It is generally accepted that moderate consumption of wine is beneficial to health, but it is still not clear how much the alcohol and the non-alcoholic compounds in the wine contribute to these benefits.

Owing to the obvious concerns of excessive alcohol intake, it is attractive to explore the production of wine from which alcohol is removed, either partially or completely. The solution might thus lie in low-and reduced-alcohol wines, but their marketing for health benefit requires research and evidence that proves similar or better outcomes on health compared with the standard wines. Some obvious advantages include reduced risk from alcohol-related diseases, reduced calorie intake, benefits for pregnant women, and advantages for consumers who, for religious or health reasons, cannot consume much alcohol.

Although earlier harvesting, and cooler climates can limit the alcoholic content of wine (1), consumers have become increasingly concerned about health, spawning some interest in low-alcohol wines. The decrease in the annual per capita wine consumption in the French, from 120 L in 1959 to 43 L in 2008 (2), may thus be reversed if palatable, healthier beverages are available. South African consumers have displayed a demand for lower-alcohol wines (3), but there continues to be some resistance to alcohol-modified wines, with the idea that their palatability is inferior to standard wines, even though advances in production methods have lead to a general improvement in quality (4). Low-alcohol wines have been described as ‘thin and watery’, but this may be due to prejudice and ‘snobbery’. A study in France found that a thousand consumers were not able to differentiate between the taste of standard wines with 13 – 14% alcohol and those with a moderate reduction of alcohol to 10 – 11% (2). The alcohol content in French, Italian, and Spanish wines has increased by an average 3% over the past fifteen years. This is attributed mainly to global warming, vineyards planting grape varieties that produce sweeter wines, and later harvesting of grapes (2).

Attempts to lower the alcohol content in wine range from altered techniques in wine production to deliberate removal of part or all the alcohol. This begs for a proper definition of a low-alcohol beverage. The definition varies in viticulture and between countries. The content for consumers is declared as volume of alcohol per volume of beverage. According to the European Commission (5), drinks are described as ‘low-alcohol’ if they contain less than 0.5% alcohol, and ‘alcohol-free’ if they contain less than 0.05% alcohol. In contrast, the South African Wine and Spirits Board, advises that a ‘light’ wine should have an alcohol level of less than 10% (3). In the US, a low-alcohol wine contains 6 – 7% alcohol. According to the Australian Food Standards Code, a ‘low-alcohol’ beverage must contain no more than 1.15% alcohol by volume (6). According to European Union (EU) regulations, a ‘wine’ needs to contain at least 9% alcohol, and if less than this, the beverage needs to be referred to as a ‘wine-based drink’ (7). European Union legislation precludes the use of the term wine for the alcohol-modified beverage, even with the use of recognised oenological practices such as reverse osmosis, distillation, nano-filtration, or centrifugation. These practices are allowed in South Africa, Australia, and California, but wines then may not be exported to the EU. Recently in the UK, the Wine Standards branch of the Food Standards Agency banned an 8%-alcohol wine because an unauthorised alcohol-lowering process was used (8). Paradoxically, similar beverages made in the US using these practices may be sold in the EU owing to an EU/US bilateral agreement (9). Reverse osmosis is allowed in France, and the spinning cone technique is licensed in Spain, but both are currently on an experimental basis. To produce natural low-alcohol wines in countries with colder climates is relatively easy, but this may not be so easy in countries with hotter climates. Theoretically, winemakers could harvest their grapes earlier, leaving them immature and lower in sugar content, to produce wines that are lower in alcohol. Such products may differ from the original, and a perception that they are ‘undrinkable’ could make them unpopular in many EU countries. This is especially so when wines with higher alcohol content (some containing alcohol concentrations of as high as 16%) are highly acclaimed by critics (10).

The most abundant alcohol in wine is ethanol, which is important in the stability and ageing of the wine, as well as imparting certain sensory characteristics to the wines. Ethanol may also be a solvent for certain tannins and pigments, and may influence the concentration of certain antioxidants (flavonoids) extracted during the winemaking process (11).

Worldwide, disorders associated with alcohol abuse, such as liver cirrhosis, certain cancers, and cardiovascular disease (CVD), contribute to a large burden of disease (12). Cardiovascular disease is rising (13) but has been found to be ameliorated by regular consumption of moderate amounts of standard alcoholic beverages, mostly wine (14). There is indirect evidence that wine offers greater protection against heart attacks and strokes compared with other alcoholic beverages (15; 16). This seems to suggest that there are compounds in wine in relatively high concentrations, which confer protection. However, this theory is refuted by studies which suggest that all alcoholic beverages are associated with lower risk (17). The French paradox may be an example of the cardio protection that wine confers in a population that consumes wine as part of a diet high in saturated fat. There is a paucity of information on health benefits of low-alcohol wines. There are however, a few scientific studies on alcohol-free beverages derived from grapes.

Many of the studies on the health benefits of dealcoholised wine and grape juice focus on the protection of low density lipoproteins (LDL) against oxidation promoted by free radicals. Oxidised LDL is thought to play a role in the progression of CVD. Red wine antioxidant polyphenols, and not ethanol, bind to LDL and protect it from oxidation (18). Studies have shown that ethanol alone was not able to protect LDL from being oxidised, and that grape juice was able to (19). Furthermore, ethanol did not significantly increase plasma antioxidant potential, but grape juice did (20). Consumption of dealcoholised red wine was found to increase antioxidant capacity in healthy people, whereas dealcoholised white wine (with an approximate ten times lower polyphenol concentration) had no such effect (21). Dealcoholised red wine, and not ethanol, significantly reduced radiation-induced DNA damage in healthy adults (22). These suggest that it is compounds other than the ethanol that are responsible for the antioxidant function.

Ethanol alone may confer some benefits for CVD by significantly reducing monocyte migration (a process that contributes to the progression of atherosclerosis) (23), but this may result in an increased susceptibility to infection (24). Certain phenolic compounds in wine, for example resveratrol, have anticancer properties (25). Grape juice has also been found to improve endothelial function (a marker of risk for CVD) (26). Consumption of dealcoholised red wine by smokers resulted in a significant decrease in plasma and urinary F2-isoprostanes, a marker of lipid peroxidation, associated with cardiovascular risk (27).

The current balance of evidence thus suggests that ethanol is not vital for providing the health benefits in moderate wine drinking. It is thus expected that reducing the ethanol in wine would in all likelihood not diminish the potential health benefits whilst enabling safer consumption.

For more information contact Dee Blackhurst at tel (021) 406-6108 (021) 406-6108 , e-mail dee.blackhurst@uct.co.za.

REFERENCES

(1) Salamon A. Techniques to achieve moderate alcohol levels in South African wine (partial requirement for the Cape Wine Master Diploma) 2006: http://www.capewineacademy.co.za.

(2) http://www.timesonline.co.uk/tol/news/world/europe/article6550419.ece.

(3) Maxwell K. Taking another look at light wines. WineLand May 2008: http://www.wineland.co.za/200805-light-wines.php3.

(4) Pickering G.J. Low-and reduced-alcohol wine: a review. Journal of Wine Research 2000; 11(2): 129 – 144.

(5) http://ec.europa.eu/research.

(6) http://www.wineaustralia.com/Australia/Default.aspx.

(7) http://business.timesonline.co.uk/tol/business/law/article5698621.ece.

(8) http://www.channel4.com/news/articles/society/health/low+alcohol+wine+banned+from+sale/988547.

(9) http://www.harpers.co.uk/misc/content/article/4589-low-alcohol-lunacy-by-eu.html.

(10) http://www.forbes.com/2009/02/13/restaurant-wine-lists-lifestyle-wine_0213_low_alcohol_wine.html.

(11) Soleas G.J., Diamandis E.P., Goldberg D.M. Wine as a biological fluid: history, production, and role in disease prevention. Journal of Clinical Laboratory Analysis 1997; 11(5): 287 – 313.

(12) Rehm J., Gmel G., Sempos C.T., Trevisan M. Alcohol-related morbidity and mortality. Alcohol Research and Health 2003; 27(1): 39 – 51.

(13) Reddy K.S. Cardiovascular disease in non-western countries. New England Journal of Medicine 2004; 350: 2438 – 2440.

(14) Blackhurst D.M., Marais A.D. Alcohol – foe or friend South African Medical Journal 2005; 95: 648 – 654.

(15) Stocker R., O’Halloran R.A. Dealcoholized red wine decreases atherosclerosis in apolipoprotein E gene-deficient mice independently of inhibition of lipid peroxidation in the artery wall. American Journal of Clinical Nutrition 2004; 79(1): 123 – 130.

(16) Truelsen T., Gronbaek M., Schnohr P., Boysen G. Intake of beer, wine, and spirits and risk of stroke. The Copenhagen City Heart study. Stroke 1998; 29(12): 2467 – 2472.

(17) Rimm E.B., Klatsky A., Grobbee D., Stampfer M.J. Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits British Medical Journal 1996; 312: 731 – 736.

(18) Ivanov V., Carr A.C., Frei B. Red wine antioxidants bind to human lipoproteins and protect them from metal ion-dependent and -independent oxidation. Journal of Agricultural and Food Chemistry 2001; 49: 4442 – 4449.

(19) Miyagi Y., Miwa K., Inoue H. Inhibition of human low-density lipoprotein oxidation by flavonoids in red wine and grape juice. American Journal of Cardiology 1997; 80(12): 1627 – 1631.

(20) Durak I., Avci A., Kacmaz M., Buyukkocak S., Cimen M.Y.B., Elgun S., Ozturk H.S. Comparison of antioxidant potentials of red wine, white wine, grape juice and alcohol. Current Medical Research and Opinion 1999; 15(4): 316 – 320.

(21) Serafini M., Maiani G., Ferro-Luzzi A. Alcohol-free red wine enhances plasma antioxidant capacity in humans. The Journal of Nutrition 1998; 128: 1003 – 1007.

(22) Greenrod W., Stockley C.S., Burcham P., Abbey M., Fenech M. Moderate acute intake of de-alcoholised red wine, but not alcohol, is protective against radiation-induced DNA damage ex vivo-results of a comparative in vivo intervention study in younger men. Mutation Research 2005; 591: 290 – 301.

(23) Imhof A., Blagieva R., Marx N., Koenig W. Drinking modulates monocyte migration in healthy subjects: a randomized intervention study of water, ethanol, red wine and beer with or without alcohol. Diabetes and Vascular Disease Research 2008; 5: 48 – 53.

(24) Saeed R.W., Varma S., Peng T., Tracey K.J., Sherry B., Metz C.N. Ethanol blocks leukocyte recruitment and endothelial cell activation in vivo and in vitro. The Journal of Immunology 2004; 173: 6376 – 6383.

(25) Jang M., Cai L., Udeani G.O., Slowing K.V., Thomas C.F., Beecher C.W.W., Fong H.S.S., Farnsworth N.R., Kinghorn A.D., Mehta R.G., Moon R.C., Pezzuto J.M. Cancer chemopreventive activity of resveratrol, a natural product derived from grapes. Science 1997; 275: 218 – 220.

(26) Stein J.H., Keevil J.G., Wiebe D.A., Aeschlimann S., Folts J.D. Purple grape juice improves endothelial function and reduces the susceptibility of LDL cholesterol to oxidation in patients with coronary artery disease. Circulation 1999; 100(10): 1050 – 1055.

(27) Caccetta R.A., Burke V., Mori T.A., Beilin L.J., Puddey I.B., Croft K.D. Red wine polyphenols, in the absence of alcohol, reduce lipid peroxidative stress in smoking subjects. Free Radical Biology and Medicine 2001: 30(6): 636 – 642.

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