Editor’s Note: Our Senior Columnist, Michael Apstein, MD, FACG, is a gastroenterologist at the Beth Israel Deaconess Medical Center in Boston, a Fellow of the American College of Gastroenterology, and an Assistant Professor of Medicine at the Harvard Medical School. If some of the material in this column sounds familiar, it is because the author uses portions of an article published on this site on December 10, 2025, to explain why drinking wine may be beneficial to health. ~MF
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Lumping wine with other alcoholic beverages is a mistake when giving advice regarding alcohol consumption because moderate wine consumption, especially with meals, may be beneficial to health. I won’t get into the argument whether the studies showing that red wine is good for you – the so-called “French Paradox” – have been disproven. I will, however, lay out recent, well-done scientific reports that show health benefits that accrue to wine drinkers compared to spirit drinkers. So, the question becomes, is a small of amount of alcohol – in the form of wine – good for you?
The U.K. Biobank study, widely quoted by neo-prohibitionists to show that alcohol consumption overall was associated with an increased risk of death, actually showed that drinking wine or drinking wine with meals, compared to other types of alcohol intake, was associated with lower overall death rates and with lower death rates specifically from cancer and cardiovascular disease. (Ortolá et al.; JAMA Network Open, 2024;7:e2424495).
Thirty years ago, investigators from Denmark showed that wine drinkers had a lower risk of death and severe cardiovascular disease compared to those who drank spirits. (Grønbaek et al., British Medical Journal, 1995;310:1165-1169). The authors confirmed and extended their findings in a subsequent article (Grønbaek et al., Annals of Internal Medicine; 2000;133:411-419).
More recently, a study from the U.K. showed that individuals drinking wine, especially red wine, regularly with food resulted in a lower risk of both major cardiovascular adverse events, such as stroke or heart attack, and death after seven years compared to those who drank spirits. (Jani, et al.; BMC Medicine, 2021;19:8-22).
At a molecular level, investigators showed that red wine, but not vodka, stimulated production of an enzyme in humans that protects against oxidative stress in cells. (Di Renzo et al., Oxidative Medicine and Cellular Longevity, 2018; 2018:1-13).
Investigators from Spain used a unique and objective measure of wine consumption, urinary tartaric acid concentration, as opposed to asking people how much wine they drank, and showed convincingly that light to moderate, but not heavy, wine consumption was associated to a reduction in cardiovascular disease in a Mediterranean population at high risk of heart disease. (Dominguez-Lopez et al.; European Heart Journal, 2025; 46:161-172).
I cite these reports as a few examples of the many that are present in the scientific literature that distinguish between the effects of wine and spirits on health. It is important to point out that these studies only point out associations. They do not establish cause and effect. You cannot conclude from these studies that moderate consumption of wine with meals will reduce heart attacks, stroke, and death from all causes. Whether the reduction in death and cardiovascular disease is due to wine per se or the type of person who drinks wine moderately with meals–a person who is typically more affluent and may have better overall health habits in general–is still unknown.
Importantly, these studies do point out that the consumption of wine and spirits have different effects on health.
Why might there be different effects on health when people drink wine as opposed to spirits?
Anthocyanins, polyphenols, and other non-alcohol components in wine, acting as antioxidants, might explain it. People often cite resveratrol, present in grapes and wine, as a magic bullet. It is well absorbed by the intestine, but the liver breaks it down rapidly and efficiently, so that hardly any resveratrol winds up in the blood. (Walle, T: Annals of the NY Academy of Science, 2011; 1215: 9-15). Whether other polyphenols or one or more anthocyanins does the trick remains unknown.
I suggest that lower blood alcohol levels among wine drinkers compared to those who drink spirits could explain the differences.
Blood alcohol determines the harm or putative benefit of alcohol. Whether you drink wine or whiskey – and whether you drink that wine or whiskey during a leisurely dinner or rapidly at a party – determines your blood alcohol level. Alcohol is the same, whether it comes from wine or whiskey. But the setting in which it is consumed determines what winds up in your bloodstream and that’s where the money is.
Blood alcohol, that is the level of alcohol in the blood – and/or maybe in the intestine as well–determines the harm or putative benefit of alcohol. The level of alcohol in the blood over time eventually determines whether people develop liver disease, breast cancer, or other illnesses, or whether they might be protected from heart or other diseases.
Blood alcohol levels differ vastly depending on whether you drink wine or spirits. That’s why conflating wine with other alcoholic beverages is fundamentally mistaken.
The numbers tell the story. What happens to those 14 grams of pure ethanol, the amount of alcohol contained in what the government calls “one standard drink,” when they are consumed quickly as one 1.5-ounce shot of 80 proof Tequila or Bourbon, or as one five-ounce glass of a 12 percent Pinot Noir sipped over 15 minutes? The hypothetical 155-pound male winds up with about a 40 percent higher blood alcohol level after drinking the Tequila compared to drinking Pinot Noir. The difference shows the enormous effect between differing beverages you may consume will have on your blood alcohol level.
It’s easy to explain why that shot of 80-proof Tequila or Bourbon increases blood alcohol levels more than wine.
The higher concentration of alcohol in a spirit like Tequila outstrips the liver’s ability to metabolize it, so more winds up in the blood. So, is a glass of wine equivalent to a shot of Tequila? The total content of alcohol is the same – each has 14 grams of alcohol – but their effects on your brain, liver, risk of cancer, and their putative benefit to your cardiovascular system is clearly not equivalent, simply because the blood alcohol level differs enormously due to differing patterns of consumption in differing settings.
Regarding “differing settings,” let’s add food consumption to the comparison. After consuming two shots of Tequila before dinner on an empty stomach, the same hypothetical 155-pound male will have a blood alcohol level about two and half times higher than that of someone who drank two 5-ounce glasses of 12 percent Pinot Noir over two hours with dinner. That’s because alcohol is absorbed into the blood more slowly when food is present in the stomach. And our hypothetical drinker is consuming wine, with its lower concentration of alcohol, over a longer period, which also slows alcohol’s absorption.
The bacteria in our intestines produce ethanol, more after we eat a meal, likely from the fermentation of ingested carbohydrates. The liver breaks it down before most of it gets into our blood, but a little ethanol does wind up there, which raises the fundamental question, would the body produce something that is harmful to itself? (Meijnikman et al., Nature Medicine, 2022, vol. 28, 2100-2106).
There are many examples in medicine of a little bit of something being beneficial while a lot of the same thing is harmful. Aspirin, whose active ingredient was originally found in the bark of the willow tree, springs to mind. A small dose protects again heart disease while a large dose causes bleeding, and a very large dose causes liver injury.
Could the same be true of alcohol? Obviously, I don’t have a definitive answer (nor does anyone else, yet), but we’ll never find the answer unless we raise the question.
It is easy to reconcile that a little bit of alcohol in the form of wine might be beneficial with the World Health Organization (WHO) statement that there is “no safe amount of alcohol consumption.” (Anderson, B.O. et al., Lancet Public Health, 2023; E6-7). The WHO conclusions come after analysis of mostly large population studies, not studies focused on what specific individuals consumed. When focusing on large populations, as the WHO did, their assessment is likely correct. The vast damage that world-wide alcohol consumption causes swamps the benefit it might provide to wine drinkers, a small and select group of individuals. We in medicine are taught to be careful to avoid applying conclusions from studies of large, diverse populations to specific individuals who may not share the same characteristics. This caution is especially important in this instance when the WHO examined alcohol in general as opposed to wine in particular. So, both “there is no safe amount of alcohol consumption,” and “a little wine might be beneficial” could be true simultaneously. It depends on the groups that are studied.
As an analogy, let’s look at driving a car. No amount of driving an automobile is safe. Any driving increases your risk of injury or death. But many individuals live their entire lives driving without any adverse effect and with clear benefits.
Might the same be said of drinking wine?
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I’ll end by reminding people of sensible general advice regarding drinking:
• Never binge drink. Binge drinking is always harmful and dangerous.
• If you drink, chose beverages, like wine, that have a lower concentration of alcohol.
• Drink moderately, slowly, and with food. Avoid becoming intoxicated.
• Check your blood alcohol level before you drive and don’t drive if your level is above the legal limit even if you “feel fine.” Remember, services like Uber, Lyft and local taxis are readily available in most locations.
• If you do not drink now, do not start with the intention of improving your health.
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Nothing in this article should be construed as medical advice. The opinions in this article are mine and mine alone and do not represent the opinions or advice of the Beth Israel Deaconess Medical Center, the American College of Gastroenterology, or the Harvard Medical School.
January 21, 2026