Does an Apple a Day Really Keep the Doctor Away?
“Does an Apple a Day Really
Keep the Doctor Away?” Does an apple a day
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 the 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.” 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 taken a prescription
medication within the last month.
8,000 individuals surveyed and only about 1 out of 10 reported
eating an apple over the last 24 hours, and the evidence 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. However, 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. 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, if 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 a bit
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 to model the effects of stroke
and heart attack mortality of all older adults being prescribed either a cholesterol-lowering
statin drug or an apple a day. 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 effect, and concluded that prescribing
an apple a day is likely to have a similar effect on the 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. I mean here in the US, one would
expect five times those numbers, though ironically, the cost of apples is likely to be greater
than those of statin drugs. I mean Generic Lipitor
is like 20 cents a day. So, yes, with similar
reductions in mortality, the 150-year-old health promotion
message of an apple a day can 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. I mean just one gulp with the drug, compared to all that
time-consuming chewing.
