An Apple a Day Keeps the Doctor Away: How Medical Proverb Compares to the Health Benefits of the Apple

The old adage “an apple a day keeps the doctor away” has been repeated so often that it essentially regarded as medical proverb. The benefits of eating an apple is taken for granted by the general public. However, it may surprise many to discover that this revered medical proverb has only been developed in recent times. In fact, apples received mixed reviews from society on their health benefits and detriments. Yet, modern research has unequivocally redeemed the apple as a valuable health supplement. Though traditional misconceptions and present concerns over the use of pesticides to produce apples serve to stigmatize the fruit, the apple’s efficacy in slowing aging (much like the health benefits of wine), preventing cancer, and promoting dental health shadow the criticisms of this essential fruit.

Origin of the “Apple a Day” Adage

Though the phrase “an apple a day keeps the doctor away” sounds as if it could have coined from a classical thinker, the phrase is surprisingly modern. Though the adage has undergone several transformations, it first appeared during the 19th century. As Washington Post writer Margaret Ely (2013) reported, the term was first recorded in 1860 and is believed to have originated from Pembrokenshire, Wales (para. 3). However, the original Welsh expression slightly differed from its common English form. Other phrasings of the expression included, “Eat an apple on going to bed, and you’ll keep the doctor from his earning, and you’ll keep the doctor from earning his bread” (para. 4). The statement was an acknowledgement of the long history that the apple had in Western civilization.

Horticulturalist James J. Luby (2003) discussed the history of the apple and its emergence in Western society. As Luby notes, the earliest example of domesticating apple comes from the Persian Empire in 500 BC (2003, p. 7). According to Luby, apple orchards were cultivated throughout the Persian Empire and were a significant part of the landscape (2003, p. 7). Though the cultivation of domesticated apples were initially a regional affair, apple orchards were introduced to the Greek world when Alexander the Great conquered the Persian Empire around 300 BC (2003, p. 7). The rise of the Roman Empire facilitated the diffusion of apple orchards across Europe, and soon apples became commonplace across the continent (2003, p. 7). In Western civilization, it was the Romans set the foundation for using the apple in medicine.

Journalist Erika Janik (2011) described the development of the culinary and medicinal uses of the apple in Greek and Roman society. According to Janik, many renowned century Greek physicians, including Galen and Hippocrates, believed that the apple was a useful dietary staple because it balanced main dishes in a meal and allowed the body to maintain equilibrium (2011, p. 69). According to Greek thought, the meats and other main sources were considered to be hot dishes, and the apple provided a counterbalance because it was considered to be a cool food (2011, p. 69). Similarly, the Romans believed that there were health benefits to consuming apples in addition to a meal. The Romans commonly ate apples following their meals in order to promote digestion (2011, p. 69). Because of these traditional beliefs, the apple became an important dietary staple for both the Greeks and the Romans.

While the Greeks recognized the medicinal benefits of the apple, the Romans established the tradition of utilizing the apple in medical treatments. As Janik noted, Romans believed that different types of apples could be cultivated to heal different medical conditions (2011, p. 69). Thus, a variety of apples were cultivated in order to treat a wide range of conditions, such as heart disease, arthritis, and sciatica (2011, p. 69). Additionally, the Romans used apples in natural remedies, diuretics and poison antidotes (2011, p. 69). While the Romans primarily viewed the apple as a beneficial fruit, the apple received mixed reviews during the Middle Ages.

The necessity of redeeming the reputation of the apple resulted in the renovation of the Welsh adage on the health benefits of apples. After the 12th century, apples were viewed with caution in European society though their medical applications were still supported. A prominent medical school in Salerno, Italy prescribed apples for medications that treated a wide range of ailments, including bowel irritation, lung ailments, and nervous system conditions (2011, p. 69). However, the general public believed that raw apples were unsafe to consume and preferred to use apples as an ingredient in alcoholic beverages (2011, p. 74). Throughout England and the Americas, apples were primarily produced so that they could be used to make apple cider (2011, p. 74). Yet, when the temperance movement threatened the profits of apple producers, they responded by attempting to focus on the traditional health benefits of apples (2011, p. 74). In face of a prohibition on apple cider, it was necessary for orchard owners to address the taboo on eating apples. Thus, fruit specialist J.T. Stinson coined the term “a apple a day keeps the doctor away” at the 1904 World Fair in St. Louis, preceding a widespread public relations campaign to enhance the reputation of apples (2011, p. 76). As the history of the apple reveals, this adage serves the dual purpose of improving the reputation of the apple while promoting its health benefits.

Drawbacks of a Daily Apple

Janik discussed many of the historical taboos on the consumption of apples. As she notes, the general public in Europe and America were wary of consuming raw apples until a 20th century campaign was launched to change public opinion (2011, p. 69). Though apples were revered in Roman society, the medieval association of the apple with the downfall of Adam and Eve in the Bible tainted the image of the fruit among the general population (2011, p. 70). Further, medieval Europeans held the common belief that the apple had an adverse effect on health. During the period, women and children were prohibited from eating apples because they were believed to cause upset stomachs and the flu (2011, p. 70). Though many of these misconceptions are no longer believed today, the tradition of viewing the apple as an impure fruit is still extant.

Even as the traditional taboos on eating an apple have vanished, present day concerns address the manner in which agricultural practices render the apple unfit for consumption. The dangers posed by the pesticides used to control pests in apple orchards became a public issue during the 1990s. In a 1993 publication, the Center for Disease Control reported an incident where twenty-six workers from nineteen different orchards became ill from their exposure to mevinphos, a pesticide that is used to control aphids that attack apples (1993, p. 993). During the incident, seven of the workers required hospitalization and four required intensive care for their condition (1993, p. 993). As the Center for Disease Control noted, the Environmental Protection Agency had classified mevinphos as an acutely toxic substance, and the Agency rated the substance with its highest level for toxicity (1993, p. 995). A concern with mevinphos was that there were many avenues through which an individual could be exposed to toxic amounts of the pesticide, including through inhalation and skin contact (1993, p. 995). One troubling aspect of this case is that the detrimental impact of mevinphos was only revealed after the danger to humans became evident.

Though the use of mevinphos was banned following the incident, many organizations caution that apple producers still use potentially dangerous pesticides on their products. According to a 2013 press release by the Environmental Working Group, apples contained the highest concentration of pesticides among all of the fruits tested (Sciammocco, 2013, para. 1). Yet, faith that individuals place in regulations to protect consumers from truly lethal pesticides may be misplaced. As Los Angeles Times journalist T. Christian Miller (2007) noted, mevinphos had already been determined to be responsible for poisonings across the country well before the 1994 apple orchard incident alerted the public to the danger of the pesticide (para. 14). As mevinphos incident demonstrates, it cannot be determined with certainty that the saturation of pesticides will not have an adverse effect on humans. Though the high pesticide rate does not reflect the safety of apples that are not treated with pesticides, it is a cause for concern for consumers who purchase apples that have been treated with pesticides during cultivation.

A final critique of the apple adage acknowledges that apples provide many health benefits, but argues that eating a full apple each day is the worst way to enjoy those benefits. As medical writer Kylie Taggart (2001) reported, extracts from a whole apple provide the greatest amount of protection from stressors that cause negative health conditions (p. 22). Citing research that compared the effects of consuming apple juice daily to the effects of eating an apple daily, Taggart concluded that the apple diet delayed cholesterol oxidation by 20 percent while the whole apple delayed damage by 9 percent (2001, p. 22). The research demonstrated that the delay in cholesterol oxidation played an important role in preventing high cholesterol from building up along the walls of the coronary artery (2001, p. 22). Thus, it was asserted that drinking apple juice was the best method of achieving positive health outcomes from an apple. Further, Taggart notes that the whole apple diet increased the subjects’ dietary fiber intake by 22 percent (2001, p. 22). The consequence of consuming apples is that the individual may consume empty fibers while obtaining fewer actual health benefits from eating the apple. Thus, a review the merits of eating an apple a day must also consider whether it is beneficial to consume the whole apple as opposed to just certain parts of an apple.

Health Benefits of the Apple

Though there are many concerns about the safety of apples, the health benefits of quality apples are well established. First, researchers have established the effect that apples have in slowing down aging and promoting resistance to stressors. In a study of the effects of a whole apple extract on the transparent roundworm, Cornell University researchers Elena M. Vayndorf, Siu Syvia Lee, and Rui Hai Lia (2013) assessed how the apple extracts impact the roundworms’ ability to adapt to different stresses. The research demonstrated that whole apple extracts increased the study subjects’ resistance to UV radiation, oxidative stress, and pathogens (p. 1242). Further, the subjects experienced reductions in DNA damage from their exposure to UV radiation (2013, p. 1242). This finding is significant to humans because it demonstrates how apples can impact the cellular processes that contribute to aging. It is also noteworthy that the subjects that were infected with bacterium and were given the apple extract survived 35.2 percent longer that the subjects who were not given the extract (2013, p. 1242). This suggests that apples can improve the immune response that an animal has to pathogens, which supports the claim that apples can be consumed to ward of illness. Further, by utilizing whole apple extract, the research demonstrates that health benefits can be obtained from consuming the entire apple rather than just a concentration of the nutrient-rich portions of the apple.

The second significant research findings on the health effect of consuming apples address the effect that apples have on cancer. As Ph.D. candidate Jeanelle Boyer and Cornell University research scientist Rui Hai Lui (2004) explained, the protective benefit of apples can be attributed to the high percentage of phytochemicals that are found in the skin of the apple (p. 3). Boyer and Lui define phytochemicals as, “nonnutrient plant compounds, including flavonoids, isoflavonoids, and phenolic acids” (p. 3). As the researchers noted, the phenolics found in apples support the health of the American public because they account for 22 percent of the phenolics that Americans consume from fruits (2004, p. 3). Further, the researchers analyzed prior research that affirmed the role of phytochemicals in reducing the risk of a broad range of diseases, including cancer.

Researcher Clarissa Gerhauser (2008) further assesses the role that all portions of the apples play in reducing incidents of cancer. In her study, Gerhauser assesses how different phytochemicals of the apple, including hydroxycinnamic acids, dihydrochalcones, flavanols, catechins, and oligomeric procyanidins, impact the health outcomes of the research subjects (2008, p. 1608). Further, she evaluates different apple products, including whole apples, apple juice, and apple components in order to determine whether the different apple products are equally beneficial to an individual’s health. Analyzing in vitro studies that analyzed the impact of different apple products on the research subjects, Gerhauser determines that the oligomeric procyanidins in apples promote antimutagenic activities, anti-inflammatory mechanisms, and general immunity, which are necessary to prevent the development of cancer caused by genetics or the environment (2008, p. 1623). Further, animal research determined that apple products prevented the development of skin, mammary and colon cancer (2008, p. 1623). As Gerhauser’s research concludes, different portions of the apple possessed different anti-cancer properties (2008, p. 1623). Thus, it is not necessarily a good strategy to solely consume the skin of an apple for its phytochemical content. Further, the study demonstrated that a serving of at least one apple each day was adequate for reducing the risk for lung and colon cancer (2008, p. 1624). As this research demonstrates, the adage of an apple a day is particularly correct when it comes to determining the right dose of apples to be consumed for the purpose of cancer prevention.

Finally, the role of apples in promoting dental health is often an overlooked value of adding the apple to one’s daily diet. As writer Laura Goldstein (2003) asserted, the acidity of apples can be used clean and brighten the teeth (para. 2). Because apples have a high concentration of fiber in their flesh, they act as a toothbrush when the individual chews on the fiber (2003, para. 2). Apples are especially useful in scrubbing away noticeable stains over a longer period of time (2003, para. 3). The utility of apples in promoting dental hygiene counters the assertion that eating an apple each day results in the consumption of empty fibers. Even though the interior of the apple may be dense in phytochemicals, the fiber that it provides can be beneficial to removing plaque and other residues from food that can lead to gum disease and other dental problems. Notably, the dental benefits of eating a full apple also affirm the soundness of the Roman tradition of eating an apple after a meal.

Conclusion

The apple has been an important dietary staple and medical ingredient for several centuries. From its role in the Bible to its influence on Western medicine, the apple serves as a symbol in Western society that has received both admiration and scorn. However, the increased research on the health benefits of apples reveal that apples are primarily a positive contribution to the daily diet. Though consumers should be cautious of agricultural practices that might corrupt the quality of an apple, apples from a sound source provide significant health benefits. The positive effect that apples play in reducing aging, preventing cancer, and fostering dental hygiene confirm that the adage “an apple a day keeps the doctor away” has earned its place among the canon of medical proverbs.

References

Boyer, J. & Liu, R.H. (2004). Apple phytochemicals and their health benefits. NutritionJournal, 3(5), 1-5. doi: 10.1186/1475-2891-3-5

Center for Disease Control. (1993, January 7). Occupational pesticide poisoning in apple orchards – Washington, 1993. Morbidity and Mortality Weekly Report 42(51): 993-995. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/00023208.htm

Ely, M. (2013, September 26). History behind ‘An apple a day’: When did humans coin the old adage? The Washington Post. Retrieved from http://www.washingtonpost.com

Luby, J.L. (2003). Taxonomic classification and brief history. In D.C. Ferree (Ed.), Apples: Botany, production and uses (1-14). Cambridge: CABI Publishing.

Gerhauser C. (2008). Cancer chemopreventive potential of apples, apple juice, and apple components. Planta Medica, 74(13), 1608-1624. doi: 10.1055/s-0028-1088300

Janik, E. (2011). Apple: A global history. London: Reaktion Books.

Lee, S. S., Liu R. H., & Vayndorf, E. M. (2013). Whole apple extracts increase lifespan, healthspan and resistance to stress in Caenorhabditis elegans. Journal of Functional Foods, 5(3), 1235-1243. doi:10.1016/j.jff.2013.04.006

Miller, J. (2007, April 8). Pesticide maker sees profit when others see risk. Los Angeles Times. Retrieved from http://www.latimes.com

Sciammacco, S. (2013, April 22). Apples top EWG’s dirty dozen. Environmental Working Group. Retrieved from http://www.ewg.org/release/apples-top-ewgs-dirty-dozen

Taggart, K. (2001, March 20). An apple juice a day keeps oxidated LDL away. Medical Post 37(11): 22-22. Retrieved from http://www.themedicalpost.net