Days of wine and chocolate (and fish,

almonds, and garlic) might cut heart risk

by more than 75%
Denise Mann
December 29, 2004
Rotterdam, the Netherlands - The increased cardiovascular (CV) risk associated with
rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and other autoimmune
diseases has attracted more attention from rheumatologists over the past year. Diet changes
are a basic step in managing CV risk, and a new "polymeal" diet combination, proposed by
Dr Oscar H Franco (Erasmus University Medical Center, Rotterdam, the Netherlands), may
capitalize on previously identified cardioprotective aspects of some foods. The polymeal is
discussed in a retrospective study in the December 18, 2004 BMJ [ 1 ].
"The polymeal promises to be an effective nonpharmacological, safe, cheap, and tasty
alternative to reduce cardiovascular disease (CVD) morbidity and increase life expectancy in
the general population," Franco et al conclude. "We should recognize that in Western society
we all have cardiovascular risk factors, so everyone is at risk and the diseases they cause are
common and fatal."

Polymeal components cut heart disease risk, extend life

The polymeal is the successor to a proposal by Wald and Law to develop a "polypill" that
would reduce CVD rates by more than 80% by combining 6 drugs that reduce different CV
risk factors [ 2 ]. This idea crashed and burned due to concern about costs and potential
adverse effects.
Franco et al applied the same multifactor approach to diet interventions and concluded that
regular consumption of a small number of foods has the potential for achieving a major
reduction in CV risk. The components of the polymeal include daily consumption of dark
chocolate, almonds, fruits and vegetables, garlic, and wine and 4 times weekly consumption
of fish.
This combination could theoretically cut CV risk by 76% and significantly increase the life
expectancy of people over age 50, Franco says. Ingredients can be combined as a meal or
taken individually throughout the day.

Potential benefits of the polymeal

Ingredients Theoretical reduction in risk of CVD (%)

Wine (150 mL/day) 32
Fish (114 g 4 times/week) 14
Dark chocolate (100 g/day) 21
Fruit and vegetables (400 g/day) 21
Garlic (2.7 g/day) 25
Almonds (68 g/day) 12.5
Combined effect 76
Franco et al culled data on the individual ingredients of the polymeal from the literature,
using estimates based on either meta-analyses or randomized, controlled trials. They then
built life tables to model the benefits of the meal in the general population from age 50,
assuming multiplicative correlations from the Framingham Heart Study and the
Framingham Offspring Study.
For men, consuming the polymeal daily might increase total life expectancy by 6.6 years,
increase life expectancy free from CVD by 9.0 years, and decrease the duration of CVD by
2.4 years. For women, consuming the polymeal daily might increase total life expectancy by
4.8 years, increase life expectancy free from CVD by 8.1 years, and reduce the duration of
CVD by 3.3 years, the researchers estimate.
These cumulative changes are based on the combined contributions of each element of the
polymeal diet to changes in blood pressure, cholesterol, and the overall risk of heart disease.
For example, Franco et al cite studies showing that about 150 mL/day of wine reduces the
risk of heart disease by nearly one third and 114 grams of fish consumed 4 times a week cuts
CVD risk by 14%. Eating 100 grams of antioxidant-rich dark chocolate each day reduces
systolic blood pressure by 5.1 mm Hg and diastolic pressure by 1.8 mm Hg—which
corresponds with a 21% reduction in risk of heart disease. Daily consumption of 2.7 grams of
garlic each day lowers serum cholesterol concentrations by 0.44 mmol/L—corresponding to a
38% reduction of heart disease by age 50. Overall, excluding any ingredients caused a slight
decline in the overall heart-protection benefits, but skipping the wine reduced the meal's
beneficial impact the most, by about 10%, Franco said.

US physicians sound off on article, diet

"This is an interesting article," Dr Stephen P Glasser (University of Alabama at
Birmingham) tells rheuma wire . "While it is only theoretical, it is based on the literature and
is consistent with dietary recommendations over the past decade—ie, more fish, limited wine,
the use of legumes, dark chocolate, and fruits and vegetables."
However "the actual diet has never been tried as a whole," points out Dr Martin Jan
Bergman (Taylor Hospital, Ridley Park, PA) "Still, there is certainly ample literature
supporting the use of dietary manipulations to treat cardiovascular disease that is the result of
the Western diet."
Bergman adds that from a practical standpoint, "the diet sounds like a lot of fun and [is]
rather tasty. While you can't have your cake and eat it too, you can have your wine, dark
chocolate, and fruit for dessert." Whether this diet will produce the striking reduction in
cardiovascular disease predicted by the authors is unclear, he says. "It is, however, a safe and
gastronomically satisfying diet that can be recommended to virtually any patient" particularly
RA patients.

Role in RA should not be overlooked

We focus so much on what medications can and cannot do for us, yet we fail to recognize the
role that lifestyle choices make in our ultimate health.
"We focus so much on what medications can and cannot do for us, yet we fail to recognize
the role that lifestyle choices make in our ultimate health," Bergman says. "Patients with RA,
who have an estimated 3-fold increase in the risk of cardiovascular disease compared with the
general public, should consider any and all measures that might decrease this risk."
The polymeal, "if it can be shown to confer the savings in terms of life and morbidity
suggested in this study, is a simple and tasty way of maintaining good health that requires
little effort and low cost," he says. However, he warns that "any patient on methotrexate (and
probably leflunomide) needs to consider that increasing alcohol intake, even by a small
amount, increases the risk of liver toxicity to a significant degree."
Although he calls the study results "intriguing," Dr Salahuddin Kazi (Dallas VA Medical
Center, TX) remains dubious. He tells rheuma wire that any conclusions on the potential
effects would have to wait for a prospective randomized controlled trial. "The "calculated"
multiplicative effect of the individual components is of questionable validity, he says, a point
Franco et al acknowledge.

Sources

1. Franco OH, Bonneux L, de Laet C, et al. 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. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%.
BMJ 2003: 326:1419-1423.
From: http://www.medscape.com/viewarticle/538065