The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7480.1447 (Published 16 December 2004) Cite this as: BMJ 2004;329:1447
All rapid responses
Fortunately, it is not the alcohol in red wine that conveys health
benefits, but
rather the polyphenols (esp. proanthocyanidin pigments). Therefore, for
red
wine, substitute unsweetened purple grape juice, preferably organic.
Alternate purple grape with pomegranate and cranberry juices for variety
and
additional benefits.
Competing interests:
None declared
Competing interests: No competing interests
Yes, the polymeal may help erectile dysfunction, better say sexual
dysfunction in both sexes. We have shown that a Mediterranean-style diet
reduced by half the prevalence of the metabolic syndrome and its
associated cardiovascular risk (1). Preliminary data from this database
seem to indicate that this kind of diet, as compared with a standard
prudent diet, improve sexual function in people with the metabolic
syndrome, by at least 17% in women and 21% in men, independently of body
weight changes. So, a right diet may help prevent or cure sexual problems
in persons at risk, such as those with the metabolic syndrome.
References
1) Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F,
Giugliano G, D'Armiento M, D'Andrea F, Giugliano D. Effect of a
Mediterranean-style diet on endothelial dysfunction and markers of
vascular inflammation in the metabolic syndrome. A randomized trial. JAMA
2004;292:1440-1446.
Competing interests:
None declared
Competing interests: No competing interests
"Adverse effects reported for garlic include malodorous breath and
body odour (13) As garlic is destined for mass treatment, few people will
still notice this after a while"
Hmmm...
Competing interests:
None declared
Competing interests: No competing interests
18 Jan 05
To the Editor:
Franco et al(1) conclude that a “Polymeal” of wine, dark chocolate,
fish, garlic, fruit and vegetables, and almonds would result in a
remarkable 76% reduction in the risk for cardiovascular disease. They
propose this dietary strategy as “a more natural, safer, and probably
tastier”alternative to the Polypill(2), a collection of six prescription
medications. The Polypill has been suggested as a way to achieve a similar
degree of cardiovascular risk reduction.
It is also remarkable that, aside from the fish, this dietary plan is
completely vegetarian (vegan), calling for no animal products whatsoever.
For those who have been advocating this dietary choice for health reasons,
this study provides further ammunition for recommending vegan eating
habits to both patients and the population as a whole.
Fish are believed to reduce cardiovascular disease risk via their
omega-3 fatty acid content. However, there are risks that go with eating
fish, as a recent article makes clear.(3) Risks include exposure to
harmful contaminants such as polychlorinated biphenyls (PCBs) and mercury.
Farmed salmon commonly contain high levels of PCBs. Mercury is such a
serious contaminant that in Maine, pregnant or nursing women and younger
children are advised not to eat any freshwater fish, due to mercury
contamination. (4)
There are alternatives to fish as omega-3 fatty acid sources. Non-
fish sources include flaxseed, canola, soybeans, and walnuts. (3) These
can be easily (flaxseed ground in a blender is a good egg replacer and
canola is a versatile cooking and baking oil) and tastily incorporated
into a healthy diet.
1. Oscar H Franco, Luc Bonneux, Chris de Laet, Anna Peeters, Ewout W
Steyerberg, and Johan P Mackenbach. The Polymeal: a more natural, safer,
and probably tastier (than the Polypill) strategy to reduce cardiovascular
disease by more than 75%. BMJ, Dec 2004; 329: 1447 – 1450.
2. Wald NJ, Law MR. A strategy to reduce cardiovascular disease
by more than 80%. BMJ 2003; 326:1419-23.
3. Fisher Wilson J. Balancing the risks and benefits of fish
consumption. Annals of Internal Medicine 2004;141:977-980.
4. http://www.maine.gov/dhhs/ehu/fish/2KFCA.shtml
Bob Lodato
allveg@kynd.net
357 Pine St.
Dover-Foxcroft, Maine 04426
Competing interests:
I am a vegan.
Competing interests: No competing interests
I noticed that the study didn't include green tea in its polymeal
menu! There are numerous epidemiological studies with evidence that green
tea has a protective effect on both cardiovascular diseases as well as
cancer. Certainly that deserves a mention, no?
References:
1) Nakachi K, Matsuyama S, Miyake S, et al. Preventive effects of
drinking green tea on cancer and cardiovascular disease: epidemiological
evidence for multiple targeting prevention. Biofactors. 2000;13(1-4):49-54
2) Yang YC, Lu FH, Wu JS, et al. The protective effect of habitual
tea consumption on hypertension. Arch Intern Med. 2004 Jul 26;164(14):1534
-40
3) Weisburger JH. Lifestyle, health and disease prevention: the
underlying mechanisms. Eur J Cancer Prev. 2002 Aug;11 Suppl 2:S1-7
4) Meydani M. Nutrition interventions in aging and age-associated
disease. Ann N Y Acad Sci. 2001 Apr;928:226-35.
5) Kerver JM, Yang EJ, Bianchi L, et al. Dietary patterns associated
with risk factors for cardiovascular disease in healthy US adults. Am J
Clin Nutr. 2003 Dec; 78(6):1103-10
Competing interests:
None declared
Competing interests: No competing interests
The Polymeal article has been healthily provocative. It raises
several important questions.
The first question is to what extent risk reduction associated with
each of these individual diet elements will be summative or not. If they
are inter-related in their disease reduction mechanisms, eating the
combination may be no more effective in reducing risk than, for instance,
just eating the vegetable component. And might the chocolate, almonds and
red wine actually hinder that part of the beneficial effects of the fish,
fruit and vegetables that is due to their low caloric and low fat content?
Similarly the wine might counteract any BP lowering effects of the fruit
and vegetables. Thus some elements of the meal might cancel each other
out. To put it another way, the best polymeal is one in which the factors
can be expected to be summative or at least not to interfere with each
other’s benefits. The easiest way to do this might be to substitute whole-
grain bread for the chocolate, almonds and wine.
Secondly, are the changes risk free in terms of other diseases (eg
obesity, diabetes, alcoholism) and are they the best or easiest way to
achieve the desired effect? Chocolate was included in the polymeal because
of one study showing a correlation with decreased BP, but are there better
ways to achieve minor reductions in minimally elevated BP, eg by exercise
and weight loss (1)? Ditto re almonds being possibly associated with an
improved lipid profile, would a reduction in total fat intake, a reduction
in saturated fat intake and /or a reduction in obesity by other means be
equally good or better methods of achieving this undoubtedly important
goal?
Thirdly, as the polymeal is being thought of as a broad population
disease prevention method, are all components relevant to all people? If
chocolate does achieve mild blood pressure reduction, is this relevant to
a given person who is not hypertensive? It may indeed be that small
reductions in BP are beneficial to these people, particularly if achieved
by a means more benign than drug therapy, but evidence on this point is
limited.
Fourthly and perhaps most fundamentally, are these foods good for
peoples’ cardio-vascular risk because they contribute something positive
to their metabolism, or is it because people tend to regulate the total
calories eaten daily and hence eating more calories from good foods means
that very harmful foods (eg rich in saturated fats) are being pushed out.
There is some evidence for ‘positive’ effects. Garlic (2) and soluble
fibre and omega 3 fatty acids and various soluble factors from fruit and
vegetables may be beneficial in themselves when removed from a dietary
framework. But the most important benefit of eating fish and vegetables is
likely to be that they are substituting for red meat (and high Glycemic
Index starches) and similarly that fruits push out the much less healthy
fat and sugar laden desserts. Additionally the lower caloric density and
higher fibre content causes satiation after less caloric intake and hence
can reduce the deadly factor of obesity. This will only occur if the whole
food pattern of the day is shifted, not just one meal, as people tend to
maintain their total daily food intake even when there are big
fluctuations in the intake at a given meal.
If competition for percentage of food intake between the ‘good’ and
the ‘bad’ foods is of major importance in actual observed reductions in
cardiovascular risk then the polymeal’s benefits will depend on what sort
of a meal it replaces. If you have a healthy balanced polymeal to replace
a ham and salad sandwich with yoghurt tub lunch, and still have steak with
chips for dinner then little good is achieved, whereas if you kept the
lunch which is not too bad and replaced the appalling dinner (maintaining
this over the long term) then you have probably achieved something of real
value in disease reduction.
Everyone would like a quick fix, which would allow them to go on
indulging in all the hard-to-resist pleasurable lifestyle vices they
currently enjoy by just adding something on top to ‘fix up’ the effects of
that lifestyle. It’s tempting but it’s a mirage. Polypill or polymeal,
neither will make more than a small dint in the death toll from modern
lifestyles if simply used as an add-on.
The basic problem is that sedentary TV/Computer watching, car driving
and processed fat and sugar rich convenience foods are literally killing
us. They will go on to kill our children after us at an even earlier age
until we as a society decide that, as with the smoking death toll and UV
driven skin cancers, we can no longer tolerate the consequences. Then we
may see the need to limit the advertising and tax up the prices of anti-
health food as we do for tobacco, subsidise the prices of fruit,
vegetables and whole-grain products, and insist on employers, schools and
governments vigorously promoting walking, stairs, cycling etc for all.
Perhaps as large organisations currently have to demonstrate that they
spend a certain percentage of their budget on training and development,
and meet Occupational Safety standards, they may in the future need to
spend a sliver of their funds on mandatory exercise breaks, discounted gym
memberships or lunchtime volleyball equipment.
Lastly we must not forget the important role of psychologic stress
and social isolation in worsening the risk of cardio-vascular and other
common lethal diseases, as highlighted by leading cardiac prevention
researcher Dr Dean Ornish (3, 4). Here also our modern consumerist
economies with their fragmented unsupportive communities are driving us to
our deaths. When doing volunteer work (5) or getting yourself a dog from
the pound are seen as higher status options preferable to having a new
car, then we will really see an extension of healthy life-span.
Perhaps, just as any new development these days requires an
environmental Impact Statement, future business and government projects
will require a community / social stress Impact Statement.
To our great credit, doctors banded together against the scourge of
unfettered tobacco marketing, leading the push for legislative change,
which has resulted in great benefit across the Western world (6). It is
now definitely the time for us to again put our patients’ real health
needs on the national agenda.
1) Primary prevention of essential hypertension. Krousel-Wood MA,
Muntner P, He J, Whelton PK. Med Clin North Am. 2004 Jan;88(1):223-38.
2) Inhibiting progression of coronary calcification using Aged Garlic
Extract in patients receiving statin therapy: a preliminary study. Budoff
MJ, Takasu J, Flores FR, Niihara Y, Lu B, Lau BH, Rosen RT, Amagase H.
Prev Med. 2004 Nov;39(5):985-91.
3) Love and Survival: 8 pathways to intimacy and health. D. Ornish,
1998 Harper Perennial.
4) Social environment as a factor in diet-induced atherosclerosis. RM
Nerem , MJ Levesque, JR Cornhill. Science, 1980, 208 (4451): 1475-76.
5) Social relationships and health. JS House, KR Landis, D Umberson.
Science, 1988, 241: 540-45.
6) Association of the California tobacco control program with
declines in lung cancer incidence. J Barnoya, S Glantz. Cancer Causes
Control. 2004 15(7):689-95.
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir
Although the ‘Polymeal’ focused on the individually reported effects
of ingredients such as wine, fish, dark chocolate, fruits and vegetables,
almonds and garlic on reduced risk of cardiovascular disease, the authors
did not include reference to the cardioprotective effects of potential
wholegrain cereal foods1. Food cereal grains such as wheat, oats, rice
and rye are more affordable staple foods, and hence could be of major
importance from a socioeconomic standpoint and from the viewpoint of the
individual at risk of coronary heart disease (CHD).
Several large epidemiological studies have concluded that there is a
strong inverse association between wholegrain intake and risk of CHD2-5.
Anderson et al. concluded from their meta-analysis that an intake of three
servings a day of wholegrain (48 g/day) could reduce risk of CHD by around
30%6,7.
The structure for all wholegrains is similar and is made up of three
components, the germ, the bran and the endosperm, which provide a package
of nutrients, phytoprotective components and fibre that work
synergistically. Greater consumption of wholegrain cereals is associated
with favourable changes in serum lipoproteins, lower serum insulin levels,
lower blood pressure and lower risk of developing diabetes. Thus a
recommendation to increase intake of wholegrains to reduce risk for CHD is
strongly supported by scientific evidence.
Emerging evidence is also indicating that people who eat wholegrain
foods every day are less likely to be overweight8,9, and that wholegrains
may enhance satiety, thereby prolonging the return of hunger following a
meal10.
Perhaps the concepts of the Polypill and the Polymeal could be
further enhanced by a wholegrain ‘Polyfiller’ approach, which could aid
weight control and provide cardioprotective benefits.
References
1. Franco, OH, Bonneux, L, de Laet C, Peeters A, Steyerberg EW &
Hackenbach JP. The Polymeal: a more natural, safer and probably tastier
(than the Polypill) strategy to reduce cardiovascular disease by more than
75%. BMJ 2004; 329: 1447–1450.
2. Jacobs DR Jr, Meyer HE, Kushi LH & Folsom AR. Wholegrain intake may
reduce the risk of ischemic heart disease death in postmenopausal
women.The Iowa Women’s Health Study. Am J Clin Nutr. 1998; 68: 248–257.
3. Liu S, Stampfer MJ, Hu FB, Giovannucci E, Rimm E, Manson J et al.
Wholegrain consumption and risk of coronary heart disease: results from
the Nurses’ Health Study. Am J Clin Nutr. 1999; 70: 412–419.
4. Jacobs DR Jr, Meyer HE, Kushi LH & Folsom AR. Is wholegrain intake
associated with reduced total and cause-specific death rates in older
women? The Iowa Women’s Health Study. Am J Clin Nutr. 1999; 89: 322–329.
5. Jacobs DR Jr, Meyer HE & Solvoll K. Reduced mortality among
wholegrain bread eaters in men and women in the Norwegian County Study.
Eur J Clin Nutr. 2001; 55: 137–143.
6. Anderson JW & Hanna TJ. Wholegrains and protection against coronary
heart disease: what are the active components and mechanisms? Am J Clin
Nutr. 1999; 70: 307–308.
7. Anderson JW, Hanna TJ, Peng X & Kryscio RJ. Wholegrain foods and
heart disease risk. J Am Coll Nut. 2000;19: 291S–299S.
8. Liu S, Willett WC, Manson JE, Hu FB, Rosner B & Colditz G. Relation
between changes in intakes of dietary fibre and grain products and changes
in weight and development of obesity among middle-aged women. Am J Clin
Nutr. 2003; 78(5): 920–927.
9. Koh-Banerjee P, Franz M, Sampson L, Liu S, Jacobs DR, Spiegelman D et
al. Changes in wholegrain, bran and cereal fiber consumption in relation
to 8 y weight gain among men. Am J Clin Nutr. 2004; 80: 1237–1245.
10. Pereira MA, Jacobs DJ Jr, Pins JJ, Raatz SK, Gross MD, Slavin JL et
al. Am J Clin Nutr. 2002; 75: 848–855.
Competing interests:
Research activities at Newcastle University; scientific adviser to food manufacturing companies and trade organisations promoting wholegrain cereals
Competing interests: No competing interests
Whatever the shortcomings of the PolyMeal might be, it surprises me that readers think that it a piece of satire.
A visit to the website of one of the listed sponsors VicHealth (part of the State Health Department of Victoria, Australia) shows that it is in line with several similar projects which have been funded by them. http://www.vichealth.vic.gov.au/default.asp?artid=570&tid=430&level=2
If coronary heart disease is the largest single cause of premature death in most Western countries, and yet relatively rare in most other countries, is it really that surprising that researchers would attempt to design the ideal diet for coronary risk reduction?
What surprises me is that it such a neglected area.
To be sure, there are problems with the PolyMeal as a piece of statistical extrapolation, but as an overall concept, is it really so silly?
Competing interests:
None declared
Competing interests: No competing interests
Twenty four Rapid Responses to the Polymeal published so far - maybe
it's time to make up the balance. What should have been a medical
scientific debate, digressed for me into a guessing game of who was
serious and who was having fun.
Fourteen respondents (Hegde, Nehrlich, Wilson, Hickey (2x),
Chittarvu, Lowe, Zauli, Van Zuiden, Rush, Levine, Mohammed, Santaella,
Baciarello): 58 % seem to me to take it dead serious, which could give
medical problems in the first place, although some of them with quite some
humor, of which 5 (Nehrlich, Hickey (2x), Van Zuiden, Levine): 21 % seem
to think that it's a joke in the sense: meant seriously but only worth
laughing about, or seem to make plain fun of it. Four (Gavron, Raphael,
Chung, Witthoft): 17 % state openly to believe the article is just
satirical, 6 (Converse, Peers, Vos, Kulkarni, Tombesi, Wyman): 25% I
believe believe the same and in the same style make fun of the subject
(but how can I be sure - maybe they are serious too?!).
In the lay press the reporting has been wide and as far as I know the
article has been taken a 100 % seriously. That's not funny anymore.
Unfortunately I'm convinced that the article is not meant as a joke (isn't
that embarrassing) so at least the general population got that right. How
are we going to prevent future instances wherein an article is of such
poor medical quality that half (52 %) of the respondents assume that it is
(meant as) a joke (besides most of the others also making serious
objections), while the public gets it served as serious medical science.
Should the Journal not take responsibility (in this case) to try get
across to the general press that the article is very controversial and on
top of that was widely wrongly understood [1]. Because even if this diet
will ever be kept by anyone, and would give the predicted reduction in
heart disease, cardiologists would have to be retrained not as chefs but
as specialists in dentistry, malnutrition, diabetes and alcoholism. The
only health benefit I see from the Polymeal is that it gave a number of
respondents a few good laughs, which is known to release tension, and
benefit people's health and recovery in many other ways.
[1] The most obvious mistake was assuming that one would live longer
if one ate this diet, instead of that one would not so quickly get heart
diseases but that this could ruin your health in many other ways. Here a
few random quotes from World Wide Web that claim that eating Polymeals
would let you live longer:
www.jpost.com/servlet/Satellite?pagename=JPost/JPArticle/ShowFull&cid=11...
"Scientists have come up with a tasty formula to lengthen your life
expectancy by an average of five to 6.6 years".
www.guardian.co.uk/food "How to live longer: a Polymeal a day".
society.guardian.co.uk/publichealth/story/0,11098,1375671,00.html "how to
live longer".
s105883597.websitehome.co.uk/showthread.php?t=214152 "could expect to live
more than six years longer".
www.whydiabetes.com/healthier-life.html "Live Longer and Healthier".
www.ift.org/news_bin/news/newsFrames.php "Polymeal: eat right: live
longer".
www.paleblue.us "How to live longer: Eat your Polymeal. Eating chocolate
and drinking red wine could save your life".
wwwc.environmentalhealthnews.org/archives.jsp?todaycount=13&date=1"How
to live longer: a polymeal a day".
presentsimple.blogspot.com "The Polymeal diet will make you live longer".
www.bnn-online.co.uk/news_search_lap.asp "LIVE LONGER ON DAILY POLYMEAL".
groupsrv.com/science/viewforum.php?f=16 "How to live longer: a Polymeal a
day".
www.colemancoaching.com/health "Polymeal is Good Food. Live longer and
better".
www.netdoctor.co.uk/news/index.asp "How to live longer: a Polymeal a day".
www.torontotelegraph.com/p.x/ct/10/id/hfu8sjsy4hjfjdha "How to live
longer: a Polymeal a day".
www.business-at.com "Polymeal, can help you live longer".
medicalnewstoday.com/medicalnews.php?startnum=9756&currpage=12&am
p;... "Wine and chocolate help you live longer and better".
www.barking-moonbat.com "Want to Live longer? Maybe all you need in your
diet is some polymeal."
Competing interests:
None declared
Competing interests: No competing interests
Platelet oleic acid as Ischemic Cardiovascular disease marker
Dear Sir,
In our study we have evaluated the platelet fatty acid composition in 50 subjects with clinical symptoms of Ischemic Cardiovascular Disease confirmed by hemodynamic investigation, and in 60 apparently normal subjects. The results obtained show that Oleic Acid (OA), Linoleic Acid (LA) and Arachidonic Acid (AA) are characteristic in the two groups. The data, evaluated with a Self Organizing Map a not supervised artificial neural network, have demonstrated a clear split between the pathological and normal subjects. In agreement with the Polymeal work, we suggest evaluating also extravirgin olive oil as a food of Polymeal group.
Competing interests:
None declared
Competing interests: Fatty Acids Normal(m±DS) Pathologic(m±DS) pC14:0 0.87±0.59 0.34±0.26 <0.01C16:0 20.68±2.15 23.32±3.17 <0.01C16:1 1.48±0.71 0.74±0.54 <0.01C18:0 11.23±3.00 17.65±2.50 <0.01C18:1 n9 22.19±2.08 17.48±2.14 <0.01C18:1 n7 1.82±0.64 1.04±0.46 <0.01C18:2 n6 19.41±2.69 10.51±3.44 <0.01C18:3 n3 0.48±0.17 0.59±0.30 <0.05C20:3 n3 2.11±0.76 0.73±0.42 <0.01C20:4 14.06±2.41 15.17±3.01 <0.05C22:6 n3 2.09±0.80 1.87±0.70 n.s.