An Apple a Day Keeps the Statins at Bay
By G. Douglas Andersen, DC, DACBSP, CCN
On the 100th anniversary of the first appearance of the phrase, "An apple a day keeps the doctor away" [see sidebar], researchers from Oxford published a paper in the British Medical Journal titled, "A Statin a Day Keeps the Doctor Away: Comparative Proverb Assessment Modeling Study."1 After I read the paper, I felt "An Apple a Day Keeps the Statins at Bay" was a better direction for doctors and their patients.
In their paper, researchers calculated that if everyone over age 50 in the United Kingdom would take statin drugs, approximately 9,400 deaths from cardiovascular disease would be prevented every year [if approximately 17 million people over the age of 50 who do not meet the U.K.'s Rx criteria took a statin drug anyway. (5 million U.K. adults over age 50 take statins to lower cholesterol.)]
They then applied the same formula, substituting an apple for the drug and an equal number of calories, consumed by 70 percent of 22 million citizens ages 50 and above. (The 95 or so calories provided by the apple were subtracted from other meals so there would not be a daily increase.) Their results revealed that if 70 percent complied, a apple a day would prevent approximately 8,500 deaths a year – almost 1,000 less than the statin drug. However, when researchers estimated side effects, they discovered the stain drug would cause almost 14,000 serious problems a year:
- Type 2 diabetes: 12,300 cases
- Myopathy: 1,200 cases
- Rhabdomyolysis: 200 cases
|Origin of "An Apple a Day Keeps the Doctor Away"
Now that we know "a statin a day keeps the doctor away" and "an apple a day or a statin a day is equally likely to keep the doctor away" come from researchers at the world-famous Oxford University Medical School in the United Kingdom;1 and "An apple a day keeps the statins at bay" comes from an obscure chiropractor from a small city in California, we can turn our attention to the origin of the proverb that inspired their study and this article.
My research revealed that many sources credit "AADKDA" to ancient Romans. But when I tried to locate any documentation in the historical record, I could not. Numerous reports on the web also attribute "AADKDA" to the author of Poor Richards Almanac and the man on America's $100 bill, Ben Franklin.
However, after having no luck finding anything in writing, I stumbled across a University of Delaware website based on the works of their longtime professor and pre-eminent expert on Benjamin Franklin, the late Dr. Leo Lemay. He confirmed "AADKDA" was not one of Mr. Franklin's many creations.2
In their paper the Oxford doctors state that the proverb is approximately 150 years old and referenced an 1866 Welsh magazine called Notes and Queries as the origin. That magazine published: "Eat an apple on going to bed, and you'll keep the doctor from earning his bread."
I will not argue with Oxford on the basic idea (apples are healthy), but I respectively disagree that the eight-word phrase in question ("AADKDA") originated in Wales 148 years ago. I also disagree with a recent piece in The Washington Post that said "AADKDA" originated in 1922.3 This is because 101 years ago, "AADKDA" appeared in a 1913 book called Rustic Speech and Folk-Lore.4
When they repeated the exercise using adults ages 30 and older, the researchers estimated that statins would save another 200 lives each year, bringing the adjusted total of prevented deaths to 9,600. Apples would prevent 300 more deaths, reaching 8,800 annually. However, if 30-year-olds all started taking a daily statin, the number of side effects would explode:
- Type 2 diabetes: up 99 percent to 24,400 cases
- Myopathy: up 100 percent to 2,400 cases
- Rhabdomyolysis: up 100 percent to 400 cases
If compliance with the apple regimen (or a second apple, for those who already consumed one a day) was 90 percent instead of the 70 percent, the annual reduction of deaths from cardiovascular causes would reach 11,000 - a 29 percent increase for a 20 percent higher compliance rate.
On the BMJ website, at the end of the article, a text box titled "What This Study Adds" states: "An apple a day or a statin a day is equally likely to keep the doctor away." I must respectively disagree: Yes, they may be equally likely to keep the undertaker away, but with 14,000 preventable cases of diabetes and muscle disease every year, "A statin a day guarantees the doctor gets pay."
- Briggs AD, Mizdrak A, Scarborough P. A statin a day keeps the doctor away: comparative proverb assessment modelling study. BMJ, published online Dec. 17, 2013.
- "Ben Franklin: Facts and Fallacies." University of Delaware Messenger, June 2005;13(4).
- Ely M. "History Behind 'An Apple a Day." The Washington Post, Sept. 24, 2013.
- Wright E. Rustic Speech and Folk-Lore. Oxford University Press, 1913.
for more information about G. Douglas Andersen, DC, DACBSP, CCN.