Does an apple a day _really_ keep the doctor away?

For more than a century, parents and grandparents have instructed children that “an apple a day keeps the doctor away.” Perhaps we’ve accepted the time-worn adage as truth because no one bothered to put this advice to the test, until relatively recently. When scientists did formally investigate it, they found that eating an apple a day does not keep the doctor away—but it just might keep the pharmacist away, according to the results of their study in JAMA Internal Medicine.

“To our knowledge, the association between daily apple consumption and use of health-care services has never been rigorously examined,” wrote the authors, led by Matthew A. Davis, PhD, MPH, DC, assistant professor, Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI. “Although some may jest, considering the relatively low cost of apples (currently $1.13 per pound of Red Delicious apples), a prescription for apple consumption could potentially reduce national health-care spending if the aphorism holds true.”

To find out, Dr. Davis and colleagues analyzed data from 8,399 eligible adults who completed a dietary recall questionnaire as part of the 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey. Of these individuals, 753 (9%) self-identified as daily apple eaters (those who consumed at least 1 small apple or 149 g of raw apple per day) and 7,646 (91%) reported they did not eat an apple a day.

Because one annual physician visit is now the de facto standard for US adult health care, the authors classified “keeping the doctor away” as successfully avoiding two or more physician visits in the past year.

Results showed apple eaters had higher educational attainment, were more likely to be from a racial or ethnic minority, and were less likely to smoke compared with non-apple eaters.

But after the researchers adjusted for sociodemographic and health-related characteristics, they found that apple eaters did not significantly “keep the doctor away” any better than non-apple eaters. Similarly, apple eaters were no better than non-apple eaters at avoiding overnight hospital stays or mental health visits. However, apple eaters were marginally more successful at avoiding prescription medications (odds ratio: 1.27; 95% CI: 1.00-1.63).

“Our findings suggest that the promotion of apple consumption may have limited benefit in reducing national health-care spending. In the age of evidence-based assertions, however, there may be merit to saying, ‘An apple a day keeps the pharmacist away,’” the authors concluded.

As such, there’s no reason to quit eating apples, they indicated.

“In terms of what we found, it sort of depends on whether or not you take the proverb literally,” said Dr. Davis, who also is a member of the University of Michigan Institute for Healthcare Policy and Innovation. “If you interpret the apple as being more of a symbol of proper nutrition, I think everyone would agree that a healthy diet is a wise choice and will likely reduce your need for excessive medical services.”