All About Wine - Part 1: The Evolution of Winemaking | Chris Kresser

All About Wine, Part 1: The Evolution of Winemaking

by Chris Kresser

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Do you know what’s really in a bottle of wine? Is wine healthy, or a health hazard? In this series about wine, I will look at how wine has changed from its traditional form into a commercialized product, go through the benefits and risks of wine consumption, and share how to find high-quality wine. This first article will cover a brief history of wine and how wine has evolved into a processed product, not unlike the other processed and refined foods we see today.

Is wine Paleo?

Although some speculate that our Paleolithic ancestors did consume “wine” in the form of fermented fruits, the earliest evidence of wine purposefully made from grapes is from the Neolithic period. A drinking vessel with tartaric acid, which only occurs in large amounts naturally in grapes, was found in an ancient village in Iran, dating from 7,000 years ago. (1) From the southern Caucasus region (which includes modern-day Iran), winemaking traveled to Palestine, Syria, Egypt, Mesopotamia, and then the Mediterranean. (2)

When Rome conquered Greece more than 2,000 years ago, winemaking was one aspect of Greek culture adopted by the Romans. (3) Southern Europe, which contains regions once in the former Roman empire, still consumes plenty of wine, usually with a meal.

In the 18th century, winemaking expanded to South Africa, Australia, and New Zealand. (4) Europeans brought wine to the Americas, first to Mexico and South America. In comparison to this extensive history, the United States’ large-scale vineyards are practically infants, only appearing around 200 years ago.

Do you know what’s in the wine you’re drinking?

What is in a bottle of wine?

Aside from water, a bottle of wine contains hundreds of substances, most of which fall into the categories below.

  • Sugar. Glucose and fructose are the principal sugars found in grapes, which are fermented into ethanol during winemaking. What isn’t fermented is called residual sugar.
  • Wine yeasts. Naturally found on grapes, yeast is what ferments the grape sugars. Most wines today, however, use added commercial yeast instead.
  • Ethanol. Yeasts ferment the sugars into ethanol, generally resulting in an alcohol content of 10 to 13 percent, (2) but this number can be modified by temperature, certain added yeast strains, and added sugar.
  • Phenols/polyphenols. Polyphenols affect the appearance, taste, mouth feel, and fragrance of wine. Found in fruits, vegetables, coffee, and tea, polyphenols are most likely responsible for the positive health outcomes associated with moderate wine consumption. They are present in the seeds, skin, and flesh of grapes but are also increased through fermentation and oak aging.
  • Methanol. Methanol, a toxic substance, is found in wine in very low levels (0.1–0.2 g/L), (2) but it also occurs naturally in other fruits, vegetables, and their juices.
  • Other alcohols, aldehydes, acids. Grape sugars are also metabolized into higher alcohols, esters, and aldehydes, contributing to the overall complex nature of wine.

The stages of winemaking 

To understand how wine has evolved over the millennia, an appreciation for the winemaking process is a good place to start. The general steps involved in winemaking are (5):

  • Harvesting the grapes
  • Stemming and crushing the grapes
  • Maceration – Time is given for phenolic components of grapes to be leached from the skin, seeds, and stems into what is called the “must”
  • Fermentation – Yeast converts sugar into carbon dioxide and ethanol
  • Draining – “Must” is drained without being pressed into barrels
  • Thermovinification – Wine may be heated at 50–80°C to improve red wine color
  • Clarification and stabilization – This may involve filtration, centrifugation, flotation, refrigeration, and/or pasteurization
  • Aging – Wine is transferred to a wooden barrel or metal container
  • Bottling – A dose of sulfite is usually added commercially to help preserve the wine

Commercialization changed wine

Everyone’s heard of wine’s supposed health benefits, but not all wine is created equal. Traditionally, wine was made with mashed grapes left to ferment for an extended period of time, resulting in a polyphenol-rich, relatively low-alcohol-containing beverage. Few additional ingredients were added and intervention was minimal. Today, picturing chemists in lab coats is a more accurate portrayal of winemaking than a casually dressed vineyard owner with an oak barrel.

Modern processes have changed wine production. Growing grapes closer together increases vine yields, but this overproduction delays fruit maturity, retains excessive acidity, and is associated with reduced wine quality. (2) To grow grapes in such close proximity, irrigation is almost always required. While this can double fruit yield and increase fruit size, over-irrigation can result in lower sugar and increased grape acidity. (2) Traditionally, a “mild water stress” following grape ripening actually improves grape quality. Unfortunately, many of these traditional methods are lost in today’s wine production.

Wine additives and contaminants

Since wine went commercial, it has evolved into something so different from what it used to be that our bodies no longer handle it well. Today, more than 70 additives are approved in winemaking to increase production, ensure repeatable outcomes, and keep costs low. If you have ever experienced headaches, asthma symptoms, or even diarrhea after enjoying a glass or two of wine, it might actually be due to all that is added to wine rather than the wine itself.

Unlike everything else we eat and drink, nutrition labels and ingredients lists are not required for wine in the United States. Instead of being regulated by the FDA, wine falls under the jurisdiction of the Alcohol and Tobacco Tax and Trade Bureau. As commercial winemakers strive to increase production and lower costs, some questionable and harmful substances have found their way into wine:

Oak chips and sawdust. Those “oak notes” discussed during wine tastings may not actually be the result of oak-aged wine. Commercially, oak chips or sawdust might be used instead to give that oak flavor without the added time of real oak barrel aging.

Fining agents. To remove unwanted substances in wine before bottling, a variety of agents can be used. Many animal-based ones, including egg white, fish bladder, and casein, might surprise many wine-consuming vegans. Bentonite clay is the most common non-animal-based fining agent.

Mega purple. Natural red wine isn’t really supposed to darkly stain your teeth, gums, and clothing. Mega purple, a super concentrated grape juice additive, is to blame. Ten thousand gallons of this sugary concoction are added to 25 million bottles of wine per year. Mega purple, along with another dye, ultra red, are used to produce wine of consistent color.

Sulfur dioxide. Although low levels of sulfites occur naturally in wine as a byproduct of yeast metabolism, commercial winemakers often add sulfite in the form of sulfur dioxide as a preservative and stabilizer. Because a small portion of the population is allergic to sulfites, a wine label must disclose if the sulfite content is more than 10 parts per million (ppm). White wines typically have more sulfites than red wines. Conventional wines can contain up to 350 ppm in the United States, while organic winemakers limit sulfites to 100 ppm.

In addition to allergic reactions, sulfites are linked to asthma induction, dermatitis, hives, abdominal pain, diarrhea, and hypotension. (6, 7, 8)

Histamines. Histamines are found naturally in many foods, including cheese, wine, seafood, processed meats, fermented foods, and eggs. I have talked about histamine intolerance in a previous post and how it is better understood as a component of mast cell activation syndrome. Histamines are produced by immune cells and are responsible for the swelling and redness you see if you get a bee sting. However, some people produce too much histamine and/or are not able to break it down properly. Histamine overload results in sneezing, headache, diarrhea, skin itchiness, and shortness of breath.

The histamine content of wine varies widely, depending on grapes used, ethanol content, sulfite content, and more. (9, 10, 11) The commercialization of wine may have increased histamine content. Fertilizing grape vines increases the histamine content of wines, (12) and organic wines have lower levels of histamine. (13)

Commercial yeasts. Before 1974, all wines were fermented with their naturally occurring yeasts, but most today in the United States are not. Winemakers instead opt for commercial yeasts to better control the fermentation process for a more reproducible product. Many of these added yeasts are genetically modified. Histamine-sensitive individuals may experience headaches after wine fermented with commercial yeasts, as some bacterial cultures produce more histamine than others. (14)

Sugar. In winemaking, yeasts ferment the sugar found naturally in grapes. Wine is “dry” when the yeasts fully ferment all the sugar into alcohol. Winemakers sometimes will add additional sugar before fermentation to increase the alcohol content or flavor. Residual sugars in wine can be masked by tannins and acidity, so you can’t always tell by the taste of wine how much sugar is present.

Pesticides/herbicides/fungicides. Just as in produce, organic wine exposes you to fewer pesticides, herbicides, and fungicides. In a study of French wines, only 10 percent were free of pesticide and fungicide traces. Vineyards are only 20 percent of produce volume in France but use 80 percent of the nation’s fungicide. In the United States, Monsanto’s Roundup is the most commonly used herbicide in vineyards. Some of these compounds are linked to cancer and can disrupt hormone function, which I have covered in depth in articles on organic produce and environmental toxins.

Arsenic. Looks like rice may not be the only food with arsenic concerns. The Environmental Protection Agency’s water standard for arsenic is less than 10 parts per billion (ppb). A few years ago, a class action lawsuit was filed against several winemakers for having up to five times the arsenic level acceptable for water in their wines. Included wines were varieties of Trader Joe’s infamous Two-Buck Chuck and some types of Franzia. Although the lawsuit was dropped for a couple of reasons, I would still steer clear of cheaply made wine.

Phthalates. Phthalates are endocrine disruptors linked to cancer and fertility issues. (15, 16) They are common in cosmetics and plastics, but a study of French wines found dibutyl phthalate in almost two-thirds of the wines tested. (17) Only 17 percent of the samples didn’t contain one of the three phthalates tested.

Mycotoxins. Mycotoxins are toxic substances produced by fungi and are linked to diabetes, obesity, and kidney disease. (18) Unfortunately, mycotoxins are widespread in wine and in other processed foods like grains. One study found a certain mycotoxin called fumonisin B(2) in 23 percent of wines tested from 13 countries. (19)

That’s quite an intimidating list! Can the health-boosting polyphenols in wine outweigh these dangerous additives? In the second article of this series, I will go through the health benefits and risks of wine consumption to determine if drinking wine can actually be good for you.

Now I’d like to hear from you. Do you suffer ill effects after enjoying a glass or two of wine? Were you aware of the additives and contaminants often found in table wine? Let us know in the comments!

57 Comments

Join the conversation

  1. Many winemakers use Carboxymethylcellulose (CMC) to enhance cold stability when refrigerated. This can cause a laxative-like effect on those sensitive to CMC. It can be difficult to find out what vintners are using it.

  2. I am happy to read this article and proof that I wasn’t getting obsessed. I have been noticing that every time I drink wine I have diarrhea and red areas on my face. However, I thought that wine was the best alcohol option in the market. Is there any alternative or good quality wine? …for those moments that alcohol is needed 😊

  3. I began having a slight allergy to red wine and seem to have much better luck with wines that only use wild yeast (as majority of wines use GMO yeast) as well low histamine levels.

    There are plenty of sources to choose from, with most luck coming from biodynamic producers as well as natural wine makers – but like any other food/drink, know your farmer!

  4. Beside the point, but as a proud South African wine drinker, I should point out that wine was first made in South Africa in 1659 👊🏻

  5. Wine causes me to sneeze uncontrollably after three glasses, so I always stop at two! It has the same effect on my mother and brother.

    • I think this may be due to the added sulfites – while they occur naturally in wine they are more abundant in conventional wine. You may want to try natural wines to see if they have the same effect on you.

  6. Just in case anyone else wants to try it….I can almost only drink boxed Vella White Zinfandel. I can’t imagine that it is of high quality, but I don’t spare myself on it and rarely feel worse for the wear the next day. I have tried other boxed white zins, and other Vella products- all seem to make me feel terrible. This is the only one that doesn’t totally wipe me out.

  7. I love wine, especially dry red, and whites too. I have been on the Paleo Autoimmune protocol for 5 years now, but do add in wine at times. I react severely to California wines, even the organic. I have found I do well with French organic wines, especially Bordeaux, and other organic European wines.

  8. I get a full blown allergic reaction to drinking wine, similar to mild anaphylaxis and a lot like severe hayfever. I believe it’s the sulphites I’m allergic to as I’ve recently drunk sulphite free wine without reacting to it.

    After much experimentation with exclusion diets and not really making any progress with symptoms of bloating, constipation, fatigue, brain fog (all the usual culprits). I think I have finally narrowed down my intolerance’s to high sulphur and sulphite containing foods. To be honest, considering the severity of reaction I have to wine I can’t believe it’s taken me quite so long to reach this conclusion.

    I have been trying to do further research as I’m aware a low sulphur diet for any length of time has it’s own downsides. This has been a bit of a challenge however as I have found conflict in the varying different online sources as to what food stuffs are high in sulphur/sulphites. There are also thiols to throw into the mix which further adds to my confusion.

    I have not done any genetic testing but suspect I have a CBS gene mutation. I was going to phone is a Podcast question to see if Chris has any experience dealing with Sulphur intolerance and CBS gene mutation.

    Any thoughts would be welcome.

    • Allergic reactions can also be due to the GMO yeast in 99% of all wines as well as the histamine level – the higher the histamines, the more allergies seems to cause.

  9. I have discovered the winemaker “Keep” – no junk in their wines. They pride themselves on clean grapes, natural process and real aging. No added junk

  10. Doc says stay away from Gluten, yeast & dairy in an effort to improve my overall health issues – mainly inflammation & fatigue. Hoping Mr Kesser finishes the article with reasonably priced/available wines that are considered good (enough) for someone like me to enjoy!

  11. I live in the south of Italy and make a few gallons of wine every year. The process consists of crushing the grapes, leaving them to ferment for 2/3 days. Squeezing them then aging in a barrel for a 2/3/4 weeks before bottling. I add nothing and I get a great wine which granted does vary year to year but tastes great isn’t relatively strong and doesnt cause any ill effects

    • I only buy wines from Italy. I also can tolerate some wines from Spain Argentina or New Zealand. figured out along time ago that any wines from California make me sick and feel ill the next day. Except for some of the smaller and local wineries in the foothills, California wines seem watered down, sugary, artificially colored, and just don’t taste well anymore.

    • Very cool! I have been experimenting with wine here on my farm. I have grapes, and various fruits I play around with. Some are better than others. I always add some, but not much, raw honey to mine. But you say you do not add any sugar to your grapes at all? That sounds even better! Thanks for posting your story!

  12. I’ve always assumed I have got worse at drinking wine due to age and menopause. (one large glass of wine often makes 2 days feeling headachey and off, it’s just not worth it!!) I’ve also become more fussy with coffee, not enjoying how caffeine makes me feel, easily made too jittery. I just feel like a fussy 50 something woman, but it’s a pain socially. I keep meaning to test spirits again to see if the problem is the alcohol or the additives, but the fear of ruining two days puts me off.

    • You’re not being fussy, but your metabolism may be. I’m 60 and in great health, but our bodies are not as ‘forgiving’ as they were in our 20’s and 30’s. If I try to drink some low priced wine these days, I feel awful the next day, yet I could drink 2 or 3 glasses of wine that’s low in sulphites and additives and feel nothing the next day–it’s quite an amazing difference. It’s fine by me that my system doesn’t tolerate alcohol, caffeine and other substances the same since my choices are far healthier on a very consistent basis than ever. But life experience is the best part of all when it comes to maturing and really enjoying the life we’ve built 🙂

    • I totally feel your pain. I suffer from the same thing with different wines, and also Foods that have lots of additives in them. I recently have only been drinking wines from Italy as well, with trial and error those wines do not bother me at all. Though lots of California wines bother my insides. And yes it is a pain socializing. I am 60 years old as well and I do believe that our bodies cannot metabolize substances that are not basically organic.

    • At the risk of offending some of my fellow seniors: Grow up! If wine makes you feel bad, just stop. Change your attitude, and all of a sudden it’s not a social “pain” but a joyful freedom from complying with social pressure. Smile, stop ingesting product that is harmful to you, and enjoy your friends!

  13. I definitely don’t like the high amount of pesticides that are obviously used in many wines (the numbers don’t lie if wineries are buying up a higher percentage of pesticides used) or the higher amounts of arsenic and coloring agents. Am looking forward to the next article you present on the subject..

    • Pesticides are not used in wines. They are sometimes used in vineyards, as are herbicides, but much less than they were, in general, and there are usually strict controls. As grapes are fermented, unlike other fruit that you might buy, the risks of any residue remaining in the finished wine are minimal.

      • You’ll need to back up your statements with some numbers, otherwise I’m just thinking you have an agenda, here. Do you have any provable fact sheets proving that there is a minimum amount of pesticide residue in wines?

        • Someone with knowledge of microbiology and micro chemistry or who has studied how grapes are grown and how wine is made would be able to pick holes in quite a bit of Chris Kresser’s post, much as I normally admire him and follow what he writes.

          Fermentation reduces pesticide residue by precipatating it out in yeast lees. Here is a link which explains how it works from a medical and goverment body – with no agenda either:
          https://www.ncbi.nlm.nih.gov/pubmed/20610173

          • Thanks, Liz; I’ll give it a read and will be happy if it changes my perception of commercial wines 🙂

          • The link was only for the Abstract and not the study article, but it led to some digging and it seems that depending on certain factors in the processing of grapes for wine, there can be a 70-100% reduction in pesticide residue; about the same as peeling vegetables before eating. Therefore, everyone needs to decide if that’s a safe level to consume. I will likely continue to drink wine on occasion, though I will be more likely to buy a red than a white, now that I’ve done some reading…That said, there is a book called “Anticancer” by David (something) that says pesticide residues in wine are 1000x higher than in tap water. I don’t know if he’s an alarmist or on to something, but I don’t know how much there is in tap water, so I’ll just proceed as if I’m consuming vegetables that have been washed or peeled and hope for the best.

          • An interesting poin, perhaps, but if you read the linked Que Choisir study you’ll see that most wine (even organic, to some degree) tests positive for pesticides . Also, while I know this is a health blog, not an ethics blog, just because it doesn’t make it into OUR bodies in large quantities doesn’t mean it’s not impacting farm-workers and ecosystems. I don’t think anyone can “poke holes” in the awareness and caution Chris is talking about.

              • Remember, ALL organic produce (not just grapes) have pesticide residues. The pesticides used by conventional growers spread everywhere. That said, conventionally-grown and organically-grown produce vary widely in the residues they contain. That’s why EWG’s Dirty Dozen/Clean Fifteen speaks in terms of highest vs. lowest residues. And, while conventionally-grown (table) grapes rank #8 on the dirty list, many other fruit — strawberries, apples, peaches, pears, cherries — rank higher in residues.

                • I’ve read those lists and really appreciate that someone put them together for important info we can all use. 🙂

  14. Like so many other traditional foods (and wine may go back much further than the 7000 BC cited in the article), wine made by mass-production, “modern” methods has lost its benefits. However, depending where you live, local winemakers produce an honest food and avoid the high-tech folderol. I live in the US Pacific NW, and I think that our artisanal cheeses vis–vis the modern “cheese-like foods” provide an interesting and accurate parallel to our local wines. Some of the local vintners dismiss the award-winning chemical concoctions as “monkey business” wines. The fakes don’t win at local tastings and contests, interestingly.

  15. Thanks Chris Kresser, for the informative article. This article depicts how wine making is transformed from traditional to commercial. It proves that commercialization has reduced the quality in the wine making.

    • That is thankfully far from the truth. I have worked in the wine trade for over 40 years and in that time, with greater understanding, the amount of sulphur dioxide used in winemaking (as a preservative) has been reduced dramatically. It’s the same for herbicides and pesticides in the vineyard. Organic grape growing has become very common, even if the wine is not labelled organic. The only ‘additives’ I usually witness in winemaking are fining agents used to clarify and these precipiate out or are filtered out. Occasionally, sugar may be added to boost alcohol content, but this is only in poor years and highly regulated. The added sugar is fermented out (to alcohol). Any wine that is sold is ‘commercial’. ‘Tradtional’ grape growers of the past had much less knowledge of viticulture and vinifcation and used herbicides and pesticides more often than nowadays, as they did not know of any different . The same with winemakers and sulphur dioxide. Chris Kresser does not mention resveratrol, an important and beneficial antioxidant, that is present in red wine. Drinking wine in moderation has been proven to be better for you than not drinking it at all.

      • If you drive by or see photos of a vineyard where the ground beneath the vines is browned off, yellow or completely bare soil (most vineyards that I see) it has almost certainly been sprayed with Round-up, and so you can likely rule out it being organic production. Rarely will organic growers flame out completely under vines for weed control.
        Organic and bio-dynamic production is labor intensive to do successfully long term in many climates and soil types. The less expensive big production wines are likely taking short cuts that involve more stabilizing with additives to reduce the risk of spoilage. Commercial natural winemaking can be a risk, particularly for the unskilled. If you have invested and need a guaranteed $ return. If the wine tastes bleuh with bretanomyces or higher acetaldehyde reviews will not be +ve.

      • Proven???? Scant epidemiological studies is not proof. Resveratrol??? Drink gallons of wine a day to get the effective dose that had just a modest effect in animal, not human studies.

    • The Romans used to burn sulphur candles in their winemaking vessels. Hardly a recent development. How far back do you want to go with ‘traditional’? All wines are commercial, in the sense that they are ‘sold’.

  16. If you are concerned about the additives used in some commercial wines, you can always make your own. We do that, and it’s not difficult. Most of the better wine kits do not have many additives (read the label to be sure). If you want to be assured that there are no additives at all, you can buy or pick your own fruit and make wine from that. If you make dry wines (which we prefer), the sugar is basically all consumed in the fermentation process, so there is little or no residual sugar. I enjoy a glass or two of our wine daily with dinner, and I have no concerns that it is bad for my health.

      • You can get a wine kit on Amazon or a lot of health food type stores. What I did was Googled “easy wine recipe” and found Rough Draft Farmstead’s wine making version and now follow that. I just use the biggest glass jars I can find to mash my fruit in, add what I *think* is enough honey and let it sit on my counter, covered with a cloth, for a couple of days. Then strain put into another jar or bottle that I can put a balloon on to watch how much gas is being created before I “cork” it. Some turn out great:) Oddly enough, some of these wines give me a worse headache than the cheap wine I buy in town.

  17. Thanks for an interesting article, Chris. I happen to be a Master of Wine, so it is a subject close to my heart. However, I have never heard of the use of mega purple in wine-making. I am based in Europe, but have to have knowledge of all the world’s wines…
    Liz

    • Thanks for drawing my attention to this article Liz. If the 25 million bottles of wine that have mega purple added is correct, and I have no cause to doubt is not, then we are talking about 0.069% of wines that have this added based on world production figures of 2015. Assuming you drank a different bottle of wine, every day, half of which is white, half red (lots of assumptions here, I know) it would take on average just shy of 8 years before you encountered a bottle with mega purple in it. Mr. Kresser, let’s put this in context, please.

  18. I usually have a glass of Carlo Rossi Burgundy wine with dinner. It is one of the cheapest wines around but I like it. I have never experienced any adverse effect from it.

  19. I agree with the inference that wine’s negative attributes may outweigh its positives, especially because people who drink wine (in the USA especially) rarely drink it in moderation. (Really, who drinks a 3 oz glass and stops?!)
    But, many of the negatives highlighted here don’t apply to high quality wine made in small quantities. For example many of the best vineyards and wineries in Sonoma and Napa counties employ organic practices and some are even biodynamic(!), with no chemicals used on the soils, grapes or in the wine. Examples would be Littorai, Preston, Hirsch, Varner and a growing number of others.
    It would be interesting to hear your view of the costs:benefits (health wise) of such wines, consumed in true moderation, and in the context of a paleo or primal meal.

  20. My husband was a winemaker in the Carneros region of Sonoma Valley. His employer, as many others in the region, produced wine according to organic practices but did not label their wine as “organic” because of the costs involved to certify the winery as organic. So just because a wine is not labeled organic doesn’t mean that pesticides and herbicides were used or there are non-organic ingredients. It always pays to ask. If you love a particular wine, call (or better yet visit!) the winery and ask. Btw, how did this winery control weeds? Sheep grazing in the vineyards!

  21. WOW!!! That information is SCARY!!! If I drink one glass of wine I get a headache, I never knew why?? Now that I’ve had a heart attack and had to take isosorbide monoritrate, I know why, because the mononitrate gave me massive headaches. Wine contains nitrates…so that must be the reason. I will never drink wine again.

    Treblig

    • Jeez, eating half a hotdog or a modern hotdog bun will likely give you worse symptoms. Not all wines contain added nitrates. As for foods that naturally are high in nitrates, there are many whose health benefits would likely not be denied by anyone — including most root veggies, lettuce, celery and various greens. Many of these are, in fact, recommended for CVD patients because the high natural nitrate content boosts NO2 production, which is beneficial for cardiac issues. Nitrates, in and of themselves, are not bad for health, and may be quite beneficial. Try a little logic and a little (scientific) research. Check nitrate contents, try the elimination method (eliminating one food at a time) and see what really causes problems.

      • Well, he knows that he gets a headache after a single glass of wine and that is not uncommon so maybe that’s enough evidence for his personal use, regardless of whether or not it’s the nitrates. Tons of research and studies don’t change the n=1 results of an individuals biochemistry.

        • Thank you Zahira!! And yes many foods contain nitrates but if the amount of nitrates in hot dogs (or whatever) was sufficient I would not have been given isosorbide mononitate AND Nitroglycerin pills. The Cardiologist would have told me to simple eat plenty of veggies and hot dogs!! It takes a lot of nitrates to make the blood vessels relax to the point that will relieve the angina when your arteries are 90 percent closed.
          No food (solid food) has ever given me a massive headache. Beer will (nitates again), wine will and so do margaritas (ready mixed in a bottle with nitatres). Solid foods (even in excess) have never given me a headache. But those isosorbide mononitate (IM) pills gave me headaches so bad that I had to get acupuncture to get relief. I couldn’t stop the IM because I was getting angina many times a day as it was. So it was either massive head aches 24/7, excruciating angina or acupuncture.
          I’ve been a vegetarian for the last 9 months since the heart attack and believe me….no amount of veggies or root vegetables with stop the angina. I had to take the IM plus numerous Nitroglycerin pills every day until I worked (literally) my way out of it.

          Treblig

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