The Matka of “An Apple A Day…”

  
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Many of us have grown up with this cliched proverb, “An apple a day keeps the doctor away”, though Wikipedia makes it a point to tell us there is no scientific evidence this is true [1]. 

Since childhood, it has been drilled into our heads (definitely my head) that eating fruits and vegetables is good for our health. In recent years, this has sometimes become a fad, with some people and nutritionists even advocating a liquid diet of fruit and vegetable juices, apparently to “detox”, as if there are built-up toxins in our bodies that are just waiting to be flushed out. Seriously!!

Food-group specific diets and food fads, such as low-carb, keto, low-fat, only fruits, etc., don’t normally work beyond the first six months or so….most of us have experienced this phenomenon first-hand [2]…we start a new “diet”, we lose weight, we tell the world and everyone claps and then all those lost kilos and pounds and sometimes even more, come back in the next 6-12 months. All these so-called “diets”, show pretty much the same results in the first six months, with little to choose between them and then all of them become equally ineffective within a year.  Dr. Tim Spector’s book, “The Diet Myth”  and Micheal Pollan’s book, “Food Rules” both explore this subject in great detail, for those interested in knowing more.

What is known to work however, is a sensible eating habit that is sustainable over the long term and becomes  part of our daily lives, coupled with physical activity (which I spoke and wrote about last week), both for weight loss and more importantly for living longer and healthier lives.

A sensible eating habit involves a balanced diet. Worldwide guidelines, all talk about eating more grains, nuts, fruits and vegetables and less sugar, processed food and meat and the Indian guidelines [3] follow a similar sensible path (Fig. 1). 

Fig. 1: The Indian guidelines for eating sensibly depicted as a food pyramid

An article by Wang D and his colleagues [4], published in Circulation this week is a timely addition to our knowledge about the importance and usefulness of fruits and vegetables as part of a balanced diet. This study looks at two large cohorts followed over 30 years, along with a meta-analysis of other similar studies that evaluate the impact of eating fruits and vegetables, on our health and longevity.

They show that eating up to five portions of a combination of fruits and vegetables significantly reduces all-cause mortality as well as cardiovascular disease, cancer and respiratory disease mortality, as seen in this graph (Fig. 2). However, eating more than 5 servings does not seem to make any further difference, which again goes in favour of a balanced diet that incorporates all food groups in a sensible manner.

Fig. 2: The number of fruit and vegetable portions (X-axis) agains mortality hazard (Y-axis). As the number of fruit and vegetable portions increases, the mortality drops, but after 5 portions and more, there is no additional benefit. 

One portion is defined as one banana or one medium-sized apple or a half-cup of strawberries or a half cup of cooked spinach. The Indian diet by and large does not lack in vegetables, but fruits are a challenge for large swathes of the population and when studies like these emphasize the benefits of fruits and vegetables, it just makes sense to consciously add 2-3 portions of fruit to our daily intake. And, it does not matter which fruit or vegetable.

I skimp on fruits. No longer. 

So what is our matka here? Eating 2-3 portions of fruits and 2-3 portions of vegetables a day will allow us live longer and healthier. As simple as that.

And while “an apple a day may not keep the doctor away”, “one apple, one banana, one cup of grapes, a half cup of bhendi and a half cup of palak, will definitely help keep the doctor away”.

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Footnotes:

1. https://en.wikipedia.org/wiki/An_apple_a_day_keeps_the_doctor_away

2. Ge L, Sadeghirad B, Ball G D C, da Costa B R, Hitchcock C L, Svendrovski A et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials BMJ 2020; 369 :m696 doi:10.1136/bmj.m696

3. https://www.nin.res.in/downloads/DietaryGuidelinesforNINwebsite.pdf

4. Wang DD, Li Y, Bhupathiraju SN, Rosner BA, Sun Q, Giovannucci EL, et al. Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation. 2021 Mar;CIRCULATIONAHA.120.048996.