrol.
After accounting for such factors as age and gender, the people with the highest concentration of resveratrol metabolites were no less likely to have died prematurely than those with no resveratrol found in their urine.
In addition, the concentration of resveratrol was not associated with rates of cardiovascular disease or cancer. The people who participated in the study comprised a random group of people living in Tuscany where supplement use is uncommon and consumption of red wine is the norm.
The French paradox
In previous research, resveratrol has been linked with long-term health benefits, such as anti-inflammatory and anti-cancer effects.
There has been speculation that it might be responsible for the French paradox: the intriguing fact that rates of heart disease are low in France, despite residents enjoying a diet rich in cholesterol and saturated fats.
Inevitably, the publication of the latest research led to a series of negative headlines, with the BBC reporting “Red wine health benefits ‘overhyped’.”
However, the headlines may have been overdone. Resveratrol is not the only antioxidant contained in red wine and chocolate. Polyphenols and other compounds could be responsible for the significant reduction in heart disease associated with chocolate and wine consumption noted in other studies.
And the research was of a “cohort study” type which, by definition, cannot show causation. So lovers of red wine and chocolate can relax.
When Juliette Binoche, the star of the film Chocolat, was asked if she agreed with the 75 per cent of British women who said they would rather have chocolate than sex, she replied that it was better to have both at the same time.
In the spirit of healthy hedonism, why not add a glass of red wine to the mix?
Dr Muiris Houston is a specialist in general practice and occupational medicine and a medical education consultant. firstname.lastname@example.org | muirishouston.com