Myths, facts & Philosophies in Health An apple a day keeps the doctor away….?

Bhaskar Borgohain, MBBS, MS, DNB Faculty of Medical Sciences NEIGRIHMS. Shillong Email: Telefax: 0364-2538075 (Off) “To keep the body in good health is a duty, for otherwise we shall not be able to trim the lamp of wisdom and keep our minds strong and clear” Gautama Buddha

It is beyond any doubt that fruits provide nutrients that are vital for health and maintenance of our body. The per capita consumption of fruits and vegetables in India was less than 3 kg in the early '90s and it has grown to 4 kg in recent years. Regular intake of certain fruits as part of an overall healthy diet may reduce risk for heart disease and stroke and it may possibly protect against certain types of cancers. Diets containing fiber-rich fruits may also reduce the risk of heart disease, obesity, and Type 2 diabetes. Consuming fruits rich in potassium may lower blood pressure, and may also reduce the risk of developing kidney stones and help to decrease bone loss or osteoporosis. Eating certain fruits that are lower in calories curb unwanted weight gain. Today's lifestyle has increased exposure to synthetic food products, environmental pollution, and stress which generate harmful free radicals inside the body systems. Fruits are natural rich sources of friendly antioxidants in right proportion. Antioxidants help combat the harmful free radicals which cause cellular damage which is responsible for causing cancers, unhealthy ageing, and cardiovascular and degenerative diseases. Other micro minerals in fruits like Zinc may stimulate our body’s immune system. Apples have long been associated with the biblical story of Adam and Eve, although it is a myth that the fruit in question was actually an apple. In Norse mythology, apples were given a more positive persona: a magic apple was said to keep people young forever. It is therefore not surprising that apple is often depicted as a mystic symbol of health. Apples' most recent history occurred in the 1800s in the U.S., when Johnny Appleseed (a real person named John Chapman) walked barefoot across an area of 100,000 square miles, planting apple trees that provided food security and a pragmatic livelihood for generations

of settlers. Apples belong to the Rose family of plants and a wide range of very popular foods, including apricots, plums, cherries, peaches, pears, raspberries, and almonds actually belongs to this family. It is believed that the apple tree originally came from Eastern Europe and Southwestern Asia from where it later spread to most temperate regions of the world. Over the centuries, many hybrids and cultivars have been developed, giving us the 7,000 varieties of apples in the market today. At a glance: the health benefits and nutritive values of fruits in general In the words of Hippocrates-“Let your food be your medicine and your medicine be your food” and therefore any fruits are our potential friends in health and in disease. They are generally health promoting food rather than therapeutic food unlike the historic use of oranges as the miracle treatment for Scurvy among the sailors in the bygone days. Most fruits are naturally low in fat, sodium, and calories. None actually have harmful fat like cholesterol. Fruits are sources of many essential nutrients that are underconsumed, including potassium, dietary fiber, vitamin C, and folate (folic acid). Dietary fiber from fruits in other hand helps reduce blood cholesterol levels and may lower risk of heart disease. Fiber is important for proper bowel function. It helps reduce constipation and diverticulosis. Fiber-containing foods such as fruits help provide a feeling of fullness with fewer calories. Whole or cut-up fruits are sources of dietary fiber but one must remember that fruit juices contain little or no fiber. Vitamin C found in many fruits is important for growth and repair of all body tissues, helps heal cuts and wounds, and keeps teeth and gums healthy through its action on formation of healthy collagen, a natural ubiquitous polymer. Folate (folic acid) found in many fruits helps the body form red blood cells. Women of childbearing age should consume adequate folate from foods, and in addition 400 mcg of synthetic folic acid from fortified foods or supplements. This reduces the risk of neural tube defects, spina bifida, and anencephaly during fetal development. Diets rich in potassium may help to maintain healthy blood pressure. Fruit sources of potassium include bananas, prunes and prune juice, dried peaches and apricots and orange juice. Antioxidant Benefits of Apple Since most of the polyphenols in apples function as antioxidants, it's not surprising to see so many health benefit studies focusing on the antioxidant benefits from apple. Particularly strong is the ability of apples to decrease oxidation of cell membrane fats. This benefit is especially important in our cardiovascular system since oxidation of fat (called lipid

peroxidation) in the membranes of cells that line our blood vessels is a primary risk factor for clogging of the arteries (atherosclerosis) and other cardiovascular problems. Apples' strong antioxidant benefits are also related to their ability to lower risk of asthma in certain studies, and their ability to lower risk of lung cancer. In addition to their unusual polyphenol composition, Apples also provide us with about 7 milligrams of vitamin C. While that amount is not a lot, it's still important, especially since the recycling of vitamin C in our body depends on the presence of flavonoids and apples do provide us with those flavonoids. Accepted Nutritive values of some popular fruits: Comparative chart
Fruit & size Cost Calorie (Kilo calorie) Total sugar(in Grams) Dietary Fibre % Saturated Fat (%) Vit C (%) Iron (%) Calcium Zinc Vit A Vit K Folate Apple 125 gm Moderate 65 17gm 12% (3gm) 0 10% (5.7 mg) 1% (0.1mg) 1% (7.5 mg) 0 1% (67.5 IU) 3% (2.8mcg) 1% (3.8mcg) Guava 165 gm Cheap 112 24 gm 36% (9gm) 2% (2gm) 628% (377 mg) 2% (0.4 mg) 3% (29.7 mg) 3% (0.4 mg) 21% (1030 IU) 5% (4.3 mcg) 20% (80.8 mcg) Pomegranate 282 grams High 234 39 gm 45% (11.3 gm) 2% (2gm) 48 % (28.8mg) 5% (0.8 mg) 3% (28.2 mg) 7% (1.0 mg) 0 58 % (46.2 mcg) 27 % (107mcg) Banana 126 gm Cheap 105 30 gm 12% (3 gm) 0 17% (9mg) 3% (0.3 mg) 1% (11.3 mg) 2% (0.3 mg) 3% (81 IU) 1% (1.1 mcg) 11% (25 mcg)

Apple, phytonutrients and diabetes risk reduction Even though apple is not an excellent source of dietary fiber (it ranks as a "good" source in WHFoods Rating System), the fiber found in apple may combine with other apple nutrients to provide with the kind of health benefits otherwise associated only with much higher amounts of dietary fiber. These health benefits are particularly important in prevention of heart disease through regulation of blood fat levels. Recent research has shown that intake of apples in their whole food form can significantly lower blood fats. The fat-lowering


effects of apple have traditionally been associated with its soluble fiber content, and in particular, with its fat-soluble fiber called pectin. Apple may slow down carbohydrate digestion. Quercetin and other flavonoids found in apples act to inhibit carbohydrate-digesting enzymes like alpha-amylase. When these enzymes are inhibited, carbohydrates are broken down less readily into simple sugars, and this lowers risk of diabetes. Apple may slow down glucose absorption from the gut. Polyphenols in apples lower the rate of glucose absorption from our digestive tract. Once again, this change lessens the sugar load on our bloodstream. Possibly certain antioxidants of apple also stimulate the pancreas to put out more insulin. Scientists have recently shown that important health benefits of apples may stem from their impact on bacteria in the digestive tract. In studies on laboratory animals, intake of apples was found to significantly alter two bacteria populations (Clostridiales and Bacteriodes) in the large intestine. We expect to see future studies confirming these results in humans, and we are excited to think about potential health benefits of apple that will be related to its impact on bacterial balance in our digestive tract. Anti-Cancer Benefits of Apple Although some preliminary results in the apple research show its benefits for several different cancer types (especially colon cancer and breast cancer risks), it's the area of lung cancer risk reduction benefits that appears noteworthy. There are studies involving vegetable/fruit intake and lowered risk of lung cancer. Although many research studies show an impressive ability of overall fruit and vegetable intake to lower lung cancer risk, very few individual fruits show up as protective against lung cancer….except apples! Researchers aren't certain why apples are closely associated with reduction of lung cancer risk. Their antioxidant and anti-inflammatory benefits are definitely involved, but they don't fully explain its health benefits. We look forward to future research that will help shed light on this. Apple versus Guava: The new Indian discovery? A series of tests on Indian fruits, including Himalayan apples and pomegranates, bananas from the south, grapes from Maharashtra, found the guava (exotic in Europe but fruit next door in India), to be the proverbial super-food with the highest concentration of antioxidants which protects against cell damage which ages skin and can cause cancer. This study was from India's National Institute of nutrition (NIN), Hyderabad. Next after the guava, was the Indian plum, grown in orchards established by British planters in the Himalayan foothills, the custard apple and the famous Indian mangoes. The scientists found antioxidant concentrations of just fewer than 500 milligrams per 100 grams in guavas, 330mg in plums and 135mg in pomegranates.

Apples have a quarter of the antioxidants in guavas, while bananas – the fruit of athletes – have just a tiny fraction with 30 mg per 100 grams. Water melons and pineapples – a staple for low-carbers – offer the least protection for the body's fight against free radicals which can cause cell damage (Low carbers are people who take low-carbohydrate diets or lowcarb diets). Mangoes, despite high fructose content, have 170 mg of antioxidants, more than three times that of papaya, which is regarded as healthy for its enzymes which ease stomach upsets. The study found, grapes are three times more beneficial to the body than oranges. So far, there is no study to suggest that antioxidants can help cure but can definitely help or cut down the risk of cancers as they scavenge the free radicals responsible for the diseases. The research team was surprised but delighted to discover one of India's cheapest fruits offered the greatest health benefits. Guava is a rich source of antioxidants, a rich source of health-friendly dietary fibre. Apple versus Pomegranate One of the oldest known fruits, found in writings of many cultures and religions, the pomegranate (Punica Granatum) is an original native of Persia. This nutrient rich, antioxidant rich fruit has been revered as a symbol of health and fertility. Pomegranates may be good for your heart and blood vessels and they may even protect from breast cancer, prostate cancer, colon cancer, leukemia and prevent tumor growth. In some studies, potent antioxidant compounds found in pomegranates have shown to reduce dangerous blood clotting by preventing platelet aggregation and naturally lower blood pressure, thus potentially preventing both heart attacks and strokes. Specific Compounds found in pomegranates are called punicalagins may benefit the heart and blood vessels. Punicalagins are the major component responsible for pomegranate's antioxidant and potential health benefits. They not only lower cholesterol, but also lower blood pressure and increase the speed at which heart’s artery blockages (atherosclerosis) get dissolved. Pomegranate contains phytochemical compounds that stimulate serotonin and estrogen receptors, improving symptoms of depression and increasing bone mass in lab animals. Word of caution Eating fruit is a good idea and for that matter… any fruit indeed. It is often alleged that the eating of so called exotic fruits is promoted for the benefit of supermarkets that buy them for cheap and sell them for an exorbitant price. Allegedly, a kind of pseudoscience is created in the print and electronic media, glorifying its nutritive and health values. Certainly, there are often no real scientific evidences to prove or disprove many tall claims.

I personally like guava, apple and pomegranate and the rest, but I eat them not because of explicit and convincing scientific evidence all the time but I just found their nutritive credentials believable and I like them, and …hopefully I am not a victim of “convincing” pseudoscience and its shrewd marketing strategy in the backdrop! Summary When focusing specifically on apples, several studies tell us that daily intake of this fruit may provide some cardiovascular and anti-cancer benefits. So there may be some truth to that old phrase, "An apple a day keeps the doctor away!" Still, we cannot recommend that everyone eat one apple on a daily basis, given the wide variety of available fruits and the nutritional uniqueness of each type even in terms of its effect on our taste buds! But we certainly can recommend that everyone eat at least 2-3 whole fresh fruits per day, or the equivalent of 2-3 cups' worth of fresh fruit. Within this framework, if apples are a type of fruit that you prefer, there is nothing wrong in consuming one. But then, the best option is to look for a way that is practical, simple and affordable to enjoy them that fit your individual lifestyle. Therefore, what's perhaps better is to buy and eat healthy local fruits because they are cheap and easily available and often quite competitive in its nutritive values as well. Guava is a rich source of antioxidants, a rich source of fibre. It's a poor man’s fruit because they're quite cheap. For a tropical and Asian country like ours, a guava a day may as well, keep the doctors away! So, choose it right or aim it right! Further reading
1. US Deptt. of Agriculture. Available at Last accessed on 18th Oct, 2013. 2. Community supported agriculture. Los Osos Valley Organic Farm. Available at Last accessed on 22th Oct, 2013. 3. Nutrition data. Condé Nast Publications. Available at Last accessed on 23th Oct, 2013. 4. The world’s healthiest foods. The George Mateljan Foundation, Last accessed 21st Oct, 2013 5. Dean Nelson, 12 Oct 2011, On Health News, The Telegraph. Available at Last accessed 23rd Oct, 2013 6. Secrets Revealed: The Powerful Health Benefits of the Pomegranate. Available at Last accessed 23rd Oct, 2013.


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