September 25

Flashback Friday: Does an Apple a Day Really Keep the Doctor Away?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Does an apple a day really keep the doctor away? That’s “a public health message” that’s been around since 1866, but is it true? You don’t know, until you put it to the test: “The association between apple consumption and physician visits,” published in the AMA’s internal medicine journal. “Objective: To examine the relationship between eating an apple a day and keeping the doctor away.”

“Promoted by the lay media and powerful special interest groups including the US Apple Association”—so powerful that Big Apple recently spent a whopping $7,000 lobbying politicians— “the beneficial effects of apple consumption” may include a facilitation of “weight loss,” protection of the brain, “cancer suppression, a reduction in asthma symptoms, and improved cardiovascular health.” So, apple consumers ought to require less medical care, right? “Although some may jest, considering the relatively low cost of apples…, a prescription for apple consumption could potentially reduce national health care spending if the aphorism holds true.”

So, they compared daily apple-eaters to non-apple-eaters, and asked if they had been to the doctor in the last year, been hospitalized, seen a shrink, or took a prescription medication within the last month. 8,000 individuals surveyed, and only about one out of ten reported eating an apple over the last 24 hours. And, the “[e]vidence does not support that an apple a day keeps the doctor away…” So, maybe it takes more than an apple a day. Maybe we need to center our whole diet around plant foods. “[H]owever, the small fraction of US adults who eat an apple a day do appear to use fewer prescription medications.” So, maybe the proverb should be updated to clarify that, if anything, “apple eating may help keep the pharmacist away.”

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But, hey, based on the average medical prescription cost, the difference in “annual prescription medication cost per capita between apple eaters…and non-apple eaters” could be hundreds of dollars. So, “[i]f all US adults were apple eaters,” we could save nearly $50 billion. Of course, if you factor in the cost of the apples themselves, we’d only get a net savings of like $19 billion. If this all seems like a bit of tongue-in-cheek-apple-polishing, you’ll note this was published suspiciously close to April Fool’s day. And, indeed, this was in the tradition of the British Medical Journal’s annual Christmas issue that features scientifically rigorous yet light-hearted research, which itself took on the apple issue “[t]o model the effects on…[stroke and heart attack] mortality of all [older] adults being prescribed either a [cholesterol-lowering] statin [drug] or an apple a day.

Basically, they took studies like this, where you see this nice dose response where the more fruit you eat, the lower your stroke risk appears to fall. And, similar data for heart disease, compared to the known drug effects, and concluded that “[p]rescribing…an apple a day…is likely to have a similar effect on population [stroke and heart attack] mortality” as giving everyone statin drugs instead. And, hey, apples only have good side effects. “Choosing apples rather than statins may avoid more than a thousand excess cases of [muscle damage] and more than 12 000 excess diabetes diagnoses,” because statins increase the risk of diabetes, and this was in the UK. Here in the U.S., one would expect five times those numbers—though, ironically, “[t]he…cost…of apples [is] likely to be greater than [that] of statin…[drugs].” Generic Lipitor is only like 20 cents a day.

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So, yes: “With similar reductions in mortality, the 150 year old health promotion message of an apple a day is able to match modern medicine and is likely to have fewer side effects.” But, apples are a few pennies a day more expensive, not to mention the increased time and difficulty associated with consuming an apple compared to a statin. Just one gulp with the drug, compared to all that “time consuming” chewing.

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