Apple
Malus sylvestris Millsp. Family: Rosaceae (roses)
Apple
 
Clinical Overview
Uses
Traditional uses include treatment for cancer, diabetes, fever, heart ailments, scurvy, and warts. Leaves, bark, and root contain antibacterials active in low concentrations. The large pectin content makes the fruit valuable for both constipation and diarrhea.

Dosing
Procyanidins of apple have been studied for hair growth using a 1% topical formulation.

Contraindications
Contraindications have not yet been identified.

Pregnancy/Lactation
Generally recognized as safe or used as food. Avoid dosages above those found in food because safety and efficacy are unproven.

Interactions
Apple juice decreases the absorption of fexofenadine, decreasing the AUC, peak plasma level, and urinary excretion of fexofenadine. It would be prudent for patients taking fexofenadine to avoid apple juice and to take the medication with water.

Adverse Reactions
No data.

Toxicology
The seeds, which can liberate hydrogen cyanide, should not be consumed in large quantities.

 
Botany
The apple is a deciduous tree with simple clusters of flowers. The fruit is termed a “pome.” Apple trees are cultivated widely throughout the temperate climates of the world and the fruit is available broadly in commercial markets. 1,  More than 1000 cultivars of apple have been identified. 2
 
History
The apple long has been recognized as a valuable food. Its uses in traditional medicine have been varied, including the treatment of cancer, diabetes, dysentery, fever, heart ailments, scurvy, and warts. 3 Apples also are said to be effective in cleaning the teeth. The fruit juice is drunk fresh, fermented as cider or as apple brandy. The wood of the apple tree is valued as a firewood.
 
Chemistry
Apple leaves, bark, and root contain an antibacterial substance (phloretin), which is active in vitro in low concentrations. 3,  Hydrogen cyanide (HCN) in the form of the cyanogenic glycoside amygdalin, is found in the seeds. 1,  , 3 In addition, the seeds contain a yellow semi-drying oil (glucoside phlorizin) with the odor of bitter almonds.
The fruit contains up to 17% pectin and pectic acids. A variety of other components, many of them with aromatic qualities, are found in apples, including tannins, quercetin, alpha-farnesene, shikimic acid, and chlorogenic acid. 3
 
Uses and Pharmacology
Traditional uses include treatment for cancer, diabetes, fever, heart ailments, scurvy, and warts.
Constipation/diarrhea   The apple often is eaten to alleviate constipation or to control diarrhea. Both therapeutic effects appear to be related to the fruit's pectin content.
Mechanism of action   Pectin absorbs water in the gastrointestinal tract and swells to a gummy mass. As such, it can provide bulk and moisture to hardened stools, or aid in producing formed stools by adding bulk in the presence of diarrhea.
Animal data   Research reveals no animal data regarding the use of apple for constipation or diarrhea.
Clinical data   Research reveals no clinical data regarding the use of apple for constipation or diarrhea.
Other uses   The antibacterial phloretin is active against some gram-positive and gram-negative pathogens. 4 Extracts of the related M. sativa have been shown to be active against Vibrio cholerae . 5
 
Administration & Dosage
Procyanidins of apple have been studied for hair growth using a 1% topical formulation. 6
 
Pregnancy/Lactation
Generally recognized as safe or used as food. Avoid dosages above those found in food because safety and efficacy are unproven. 7
 
Interactions
Apple juice has been shown to decrease the absorption of fexofenadine, probably by inhibition of intestinal transport. 8,  The effect of apple juice on the pharmacokinetics of fexofenadine was studied in 10 healthy volunteers. 8 Each subject received 120 mg fexofenadine with 300 mL of water or normal strength apple juice, followed by 150 mL every 0.5 up to 3 hours (total volume 1.2 L). Compared with water, apple juice reduced the fexofenadine area under the plasma concentration-time curve (AUC) 73%, the peak plasma concentration 72% (from 288 to 81 ng/mL), and the urinary excretion 69%. The decrease in the AUC of fexofenadine was variable among subjects; however, individuals with the highest fexofenadine AUC with water experienced the greatest decrease with apple juice.
 
Adverse Reactions
Research reveals little or no information regarding adverse reactions with the use of this product.
 
Toxicology
Because of their HCN content, apple seeds should not be ingested in large quantities. A small number of seeds, however, may be ingested without symptoms. 1,  Large amounts of seeds have the potential for toxicity. One recurring report cites the case of a man dying of cyanide poisoning after ingesting a cupful of apple seeds. 3,  Because cyanogenic glycoside must be hydrolyzed in the stomach in order to release cyanide, several hours may elapse before symptoms of poisoning occur. 1
 
References
 

1. Lampe KE, McCann MA. AMA Handbook of Poisonous and Injurious Plants . Chicago, IL: American Medical Association; 1985.

 

2. Mabberley DJ. The Plant-Book . Cambridge: Cambridge University Press; 1987.

 

3. Duke JA. Handbook of Medicinal Herbs . Boca Raton, FL: CRC Press; 1985.

 

4. Lewis WH, Elvin-Lewis MPF. Medical Botany: Plants Affecting Man's Health . New York, NY: John Wiley & Sons; 1977.

 

5. Guevara JM, Chumpitaz J, Valencia E. The in vitro action of plants on Vibrio cholerae [in Spanish]. Rev Gastroenterol Peru . 1994;14:27-31.  PubMed

 

6. Kamimura A, Takahashi T, Watanabe Y. Investigation of topical application of procyanidin B-2 from apple to identify its potential use as a hair growing agent. Phytomedicine . 2000;7:529-536.  PubMed

 

7. Food Additives. USA: GRAS Substances. Multipurpose GRAS Food Substances. Degussa Food Ingredients. Available at: http://www.degussa-health-nutrition.com/degussa/html/e/health/eng/kh/f4.7.htm . Accessed March 15, 2004.

 

8. Dresser GK, Bailey DG, Leake BF, et al. Fruit juices inhibit organic anion transporting polypeptide-mediated drug uptake to decrease the oral availability of fexofenadine. Clin Pharmacol Ther . 2002;71:11-20.  PubMed