Red wine and health: a balancing act between benefits and risks

This review critically examines the health implications of red wine (RW) consumption, navigating its potential cardiovascular benefits against the risks associated with alcohol intake. Despite public health guidelines discouraging alcohol consumption due to its carcinogenicity and other health risks, moderate RW consumption within the Mediterranean diet framework has been linked to reduced cardiovascular disease (CVD) risk.

RW is rich in polyphenols, such as flavonoids and non-flavonoids, which contribute to its antioxidant properties. Randomized controlled trials (RCTs) indicate that moderate RW intake may enhance oxidative stress markers, improve lipid profiles, and modulate gut microbiota. These benefits include increased high-density lipoprotein (HDL) cholesterol levels, reduced low-density lipoprotein (LDL) oxidation, and favorable impacts on inflammation and thrombosis markers. Furthermore, studies show modest improvements in endothelial function and arterial stiffness, factors critical to cardiovascular health.

However, these benefits must be weighed against the risks of excessive alcohol consumption. Chronic intake can elevate the risk of liver diseases, neuropsychiatric conditions, and several cancers. Conflicting results also exist regarding RW's effects on blood pressure and glucose metabolism, with some studies reporting benefits and others suggesting potential adverse effects. De-alcoholized red wine shows promise as an alternative, offering similar polyphenol-mediated benefits without the risks linked to ethanol.

This review underscores the need for long-term RCTs to clarify the health impacts of RW, particularly regarding dose thresholds that balance benefits and risks. Such insights will guide public health policies and individual dietary choices.