The Polymeal is an effective, natural, probably safer, and tastier alternative to the Polypill to reduce cardiovascular disease and increase life expectancy in the general population. The effect was consistent in both men and women at age 50. 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. No additional adverse effects should be expected from the other ingredients of the Polymeal (in the quantities recommended here) except in people who are allergic to the components. Another advantage of the Polymeal is that its ingredients can be taken combined as a meal or individually at different times of the day. Taking the Polymeal on a daily basis (fish two to four times a week) should be feasible, considering that the ingredients are generally well tolerated and appreciated among the general population. The development and distribution of specific recipes combining the Polymeal ingredients could enhance the compliance of the population.
Costs and precautions
Although the exact price of the Polymeal is unknown and will be country specific, it could be expected to be similar to or perhaps higher than that of the Polypill. By checking a local supermarket in Rotterdam, the Netherlands, we estimated a total price for the Polymeal of €21.60 (£15.20; $28.10) a week (€3.50 for the wine, €6.23 for fruit and vegetables, €2.80 for almonds, €4.34 for dark chocolate, €0.14 for garlic, and €4.60 for fish). Although we do not recommend particular brands, spending more—for example, on your favourite bottle of wine or brand of chocolate—might also be rewarded by an improved quality of life.
The Polymeal should not be combined with additional consumption of alcohol, in order to avoid intoxication and conflicts with friends, relatives, and authorities; furthermore, additional alcohol consumption could attenuate the effects of the Polymeal and negatively influence other health measures. Driving motor vehicles or performing activities that require high levels of attention shortly after the consumption of the Polymeal should be avoided. Moreover, considering the disturbing adverse effects of garlic, we do not recommend taking the Polymeal before a romantic rendezvous, unless the partner also complies with the Polymeal.
We believe our search was comprehensive and although we looked for additional ingredients to include in the Polymeal, we found no other potential components with a sufficient level of evidence or with clearly reported effects on cardiovascular disease events or on modification of risk factors of cardiovascular disease. Some other ingredients could be added to the Polymeal (olive oil, echium oil, soya oil, soya beans, tomatoes, oat bran, cereals, nuts, tea, chickpeas, and so on), but this will only improve its effect on cardiovascular disease risk reduction.
Concerns might be raised about the validity of the source evidence and the multiplicative model used to calculate effects of the ingredients of the Polymeal. However, these are shared by the Polypill analyses, as we used a similar approach. None the less, a greater possibility of interaction exists between dietary factors as less information is available about underlying mechanisms of action. This might result in an overestimation of the effect of the Polymeal.
What is already known on this topic
Prevention of cardiovascular disease is limited by high costs and low compliance
The concept of a combination pill (the Polypill) to reduce cardiovascular disease by more than 80% was introduced in 2003
Pharmacological interventions are not the only option for preventing heart disease; a healthy diet and an active lifestyle reduce cardiovascular disease as well
What this study adds
A combined meal of seven food components (the Polymeal) could reduce cardiovascular disease by more than 75%
Chocolate, wine, fish, nuts, garlic, fruit, and vegetables are all known to have a positive effect on cardiovascular disease, and have been enjoyed by humankind for centuries
Finding happiness in a frugal, active lifestyle can spare us a future of pills and hypochondria
Another potential limitation of our study is that no back flows are allowed in the multi-state life tables, and only the first entry into a state is considered. This is not always seen in real patterns of morbidity and mortality.
No contraindications to combining the Polymeal with additional interventions seem to exist. After the daily consumption of the Polymeal, for example, half an hour of walking could prevent further cardiovascular disease events.21
For those people earnestly seeking to prevent cardiovascular disease, the Polypill can be combined with the Polymeal. The fortification of flour with Polypill ingredients (a statin, two antihypertensive drugs instead of three, folic acid, and aspirin) certainly merits further study. Redundant cardiologists could be retrained as Polymeal chefs and wine advisers.
The preventive strategy outlined here is radical. But the “healthy person” is an outdated concept from the era before scientific prevention. We should recognise that in Western society we all have cardiovascular risk factors, so everyone is at risk, and the diseases they cause are common and often fatal. It may be argued that the Polypill is even more effective, but the Polymeal promises to be an effective, nonpharmacological, safe, and tasty alternative for reducing cardiovascular morbidity and increasing life expectancy in the general population.