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expert reaction to study looking at eating two apples per day, and cholesterol levels

Research, published in the American Journal of Clinical Nutrition, reports that eating two apples per day can reduce cholesterol levels.


Prof Tim Chico, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist, University of Sheffield, said:

“This study did show that eating two apples a day led to a slight reduction in cholesterol compared with an apple drink.  The effect on cholesterol was very small compared with drug therapy with statins, and so it is not clear whether this effect would lead to a decrease in heart disease or stroke.  However, the study was over a short period and any benefits are likely to accumulate over a lifetime of a healthy diet.  A high fibre whole food diet is already known to reduce the risk of a number of diseases including cancer and heart disease.

“So, can people who need to take statins swap them for apples?  No, not on the evidence of this study.  Should all people (whether on statins or not) eat more vegetables and fruit if they want to reduce their risk of heart disease?  Emphatically yes, alongside taking more regular physical activity, not smoking, and maintaining a healthy weight.”


Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“The results of this study are of interest – any simple dietary changes that help lower cholesterol are to be welcomed, even if the reduction is relatively modest at around 4%, which is not sufficient to treat high cholesterol in many people at elevated risk of heart disease.

“However, the trial, whilst well designed, was relatively small in size and short in duration and measured many things, so I would not say these results are definitive.  Larger, longer studies are required to confirm and should be done.

“That said, eating apples is clearly better than drinking fruit juice with the former providing considerable fibre as well as a far slower delivery of sugar to the body.  So, irrespective of any benefit on cholesterol, anything that encourages people to eat one or two more pieces of fruit per day is to be welcomed.  As with many dietary factors, people can start to enjoy more fruit daily – whether apples, bananas, or oranges – if they give themselves a chance to adapt to new tastes and food textures.”


‘Two apples a day lower serum cholesterol and improve cardiometabolic biomarkers in mildly hypercholesterolemic adults: a randomized, controlled, crossover trial’ by Athanasios Koutsos et al. was published in the American Journal of Clinical Nutrition at 04:00 UK time on Monday 16 December 2019.

DOI: 10.1093/ajcn/nqz282


Declared interests

Prof Tim Chico: “No conflicts.”

Prof Naveed Sattar: “Have consulted for Amgen, Sanofi.”

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