# Drug-Food Interactions with a Focus on Mediterranean Diet
## 3 Mediterranean Food Products and Potential DFIs
### Drug-Med Diet Interactions
#### 3.2.5 Wine and Other Beverages  
Wines, except for their alcohol content (~11% for whites and 15% for reds), have a rich composition of bioactive compounds such as polyphenols. Resveratrol, anthocyanins, catechins, and tannins (proanthocyanins and ellagitannins) are some of the most often found polyphenols with a higher content in red wines which also explicate the beneficial effect of from wine consumption [172; 173]. One of the most known examples is the French paradox, the epidemiological observation of low coronary heart disease death rates despite high intake of dietary cholesterol and saturated fat in southern France which is attributed in red wine consumption in those populations [174]. Regarding DFIs, polyphenols can modulate the phase I and II metabolism as stated earlier but for wine this effect can be considered minimal compared to the effects of alcohol in the case of regular or heavy drinking.  
Alcohol can enhance the effects of medications, especially in cases of chronic conditions. PK-DFIs of alcohol are related mostly with induction of CYP2E1 and to a lesser extent CYP3A3 and CYP2A1. Heavy alcohol drinking can lead to PD-DFIs of alcohol such as sedation when combined with CNS acting drugs (sedatives, antihistamines, antidepressantsants, antipsychotics etc.), induce gastric bleeding when combined with aspirin and relative painkillers or anticoagulants, and hypoglycemia with antidiabetic drugs [43; 175]. Regarding the vexed issue, the widespread opinion that concomitant drink of alcohol with antibiotics or other antimicrobials will cause toxicity or treatment failure, a recent review of the available evidence suggested that the data are poor and sometimes controversial [176]. The reduced efficacy refers mostly to erythromycinomic and doxycycline. Disulfiram-like reaction (distress, pain, flushes, irregular heartbeat) can occurs in co-administration of metronidazolezole, ketoconazole, grisgeofulvin and cephalosporporines (i.e., cefuroxime, cefotreat, ceftrixome, cefotrazome). Ambiguous data for ADRs exist for trimethoprim sulfamethoxazole. On the other hand, penicillins, fluoroquinolones, azithromycin, tetras, cyclines, nitrofurantoin, sencidazole, tinidazole, and fluconazole have not been causally related to ADRs [176]. Another mechanism involved is the reduction in the immune response and epidemiological studies have shown alcohol abuse to be associated with an increased incidence of infectious diseases. But this is related mostly to cases of alcohol abuse, consumption of high content alcoholic drinks and overall, a poor quality of life regarding well-being and disease prevention. Thus, it is a good idea from the healthcare perspective, especially for heavy-drinking patients under treatment, to advise towards drinking cessation [177; 178]. On the other hand, the moderate consumption of red wine seems to be beneficial in cases of immune protection due to its polyphenol content [177]. Thus, although the quality and quantity of data are vague, the avoidance of or reduction in consuming alcohol in low or moderate amounts (e.g., a social occasion with one glass of wine or beer) as is suggested through Med-D can be enjoyed.