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Apple Fruit (Malus domestica)

Malus domestica
Evidence Level
Limited
8 Clinical Trials
7 Documented Benefits
2/5 Evidence Score

Apple (Malus domestica) is eaten as fresh fruit, dried apple, cloudy juice and clear juice, and these forms are not equivalent. A medium raw apple (182 g) supplies about 95 kcal, 4.4 g of fiber, largely pectin, and 19 g of natural sugars. The skin carries most of the flavonol quercetin, about 4 mg per 100 g with skin versus 1 mg without, while the flesh also holds epicatechin. In controlled feeding trials, two whole apples a day lowered total and LDL cholesterol versus a sugar-matched apple drink, and three apples a day lowered C-reactive protein versus avoiding apples. Eating an apple 30 minutes before a rice meal blunted the blood sugar rise. Other trials found only trends, and pooled trial data show no clear effect on blood fats. Clear juice, which loses the fiber, raised LDL compared with whole apples. Apple polyphenol extracts and apple cider vinegar have their own pages.

Studied Dose 2 fresh apples (340 g with skin) a day for 8 weeks; 3 Gala apples (about 200 g) a day for 6 weeks; 550 g/day whole apples or 500 mL/day juice for 4 weeks; 75 g/day dried apple for 1 year; 3 apples a day added to the diet for 10 weeks; one apple (about 143 g) 30 minutes before a meal.
Active Compound Whole apple fruit: dietary fiber (mainly pectin), natural sugars (mainly fructose and glucose), the flavonol quercetin (concentrated in the skin), flavan-3-ols (epicatechin, catechin), procyanidins and dihydrochalcones; amounts vary by variety. Clear juice keeps the sugars but loses the pectin and other cell wall fiber.

Benefits

Total and LDL cholesterol with two whole apples a day

In a crossover trial in 40 adults with mildly raised cholesterol, two apples a day for 8 weeks lowered total cholesterol by about 4% and LDL cholesterol versus a sugar-matched apple drink. Other trials found only trends, and a meta-analysis of randomized apple trials found no significant change in blood lipids.

Supported by Trial 1, Trial 2

Whole apples versus clear apple juice for blood cholesterol

In a Danish crossover trial in 23 healthy adults, LDL cholesterol after 4 weeks of clear apple juice (500 mL a day) was 6.9% higher than after whole apples or apple pomace. Whole apples and cloudy juice showed only trends toward lower LDL versus no apples. The authors concluded the fiber is needed for any cholesterol effect.

Supported by Trial 2

Dried apple and cholesterol over one year in women after menopause

In a one-year trial in 160 postmenopausal women, 75 g of dried apple a day was compared with dried plum. Total and LDL cholesterol fell within the apple group, but the groups differed only for total cholesterol at 6 months. With dried plum as the comparison food and no untreated group, the size of any apple effect is uncertain.

Supported by Trial 3

Blood vessel function when apples are eaten with the skin

In a crossover trial in 30 adults at raised cardiovascular risk, eating apples with the skin raised flow-mediated dilation, a measure of artery lining function, versus apple flesh alone, both after one serving and after 4 weeks. Blood pressure, arterial stiffness, glucose and blood fats did not change.

Supported by Trial 4, Trial 2

Blood sugar rise when an apple is eaten 30 minutes before a rice meal

In a crossover trial in 18 healthy women, an apple eaten 30 minutes before rice, with total carbohydrate held equal, halved the 2-hour blood sugar response versus rice alone; a matched sugar drink had a smaller effect. In another trial, three apples eaten with a high-fat meal did not change glucose but raised insulin.

Supported by Trial 6, Trial 7

Inflammatory markers with three apples a day for 6 weeks

In a randomized trial in 46 adults with overweight or obesity, eating 3 Gala apples a day for 6 weeks lowered C-reactive protein by 17% and IL-6 by 12% compared with avoiding apples. Weight and other heart risk markers did not change. Both groups limited other high-fiber, polyphenol-rich foods during the trial.

Supported by Trial 5, Trial 1

Body weight and calorie intake when whole apples are added to the diet

In a 10-week trial in 49 Brazilian women with overweight, adding three apples a day lowered energy intake and body weight (0.93 kg), while weight did not change with oat cookies of similar fiber and calories. In a one-meal test, apple pieces before lunch cut total lunch calories by 15% versus no starter. This was a small trial, and a meta-analysis of apple trials found no change in body weight, though BMI fell slightly.

Supported by Trial 8

Mechanism of action

1

Fiber and the intact fruit structure

Clear juice removes pectin and other cell wall material. In a feeding trial, whole apples and pomace, which keep the fiber, gave lower LDL cholesterol than clear juice, and solid apple was more filling than applesauce or juice matched for calories. Pectin's binding of bile acids is the usual explanation and is covered on the pectin page.

2

Flavonoids concentrated in the skin

USDA data list about 4 mg of quercetin per 100 g of apple with skin versus about 1 mg without. In a crossover trial, apples eaten with skin raised blood flavonoid metabolites and artery lining function more than flesh alone, which suggests the skin compounds play a part.

3

Sugar profile and meal timing

In the rice-meal trial, the apple's sugars were about 55% fructose and 45% glucose, and a drink with that sugar mix also lowered the glucose peak, though less than the whole apple, so the sugars explain part of the effect but not all of it.

Clinical trials

1
Two Apples a Day and Cholesterol: 8-Week Crossover RCT vs Sugar-Matched Drink
PubMed

Randomized, controlled crossover trial: 2 Renetta Canada apples a day (340 g, rich in procyanidins) or a sugar- and energy-matched apple control drink for 8 weeks each, 4-week washout. Supported in part by an Italian AGER agribusiness grant for an apple fruit quality project, Fondazione Edmund Mach and EU Horizon 2020 funds; apples donated by Consorzio Melinda; authors reported no conflicts. (Koutsos et al. 2020, Am J Clin Nutr)

40 healthy UK adults (23 women, 17 men) with mildly raised cholesterol, mean age 51.

Versus the control drink, apples lowered total cholesterol (5.89 vs 6.11 mmol/L), LDL cholesterol (3.72 vs 3.86 mmol/L), triglycerides and ICAM-1, and improved microvascular vasodilation. Uric acid rose slightly (341 vs 330 micromol/L). Blood pressure and other cardiovascular markers did not change.

2
Whole Apples, Pomace, Cloudy and Clear Juice and Blood Lipids: 5-Period Crossover
PubMed

Randomized crossover trial with five 4-week periods: whole apples (550 g/day), apple pomace (22 g/day), cloudy juice or clear juice (500 mL/day), or no apple product. Listed as government funded in a later review. (Ravn-Haren et al. 2013, Eur J Nutr)

23 healthy adults in Denmark.

Serum total and LDL cholesterol differed across periods. Whole apples (6.7%), pomace (7.9%) and cloudy juice (2.2%) showed only trends toward lower LDL, while clear juice raised LDL by 6.9% compared with whole apples and pomace. HDL, triglycerides, weight, blood pressure, hs-CRP, gut bacteria and glucose markers did not change.

3
Dried Apple vs Dried Plum and Cholesterol: 1-Year RCT in Postmenopausal Women
PubMed

Randomized one-year trial of 75 g/day dried apple versus dried plum as the comparison food, with blood tests at 3, 6 and 12 months; indexed as US government funded. A companion bone paper from the same trial used dried apple as the control for dried plum. (Chai et al. 2012, J Acad Nutr Diet)

160 postmenopausal women in the Tallahassee, Florida area.

Between groups, total cholesterol was lower with dried apple only at 6 months; other lipid differences were not significant. Within the apple group, total and LDL cholesterol fell 9% and 16% by 3 months and 13% and 24% by 6 months. The apple group lost 1.5 kg, not significantly different from the plum group.

4
Apple With Skin vs Flesh Only and Flow-Mediated Dilation: Crossover RCT
PubMed

Randomized, controlled crossover trial of apple eaten with skin (high flavonoid) versus apple flesh only (low flavonoid), tested after one serving and after 4 weeks; funding not stated in the abstract. (Bondonno et al. 2018, Mol Nutr Food Res)

30 adults in Australia at raised risk of cardiovascular disease.

Versus flesh only, apple with skin raised flow-mediated dilation by 0.8% acutely and 0.5% after 4 weeks, and raised plasma flavonoid metabolites. 24-hour blood pressure, arterial stiffness, fasting glucose and lipids did not change significantly.

5
Three Apples a Day and Inflammatory Markers: 6-Week RCT vs Avoiding Apples
PubMed

Randomized, controlled parallel trial: 3 whole Gala apples a day (about 200 g edible) or no apples for 6 weeks, after a 2-week lead-in avoiding polyphenol- and fiber-rich foods; funding not stated in the abstract. (Liddle et al. 2021, Am J Clin Nutr)

46 adults with overweight or obesity in Canada (44 completed; mean BMI 33.4).

Versus control, apples lowered fasting C-reactive protein by 17.0%, IL-6 by 12.4% and LPS-binding protein by 20.7%, and lowered IL-6 and IL-17 released by blood immune cells in the lab. Body measurements and other cardiovascular markers did not change.

6
Apple Eaten Before a Rice Meal and Blood Glucose: Crossover RCT
PubMed

Randomized crossover trial comparing rice alone, apple eaten with rice, apple eaten 30 minutes before rice, and a sugar drink matched to the apple's sugars eaten 30 minutes before rice, all with 50 g available carbohydrate; funded by a China Agricultural University nutrition fund. (Lu et al. 2019, Nutrients)

18 healthy women in China.

The apple preload cut the 2-hour glucose response by 50% and the peak by 51.4% versus rice alone, and gave lower glucose at 30 and 45 minutes than eating the apple with the rice. The sugar drink cut the peak by 29.7%. Satiety ratings did not differ from rice alone. A single-meal test.

7
Three Apples With a High-Fat Meal and Post-Meal Blood Fats: Crossover RCT (no change)
PubMed

Randomized crossover meal trial: a high-fat test meal with or without three raw Gala apples (about 200 g), with blood sampled for 6 hours; funding not stated in the abstract. (Lin et al. 2020, Br J Nutr)

26 adults with overweight or obesity in Canada (17 women, 9 men; mean BMI 34.1).

Apples did not change the post-meal triglyceride response (primary outcome), chylomicron properties, glucose or gastric emptying. The apoB48 peak and the insulin rise from 20 to 180 minutes were higher with apples.

8
Three Apples, Three Pears or Oat Cookies a Day and Body Weight: 10-Week RCT
PubMed

Randomized trial at a primary care unit in Rio de Janeiro adding three apples, three pears or three oat cookies (about 6 g fiber and 200 kcal) to the usual diet for 10 weeks; indexed as non-US government funded. An earlier report of the same trial notes all women were advised on a weight-reduction diet and found more weight loss in the fruit groups combined than with oat cookies. (de Oliveira et al. 2008, Appetite)

49 women aged 30 to 50 with a BMI over 25 in Brazil; the earlier report describes them as having raised cholesterol.

Energy density and energy intake fell in the apple group (about 25 kcal a day) while the oat group's rose slightly. Weight fell by 0.93 kg with apples and 0.84 kg with pears, while weight did not change with oat cookies (+0.21 kg). Small trial; the weight changes were under 1 kg.

Side effects and drug interactions

Common Potential side effects

Apple allergy: in people with birch pollen allergy, the apple protein Mal d 1 can cause itching or swelling of the mouth and throat soon after eating raw apple. A European study found these reactions were usually confined to the mouth. In Spain, allergy driven by the lipid transfer protein Mal d 3, found mostly in the skin, more often caused whole-body reactions. Anyone with throat tightness or breathing trouble after eating apple needs urgent care.
Apple seeds contain amygdalin, which the body converts to cyanide. Poison center guidance says swallowing the seeds in an apple core is safe; a large number of seeds would need to be chewed or ground to pose a risk. Do not eat crushed seeds in quantity.
Sugar: a medium apple has about 19 g of natural sugar. Clear juice keeps the sugar but is free of pectin and other cell wall fiber. Juice and applesauce were less filling than whole apple in a meal study.
Extra fiber from several apples a day can cause gas or bloating in some people; increase intake gradually.
In a feeding trial, two apples a day raised blood uric acid slightly compared with a control drink; three apples with a high-fat meal raised the insulin response in another trial.

Important Drug interactions

Fexofenadine (Allegra): taking it with 300 to 600 mL of apple juice cut the amount absorbed to 39 to 59% of the level with water, while 150 mL had no meaningful effect. Take fexofenadine with water and keep juice away from the dose.
Diabetes medicines: an apple eaten before a starchy meal blunted the blood sugar rise in healthy people, while apple juice supplies sugar without most of the fiber. Neither effect has been tested with glucose-lowering drugs; people on them should follow their usual monitoring.

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Frequently asked questions about Apple Fruit (Malus domestica)

Is apple juice as good as eating a whole apple?

Not in the trials cited here. In a Danish crossover trial, LDL cholesterol was 6.9% higher after a month of clear apple juice than after whole apples, and the authors concluded the fiber matters. In a meal study, juice was also less filling than the same calories as whole apple. Cloudy juice showed only a small trend toward lower LDL (2.2%).

Are apple seeds poisonous?

Apple seeds contain amygdalin, which can release cyanide when the seeds are chewed or crushed. The amount is small: poison center guidance says swallowing the seeds in an apple core is safe, and toxicity would take a large number of chewed or ground seeds.

Why can raw apples make my mouth itch?

In people with birch pollen allergy, the apple protein Mal d 1 resembles a birch pollen protein, so raw apple can cause itching or swelling of the mouth and throat. This protein is broken down by heat and digestion. In southern Europe, a different protein concentrated in the skin, Mal d 3, is linked to more serious reactions. See an allergist if reactions go beyond the mouth.

How is this different from apple polyphenol supplements?

This page covers apples as food: fresh fruit, dried apple and juice. Apple polyphenol extracts such as Applephenon concentrate certain compounds without the fiber and sugar, and dried apple peel powder (AppleActiv) is sold separately; each has its own page. Results from whole apples do not automatically apply to capsules.

What is Apple Fruit?

Apple (Malus domestica) is eaten as fresh fruit, dried apple, cloudy juice and clear juice, and these forms are not equivalent. A medium raw apple (182 g) supplies about 95 kcal, 4.4 g of fiber, largely pectin, and 19 g of natural sugars.

What is Apple Fruit used for?

Apple Fruit is researched primarily for Cardiovascular, Metabolic Health, and Anti-Inflammatory. In a crossover trial in 40 adults with mildly raised cholesterol, two apples a day for 8 weeks lowered total cholesterol by about 4% and LDL cholesterol versus a sugar-matched apple drink.

What is the recommended dosage of Apple Fruit?

The clinically studied dose is 2 fresh apples (340 g with skin) a day for 8 weeks; 3 Gala apples (about 200 g) a day for 6 weeks; 550 g/day whole apples or 500 mL/day juice for 4 weeks; 75 g/day dried apple for 1 year; 3 apples a day added to the diet for 10 weeks; one apple (about 143 g) 3… Always follow the product label and check with a healthcare provider for personal advice.

Is Apple Fruit safe, and does it have side effects?

Side effects and cautions reported for Apple Fruit include: Apple allergy: in people with birch pollen allergy, the apple protein Mal d 1 can cause itching or swelling of the mouth and throat soon after eating raw apple. A European study found these reactions were usually confined to the mouth. It may also interact with some medications. Apple Fruit is not right for everyone, so check with a healthcare provider first if you are pregnant or breastfeeding, have a medical condition, or take prescription medication.

Does Apple Fruit interact with any medications?

Possible interactions include: Fexofenadine (Allegra): taking it with 300 to 600 mL of apple juice cut the amount absorbed to 39 to 59% of the level with water, while 150 mL had no meaningful effect. Take fexofenadine with water and keep juice away from the dose. If you take prescription medication, check with a pharmacist or doctor before using it.

How strong is the scientific evidence for Apple Fruit?

NutraSmarts rates the evidence for Apple Fruit as Limited (2 out of 5). It is backed by 8 study summaries and 16 cited references summarized on this page. A higher rating reflects more, larger, and better-designed human studies.

References(16 citations)

Evidence ratings on NutraSmarts are based on the totality of human clinical research, with emphasis on randomized controlled trials, meta-analyses, and systematic reviews. The references below directly support claims made throughout this page.

  1. Koutsos A, Riccadonna S, Ulaszewska MM, Franceschi P, Trošt K, Galvin A, Braune T, Fava F, Perenzoni D, Mattivi F, Tuohy KM, Lovegrove JA. Two apples a day lower serum cholesterol and improve cardiometabolic biomarkers in mildly hypercholesterolemic adults: a randomized, controlled, crossover trial. Am J Clin Nutr. 2020;111(2):307-318. doi: 10.1093/ajcn/nqz282.PubMedUsed to support: Randomized, controlled crossover trial in 40 UK adults with mildly raised cholesterol: two Renetta Canada apples a day for 8 weeks lowered total cholesterol (5.89 vs 6.11 mmol/L), LDL cholesterol (3.72 vs 3.86 mmol/L), triglycerides and ICAM-1, and improved microvascular vasodilation, versus a sugar- and energy-matched apple control drink. Uric acid rose slightly and blood pressure did not change. Supported in part by an Italian AGER agribusiness research grant for an apple fruit quality project, Fondazione Edmund Mach and EU Horizon 2020 grants; the apples were donated by Consorzio Melinda; authors reported no conflicts.
  2. Ravn-Haren G, Dragsted LO, Buch-Andersen T, Jensen EN, Jensen RI, Németh-Balogh M, Paulovicsová B, Bergström A, Wilcks A, Licht TR, Markowski J, Bügel S. Intake of whole apples or clear apple juice has contrasting effects on plasma lipids in healthy volunteers. Eur J Nutr. 2013;52(8):1875-89. doi: 10.1007/s00394-012-0489-z.PubMedUsed to support: Crossover trial in 23 healthy Danish adults, five 4-week periods: whole apples (550 g/day), apple pomace (22 g/day), clear or cloudy apple juice (500 mL/day) or no supplement. Only trends toward lower LDL were seen after whole apples (6.7%), pomace (7.9%) and cloudy juice (2.2%), while LDL was 6.9% higher after clear juice than after whole apples and pomace. HDL, triglycerides, weight, blood pressure, hs-CRP, gut microbiota and glucose markers did not change.
  3. Chai SC, Hooshmand S, Saadat RL, Payton ME, Brummel-Smith K, Arjmandi BH. Daily apple versus dried plum: impact on cardiovascular disease risk factors in postmenopausal women. J Acad Nutr Diet. 2012;112(8):1158-68. doi: 10.1016/j.jand.2012.05.005.PubMedUsed to support: One-year randomized trial in 160 postmenopausal US women: 75 g/day dried apple versus dried plum as the comparison food. Total cholesterol was lower in the apple group than the plum group only at 6 months; other between-group lipid differences were not significant. Within the apple group, total and LDL cholesterol fell 13% and 24% by 6 months. Indexed as US government funded.
  4. Gayer BA, Avendano EE, Edelson E, Nirmala N, Johnson EJ, Raman G. Effects of Intake of Apples, Pears, or Their Products on Cardiometabolic Risk Factors and Clinical Outcomes: A Systematic Review and Meta-Analysis. Curr Dev Nutr. 2019;3(10):nzz109. doi: 10.1093/cdn/nzz109.PubMedUsed to support: Systematic review and meta-analysis of 22 studies (7 randomized trials, 1 nonrandomized trial, 14 cohorts) of apples or pears. Pooling 3 to 5 randomized trials per outcome (whole apple, dried apple, apple juice or apple or pear against varied controls such as a matched drink, dried plum, oat cookies or kiwi), apple intake lowered BMI slightly (0.39 kg/m2; 3 trials, 229 people) but did not change body weight (5 trials, 393 people), blood lipids, blood glucose or blood pressure. Cohort studies linked apple or pear intake with lower cardiovascular and diabetes risk, which shows association, not cause. Supported by a grant from the US Apple Association.
  5. Bondonno NP, Bondonno CP, Blekkenhorst LC, Considine MJ, Maghzal G, Stocker R, Woodman RJ, Ward NC, Hodgson JM, Croft KD. Flavonoid-Rich Apple Improves Endothelial Function in Individuals at Risk for Cardiovascular Disease: A Randomized Controlled Clinical Trial. Mol Nutr Food Res. 2018;62(3). doi: 10.1002/mnfr.201700674.PubMedUsed to support: Randomized, controlled crossover trial in 30 Australian adults at raised cardiovascular risk: apple eaten with its skin (high flavonoid) raised brachial flow-mediated dilation versus apple flesh only, by 0.8% acutely and 0.5% after 4 weeks, and raised plasma flavonoid metabolites. Ambulatory blood pressure, arterial stiffness, glucose and lipids did not change significantly.
  6. Liddle DM, Lin X, Cox LC, Ward EM, Ansari R, Wright AJ, Robinson LE. Daily apple consumption reduces plasma and peripheral blood mononuclear cell-secreted inflammatory biomarkers in adults with overweight and obesity: a 6-week randomized, controlled, parallel-arm trial. Am J Clin Nutr. 2021;114(2):752-763. doi: 10.1093/ajcn/nqab094.PubMedUsed to support: Randomized, controlled parallel trial in 46 adults with overweight and obesity (44 completed): 3 whole Gala apples a day (about 200 g edible) for 6 weeks lowered fasting C-reactive protein by 17.0%, IL-6 by 12.4% and LPS-binding protein by 20.7% versus avoiding apples, with both groups limiting other polyphenol and fiber sources. Body measurements and other cardiovascular markers did not change.
  7. Lu J, Zhao W, Wang L, Fan Z, Zhu R, Wu Y, Zhou Y. Apple Preload Halved the Postprandial Glycaemic Response of Rice Meal on in Healthy Subjects. Nutrients. 2019;11(12):2912. doi: 10.3390/nu11122912.PubMedUsed to support: Randomized crossover trial in 18 healthy Chinese women: a Fuji apple (15 g available carbohydrate) eaten 30 minutes before rice, with total carbohydrate held at 50 g, cut the 2-hour glucose response by 50% and the peak by 51.4% versus rice alone. A sugar solution matched to the apple's sugars cut the peak by 29.7%. Satiety did not differ. Funded by a China Agricultural University nutrition fund; no conflicts declared.
  8. Flood-Obbagy JE, Rolls BJ. The effect of fruit in different forms on energy intake and satiety at a meal. Appetite. 2009;52(2):416-22. doi: 10.1016/j.appet.2008.12.001.PubMedUsed to support: Within-subject trial in 58 US adults: preloads of peeled apple, applesauce, or apple juice with or without added fiber (266 g, 125 kcal each), eaten 15 minutes before an unlimited lunch. Whole apple cut total lunch energy intake (preload plus meal) by 15% (187 kcal) versus no preload and was more filling than applesauce or juice. Adding fiber to juice did not raise fullness. Supported by an NIH grant.
  9. Lin X, Liddle DM, Neizer HR, Robinson LE, Wright AJ. Acute whole apple consumption did not influence postprandial lipaemia: a randomised crossover trial. Br J Nutr. 2020;123(7):807-817. doi: 10.1017/S0007114519003441.PubMedUsed to support: Randomized crossover trial in 26 adults with overweight and obesity: three raw Gala apples (about 200 g) eaten with a high-fat test meal did not change the post-meal triglyceride response (primary outcome), glucose or gastric emptying versus the meal alone, but led to a higher apoB48 peak and a larger insulin rise.
  10. Fernández-Rivas M, Bolhaar S, González-Mancebo E, Asero R, van Leeuwen A, Bohle B, Ma Y, Ebner C, Rigby N, Sancho AI, Miles S, Zuidmeer L, Knulst A, Breiteneder H, Mills C, Hoffmann-Sommergruber K, van Ree R. Apple allergy across Europe: how allergen sensitization profiles determine the clinical expression of allergies to plant foods. J Allergy Clin Immunol. 2006;118(2):481-8. doi: 10.1016/j.jaci.2006.05.012.PubMedUsed to support: Study of 389 people with apple allergy in the Netherlands, Austria, Italy and Spain. In the first three countries apple allergy was mild (over 90% had symptoms only in the mouth) and tied to birch pollen sensitization through Mal d 1. In Spain it was more severe (over 35% had whole-body reactions) and tied to peach allergy and the lipid transfer protein Mal d 3.
  11. Siekierzynska A, Piasecka-Kwiatkowska D, Myszka A, Burzynska M, Sozanska B, Sozanski T. Apple allergy: Causes and factors influencing fruits allergenic properties-Review. Clin Transl Allergy. 2021;11(4):e12032. doi: 10.1002/clt2.12032.PubMedUsed to support: Review of apple allergens. Mal d 1 cross-reacts with the birch pollen allergen Bet v 1 and mainly causes itching and swelling of the mouth and throat; these allergens are heat-labile and easily digested. Mal d 3, a lipid transfer protein, drives less frequent but more severe allergy in the Mediterranean and is expressed two to five times more in the skin than the flesh. Peeling, heat treatment and lower-allergen cultivars could reduce severe reactions.
  12. Luo J, Imai H, Ohyama T, Hashimoto S, Hasunuma T, Inoue Y, Kotegawa T, Ohashi K, Uemura N. The Pharmacokinetic Exposure to Fexofenadine is Volume-Dependently Reduced in Healthy Subjects Following Oral Administration With Apple Juice. Clin Transl Sci. 2016;9(4):201-6. doi: 10.1111/cts.12400.PubMedUsed to support: Crossover study in 10 healthy adults: fexofenadine 60 mg taken with 300 or 600 mL of apple juice lowered drug exposure to 59% and 39% of the level seen with water, while 150 mL had no meaningful effect.
  13. US Department of Agriculture, Agricultural Research Service. Apples, raw, with skin (FDC ID 171688, SR Legacy NDB 09003). FoodData Central. USDA FoodData Central. 2019;Accessed 2026. Not PubMed-indexed..SourceUsed to support: Not PubMed-indexed (USDA nutrient database). Per 100 g of raw apple with skin: 52 kcal, 85.6 g water, 13.8 g carbohydrate, 2.4 g total dietary fiber, 10.4 g total sugars, 4.6 mg vitamin C and 107 mg potassium. A medium apple (3 inch diameter) weighs 182 g.
  14. Haytowitz DB, Wu X, Bhagwat S. USDA Database for the Flavonoid Content of Selected Foods, Release 3.3. US Department of Agriculture, Agricultural Research Service, Nutrient Data Laboratory. 2018;Release 3.3, March 2018. Not PubMed-indexed..SourceUsed to support: Not PubMed-indexed (USDA database). Raw apple with skin (NDB 09003) averaged 4.01 mg quercetin, 7.53 mg epicatechin, 1.30 mg catechin and 1.57 mg cyanidin per 100 g; raw apple without skin (NDB 09004) averaged 1.05 mg quercetin and 6.25 mg epicatechin per 100 g.
  15. Klein-Schwartz W; National Capital Poison Center. An apple a day keeps the doctor away. But what about the seeds? Poison Control (National Capital Poison Center). 2026;Web article, no publication date shown; accessed 2026. Not PubMed-indexed..SourceUsed to support: Not PubMed-indexed (poison center guidance by a clinical toxicologist). Apple seeds contain amygdalin, which the body converts to cyanide, but very little of it; the seeds in an apple core can be swallowed safely, and a person would need to chew or grind and swallow a large number of seeds to risk cyanide poisoning.
  16. de Oliveira MC, Sichieri R, Venturim Mozzer R. A low-energy-dense diet adding fruit reduces weight and energy intake in women. Appetite. 2008;51(2):291-5. doi: 10.1016/j.appet.2008.03.001.PubMedUsed to support: Randomized trial in 49 Brazilian women aged 30 to 50 with overweight: adding three apples, three pears or three oat cookies (about 6 g fiber and 200 kcal) to the usual diet for 10 weeks. Energy density and energy intake fell in the apple group (about 25 kcal a day) and weight fell by 0.93 kg, while the oat group's weight did not change (+0.21 kg). An earlier report of the same trial (Nutrition 2003, PMID 12620529) found more weight loss in the fruit groups combined than with oats (P = 0.004) and notes all women were advised on a weight-reduction diet.