Susie & Peter / Podcast Episodes  / Season Six / Life or Death? On Wine and Health

Summary

Consider this our call to arms for wine.

Where we grapple heroically with the thorny issue of wine and health, calling out misinformation and over-reach, and learn that the truth is always complex, potentially positive – but often mis-represented.

This makes us angry and frustrated. And you should feel the same too.

You may also feel confused or jaded by this topic. Understandably so.

But join us and we will hopefully clear things up AND imbue you with renewed vigour to fight the good fight. Because this is about things we all hold dear – freedom, fairness and our health and personal pleasure.

For wine lovers, this is not a time to stay silent.

Helping us shed light on this contentious topic are Christopher Snowdon from the Institute of Economic Affairs and Dr Laura Catena, former emergency physician in San Francisco, now head of respected Argentine winery Catena Zapata.

Also cited are Tim Stockwell, Sir David Spiegelhalter, Kenneth Mukamal, Eric B Rimm and Edward Slingerland.

Along the way we talk dogs, megaphones, the J-shaped curve, bacon sandwiches, zombie arguments and quantifying joy. We even find time to recommend some delicious wines…

Starring

Dr Laura Catena…and fan
Christopher Snowdon

Links

  • This podcast is a great listen on this topic, featuring Dr Tim Stockwell, Sir David Spiegelhalter and others: How Risky is Drinking Alcohol? The Food Chain
  • Another interesting programme on this is by Stuart Richie and Tom Chivers, which also cites Stockwell and Spiegelhalter: The Studies Show Ep 48: Alcohol
  • Finally on the podcasts front, Tim Stockwell is interviewed by Felicity Carter on the Drinks Insider podcast
  • The book discussed in the podcast is Drunk: How we sipped, danced and stumbled our way to civilisation by Edward Slingerland. We highly recommend it.
  • It’s well worth checking out this punchy article in Harvard Public Health: Is Alcohol Good or Bad for You? Yes.
  • You can find our podcast on all major audio players: Apple Podcasts, Spotify, Google, Amazon and beyond. If you’re on a mobile, the button below will redirect you automatically to this episode on an audio platform on your device. (If you’re on a PC or desktop, it will just return you to this page – in which case, get your phone out! Or find one of the above platforms on your browser.)

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Wines

The following recommendations are wines tasted either in London in July 2024 or in Winchester October 2024.

The former occasion was a tasting with Laura Catena attended by Peter when they sampled new releases and also historic vintages back to the Catena Chardonnay 1999 (think: creme brulee…) and the Catena Malbec 1994 (stunning…the first Catena Malbec exported and originally sold for just £10!)

It was at this tasting that Laura said (as quoted by Peter in the podcast): ‘I’m confident today I’m saving more lives with wine than I did as a doctor.’

Links below take you to Wine Searcher for international availability. We mention UK prices and availability in the episode.

Press coverage

After we broadcast this episode, Laura’s comments were picked up in the national press on 23rd October 2024.

The Daily Express is on the left and The Star is on the right.

Get in Touch!

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Transcript

This transcript is AI generated. It’s not perfect.

Susie: Hello, you’re listening to Wine Blast. Whether you’re new to the show or a longtime listener, you are very welcome here. Our aim is always to leave you a, little happier, a little wiser and a little thirstier than before…

Peter: And can we add to that list a little healthier?

Susie: Probably not!

Peter: Well, but then again, we can’t be sure, can we? Especially, you know, if we’re joining you on a vigorous run, if you’re out for a bracing walk with the dogs, or even a healthy meal with a cheeky glass of wine… And all that is what we’re getting into in this fascinating and probably controversial programme, I’ll be honest. Here’s a taster of what’s coming up:

Laura Catena: Wine in moderation can really bring joy and be part of a healthy lifestyle. But the point is, what are we on this earth for? You know, we all work really hard, we love our families and we try to be a good person every day. And, you know, if you were to tell me that my Friday night bottle of Chianti Clasico with my husband needs to be removed, that would make me very unhappy. It would make my life a lot worse. I think it is very incorrect for the WHO or for any government to tell us not to have this pleasure. That’s an alarmist approach that is unfair. Drink wine in moderation, as part of a joyful life.

Christopher Snowdon: You know, I can’t imagine life without alcohol, really. And I don’t need to be any health benefits in order to defend it. It’s about pleasure and enjoyment and all the things that the public health lobby just kind of pretend don’t exist or don’t matter.

Susie: Doctor Laura Catena and Christopher Snowdon there. Two people who take a very active interest in this issue, albeit from different backgrounds. In this programme we’ll be hearing more from them as well as throwing our twopence into this debate and recommending some delicious wines.

Peter: Something for everyone. Timeless stuff. and I’d like to thank an important contribution to what is a pretty vexed and intense debate that is raging at the moment. and one that needs a bit of prefacing before we get into the white heat of it all, I think. Yeah, over to you.

Susie: Okay, so, wine and health. Now, if you hear those words together and mentally switch off or roll your eyes or feel sorely tempted to do it, anything, something, anything else, we hear you. It’s totally understandable, but please stick with us. We are angry and frustrated, which should make for fun, listening, if nothing else, and we feel you should be too. This is about freedom and justice and health, important things we all rightly hold dear, but they are potentially being denied to us. So we all need to sit up, pay attention and at the very least, get involved.

Peter: Yeah, it’s time to pick a side, do something about it. so here we are. now, we’ve touched on health issues on the pod before. We’ve, talked about dry drinking, biogenic amines, functional drinks, red wine headaches. We’ve had microbiome guy, doctor Tim Spector on the pod, which was fantastic. 17. And some of this has even filtered into the national and international press. but of course, these stories come from our, specific angle as wine lovers, as Masters of wine

Susie: And this is the problem. wine or just booze gets into the headlines on a regular basis and yet there seems to be constantly conflicting advice. One day it’s good for you, the next day it’s killing you. For years we’ve been witnessing a polarised argument conducted via media megaphones rather than a grown up debate between experts and informed adults. it’s hard not to feel confused and conflicted. And believe it or not, the situation is getting worse.

Peter: Yeah, which is why we are feeling upset, which we’ll come on to. But, you know, to back up a bit, let’s discuss the context. The long term health effects or health impacts of wine or alcohol are not something that’s easy to study scientifically. Gold, standard randomised controlled trials, or RCT’s, with lots of people over many years, are hard to do, practically, financially, ethically, when it comes to booze. So, most of the evidence we have is from observational studies. Now, they can show correlation, but not causation. Nonetheless, they’re still helpful, you know, and they’re better than nothing, especially when you kind of add them all up together.

Susie: And what these studies, over decades and thousands of papers have overwhelmingly shown is evidence of what’s called the J shaped curve. Now, this is a graph with the amount you drink on the vertical axis and the risk of death on the horizontal axis. Non drinkers are the base level on the far left of the graph. Small or moderate levels of alcohol intake are, ah, then associated with a dip in all cause mortality before the curve rises

00:05:00

Susie: steeply, as more booze means more risk of death.

Peter: Yeah. Presumably there’s a little picture of a grim reaper dancing a jig at some.

Susie: Point on the top of the point.

Peter: At the curve as the curve for last stratosphere I completely agree. in the same way those maps used to say, here be monsters. You know, a bit like that. Sorry, we’re talking about science, aren’t we? Sorry. Let’s keep on tracking. So, in essence, I always put everything comes back to me in my world, you know, this j shaped curve, it shows that moderate drinkers are healthier not only than heavy drinkers, which makes sense, but also healthier than teetotalers or non drinkers. That’s really important. So, you know, therefore, moderate drinking is associated with good health.

Susie: Bingo. But there’s a new narrative, a new angle in town, largely put forward by a guy called doctor Tim Stockwell, who is at the Canadian Institute for Substance Use Research. Now, note that location, because we’ll be coming back to it. And he’s basically saying, hang on, guys, we’ve got this all wrong. These previous studies are all flawed because in the non drinkers group, they included sick or fragile people, or those who used to be heavy drinkers but have now given up. So these are the so called sick quitters. So that’s not fair or representative. We need to dismiss all these previous findings. The J shaped curve is all wrong. And actually, there are not only no health benefits from drinking, but there is no safe level of drinking.

Peter: And that is now the official position of the World Health Organisation, or WHO There is no safe level of drinking. Canada has recently proposed revising its drinking guidelines for low risk, down to one to two drinks per week. And, I’ll say that again, not per day. Per, week.

Susie: One to two drinks.

Peter: One to two drinks. The US is shortly about to change its own drinking guidelines, and the indications are that they could be going in the same direction. authorities in the UK and Europe seem to be increasingly adopting this logic, too. And of course, the media are loving it, because it’s giving them a tasty new piece of clickbait with a veneer of novelty and public health justification in this new narrative.

Susie: M. But there’s only one problem, isn’t there? In the opinion of Sir David Spiegelhalter, emeritus professor of statistics at the University of Cambridge, saying we should reduce the guidelines is complete and utter bollocks. So the basic point is, things are not as simple as this new narrative leads us to believe. There are risks and benefits to pretty much everything we do in life, and alcohol consumption is no exception.

Peter: Yeah. So, in a recent episode of the Food Chain podcast called how risky is drinking alcohol? Which, by the way, is essential listening, we’ll put a link up on the show notes, David Spiegelhalter says there’s risks to everything we do. There’s no safe level driving, there’s no safe level of living, but no one recommends abstention. Fantastic turn of phrase. He says obesity and lack of exercise are far more important in terms of reducing life and expectancy. And he adds, I get irritated when the harms of low levels of drinking are exaggerated. With claims no level of alcohol is safe, the evidence doesn’t support it. We need to look at the benefit harms trade off. And I, as many feel there is a benefit from drinking at, low to moderate levels, and that’s never mentioned in this discussion.

Susie: And m he goes on to put things into perspective. He says people drink for a reason, they enjoy it. And he says the current UK guidelines are quite good, no more than 14 units a week, because they were devised by a team trying to estimate the level at which there’d be a one in 100 chance of alcohol leading to your death. That means drinking 14 units a week could decrease the average life expectancy by 1%, which over 50 years of drinking could take six months off your life, which is a similar risk, he says, to watching 1 hour of TV a day or eating a bacon sandwich twice a week. Now, he calls these eminently acceptable voluntary risks people take in their lives. And he so one reasonable to drink a day would take six months off your life works out at 15 minutes off each day. That seems a reasonable trade off for a pleasurable experience.

Peter: He also says that people are, grown ups and can make their own decisions on this, and that the new canadian guidelines are completely unnecessary, one risk being that alarmist public health messaging will erode public trust when it comes to really important stuff.

Susie: And on the subject of the canadian guidelines, in this same programme, Tim Stockwell, the new narrative man, admits

00:10:00

Susie: they use the wrong language, that the risk they’re quantifying is tiny, and that the difference in life expectancy of two drinks a week could amount to two to three lost days of life over an entire average lifespan. He also, by the way, believes he takes more risks than low level drinking when he gets on his bicycle in the busy city he lives in. And he freely admits to drinking, sometimes more than even the non canadian guidelines.

Peter: Interesting. I think we could all make up our minds, about that. Meantime, let’s move on to an article that appeared in Harvard Public Health in August 2024 entitled, is alcohol good or bad for you? Yes, which I guess is an attempt to sum up the complex and confusing nature of the debate, which often comes off in a sort of absurd logic. And this does a really good job of summarising what might be defined as the position of the grown ups in the room in the face of all of this stuff that’s going on.

Susie: Yeah. So I think it is worth quoting bits of it. The study’s authors are Kenneth Mukamal, professor of medicine at Harvard Medical School, and Eric B. Rimm, professor of nutrition and epidemiology at, the Harvard TH Chan School of Public Health. Now, they say, The science around alcohol and health is complex. We need the media to treat the subject with the nuance it requires. Drinking alcohol may raise the risk of some conditions, but not others. What does that mean for individuals? Patients should work with their clinicians to understand their personal risks and make informed decisions about drinking. Those who try to correct the simplistic view are disparaged as pawns of the industry, even when no financial conflicts of interest exist. Meanwhile, some authors of studies suggesting alcohol is unhealthy have received money from anti alcohol organisations.

Peter: Yeah, the fact that this subject, is complex and individual and the arena of many competing agendas is one of the most important things to bear in mind here. Now we want to get into Tim Stockwell’s work, this new narrative that claims to support the line that not only are there no health benefits to moderate drinking, but that there is no safe level of drinking at all.

Susie: So we got in touch with Christopher Snowdon, a high profile commentator on this issue from the Institute of Economic Affairs in London. Now, to be very clear, we’re far from the biggest fans of the. But, Snowdon is a respected voice in this debate who has raised some very reasonable questions. So we wanted to get his view.

Peter: Yeah, I asked him for his take on this new narrative about the J shaped curve being the stuff of fiction.

Christopher Snowdon: Yeah, the media kind of like this story and they do tend to give, I think, undue prominence to, a small handful of naysayers who are always casting doubts on the evidence. The evidence, I should say, comes from various different types of science. and, the evidence goes back 50 years, but some people, particularly in the kind of anti alcohol movement, don’t, like the sound of it, which is why the who is so keen to say there’s no safe level. And various plausible explanations were put forward for this. Alternative explanations, the most common of which was the sick quitter idea. The idea that, well, okay, you’re comparing non drinkers to drinkers, and the drinkers, or moderate drinkers at least, are living longer than teetotalers. But this could be because some of your non drinkers used to be drinkers and they made themselves very ill, hence sick quitter, which is a reasonable thing to say. but for the last 30 years, most of the reputable studies have been separating the ex drinkers from the never drinkers. And, yeah, there is a slight, difference between them. The former drinkers do tend to be a bit sicker than the teetotallers, but the moderate drinkers are still healthier and live longer than either, of those non drinking groups. So this is a bit of a zombie zombie argument. It just keeps coming up as if nobody’s ever considered this before. The epidemiology on this particular issue has probably been tested harder than pretty much any other observation. If the same body of evidence showed harm from alcohol, people wouldn’t even be researching it anymore. It would just be considered settled science. It’s because it’s so politically awkward for some people, because, they want to demonise alcohol, that it continues to be disparaged. And people cast usually fairly spurious doubts on it, such as the sick quitter hypothesis. And, the most recent example of this is a guy called Tim Stockwell, who spent the best part of 20 years trying to downplay the benefits of moderate drinking. He’s over in Canada. He and M. His colleagues, just repeatedly produce sort of what they call systematic reviews or meta analyses, but dispose of so much of the evidence that it just strikes me as being fairly obviously cherry picking. So, the most recent one, which was actually published in January, but was press released for some reason in July, he started out with about 3200 pieces of evidence. He refined that down to 200 and then cut it down to six, and then finally to five. So it literally got rid of

00:15:00

Christopher Snowdon: 99.9% of the evidence. and it’s not clear, really, what his selection criteria were. It didn’t seem to me that the five studies that he ended up with were particularly great compared to the others. And indeed, those five studies didn’t really prove his point. I mean, they were a mixed bag. There were two of them clearly showed the J curve, two of them didn’t seem to, and one of them m gave mixed evidence. So, I mean, even. Even after the. That, vigorous filtering of the evidence, he still didn’t make a very strong case that there’s no health benefits. And that’s only by looking at certain types of evidence and ignoring all the other stuff that stop looking at the biology of this and animal studies and ecological studies and all sorts of other evidence. So, yeah, we’ve got literally thousands of pieces of evidence, the vast majority of which supports, the Jacob.

Peter: So even if we take into account the sick quitter hypothesis, the j shape curve, still holds.

Christopher Snowdon: Yeah, yeah, absolutely. It really doesn’t actually make that much difference. I mean, people then come up with other, you know, other excuses, if you like, or alternative explanations. They say, well, maybe people who drink moderately are just inherently healthier in other ways. but of course, you can say that about any. Any epidemiological finding based on observation. But it starts to look like you’re kind of a merchant of doubt eventually, because, you know, epidemiologists are well aware of these kind of confounding factors and they try and adjust for them. And it might be more of an art than a science sometimes, but that’s just epigenetics. If you want to throw the whole, epidemiological baby out with the bathwater, by all means do so. But bearing in mind most of the evidence of alcohol harms comes from the same type of science. No, one’s going to be doing that anytime soon. So, you know, these are people, they know what they’re doing. They can adjust for age and socioeconomic status and education and prior disease and all the other things. And as I say, the tires on this have been kicked more than any other, epigenetical findings. So there are lots of people who got motivated to disparage it, but they haven’t been able to actually produce evidence themselves. And someone like Tim Stockholm doesn’t actually do primary research into this. He just looks at other people’s research and then kicks most of it out. of the evidence for this is genuinely stronger than the evidence for most forms of alcohol harm.

Peter: Now, you say, you’ve mentioned that this is about politics and that there is another agenda about neo prohibition or neo temperance, however you wanted to say it. Could you delve into a bit as to why? What is the politics? What are the motivations going on here?

Christopher Snowdon: people who would like people to drink less and would like more regulation of alcohol are essentially following the anti tobacco playbook. They’ve looked at tobacco control, they’ve seen the success that’s been had in reducing the smoking rate, and they want to treat these other issues exactly the same, inappropriately, in my opinion, for various reasons. but one of the things that they see as being necessary to do that in terms of alcohol is by saying there’s no safe level, which is what they say about smoking and eventually what they said about secondhand smoke as well. it sends a very clear message to the public. Even people who are not particularly anti alcohol in medicine, a lot of them still want to send a clear message to the public. They don’t really trust the public to understand nuance. Things, are either good or bad. You should either be doing more of something or should be doing less of something. And the idea that you could try and strike, a moderate balance doesn’t really appeal to that many doctors. They just want to have a clear message. So it’s a slightly patronising approach from some people in medicine, but also. But an outright political approach from some people in the neo temperance movement, that they simply want to not just send out a clear message to the public, but to essentially demonise the product. And they feel that at the moment, because alcohol can not only be enjoyed, safely, but actually can be healthy, they see that as a stumbling block to tobacco style regulation, probably rightly. I always say that it doesn’t matter to me at all whether there’s health benefits from moderate drinking. I’m pretty sure there are, but it’s not the reason I drink and I don’t drink moderately anyway, apply to me on the high part of the j curve, you know. but I find it suspicious that these people are so obsessed with it. Why are they so keen to downplay what should be good news? If you’re into public health, this should be good news. You should be celebrating it, not trying to, knock it down. So I’m suspicious of the motives of people who are so enthusiastic about, destroying this particular literature.

Peter: Now, ah, you say, you say you enjoy drinking, probably, you know, slightly more than a healthy amount. Can I. Can I just ask you why you said you don’t drink? Because the health benefits. Why do you drink?

Christopher Snowdon: Well, for this, I enjoy the taste, but it’s the social benefits mainly. There’s a great book you may have read and I’m sure you, and your listeners would enjoy it by Edward Slingerland called drunk. Do you know this book only came out two or three years ago? It’s a celebration, not just a drinking, but of actually getting drunk. And he makes a very compelling case, I think, for the importance of alcohol, in the creation of civilization, getting people thinking and talking and socialising and getting on, you know, I can’t imagine

00:20:00

Christopher Snowdon: life without alcohol, really. So that the health benefits, which, as I say, won’t apply to me even with the most generous reading of the evidence, no, I’m not particularly interested, and I don’t need to be any health evidence, health benefits, in order to defend it. It’s about pleasure and enjoyment and all the things that the public health lobby just kind of pretend don’t exist or don’t matter.

Peter: Yeah, I think many people, if they’re honest, would say that, you know, the joy, the fun that, for example, in our line of work, wine can bring is one of the key reasons why they drink. I completely agree. But, you know, the problem is it’s very, very hard to quantify joy and fun and pleasure. You know, to your knowledge, has there been any attempt to sort of quantify or bring this into a scientific understanding of the benefits?

Christopher Snowdon: Well, what an economist would do, we just look at how much people spend on alcohol and they would say that the amount of enjoyment people get from it is at least that figure, otherwise they wouldn’t spend the money on it. So, yeah, people. Slingerland again, makes this point. People have gone to incredible lengths over the millennia to, rate alcohol, to make alcohol, and drink alcohol to the exclusion of all sorts of other things, just going hungry, basically, to brew whatever, and to make alcohol from almost anything they find. so, yeah, it’s tremendously important to people.

Peter: Christopher Snowdon thank you very much indeed.

Christopher Snowdon: Thank you.

Susie: So let’s quantify the amount of joy alcohol brings by Christopher Snowdon’s reckoning, and these are our very sort of rough estimates, that’s about 80 billion pounds in the UK and 200 pounds, billion dollars in the US every year. That’s a fairly large amount of joy.

Peter: 80 billion quid’s worth of joy. That’s a lot of joy, isn’t it? I don’t think, to be fair, I don’t think all of it necessarily brings joy. I think that’s the point, isn’t it? Some of it probably brings misery and death. You know, if we’re going to properly embrace the ambivalence of this debate, but a fair chunk of it will bring joy and fun and social cohesion and, you know, cementing relationships.

Susie: Would we have got married if it wasn’t for wine?

Peter: Now, there’s a big question to throw at me in the middle of this debate. Would I ever have picked up the courage to ask you out if it wasn’t for a helpful bit of booze? Greasing the wheels? But who knows? And this podcast may never have existed as a result. No, but I think this is all.

Susie: Getting a bit meta one for another time.

Peter: Self interested. Exactly. Let’s focus I wanted to pick up on, to shift topic a bit on the book that. That, Christopher Snowdon mentioned, Drunk, which I read recently.

Susie: Yeah, it’s the one you’ve been carrying around, isn’t it? Everyone’s been laughing at you for, isn’t it?

Peter: Have they? Have. I wasn’t aware. No, I was very aware. Of course they have. That’s the one. I did explain to everyone it was work, but, they just laughed at me. Anyway. Yeah. This book, ah, drunk is by Edward Slingerland, who’s a professor of philosophy in Canada. And it makes a very detailed and convincing case for alcohol being, you know, not an evolutionary hangover or a mistake, but actually an essential part of what makes human society and humans work as a substance that allows individualistic primates, essentially, to function in a collaborative society. He doesn’t shy away from the harms alcohol can do, particularly in relation to spirits and the risks of drinking alone. But he details the many positives, from creativity to culture, to communality, and a salve for, self awareness. His mantra is before civilization, intoxication, you know, and I recommend it highly.

Susie: Definitely sounds like your kind of book. And interesting. All these things are in Canada, aren’t they? I don’t quite understand that. Anyway, time to move on, because coming up, we have the magisterial Laura catena and some very tasty wines to recommend. By way of summary, so far, we are nothing happy. And that’s because the potential benefits of our beloved wine are being questioned and undermined like never before. And on the basis of what looks to be pretty shaky evidence, the fact this could go on to shape public health policy, taxation and other government strategy is extremely worrying.

Peter: Yeah. So given all of this, we wanted to get the insider’s track. So who better to talk to than a doctor who’s also a wine lover? In fact, more than that, a wine producer. And she said something really interesting to me recently. She said, I’m confident I’m saving more lives today with wine than I did as a doctor. which is quite something to say. Hence wanting to chat with her.

Susie: That is a big thing to say, especially when you consider that doctor. Laura Catena is an emergency physician who studied at Harvard and then worked in A and E in St Francisco for many years. In 2019, she then took over her family winery in Argentina, Catena

00:25:00

Susie: Zapata. Hers is a unique perspective, straddling health and wine She’s also uniquely accomplished in the communication sphere. A true rock star of the wine world.

Peter: Yeah, so I jumped right in by asking her if it was hard to reconcile being a doctor with making and selling wine

Laura Catena: Well, not at all, because I think that, wine heals a lot of people. It gives you joy. It makes a moment that maybe would have lasted ten minutes eating into a 1 hour conversation with friends and family. So, I think that, wine in moderation, and this is, I will repeat over and over, wine in moderation can really bring joy and be part of a healthy lifestyle. So I don’t think that these two areas of my life are contradictory.

Peter: Well, let’s get into the detail a little bit, then. let’s start with the bad news. In what ways might wine m be considered bad for us?

Laura Catena: Yes. So I think that we’re really talking about alcohol beyond wine So alcohol in excess is very, very bad. So would you like me to list some of the bad?

Peter: I would, actually. Can you just. Maybe the headlines? Because obviously, these things are complicated and personal, but what are the main things we should be worrying about?

Laura Catena: Yeah. So, I think in terms of how much you should drink, you should follow country’s guidelines and skip a few days per week. So, what are some of the bad things? So, starting with cardiovascular. so if you drink too much, actually, your blood pressure will go up. If you drink in moderation, your blood pressure will either stay the same or go down. If you drink too much, you can get some damage to your heart, to the muscle of your heart, and you can get something called cardiomyopathy. You can get something called atrial fibrillation. And so you can get a lot of bad things. Also, we talk about how alcohol can be a blood thinner, right? Alcohol can be a blood thinner, and so it might help keep your arteries in your brain clear. Right. So reduce the risk of strokes of the clot type, and also might be good for preventing dementia. But that’s only in moderation. If you drink too much, you have a bleeding stroke. Potentially, you have the risk of the bleeding stroke, and also, you have increased risk of dementia, because alcohol, if it sticks around too long, it can be toxic to your brain. So that’s why moderation is the key. It has to do with how long the alcohol sticks around in your body.

Peter: So, alcohol, both are, potentially very damaging and potentially very healthy in the same, liquid. But what about cancer? There’s a lot of talk about cancer as well.

Laura Catena: So, in excess, alcohol can increase the risk of some m cancers. In moderation, it can also increase the risk of some particular cancers. So what you need to understand about alcohol is that we have these great enzymes in the liver that basically clear out the alcohol pretty quickly. So if you’re having alcohol and food, what happens? The absorption of the alcohol is happening more slowly. So the level of alcohol is less high, but it stays on for a little longer, and then your liver has no problem metabolising all this and getting rid of it. So there is probably no toxic effect. That’s why most of the literature on drinking with food shows absolutely no negative effect. And the mediterranean diet, which includes alcohol, in moderation, shows decreases in cancer and decreases in heart disease. So now about the cancer. So with moderation, you can see some increases in oral and esophageal cancers, small increases, not high increases. So, for example, people talk about liver cancer. You have to drink a lot to be at risk for liver cancer, colon cancer, you have to drink a lot. If you drink in moderation, you don’t have increases in some of these other cancers. Now, breast cancer is an issue, and that’s because alcohol can slightly increase oestrogen. And we know there are a lot of breast cancers that are affected by oestrogen levels. But there’s often misinformation about this because people say there is a 10% increase. So what do you think, Peter? A, 10% increase in the rate of breast cancer means?

Peter: Well, it sounds quite scary, right? I’d be worried if I’m a woman. 10% increase. That sounds worrying.

Laura Catena: Now, what if I tell you that your risk is 10% and it’s a, 10% increase on the 10%? So your risk in your lifetime just went from 10% to 11%. What do you think now?

Peter: I would definitely keep drinking.

Laura Catena: Exactly. So that’s the thing. If you have a very strong family history of cancer, you know, everybody in your family has had some kind of cancer, or breast cancer is an issue in your family and yourself, then you really need to think about it. And you need to think about what does that change from the 10% to the 11% mean? Or maybe your risk is 20%. So you’re going from 20% to 22%

00:30:00

Laura Catena: and you have to make your decision. Yeah, there are actually some cancers that are decreased by moderate alcohol consumption. And there’s good data on that. It’s just as good as the data showing this potential oral, cancer increase and the breast cancer increase. So we see decreases in thyroid cancer, in some renal cancer, and some haematological malignancies. So, you know, a lot of people might have that in their family. And actually drinking moderation could have a positive effect. There.

Peter: How much of this is about the difficulty associated with quantifying and evaluating individual risk?

Laura Catena: Absolutely. And I want to remind everybody that I am not giving you medical advice here because I’m talking in very general terms, and that’s about your relationship with your medical doctor, who can ask you about your family history, about what your risks might be. But, the interesting thing is that inflammation is a big risk factor for both heart disease and cancer. And there’s a lot of other factors, much worse in terms of inflammation causation than alcohol. So, for example, if you look at the overall risk of cancer, over 25% is from obesity. So actually, if you exercise and lose some weight, that will have an extraordinary impact.

Peter: Now, the, who has been increasingly vocal lately, the World Health Organisation, about the risks of alcohol, calling it many things, but the headline, obviously, that gets repeated a lot, is who stating there is no safe level of alcohol consumption. What’s your response?

Laura Catena: Well, I think that the data does not support that, because we have a lot of data that shows that in moderation, actually, alcohol has cardiovascular benefits. Hundreds of studies, well done studies, that show about a 20% to 30% decrease in heart attacks, in embolic strokes, in cardiac events, in people who drink in moderation. And then we have some of this literature on the, cancer risk. And then we have some literature that says that some cancers are reduced, potentially by alcohol. Now, if we’re talking moderation, I think that really, we have kind of a washout. We have some positives that are pretty significant in terms of cardiovascular risk, and some negatives and some positives in terms of the cancer risk. So what I think is that everybody needs to read all this and make their own decision and talk to their doctor. But in the end, actually, if you look at what affects your lifespan, being happy and spending time with friends and eating good food, such as the mediterranean diet, is associated with longer lifespans. And actually, there is also some literature that alcohol in moderation, people who drink alcohol in moderation, especially in meals, have a longer lifespan.

Peter: It strikes me that quantifying the bad effects of alcohol is quite easy. Cost to the health service, cost to the police, cost to whatever economic impact. But it’s very hard quantifying the joy that alcohol or wine particularly can bring.

Laura Catena: Yes.

Peter: Is there anything that can be done in that regard?

Laura Catena: Well, there’s actually one study that shows that people who drink wine smile more. And there is a study, yeah, there is a study, but the point is, what are we on this earth for? You know, we all work really hard. We love our families. We love our dogs. I’m obsessed with my dog right now, and we try to be a good person every day. And, you know, if you were to tell me that my Friday night bottle of Chianti Clasico with my husband needs to be removed, I mean, that would make me very unhappy. It would make my life a lot worse. And I really think that it’s unacceptable based on the current data, which is actually quite positive for alcohol moderation, despite these few negatives. but in the end, if you do the math on the positives and the negative, I think you come at either more positive or neutral. I think it is very, you know, incorrect for the who or for every. Any government to tell us not to have this pleasure. It would be like telling me, don’t pet your dog. I mean, literally, you know, animals have been shown to decrease inflammation. If you have a pet, it brings you enough joy that it decreases inflammation, it decreases your risk of heart attacks. So wine is doing the same thing for me. And so I think it’s very intrusive for them to say that. but I do think that they are concerned about over drinking and alcoholism

00:35:00

Laura Catena: and not drinking in moderation, and that is a very adequate concern. But I don’t think the approach should be telling people that a small amount that brings you joy is bad for your health. I think that that’s an alarmist approach. That is unfair and incorrect.

Peter: So, coming back to the data and the research, the WHO has said there are no studies that would demonstrate that the potential beneficial effects of light and moderate drinking on cardiovascular diseases and type two diabetes outweighdenae the cancer risk associated with these same levels of alcohol consumption for individual consumers. What’s your response?

Laura Catena: That’s completely incorrect. And if you talk to any leading researcher in alcohol, and I say leading because they are basing some of their statements on articles that are published in not the top publications. If you look at the articles published in top publications, which include the Lancet, the Lancet study, which is quoted by the World Heart Federation, that is the. Of the WHO says that actually up to 100 millilitres, you know, which is a small glass of wine per day, is health neutral. Now, their study and what this whole statement is based on is the fact that they have decided that all the studies that show cardiovascular benefits are incorrect because they included, in some cases, people who stopped drinking, who might have had, an issue with drinking. Now, they’re using the same studies to look at the cancer data, which is very strange. So you decide this study is bad for the, cardiovascular, but for the cancer data, which is the one I want to talk about, they’re good. So that makes no sense. It’s the same databases. The same, the same, the same. Now, what they say about there being some studies that include, in their control group, when they’re comparing, you know, drinking versus non drinking, they include people who used to drink a lot. That is true. That that is not a group that should be included because they might have some problems related to their previous drinking. Now, all that data has been looked at again, because this is data where they knew everything about these people. These are hundreds, of thousands of people in databases, you know, in Boston by mass general, Harvard affiliated Hospital in UK. They have these huge databases that are incredibly well studied. They know everything about these people that they’re following, and they are able to then look back at the data and eliminate those people. That has been done. Multiple studies have relooked at the data and they still see the cardiovascular benefits. So I, am not sure where the who is getting their information because it’s simply incorrect.

Peter: So why. The question then is why? Why are they taking this position? Is it that they are so worried about the effects of over drinking that they’re prepared to, in a way, moderate drinkers who enjoy alcohol are acceptable collateral? Is that what’s going on?

Laura Catena: Well, you know, I can’t guess what they’re thinking, but I think that that is probably a good interpretation. And, you know, there is some good to that, you know, to say, okay, those people that, are drinking fine wine we don’t need to help them. They’ll probably keep on drinking despite what we say. We need to help people who drink too much and get into car accidents and go home and are depressed and are drinking too much and that’s making their depression worse or there’s a lot of abuse at home associated with overdrinking in many countries. I think it’s coming from a good place, but I just don’t think that’s what we, as people who live in democracies want. You know, we want to be given the information and we want to make our decision.

Peter: We talk about studies and the fact that most studies are observational rather than randomised, which is the case in the drug industry, the pharmaceutical industry. Is there a way to design and fund a proper study to settle this debate once and for all, and particularly looking at wine in that regard?

Laura Catena: Yes, absolutely. We need a study randomised, controlled, and there was a huge study being planned that was going to be funded by the NIH, the National Institute of Health in the United States, and they actually had sites all over Europe, in Argentina, and they had planned this study and it was going to be funded by the alcohol industry. And there had been articles saying how horrible that the alcohol industry was going to fund this study. But actually, most people don’t know that all the drug studies are funded by the pharmaceutical industry. What happens is that a government group will take the money from whoever’s

00:40:00

Laura Catena: funding it and then will fund the researchers, and the researchers publish whatever the study shows. So this researcher in the US, it was actually a group of researchers all over the world, Europe, US, South America, who were doing this study. And actually, I know the researcher, and he told me he actually talked to the alcohol industry on the bequest of the NIH, the National Institute of Health in the US, and that some representatives from the alcohol industry said, well, what will you do if the study shows that alcohol is really bad? And he said, I will run to the New England Journal of Medicine, which is, you know, the top medical publication, and publish it because everybody is going to want to know this. But, you know, they defunded that study. It became a sort of political scandal.

Peter: Why? Because. Because it was being funded and therefore the results were going to be questionable.

Laura Catena: Exactly. But that is how all the pharmaceutical studies get done. And there is a mechanism for not allowing any bias. That’s why not all drugs go through. You know, we always hear about, oh, there’s a new drug that, you know, might prevent, Alzheimer’s. How many times have you seen that? But then, you know, a few months later, they say, well, but it was studied and it has too many side effects, and we’re not approving it.

Peter: Talking about mechanisms, can you, can you explain, please, simply, the mechanism or mechanisms for why alcohol, or how alcohol can be beneficial?

Laura Catena: Yes, yes, absolutely. And I think this is really important because when you have a medical theory that’s not based on a mechanism, you should question it. So, for example, you know, like when we talk about some of these cancers that maybe are prevented by alcohol, I don’t have a good mechanism. So, you know, I’m not 100% sure if those are true. Now, alcohol actually has been known in the lab and in the blood of people that has been tested before and after alcohol to be a, mild blood thinner. And we know that a lot of people take blood thinners to prevent cardiac disease. So that actually makes a lot of sense that alcohol, which many people drink who don’t know they have some heart disease. Could be preventative for heart attacks because it’s a mild blood thinner. And that’s been shown over and over again. It’s a fibrinolytic agent. That is factual. Now, there’s a new mechanism, out of some research at Harvard, and he is a cardiovascular specialist, researcher out of Harvard. He has a huge lab. He’s a very, very well published person. He looks at the scans, the brain scans of people, and he looks at their, heart scans as well. And he found a mechanism for white alcohol, in moderation, might be cardio protective, might reduce heart attack. So you know that there is a high correlation between high stress and heart attacks. That is factual. You know, you always hear of somebody that has something terrible happen, and they have a heart attack that’s not made up. That is true. If we want to reduce our risk of heart attacks, we need to reduce our stress levels, get a dog walk, you know, not get into fights with people. And what he showed was that people who drank in moderation had reduced activity of the amygdala, which is the fight or flight sector. And that, he thinks, is a mechanism for some of the cardioprotective effects of alcohol moderation. And I thought that was really interesting because it makes sense. And the other thing he showed was that it worked even better for highly anxious people. So in people who describe themselves as highly anxious, that glass of wine per day was extremely effective in reducing their cardiovascular risk. So I think that’s a really interesting mechanism that has only been published recently.

Peter: Now, alcohol and wine included is being increasingly lumped in with things like cigarettes. Is that comparison valid? From a medical point of view?

Laura Catena: That is  absolutely not valid. It. So, for example, I’ve heard a lot of people say, oh, everything in moderation. No, that is not true. Some things are bad, even in small doses. So smoking one cigarette per day is bad for you. It increases your risk of cancer and heart disease. Not as much as having a packet per day, but it does increase it.

Peter: I’m, going to ask you some quick fire questions. Is wine good for you?

Laura Catena: Well, for me in particular, Laura Catena, it’s so good for me. It brings me joy. I drink it in moderation. I’m, extremely careful about how much I drink. So for me, Laura catena is very good for me.

Peter: Can wine be bad for you?

Laura Catena: Absolutely. wine alcohol in excess, can be bad for you? Absolutely, 100%.

Peter: So what’s the best way to drink Wine? To be healthy?

Laura Catena: To drink it with food with friends and family.

Peter: How

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Peter: important is joy and sociability and conviviality, the kind of things that wine can help, foster? How important is that for us as people?

Laura Catena: Well, that is so important. And we’re seeing a loneliness epidemic in the world. And, you know, I think that having that little glass of wine with food, with friends, makes you a little bit more social. And why not? Now, the really important thing is that we cannot romanticise the culture of excess, you know, of getting drunk. I think that we, as an industry, need to promote, you know, moderate drinking and we should not glamorise excess drinking, ever.

Peter: What would be your one headline message for people out there when it comes to wine and health?

Laura Catena: Drink wine in moderation, as part of a joyful life.

Peter: So here’s to, wine and joy and friendship and conviviality. Reality. Laura Catena, thank you very much indeed.

Laura Catena: Thank you, Peter.

Susie: Okay, so lots to be getting on with there. I mean, I guess it really comes down to individual choice. You know, we all need to understand that alcohol can be harmful in excess or if we have individual risk factors, like a history of breast cancer in the family. But I think we should also recognise that alcohol and wine in particular, is a delicious drink that goes well with food and, encourages social interaction and joy and fun and can have benefits.

Peter: Exactly. Exactly. You can do both, you know, and if you’re in any doubt, have a chat with your doctor. You know, either way, we’re grown ups, you know, we can understand risk and reward and we can make up our own minds, you know, if we come across bad stuff related to booze, which definitely does happen, as you say, let’s not gloss over it, let’s be honest, deal with it, help ourselves, help others. You know, it’s sort of better to be understanding and collaborative than it is to be preachy and judgmental and narrow viewed about this.

Susie: Yeah. And Laura did say she knows both a winemaker and a wine writer who don’t drink because it’s dangerous for them. So they still enjoy the world and the culture, but they just don’t drink, which is interesting. You know, we’re not like that. We do enjoy our wine and we’ve got a couple of bottles here, haven’t we?

Peter: We do, we do. Now, this is a lot episode, so, we’ve got a lot here, but I think we’ll just recommend a couple here. But we will put more on our website, show notes, I promise. now, these are all Laura’s wines. And first up we have the slightly wacky La Marchigiana criolla rosé 2023. It’s a deeply coloured rosé. Yeah, you can see in the bottle, it’s made in the kind of natural style.

Susie: It’s almost like a pale red.

Peter: Yeah, it’s definitely sort of got a nutty, oxidative kick to it, but it’s also savoury and herbal and juicy and elegantly dry. It’s one for a plate of charcuterie and cheese, you know, so drinking in moderation with food, as Lara suggests. Perfect for this one.

Susie: And, not to mention a rose with character, which is what we were championing on our rosé episode recently. and it’s quite fun too. Now I’ve got a couple of reds. First up, the Catena Highmountain Vines Malbec 2022. This is $13.99 from Waitrose. and majestic. And it’s juicy and plump. Very, decent at the price. Very easy to like, isn’t it? You know? And then also the container Adriana vineyard for tuna Terrae Malbec 2019, which is a bit posher and certainly a bit pricier. it’s about 85 to 100 pounds, a bottle. But it’s really serious, dense, complex. You know, it’s a big wine for wintry food and a special occasion.

Peter: Yeah, it’s classy stuff, isn’t it? You know, I think Argentina is doing such good work these days, you know, particularly with its top end reds, which are just so serious and classy and complex these days. You know, when I was tasting with Lara, we had some of her malbecs back to 1994. They’d aged beautifully, you know. So, you know, these wines are well worth checking out, you know, as part of your rounded, healthy lifestyle.

Susie: And we didn’t actually have time to include it from the interview, did we? But Katena also doing some interesting work with lightweighting bottles and promoting diversity of plant material.

Peter: Yeah, really interesting.

Susie: So, by way of closing summary, the wine and health issue is complex and nuanced. Impossible to simplify into a headline or sound bite. There are benefits and drawbacks to drinking wine and we all need to be able to make up our own minds based on the best evidence. We need more research. But in the meantime, misrepresentations of the evidence and authorities overstepping the mark need to be called out and challenged.

Peter: So, in a way, this programme is a call to action for you, for us wine lovers, you know, we need to make our voices heard in the interests of fairness and individual freedoms. You know, the good news is according to the current best evidence, we stand a decent chance of living a long and happy life so we can make our influence felt for a long time.

Susie: I like it.

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Susie: Anyway, if you’d like to get in touch as a result of this episode, please do go to our website, susieandpeter.com, where we’ll have all the show notes and links and wine details. And from there you can send us a voice message via speakpipe or an email, or you can engage or help amplify our message on Instagram and Twitter. X. You know, whatever you do though, don’t be silent. It would be a tragedy if this beautiful thing we call wine was slowly marginalised in our lives because of ignorance or malign agendas.

Peter: Yeah, we wine lovers need to stand together. Lovely bunch that we are. On which note, thanks to our interviewees, Christopher Snowdon and doctor Laura Catena. And of course, thanks to you for listening. Until next time. And we mean this even more sincerely than we normally do.

Peter: Cheers.

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