Beyond alcohol: re-assessing wine in the context of the Med Diet and drinking patterns

In this commentary (1) responding to Rivas Ruiz et al (2) regarding their recent publication (3), the researchers emphasize that drinking patterns need to be considered when speaking about the effects of alcohol. Adherence to the Mediterranean alcohol drinking pattern can influence or even reverse potential harmful effects of alcoholic beverages.

They discuss that even though ethanol is a group 1 carcinogen, the association between low-dose alcohol intake and cancer is complex and requires careful consideration of both biological mechanisms and methodological limitations such as:

• Underreporting of heavy drinkers à misclassified as low-dose drinkers and thus, they artificially inflate cancer rates in the low-dose category.
• Limited smoking assessment à may incorrectly attribute to alcohol some of the well-established adverse cancer effects of active and passive smoking.

These potential biases may obscure the effects associated with low-dose consumption of alcoholic beverages. In their studies, they focused on wine rather than alcohol alone and found a significantly lower risk of cancer mortality, when combined with higher MedDiet adherence.

The authors further describe that recent methodological reassessments have not refuted the existence of J-shaped associations for coronary heart disease or diabetes. And with some exceptions, many alcohol-attributed harms are due to intoxications, heavy exposure, or binge drinking.