Why Use Apple for Hydration?

Why Apple?

A lot of companies make claims about how their product effects the body on a biochemical or cellular level. Companies use textbook understanding of physiology, to make claims about how their ingredients could act on that physiology. 

For example: Electrolyte A acts on Cell X. Cell X is responsible for energy. Therefore, those who consume Electrolyte A will have “more energy”.

It sounds great in theory, but it completely underestimates the complexity of the human body. 

The medical literature is filled with endless examples of research hypotheses - created based on the understanding of physiology - that have ended up showing NO clinical benefit to patients, as determined in large, well-done, randomized control trials.

The reason for this is that humans are incredibly complicated. Just because we think we understand something on a cellular level, doesn’t mean that we can reliably use that physiology to determine which ingredients will have meaningful benefit to patients/consumers.

We have tried to go about our business in a different way. Instead of looking at the physiology and suggesting what may work, or using industry funded data to show our product is better than a competitor… We decided, let’s start with the data that currently exists and try to find some reasonable support for a base hydration formula.

Which brings us to our rationale for an apple-based hydration drink:

In our search for a base hydration formula, we came across a large, well-designed, randomized control trial in JAMA (2016), where physicians and researches were blinded to treatment allocation. They randomized 647 children into two groups:

What they found was: ½ strength apple juice is equivalent to electrolyte solutions (i.e. Pedialyte) when looking at outcomes of: hospitalization, need for IV rehydration, protracted symptoms > 7 days, weight loss > 3% or Clinical Dehydration Score > 5 on follow-up

There was actually a trend towards ½ strength apple juice being more effective, with a treatment failure rate of 16.7%, versus failure rate of 25% in the electrolyte solution group (i.e. Pedialyte).

There was also significantly less IV rehydration required in the ½ strength apple juice cohort (2.5%), versus electrolyte solution group (9%).

Rather than spending our time selling you on why a specific ingredient may make a difference based on our understanding of physiology… we have decided to focus on the data, and let that guide our rationale for a hydration drink. 

When reviewing impact of articles, it is important to see what other specialists and researchers are saying about their interpretation of the data:

Dr. Salim Rezaie and Dr. Jennifer Shangkuan had this to say:

“Previously, we had been taught that juice would cause increased fluid loss through osmotic diuresis.  This study shows that this risk is theoretical, and that dilute apple juice or preferred fluids did not increase the risk of IV hydration, hospitalization, protracted symptoms, or worsen dehydration.  When children have mild gastroenteritis and require oral hydration, hydration does not have to be done with electrolyte solutions, especially if children do not want to drink them or if electrolyte solutions are too expensive or difficult to access for caregivers.”

Read full analysis here.

Let’s see what others have to say…

Dr. Ken Milne from Skeptics Guide to Emergency Medicine has an excellent write-up and podcast summarizing his analysis of the data. 

Read more here.