Unlock the Secrets of the Mediterranean Diet: How to Enjoy Alcohol Without Ruining Your Health!

The Mediterranean diet, celebrated for its health benefits and delicious flavors, is rooted in the traditional eating habits of countries bordering the Mediterranean Sea. This diet, rich in plant-based foods, healthy fats, and lean proteins, is often associated with moderate consumption of red wine. However, the role of alcohol, particularly wine, in the Mediterranean diet remains a topic of scientific debate. This article explores the complex relationship between alcohol consumption and the Mediterranean diet, considering both potential benefits and risks.

Defining the Mediterranean Diet

The Mediterranean diet is more than just a set of recipes; it's a way of life. There's no single, rigid definition, but rather a collection of dietary habits common to the Mediterranean region. The foundation of this diet consists of plant foods, including:

Fruits and Vegetables: Aim for 2 to 3 servings of fruit and four or more servings of vegetables each day.
Whole Grains: Choose whole-grain bread, cereal, and pasta, as well as other whole grains like bulgur, barley, and farro.
Legumes and Nuts.
Healthy Fats: Olive oil and nuts are the primary sources of fat, providing unsaturated fats.

Moderate amounts of dairy, poultry, and eggs are also included, along with seafood consumed two to three times a week. The Mediterranean diet emphasizes fresh, local, and seasonal ingredients, with minimal processed foods.

Alcohol's Role: A Contentious Issue

Low-to-moderate wine intake (with meals) is a characteristic component of a traditional Mediterranean diet, enjoyed in populations made famous for their longer lives and lower rates of chronic disease. Like people all over the world, some who live in the Mediterranean region drink alcohol and some do not. Red wine tends to be included more often than is white wine. Despite nearly a century of strong and consistent research linking a Mediterranean diet (which contains low to moderate wine consumption with meals) with heart health, wine’s role in a healthy diet has more recently become a matter of scientific debate.

Potential Benefits

There’s a large body of research pointing to a link between alcohol consumption and reduced risk of cardiovascular disease. Alcohol consumption clearly reduces risk of cardiovascular disease (CVD) in populations throughout the world and may contribute to lower rates of CVD among residents of Mediterranean countries. In addition, overall mortality rates are generally slightly lower among moderate drinkers than among abstainers. In another study, they found that people who followed what the researchers defined as a moderate Mediterranean drinking plan-choosing red wine, drinking with meals, and spreading consumption over the course of the week-had a lower risk of mortality than people who abstained from alcohol. The Mediterranean Diet Pyramid, which depicts low-to-moderate red wine intake alongside meals centered around an abundance of healthy foods like olive oil, vegetables, and nuts, is descriptive, not prescriptive, representing decades of scientific research and expert consensus on the building blocks of a Mediterranean diet.

Moderate alcohol intake (or, more specifically, red wine) represents one of the postulated beneficial components of the traditional Mediterranean diet. Many well-conducted nonrandomized studies have reported that light-to-moderate alcohol intake is not only associated with reduced risk of cardiovascular disease, but also of all-cause mortality.

One clear benefit is socializing. Blue Zones are known for being hubs of community and support, and research suggests those strong social bonds contribute to longevity. Drinking wine brings people together, which can relieve stress, reduce loneliness, and positively stimulate the nervous system. When alcohol is consumed as part of a balanced meal, and coupled with daily movement and social connections, as in the Mediterranean, studies ﬁnd a net health beneﬁt.

The polyphenols in wine are found in the grape skin, and red wine is going to have more time in contact with those during the maceration process. There are other types of polyphenols in white wine, but the big difference is that in red wine you’re going to see drastically higher numbers of those polyphenols than in white wine. It will be about one gram per liter, whereas in white wine, you might only have one or 200 milligrams per liter. There are also other biologic compounds in red wine. One of the things that [these compounds] do, which I think is so cool, is increase the “bioavailability” of other nutrients. An example of that is when you consume red wine and olive oil with red meat. In some ways, red meat is not necessarily the most healthy type of protein to consume, because it can result in damaging compounds being created in your body and the fat profile is not nearly as beneficial to health as other types of proteins. However, when you consume red wine and olive oil with that red meat, both the polyphenols from the olive oil as well as the red wine have an ability to protect against some of that damage. It could be a drizzle on your steak, it could be in the vinaigrette in your salad. And it doesn’t have to be both. You can just have olive oil with your steak and get some of that benefit. You could have red wine with your steak and get some of that benefit.

Associated Risks

However, Martínez-González noted that alcohol’s potential harms must be considered, particularly for young people. One out of every four deaths of Americans ages 20 to 34 can be attributed to alcohol, he said, noting that in addition to increasing the risk of accidental deaths, alcohol may also increase the risk of breast cancer. Growing evidence has linked alcohol to a higher risk of cancer. Doctors, including the US Surgeon General, are sounding the alarm that drinking alcohol is linked to cancer. Several studies have linked alcohol consumption (even amounts equivalent to two drinks daily) to increased rates for certain cancers, especially breast cancer in women.

The World Health Organization warns against alcohol consumption due to its classification as a Group 1 carcinogen and its role in increasing the risk of at least seven types of cancers. Nonetheless, alcohol is an addictive substance imposing huge threats for public health. Alcohol consumption is associated with increased risks of cancer, neurological harms, injuries, and other adverse outcomes. Both the Global Burden of Disease (2016) and Mendelian randomization studies recently supported that the healthiest level of alcohol intake should be 0.

Read also: Delicious Mediterranean Recipes

Moderation and Context

If occasional to moderate wine consumption with healthy meals is not a ritual that you are interested in abandoning, the Mediterranean diet presents an example of how to enjoy alcohol in moderation in a way that may support cardiometabolic health and help to foster positive social connections.

When you are exceeding your body’s ability to eliminate alcohol, that byproduct builds up and we know that acetaldehyde is a compound that is associated with tumorous cancers of the upper gastrointestinal system. Having alcohol with food also reduces glucose bioavailability - which is demonstrated by the glucose lowering effects of moderate wine consumption. However, that can be dangerous for those with diabetes, as glucose levels can drop so low it causes complications. The presence of food may also reduce the amount of alcohol available to mouth bacteria, which start to metabolize ethanol/alcohol into acetaldehyde - a byproduct of alcohol metabolism.

Generally, that’s like 12 ounces of a regular beer at 5% ABV and about 1.5 ounces of tequila, bourbon, or any sort of distilled spirit. In other countries, based on their population, sometimes it’s up to three drinks a day for women and four for men. I looked into the Mediterranean countries - what’s traditional and their diet - and it is similar to one to two drinks per day, but generally it is even less. I’ve also read about some interesting drinking patterns where they might have like two ounces at a time - in the morning, and then with lunch, and then with dinner and so on. So it’s almost like they’re having a tipple all day long. But it’s never a huge amount. Depending on the population - and even the country - the definition of “moderate intake” differs.

Ongoing Research and Future Directions

Randomized controlled trials are needed to ensure that potential benefits or harms from alcohol consumption are adequately assessed, Martínez-González said. He and his colleagues at the University of Navarra received funding for such a study earlier this year. The study is recruiting physicians ages 50 to 75, who will be randomized to moderate drinking or abstention groups.

In this context, a new 4-y noninferiority pragmatic trial in Spain (University of Navarra Alumni Trialist Initiative or "UNATI"), publicly funded by the European Research Council, will randomly assign >10,000 current drinkers (males, 50-70 y; females, 55-75 y) to repeatedly receive advice on either abstention or moderation in alcohol consumption. The recruitment will begin in mid-2024. The primary endpoint is a composite of the main clinical outcomes potentially related to alcohol intake including all-cause mortality.

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