An apple or aspirin a day?

Health strategies have recommended both an aspirin a day or an apple a day to keep the doctor away. What are the benefits and risks of these strategies in managing your health? Depending on the variety and the geographic region, apples are in season from late July to early November. However, apples can be stored for long periods of time by controlling the atmosphere with a combination of temperature, humidity, oxygen and carbon dioxide. This is one reason why apples can be a fruit available year-round. A medium apple has less than 100 calories. Apples are high in both fiber and water content, so they are filling. They are a great source of vitamins and polyphenols, which are antioxidants. It is important to eat the skin of the apple since over half of the fiber and the polyphenols are found there. Some health benefits of apples include heart health and reducing the risk of developing diabetes. The fiber in an apple can help reduce cholesterol levels for heart health. One of the polyphenols is the flavonoid epicatechin and it has some blood pressure lowering effects. Studies have shown a reduction in stroke risk when eating fruits like apples and pears. Apples contain another polyphenol known as quercetin. Quercetin has properties capable of reducing inflammation in the body. A 2020 study published in the Journal of Inflammation Research was evaluating the damaging effects of obesity-induced inflammation in the body. The authors complied evidence for improvement in insulin resistance in the body, which can help modulate diabetes or prevent the development of diabetes. It is important to note the amount of sugars and carbohydrates in apples, which are capable of increasing blood sugar in someone with diabetes. For those counting calories and carbohydrates, apples must be figured into the total for the day or meal. As scientists learn more about the importance of gut health and the importance of the microbiota (healthy organisms in the gastrointestinal tract), the better we understand what foods can help keep the gut in balance. The fiber in apples is known as pectin and it is a prebiotic with the ability to help good bacteria flourish in the intestines. An apple a day has some significant health benefits. Does an aspirin a day have the same benefit? Several years ago, we would have answered this with an emphatic yes! As science progresses, we are learning more about the benefits and risks of daily aspirin. In April 2022, the United States Preventive Services Task Force published recommendations for the daily use of aspirin. The experts on the task force reviewed available evidence to make a general recommendation. The experts do not recommend daily aspirin for those over the age of 60 years who have not had a heart event to prevent having a heart event. So, there is no benefit beyond this age in preventing the first heart event with a daily aspirin. This is known as primary prevention and should not be confused with secondary prevention. Secondary prevention is when someone has already had an event and is at risk for another event. Aspirin in conjunction with other medications can help to prevent future heart events. The task force was not as clear on the recommendation of a daily aspirin for those age 40 to 59 years of age who are at high risk of a heart event. These are individuals who have not had a primary heart event but have significant risk factors such as high cholesterol, high blood pressure, and being overweight. The evidence for benefit was very small and the committee recommended for prescribers to evaluate risk versus benefit in each person. The task force reinforced previous data evaluating the significant risk of bleeding from the gastrointestinal tract especially in those over the age of 80 years. The task force was very specific that the risk of bleeding far outweighs the benefits of aspirin in this age group. A study published in JAMA Internal Medicine on November 7, 2022 reported another serious risk to daily aspirin. The study was evaluating low-dose aspirin use in an older, healthier adult population to reduce the risk of falls and broken bones or fractures. The research was done in Australia in individuals 70 years and older living independently in the community. The study results were a bit of a surprise. Not only did the aspirin dose not reduce broken bones, but it actually increased the risk of falls in the aspirin group compared to the group given a placebo. This evidence is one more piece to consider when using daily aspirin in the older population. It is important to talk to your healthcare provider before taking a daily aspirin to discuss risk versus benefits. An apple a day can be a good choice for many. ONU HealthWise is offering COVID-19 vaccines as well as flu shots Monday through Friday from 10 a.m.-5 p.m. The bivalent COVID-19 vaccines are available. Clinics are Monday through Friday from 4-6 p.m. Please call the pharmacy for more information. Kier is a pharmacist with the ONU HealthWise team.