020 - How Many Drinks Are Actually Safe? Cardiologist Explains the J‑Curve of Alcohol and Longevity
Cardiologist John Osborne explains the J-curve: 1-2 glasses of wine daily are linked to lower heart disease risk and neutral mortality, while abstinence or heavy drinking raise risk. An Australian trial found cutting alcohol from 2 to 0.3 glasses per day reduced atrial fibrillation episodes by 82 percent.
Chapters
There's been a lot of controversy in the science world about this. There is no safe amount of alcohol use. So we're going to do some great scientific investigation. I'm going to show you the data. People who never drank, teetotalers. We'll talk about people who drank and quit, their risk of cardiovascular events. We're going to compare that to people who drink moderately, and then we're going to look at people who drink very heavily. So welcome everybody to another special brought to you by Clear Cardio. We are really, really blessed and have a special guest today. His name is DJ Warner. DJ Warner, if you are an aficionado of wine, you probably know the name. He is married to the exemplary winemaker Helen Keplinger.
Mm-hmm.
I've had the fortunate enough circumstances to know DJ for a number of years. We met a number of years back in Napa. before Helen was as famous as she is now. He is the co-founder and co-owner of Helen Keplinger Wines and has a phenomenal story. We're gonna investigate that, talk about that, and we're really, really delighted and happy to have DJ Warner on the, on the episode today. And then of course we're gonna couple this with a There's been a huge amount of controversy about the role of alcohol, particularly, I mean, I'm going to specify this, moderate alcohol use. We'll talk about what exactly that means as far as health benefits. Are there health benefits? Are there no health benefits? Is there harm? There's been a lot of interesting literature in the scientific literature and also in the lay media relevant to that in the last few years. So we're going to cut through all that and we're really going to give you a very Good science-based, evidence-based understanding of the role of moderate alcohol use and health. So I will give you a little teaser. It's good, but we're going to really explore this in depth. I will have some slides. We'll show some science here as well. But first of all, I just want to talk with DJ and hear his story, hear his evolution, have him talk about his— His famous wife as well, the winemaker. And we'll go ahead and start with that. So DJ, it's such a pleasure to have you on Power is Prevention, which is our podcast, by the way. Be sure to subscribe, give us comments, check out our website at www.clearcardio.com. The preeminent, I like to say, preventative cardiology organization in the US as well. So please do that, but in the meantime, let's go ahead and get on to DJ, and I'm going to have DJ introduce himself and maybe just tell his wine story over the years.
Thank you, John. It's great to be here. Wine for me, you know, I was thinking about it on the way over, you know, it started mainly when I was waiting tables at towards the end of my college years and into my first year or two in the professional world. And— but then I thought, you know, I remember tasting wine at the dinner table with my parents during holidays. So— and I didn't like it, but it was interesting. And I found that memory pretty interesting in itself, just Every Thanksgiving or Christmas, I would go over to the adults' table and ask my mom or dad for a sip, because I was just curious.
So, DJ, where'd you grow up?
I grew up just outside of Baltimore in Maryland.
Oh, OK.
And so, waiting tables outside of DC, we had a bartender who took it upon himself to teach the servers about wine. And it was an Italian restaurant, so there were some great wines on the list that no one really knew a whole lot about. And we would do tastings about once every 2 weeks and really learn about the different regions, the grapes. And that, to me, was super interesting.
Mm-hm.
And I'll never forget taking a first bottle to a friend's house and having it with dinner. And the light bulb just kind of went off, like, this This is really, really good, but also just so different than any beverage I had had in my life at that point.
Very cool. So, so keep going with your story. I want to hear how you met, met Helen and where all that started from. There's a reason heart disease is still the number one killer, and it's not because we can't stop it. It's because most people don't know it's already started. At Clear Cardio, we're done waiting for the heart attack. The Pulse is our weekly newsletter. Real talk, cutting-edge science, and simple actions to detect plaque early, reverse disease, and stay in the game for decades. This isn't fluff. It's for the proactive people who take prevention seriously. If that's you, subscribe now. Be informed, be proactive, and never get blindsided by something you could have stopped.
Yeah. So let's see. That was actually one of those epiphany bottles that I had was with Helen.
Hmm.
During college, it was kind of, OK, I'm interested. But then I moved to Los Angeles to leave the tech world and head out to LA to start an organic food company with a friend of mine. We were making a consumer product line of foods. And I was waiting— no, I wasn't waiting. I was managing a Spanish wine shop part-time, about 4 nights a week, and we tasted every week, and it was fabulous. I was learning so much about wine, and I met Helen in that shop over a bottle of wine.
Hmm.
And at the time, I didn't know that she was a winemaker. She was up in Santa Barbara making wine, having left Napa Valley. And we obviously hit it off. And she took my recommendation. Actually, we didn't have anything that she was looking for, some of the wineries that she was exploring, because she was about to take a job and go to Spain to make wine.
Mm-hmm.
And so, she took my recommendation and enjoyed the bottle. We started dating. And then a good friend's husband came over to visit. He was in LA on business, actually. And we went out to a restaurant in LA called Bastide, which was this great French restaurant. And they had a great wine list. And he ordered a bottle. It was like a mid-'90s Côtes d'Estournel.
Mm-hmm.
And when I tasted that, I just kind of stopped.
I understand.
And I said, what is this? At that point, I'd had wines, but I hadn't had that level of wine yet or that type of wine yet. And it just blew me away. I mean, just the complexity and the interest and the depth of the wine. As well as the elegance of the wine, just— and the way it paired with the food, I just said, OK, I'm going to drink wine for the rest of my life. There's no doubt about it. And so, I slowed my pace. I savored every sip. I quickly did the math and said, OK, how many glasses of this do I have left? I'm going to savor every second of it. It was fabulous.
That's kind of the experience I get when I drink your wines.
Oh, thank you. So Helen took that job. She went to Spain and Priorat, about an hour south of Barcelona. And it was just a great experience for her. I went over to visit, she came back, and then she wound up taking a job to go back to Napa. And we moved there together in 2005. And so, she was launching a new project called Kenzo Estate, and I still had my food company, but always had an interest in wine. And I started to really look at the landscape in Napa. And at the time, we were trying our hardest with our little food company, but it was challenging and food margins are so slim.
Mm-hmm.
And so, I started working with a sales and marketing consultant in Napa to really learn the industry. And so, just had a great experience within the whole valley, the folks that I met, the friends that we made. And we were part of a tasting group every month.
Mm-hmm.
And that was just a complete new level for me to learn wine and it was just fabulous. So, wound up putting the organic food company to bed and Helen said to me one night over dinner, she said, I really wanna start making my own wine. And I was super excited to hear that. And I said, well, I'm cheap labor. Let's go. And so, She bought some fruit from a vineyard out in— pardon me— in Knights Valley, Syrah and Grenache, and made our first vintage in 2006, 2 bottlings. And so, it sat for about 18 months in barrel, about 16, 18 months. And so, we released our first vintage in 2008.
Wow.
about 250 cases. And along the way, I started putting together and working with her to just get our website established, our licensing, all that good stuff, and really understand kind of the sales aspect of the business and how we were going to start to get known, really. And I'll never forget, we We started, we had a fax machine that would then take in orders. So we had a PDF we would email out, and we started building our mailing list. And sometimes the fax machine would go off at 5 o'clock in the morning from the East Coast, and we would kind of high-five in bed and say, oh, we got an order.
Great. Right, right. Every time it goes off.
Yeah. So it was such a great moment to just have our own wine and to share it with people and to start seeing restaurants buy it in Napa Valley. It just was, at that point, just super exciting.
So I know Helen had done— was in Spain for at least a couple years, right? As I recall, from my memory.
She was there living She was there for about a year, a little over a year. And then she came back for the job at Kenzo. And she kept the job in Spain and was doing harvest in Napa as well as Spain for '05 and '06.
Oh, wow.
And so, yeah.
And I think the varietals she was— was it more GSM that she was working with? Over in Spain?
Mainly Grenache, Carignane, and in Priorat, you know, they're interesting blends. The wine, from what I recall, was mainly Grenache with a lot of Carignane, a hair of— sometimes they'll blend in a little Cab, sometimes even a little Syrah, but usually Grenache and Carignane kind of dominate the blends over there.
Yeah, yeah. And I think that's the— those are the first Sort of wines that you guys developed in Napa.
Grenache and Syrah.
Right.
Yeah.
Right, right. And, uh, they're, they're amazing. By the way, this is where you have to throw out your, uh, your URL to, uh, for anyone that might be interested in your wines. Um, phenomenal. I, I've been fortunate enough to be on your allocation wine list for a number of years. Um, uh, so, but, uh, for anyone that might be interested in, uh, In your wines.
KeplingerWines.com.
There you go. Keplinger Wines. Great. Phenomenal wines. And we'll talk about some of the wines that you've evolved into. And also too, and I know you and Helen are very, very modest, but Helen was named in the Venus— Vinius? Vinius?
Oh, Venus.
Venus, the Winemaker of the Year in 2023, as I recall.
Correct.
And also has been awarded more than one 100-point wines, which is really quite, uh, quite, quite remarkable for, for, uh, anyone in the wine industry. So, uh, very, very excited for you guys and, uh, proud to know, to know both of you, um, and all you've accomplished. So, so you started with a couple of, uh, bottlings, Grenache and a little Syrah, and then kind of tell me how you evolved since then.
So, um, We focused on single vineyard Rhône wines. We, in our second vintage, '07, Helen, through some contacts from UC Davis, started looking at some vineyards out in the Sierra foothills about 2 hours east of Napa. And so, we started working with 2 vineyards out there. We doubled our production just about in our second year. And then we—
Yeah.
We were steady for a bit, and then we added a wine from the Russian River, a Grenache bottling. And we kind of just grew steadily and surely along the way. And Helen would find vineyards that she just loved the soils, the aspect, the terroir, and the grower. And everything has to come together with the grower's approach to the farming and the farming team. And then she's 100% on board. She works super closely with all of our growers and their teams to really understand what's going on with the vineyard throughout the year. And that informs how she makes the wines. And I think that that's one of the great things that winemakers do. It's like it's your garden, right?
Mm-hmm.
So you kind of have to really understand how you're taking care of it, and how you're going to be able to harvest the best fruit possible. And that's our goal, is to do that and then make the best wine possible. So, she's super involved. She has a great team at the winery and also just is super involved with the winemaking. So, every harvest, her hands are stained purple.
I bet.
And she makes the wine, and you can tell. It's her thumbprint on the wines for sure.
Yeah, absolutely. And I think you now make a whole variety of different wines and different price points and stuff. I know, I think we probably got the first bottling of Vermilion, which is a fantastic daily drinker. I just, my wife and I really, really love that. And it's weird. So I obviously unabashedly, I love wine. particularly love their wine, but really a massive wine lover. In fact, I will say we're going to be doing a special wine tasting featuring DJ and doing a fantastic pairing coming up this weekend. He was over in Southlake last night doing a tasting there at a great place called Roots and Water. Unfortunately, I couldn't make it, but— and then I was at another wine tasting with some other people that we Collectively know on Wednesday as well. So it's been a great wine week for me. So I'm very happy. And tell me about some of more of our recent developments in getting into the Cab world.
Yeah, so after making single vineyard Rhône up through 2013, A couple years prior to that, I had asked Helen, I said, what do you think about making Cabernet? And we live in Napa. You make great Cabernet for other wineries. Do you think we'll make Cabernet? And she looked at me and she said— I've been thinking about it for quite some time. I've been talking to certain growers, but I really wanna find the right site, the right blocks, and make something that's really special. As we know, there's tons of Napa Cabernet in the world and there's some great wines out there. And that was kind of the answer I thought I would get. And so, she did. She finally agreed to work with a vineyard on the east side of Oakville, Oakville Ranch. Owned by Mary Miner, farmed by Phil Coturi organically. I mean, Phil's one of the greats in wine country. And so, we had our first vintage of Oakville Ranch Cab, 2014, that we released in '16. She had been speaking with the Phillips family for that same amount of time. I think it took about 7 years or so.
Yeah.
for some fruit to become available. And so we wound up working with their vineyard, Vine Hill Ranch. It's in the southwest corner of Oakville. And so that first vintage was 2018. And in '18, we made a second bottle off of Oakville Ranch that has more Cab Franc in the wine, about 25%. And that's a dedication bottle to her dad. We call it RBK for Robert Barr Keplinger. And Robert went by Pete, and Pete was a wine enthusiast throughout his life and just collected wine. They had wine with dinner every night. And one of the first influencers to Helen to start making wine. She would collect the bottles after they were finished with dinner, and she had a rock collection. So, they were all early signs of her looking towards wine.
Right.
She was actually going to med school. Well, she wanted to— she had her applications that she was putting together for med school, and she did medical research at UMass.
Oh, wow. Oh, wow. I didn't know that.
Mass General, sorry.
Oh, Mass General. OK. All right.
Mass General. And she was a biochem major. And along the way, she was reading My Lady Vine, the autobiography of Philippe de Rothschild. And she stopped, and she kind of thought, maybe wine is a path for me. And so she applied to UC Davis. She got into the grad program there, dropped her med apps, and went to Davis.
Wow.
And then got an internship— I'm trying to remember if it was Australia, and then on to Napa, and then became the assistant winemaker under Heidi Barrett at Paradigm in Yountville, which was just a great experience for her. And Heidi was great.
Quite the mentor.
Great, great early mentor. Yeah. And from there, that's when she went down to Santa Barbara and then on to Spain.
Wow. Well, great story. Great story. Well, obviously the wines you make are just top shelf. They are those wines that you drink them and the light bulb goes off. And, and, uh, thank you. They, they really, you know, I think we were talking earlier that wine creates, uh, incredible camaraderie. Um, I, I think it really creates the moment and it creates memories. And, uh, you know, that is always to me the sign of the best wine, um, is that, uh, you, you come away with all of those emotions and feelings and, uh, connections. And, uh, that, that's That's really the— wine is just the glue that brings all that together, I think, and holds it together.
It is. I just— part of my job is to obviously promote the wines and make sure that wine-drinking friends out there and circles of wine enthusiasts know who we are. And for instance, last night, And there were a fair amount of people in the room who didn't know who Keplinger was, and now they do.
Well, good. I'm glad you're continuing to spread the word. I do my little bit as well in my network, but that's great. It's such a fantastic— I mean, your productions are just phenomenal. So it's just great to be able to share this with the rest of the world too.
And when I was with the folks last night, it was really— at the end of the night and through the night, I just— it hits you that wine is exactly that. It brings people together. We had such a great time. Everyone is laughing throughout the entire experience of the evening. And it's like you said. It's the glue. And there's, I think, one of the great things about wine is you make new friends very quickly. People are telling stories about their wine experience or the wine that they brought to have with friends that night, who the owners are, where the vineyard is, how they came upon the wine. And it's just those moments that are special. You make new friends. And some of my wine friends out there feel like family now.
Mm-hmm.
If I come to town, I want to let them know, and I have to let them know, just because it's— you see them maybe once or twice a year, but when you do, it enriches your life.
And it's usually like no time has passed, right? You may have not talked for months or so, and then suddenly you connect and it's like no time passed at all.
Exactly.
Yeah. Yeah. Well, it was funny because I was at this wine event and I'm going to admit I love wine, but I'm absolutely a dilettante. I mean, I just— I love it. I love drinking it. Love the camaraderie. Love meeting the people involved in wine. But I'm absolutely a dilettante. But it was funny because I know a couple of people And I, and I at this wine thing on Wednesday, I'm saying, "Oh, do you know DJ Warner? He's coming to town." Oh yeah, DJ. Yeah, yeah, yeah. And I got to tell you this, and I hope it's not embarrassing to you.
They said, "Oh yeah, DJ Kepler." Not the first time, and certainly not the last.
Yeah. Well, I didn't make that up, so it's coming from your friends. So people like Juan Mercado, Fernando or Fern. phrase. Who else were we talking about as well? Anyway, just some other people that— it was just funny that we just happened to exist in that sort of network. Again, I'm just an outsider dilettante, but it's kind of funny to— fun to be able to, you know, know some of the people that really make such fantastic, fantastic wine. So what I'm going to do now is we're going to switch gears a little bit because, again, there's been a big controversy about the role of alcohol in general, if you want to think of that. But I think obviously we're going to keep our comments more directed to wine consumption. But there's been a lot of controversy in the recent few years about alcohol, moderate alcohol use. Are there harms to it? Are there benefits? Do the benefits outweigh the harms or all of those issues? And I think it's gotten very, very cloudy recently. And I want to do a little bit of an exposé. A lot of the more recent papers and papers that have captured the public's attention and have been in the media have come from a guy named Tim Stockwell.
Mm-hmm.
So Tim Stockwell is the head of an organization up in Canada called the Canadian Institute for, it's CISAR, Canadian Institute for the Science, oh, I'm blanking on it. Probably had too much alcohol last night. But CSAR is the name of the organization that's designed to look at the role of public health of alcohol. And he has published a number of papers and has done this for the last 20 years that basically draw the conclusion that there is no safe amount of alcohol use. In other words, to really paraphrase what he says, it's dangerous from the first drop. And I'm gonna speak a little bit on the other side of that argument. Again, approach this on the scientific basis. I will note, so his background, I think, is relevant to this discussion. He literally was the president of the Neo-Temperate Society in Canada for a number of years. So you certainly know his bias. And I think we're all biased, but he comes at it from a no alcohol bias. And of course the science, the literature, the data coming out of his organization really leads with the idea, the narrative that there is no safe amount of alcohol. Then we'll apply the science to back up that, his notion. And in fact when you look at the data, and there's been a lot of controversy in the science world about this. His data are really highly, highly suspect. Now, obviously, if you convey this to New York Times and the media, they'll suck this up and they'll say, oh, see, there is no safe amount of wine. And, you know, it sells papers and it creates headlines. But it is interesting. So if you look at his methodology, he was notable for publishing, I think in '24, a paper that hit the, the scientific media and hit the lay public media that purported to show that there was no safe amount of alcohol. It's again, quote, dangerous from the first drop, according to him and his organization. Whereas if you look at the studies, what he did is he looked at about 3,200, 3,400 different publications over the last 50 years, winnowed those down, and in fact winnowed these 3,200 or 3,400 down publications relevant to answering discussion about the potential harm or benefit of wine. Because there is— the background is there's a lot of significant data and a very consistent amount of data that shows that moderate alcohol use, wine use, is associated with a lower risk of cardiovascular mortality. That is deaths from strokes and heart attacks. And that's a very consistent finding across many, many different publications and papers. and organizations and individuals publishing this data. So it was really quite shocking to hear someone come out and say, well, there is no safe amount of alcohol use. And again, when I say moderate amount of alcohol use, we're really talking about the sweet spot, which is 1 to 2 glasses a day. We'll say wine, which is defined as 5 ounces of wine per glass. And we'll show you the science here in a moment. But what he did with his narrative, and I think he's clearly very biased, is he first of all started out with about 3,200, 3,400 papers in the literature relevant to this discussion about harm and benefit, winnowed those down, applied his own selection criteria, and literally ended up with 5 papers, literally excluding 99.9% of the literature, That supported his conclusion. So it— and if you look, there are some interesting dialogues and discussions about sort of the science and his scientific shenanigans to that end. But needless to say, when you come out with a headline like that, the media picks it up. So we're going to do some great scientific investigation. I'm going to show you the data, and it's really impressive. We'll show you the data about people who never drank, teetotalers. We'll talk about people who drank and quit, their risk of cardiovascular events, 'cause again, we're gonna talk about below the neck and above the diaphragm, 'cause I'm a cardiologist. We're gonna compare that to people who drink moderately, and then we're gonna look at people who drink very heavily. And there's no question, heavy alcohol use is not a good thing for your health. It causes weight gain, it causes high blood pressure, it causes problems with the cholesterol. obviously liver issues. So heavy alcohol use, and we'll define what that is in a moment, is clearly not good. But the question is, is there a relationship between moderate alcohol use and a cardiovascular benefit? And I'm going to show you the science. I'll let you make your own conclusions, but I'm going to show you the science as well behind that. So to that end, I have a couple slides I'm going to show you. This will not be death by PowerPoint. So let me break down this first slide. A study of over 45,000 people, so very large, and basically what they're looking at is cardiovascular events. This is your strokes, your heart attacks, balloon stents, bypass surgery, all the things we want to avoid and all the things that, as a preventative cardiologist, I'm going to work to try to eliminate because my ultimate professional goal is not just to do preventative cardiology but actually to translate that into Eliminating heart disease, 'cause that's my ultimate goal. And I love to say, and my big ask for all of you and for DJ here who's with me, ultimately why I do this, why I'm in my profession, is to work to have you guys put me out of business, okay? So that's my ultimate goal, put me out of business as a cardiologist. So here is the data, large study, very large data set, The larger the number of patients and people involved in the study, the more confident you can be with the science. So here's what's fascinating. So up here, so this is the line of it is completely neutral, right? There's no harm, there's no benefit for cardiovascular benefits. Here are these 2 points are people who never drank, so complete teetotalers at a somewhat higher risk here. Are ex-drinkers, okay? But if you look at the 2 of these, these are called the point estimates, the averages. These are the confidence intervals, the scientific pluses and minuses, if you will. So basically, whether you never drank or whether you did drink but you stopped, you can see they're at quite a high— a much higher risk of cardiovascular events than people who drank and do drink moderately. So what we're seeing is here This is the no-harm line. They are all above the no-harm line, indicating harm, whether you never drank or you drank and quit. But people who drank moderately— this is basically the equivalent of 1 to 2 glasses of wine, maybe even a little bit more than that— are actually, you can see, actually have a lower risk of cardiovascular events. Now, when you go to higher amounts of alcohol, so now this would be equivalent of You're drinking 3 to 4 glasses of wine a day, we can see an increased risk, but note, still below people who never drank or drank and quit. And you really have to go up to much higher amounts of alcohol use. This amount of alcohol would be the equivalent of you're drinking heavy, like multiple glasses of wine every day, right? And even then, you're still a lower risk of cardiovascular events than people who never drank or drank and quit. And now do not drink. So I think this is pretty fascinating. We'll take it one step further. And again, this is cardiovascular events, strokes, heart attacks, balloon stents, bypass surgery, heart failure, et cetera. And we'll give some caveats too. There are some people that probably do need to watch their alcohol use, but, and we'll talk about that as well. But now let's move on to the net-net of all of this. This is all-cause mortality, right? So all-cause mortality is a fascinating endpoint to look at. A, You really don't need to be a scientist to determine are you breathing and do you have a pulse, okay? So it's a very, very hard endpoint that is unequivocal. In addition, when you look at all-cause mortality and you're saying does an activity, does an exercise, does a drug, or does alcohol increase or reduce or is it neutral for all-cause mortality, what all-cause mortality says is everything in life is full of benefits and harms, right? So exercise certainly we'll say is beneficial. But interestingly, in that same literature, you can show people that do extreme exercise, ultramarathons, Ironman, et cetera, they actually have a higher rate of atherosclerosis and plaque when we do cardiac CT and imaging tools like that than people who don't. So, There is a, what we call a J-shaped curve for exercise. So higher if you don't exercise, lower if you exercise moderately, but when you go to extreme amounts of exercise, there actually may be harm of overexercising, okay? That doesn't apply to many people. I'm talking to people that do like the 100-mile runs and, you know, just crazy amount of exercise. There actually may be harm at the very extremes of that as well. So again, we're talking about the happy middle, the moderate aspect of all this. So the point is that when you look at all-cause mortality, it's both combining, is there a benefit of a given activity, wine use, exercise, drugs, whatever, plus it also integrates any potential harm. So the net-net of mortality is, if there is a mortality benefit, it says that Whatever activity, tool, drug, whatever we're doing has benefit that even also outweighs any potential harms that could be harmful in anything we might do, whether it's drugs, exercise, or alcohol. So this is the all-cause mortality curve, and we're seeing exactly the same relationship with all-cause mortality. Again, here are the people who drank but stopped drinking, which, by the way, might suggest maybe they had a problem with alcohol and hence they stopped. These are the people that never drank, and you can see this is the line of neutrality that both of those groups are at higher risk. This is the group of people that drink moderately. We're talking one to two glasses of wine a day is fully acceptable, and you can see really there is it is completely neutral for all cause mortality. Whatever harms they may be, they're also mitigated by the benefits. As well. Probably most of those are conveyed by the cardiovascular benefits. As you go to somewhat higher intake— now again, this amount of alcohol would be like in the range of 2 to 4 glasses a day, and up here we're looking at even more, and then up here clearly at high, large amounts of alcohol use on a regular basis, there clearly is harm. But note, if you look at the— those that drank and quit and those that drank that drink very, very heavily, it's probably just about a wash as far as all-cause mortality. So this is the science. Again, if you highly select the data as Tim has done in Canada, select out just the studies that support your hypothesis and your narrative, sure, you can take the literature and make it show anything you want. But I think this is, studies like this that are somewhat less biased, are really very important to review and when we get into this very important question of that. Here's another study, again a meta-analysis, multiple, multiple trials lumped together, which shows moderate alcohol use is associated with a lower risk of cardiovascular events than people who either don't drink or drank and don't drink now. So again, the science really shows a benefit of alcohol use. There may be some people and individuals where that may be cautionary, and we'll talk about that here in a moment. And then the last thing I'm going to show you, very simple, we're looking at drinks per day of alcohol consumption. So relative to wine, a glass is 5 ounces of wine. I know I have gotten these massive glasses of wine, wine glasses, and people say just 1 glass a day of wine, the whole—
That's not a glass.
Hold a whole bottle. But technically, when we talk about wine, that's about— a glass of wine is defined as 5 ounces of wine, which is about, for the record, 14 grams of alcohol on average. So here's drinks per day of alcohol. We'll use wine for this as well. And then this is just looking at mortality. Again, all-cause mortality. So all the goods, the bads, all lumped together. And we also here have the difference between men and women. So here is the curve for men, and you can see this is the line of neutrality. So there's neither harm nor benefit. And if you take that line far enough, you can see 4 glasses of wine a day are still neutral. There's cardio— there's benefit of all-cause mortality at lower rates, and it doesn't cross over to even looking like it's harmful until, for guys, we're drinking 4 glasses of wine a day. Now also note these lines are the confidence intervals. Science is always murky, a little plus minus, but you can see these confidence intervals are pretty tight so that we can safely say at 4 glasses of wine a day, this is, this is per day, plus or minus around about 4 glasses of wine, there is no mortality harm. But there clearly is a mortality benefit at the lower doses that I think most of us talk about and do with respect to wine consumption. For women, again, there's been concerns about cancers and particularly breast cancer. But here, if you look at women, clearly up to about 2.5 glasses of wine a day, completely neutral. We also see that dip here at the low to moderate doses of alcohol use. Obviously, lots of alcohol use is a problem. With women, you can see the confidence intervals are larger, so we have not quite as precise as we can say with men, but I think this is really a telling attribute, a telling study that really kind of reduces some of the heat and steam and lightning of this discussion about mortality and alcohol use as well. So here again, you can see that J-shaped relationship. Like a big J, benefit of mortality and also clear benefit of cardiovascular events at the low to moderate doses that I think we're talking about for most responsible wine drinkers. And I will say, DJ, if you're drinking your wine, yeah, I'm not going to be drinking that many glasses of it a day because I can't afford to do that. But that's the value of drinking great wine. It has its own self-limiting governor built in, right? But I think this is also very telling about that question. I will say, in the cardiovascular space, one condition that may be an exception to this is atrial fibrillation. That's a very, very common heart rhythm. It's the most common heart rhythm in the US. About 6 million people have it. It generally comes on with maturity, I like to say. None of my patients get older, we just get more mature. And for atrial fibrillation, the average age of AFib onset is about 75, so it's really seen in our older individuals. Younger people can get it, but about 84% of people with atrial fibrillation are above 65 or 67. So it is a condition that generally comes on later in life. It needs to be identified and managed and taken care of. The most important medical management of atrial fibrillation which I'm not gonna go into, but is really using anticoagulation and blood thinners. But there is a pretty powerful relationship between atrial fibrillation and alcohol. In fact, as a medical student, we were taught the relationship with alcohol, again, this is any kinds of alcohol, and atrial fibrillation. It was called the Saturday night syndrome. So you'd go out, you'd binge, you'd overconsume, way on the far side of those glasses of wines per day, and that certainly can cause AFib. We've also now more in the last few years done some really nice studies that I think are interesting come out of Australia, because I think if I think about Australia, I think of people that probably drink pretty hard. Sorry, Australians and Aussies, but that's kind of my stereotype of people who live in Australia. They took people with a history of atrial fibrillation, they randomized these people, they were able to get people that said, if you're randomized to one arm, you're going to drink like you normally do, or else in the other arm, we're going to ask you to really cut it back. So they did get a cohort of Australians that were willing to do that. They randomized these people to just, you know, however amount of alcohol you drink, which as it turns out was about 2 glasses of alcohol a day. The other group, they said, We're going to really ask you to cut down the alcohol a lot. So they cut down to about 2 glasses of wine a week. So when you looked at subsequent episodes of atrial fibrillation, it was lowered by about 82% if you really backed off on the alcohol use. Now, again, that's any kinds of alcohol. We're not talking wine precisely. But so if you have atrial fibrillation, that's something you need to discuss with your doctor. Could that be playing a role in causing it? could cutting back be beneficial to you as well. Also, at very, very high uses of rates of lots and lots of alcohol, people that really probably have alcohol problems, it can cause weakening of the heart called cardiomyopathy. So again, there are certainly caveats, but generally these are at quite high uses of alcohol. We're not talking about the people that enjoy wine, that drink moderately. Uh, pair it with food, uh, et cetera. We're talking about people with real alcohol use, uh, problems. Uh, so cardiomyopathy would be another asterisk on that as well. Again, something to discuss with your doctors about that. But I think it is really fascinating for me as a scientist, as a clinician, to kind of go through this data. I think, uh, there are people, as we all know, uh, with the internet, everybody has a voice. We have a voice too. My voice is hopefully going to be of moderation and reason. So, but I think it is interesting when you actually look at the science in an unbiased way, I think you really see that moderate amount of alcohol use is fine. We talked about sort of the non-tangible benefits of enjoying it with friends and family and how it really can make moments and make memories, et cetera. And it's great to have DJ featured today on our podcast. But I also do love enjoying looking at the science and really, you know, just let the science speak for itself. So I've talked way too long. DJ, do you have any final things you want to share with our audience? Also, too, we'll make sure that we do get your website, Keplinger Wines, on our, on our YouTube channel as well.
Definitely.
Uh, personally highly recommend them. Wonderful, wonderful wines. They have a great spectrum of wine. In fact, we had a— because I knew DJ was coming, we broke out one of their great wines of, uh, great bottles of Chardonnay last night and, uh, enjoyed that. Um, so, uh, definitely check out their website. Be sure to subscribe if you're not already subscribed to our podcast as well. We also have a newsletter that goes out too, so you can sign up for that as well. Lots of interesting topical stuff about preventative cardiology and how we can help to eliminate heart disease. And as I always say, thank you for all those that are helping me eliminate heart disease. And please continue to work to put me and my colleagues in cardiology out of business. So, DJ, any final words or summary or thoughts?
You know, thank you. Thank you so much for having me. I think it's a great topic, especially today. with everyone looking at alcohol consumption, like you're saying, and just the different choices that you have out there. Obviously, being a vintner, my choice is wine, but I do love a great cocktail. I like good beer. So I like to mix it up. But I find that in looking at some of the studies over the years, wine just sticks out to me as something that if you enjoy it, there are those health benefits that it brings to the table that I think other beverages do not. And obviously, this tells you that you can have a few glasses through the week on a nightly basis. And I mean, even myself, I average maybe 5 nights a week when I'm drinking wine. It's not every night. I think I don't know. Sometimes you get a little bored.
Well, and I have to say, DJ, here's kudos to you. For a guy of 90, you look good.
So it's, you know, it's, I think anything in moderation. I'm not going to use a stick of butter every day, but I love butter. So yeah, keep drinking wine, folks.
Absolutely.
It's good for you.
Hear, hear. Well, thanks, everybody. Please come back next time. We got a lot of new new podcasts coming out. Uh, we'll keep you enticed and, and excited and entertained as well. Uh, and have some really fantastic guests on, on our, our channel as well. And, uh, until then, uh, power is prevention. Check out Clear Cardio, and we will see each other soon.
