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Apple (Malus domestica)

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Also listed as: Malus domestica
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Æble (Danish), apal (Norwegian), apel (Swedish), Apfel (German), appel (Dutch), appelaar (Dutch), äpple (Swedish), apple extract, apple fiber, apple juice, apple pectin, apple pectin powder, apple picking, apple polyphenols, apple procyanidin, apple scab, apple tree, apple wassail, apple-John, applesauce, appleseed, B-linked proanthocyanidins, Cameo®, divja gozdna jablana (Slovenian), divlja jabuka (Croatian), ezonoko ringo (Japanese), hime ringo (Japanese), hua hong (Chinese), iablonia (Russian), jablon domáca (Slovakian), jablon plonka (Polish), jabuka (Croatian), koma (Nepalese), lai ch'in (Chinese), maça (Portuguese), malum (Latin), Malus acerba Mérat, Malus asiatica Nakai, Malus asiatica Nakai var. argutisserrata, Malus baccata (L.) Borkh., Malus baccata (L.) Borkh. f. gracilis Rehder, Malus baccata (L.) Borkh. f. jackii Rehder, Malus baccata (L.) Borkh. subsp. himalaica (Maxim.) Likhonos, Malus baccata (L.) Borkh. var. baccata, Malus baccata (L.) Borkh. var. mandshurica (Maxim.), Malus baccata (L.) Borkh. var. sibirica, Malus communis Poir., Malus communis Poir. subsp. sylvestris (Mill.) Gams, Malus dasyphylla Borkh., Malus dasyphylla var. domestica Koidz., Malus domestica Borkh., Malus domestica Borkh. var. asiatica (Nakai), Malus domestica Borkh. var. rinki (Koidz.), Malus dulcissima Koidz. var. asiatica Koidz., Malus dulcissima var. rinki (Koidz.) Koidz., Malus floribunda, Malus floribunda Siebold ex Van Houtte, Malus malus (L.), Malus malus (L.) Britton nom. inval., Malus mandshurica (Maxim.) Kom., Malus matsumurae Koidz., Malus niedzwetzkyana Dieck, Malus pallasiana Juzepãuk ex Komarov, Malus paradisiaca (L.) Medik., Malus praecox (Pall.) Borkh., Malus prunifolia Borkh., Malus prunifolia Borkh. var. ringo Asami, Malus prunifolia Borkh. var. rinkii (Koidz.), Malus pumila auct., Malus pumila auct. var. domestica (Borkh.), Malus pumila Mill., Malus pumila Mill. var. niedzwetzkyana (Dieck), Malus pumila Mill. var. paradisiaca (L.), Malus pumila Mill. var. rinki Koidz., Malus pumila var. domestica, Malus pumila var. dulcissima, Malus pumila var. niedzwetzkyana (Dieck), Malus pumila var. paradisiaca (L.), Malus ringo Siebold ex Carrière, Malus rockii Rehder, Malus sargentii Rehder, Malus sibirica Borkh. ex Roem., Malus sibirica (Maxim.) Kom., Malus sylvestris, Malus sylvestris American auth. auct. non Mill., Malus sylvestris auct., Malus sylvestris auct. var. domestica (Borkh.) Mansf., Malus sylvestris (L.) Mill., Malus sylvestris (L.) Mill. var. niedzwetskyana (Dieck), Malus sylvestris (L.) Mill. var. praecox, Malus sylvestris (L.) Mill. var. praecox (Pall.) Ponomar, Malus sylvestris Mill. subsp. mitis (Wallr.) Mansf., Malus sylvestris var. domestica (Borkh.) Mansf., Malus sylvestris var. niedzwetskyana (Dieck), manzana (Spanish), marjaomena (Finnish), mela (Italian), nai (Japanese), pomi (Latin), pomme (French), pomo (Italian), procyanidin B-2, Pyrus acerba DC., Pyrus acerba (Mérat) DC., Pyrus baccata L., Pyrus baccata var. aurantiaca Regel, Pyrus baccata var. genuina Regel, Pyrus baccata var. himalaica Maxim., Pyrus floribunda G.Kirchn., Pyrus malusastracanica, Pyrus malus L., Pyrus malus L. subsp. acerba (Mérat) Syme, Pyrus malus var. astracanica, Pyrus malus var. paradisiaca L., Pyrus matsumurae (Koidz.) Cardot, Pyrus niedzwetzkyana (Dieck) Hemsl., Pyrus prunifolia Willd., Pyrus praecox Pall., Pyrus pumila (P.Mill.), Pyrus ringo Wenzig, Pyrus sargentii (Rehder) Bean, Rosaceae (family), sargentapal (Norwegian), Siberian crab apple, sufferjang (Hindi), tapuach (Hebrew), tuffahh (Arabic), ursolic acid, villiepli (Icelandic), yag wang na mu (Korean).
  • Selected combination products: Anticholest (apple-pectin-guar soft drink), ApplephenonT, Classic AU-701, Diarrhoesan® (apple pectin-chamomile extract).

Background
  • Apple (Malus domestica) is the name for both the tree and fruit. The word "apple" is thought to come from the Old English word æppel. Experts have suggested that the word "apple" may be one of the oldest Indo-European words in the English language. The scientific name, Malus, is derived from the Latin word for apple and from the archaic Greek malon.
  • Apple is one of the most widely cultivated fruits. It can be stored for months and still have nutritious value. Winter apples, which are picked in late autumn and stored at just above freezing, are considered an important food in Europe, Asia, Argentina, and the United States. Apples have always been consumed as a food, but their constituents and potential medicinal uses remain under investigation.
  • Apples can be canned, juiced, pureed, baked, stewed, and fermented. They can be used to make juice, cider, applesauce, vinegar, pectin, and baked goods. Dried apples can be mixed with water, alcohol, or other liquids for later use. Apples can also be used to make alcoholic drinks such as applejack, Calvados, and wine.
  • Apples are high-fiber, low-calorie fruits that contain vitamin C. They are also rich in antioxidants, which are compounds that may help prevent colon, prostate, and lung cancer. Studies have found that phenolics, a type of antioxidant found in apples, may protect nerve cells from damage and reduce the risk of diseases like Alzheimer's and Parkinson's. However, more research is needed to confirm these findings.
  • Apples are considered to be a safe part of the human diet. They are thought to be an effective treatment for diarrhea in children, high blood cholesterol, hair growth, burn wounds, allergies, mercury poisoning, and the side effects of radiation. Some studies suggest that apples may help slow cancer development, manage diabetes, and help patients prepare for surgery.
  • Apple contains pectin, a type of fiber that may prevent high cholesterol, colon cancer, high blood pressure, and gallstones. Pectin may also reduce diarrhea, although more evidence is needed to confirm this. Apples also have a compound called quercetin, which is thought to prevent heart attacks, eye diseases, and arthritis. Quercetin may help control asthma, stomach disorders, and chronic heartburn. Other compounds found in apples called phenolic phytochemicals may protect the brain from damage that can lead to Alzheimer's and Parkinson's diseases. However, further research is necessary.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Apple polyphenols are effective in alleviating symptoms of persistent allergic rhinitis (nasal mucous membrane inflammation). Furthermore, the polyphenols did not cause the adverse events associated with antihistamines and steroids. However, the effect of apple alone cannot be determined from the available information. Further research is required before conclusions can be made.

C


There is some evidence in support of soy increasing antioxidant status in humans. In general, diets high in plant foods may offer antioxidant benefits. Further research is required in this field before conclusions can be made.

C


Treatment with apple pectin on burn wounds demonstrated positive effects and was well tolerated. The most significant improvements were shown when pectin application was performed from the first day after burn injury. Randomized trials are still required on apple and apple products before firm conclusions can be made.

C


Some studies have linked the intake of apples with a reduced risk of various cancers. The analysis revealed a consistent association between apples intake and the decreased risk of various cancers.

C


Fiber consumption may result in lower fasting blood sugar and cholesterol values. Overall, high-carbohydrate, high-fiber diets showed the most potential for long-term use. The benefits of increasing apple fiber were not clear from this review, and randomized controlled trials in support of apple fiber for diabetes are limited.

C


A combination of apple pectin and chamomile extract may improve diarrhea symptoms in children. Clear apple juice was found to be more likely to promote diarrhea than cloudy apple juice.

C


Preliminary research suggests the potential for benefit of apple powder in patients with chronic enteritis (intestinal inflammation). Further research is needed in order to form conclusions in this field.

C


Some studies found that an apple-derived tonic showed promising results in the treatment of male-pattern baldness. The tonic demonstrated effectiveness in hair growth and increased hair diameter in men who received the active treatment. The effect of apple itself cannot be determined from these interventions.

C


Human studies show conflicting evidence on whether apple juice, powder, and pectin increase total mean cholesterol and triglyceride concentrations. Further randomized studies involving apple are required before conclusions can be made.

C


A preliminary study of apple pectin in children exposed to mercury showed that pectin may be effective in mercury intoxication treatment. Further research is required in this field before recommendations can be made.

C


Drinking apple juice before surgery may provide beneficial effects on anxiety, thirst, and hunger in children. Further research is needed.

C


Dietary supplementation with apple pectin appears to have a positive effect on radiation. Further research is needed.

C


Studies have tested the effects of pectin on ulcer recurrence in patients with recently healed ulcers. At this time, there is insufficient evidence to recommend the use of apple for duodenal ulcers. Caution is warranted.

D
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Abortion, aging, amenorrhea, anthelmintic, antibacterial, anti-inflammatory, arthritis, asthma, astringent, atherosclerosis, atopic dermatitis, bile secretion, cardiovascular conditions, cataracts, cathartic, colon cancer, constipation, Crohn's disease, dental caries, dental hygiene, diarrhea (adults), dysentery, eye diseases, fever, gallstones, gastroesophageal reflux disease (GERD), gastrointestinal disorders, gout, heartburn, laxative, lead toxicity, macular degeneration, myocardial infarction prevention, neurodegenerative diseases (Alzheimer's disease, Parkinson's disease), oral hygiene (mouthwash), rheumatoid arthritis, scurvy, toothache, urinary tract infection, warts.

Dosing

Adults (18 years and older)

  • Daily supplementation with 500 milligrams of apple pectin by mouth has been used.
  • Dried apple peel is commonly used to make tea.
  • As an antioxidant, after fasting, 150 milliliters of apple juice has been used.
  • For ulcers, 10 grams of apple pectin powder has been used twice daily for six months.
  • For fever, 5-20 grains of an apple compound have been used as a tonic.
  • For gallstones, one liter of apple juice has been used daily for seven days.
  • Before surgery, 60-250 milliliters of apple juice has been used.
  • For burns, a solution containing apple pectin has been applied to the skin.
  • For hair growth, a tonic derived from apple has been used for 4-6 months.

Children (under 18 years old)

  • Raw apples should be thoroughly chewed before swallowing, especially when consumed by children.
  • For sudden diarrhea, 15 milliliters of apple juice per kilogram of body weight has been used twice daily.
  • For ongoing diarrhea, 10 milliliters of cloudy apple juice per kilogram of body weight has been used for five days.
  • For mercury poisoning, apple pectin has been used.
  • Before surgery, a maximum volume of 250 milliliters of apple juice has been used.
  • For radiation side effects, one teaspoon of apple pectin powder mixed in water has been used twice daily at meals for three weeks. A spoonful of apple pectin powder has also been mixed with water during meals for 16 days.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in individuals with a known allergy or sensitivity to apple, apple products, or plants in the Rosaceae family. Use cautiously in patients with a known allergy to related species.

Side Effects and Warnings

  • Side effects from apple are generally uncommon. Apples and apple products are likely safe for healthy adults and when given to children in moderate amounts.
  • Apple may cause increased blood pressure, increased cholesterol, dental problems such as cavities, skin rash, nausea, diarrhea, colic in infants, constipation, aspiration pneumonia when consumed before surgery, gastrointestinal hemorrhage, lower back pain, headache, mild dizziness, and cold symptoms.
  • Apple may affect blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Apple may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
  • Use cautiously in patients with a history of diarrhea, especially in infants and children.
  • Use cautiously in patients with dental problems.
  • Use cautiously in patients with high cholesterol, as apple may increase cholesterol.
  • Use cautiously in patients with fructose intolerance.
  • Use cautiously in patients with high blood pressure, as apple may increase blood pressure.
  • Use cautiously in patients before surgery.
  • Use cautiously in patients with a history of ulcers.
  • Use cautiously in patients taking fexofenadine, quazepam, or theophylline.
  • Use cautiously in individuals with a known allergy or sensitivity to apple, apple products, or plants in the Rosaceae family. Use cautiously in patients with a known allergy to related species.
  • Avoid high consumption of apple seeds due to the potential of toxicity.

Pregnancy and Breastfeeding

  • Apple is likely safe in pregnant and breastfeeding women at levels commonly found in the diet. The effects of apple or apple products for therapeutic uses in this population have not been well studied.

Interactions

Interactions with Drugs

  • Apple may affect blood sugar levels. Caution is advised when using medications that may also affect blood sugar. Patients taking insulin or drugs for diabetes by mouth should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Apple may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
  • Apple may increase blood pressure. Caution is advised in patients taking drugs that affect blood pressure.
  • Apple may also interact with antibiotics, calcium salts, cholesterol-lowering agents, cisplatin, cyclosporine, fexofenadine, iron salts, omeprazole, quazepam, ramipril, ranitidine, and theophylline.

Interactions with Herbs and Dietary Supplements

  • Apple may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
  • Apple may affect blood sugar levels. Caution is advised when using herbs or supplements that may also affect blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Apple may increase blood pressure. Caution is advised in patients taking herbs or supplements that affect blood pressure.
  • Apple may also interact with antibacterials, cholesterol-lowering herbs and supplements, antioxidants, calcium, fiber, iron, quercetin, and vitamin E.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Anderson, J. W., Gustafson, N. J., Bryant, C. A., and Tietyen-Clark, J. Dietary fiber and diabetes: a comprehensive review and practical application. J Am Diet Assoc 1987;87(9):1189-1197.
  2. Becker, W. M., Vogel, L., and Vieths, S. Standardization of allergen extracts for immunotherapy: where do we stand? Curr Opin.Allergy Clin Immunol. 2006;6(6):470-475.
  3. Campbell, G., Pickles, T., and D'yachkova, Y. A randomised trial of cranberry versus apple juice in the management of urinary symptoms during external beam radiation therapy for prostate cancer. Clin Oncol.(R.Coll Radiol.) 2003;15(6):322-328.
  4. Davidson, M. H., Dugan, L. D., Stocki, J., Dicklin, M. R., Maki, K. C., Coletta, F., Cotter, R., McLeod, M., and Hoersten, K. A low-viscosity soluble-fiber fruit juice supplement fails to lower cholesterol in hypercholesterolemic men and women. J Nutr 1998;128(11):1927-1932.
  5. Dennison, B. A. Fruit juice consumption by infants and children: a review. J Am Coll Nutr 1996;15(5 Suppl):4S-11S.
  6. Enomoto, T., Nagasako-Akazome, Y., Kanda, T., Ikeda, M., and Dake, Y. Clinical effects of apple polyphenols on persistent allergic rhinitis: A randomized double-blind placebo-controlled parallel arm study. J Investig.Allergol.Clin Immunol. 2006;16(5):283-289.
  7. Fahlstrom, M., Fahlstrom, P. G., Lorentzon, R., and Henriksson-Larsen, K. Positive short-term subjective effect of sports drink supplementation during recovery. J Sports Med Phys Fitness 2006;46(4):578-584.
  8. Gallus, S., Talamini, R., Giacosa, A., Montella, M., Ramazzotti, V., Franceschi, S., Negri, E., and La, Vecchia C. Does an apple a day keep the oncologist away? Ann Oncol. 2005;16(11):1841-1844.
  9. Ko, S. H., Choi, S. W., Ye, S. K., Cho, B. L., Kim, H. S., and Chung, M. H. Comparison of the antioxidant activities of nine different fruits in human plasma. J Med Food 2005;8(1):41-46.
  10. Mahalko, J. R., Sandstead, H. H., Johnson, L. K., Inman, L. F., Milne, D. B., Warner, R. C., and Haunz, E. A. Effect of consuming fiber from corn bran, soy hulls, or apple powder on glucose tolerance and plasma lipids in type II diabetes. Am J Clin Nutr 1984;39(1):25-34.
  11. Parsons, S. R. Effects of high fiber breakfasts on glucose metabolism in noninsulin-dependent diabetics. Am J Clin Nutr 1984;40(1):66-71.
  12. Shah, M., Griffin, I. J., Lifschitz, C. H., and Abrams, S. A. Effect of orange and apple juices on iron absorption in children. Arch Pediatr Adolesc Med 2003;157(12):1232-1236.
  13. Splinter, W. M., Stewart, J. A., and Muir, J. G. The effect of preoperative apple juice on gastric contents, thirst, and hunger in children. Can J Anaesth. 1989;36(1):55-58.
  14. Tanabe, T., Ebina, M., Ishihara, H., Matsuki, A., Oshima, S., and Fukushi, S. [Preanesthetic meals in elective surgical patients]. Masui 1997;46(6):788-792.
  15. Valois, S., Costa-Ribeiro, H., Jr., Mattos, A., Ribeiro, T. C., Mendes, C. M., and Lifshitz, F. Controlled, double-blind, randomized clinical trial to evaluate the impact of fruit juice consumption on the evolution of infants with acute diarrhea. Nutr J 2005;4:23.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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