An apple a day may not keep the doctor away, but it’s a healthy choice anyway

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I don’t know about you, but I am a longstanding believer in an apple a day. There’s always a big wire basket of Galas or Fujis in my kitchen, and I break my fast with an apple over morning email. The enjoyment of apples in my home even crosses the species barrier, as our Giant Schnauzer maws down his twice-daily thyroid pill in meaty quarters of apple. But, are there true apple health benefits? Or, is this just an old adage.

So I read with great interest a report entitled “Association Between Apple Consumption and Physician Visits: Appealing the Conventional Wisdom That an Apple a Day Keeps the Doctor Away” in this week’s edition of JAMA Internal Medicine.

The report was published in the journal’s inaugural April Fools’ Day issue by a pack of parodists from Dartmouth College, the University of Michigan School of Nursing, and the Veteran Affairs Medical Center in White River. It’s based on actual national nutrition data collected from nearly 8,400 men and women — 753 of whom ate an apple a day — and follows rigorous study methods.

Disappointingly, the study concludes, “Evidence does not support that an apple a day keeps the doctor away; however, the small fraction of US adults who eat an apple a day do appear to use fewer prescription medications.”

Apples may have failed this critical scientific test, but you’ll have to pry this tasty fruit from my cold, dead fingers. I wondered if Harvard nutrition experts believe in apple health benefits as strongly as me.

“I do not eat an apple every day,” admits registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women’s Hospital. “However, I do love apples and eat them frequently.”

McManus reassured me that, even though the JAMA study is published with tongue in cheek, you can trust your taste buds if you are an apple fancier. There are some true apple health benefits.

For one thing, you can’t beat the convenience of an apple, McManus points out. “They are an easy go-to snack.” Since apples are about 85% water by weight, they can help fill you up without a lot of calories.

Apples also follow kindergarten rules, since they play nicely with other healthy foods. “I often encourage my patients to combine a healthy carb with a healthy fat and protein by spreading peanut butter on an apple,” McManus says. “Low fat cheese also goes well with apple. Apples are great in salads and salsas, too.”

The belief in apple health benefits seems beyond repute. But can we be sure? In the health field, invisible agendas are omnipresent. After all, the JAMA authors warn, the health benefits of frequent apple intake have been “promoted by the lay media and powerful special interest groups, including the US Apple Association.”

Health reporters need to ask the hard questions. The people demand to know why apples are healthy. I asked McManus to bottom-line it for me.

“In fresh fruit and vegetables you get a complete package of healthy nutrients,” she says. “There is good data to show that the soluble fiber in apples can help prevent cholesterol from building up on artery walls. Apples contain a good amount of potassium, which can be beneficial for those who are watching their blood pressure.”

McManus disclosed no financial relationships with the apple industry. I, on the other hand, can be bought for a paltry peck of Newtown Pippins. It seemed sensible to contact the U.S. Apple Association for comment (and see if they would make me an offer I couldn’t refuse).

In a somewhat carefully prepared statement, Wendy Brannen, Director, Consumer Health & Public Relations for U.S. Apple Association (USApple) said, “Here at USApple, we are all for research and always happy to put the age-old ‘apple a day’ adage to the test.”

However, Brannen asserted, she and her apple-promoting colleagues “are of the mind that an apple a day really does keep the doctor away — or at the minimum make your doctor visits much more palatable.”

Brannen added: “We realize this is going in JAMA’s April Fools’ issue, but it’s foolish to even imply enjoying an apple a day doesn’t support good, preventative health.”

No offense, but I’d call that sour grapes! Thank goodness for objective, evidence-based apple epidemiology.

It would be irresponsible not to address the most controversial public health issue regarding apples: Is apple juice as good for you as a whole apple? McManus is clear on this: “I strongly suggest you eat the whole apple. Juice does not have the fiber a whole apple does, and a good part of the beneficial nutrients are in the skin. Apple juice is not equal to a real apple.”

Are you listening, Apple Juice Industrial Complex?

What we need to resolve this controversial issue is better data. So here’s a suggestion for next year’s April Fools’ issue: “Juice Box or Jawbone: A Randomized Clinical Trial Assessing the Health Benefits of Liquid or Solid Preparations of Apples.”