Is a daily glass of wine healthy?

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Transcript

Chrissy Billau:
Welcome to Prescribed Listening from the University of Toledo Medical Center. On this podcast, we interview our experts to get the answers you need and can trust. I'm your host Chrissy Billau. Today, we are diving into some of the top Googled health questions from 2020 and 2021 with Dr. Mark Burket, who specializes in cardiovascular medicine at UTMC. Thank you for joining us.

Dr. Mark Burket:
Thanks for having me.

Chrissy Billau:
While you may have heard of wine mom culture or the mommy needs wine jokes and memes. Have you ever wondered though, if a daily glass of wine is actually healthy for you? Well, let's ask our expert, Dr. Burket. Here is one of the top Googled health questions, is a daily glass of wine healthy?

Dr. Mark Burket:
So the simple and short answer is no. This is a reversal of where we've been for many years. It used to be that the general teaching in medicine was that one to two alcoholic drinks per day was actually heart healthy. In fact, I remember as a resident at Ohio State where I went to medical school, there was a lecture that I heard in which the presenter said two beers, two miles, two aspirin was the formula for cardiovascular health. And he went on to recite the data about how exercise was good and aspirin was good and a little bit of alcohol was good. And we've actually back pedaled on two of the three of those.

Chrissy Billau:
That's interesting because I feel you always see a study over the years that comes out. There's a good reason to drink that glass of wine at night. That's not true.

Dr. Mark Burket:
That's right. It's no longer considered to be true. So one of the recent publications that put this on its head, was an analysis of over 300,000 individuals that was done through some researchers centered at Massachusetts General Hospital. And they looked at the association between overall health and alcohol consumption. As I mentioned in the past, a lot of times there was this signal that people who had one to two alcoholic beverages per day actually had better cardiovascular health and you got into trouble if you were an excessive alcohol user, or if you were a teetotaler and didn't consume any at all.

Dr. Mark Burket:
But this recent study actually has shown that probably the reason that people who drank one or two drinks per day had better cardiovascular health is because of other factors. So people who consume a little bit of alcohol were probably more likely to eat a healthy diet, to exercise and to not smoke. And those things probably carried the day and the alcohol was just a kind of as spurious or an inaccurate result.

Chrissy Billau:
Is there any benefit to a daily glass of wine at all? I mean, I know they're from grapes. You get all the, all the excuses out there. Is there anything that it could help in your body?

Dr. Mark Burket:
So as it turns out, excuse me, the answer is probably no. And again, we used to think that one or two was great and we didn't quite go as far as encouraging people to drink alcohol, but we certainly didn't discourage the use of alcohol. But some of the more recent information has come out that actually shows that even a small amount of alcohol may increase the chance of having an unusual heart rhythm called atrial fibrillation.

Dr. Mark Burket:
So with atrial fibrillation, the upper chambers of the heart, essentially quiver, they don't contract normally, they just quiver in place. And that's actually a very high risk for other problems with your health. For example, when there is atrial fibrillation, a clot can form in the heart and then that clot can become dislocated and could cause a stroke or a heart attack, or a blocked artery anywhere in the body. Turns out that even a little bit of alcohol increases the risk of atrial fibrillation.

Chrissy Billau:
Red or white wine would not make a difference in this?

Dr. Mark Burket:
That's right. So again, if we turn the clock back, it used to be that there was this assumption that the best of all alcohols was red wine. There was this thing called the French paradox. So what was observed was that in France, there was a relatively high consumption of wine and people also in France smoked more often than people in other countries. They had very high fat contents in their diet, and yet they didn't seem to have as much coronary artery disease as you would expect. So there was this thought that, well, maybe the red wine that the French population consumes is protective, and there was all types of research done to see if there was some component of the red grape that was beneficial that might not be found in white wine or beer or hard liquor. And so that was taught for quite a while, but I think the most recent indication is that probably no alcohol is beneficial for the heart.

Chrissy Billau:
Okay. And I know we talked about AFib, any other negative consequences from drinking a daily glass of wine a day?

Dr. Mark Burket:
So at low doses, there's probably not very much detrimental with regard to alcoholic consumption of wine or otherwise, but as alcohol consumption increases, then it can actually destroy the heart. And there is an abnormality called alcoholic cardiomyopathy. With alcoholic cardiomyopathy, this is typically seen in people who might put down a fifth of hard liquor a day, for example. And what it does is essentially destroys the heart muscle and we would evaluate patients and find out that their ability for the heart to contract was just shot and it was thought to be a direct, toxic effect from high doses of alcohol.

Chrissy Billau:
So what do you say to the person who, "I'm going to put my kid to bed and I'm going to have a glass of wine and just watch TV or read my book." What do you say to that person?

Dr. Mark Burket:
So you may enjoy the wine. You may enjoy the taste. You may enjoy the relaxing effect of the wine, but don't fool yourself into thinking that there's something here, which is heart-healthy. If you want to drink the wine, that's one thing, but it's not going to be beneficial for your heart.

Chrissy Billau:
So next one is, with the pandemic a lot of people have been sitting around for two years. What is a heart healthy way to get yourself moving again?

Dr. Mark Burket:
Ah, great question. So the inactivity associated with COVID for many people was really a negative thing, a destructive thing. The flip side is for many people, they actually got more active. They stopped their one hour commute to the office, and instead they went to the local park and had exercise. But for many people, they were just locked down inactive and for a lot of people that gained weight and lost physical fitness.

Dr. Mark Burket:
Probably the most important thing to realize about getting back into an exercise program is to take it slow. So a lot of times people want to jump in right away and exercise for an hour, a day, six days a week. And that's a mistake you're much better off to just gradually start in with something slowly and then increase it gradually. One of the pieces of advice from the cycling world is if you're increasing cycling, increase about 10% per week in your mileage, that's a pretty good idea of how to increase the level of activity.

Dr. Mark Burket:
So just a little bit at a time, gradually increasing it. In that way, if you have developed any cardiovascular problems or other health problems, they tend to surface, as you gradually increase your level of activity without causing a major health crisis.

Chrissy Billau:
Now, what type of cardio is best and for whom? So you have high intensity or slow and steady. I myself do HIIT train, the high-intensity interval training, but I'm starting to see a few things about list cardio creeping into social feeds. It's that low intensity steady state cardio. What is best and for whom?

Dr. Mark Burket:
So when considering exercise, I think the most important thing is picking something that you will stick with. So if you hate to run, don't start running. If you love to swim, then swim. So if you can find something that you like a lot, or maybe hate the least, that's the thing to pursue. So find something that you enjoy and do that, do it on a regular basis and that's the most beneficial.

Dr. Mark Burket:
That said, there are general forms of exercise that are typically more heart-healthy. Those are the, we talk in terms of aerobic exercise. The list is pretty long, really of things that are beneficial. So running is great for cardiovascular health. One of the downsides of running is that, especially if you don't have proper footwear and use proper technique, it can be pretty hard on the joints and on the spine.

Dr. Mark Burket:
So it's great for the heart, but can take its toll elsewhere. So some of the ways that you can avoid that is to do other aerobic exercise that is not so injurious to the joints, for example, cycling. So cycling is a fantastic way to get a good aerobic workout. And it's much easier on the joints than running. The tricky part about cycling is once again, you have to be very safety conscious.

Dr. Mark Burket:
If you don't wear a helmet, you increase your risk of a head injury with a fall and you also have to be very cognizant of the traffic pattern where you're cycling, because if you have a healthy heart, but then you have a serious accident, you haven't gained anything. Swimming is good. Wintertime cross-country skiing is phenomenal. Actually, when they've looked at oxygen consumption, which is a way of measuring what your overall physical fitness is, your ability to burn oxygen, the higher amount of oxygen you can burn, the better your cardiovascular fitness is.

Dr. Mark Burket:
Turns out that the world record for both men and for women for oxygen consumption is in cross-country skiers. So one of the things about cross-country skiing is you're doing a very hard upper body workout, at the same time that you're doing a very hard, lower body workout. With running your arms aren't doing a whole lot. So cross-country skiers really get the complete workout.

Chrissy Billau:
Weight loss too. When people start putting in their Googles, "Give me a weight loss story, what's worked for somebody else?" And particularly the Mediterranean diet is a popular Google health search topic. Is the Mediterranean diet good for heart health?

Dr. Mark Burket:
Yeah. The Mediterranean diet, it's a good way to maintain a heart-healthy diet. It's sensible. It's not a radical diet. There are a lot of radical diet programs out there that are really not advisable, but the Mediterranean diet is pretty simple, straightforward, and it is heart-healthy.

Chrissy Billau:
And there's a lot of the fad diets that pop up like the keto diet. How does the extreme fluctuation in macros impact you?

Dr. Mark Burket:
Yeah, I wouldn't encourage a keto diet for heart health. I think when we look at some of the success stories with heart health and weight loss, the Mediterranean diet is one example. Generally, what I recommend to my patients is they eat a well balanced diet, but they eat less of it than they were eating before. So if you think back to grade school on the pyramids and all that kind of stuff, that really is not all that bad, that information. Typically, the problem is not the type of diet, I'm sorry, the components in the diet, but the volume.

Dr. Mark Burket:
So another thing that I have often patients will come in and they'll say that because they want to eat heart healthy, they eat a whole bunch of chicken and they eat a whole bunch of fish and they are 30 pounds heavier than they were before. Well, the idea is we're not trying to get you to eat a whole lot of chicken or a whole lot of fish or whatever thing you might think is heart-healthy, but eat a lower amount so that you can maintain a slow, steady weight loss.

Chrissy Billau:
And a lot of people skip breakfast. Do you?

Dr. Mark Burket:
I eat breakfast 99% of the time. Yeah, I think there have been studies that have indicated that people who eat breakfast generally have better weight management and better health. I encourage my patients to eat a reasonable breakfast on a regular basis.

Chrissy Billau:
How can someone edit their own diet? Is there something they can throw in that might make it more heart-healthy? Simple changes they can make.

Dr. Mark Burket:
Yeah. So you mentioned the Mediterranean diet and the things in the Mediterranean diet are generally a good way to approach a diet. There's really not one or two specific things that you can add that'll make a big change. Avocados are one of the big trendy things right now. They are probably pretty good for overall health, but there's not like a certain food or a certain type of food that really is a big game changer with this.

Chrissy Billau:
Eat less, and I always hear more protein, more fiber. Fiber's a big thing I've been hearing about lately.

Dr. Mark Burket:
Yeah. So fiber's actually really beneficial for overall health. The story behind fiber is in incredible. The person who was one of its champions actually has a name that's pronounced the same way as mine, Dennis Burket. He was a surgeon from England who was actually a healthcare provider in Uganda, in Africa. And he noticed that where the diet was high in fiber, he saw a lot less of the diseases that are common in Western civilization. So he didn't see as many varicose veins, he didn't see as many hemorrhoids, he didn't see diverticular disease of the colon and he didn't see atherosclerotic disease to the same degree. So he was actually a champion of the high fiber diet. And I think there's some validity to that. So foods that are high in fiber generally promote good overall health as well as cardiovascular health.

Chrissy Billau:
So what are some foods off the top of your head that are high in fiber?

Dr. Mark Burket:
Great question. So things that are high in fiber, beans are high in fiber, whole grains. So if you're at the grocery store and you get beans and you get whole grains and you get fresh fruit, those tend to be really high in fiber and they're excellent sources of that.

Chrissy Billau:
I saw you could get a whole grain waffle, a frozen waffle to make. I thought that was pretty impressive.

Dr. Mark Burket:
Yeah. I think there are a lot of creative ways to get a lot of whole grains in, but basically, you want to avoid the stuff that's really highly processed because that tends to take the fiber out. And also that you won't find fiber in things like a lot of red meat and vegetables and things like that. But the fruits, grains and legumes are really good.

Chrissy Billau:
Next, I'd like to talk about heart health differences for men and women. I know the signs of heart attack can be different. Are there any others?

Dr. Mark Burket:
So I think the overall recommendations are about the same for men and women. We still advocate total abstinence from tobacco products, exercise, maintain an ideal body weight. And now essentially there's no recommendation for the addition of alcohol to promote good health. And so really the overall formula is about the same.

Dr. Mark Burket:
You pointed out that the symptoms can be different. So that has been something that's been observed over the years, that typically if a woman presents with an acute cardiac event, it's more likely that we're going to get confused. There will be something about the symptoms that doesn't quite follow the textbook and the symptoms that men provide more often will. That's a general statement. Sometimes men have symptoms that make absolutely no sense and a woman might be right out of the textbook, but tends to be a little bit more confusing with women.

Chrissy Billau:
If you're on about in your day and, man or woman, but something doesn't feel right and you think this might be it, but you have no idea. And you wear your Apple watch and you know your heart rate and how things are going and something's different. What do you do?

Dr. Mark Burket:
Yeah. So in this day and age, an Apple watch may start to give you some clues if there are some abnormalities on the rhythm tracing or on the electrocardiogram. But some of the things that I think are the most consistent for men or women, when you're really in trouble would be a pressure-like sensation in the middle of the chest. Often it'll be associated with shortness of breath.

Dr. Mark Burket:
We ask about other symptoms that might be there as well. So nausea, shortness of breath, you might feel clammy. But the single thing that I look for the most is are you having a pressure-like pain in the middle of the chest? And what's interesting is oftentimes I'll ask a person, I'll say, "So tell me about your chest pain." And they'll say, "Oh, it's not pain. It's pressure." Well, to a cardiologist, the word pressure and pain are used synonymously.

Dr. Mark Burket:
So people might say that it's not sharp and therefore they're not concerned about it. To me that's not reassuring at all. If they say it's not sharp, they'll often say, "Yeah, it just feels like a pressure, a weight." Some people will describe it feels like an elephant sitting on my chest. When you get those kinds of symptoms, you better get to an emergency department fast.

Chrissy Billau:
Piggybacking on the Google searches, I want to ask you Dr. Burket, what is the most common question you get from patients and what's your answer?

Dr. Mark Burket:
That's a good question. So much of my practice involves the vascular side of cardiovascular disease. And very often I will see people who have leg symptoms and they are concerned about the significance of the pain or the cramping that they're having in their legs. So probably the most common question that I get is what is causing the pain that I'm having in my legs and what can we do about it?

Chrissy Billau:
And what's the common answer, or is an easy one?

Dr. Mark Burket:
So actually the list of things that cause leg pain is really long. And that's where you have to do some detective work and sift through the different causes of leg pain and there are a lot. So probably the most common cause of leg pain that people, almost everybody gets once in a while, are leg cramps. And people will say that they have these terrible leg cramps and they think maybe they have some serious problem that's causing them. And it turns out that most normal people from time to time will have cramping in their legs and it might be really bad.

Dr. Mark Burket:
Oftentimes we don't figure out the cause of leg cramps, but generally, if it occurs at nighttime in bed, it really doesn't carry a whole lot of health significance. So that's one of the more common causes of leg pain.

Dr. Mark Burket:
One of the other things I see really often is called intermittent claudication. So this is pain in the legs that comes with walking. So people very often will describe that they can go out for a certain distance. Often it's very predictable. They'll say, "I walk for 100 feet out to my mailbox and then my calves start tightening up. They start burning. They feel like they're nodding up and I have to stop and rest." So that's kind of the classical description of intermittent claudication.

Dr. Mark Burket:
Claudication does indicate that there's a serious problem going on. So that comes from a blockage in the arteries that supplies the musculature of the leg. And typically this will be in people who have risk factors for atherosclerosis. So cigarette smoking is far and away the number one risk factor for this. Diabetes is also a risk factor and simply being older. So if there's somebody in their 70s, who's been a long-time smoker, maybe they're diabetic, if they say that they go out for a walk and predictably get pain in their legs, that's probably claudication.

Chrissy Billau:
And that's a reason to go see a cardiologist?

Dr. Mark Burket:
Yeah. So the providers of vascular care can come in a number of different stripes. So this could be a general internist or a family doctor would be a good place to start. And then after that, you really want to have a vascular specialist. So some cardiovascular specialists stick strictly with the heart. Others do the whole gamut, cardiac and vascular. Vascular medicine and vascular surgery are all the fields where this can be taken care of.

Chrissy Billau:
And to be taken care of, there's a way that it can be fixed and you can go farther than a little walker to your mailbox again?

Dr. Mark Burket:
Absolutely. So that's been one of the exciting things about the last couple of decades in healthcare is the progress that's been made in doing what's called minimally invasive therapy. So minimally invasive means that short of an open surgical procedure, we can improve circulation. So let's say that we have that typical person, 70 years old, they've smoked for their whole life, they notice that they have this cramping when they walk. That typically leads to a good physical examination. We examine the pulses and do a full cardiovascular examination. After that, we'll often often do an ultrasound study where it helps us to get an idea about what the circulation to the lower extremities is like.

Dr. Mark Burket:
Once we have that kind of confirmation of diagnosis, then we can start on a treatment plan. So there are a number of things that are simple and safe that are effective. The first is structured or supervised exercise. So we actually have at UT, peripheral arterial disease rehab program, where people can come in and the experts there will help them to structure an exercise program that's been shown to increase their walking ability. So that's one of the more conservative sides of treatment.

Dr. Mark Burket:
We recommend the medications that have been shown to be beneficial. In this case, aspirin is beneficial. Typically, we use a lipid-lowering agent, a cholesterol-lowering medication. We encourage cessation of smoking. So those are all part of it as well. There's one specific medication, which is pretty effective in increasing walking distance that's called cilostazol. It's a prescription medication. It's actually quite safe. And it's a medication that patients take orally twice a day. Then if that doesn't get us where we need to go, that's where we can start to open up blood vessels with balloons and stents and rotor rooters, and all types of different tools. And that field has become very exciting and very rewarding because we can take people who might not even be able to walk across the room without pain and have them go out and ride bike to the bay a month later. It really can be dramatic.

Chrissy Billau:
That's a huge. You're talking more about things we have at UTMC. I'd like to talk about aspects of your practice in cardiovascular medicine at UTMC. What are you working on?

Dr. Mark Burket:
So most of my practice now focuses on vascular disease, and that can be both the arteries that supply blood to the organs and the veins that draw the blood back towards the heart. And so a lot of what I do is help people to walk better who have blocked arteries, trying to figure out what the cause is and then we figure out how to open that up. For many years, we've been involved with research with drug-coded products.

Dr. Mark Burket:
So when we open up an artery in the leg, one of the problems after we open up a blockage with a balloon is that narrowing may recur. And so probably about 15 years ago, we and many others were participating in research where we asked the question, well, what if there were a coding on that balloon that inhibited the regrowth of the blockage? And so we started experimenting with balloons that were covered with a material called paclitaxel.

Dr. Mark Burket:
It's actually a chemotherapy drug that's used for breast cancer therapy under the trade name of Taxol. And we use a dose that's about one 1000th of what you would use to treat breast cancer, coat the balloon with that and then when the balloon is inserted into the blockage and the blockage is opened up, a trace amount of this material is left behind. And that significantly decreases the chance that blockage will come back. So we had the thrill really of being involved with a number of research trials, where we were putting that on balloons or stents, which are essentially a metal mesh that holds the blood vessel open, and patients could come to UT Medical Center, get this device long before it was Food and Drug Administration approved as part of a research trial. These things later proved to be efficacious, got FDA approval and now they're routinely used in cath labs across the country.

Dr. Mark Burket:
So that's been an area that we've been involved with for many years. And then on the venous side, one of the other really common problems that we encounter is varicose veins. So there are the spider veins that nobody likes because of their appearance, but then it gets a lot more severe than that with these, what we call ropey varicose veins, it almost looks like there's a piece of rope tangled under the skin. And with that, people can have a lot of problems. They can have legs that ache and sting and burn and restless legs at night, and they can't sleep.

Dr. Mark Burket:
And they're actually very easy treatments to take care of those now. We can go into a vein and sometimes it's as simple as gluing it shut with a material that's almost identical to super glue.

Dr. Mark Burket:
So we identify the vein under ultrasound and then insert a small tube that delivers tiny little amounts of this super glue-like material inside the vein while we push the vein closed and it stays glued shut permanently.

Chrissy Billau:
Wow.

Dr. Mark Burket:
Yeah, it's pretty cool. And so I've been doing this a long time and to me it's still exciting. It's as exciting now as when I first got into it and that's just one of the examples. So this is a relatively new treatment, but very effective and we already have studies that show that even five years after the administration of glue, 95% of the veins that were glued shut are still shut.

Chrissy Billau:
So it must be fascinating how things change over time.

Dr. Mark Burket:
Yeah, so the change, so I'm revealing my age, but when I was in medical school was the first time that a guy by the name of Andreas Grüntzig, who was a guy who was born in Germany and he did the very first angioplasty in the world. So I'm a medical student. As I entered medical school, there had never been an angioplasty done. And now there have been millions of angioplasties done and then came stents, which made angioplasties more reliable and durable. And it's just been an explosion of these minimally invasive techniques that it's been a great career, very exciting, but importantly, patients are way better off because of these.

Chrissy Billau:
What can people do to better their health? If it's not that glass of wine at the end of the day, after you put the kids to sleep, what can you do? Is there something else you can do in its place to be more healthy and relax?

Dr. Mark Burket:
Yeah. So we've talked a lot about exercise. It turns out that exercise, you can draw a direct line between exercise and cardiovascular health, but one of the faculty members, Dalynn Badenhop once gave a grand rounds and he was talking about this miracle drug. And the miracle drug was exercise. And the reason is that not only has exercise been shown to directly correlate to cardiovascular health, there are also lower rates of depression. You're more likely to be optimistic, have a positive outlook on life. There are actually some studies that indicate you may be less likely to have a malignancy if you're a regular exerciser. I would say probably the number one thing, if you're going to put down the glass of wine is to pick up the running shoes and go out for a walk or a run that's really, really important for overall health.

Dr. Mark Burket:
I think some of the other stuff that we've seen from COVID is just how important healthy interpersonal relationships are. People do not do well in isolation. And so if you find that group of people that adds life to you, then I think that is really beneficial for your overall health, a sensible diet, maintaining a good weight, all those are important.

Chrissy Billau:
So if you, if you do exercise, if you do find that social aspect back in your life, everything mixes together, that you may not want to reach for that glass of wine at the end of the day.

Dr. Mark Burket:
That's right. And especially the recent information about the link between even low consumption of alcohol and atrial fibrillation, I think is pretty compelling. And the reason for that is if you watch TV, you'll see the advertisements for the medications that are used in atrial fibrillation. Millions of people have it. And atrial fibrillation is a bad thing to have. It clearly increases the risk of stroke, which when I talk to patients, there are really two words that I think that they fear more than death. If I say the word stroke, or if I say the word amputation. That actually catches their attention more than if I mention death, nobody wants to have a stroke, nobody wants to have atrial fibrillation and now there's a pretty clear link between alcohol and atrial fibrillation.

Chrissy Billau:
Now, this has been a really fascinating conversation. I know people who are listening, how can someone schedule an appointment to see you?

Dr. Mark Burket:
So I have an outpatient clinic in Maumee at the UT facility there on Clover Road. And people with vascular disease are welcome to schedule an appointment. If you just look up UT physicians, look up my name, there should be a phone number there, (419) 931-0030. We'll get you there.

Chrissy Billau:
All right. Well, thank you, Dr. Burket, that's all for this episode of Prescribed Listening from the University of Toledo Medical Center. Subscribe to hear more on your favorite podcast platform. Join us next week for another episode where we tackle more of the top Googled health questions.