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As the saying goes, The way to a man's heart is through his stomach. Andaccording to the authors of the "polymeal" concept, which wasintroduced in the December 2004BMJ,1 itappears to be true.
A team of Dutch scientists has concocted a diet regimen including a dailyintake of almonds, dark chocolate, fish, fruits, garlic, vegetables, and winethat they say will cut the risk of cardiovascular disease by 76%, as well asadd 9 years of life expectancy free from heart disease for men and 8.1 yearsfor women.
And they had a lot of fun writing about it.
"Considering the disturbing adverse effects of garlic, we do notrecommend taking the polymeal before a romantic rendezvous, unless the partneralso complies with the polymeal," write the authors, led by Oscar H.Franco, MD, of the department of public health at the University MedicalCenter in Rotterdam, the Netherlands.
About enjoying a little hedonism they write: "Although we do notrecommend particular brands, spending more—for example, on your favoritebottle of wine or brand of chocolate—might also be rewarded by animproved quality of life."
To be included in the polymeal, each food item had to have its own effectson reduction of heart-disease events or modification of risk factors. Thefoods are to supplement a healthy, balanced diet, and do not necessarily needto be eaten all at the same sitting. One of the advantages of the polymeal,however, is that many of the foods can be combined.
"This would be a great way to get folks, particularly folks with type2 diabetes, on a better track," says Roberta Anding, RD, CDE, aninstructor at Baylor College of Medicine in Houston. "If you adddifferent components to your diet, they can help lower blood pressure,cholesterol, and so on," she says. "It doesn't have to be thebland carbfree foods."
The polymeal was designed as a direct response to the"polypill" proposal published in the same journal in2003.2 Both studiesinvolved a meta-analysis of published randomized trials and cohortstudies.
The polypill study found that a single pill composed of a statin, threeblood pressure–lowering drugs, aspirin, and folic acid could reducecardiovascular disease by 80% if taken by everyone over age 55 and everyonewith existing cardiovascular disease or diabetes, regardless of age.
"For those people earnestly seeking to prevent cardiovasculardisease, the polypill can be combined with the polymeal," theresearchers suggest. "The fortification of flour with polypillingredients... certainly merits further study. Redundant cardiologists couldbe retrained as polymeal chefs and wine advisers."
To arrive at their findings on reduced risk of heart disease as a result ofconsuming the polymeal ingredients regularly, the authors are extrapolating arisk, Anding notes, not suggesting there is a direct cause andeffect.
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She cautions that cold-water fish and garlic, in addition to helping lowercholesterol, also influence the way blood clots and can work like aspirin. The2.7 daily grams of fresh garlic recommended for the polymeal, or itsequivalent as a supplement, would cause the garlic to act as a drug, Andingsays, as would significant amounts of the omega-3 fatty acids found incold-water fish. They would have some pharmacological benefits, but allpharmacy has some benefits and some risks, she points out. And individualsshould consume wine in moderation, of course, in order to reap its healthbenefits.
"I would tell patients to discuss any significant change in diet withthe person who is managing their medication," Anding says, noting thatsuch changes include adding fish-oil pills, garlic capsules, or othersupplements. "Our most important person is the patient, and patientsneed to do a really good job communicating with their care team."
The Science Behind the Humor
Lest readers wonder if the polymeal article was written in jest, DOC Newscaught up with lead author Oscar H. Franco, MD, of the department of publichealth at the University Medical Center in Rotterdam, the Netherlands, whohelped illuminate the sincerity at the humorous heart of the polymealresearch.
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DOC News: Is this for real?
Franco: Certain aliments and a healthy diet can prevent cardiovasculardisease: That is for real!
DOC News: A 76% reduction of cardiovascular disease?
This seems shocking, albeit simple, news that should be shouted from everymountaintop and across all the airwaves.
Franco: You are right. It is not the effect, but the magnitude of it. Thepolypill authors found that with a combination of pills, cardiovasculardisease could be reduced by 80%. We used their same methods and models to showthat a healthy diet potentially can have the same effects as a polypill.
DOC News: So should we be drinking red or white wine?
Franco: The manuscript we used for our study does not advocate a particulartype of wine, and for that reason neither do we. If you check further in theliterature you will find that perhaps red wine is more effective due to itshigher levels of flavonoids.
DOC News: What about the fat in chocolate and almonds?
Franco: Yes, chocolate contains high levels of fat and calories. Our adviceto whoever wants to take the polymeal: Do it under the proper supervision ofyour personal physician or dietitian.
DOC News: What is your take-home message for primary care providers?
Franco: That pharmacological methods are not the only way to go. A healthylifestyle, including diet and exercise, should be promoted first. Think aboutit: A pill with "I" ingredients may not only have "J"actions but also "K" side effects.
References
2. Wald NJ, Law MR: A strategy to reduce cardiovascular disease bymore than 80%. BMJ 326:1419–1424, 2003.
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