← Becker’s Healthcare Podcast
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
- [00:32]
B
This is Scott Becker with the Becker's Healthcare Podcast. We're thrilled today to be joined by a physician, Dr. Lara Catena. And Dr. Catena is originally from Argentina and she's going to talk to us today about something a little different than our typical podcast. She's got a particular focus and she's written about the intersection of wine and health, something that many of us are curious about. Dr. Catena, can you take a moment to introduce yourself and describe a little bit why this intersection of wine and health became so important to you?
- [01:06]
C
Yes, absolutely. Well, I was born part of a fairly well known wine family in Argentina, but when we came to the United states in the 80s, it was a difficult time in Argentina and I went to medical school, Harvard undergrad, biology, medical school at Stanford. I decided to become an emergency physician. I had no intention of ever going to work at the family winery. And then I felt a call in for my father who was trying to revolutionize Argentine wine, and I started working with him. And for almost 27 years I was actually practicing emergency medicine and working for my family winery. We do a lot of viticultural research, but also doing the things that you do at a family business. But the reason why I'm so interested in this topic is, well, first of all, it's the business of my family. It's a multi generation business, four generations in Argentina, two generations in Italy before that. And I've always felt that drinking wine in moderation could be part of a healthy lifestyle. And I still think that. However, there's been a lot of anti alcohol stress in the news, like mostly in the mainstream news and also in some of the scientific news. And I feel that as a physician, I need to make sure to tell people the correct science. And that's why I've been speaking a lot about this topic, because I think it's really important to know what we know, what we don't know, and to not take sides, to literally tell patients, tell other scientists or doctors what the science shows, and also welcome people saying they disagree, which happens a lot in this field 100%.
- [02:53]
B
And talk about this for a second because for a very long time it was sort of commonly believed that a glass or two of wine might be very good, almost a part of the Mediterranean diet. The concept that, you know, might help to thin the blood, might be helpful for people. And then more recently, as you've said, you see some of the media saying, no, that's all wrong, it's horrible for you, and so forth. And the truth on most of these things is somewhere in between. But tell us, what is the reality of this, the wine versus health debate?
- [03:26]
C
Yeah, absolutely. And we don't have that much research specific to wine. We have some, especially when it comes to Mediterranean diet. But a lot of the research is looking at alcohol in moderation. So the data has not changed that much actually in the last 30 years we see still a reduction in mortality for moderate drinkers. The National Academy study, which was finished in 2025, showed that people who drank in moderation, which is described as one glass per day, up to one glass per day for women, up to two for men, compared to never drinkers, lived longer. They also had to a heart attack. And there was this slight increase in breast cancer risk, not death. So that literature, whether it's longer lifespan for moderate triggers, has always been there. There's also been literature on the cancer risk, even at small volumes. So the breast cancer data is there for a while, is thought to be related to estrogen and you know, then you've got the esophageal cancer, oropharyngeal cancer. Those are much more common in people who both smoke and drink alcohol, but are mostly in people who are drinking over moderate level. So this data has been around for a long time and shows the same thing. Now some of the challenges on the cardiovascular potential, associated benefits, and we really need to say associated benefits because we can't just say causality unless we have a randomized control trial. And there's a few small ones, but there isn't really a large one. A large one is about to happen. So I want to tell you more about that later. But basically there's this thing called Mendelian randomization that is looking at the genetics of alcohol. And what they look at is people who genetically are less likely to drink a lot. And it has to do with the alcohol dehydrogenase metabolism. So some people who metabolize very quickly, they feel uncomfortable, they tend to drink less, but the relationship is non linear. And some of these studies actually are interesting because they don't show the cardiological benefit, but they also don't show the cancer risk at moderate levels. So there's a question mark there. So the bottom line is that there is still data, even recent data showing this associated longer lifespan and less cardiac deaths. And the American Heart association published a really great paper. It's in circulation. I recommend that anybody that's interested in this read it, where they show all these associations. At what level does blood pressure increase? And the randomized control data versus the observational data are slightly different. They see a decrease in strokes for moderate drinkers, a decrease in sudden death, a decrease in heart attacks. And then we have all the diabetes data that shows that people who drink in moderation have better sugar control and less incidence of diabetes. However, the big problem is that if you tell people drinking wine or beer or whatever in moderation might help you, people tend to drink more and binge drink. It has a very bad outcome because people tend to think, well, if I have a little and that's fine, then I can have more. So as physicians, we have to be really careful with patients to basically say what I just said. There's some data that shows off the lifespan. There's definitely data with cancer. So if you really like drinking and it's part of your social life, and drink wine with a Mediterranean diet and you exercise, well, that's wonderful. You know, for me, I'm of Italian descent. That's part of my culture. I really like my little glass of wine that I don't have every day because I like to not drink every day. And, you know, I don't think right now the data is telling us you should stop that habit if you're drinking in moderation. However, most guidelines, all guidelines say that you should not tell somebody to start drinking for health because you don't know who's going to develop an alcohol use disorder. So it's a complex topic, but it's not that complex, actually, because the data have shown the same thing for decades.
- [07:49]
B
No, and I love that. And I think your point is so well taken on. I know, for example, if the doctor says I could eat a certain thing, you know, or my weight goes down, then I overdo it and. And I splurge. And so the concept of not encouraging people to drink is. Is probably right because people, then they hear that it's. It's almost when the doctor says, oh, my God, your skin looks great. We don't have a skin risk right now that then I go out in the sun too much. I think that's right on.
- [08:18]
A
Yeah.
- [08:18]
B
No I think we're all a little bit wired like that. And what advice would you have for. I mean, you've built this fascinating career. Great physician, Stanford and Harvard, and then also, you know, love this intersection. You've got a passion for this intersection. Partly born out of a family business, originally for wine and so forth. But tell me, tell me what you're most excited about this year and focused on.
- [08:46]
C
Well, what I'm most excited about is the study that's going on Spain. It's the first randomized controlled trial with wine. And so they're taking in people who follow the Mediterranean diet, and they're randomizing them to either you keep on drinking wine, because most people follow the Mediterranean diet who live in a region that follows the Mediterranean diet, drink wine as their alcohol beverage, and then they randomize them to keep on drinking wine or stop. And actually, they're planning to get 10,000 people, and they're already at 7,500 calls. And it's at the University of Navarra, and it's led by this researcher, Miguel Anche Martinez Gonzalez, who is also a visiting professor at Harvard. And so this is the golden standard study. And the other really cool thing is that they're actually checking urine and hair on the patients to make sure that they're being truthful, because that's one of the issues with a lot of these observational trials is that people may not be telling the truth about their drinking in addition to compound. We could talk about all the problems with some of the previous studies, but this study will at least answer the question for why? And I am so excited about that because it will at least tell us, is there a potential cardiovascular benefit? Because we have all these mechanisms for cardiovascular benefits. We have the blood thinning effect, we have the diabetes effect, we even have this reduction in hyperactivity of the amygdala effect. So I think for most patients, it'd be helpful to know is there some associated cardiovascular benefit or not? So, yeah, this is what I'm most excited about, and I'm really excited about this. We're not going to have the results for 2029, though.
- [10:33]
B
Thank you. And I tell you, such an informative discussion. Dr. Catena. Fantastic what you do. Any advice for physicians trying to have great, impactful careers?
- [10:45]
C
Yeah. First of all, I want to say that I have a conflict of interest because I'm a winery. So if you want to look at all the data behind what I'm saying, that is research done by other people who don't have a conflict of interest. It's on my website, indefenseofwine.com and my main advice to physicians in general, to really enjoy the patient. I am hoping that with AI the paperwork will become less. What was hardest spent my last couple of years working with having to chart while I was talking to patients and just, you know, that feeling that you're never caught up with your charting, with your ordering. And I have this great hope that with AI that will become simpler and we'll be able to spend more time with patients, which is what patients want. And, you know, patient care is what I always love to do. And I think it's such a noble profession, so rewarding. But making wine is kind of fun, too. So I would say to musicians, you know, do it while you can. And then if you decide you want to do something else, you've already developed all the good habits. You know, you're hardworking, you're able to stay up at night, you finish what you start, you have energy, and so you would probably be good at anything else you do. So that's what I would say.
- [12:02]
B
Thank you so much. Dr. Catena, what a brilliant physician. What a pleasure to visit with you. Thank you so much for taking the time with us today. I really enjoyed it. Thank you so much for joining us.
- [12:12]
C
Thank you, Scott. I had a good time, too. Thanks for all the questions.
- [12:17]
B
You're fantastic. Thank you very, very much.