An Apple a Day May Keep the Pharmacist Away

Which would save more lives: eating an apple a day or taking statin drugs?

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. As I discuss in my video Flashback Friday: Does an Apple a Day Really Keep the Doctor Away?.

The objective of “The Association Between Apple Consumption and Physician Visits,” an article published in the American Medical Association’s internal medicine journal, was simple: “To examine the relationship between eating an apple a day and keeping the doctor away.”

The message has been “promoted by the lay media and powerful special interest groups, including the US Apple Association”—a force so powerful that it spent a whopping $7,000 lobbying politicians during the 2017-18 election cycle. (Okay, so maybe Big Apple is more like an itty bitty appletini.) At any rate, the beneficial effects of apple consumption may include facilitation of “weight loss, prevention of neurologic degradation [protection of the brain], cancer suppression, 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.”

Researchers 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 mental health professional, or took any prescription medication within the last month. More than 8,000 individuals were surveyed, and only about one out of ten reported they had eaten an apple in the last 24 hours. The finding? “Evidence does not support that an apple a day keeps the doctor away…” Maybe it takes more than an apple a day? Maybe we need to center our whole diet around plant foods. “However, the small fraction of US adults who eat an apple a day do appear to use fewer prescription medications.” Given that, perhaps we should “update the well-known proverb to clarify that, if anything, apple eating may help keep the pharmacist away.”

But, based on the average medical prescription cost, the researchers estimate that “the difference in annual prescription medication cost per capita between apple eaters ($1697) and non-apple eaters ($1925) to be $228”—hundreds of dollars saved. So, if all U.S. adults were apple eaters, we could save nearly $50 billion. Of course, if you factor in the cost of the apples themselves, our net savings would be closer to $19 billion, but that’s still a hefty chunk of change. If this all seems a bit like tongue-in-cheek-apple-polishing, you may be tickled to learn this study was published suspiciously close to April Fool’s Day. Indeed, this was in the tradition of the British Medical Journal’s annual Christmas issue that features scientifically rigorous, yet light-hearted, research. In fact, the BMJ itself took on the apple issue to model the effects on stroke and heart attack mortality of all older adults prescribed either a cholesterol-lowering statin drug or an apple a day.

Essentially, researchers took studies like the one I show at 3:06 in my video, where we see a nice dose response indicating the more fruit you eat, the lower your stroke risk appears to fall, as well as similar data found for heart disease compared to the known drug effects, and concluded that prescribing an apple a day “is likely to have a similar effect” on population stroke and heart attack mortality as giving everyone statin drugs instead. Bonus that apples only have good side effects. “Choosing apples rather than statins may avoid more than a thousand excess cases of myopathy [muscle damage] and more than 12 000 excess diabetes diagnoses” (because statins increase the risk of diabetes). And, this article was from the UK. In the United States, one would expect five times those numbers. Ironically, though, the cost of apples is likely to be greater than that of statin drugs. (Generic Lipitor is only around 20 cents a day.) 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 they “require the more complex and time consuming process of coordinated mastication and swallowing.” Just one gulp with the drug compared to all that time-consuming chewing…

Should we see our doctors every year regardless of how we’re feeling? See my videos Is It Worth Getting Annual Health Check-Ups?, Is It Worth Getting an Annual Physical Exam?, and Flashback Friday: Worth Getting Annual Health Check-Ups and Physical Exam?.

Do you like the thought of taking a more food-based approach to treatment? If so, you’ll love lifestyle medicine. Check out Lifestyle Medicine: Treating the Causes of Disease.

Sadly, Physicians May Be Missing Their Most Important Tool.

KEY TAKEAWAYS

The public health message an apple a day keeps the doctor away has been circulating since 1866.
Benefits of apple consumption may include facilitation of weight loss, protection of the brain, cancer suppression, reduced asthma symptoms, and improved cardiovascular health.
When researchers compared daily apple eaters to non-apple eaters, they found that evidence does not support the well-known proverb, although those eating an apple a day do appear to use fewer prescription drugs.
Given average medical prescription costs, researchers estimated that each person could save hundreds of dollars annually just by eating apples. In fact, if all U.S. adults ate apples, we could save about $19 billion after factoring in the cost of the fruits themselves.
The more fruits we eat, the lower our stroke risk appears to fall.
Researchers concluded that a daily apple may have a similar effect on stroke and heart attack mortality as statin drugs, and apples only have good side effects, unlike statins, which increase the risk of diabetes.

For more on apples, see:

What about apple cider vinegar? Check out Flashback Friday: Does Apple Cider Vinegar Help with Weight Loss?.

In health,

Michael Greger, M.D.

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