Resveratrol Is Not Recommended for Therapeutic Use Due to Limited Evidence of Efficacy and Safety
Resveratrol, a polyphenol found in grapes and red wine, should not be used for therapeutic purposes due to insufficient evidence supporting its efficacy and safety in clinical settings. 1
Current Guideline Recommendations
Multiple clinical practice guidelines explicitly recommend against the use of resveratrol for therapeutic purposes:
The International Working Group on the Diabetic Foot (IWGDF) strongly recommends against using resveratrol to promote perfusion and angiogenesis for diabetic foot ulcer healing, citing low-quality evidence and uncertain benefits 1
The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines explicitly state that resveratrol cannot be recommended for treating non-alcoholic fatty liver disease (NAFL) or non-alcoholic steatohepatitis (NASH) until further data regarding its efficacy are available 1
Resveratrol is not recommended as an otoprotective agent for preventing cisplatin-induced hearing loss according to ESMO-EONS-EANO clinical practice guidelines 1
Evidence on Safety
While resveratrol is generally reported to be safe at doses up to 5 g/day 2, several concerns exist:
Perioperative management guidelines recommend holding resveratrol for 2 weeks before surgery due to potential antiplatelet effects through inhibition of COX pathways or cellular calcium channels 1
Clinical trials have reported mild to moderate side effects that would likely limit doses in future therapeutic applications 2
In some studies, resveratrol administration has been associated with increased liver enzymes (ALT and AST) 1
Evidence on Efficacy
The evidence for resveratrol's therapeutic efficacy is inconsistent and limited:
In NAFLD/NASH patients, studies show contradictory results:
- One study using 3000 mg for eight weeks showed no effect on insulin resistance, steatosis, or plasma lipids, while significantly increasing liver enzymes 1
- Another trial using 2×150 mg for three months reported improvements in liver enzymes, lipid profiles, and inflammatory markers 1
- A third study found 500 mg with lifestyle intervention more effective than lifestyle intervention alone 1
Despite numerous preclinical studies suggesting potential benefits in various conditions (diabetes, cardiovascular disease, cancer), there is no consensus on treatment regimens for any specific condition 3
Current State of Research
The research landscape for resveratrol remains problematic:
Nearly 200 studies have evaluated resveratrol across at least 24 different indications over the last 20 years 3
There is a lack of large, high-quality clinical trials with clearly defined biomarkers or endpoints 3
While resveratrol consistently reduces inflammatory markers and improves aspects of dysregulated metabolism in some studies, the evidence is not sufficient to support clinical recommendations 3, 4
Practical Implications
For healthcare providers considering resveratrol:
- Do not recommend resveratrol for therapeutic purposes in any clinical setting based on current evidence
- Advise patients that while dietary sources of resveratrol (grapes, red wine, berries) are generally safe, supplementation beyond dietary intake is not supported by clinical evidence
- For patients already taking resveratrol supplements:
- Inform them about the lack of proven clinical benefits
- Advise discontinuation at least 2 weeks before any surgical procedures 1
- Monitor liver function if continued use is chosen by the patient
Future Directions
For resveratrol to transition from health food stores to clinical practice:
- Large, high-quality clinical trials with appropriate sample sizes are needed
- Studies should focus on specific conditions with clearly defined endpoints
- Improved formulations addressing resveratrol's poor bioavailability may be necessary
In conclusion, despite the theoretical promise and media attention, resveratrol currently lacks sufficient clinical evidence to support its therapeutic use for any specific condition.