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FILLERS: "Design a Polymeal" competition winner BMJ 2005; 330: 1422 [Full text]

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Consider Avoiding Overfished Atlantic Cod

Simon C Hampson   (17 June 2005)

The winning “Polymeal” and migraine

Ellen C G Grant   (19 June 2005)

Bruised fruit

Tom Lewis   (23 June 2005)

Wouldn't a simple diet be better?

Frank J Leavitt   (23 June 2005)

Re: The winning “Polymeal” and migraine

Adam Jacobs   (29 June 2005)

Consider Avoiding Overfished Atlantic Cod 17 June 2005
Simon C Hampson, Consultant Psychiatrist Littlemore Mental Health Centre, Oxford OX4 4XN Send response to journal: Re: Consider Avoiding Overfished Atlantic Cod	I look forward to trying the recipe for the winnning Polymeal. At the risk of sounding gloomy, the Marine Conservation Society (www.fishonline.org) advises us to avoid overfished Atlantic cod until stocks have improved. Happily there are many alternatives such as coley, hoki, whiting or line-caught Pacific cod. Competing interests: None declared
The winning “Polymeal” and migraine 19 June 2005
Ellen C G Grant, physician and medical gynaecologist Kingston-upon-Thames, KT2 7JU, UK Send response to journal: Re: The winning “Polymeal” and migraine	Will the BMJ competition-winning Polymeal cause migraine? 2 teaspoons red wine vinegar, 150 ml fruity red wine; 4 tablespoons white rum, 25 g butter 400 g plain bitter chocolate, 100 g white chocolate1 If I wanted to cause migraine and a higher risk of stroke, prescribing a meal with the above ingredients, which is probably intended to be washed down with yet more alcohol, would be a good way to do it. In the 1970s much publicity was given to common dietary precipitants of headaches such as cheese, chocolate, oranges and red wine.2,3 After a 5-day period of withdrawal from their usual diet, a third of migraine patients reacted adversely to chocolate, cow’s milk and yeast. Avoiding regular medications, exogenous hormones and tea, coffee and alcoholic drinks, unmasked adverse reactions to frequently consumed food and drinks. None needed regular medication and 85% of patients became headache-free when they ate a low-allergy diet and those with hypertension became normotensive.4 Some members of the medical profession are known to be regular drinkers of alcohol. It is unfortunate that epidemiological studies have given an illusory impression of benefit of alcohol drinking. A reality is that less healthy, allergic migraine patients are often intolerant of alcoholic drinks and are therefore classified in studies as non-drinking controls. Drinking recommended units of alcohol therefore became fashionable and drug prescribing for migraine has flourished. The supreme importance of eating fish is being realised after eons of over-fishing suggesting humans always knew this, while they were busy over -populating the world. 1."Design a Polymeal" competition winner.BMJ 2005; 330: 1422 2. Hannington E. In Background to Migraine. 1969 Ed R Smith, London, p10. 3 Smith I, Kellow AH, Mullen PE, Hanington E. Dietary migraine and tyramine metabolism. Nature 1971; 230: 246-8. 4. Grant ECG. Food allergies and migraine. Lancet 1979:1: 966-69. Competing interests: None declared
Bruised fruit 23 June 2005
Tom Lewis, SHO Selly Oak Hospital Birmingham Send response to journal: Re: Bruised fruit	Damaged fruit contains higher levels of salicylates. Could your chef advise on whether we should be dropping our fruit on the floor before dipping it in the fondue? Or would the resultant forfeits outweigh any health benefits? Competing interests: None declared
Wouldn't a simple diet be better? 23 June 2005
Frank J Leavitt, Chairman, Centre for Asian and International Bioethics, Faculty of Health Sciences, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel Send response to journal: Re: Wouldn't a simple diet be better?	I wish to congratulate Dr Heather A Haywood for the beautiful recipes. I haven't studied the evidence in favour of the medical benefit of the ingredients adequately enough to form a clear judgment about them. But I would like to ask the opinion of fellow readers whether a simple meal -- say some poultry cooked with garden vegetables, a salad and a glass of wine -- might not be just as healthy. It might even be tastier if one has't accustomed one's palate to the fancy cooking which professionals such as doctors may be used to. I would add that if one were to take the net time invested in gourmet cooking (over and above the time needed to cook a simple meal) and put it into strenuous sport or martial art, the health benefit may even be greater. I would also like to ask whether the fact that there is proven health benefit for each of the various major components of a meal entails that they are beneficial when combined together. Wouldn't this have to be proved? And wouldn't there have to be separate proofs for each of various combinations? Competing interests: None declared
Re: The winning “Polymeal” and migraine 29 June 2005
Adam Jacobs, Director Dianthus Medical Limited Send response to journal: Re: Re: The winning “Polymeal” and migraine	Perhaps the answer to Ellen Grant's concerns about the migraine- inducing effect of the polymeal would be to serve it with a side salad to which a few feverfew leaves have been added, or possibly to wash it down with a mug of feverfew tea. Feverfew may have some efficacy in preventing migraine, although this has not been demonstrated convincingly [1]. As with most herbal treatments, however, this may well be more to do with a lack of rigorous studies than a lack of efficacy. I hope that the randomised controlled trial of the polymeal (I take it someone is planning one?) will include a feverfew salad arm and a control salad arm so that we can settle this question once and for all. References: 1. Pittler MH, Ernst E. Feverfew for preventing migraine. The Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002286. DOI: 10.1002/14651858.CD002286.pub2. Competing interests: None declared