We’ve all heard an apple a day keeps the doctor away. This longtime adage most likely refers to an apple’s effect on inflammation. With uncontrolled inflammation, aka, chronic inflammation, we find often ourselves seeking a healthcare provider to help address chronic symptoms or disease due to uncontrolled inflammation. Most people are unaware of the smoldering inflammation going on in their body. Given that its apple season, it seems a good time to talk about why eating apples can provide preventative health benefits. So, let’s talk about whether an apple a day keeps inflammation at bay.

Why eat apples? Well, here’s some of their benefits:

• Decrease enzymes that cause inflammation, reducing C-reactive protein (CRP), a key marker of inflammation in the blood.
• High in antioxidants and fiber.
• Rich in bioactive polyphenols, procyanidins, and fiber.
• Help curb appetite.
• Keep longer than other fruits.

Some research on apples:

• Cancer Prevention: Cancer prevention is one reason why apples are an important part of dietary intake. Consumption of apples has been shown in case-controlled studies to be statistically significant in reduction of lung, colorectal, breast and overall digestive cancers.[i] [ii]Specific to colorectal cancer, an earlier case-controlled study demonstrated a specific protective benefit related to apple consumption relative to other fruits or vegetables which did not show these same effects. The benefit was presumed to be related to apples rich polyphenol and flavonoid content.[iii]
• Aging: Specific to the benefits of apples on aging, a study of elderly women demonstrated that apple intake showed an inverse relationship to all causes for death and disease, meaning that the greater the consistent intake of apples, the less they were likely to experience early death and disease.[iv] The positive impact of apples on aging has also been demonstrated in animal and vitro studies.[v],[vi] ,[vii]
• Cardiovascular/Peripheral Artery Disease: Evidence suggests that consuming apples or their bioactive components provides beneficial effects on lipid metabolism and other markers of cardiovascular disease (CVD). But, are two apples per day better than one? In a randomized trial, while greater consumption of apples had no effect on blood pressure, this study showed beneficial effects on lowering cholesterol and improving vascular effects in mildly high cholesterol individuals.[viii]

Apple extracts have also been studied for their benefits.  In a randomized trial of patients with peripheral artery disease (PAD), both placebo and test groups receive 4 capsules daily. The test group capsules contained Annurca apple polyphenolic extract. The placebo group capsules contained only maltodextrin. The test group showed significant improvements in walking autonomy, ankle-brachial index, and acceleration time. Researchers reported that the results may indicate that the apple-containing product may be a promising natural and safe tool for treatment of symptoms related to PAD.[ix]

• Diabetes: Apple polyphenols (AP) have demonstrated health benefits for diabetes, another disease of inflammation. AP administration significantly improved impaired glucose tolerance in high-normal and borderline subjects. [x]Another study of apple cider vinegar in patients with diabetes and hyperlipidemia demonstrated that apple vinegar consumption improved glycemic indices and oxidative stress. This particular study, however, did not reduce homocysteine, an inflammatory marker.[xi] 
• Gastrointestinal Disorders: One study demonstrated an effect on AP on helping reduce H. Pylori infection and help heal damage gut mucosa.[xii] The mechanism of apple’s impact on reducing gut permeability was studied in rats demonstrating that AP exerts health benefits through inhibiting gut dysbiosis and chronic inflammation and modulating gut permeability.[xiii]
• Chronic Pain: A small open-label study examining the effects of dried apple peel powder on 12 healthy people with moderate loss of joint ROM and associated chronic pain showed reduction in inflammatory enzymes, reduced pain, and improved joint function, suggesting that pain reduction was associated with the apple polyphenol’s anti-inflammatory effects and improved anti-oxidant status. [xiv]

Ways to incorporate apples into your diet:

• Keep a stash of apples in your refrigerator
• Slice apples on top of oatmeal
• Put some organic nut butter onto an apple wedge
• Use apple slices as a condiment
• Saute apples in a little butter and cinnamon
• Make applesauce…it’s easy!
• Avoid apple juice as it is usually loaded with sugar. It’s important to have the whole fruit as you get the benefits of the fiber, which also slows the rate of sugar absorption.

To summarize: Apples are a great addition to routine dietary intake given that they have demonstrated positive impacts on reducing incidence of specific diseases as well as helping to control them. So, make apples a routine part of your diet to keep your inflammation at bay and you’ll likely keep make those unwanted visits to the doctor away.

[i] Fabiani R, Minelli L, Rosignoli P. Apple intake and cancer risk: a systematic review and meta-analysis of observational studies. Public Health Nutr. 2016 Oct;19(14):2603-17. doi: 10.1017/S136898001600032X. Epub 2016 Mar 22. PMID: 27000627

[ii] Gallus S, Talamini R, Giacosa A, Montella M, Ramazzotti V, Franceschi S, Negri E, La Vecchia C. Does an apple a day keep the oncologist away? Ann Oncol. 2005 Nov;16(11):1841-4. doi: 10.1093/annonc/mdi361. Epub 2005 Aug 9. PMID: 16091428.

[iii] Jedrychowski W, Maugeri U, Popiela T, Kulig J, Sochacka-Tatara E, Pac A, Sowa A, Musial A. Case-control study on beneficial effect of regular consumption of apples on colorectal cancer risk in a population with relatively low intake of fruits and vegetables. Eur J Cancer Prev. 2010 Jan;19(1):42-7. doi: 10.1097/CEJ.0b013e328333d0cc. PMID: 19926998.

[iv] Hodgson JM, Prince RL, Woodman RJ, Bondonno CP, Ivey KL, Bondonno N, Rimm EB, Ward NC, Croft KD, Lewis JR. Apple intake is inversely associated with all-cause and disease-specific mortality in elderly women. Br J Nutr. 2016 Mar 14;115(5):860-7. doi: 10.1017/S0007114515005231. Epub 2016 Jan 20. PMID: 26787402.

[v] Stirpe M, Palermo V, Bianchi MM, Silvestri R, Falcone C, Tenore G, Novellino E, Mazzoni C. Annurca apple (M. pumila Miller cv Annurca) extracts act against stress and ageing in S. cerevisiae yeast cells. BMC Complement Altern Med. 2017 Apr 5;17(1):200. doi: 10.1186/s12906-017-1666-7. PMID: 28381226; PMCID: PMC5381082.

[vi] Sunagawa T, Shimizu T, Kanda T, Tagashira M, Sami M, Shirasawa T. Procyanidins from apples (Malus pumila Mill.) extend the lifespan of Caenorhabditis elegans. Planta Med. 2011 Jan;77(2):122-7. doi: 10.1055/s-0030-1250204. Epub 2010 Aug 17. PMID: 20717869.

[vii] Palermo V, Mattivi F, Silvestri R, La Regina G, Falcone C, Mazzoni C. Apple can act as anti-aging on yeast cells. Oxid Med Cell Longev. 2012;2012:491759. doi: 10.1155/2012/491759. Epub 2012 Aug 30. PMID: 22970337; PMCID: PMC3437301.

[viii] Koutsos A, Riccadonna S, Ulaszewska MM, Franceschi P, Trošt K, Galvin A, Braune T, Fava F, Perenzoni D, Mattivi F, Tuohy KM, Lovegrove JA. Two apples a day lower serum cholesterol and improve cardiometabolic biomarkers in mildly hypercholesterolemic adults: a randomized, controlled, crossover trial. Am J Clin Nutr. 2020 Feb 1;111(2):307-318. doi: 10.1093/ajcn/nqz282. PMID: 31840162; PMCID: PMC6997084.

[ix] Tenore GC, D’Avino M, Caruso D, Buonomo G, Acampora C, Caruso G, Simone C, Ciampaglia R, Novellino E. Effect of Annurca Apple Polyphenols on Intermittent Claudication in Patients With Peripheral Artery Disease. Am J Cardiol. 2019 Mar 1;123(5):847-853. doi: 10.1016/j.amjcard.2018.11.034. Epub 2018 Dec 3. PMID: 30573159.

[x] Shoji T, Yamada M, Miura T, Nagashima K, Ogura K, Inagaki N, Maeda-Yamamoto M. Chronic administration of apple polyphenols ameliorates hyperglycaemia in high-normal and borderline subjects: A randomised, placebo-controlled trial. Diabetes Res Clin Pract. 2017 Jul;129:43-51. doi: 10.1016/j.diabres.2017.03.028. Epub 2017 May 2. PMID: 28505543.

[xi] Gheflati A, Bashiri R, Ghadiri-Anari A, Reza JZ, Kord MT, Nadjarzadeh A. The effect of apple vinegar consumption on glycemic indices, blood pressure, oxidative stress, and homocysteine in patients with type 2 diabetes and dyslipidemia: A randomized controlled clinical trial. Clin Nutr ESPEN. 2019 Oct;33:132-138. doi: 10.1016/j.clnesp.2019.06.006. Epub 2019 Jul 9. PMID: 31451249.

[xii] Pastene E, Speisky H, Troncoso M, Alarcón J, Figueroa G. In vitro inhibitory effect of apple peel extract on the growth of Helicobacter pylori and respiratory burst induced on human neutrophils. J Agric Food Chem. 2009 Sep 9;57(17):7743-9. doi: 10.1021/jf9006592. PMID: 19691323.

[xiii] Wang S, Li Q, Zang Y, Zhao Y, Liu N, Wang Y, Xu X, Liu L, Mei Q. Apple Polysaccharide inhibits microbial dysbiosis and chronic inflammation and modulates gut permeability in HFD-fed rats. Int J Biol Macromol. 2017 Jun;99:282-292. doi: 10.1016/j.ijbiomac.2017.02.074. Epub 2017 Feb 24. PMID: 28238909.

[xiv] Jensen GS, Attridge VL, Benson KF, Beaman JL, Carter SG, Ager D. Consumption of dried apple peel powder increases joint function and range of motion. J Med Food. 2014 Nov;17(11):1204-13. doi: 10.1089/jmf.2014.0037. Epub 2014 Oct 1. PMID: 25271471; PMCID: PMC4224039.