I aim to eat a nice, juicy apple every day. As one of the main dietary sources of a type of antioxidant polyphenol known as flavonoids, eating apples brings numerous health benefits. Researchers have found associations between increased flavonoid intake (mostly from apples) and a reduced risk of death from all medical causes, especially from heart attack or stroke.
Eating apples is also linked with a lower risk of type 2 diabetes, a lower LDL-cholesterol level and possibly even a reduced risk of cancer. Apple peel even has blood-pressure lowering actions similar to those of ACE inhibitor drugs.
Surely, eating an apple a day must keep the doctor away. How could they not? Imagine my surprise when recent headlines suggested the opposite.
The study seemed odd from the start
The study that generated the negative headlines looked for any association between apple consumption and physician visits in 8,399 healthy adults, aged 18 and over. Participants were classified as either apple-eaters or non-apple eaters based on a cut-off point of 149 grams apple per day. This figure, calculated from their 24-hour dietary recall surveys, corresponds to eating at least one small apple (7cm diameter) a day. Those whose apple intake was mainly derived from apple juice and apple sauce were excluded. So far so good.
The first odd thing was that only 753 apple eaters were identified among the participants – just 9% of the eight thousand plus taking part. That doesn’t mean the other 7,646 never met an apple, however. It just means they didn’t eat one within their 24 hour dietary recall period. Perhaps the day before their food frequency questionnaire was an orange day, or a banana day, or even a spikey rambutan day. Perhaps they normally ate a huge, juicy apple on six days out of every seven except on Wednesdays. Because they didn’t eat that one apple on that one particular day, they were classified as a non-apple eater.
The second odd thing about this study is that the definition of ‘keeping the doctor away’ was measured as no more than one self-reported visit to a physician during the previous year. I don’t know about you, but I visit my own GP several times a year for various health screenings, routine check-ups and what-not. Surely that doesn’t mean my daily apple is not keeping me healthy?
The third odd thing about this study is that unadjusted analyses DID show that apple eaters were more likely to stay away from their doctor – 39% of those consuming that apple on the day before their survey avoided seeing their doctor more than once in a year, compared with 33.9% who allegedly did not eat apples.
Apple eaters were also more likely to avoid taking a prescription medicine during the previous month than non–apple eaters (47.7% vs 41.8%). But the researchers then did some number crunching based on ‘sociodemographic and health-related characteristics’ such as age, sex, race, ethnicity, educational attainment, body mass index, smoking status and health insurance type and any significance in these findings mostly went away.
The fourth odd thing about this study is that it was published in time for headlines to hit on April 1st – April Fools Day – which just about sums it up for me.
Although the researchers claim their ‘Evidence does not support that an apple a day keeps the doctor away’ I don’t agree.
These findings are nowhere near robust enough for me to stop eating my daily flavonoid-enriched globe of juicy luciousness.
Am I the only one who feels this study does not deserve the headlines it gained?
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