Polyphenols are dietary constituents of plants associated with health-promoting effects. In the human diet, polyphenols are generally consumed in foods along with macronutrients. Because the health benefits of polyphenols are critically determined by their bioavailability, the effect of interactions between plant phenols and food macronutrients is a very important topic. In the present review, we summarise current knowledge, with a special focus on the in vitro and in vivo effects of food macronutrients on the bioavailability and bioactivity of polyphenols. The mechanisms of interactions between polyphenols and food macronutrients are also discussed. The evidence collected in the present review suggests that when plant phenols are consumed along with food macronutrients, the bioavailability and bioactivity of polyphenols can be significantly affected. The protein–polyphenol complexes can significantly change the plasma kinetics profile but do not affect the absorption of polyphenols. Carbohydrates can enhance the absorption and extend the time needed to reach a maximal plasma concentration of polyphenols, and fats can enhance the absorption and change the absorption kinetics of polyphenols. Moreover, as highlighted in the present review, not only a nutrient alone but also certain synergisms between food macronutrients have a significant effect on the bioavailability and biological activity of polyphenols. The review emphasises the need for formulations that optimise the bioavailability and in vivo activities of polyphenols.