An Apple a Day Keeps the Statins at Bay

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 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 goal for doctors and their patients. In their paper, researchers calculated that if everyone over 50 in the United Kingdom would all take statin drugs, ~9400 deaths from cardiovascular disease would be prevented every year.* They then used the formula substituting an apple for the drug and an equal number of calories** (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% complied, an apple a day would prevent ~ 8500 deaths a year — almost 1000 less than the statin drug. However, when researchers estimated side effects, the stain drug would cause almost 14,000 serious problems a year:
Type 2 diabetes - 12,300 cases
Myopathy - 1200 cases
Rhabdomyolysis - 200 cases.

When they repeated the exercise using adults aged 30 and above, they estimated that the statins would save another 200 lives each year for a new total of 9600. Apples would prevent 300 more death’s reaching 8800 annually. If 30 year olds all started a daily statin, the annual But the number of side effects would explode:
Type 2 diabetes – up 99% to 24,400 cases
Myopathy - up 100% to 2400 cases
Rhabdomyolysis – up 100% to 400 cases.

If compliance with the apple (or a 2nd apple for those who already consumed 1 a day) was 90% instead of the 70%, the annual reduction of death from cardiovascular causes would reach 11000 - a 29% increase for a 20% 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.”


* if ~17+ million people over the age of 50 who do not meet the UK’s rx criteria took a statin drug anyway (5 million UK adults over 50 take statins to lower cholesterol)
** consumed by 70% of 22 million citizens 50 and above

Sidebar: The origin of “An apple a day keeps the doctor away” (AADKDA)

Now that we know that “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‘” comes from researchers at the world famous Oxford University Medical School in the United Kingdom 1and ‘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 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 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 preeminent expert on Benjamin Franklin, the late Dr. Leo Lemay. He confirmed AADKDA was not one of Mr. Franklins many creations.
1 In their paper the Oxford doctors state that the proverb is ~150 years old and referenced an 1866 a 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 8 word phrase in question (AADKDA) originated in Wales 148 years ago. I also disagree with a recent piece in the Washington Post which said AADKDA originated in 1922.
2 This is because 100 years ago (as I write this – or 101 yrs ago as you read this), AADKDA appeared in a 1913 book called Rustic Speech and Folklore.

Doug Andersen DC DACBSP CCN
Brea Ca

References
1. Briggs AD, Mizdrak A, Scarborough P. A statin a day keeps the doctor away: comparative proverb assessment modeling study. BMJ 2013; DOI: 10.1136/bmj.f7267. Accessed 12-21-13
2. http://www.udel.edu/PR/Messenger/04/04/ben.html. Accessed 12-21-13
3. www.washingtonpost.com/lifestyle/wellness/history-behind-an-apple-a-day/2013/09/24/aac3e79c-1f0e-11e3-94a2-6c66b668ea55_story.html. Accessed 12-21-13
4. Wright, Elizabeth. Rustic Speech and Folklore. Published 1913. https://archive.org/details/rusticspeechfolk00wriguoft. Accessed 12-21-13.

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