Should heart failure patients whine for more wine?

Sometimes when I am out for dinner at a restaurant, people who are aware of my heart condition make the observation that it should be okay for me to drink wine.  I think this is because there have been a number of studies that indicate that wine is good for the heart.  My recollection is that this started in the 1980’s with a study known as the French Paradox. 

There have been many articles written about the French Paradox since the 1980s, most of the articles analyzing rather than explaining what the paradox is/was.  But I found a good explanation on the website for the American Society for Nutrition (nutrition.org).  According to the first two paragraphs of an article by Stefano Vendrame:  
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• “Here we go again. I’m reading the billionth newspaper article referring to the “French paradox,” with the author explaining that “in spite of their high saturated fat intake, the French die less of coronary heart disease thanks to their higher consumption of red wine.”
• It’s an old story that keeps coming back. I’ve heard it time and again from TV shows, newspapers, books and magazines, even university professors. It has been told so many times that in the back of their minds a lot of people still believe the concept that drinking red wine can prevent cardiovascular disease. It all dates back to the early nineties, when Serge Renaud and Michel De Lorgeril published a paper in Lancet entitled “Wine, alcohol, platelets, and the French paradox for coronary heart disease”. 

So where do I fall in the debate over the French Paradox.  I usually decline a glass of wine (mainly because I just am not fond of the taste of wine).  I was a Bourbon drinker from way back.  But now, I drink alcohol very cautiously.  Here are the reasons for my vigilance.

I listen carefully to what my doctor says and I read very carefully all the literature I can find on heart failure.  I specifically search for information about things I should do to strengthen my heart and things I should generally avoid.  I also mull over the reasons that accompany each piece of information I am provided so that I understand the implications of ignoring the medical advice.

I remember having a conversation with my heart failure doctor about an individual who was an alcoholic and also had heart failure.  The doctor told me that the best thing that this individual could do was to stop drinking alcohol.  My doctor is in good company in advising heart failure patients to avoid alcohol.     
If you have been reading this blog for a while, you know that I take the new heart failure drug Entresto, and I am also a member of the Entresto Central Support Program.  The program has sent me a wealth of helpful, information packets that are easy to understand.  One of those packets has a paragraph devoted to “avoiding alcohol”.  It says:

• “It’s also important for people with heart failure to limit the amount of alcohol they drink.  In addition to being a liquid, too much alcohol may increase their heart rate and make heart failure worse.  People with heart failure should discuss any alcohol use with their doctor.”

 
Note:  The reference to being a liquid relates to the general advice for heart failure patients to limit fluid/liquid intake.  If you can only have so much fluid, well it stands to reason that the majority of it should be water and not something intoxicating and even dehydrating.

The Mayo Clinic website, one of my go to sites for heart health information also has a very informative article on the benefits and issues associated with drinking red wine.  The article is entitled:  “Red Wine and Resveratrol: Good for Your Heart?”.  The article basically covers the theories of why drinking red wine in moderation may help some individuals avoid coronary artery disease, the condition that can lead to heart attacks.  The reason apparently is related to a substance in red wine called “resveratrol”.  Notice that I said how it may help “some” individuals.  Why is this qualification important?

Well first, the Mayo Clinic wants to avoid encouraging those who do not drink from starting to use alcohol especially if they have history of alcohol abuse in their family.  As the article reminds us, too much alcohol can have “harmful effects on your body”.   In the section entitled  Drink in moderation  - or not at all, the article states:  “However, it's important to understand that studies comparing moderate drinkers to non-drinkers might overestimate the benefits of moderate drinking because non-drinkers might already have health problems. *** Neither the American Heart Association nor the National Heart, Lung, and Blood Institute recommends that you start drinking alcohol just to prevent heart disease. Alcohol can be addictive and can cause or worsen other health problems.”

The article ends with the observation that drinking too much alcohol increases your risk of other conditions, which include the condition of heart failure.  So if it can increase the risk that you will get heart failure, imagine the damage that can result if someone with heart failure drinks too much?  The article concludes with the familiar advice:  If you have questions about the benefits and risks of alcohol, talk to your doctor about specific recommendations for you.

The American Heart Association webpage also has some helpful information on drinking alcohol when one is suffering from a heart condition.  In the article entitled “Alcohol and Heart Health” there is a section on the cardiovascular risks associated with drinking alcohol.  It says:

• Drinking too much alcohol can raise the levels of some fats in the blood (triglycerides).  It can also lead to high blood pressure, heart failure and an increased calorie intake. (Consuming too many calories can lead to obesity and a higher risk of developing diabetes.)  Excessive drinking and binge drinking can lead to stroke. Other serious problems include fetal alcohol syndrome, cardiomyopathy, cardiac arrhythmia and sudden cardiac death.

Again, I already have heart failure which apparently is the result of a significant cardiomyopathy.  So it would seem doubly foolish for me to drink heavy amounts of alcohol.    

I also found similar guidance about alcohol use at the website UPMC.org, which appears to be the affiliated with the University of Pennsylvania Medical Center.  On the page for UPMC health beat, which is associated with a heart and vascular institute, there is a February 2018 article entitled 5 myths about red wine and heart health.  It says: 

• Red wine and other types of alcohol can immediately increase your risk of heart attack and stroke, according to the American Heart Association. This risk, however, decreases over time. As long as you’re consuming a moderate amount of alcohol (one drink per day for women and two drinks for men), red wine will likely not harm your heart in the long run.On the other hand, consuming heavy amounts of alcohol, including red wine, can increase your risk for cardiovascular disease and stroke. Consider reducing the amount of alcohol you drink to give your body a break.
• So not to beat a dead horse, but It seems logical to me that given my already present heart failure/cardiomyopathy, the name of the game is caution when it comes to drinking alcohol.  Notice I say “caution” and not total abstinence, as I am not a dead horse but I am only human.

So in preparation for my cruise, where food and alcohol flow like water, I did what the websites suggest.  I consulted my heart failure doctor.  He was okay with me having one modest drink each night.  Since I was seasick once and tired a couple of nights, I didn’t even drink each night – so once again,  I stayed within reasonable limits, but I still enjoyed myself.  I determined that the important thing wasn’t what I was drinking, but who I was sitting with.  I traveled with a group of 11 other people, and we were always laughing and enjoying life on the boats.  While liquor is nice, I found the camaraderie of good friends to be more refreshing and invigorating than anything served from a bottle.

As I mentioned earlier in this post, my former drink of choice was good Bourbon and water.  But that seemed a powerful drink for someone who isn’t a big drinker at this point in her life.  So I went with a modest serving of Amaretto for my regular drink.  This is a nice liqueur, allegedly the best selling alcohol from Italy and it comes with a lovely legend.  The Delicious magazine website (deliciousmagazine.co.uk), has a webpage devoted to All About Amaretto.  It says:
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• As far as love stories go, you can’t beat the Amaretto legend.  The potent tipple was invented by a widowed innkeeper in Saronno in 1525.  After moonlighting as a model for Da Vinci art student Bernardino Luini, who needed a sitter to represent the Virgin Mary in the local church’s frescos (the painting can still be viewed in the chapel of Sante Maria delle Grazie), the lovesick lady created a concoction of brandy and apricot kernels as a symbol of her everlasting devotion.  It’s not known if the relationship fizzled out – the recipe certainly didn’t.

Amaretto tastes good and it has a lovely story –how could I go wrong?

So what I have learned when it comes to alcohol is that like everything else in my life, it requires forethought and planning.  It is another example of how I need to make sure that my life is always in balance with my heart –especially when the extra care I observe will ensure that I do not lose balance on the cruise ship’s dance floor from an excess of distilled spirits and wine!