Red wine

Drinking a lot of alcohol has been linked with an increased risk of psoriasis, but is red wine any different?

Made from black grapes, red wine gets its colour from the red and purple pigments found in the skin of the grapes known as anthocyanins. Anthocyanins and other plant chemicals found in the skin of grapes have powerful antioxidant activity 1 that can benefit health2.

What do we know about red wine and psoriasis?

The not so good

Studies show people with psoriasis tend to consume more alcohol than control groups3. High intakes of alcohol (more than 80 grams of alcohol per day, equivalent to around four alcoholic drinks) have been linked with an increase in both the risk of developing psoriasis, and the severity of the condition4, especially in men5,6.  

It’s thought alcohol may worsen psoriasis by triggering inflammation, drying and irritating the skin, reducing the effectiveness of medications, or compromising immune function7,8.

Alcohol – in particular beer and wine – are also high in histamine, a compound involved in allergic type responses that triggers inflammation and itching. Histamine has been detected in high levels in psoriatic lesions 9, and is thought to play a role in the movement of inflammatory cells into the skin10.

The good

On the opposite side, there is some evidence which suggests the links between psoriasis and alcohol intake may vary by the type of alcoholic drink (beer versus wine), as has been found with other diseases11,12.

Red wine may carry a different risk because the anthocyanins it contains have strong antioxidant activity in humans13, which could potentially be of benefit in psoriasis. The antioxidants in red wine are also thought to be the reason that moderate intakes appear to protect against heart disease risk, which is raised in people with psoriasis. 1,14.  

What does the science say?

At present, there are very few studies looking specifically at the effect of red wine on psoriasis, but some evidence does suggest that red wine might not carry the same risk as beer or spirits.  

In one study of American women who were asked to record their intake of alcohol at fixed intervals over a 14-year period, non-light (normal strength) beer but not red or white wine was associated with an 2.3 times increase in the risk of psoriasis.15 The researchers in this study think the association between beer and psoriasis might be due to the starch in beer, but there’s not enough evidence to say confidently whether this is true.

Outside of psoriasis, beer and spirits – but not wine – have been linked to an increase in gout, a type of inflammatory arthritis which shares some similarities with psoriasis. 11

Beer and spirits also appear to increase the risk of heart disease, whereas wine may have a protective effect 16. This may be due to some of the compounds in the skin of grapes (such as resveratrol) that have anti-inflammatory effects. 17

In one study, a daily glass of red wine (150ml / 15 grams of alcohol) consumed over a period of three weeks slightly reduced one marker of inflammation in healthy, non-smoking adults18. Other studies have also found that moderate red wine consumption can reduce inflammatory markers in healthy adults, but we can’t say whether this is true in psoriasis.2,19,20,21.  

The effects of dietary histamine on psoriasis aren’t clear, but in people who are unable to break down histamine (known as histamine intolerance) consuming histamine rich food may trigger itching and redness 22. This may explain why some people report a worsening of psoriasis with consumption of wine whereas others find no effect.  

Side effects

Alcohol may reduce the effectiveness of medicines used to treat psoriasis, as both are metabolised in the liver.

There’s also some evidence to suggest that high intakes of alcohol can increase the risk of liver damage from some medications such as methotrexate or acitretin.  

How much is too much?

From the evidence available, more than 80 grams of alcohol per day (around 4 drinks) has been linked with an increase in the risk and severity of psoriasis.

In the study of U.S. women, consuming more than 2.3 alcoholic drinks per week was associated with an increased risk of psoriasis 9. The same study found that drinking more than five beers a week was an independent risk factor for developing psoriasis in women. There isn’t any specific  information on red wine and psoriasis at this time.

Learning points

  • Red wine is a source of antioxidants, thanks to pigments found in the skin of red grapes.
  • Moderate consumption of red wine has been shown to increase antioxidant levels and may offer some protection against heart disease
  • The effects of red wine on psoriasis aren’t clear. High intakes of alcohol (over 4 drinks a day) appear to increase the risk of severity of psoriasis, but the relationship appears strongest with beer.

 

Sources

  1. López-Vélez, M., Martínez-Martínez, F. & Del Valle-Ribes, C. The study of phenolic compounds as natural antioxidants in wine. Crit. Rev. Food Sci. Nutr. 43, 233–244 (2003).
  2. Modun, D. et al. The increase in human plasma antioxidant capacity after red wine consumption is due to both plasma urate and wine polyphenols. Atherosclerosis 197, 250–6 (2008).
  3. Kirby, B. et al. Alcohol consumption and psychological distress in patients with psoriasis. Br. J. Dermatol. 158, 138–40 (2008).
  4. Behnam, S. M., Behnam, S. E. & Koo, J. Y. Alcohol as a risk factor for plaque-type psoriasis. Cutis. 76, 181–5 (2005).
  5. Monk, B. E. & Neill, S. M. Alcohol consumption and psoriasis. Dermatologica 173, 57–60 (1986).
  6. Naldi, L., Peli, L. & Parazzini, F. Association of early-stage psoriasis with smoking and male alcohol consumption: evidence from an Italian case-control study. Arch. Dermatol. 135, 1479–84 (1999).
  7. Farkas, Á. & Kemény, L. Psoriasis and alcohol: Is cutaneous ethanol one of the missing links? Br. J. Dermatol. 162, 711–716 (2010).
  8. Gupta, M. A., Schork, N. J., Gupta, A. K. & Ellis, C. N. Alcohol intake and treatment responsiveness of psoriasis: a prospective study. J. Am. Acad. Dermatol. 28, 730–2 (1993).
  9. Petersen, L. J. et al. Studies on mast cells and histamine release in psoriasis: The effect of ranitidine. Acta Derm. Venereol. 78, 190–193 (1998).
  10. Gschwandtner, M. & Mommert, S. The histamine H4 receptor is highly expressed on plasmacytoid dendritic cells in psoriasis and histamine regulates their cytokine production and migration. J. Investig. … 131, 1668–1676 (2011).
  11. Choi, H. K., Atkinson, K., Karlson, E. W., Willett, W. & Curhan, G. Alcohol intake and risk of incident gout in men: a prospective study. Lancet 363, 1277–81 (2004).
  12. Nanji,  a a. Alcohol and ischemic heart disease: wine, beer or both? Int. J. Cardiol. 8, 487–9 (1985).
  13. Spormann, T. M. et al. Anthocyanin/polyphenolic-rich fruit juice reduces oxidative cell damage in an intervention study with patients on hemodialysis. Cancer Epidemiol. Biomarkers Prev. 17, 3372–3380 (2008).
  14. Serafini, M., Maiani, G. & Ferro-Luzzi,  a. Alcohol-free red wine enhances plasma antioxidant capacity in humans. J. Nutr. 128, 1003–1007 (1998).
  15. Qureshi, A. a, Dominguez, P. L., Choi, H. K., Han, J. & Curhan, G. Alcohol intake and risk of incident psoriasis in US women: a prospective study. Arch. Dermatol. 146, 1364–1369 (2010).
  16. Rimm, E. B., Klatsky,  a, Grobbee, D. & Stampfer, M. J. Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits. BMJ 312, 731–736 (1996).
  17. Martín, A. R., Villegas, I., Sánchez-Hidalgo, M. & de la Lastra, C. A. The effects of resveratrol, a phytoalexin derived from red wines, on chronic inflammation induced in an experimentally induced colitis model. Br. J. Pharmacol. 147, 873–85 (2006).
  18. Retterstol, L. et al. A daily glass of red wine: does it affect markers of inflammation? Alcohol Alcohol 40, 102–5 (2005).
  19. Torres A, Cachofeiro V, Millán J, Lahera V, Nieto ML, Martín R, Bello E, A.-S. L. Red wine intake but not other alcoholic beverages increases total antioxidant capacity and improves pro-inflammatory profile after an oral fat diet in healthy volunteers. Rev. Clínica Española 215, 486–94 (2015).
  20. Estruch, R. et al. Different effects of red wine and gin consumption on inflammatory biomarkers of atherosclerosis: A prospective randomized crossover trial: Effects of wine on inflammatory markers. Atherosclerosis 175, 117–123 (2004).
  21. Sacanella, E. et al. Down-regulation of adhesion molecules and other inflammatory biomarkers after moderate wine consumption in healthy women: A randomized trial. Am. J. Clin. Nutr. 86, 1463–1469 (2007).

22. Maintz, L. & Novak, N. Histamine and histamine intolerance. Am. J. Clin. Nutr. 85, 1185–1196 (2007).

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