The People's Perspective on Medicine

Will Two Apples a Day Keep Your Heart Healthy?

Researchers report that people eating two apples a day, everything except the core, lowered their total and LDL cholesterol modestly.
Delicious appetizing beautiful fresh two red apples isolated on a white background.

You may have heard that an apple a day keeps the doctor away. Scientists at the University of Reading in England have found that you might want to eat two apples daily (American Journal of Clinical Nutrition, online Dec. 16, 2019). They could improve your heart health.

What Is the Story on Two Apples a Day?

These fruits are rich in fiber and polyphenols called proanthocyanidins. The researchers thought they might lower cholesterol, so they recruited 40 volunteers with moderately high cholesterol. About half the group was assigned to eat two whole apples, skin and all but no cores, every day for two months. The other participants consumed an apple juice concoction with sugar. Calories were roughly the same for each group. 

After two months, the volunteers ate no apples or apple products for four weeks. Then their assignment was switched. The first group got the apple juice concoction, while the second group ate two apples a day. The apples chosen were Renetta Canada, an old French variety rich on polyphenols. An Italian apple grower, Melinda, provided the fresh apples for the volunteers.

How Do Apples Affect Cholesterol?

The researchers found that when people ate apples, their LDL cholesterol dropped by about 4 percent. They also had slightly lower total cholesterol and more flexible blood vessels.

The investigators hypothesize that the pectin and other fiber in combination with the polyphenol compounds may have a beneficial impact on gut microbes that helps lower cholesterol. Cardiology experts warn, however, that people should not count on eating apples instead of taking statins to lower their cholesterol. The apple effect is not as great as that of the drugs.

A Dietary Portfolio to Lower Cholesterol:

Scientists established the power of a high-fiber diet to control cholesterol nearly a decade ago (JAMA, July 23, 2003). Canadian researchers compared a dietary portfolio high in viscous fibers, almonds, plant sterols and soy protein to a low-fat diet and a low-fat diet with the addition of lovastatin. This cholesterol-lowering drug was the standard treatment for high cholesterol at the time. Just to be clear, pectin is a viscous fiber similar to the fiber featured in the dietary portfolio. 

According to the investigators, 

“There were no significant differences in efficacy between the statin and dietary portfolio treatments.”

In other words, the dietary portfolio worked just as well to lower cholesterol as a statin drug.

A systematic review of the evidence on the dietary portfolio found that people following such a plant-based diet lower their LDL cholesterol and reduce their risk of heart disease (Progress in Cardiovascular Diseases, May-June 2018). However, the dietary portfolio is not the only eating pattern that can help protect people from heart disease. In addition, scientists have found evidence supporting the DASH diet (Dietary Approaches to Stop Hypertension). Specifically, scientists reviewing the evidence found that people embracing this plant-based dietary pattern lower their blood pressure and other cardiometabolic risk factors (Nutrients, Feb. 5, 2019). In conclusion, plant-rich diets go well beyond apples. When you adopt a full dietary pattern high in plant fiber and polyphenols, you may be able to control cholesterol quite well. 

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Citations
  • Koutsos A et al, "Two apples a day lower serum cholesterol and improve cardiometabolic biomarkers in mildly hypercholesterolemic adults: A randomized, controlled, crossover trial." American Journal of Clinical Nutrition, online Dec. 16, 2019. https://doi.org/10.1093/ajcn/nqz282
  • Jenkins DJ et al, "Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein." JAMA, July 23, 2003. DOI: 10.1001/jama.290.4.502
  • Chiavaroli L et al, "Portfolio dietary pattern and cardiovascular disease: A systematic review and meta-analysis of controlled trials." Progress in Cardiovascular Diseases, May-June 2018. DOI: 10.1016/j.pcad.2018.05.004
  • Chiavaroli L et al, "DASH dietary pattern and cardiometabolic outcomes: An umbrella review of systematic reviews and meta-analyses." Nutrients, Feb. 5, 2019. DOI: 10.3390/nu11020338
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Please give us more information on what foods are high in viscous fibers besides apples. Also, what are plant sterols and polyphenols, and what foods have them?
Too many undefined words in this post.

Okra and eggplant are both rich in viscous fibers. Viscous fiber is the same as soluble fiber, so psyllium is a good source. So are rolled or steel-cut oats, barley and beans. Vegetables including asparagus, Brussels sprouts, sweet potatoes and turnips are other good sources.
Plant sterols are compounds made by plants with a chemical structure that somewhat resembles cholesterol. We don’t know if that is why consuming foods rich in plant sterols such as nuts and seeds can help control cholesterol levels.
Polyphenols are also chemicals made by plants. The definition is based on the chemical structure (they contain multiple phenolic hydroxyl groups and have 5 to 7 aromatic rings per 1000 Dalton). Consequently, the definition is not all that helpful for most of us non-chemists. It helps to know they are predominately water soluble, anti-oxidant compounds and often they are colorful. Good sources include vegetables and fruits (especially those with deep colors), whole grains, tea and coffee.

Thank you, again, for all your great articles!

Encouraging, yes. However, I have the impression that apples have one of the highest pesticide contents of all fruits and berries. And clearly, from the article it is important to eat the skin of the apple.

In the section “How do apples affect cholesterol?” the second-to-last sentence is confusing. Shouldn’t it say that “…experts warn that people should NOT count on eating apples…” etc.

Could the following paragraph from this morning’s column possibly have an error? Did you mean to say people should “not” count on eating apples instead of…….?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Cardiology experts warn, however, that people should count on eating apples instead of taking statins to lower their cholesterol. The apple effect is not as great as that of the drugs.

You seem to be missing the word “not” in this sentence: “Cardiology experts warn, however, that people should count on eating apples instead of taking statins to lower their cholesterol.”

Cardiology experts warn, however, that people should count on eating apples instead of taking statins to lower their cholesterol. “Not?”

Unlike in this trial Americans often add something to their diet when it is recommended but do not compensate by removing something else to maintain caloric intake. Two large apples can add 50 grams of sugar per day so you might want to cut back significantly on other sources of sugar.

Encouraging…

Did you mean to write that …”people should count on eating apples instead of taking statins..” ?????

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