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Wine

Medically reviewed by Drugs.com. Last updated on Jul 1, 2018.

Scientific Name(s): Vitis vinifera L.

Clinical Overview

Use

Numerous clinical and epidemiological studies document an inverse relationship between red wine consumption and the incidence of some cardiovascular disease and risk factors, including coronary disease, heart failure, hyperlipidemia, metabolic syndrome, and hypertension. However, as with cancer studies, results are equivocal with somewhat high heterogeneity observed among studies. Some results show greater beneficial effects with moderate consumption of red wine than with higher consumption or in nondrinkers. Other trials have investigated red wine for use in depression, and to improve cognitive function and decision making. The antioxidant activity of red wine is fairly well established. For information specific to the activity of resveratrol, a constituent of red wine, see the Resveratrol monograph.

Dosing

Red wine extract supplements are available in numerous dosages and doseforms. Clinical trials evaluating the effects of red wine on risk factors for cardiovascular disease (eg, blood pressure, LDL) have used the following dosages: 125 mL twice daily (total daily dose, 250 mL) of red wine or red wine-onion extract for 10 weeks; or 150 mL of red wine with dinner for 6 months. Higher red wine consumption (200 to 300 mL/day) for 4 weeks was evaluated in premenopausal women to determine effects on blood pressure.

Contraindications

Hypersensitivity to red wine or any of its components. Anaphylactic reactions have been documented. Alcohol consumption is contraindicated in patients with viral hepatitis (eg, hepatitis B and C).

Pregnancy/Lactation

Avoid use during pregnancy and lactation because of the risk of birth defects and fetal alcohol syndrome. Avoid nonprescription supplements because of the lack of clinical data.

Interactions

Red wine is reported to be an effective reversible inhibitor, but weak irreversible inhibitor, of cytochrome P450 (CYP-450) 3A4 activity. A negative interaction occurred between wine and rosuvastatin in a large multicenter study, although data regarding type of wine used (red vs white) were not reported. Red wine should be used with caution when coadministered with other medications.

Adverse Reactions

Adverse reactions to pure wine are rare. However, because the vast majority of commercially prepared wines now contain sulfites as preservatives, individuals sensitive to these chemicals may develop severe allergic reactions, including wheezing and tachycardia. Headaches following ingestion of some wines have been associated with histamine or tyramine content.

Toxicology

Toxicity with excessive alcohol consumption is well documented.

Scientific Family

  • Vitaceae

Source

Wine is an agricultural product created by the natural fermentation of sun-ripened grape juice. Yeast-induced fermentation converts endogenous sugars to alcohol, and the flavors associated with each wine depend on the grape variety, harvesting, and fermentation conditions. While most wines are derived from grapes, fermentation of other fruits and vegetables has yielded wine-like alcoholic beverages. Wine production includes a series of steps, including extraction of juice, fermentation, clarification, and aging.Ensminger 1994, Wine 1986

History

Wine has played an important role in societal development for thousands of years. The first cultivated grapes were grown in Asia Minor around 6000 BC. Archaeologists have uncovered the remains of a 2,600-year-old winery in Israel,Wine 1986 and Egyptian accounts of winemaking date back to 2500 BC. The Bible makes reference to raising grapes to make wine and suggests potential health benefits of wine.Ensminger 1994 Hippocrates (450 to 370 BC) was said to be the first physician to understand the healing value of wine.Van Laere 1996 The Romans disseminated information about the science and art of making wine throughout much of the world, and Europe subsequently became the center of winemaking expertise. Winemaking techniques were documented and preserved during the Early Middle Ages by members of the clergy.

Early fermentation procedures produced heavy wines that were often exceedingly sweet. Refinement of the fermentation process resulted in the development of numerous varieties of wines, each with unique flavors and alcohol content. Wine has played a role in societal interactions and many religious ceremonies. The growth of the American wine industry during the 20th century was halted by Prohibition (1920 to 1933), but has been steady since. Wine is currently produced throughout the United States, with boutique wineries accounting for a proportional increase in production.Ensminger 1994, Wine 1986

Many articles discuss the history of wine and its use in medicinal practice.Berland 1966, Cambon 1968, Favazza 1968, Haas 1998, Leake 1967, Lucia 1972, Soleas 1997, Spring 1977, Van Laere 1993, Wine 1969

Chemistry

The chemical composition of wine is complex. A typical wine contains more than 300 components in addition to alcohol, often including minerals and vitamins not found in other fermented beverages.Wine 1986 Alcohol concentrations may vary from 10% to 14% for table wines, and up to 20% for certain aperitifs. While the prevalent alcohol is ethanol, glycerol and more than a dozen other alcohols have been isolated from wines.WAB 1975

The medical literature documents numerous biological propertiesOpie 2007 for wine polyphenols, which include the phenolic acids p-coumaric, cinnamic, caffeic, gentisic, ferulic, and vanillic acids, as well as the trihydroxy stilbenes polydatin and resveratrol.Halpern 1998, Soleas 1997 Resveratrol has attracted the most attention because of its biological activity.Opie 2007

There is a wide range of phenol concentrations in select wines. One Japanese report analyzes resveratrol and piceid, along with their isomer content in 42 different wines. The average stilbene content was 4.37 mg/L in red wines and 0.68 mg/L in white wines.Sato 1997 Red wines have higher concentrations of total phenols, flavonoids, flavonols, and anthocyanins than white or rosé wines.Li 2009

Red wines have trans-resveratrol concentrations 6 times those found in white wines, while wine varieties made with white grapes contain higher concentrations of cis-resveratrol.Feijóo 2008 Red and white wines contain 0.12 to 0.06 mg/L of cis-resveratrol, while red wines contain a concentration of 12.68 mg/L of trans-resveratrol.Feijóo 2008 Wine flavonoids are also present (1 to 3 g/L in red, 0.2 g/L in white) and include flavonols, anthocyanins, flavonols (catechins, quercetin), oligomers (procyanidins), and polymers (tannins) of the catechins.Soleas 1997 Anthocyanins are responsible for the color of wine.Guerrero 2009

Champagnes and sparkling wines contain approximately 1.5% carbon dioxide. Other wine components include carbonyl compounds, organic acids, tannins, carbohydrates, and esters.WAB 1975, Wine 1986

Uses and Pharmacology

Studies evaluating the effects of wine are reported in this monograph. For information specific to the activity of resveratrol (eg, effects on aging, cancer, inflammation, and neurodegenerative disease), see the Resveratrol monograph.

Antioxidant activity

Clinical data

In a double-blind, randomized, clinical trial of patients with hypercholesterolemia (N=23) assigned to consume 250 mL/day of either red wine or a red wine-onion extract for 10 weeks, plasma antioxidant status was significantly improved (P<0.05) in both groups. Antioxidant status was based on various plasma oxidative indexes and erythrocyte antioxidant enzymes (thiobarbituric acid reactive substances, trolox equivalent antioxidant capacity, glutathione peroxidase, glutathione reductase, reduced glutathione). Major limitations of this study were its small sample size and the lack of a control.Chiu 2016

Cancer

Clinical data

Meta-analyses of study data regarding alcohol consumption and risk of ovarian, lymphoma, and melanoma cancers have been conducted.Bracci 2014, Kelemen 2013, Miura 2015 Pooled data from case-controlled studies across several countries in the Ovarian Cancer Association Consortium (comprising 5,342 ovarian carcinoma cases, 1,455 borderline tumors, and 10,358 controls) and with quantitative information on recent alcohol intake and specific types of alcohol revealed a nonsignificant decrease in ovarian cancer risk in women who consumed more than 8 oz/day (240 mL/day of wine) compared with women who did not drink wine. Further analyses found no significant associations based on type of wine (red or white).Kelemen 2013 In another pooled analysis from 13,766 controls and 1,052 marginal zone lymphoma (MZL) cases (633 were extranodal, 157 nodal, and 140 splenic), a similar but significant inverse relationship was found between alcohol consumption, particularly wine consumption, and the risk of MZL; reduced risk was observed in patients consuming lower amounts of wine compared with nondrinkers (P<0.002 for trend). When assessed based on MZL subtype, risk for nodal MZL was significantly reduced (P<0.003) for wine drinkers who consumed lower amounts of wine per day (quartiles 1, 2, and 3 [quartile 1 being the group consuming the lowest amount]); however, no significant association between wine consumption and risk for the extranodal or splenic subtypes was observed.Bracci 2014 In a meta-analysis restricted to women participating in 5 studies, the association between alcohol consumption and melanoma was investigated independent of sun exposure. From 1,886 melanoma cases and 2,113 controls, the pooled odds ratio (OR) was slightly higher for women who consumed alcohol compared to those who did not. This association was statistically significant only for wine (OR, 1.4; 95% CI, 1.1 to 1.8); however, there was significant heterogeneity among the studies, which confounded results.Miura 2015

Cardiovascular disease

Numerous mechanisms have been suggested for the beneficial cardiovascular effects of wine polyphenols, including nitric oxide production by vascular endothelium, defense against ischemic-reperfusion injury, promotion of vasorelaxation, protection and maintenance of intact endothelium, antiatherosclerotic properties, inhibition of LDL oxidation, suppression of platelet aggregation, and estrogen-like actions.Engel 2008, Saiko 2008, Soleas 1997

Animal data

Studies in animals are limited and more commonly focus on resveratrol alone. In mice, red wine polyphenolic extract reduced the degree of hyperhomocysteinemia, an important vascular risk factor for atherosclerosis.Dudley 2009

Clinical data

World Health Organization data show that fat consumption is associated with coronary heart disease (CHD) mortality. However, certain populations in areas where daily consumption of wine is highest (eg, Italy, Switzerland, France) had high-fat intake but low CHD mortality rates. This has been termed the "French paradox."Renaud 1992 Researchers previously found a population-based association between CHD mortality and increased wine consumption.St Leger 1979 Subsequent reports confirmed that moderate intake of wine lowers CHD mortality.Criqui 1994, Klatsky 1993, Marmot 1981

In one study, the yearly rate of CHD mortality per 1,000 men decreased from approximately 22 for nondrinkers to approximately 8 for those who had 2 drinks per day.Blackwelder 1980 The Copenhagen City Heart Study, initiated in 1976, analyzed 13,329 patients (45 to 84 years of age) for 16 years to determine the risk of first stroke. Although this report did not address factors such as genetic diversity, existing risk factors, wine type (red or white), or amount of wine consumed, researchers concluded that wine has beneficial effects. Compounds other than ethanol in wine are likely responsible for a protective effect against the risk of stroke.Truelsen 1998 The National Stroke Association has concluded that heavy drinking increases stroke risk, while modest consumption, such as a 5 oz glass (150 mL) of wine per day, may lower stroke risk, provided there is no other medical reason to avoid alcohol.NSA 2014 One drink of ethanol dilates the brachial artery but does not activate sympathetic outflow; 2 drinks increase the heart rate, cardiac output, sympathetic nerve firing rate, and cardiovascular risk factors.Spaak 2008

A review of 30 population studies suggests a correlation between alcohol consumption and a decrease in cardiovascular risk, but also emphasizes that the effect of alcohol on cardiovascular risk is highly dependent on other risk factors. Alcohol as a heart medicine was deemed ineffective in this report.Grønbaek 1997 A later study agreed that alcoholic intake is associated with lower CHD risks, but found that mortality can be influenced by lifestyle characteristics (eg, smoking, obesity).Wannamethee 1999 Alcohol consumption and preference data from the Physician's Health Study, a double-blind, randomized, placebo-controlled trial that investigated primary prevention of cardiovascular disease and cancer in US male physicians, showed no evidence of an association between beverage preference (ie, wine, beer, liquor) and mortality. These data were collected from 449 heart failure cases that were followed for an average of 7 years; mean age of participants was 75.7 years.Petrone 2014 The possible relationship between daily wine intake and clinical outcomes was also assessed in post-myocardial infarction (MI) patients with chronic, stable heart failure and left ventricular dysfunction enrolled in the GISSI Prevenzione multicenter study (N=6,975). Fully adjusted results from the 3.9-year follow-up revealed a statistically significant interaction between increased wine consumption and use of rosuvastatin for both all-cause mortality (P=0.004) or all-cause death or hospitalization for cardiovascular causes (P=0.03). Among cardiovascular risk factors, smoking was positively correlated with wine consumption; incidence of chronic obstructive pulmonary disease and neoplasia was higher in groups with higher wine consumption; an inverse correlation was observed with wine intake in patients with a history of hypertension. Wine intake was positively associated with a more favorable New York Heart Association functional class. Circulating levels of a potent vasoconstrictor (osteoprotegerin) and vascular inflammation (PTX3) biomarkers (P=0.01) were inversely related to wine consumption (adjusted P<0.0001). One of the major limitations of this study was that the dietary questionnaire did not distinguish between red and white wine.Cosmi 2015

Phenolic compounds in red wine have positive effects on plasma antioxidant capacity.Carbonneau 1997 Antioxidants prevent the oxidation of LDL cholesterol into plaque, which is known to clog arteries and lead to cardiovascular disease.Esterbauer 1992 The most potent antioxidants for LDL are the phenolics epicatechin, catechin, and resveratrol.Frankel 1993 A double-blind, randomized, clinical trial involving 23 hypercholesterolemic participants investigated the effects of red wine and a red wine-onion extract on lipid parameters as well as antioxidant and inflammatory biomarkers. In vitro assessments revealed red wine contains the highest phenolic content, the red wine-onion extract the highest total flavonoid content, and onion the least amount of phenols and flavonoids. In study participants, consuming 125 mL twice daily of either red wine or the red wine-onion extract for 10 weeks resulted in a significant reduction in LDL cholesterol (P<0.05 each) compared with baseline. Significant reductions occurred as early as 6 weeks and continued for a total of 12 weeks. The red wine-onion extract group also exhibited statistically significant reductions in triglycerides and total cholesterol at 6 through 12 weeks. Plasma antioxidant status was significantly improved (P<0.05) in both groups, based on various plasma oxidative indexes and erythrocyte antioxidant enzymes (thiobarbituric acid reactive substances, trolox equivalent antioxidant capacity, glutathione peroxidase, glutathione reductase, reduced glutathione). A major limitation in this study was the lack of a control.Chiu 2016

Wine flavonoids and phenolics inhibit clotting by platelet and monocyte aggregation inhibition,Imhof 2008, Saiko 2008 apparently caused by inhibition of either oxygenase enzymesGryglewski 1987 or thromboxane synthesis.Soleas 1997

Purple grape juice may have the same effects as red wine in reducing heart disease risk.Coimbra 2005 Fruit consumption has also correlated highly with reduced CHD mortality.Criqui 1994 White wine provides cardiovascular protection similar to that of red wine when it contains tyrosol and hydroxytyrosol.Dudley 2008

In a post hoc analysis of data from the randomized, factorial, controlled Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial (N=11,140), the risks of cardiovascular events and all-cause mortality in adults with type 2 diabetes mellitus were 22% and 23% lower, respectively, in those who drank primarily wine compared with those who drank no alcohol. Major limitations included no differentiation between red or white wine, and self-reported use of alcohol.Blomster 2014 A substudy of the Cardiovascular Diabetes and Ethanol (CASCADE) trial assessed the effects of moderate red wine consumption on blood pressure in 224 patients with type 2 diabetes mellitus. All patients were alcohol abstainers (no more than 1 drink per week) and were randomized to receive 150 mL of red wine or mineral water per dinner for 6 months, and were required to adhere to a Mediterranean diet. Additionally, the effect of the prevalent and impactful alcohol dehydrogenase 1 beta polypeptide (ADH1B) polymorphism on ambulatory blood pressure was assessed. Although negligible differences were observed in mean 24-hour blood pressure between the 2 groups, significant reductions in systolic blood pressure were noted in the red wine group at midnight (3 to 4 hours after ingestion; −10.6 vs +2.3 mm Hg with mineral water; P=0.03) and at 7 to 9 AM (−6.2 vs +5.6 mm Hg; P=0.014). Pulse pressure was similarly reduced. These effects were observed to be more pronounced in patients who were taking antihypertensives and for those who were homozygous for the gene variant ADH1B*2 (TT).Gepner 2016

Premenopausal women (mean age, 39 years; range, 24 to 49 years) were enrolled in a 3-phase observational crossover study to determine the effects of different amounts of wine on blood pressure. Women entered a higher-volume red wine phase, a lower-volume red wine phase, and a higher-volume dealcoholized red wine phase. Consumption of higher amounts of red wine equivalent to 200 to 300 mL/day (approximately 2 to 3 drinks/day) significantly increased 24-hour systolic and diastolic blood pressure compared with both dealcoholized red wine (P=0.001 and P=0.028, respectively) and lower volumes of red wine equivalent to 100 mL/day (approximately 0.5 to 1 drinks/week) (P=0.014 and P=0.005, respectively). These effects were more pronounced during the daytime. No significant difference was found between consumption of lower amounts of red wine and dealcoholized red wine. HDL cholesterol and plasma fibrinogen were also observed to be significantly improved during the higher-volume red wine phase, but not the lower-volume phase, compared to the dealcoholized red wine phase.Mori 2015

CNS effects

Clinical data

Wine did not offer protection against Parkinson disease in a meta-analysis. A total of 32 identified references published up to October 2013 investigated the effects of alcohol consumption on the risk of Parkinson disease. The majority of studiesSato 1997 were matched case-controls, whereas 8 were prospective and 7 were unmatched case-control studies (N=677,550; 9,994 cases). Pooled data showed an overall relative Parkinson disease risk of 0.75 for the highest versus the lowest level of alcohol intake, with moderate heterogeneity. Although the protective effect was more pronounced with beer (relative risk [RR], 0.66 [95% CI, 0.48 to 0.91]; smoking-adjusted RR, 0.59 [95% CI, 0.39 to 0.9]) than wine or liquor, the effect difference was not significant for any alcohol type (P=0.28).Zhang 2014

Wine consumption was associated with a significantly lower rate of depression in a subset of 5,505 patients at high cardiovascular risk from the PREDIMED study (a prevention trial that included Mediterranean diet as part of the intervention). Wine was the most frequently consumed alcoholic beverage in this traditional Spanish population of older patients (55 to 80 years of age). A statistically significant inverse relationship was seen for light drinkers (greater than 0 to 5 g/day; RR, 0.73 [95% CI, 0.57 to 0.95]) and for low-to-moderate drinkers (greater than 5 to 15 g/day; RR, 0.69 [95% CI, 0.5 to 0.96]). Overall, low-to-moderate consumption of wine (2 to 7 drinks per week) resulted in the strongest inverse association with rates of depression (hazard ratio [HR], 0.68; 95% CI, 0.47 to 0.98).Gea 2013 In another study, the effect of low-dose wine, as well as the anticipated effect of drinking alcohol (placebo effect), was associated with impaired decision making in 75 healthy students via subjective assessments as well as objective functional magnetic resonance imaging results.Tsurugizawa 2016 A significant correlation was identified between wine consumption and perception of better health status (P<0.0001) and in post-MI patients with chronic, stable heart failure and any level of left ventricular dysfunction enrolled in the GISSI Prevenzione multicenter study, and an inverse association was found between depression score and wine intake (P=0.01).Cosmi 2015

A large body of evidence has accumulated regarding the benefits of moderate wine intake in the management of other conditions, including emotional tension, anxiety, and inability to relax. The pharmacology of ethanol has been well characterized, including its effects on the CNS and smooth and skeletal muscles.Ensminger 1994, WAB 1975

GI effects

Clinical data

Wine may help relieve achlorhydria and related gastric disorders and malabsorption syndromes.St Leger 1979, WAB 1975 Certain substances in wine promote better absorption of minerals (eg, calcium, magnesium, phosphorus, zinc). The aroma and taste of wine stimulate the appetite, especially in elderly and debilitated patients.Ensminger 1994, WAB 1975 In addition, white wine shortens gastric emptying time.Pfeiffer 1992

Immunomodulatory effects

Clinical data

Consumption of wine was associated with a significantly reduced risk of systemic lupus erythematous (SLE) (P<0.03 for trend) in female nurses enrolled in the Nurses' Health Studies (NHS and NHSII). A prospective cohort analysis of 204,055 female nurses from the 2 studies who were free of connective tissue disease and had provided alcohol information at baseline was conducted; 244 cases of SLE were identified. When multivariable-adjusted analysis was performed based on alcohol type, only wine demonstrated a significant inverse relationship (HR, 0.65; 95% CI, 0.45 to 0.96) for women who consumed at least two 4 oz glasses (120 mL) of wine per week compared with those who did not consume alcohol or who consumed more than 1 glass (120 mL) per month but less than 1 glass (120 mL) per week. Beer and liquor associations were not significant.Barhaiya 2017

Longevity

Clinical data

A systematic review of studies reporting positive factors that impact human longevity identified moderate wine consumption as 1 of 14 factors that improved longevity. A total of 6 studies were identified that studied wine. However, drinking wine was considered an "ambivalent" factor because it was not dose dependent, such that drinking 1 glass per day of red wine was mainly positive, whereas 5 glasses per day resulted in negative effects. No population sizes or evidence ratings were provided for the summarized studies.Iacob 2016

Metabolic disorder

Clinical data

Using baseline data from 5,801 participants in the PREDIMED study, a cross-sectional study was conducted to determine the association between red wine consumption and the prevalence of metabolic syndrome in high–cardiovascular-risk adults on the Mediterranean diet. In total, 52% of the study population did not drink red wine, 36% consumed less than 1 drink per day, 12% consumed more than 1 drink per day, and 2% consumed at least 5 drinks per day. Analysis of dietary patterns related to red wine intake revealed that those who drank more than 1 drink per day consumed more carbohydrates, protein, fats, total cholesterol, and total energy. Overall, consuming less than 1 drink per day of red wine was associated with a significantly lower risk of metabolic syndrome (P<0.001). In the sensitivity analysis, the same association was found for all metabolic parameters (except for triacylglycerol) with consumption of more than 1 drink per day, but only when heavy drinkers (more than 2 drinks per day for women; more than 4 drinks per day for men) were excluded. Stratifying by gender and age, a lower risk was found in women and in participants younger than 70 years of age (P<0.001 for each).Tressera-Rimbau 2015

Wine does have some effects on glucose metabolism and utilization. Although data are limited, more beneficial effects may occur in patients with higher hemoglobin A1c (HbA1c) levels, and genetic differences in alcohol metabolism have an impact on results.Fragopoulou 2018

Wound healing

Clinical data

According to case reports, wine compresses may help stimulate wound healing and improve rheumatoid skin ulcerations.Alterescu 1983

Dosing

Red wine extract supplements are available in numerous dosages and doseforms. Clinical trials evaluating the effects of red wine on risk factors for cardiovascular disease (eg, blood pressure, LDL) have used the following dosages: 125 mL twice daily (total daily dose, 250 mL) of red wine or red wine-onion extract for 10 weeks;Chiu 2016 or 150 mL of red wine with dinner for 6 months.Gepner 2016 Higher red wine consumption (200 to 300 mL/day) for 4 weeks was evaluated in premenopausal women to determine effects on blood pressure.Mori 2015

Pregnancy / Lactation

Avoid use during pregnancy and lactation because of the risk of birth defects and fetal alcohol syndrome. Avoid nonprescription supplements because of the lack of clinical data.

Interactions

Red wine may cause dose dumping of calcium antagonists (eg, extended-release felodipine) in certain populations.Bailey 2003

Red wine may reduce cyclosporine concentrations, decreasing the pharmacologic effect and increasing the risk of transplant rejection. In 12 healthy subjects, 177 mL of red wine consumed 15 minutes before ingestion of cyclosporine 8 mg/kg and a second 177 mL of red wine consumed with cyclosporine and for 15 minutes following cyclosporine administration, decreased the AUC and Cmax of cyclosporine by 30% and 38%, respectively.Tsunoda 2001

Adverse Reactions

Individuals allergic to any of the ingredients in red wine should avoid use because anaphylactic reactions have been documented.Alcoceba 2007 Alcohol consumption is contraindicated in patients with viral hepatitis (eg, hepatitis B and C).

Adverse reactions to pure wine are rare. However, because the vast majority of commercially prepared wines contain sulfites as preservatives, individuals sensitive to these chemicals may develop severe allergic reactions, including wheezing and tachycardia. Sensitivity to yeast may result in allergies to some wines. While a glass of wine before bedtime has long been an accepted treatment for temporary insomnia, a larger amount may be counterproductive due to repressed respiration resulting in sleep apnea.Taasan 1981

Patients with gastroesophageal reflux should ingest wine cautiously because it may cause additional reflux.Pehl 1993, Rubinstein 1993

A direct association has been made between increased wine consumption and the rate of ovarian cancer in women in Italy.La Vecchia 1992 Excessive wine consumption has been associated with a reversible rise in systolic blood pressure levels.Periti 1988

Toxicology

Toxicity with excessive alcohol consumption is well documented; the dangers of excessive wine consumption have been compiled in a concise summary.Ensminger 1994

In addition, a report on the management of heavy drinkers is referenced.Haines 1992

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