Prescribing an apple a day to all adults aged 50 and over would prevent or delay around 8,500 vascular deaths such as heart attacks and strokes every year in the UK -- similar to giving statins to everyone over 50 years who is not already taking them -- according to a study in the Christmas edition of The BMJ.
The researchers conclude that the 150 year old public health message: "An apple a day keeps the doctor away" is able to match more widespread use of modern medicine, and is likely to have fewer side effects. The research takes into account people who are already appropriately taking statins to reduce their risk of vascular disease and therefore the authors stress that no-one currently taking statins should stop, although by all means eat more apples.
In the United Kingdom, lifestyle changes are the recommended first step to prevent heart disease. However, trial data suggest that statins can reduce the risk of vascular events, irrespective of a person's underlying risk of cardiovascular disease. As such, calls are being made for greater use of statins at a population level, particularly for people aged 50 years and over.
Using mathematical models a team of researchers at the University of Oxford set out to test how a 150 year old proverb might compare with the more widespread use of statins in the UK population. They analysed the effect on the most common causes of vascular mortality of prescribing either a statin a day to those not already taking one or an apple a day to everyone aged over 50 years in the UK.
The researchers assumed a 70% compliance rate and that overall calorie intake remained constant.
They estimate that 5.2 million people are currently eligible for statin treatment in the UK and that 17.6 million people who are not currently taking statins would be offered them if they became recommended as a primary prevention measure for everyone over 50.
They calculate that offering a daily statin to 17.6 million more adults would reduce the annual number of vascular deaths by 9,400, while offering a daily apple to 70% of the total UK population aged over 50 years (22 million people) would avert 8,500 vascular deaths.
However, side-effects from statins mean that prescribing statins to everyone over the age of 50 is predicted to lead to over a thousand extra cases of muscle disease (myopathy) and over ten thousand extra diagnoses of diabetes.
Additional modelling showed a further 3% reduction in the annual number of vascular deaths when either apples or statins were prescribed to everybody aged over 30. However the number of adverse events is predicted to double.
"This study shows that small dietary changes as well as increased use of statins at a population level may significantly reduce vascular mortality in the UK," say the authors.
"This research adds weight to calls for the increased use of drugs for primary prevention of cardiovascular disease, as well as for persevering with policies aimed at improving the nutritional quality of UK diets," they conclude.
Dr Adam Briggs of the BHF Health Promotion Research Group at Oxford University said: "The Victorians had it about right when they came up with their brilliantly clear and simple public health advice: "An apple a day keeps the doctor away." It just shows how effective small changes in diet can be, and that both drugs and healthier living can make a real difference in preventing heart disease and stroke.
While no-one currently prescribed statins should replace them for apples, we could all benefit from simply eating more fruit."
Editor's Note: The British Medical Journal traditionally publishes a Christmas issue containing a number of articles of a lighthearted nature. For a full list of articles in the 2013 issue, see: http://www.bmj.com/content/347/7938
Materials provided by BMJ-British Medical Journal. Note: Content may be edited for style and length.
- A. D. M. Briggs, A. Mizdrak, P. Scarborough. A statin a day keeps the doctor away: comparative proverb assessment modelling study. BMJ, 2013; 347 (dec17 2): f7267 DOI: 10.1136/bmj.f7267
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This proverb, ‘an apple a day keeps the doctor away’, is said to have originated in Wales in the 1860s.
When first used, however, this proverb had a slightly different form. It began, ‘eat an apple when going to bed’ and then followed this up with ‘you will keep the doctor from earning his bread’.
‘Bread’, in the above phrase, roughly means ‘salary’ – i.e. ‘you will stop the doctor from earning his salary’ (due to the fact that there are fewer ill people demanding his attentions). It was not until the 1920s that the proverb in its current form appeared in print.
This proverb, ‘an apple a day keeps the doctor away’, has both a literal and a more broad meaning. Literally, it suggests that eating one apple a day will mean that you do not need to visit the doctor.
More broadly, it is about getting into a healthy daily routine. Our routine might not literally involve eating an apple every day. It might involve healthy eating more generally.
This proverb is all about looking after our health. It can be applied both in a specific sense and in a more general sense. In its specific sense, this proverb is telling us literally to eat an apple every single day (if we can) to get the benefit of the fiber, vitamins and other nutritional advantages this fruit offers. In its more general sense, this proverb signifies that we should look after our health.
So, in summary, this proverb can be taken to mean:
- Eating apples is good for our health
- Looking after our health is a good idea
- Taking responsibility for our own health will prevent us from having to see the doctor.
- Getting into a daily routine can be good for health
- Good health can start with simple acts – like eating an apple
Establishing a healthy routine means we will have fewer health issues. Building up a good routine is so important. A healthy diet is crucial for mental and physical well-being. More broadly, healthy living (such as sleeping well and exercising) will stop us needing medical attention. Fruit and vegetables: fruits like apples are great sources of vitamins and fiber. Taking positive action for our health is always a good idea.
This proverb can only be understood if its historical context is explained. Nowadays we usually visit the doctor. So, why does the proverb suggest that an apple ‘keeps the doctor away?’ Surely, it should say ‘keeps us away from the doctor?’ Well, until relatively recently, doctors used to visit their patients rather than the other way around. This is still the case in many parts of the world. So that is why the proverb suggests away of preventing doctors’ visits to us.
This proverb has also been turned into a popular joke. The joke goes: ‘An apple a day keeps the doctor away, if you aim right’. Here, the joke suggests that the best way to keep the doctor away is not to eat an apple – but to throw it at the doctor. The fact that this joke has become so popular attests to the popularity of the original proverb. People would not understand the joke if they did not first understand the proverb that it is based on.
1. Staying healthy: even if we do not literally eat one apple every single day, this proverb does remind us of the importance of good health.
2. Daily routine: the proverb suggests that getting into a good daily routine can help us to stay healthy. And that health can be both mental and physical.
3. Motivation: this is a proverb that we can use to motivate ourselves to look after ourselves.
4. The power of simple acts: eating an apple daily is a very simple thing to do. however as this proverb shows, even a simple act can be a powerful one.
5. Valuing ourselves: this proverb encourages us to value ourselves and our health and to keep ourselves in good condition.
6. Taking responsibility for ourselves: this is a proverb that motivates us to take positive action to improve our lives rather than simply expecting others to take care of is.
7. Forward thinking: looking after ourselves now, this proverb demonstrates, is better than ending up with bigger problems that will need specialist help to put right. As such, this proverb also attests to the value of taking positive action now rather than waiting for things to get worse.
A simple, rhyming proverb, this saying actually has a lot to tell us. Firstly, it motivates us to take positive action to look after our health. It emphasizes the importance of well being and of valuing ourselves by taking good care of ourselves every day.
Relatedly, this proverb also shows us the value of getting in to a good daily routine. And, it encourages us to get into good habits early on and as soon as possible rather than not taking positive action until it is too late. This is surely one of the more common proverbs out there. Even if we do not actually like the taste of apples, we can still absorb the general principles about health, motivation, and self care that are right at the heart of this popular saying.
Read more in Wikipedia.
Category: Proverbs, Sayings, Idioms and Phrases