Is alcohol-free wine better for your health than the real stuff? Tony Edwards takes a deep dive into the evidence
In almost every country round the world, the “alcohol guidelines” are now much lower than they were a decade ago. For example, in 2016 the UK reduced its advised intake from four “units” of alcohol a day to two, while marijuana-smoking Holland slashed theirs to one unit (a maiden aunt’s glass of sherry) per day.
Understandably, many people now believe that alcohol is more harmful than was thought and that it might be prudent to give it up altogether—as with tobacco. Indeed, according to the World Cancer Research Fund, from the point of view of cancer prevention, the best level of alcohol consumption is zero.1
On the other hand, red wine is often touted as a superfood, and studies show that moderate wine drinkers generally live longer than teetotalers.2 They also have reduced risks of heart disease,3 diabetes,4 metabolic syndrome,5 dementia6 and even certain cancers.7
So the question is, given the privileged position of wine, are there any health advantages to drinking alcohol-free versions of the liquid?
Alcohol-free wines haven’t been around long enough and amassed enough epidemiological data to definitively judge whether they’re better for health than the real stuff. By definition, there can be no research comparing the long-term benefits of proper wine and alcohol-free wine (from now on referred to as “real wine” and “fake wine”).
However, there have been some short-term clinical studies, which paradoxically may be more useful. Simply put, healthy human volunteers have been brought into laboratories to compare their various bodily functions after consuming real and fake wines. Modern technology makes this both easy and instructive, as the data obtained provide solid evidence of harm or benefit by measuring bodily biomarkers.
Much of this research has been carried out in two countries at opposite ends of Europe: Spain and Finland. One of the first studies was at Finland’s Turku University, where doctors measured blood flow through the heart. They found a clear difference between real and fake wine, with the real stuff increasing the men’s “coronary flow velocity reserve” (CFR). There’s no doubt whatever that a good CFR is a very healthy outcome.8
Interestingly, the Finns found that alcohol on its own does not increase CFR, implying that there’s a health-promoting synergy between real wine’s polyphenols (see ‘What’s so good about wine?,’ below) and alcohol. In other words, it seems grape juice needs to be fermented to have any CFR benefit.
A second Finnish study found “high doses” of real wine inhibit blood clotting, while alcohol itself and fake wine do not.9
Now, is that good or bad news? The Finns say it’s bad news because blood that won’t clot properly is a risk factor for heart disease. Fair enough, but on the other hand, if your blood doesn’t clot easily, that means it’s been thinned, reducing the risk of an ischemic stroke and high blood pressure.
Indeed, heart disease patients are often prescribed blood-thinning drugs called vasodilators. And you don’t have to be a patient to benefit from vasodilation. For example, if you were drinking real wine during the Covid crisis, you might have been protected against the blood clots associated with both the illness and the vaccines.
In summary, the Finns’ research findings are pretty clear that real wine has far more health benefits than fake wine.
Australian dieticians have also investigated the fake wine health question in postmenopausal women prone to high levels of harmful cholesterol. For six weeks the women were asked to drink half a bottle of either fake or real wine a day, after which they were swapped in what’s called a crossover trial.
At the end of each six-week session, their cholesterol levels were tested. Fake wine was found to have no effect whatever, but real wine increased “good” (HDL) cholesterol and reduced “bad” (LDL) cholesterol.10
Similar human guinea-pig tests have been done in the US, where muscadine red wine was compared to muscadine grape juice. They found that consumption of wine, but not grape juice, significantly increased antioxidant capacity and resulted in beneficial changes to blood vessels.11
In 2009, German diabetes experts reported on the results of a clinical trial that again pitted real and fake wines head-to-head. They knew real wine reduced the risk of diabetes, but they wanted to see if fake wine would do just as well.
The biomarker they tested was adiponectin, a valuable protein known to reduce the risk of diabetes, arterial disease and obesity. But once again fake wine failed the test, having “no substantial effect on adiponectin concentrations,” whereas real wine did.12
Spain’s major alcohol and health research center is at the University of Barcelona, where Professor Ramon Estruch, one of the country’s leading alcohol experts, runs the Institut d’Investigacions Biomèdiques. Over the last 20 years, he and his research team have conducted a host of clinical trials on alcoholic drinks—probably the most anywhere in the world.
Estruch’s laboratory bristles with high-tech analytical hardware generating sophisticated measurements of health biomarkers in samples of bodily fluids. As soon as alcohol-free wines began to take off, he was keen to discover how much better—or worse—they might be for drinkers’ health. So he set about comparing real and fake wines in clinical trials, mimicking the ones often used in the pharmaceutical industry.
In an early trial, he asked 70 healthy adult volunteers to alternate between real and fake wines over four-week periods to see what effects each had on the body. They were given nearly half a bottle of wine to drink per day with meals.
It wasn’t plain sailing, however, as many of his human guinea pigs could barely tolerate the taste of fake wine; two of them actually refused to drink it. Still, those who stomached it provided some useful information.
First, the blood data showed there was no difference between real and fake wine in terms of glucose metabolism. They were equally beneficial.13 That’s an important finding, as efficient glucose metabolism decreases the risk of diabetes and obesity.
So, full marks to both real and fake wine for that. But not for a substance in the blood called lipoprotein (a). Here they found a significant difference: real wine showed much lower levels than fake wine. What do higher lp(a) levels mean healthwise?
Sadly for fake wine drinkers, it’s bad news, as high lp(a) is a risk factor for atherosclerosis (clogged arteries), coronary heart disease and stroke.14 One in six of us has high levels, so the study suggests a significant proportion of the population could benefit from drinking real wine rather than the fake stuff.
But surely there must be some benefit from fake wine, Estruch told himself. One obvious area is the simple one of high blood pressure, as it’s been known for over a century that excessive drinking can raise it fairly substantially.15
Estruch’s hunch was right. In another three-month clinical trial, he found that although moderate amounts of both real and fake wine reduced blood pressure, the latter reduced it slightly more—but only by a “modest” amount, he says.16
The team has also compared real and fake wine’s effects on gut bacteria, the microbiome. Again, by clinically testing volunteers, they found a significant difference in gut health in real wine’s favor.
“The diversity of the fecal microbiota was higher after the red wine dosing period. We found a significant increase in the Proteobacteria, Firmicutes, and Bacteroidetes phyla, but not after the de-alcoholized red wine period. Moreover, after the red wine period, there was an important decrease in the Clostridium genera and Clostridium histolyticum group.”17
In layperson’s language: compared to fake wine, real wine improves the diversity of gut bacteria, as well as increasing beneficial bacteria and reducing harmful bacteria. So far, in the Health Stakes horse race, the real wine stallion is already many lengths ahead of his gelding rival. But real wine’s lead is about to open up even further because of hydroxytyrosol (HT).
HT is a recently discovered constituent of both wine and olive oil and is now thought to be a key explanation for the health benefits of a Mediterranean diet (see ‘What’s so good about wine?,’ below). In fact, wine may be even more important than olive oil—laboratory tests have shown it produces 40 percent more HT in the body than olive oil.18
In 2015 another Spanish research team led by Professor Rafael de la Torre asked the key question we’re discussing: vis-à-vis HT, is fake wine as health-promoting as real wine?
And once again, the answer was sought from human guinea pigs: 28 healthy male subjects aged about 26.
They were given a small glass of real wine, then one of fake wine, in each of two suitably spaced sessions.
At the end of each session, their urine was tested for the presence of HT. The results were astonishing: in these men’s bodies, real wine produced more than twice the amount of HT as fake wine.19
On the face of it, however, this is puzzling. After all, the antioxidant polyphenols in both real and fake wine are exactly the same, so how can the presence of alcohol, which is not itself an antioxidant, increase the antioxidant value of real wine?
De la Torre says the answer lies in dopamine, a chemical our bodies naturally produce when we feel pleasure. Lying in the sun, having sex and listening to music all produce dopamine—and so does drinking alcohol, probably due to its relaxing effect.
Okay, but so what? De la Torre’s crucial discovery has been that dopamine forms a chemical bond with an ingredient in wine called tyrosol, resulting in the actual manufacture of HT within the body.
This is a stunning finding: the alcohol in real wine contributes to its health benefits by exerting beneficial effects on mood. Put simply, getting gently squiffy is good for your health.
In fact, alcohol’s effects as a de-stressor are only now beginning to be studied. Medics at Massachusetts General Hospital have found that drinking produces less “stress signaling” in the amygdala, the part of the brain that regulates fear responses. This could help reduce blood pressure and the risk of stroke and heart attack, particularly in the chronically stressed, say the researchers.20
So what’s the expert verdict on real vs fake wines? Professor Estruch’s conclusion is that “apart from possible effects on blood pressure, regular wine is ‘better’ than de-alcoholized wine since it combines the beneficial effects of alcohol and polyphenols.”21
There are only a very few narrow categories of people who shouldn’t drink real wine, he says: pregnant mothers, the underage, people on certain medications or with preexisting conditions (such as liver disease), and those who hold particular religious beliefs (such as Muslims).
Most of wine’s constituents are water and alcohol, of course, but the liquid contains a huge array of natural chemicals derived from grapes, most notably a group of health-promoting antioxidants called polyphenols.
Resveratrol
From early on, the polyphenol that stood out from the crowd was a compound called resveratrol (RSV)—possibly because red wine contains quite a lot of it, and white wine almost none. The first RSV study was done in 1978. By 2023, the number stood at over 17,000.
According to a 2020 paper summarizing the findings, “Resveratrol has antioxidant, anti-inflammatory, immunomodulatory, glucose and lipid regulatory, neuroprotective, and cardiovascular protective effects. It can protect against chronic diseases such as cardiovascular disease, cancer, liver disease, obesity, diabetes, Alzheimer’s disease and Parkinson’s disease.”1
However, all this is possibly hype. Yes, RSV has caused these protective effects—mainly in laboratory test tubes, and to a certain extent in mice and rats. But in practice it’s not been very effective in human beings.
That’s mainly because RSV is not very bioavailable—it’s poorly absorbed by the body. So although it’s a major ingredient of red wine, there’s not enough of it in a bottle to deliver any significant health benefits in practice.
For example, a clinical trial showing that RSV is “effective in improving glycemic control in diabetes”2 used a daily dose of 250 mg of RSV—the amount in 20 L of wine. Undrinkable and unthinkable.
Another example: in one study, RSV showed some mild benefit for Alzheimer’s disease, but the old folk needed to ingest up to 1,000 mg a day of the stuff.3
So, how to explain red wine’s health benefits? If they’re not due to RSV, what else could be responsible?
Hydroxytyrosol
Hydroxytyrosol, or HT, a compound widely found in the plant kingdom, is rapidly being acknowledged as “one of the strongest dietary antioxidants.”4 In fact, it’s becoming increasingly recognized as a major reason for the health-giving properties of the Mediterranean diet, as it’s found in both olive oil and wine—two key components of the diet.
Research shows HT has antioxidant, anti-inflammatory, anti-cancerogenic, neuroprotective, immunomodulatory, antidiabetic, antimicrobial, antiviral and skin protective properties. It also appears to be useful for defending against heart disease in animals thanks to its ability to inhibit blood clotting, chronic oxidative stress and mitochondrial dysfunction in the heart, aging, and the effects of metabolic disorder.5
All that medical lingo boils down to one simple thing: HT is damn good for our general health. So, what’s the best way of getting the stuff down your throat so it can do all those good things to your body?
Although olive oil contains more HT than wine, in practice your salad would literally need to be drowning in vinaigrette for you to get a clinically meaningful dose. The fact is that no one drinks olive oil for pleasure, whereas of course wine is the complete reverse.
Red wine is a good source of HT, containing about 5 mg per liter,6 so HT is one of wine’s most abundant antioxidants. It’s also more bioavailable than other polyphenols, such as RSV—in fact, up to 100 percent of HT is absorbed by the body.7
Furthermore, it becomes an even more powerful antioxidant when combined with alcohol,8 so its presence in wine gives it an extra boost.
Beyond RSV and HT
Despite the hoopla about HT, there’s a growing realization that because wine’s health benefits are so robust, they’re unlikely to be due to the action of single ingredients. Rather, wine’s constituents should be seen more holistically, as behaving synergistically as a mutually reinforcing family of complex “bioactives.”9
There’s also evidence that that the alcohol in real wine contributes to its health benefits due to its beneficial effects on mood (see main text).
According to the late Professor Gerald Weissmann of New York University, as long as it’s taken in moderation, all signs show that red wine may be ranked among the most potent health foods we know.10
Removing the alcohol from wine requires a substantial amount of processing. A variety of techniques are used: centrifugation, reverse osmosis, vacuum steam distillation, osmotic transport, spinning-cone column, thin-film evaporation under reduced pressure and thermal gradient process. The resulting liquid is little more than a syrup, say the Italians.
To attempt to restore it to a semblance of wine, bottlers add water, concentrated must, gum arabic, deacidifiers, clarifiers, grape juice and grape juice concentrate.
The resultant product in your glass appears to be the wine equivalent of ultra-processed food—a commodity increasingly shown to be harmful to health.
In 1999, British researchers at Guy’s Hospital Medical School in London compared the antioxidant properties of wine to those of standard fruits and vegetables . . . with remarkable results.
They reported that the antioxidant activities of a single glass (150 mL) of red wine are equivalent to those of any of the following:
That is an astonishing finding. Alone, it shows that a small glass of red wine will more than fulfill the ubiquitous government-mandated “five-a-day” fruit and vegetable regimes.
By the way, the British medics also found that a glass of white wine didn’t come close. It contained only 1/12 of the antioxidants in red. Why? The principal reason is that red wine is made from the entire grape—juice, skin, seeds, pulp and even grape stems—whereas white wine is made from only the juice.1
The evidence about alcohol in general and wine in particular, far from becoming more worrying as the years have gone by, is robustly continuing to confirm that moderate drinking—at intakes that often contradict official guidance—is exceptionally good for one’s health.
Here are some of the latest findings.
What’s moderate drinking?
What’s considered a moderate amount of wine varies from country to country and study to study, but generally it’s about a third of a bottle of wine a day. And the healthiest way to imbibe is with meals, research shows.7
That’s because food slows the flow of alcohol into the bloodstream while retaining wine’s healthy polyphenols.
Indeed, data from the UK Biobank project shows that the healthiest drinking patterns—associated with a lower risk of death and cardiovascular events, like heart attack or stroke—are drinking red wine, drinking it with food and spreading intake over three or four days.8
And for even healthier wine, go for organic wine, made without potentially harmful pesticides.
Adapted from Tony Edwards’s latest book, The Very Good News about Wine (Third Eye Media, 2023), available on Amazon
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