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
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.