The
Zen of Science
I once read the
following advice in an article by a so-called alternative healer.
“If you really crave a food, you ought not to eat it because
craving is a sign of allergy.” This sentiment looks to me
like a modern restatement of the old Puritanical distrust of the
physical body, wrapped up in pseudo-scientific gobbledygook. If
something appeals to your senses, that author reasons, it must
be bad for you. Only now it seems that it’s not just bad
for your soul. It’s bad for your body too.
Much of what passes in the standard medical literature for solid
nutritional advice is also cast in such a negative tone. It’s
all about what you shouldn’t put in your mouth: saturated
fat, alcohol, simple carbohydrates, etc. Though inundated by messages
about what not to consume, the American public eats less healthily
and supersizes itself more with every passing year. Epidemiologists
are even speculating that some of the gains in longevity made
in recent decades are being wiped out by the obesity epidemic.
After a half-century of harping, you’d think both the straight
and the alternative medical communities would get the message
that self-denial doesn’t work, at least not as a public
health strategy.
In 2003, a couple of professors from the University of London
published an article in The British Medical Journal entitled,
“A strategy to reduce cardiovascular disease by more than
80 percent.” Their work broke new conceptual ground in the
field of health promotion and disease prevention. The authors
recommended universal administration of a “Polypill”
to people over 55. This pill would contain a small dose of a cholesterol-lowering
drug, aspirin, folic acid, and sub-therapeutic doses of three
antihypertensive drugs.
The cholesterol
drug reduces levels of LDL (“bad”) cholesterol, and
so retards growth of the plaque on coronary and cerebral arteries
that can initiate the clots that cause heart attack or stroke.
Aspirin inhibits blood clotting. Folic acid raises homocysteine
levels. (Though we don’t know the exact mechanism or even
if there’s a real cause and effect relationship between
homocysteine and arterial plaque, we do know that lower levels
of this amino acid are associated with higher levels of vascular
disease.) And there is a near-linear relationship between blood
pressure and arterial disease risk. The lower the pressure, the
lower the risk.
So, the doctors
reasoned, why not reduce everybody’s risk factors for the
deadliest diseases in the developed world by giving small, safe
doses of drugs that heretofore have been prescribed in larger
therapeutic doses only for people who have bona fide elevated
risk of arterial disease? And they threw in aspirin and a vitamin
too.
The scientists
calculated that if this regimen were adopted by every British
adult 55 and over, it would reduce the incidence of coronary artery
disease by 88 percent and of stroke by 80 percent, tacking an
average of 11 years onto the life of the Queen’s subjects.
They estimated that with a formulation containing lower-cost anti-hypertensive
medications, about 15 percent of recipients would suffer significant
side effects. That number could be whittled down to eight percent
by using more expensive drugs with fewer side effects, a regimen
that might be reserved for those who don’t tolerate the
lower-cost combination.
The majority of
complications would be caused by the small dose of aspirin, 75
mg., about one fifth the quantity in a regular-strength adult
aspirin. Those side effects are bleeding from the stomach and
bleeding into the cranium. Still, the excess deaths resulting
from stomach hemorrhages would be far less than the lives saved
by preventing heart attacks and strokes. Furthermore, the strokes
avoided by retarding blood clots from forming in or traveling
to the brain would significantly outweigh the increased incidence
of hemorrhagic strokes, producing an overall net reduction of
cerebral events by 16 percent.
This sounds like
a good deal, doesn’t it? It certainly would make my job
easier, requiring a lot less medical testing and tedious individualizing
of drug choices and doses. A universally applied, one-size-fits-all
approach to vascular disease prevention might help a wide swath
of my patients who were otherwise destined to die from or to be
incapacitated by heart attack or stroke.
These ideas have
generated a lot of discussion. There is plenty to quibble about
in terms of estimating and balancing positive effects of each
of the medications and of the overall intervention with negative
effects and costs. As far as I know, no government nor pharmaceutical
company has begun developing a Polypill since the article came
out in 2003.
About a year and half after publication of the original Polypill
piece a most interesting response appeared, also in The British
Medical Journal, written by researchers from Holland, Belgium
and Australia. Their work, a takeoff on the Polypill concept,
is entitled, “The Polymeal: A more natural, safer, and probably
tastier (than the Polypill) strategy to reduce cardiovascular
disease by more than 75 percent.” These scientists took
the best epidemiologic evidence about foods that reduce the risk
of cardiovascular disease and came up with an eating plan which
they called the “Polymeal.” They calculated the Polymeal
would decrease the incidence of heart attack and stroke by almost
as much as the Polypill.
Like their Polypill colleagues before them, the Polymeal folks
did not preach avoidance of a whole list of pleasurable foods.
Their positive attitude ought to give the intervention a much
better chance of working than the usual abstinence-based lifestyle
recommendations so piously intoned by just about every healthcare
professional and organization. The “Just Say No” approach
appears to be doomed to irrelevance when it comes up against the
biological fact of human appetites.
By contrast, the
Polymeal actually sounds pleasurable. It is a prescription for
daily consumption of five ounces of wine, three ounces of dark
chocolate, 14 ounces of fruits and vegetables, two ounces of almonds,
and the equivalent of about one clove of garlic, plus four ounces
of fish four times a week. Imagine, a diet that requires wine,
dark chocolate and almonds!
Unlike with the
Polypill, there are no side-effects of the Polymeal lifestyle,
except, of course, for those who may be allergic to one or more
of the prescribed comestibles. There are well-founded concerns
about people who cannot keep their alcohol consumption to a reasonable
level or who cannot stay off the road after drinking. And some
scientists worry that increased intake of large ocean fish, which
concentrate mercury pollutants in their flesh, could raise the
quantity of that toxic substance to unacceptably high levels in
the human body.
There is a problem
with garlic too. Even when delivered in capsules as a powder,
garlic causes indigestion in some and a garlicky body odor in
many. Referring to this spice, the authors “...do not recommend
taking the Polymeal before a romantic rendezvous unless the partner
also complies with the Polymeal.”
Without enhancements,
the researchers estimate that the Polymeal would add 6.6 years
to the lives of British men and 4.8 years to women. Other healthful
dietary practices, not so well studied and quantified as those
recommended by the authors, such as consuming monounsaturated
oils like olive and canola, tomatoes, oat bran and other foods,
could further increase the benefits to a population that adopts
them. Walking and other forms of exercise would certainly contribute
to longevity too.
The Polypill regimen
could even be added to the Polymeal (or vice versa). The authors
of the Polymeal article go so far as to suggest that if enough
of these dietary and pharmacologic practices are adopted by a
large segment of the population, “Redundant cardiologists
could be retrained as Polymeal chefs and wine advisers.”
Judging by the appeal of their recommendations, not to mention
the wit with which they write, the Polymeal folks have significantly
more fun than the Polypill people do. You’d probably be
better off and certainly happier if you were to break bread with
the authors of either of the articles than you would with that
guy who believes that any food you crave must not be good for
you.
Marc Ringel,
MD, is a family practitioner and writer based in Greeley, Colorado.
JULY/AUGUST 2008 FEATURE ARTICLES
