Are apples good for blood sugar?

Apples have not been shown to move fasting blood sugar in either direction. A 2022 meta-analysis of 18 randomized trials of whole apples, apple juice and apple extracts, 12 of which measured glucose, found no significant effect on fasting glucose or insulin. Where apples do show an effect is a single meal. In a crossover trial of 18 healthy women, an apple eaten before a rice meal cut the peak glucose rise by 51.4 percent against rice alone.

Unsettled. Whether apples help blood sugar over months is not answered. The 2022 review rated its glucose and insulin results low quality by GRADE, because its trials ran 1 to 12 weeks and mixed whole fruit with juice, extract, powder, pomace and vinegar. A 2019 review found only 2 randomized trials of apples that measured blood glucose, and neither showed a difference between groups.

What the trials found

One meal: a real but narrow effect

The rice trial measured more than the peak. The apple preload also halved the glucose area over two hours and cut the overall swing in glucose by 52.6 percent, while a sugar solution eaten the same way cut the peak by 29.7 percent. A second crossover trial from the same research group, in healthy women whose number the abstract does not give, found an apple before rice halved the peak glucose rise and cut the glucose area over 3 hours by 45.7 percent. Both trials measured one meal in healthy young women. Neither tells you what happens in someone with diabetes.

A concentrated extract behaves differently from the fruit. In a double-blind crossover trial of 25 healthy adults, a drink carrying 1200 mg of apple polyphenols lowered glucose in the first 30 minutes after a starchy meal, and the difference over 120 minutes was not significant.

Weeks of apples: no measurable change

In a crossover trial of 23 healthy adults, 19 oz (550 g) of whole apples a day for 4 weeks did not change insulin or other markers of glucose metabolism. The abstract does not report fasting glucose itself. A 2026 systematic review of 38 apple intervention studies, which did not pool them, landed in the same place. Apples may improve blood glucose mainly in short-term tests, while the longer studies reported an apparent improvement in gut bacteria.

Myth. The worry that the sugar in a whole apple pushes blood sugar up over time is not what the trials show. Across the 2022 meta-analysis, apple products left fasting glucose and insulin where they were. That is low-certainty evidence of no effect in trials of 1 to 12 weeks, and it is the best trial evidence we found.

Fruit in general, where there is a longer measure

No apple trial we found measured HbA1c. Fruit as a group has been tested. A 2018 BMJ meta-analysis of controlled feeding trials lasting at least 7 days, in people with and without diabetes, found that fruit eaten in place of other carbohydrate at equal calories lowered HbA1c by 0.19 percentage points (95% CI -0.35 to -0.03) across 6 comparisons. That is fruit of every kind, most of the evidence was rated low quality, and the trials disagreed with each other a good deal.

What the cohorts show

Pooled from 6 cohorts with 339,383 people, those eating the most apples or pears had a 14 percent lower risk of type 2 diabetes (RR 0.86, 95% CI 0.77 to 0.95), with high heterogeneity between studies. In three large US cohorts, each 3 servings a week of apples and pears tracked with 7 percent lower risk (HR 0.93, 0.90 to 0.96). Eating them 5 or more times a week against less than once a month tracked with 23 percent lower risk (HR 0.77, 0.65 to 0.83). These are associations. People who eat apples often also eat differently in other ways, and none of these sources states the absolute risk, so we cannot turn the percentages into cases per thousand people.

Who should be careful

Juice is where the answer gets less comfortable, and the evidence on it disagrees. In the same BMJ meta-analysis, fruit juice added on top of the usual diet raised fasting glucose by 5.2 mg/dL (95% CI 1.6 to 8.8; metric: 0.29 mmol/L, 0.09 to 0.49), but that rests on only two comparisons and the juice was not limited to apple. A 2025 meta-analysis found 100% fruit juice made no difference to glucose metabolism against the comparator. WHO counts the sugars naturally present in fruit juice as free sugars, the kind it advises limiting, and does not count the sugars in whole fruit.

The one drug interaction we found is with apple juice. In a crossover trial of 14 healthy adults, apple juice taken once with the allergy drug fexofenadine cut the drug's blood levels by 49 and 59 percent for its two forms.

We found no evidence on apples specifically for people who take insulin or other diabetes medicines. How fruit fits a treated diet is a question for the person treating you.

Not for everyone. If you take fexofenadine, apple juice is the wrong drink to swallow it with. If you are watching blood sugar, the whole fruit and the juice are not interchangeable in the guidance, and WHO treats only the juice as free sugar.

What expert bodies say

WHO defines free sugars to include sugars naturally present in fruit juices and fruit juice concentrates, and leaves sugars in whole fruit outside that definition. We tried to retrieve the American Diabetes Association's 2025 standards of care on fruit and juice and found only a press release and secondary pages, so we do not quote them. We found no Cochrane review of apples and blood sugar.

How we searched

What would change this answer

• An adequately powered randomized trial of whole apples in people with prediabetes or type 2 diabetes, measuring HbA1c over several months. One registered trial of apple polyphenols in prediabetes was terminated without results.
• Results from a registered trial in insulin-resistant adults that has not yet reported.
• A meal trial in people with diabetes. The halving of the glucose peak has been shown only in healthy women.

More on apples themselves, including the cholesterol trials: Apple.

Sources

1. ev-aplbs-01 · Meta-analysis or systematic review · systematic review and meta-analysis of RCTs · n = 12 RCTs for glucose
   No significant effects were found for glucose, insulin, or CRP levels.
   
   Who: adults in RCTs of whole apple, apple juice, extract, powder, pomace or vinegar, 1 to 12 weeks; glucose reported in 12 trials, insulin in 9
   Effect: fasting glucose and insulin: no significant difference versus control, consistent across subgroups
   Certainty: Mixed apple products and short trials; GRADE low for glucose and insulin.
   Frontiers in Nutrition, 2022, Metabolic and Cardiovascular Benefits of Apple and Apple-Derived Products: A Systematic Review and Meta-Analysis of Randomized Controlled Trials · checked 2026-10-07 · we read the fulltext
2. ev-aplbs-02 · Meta-analysis or systematic review · GRADE assessment within a meta-analysis of RCTs · n = 18 RCTs
   The confidence for reporting TC, LDL, TG, DBP, and SBP was rated as moderate quality (all downgraded for indirectness), whereas low quality for HDL, glucose, and insulin and very low quality for CRP were rated.
   
   Who: 18 RCTs of apples and apple-derived products
   Effect: GRADE: moderate for TC, LDL, TG, blood pressure; low for HDL, glucose, insulin; very low for CRP
   Certainty: Most trials did not mask apple products, which raised risk of bias.
   Frontiers in Nutrition, 2022, Metabolic and Cardiovascular Benefits of Apple and Apple-Derived Products: A Systematic Review and Meta-Analysis of Randomized Controlled Trials · checked 2026-10-07 · we read the fulltext
3. ev-aplbs-03 · Meta-analysis or systematic review · systematic review and meta-analysis of RCTs and cohorts · n = 2 RCTs
   Two RCTs (32, 39) that reported the effect of apple intake on blood glucose levels and 1 RCT (32) that reported on glucose:insulin found no difference between groups.
   
   Who: adults healthy or at risk for cardiovascular disease in apple RCTs
   Effect: blood glucose and glucose:insulin ratio: no difference between groups; too few trials for meta-analysis
   Certainty: Very thin trial base for glucose; insulin also unchanged in 3 RCTs with 236 participants.
   Current Developments in Nutrition, 2019, Effects of Intake of Apples, Pears, or Their Products on Cardiometabolic Risk Factors and Clinical Outcomes: A Systematic Review and Meta-Analysis · checked 2026-10-07 · we read the fulltext
4. ev-aplbs-04 · Observational data · meta-analysis of prospective cohort studies · n = 339,383
   Meta-analysis of 6 cohorts in 4 publications (42–45) included 339,383 participants and found a significant decrease in risk of diabetes (summary adjusted RR: 0.86; 95% CI: 0.77, 0.95) with a high heterogeneity (I2 = 78.0%; P = 0.001) when comparing the highest with the lowest quantile of apple or pear intake (Figure 6).
   
   Who: adults in 6 prospective cohorts in 4 publications
   Effect: highest vs lowest apple or pear intake: adjusted RR 0.86 (95% CI 0.77 to 0.95), I2 78%
   Certainty: Association only, high heterogeneity; residual confounding by overall diet likely.
   Current Developments in Nutrition, 2019, Effects of Intake of Apples, Pears, or Their Products on Cardiometabolic Risk Factors and Clinical Outcomes: A Systematic Review and Meta-Analysis · checked 2026-10-07 · we read the fulltext
5. ev-aplbs-05 · Observational data · pooled analysis of three prospective cohort studies · n = 187,382
   With mutual adjustment of individual fruits, the pooled hazard ratios of type 2 diabetes for every three servings/week were 0.74 (0.66 to 0.83) for blueberries, 0.88 (0.83 to 0.93) for grapes and raisins, 0.89 (0.79 to 1.01) for prunes, 0.93 (0.90 to 0.96) for apples and pears, 0.95 (0.91 to 0.98) for bananas, 0.95 (0.91 to 0.99) for grapefruit, 0.97 (0.92 to 1.02) for peaches, plums, and apricots, 0.99 (0.95 to 1.03) for oranges, 1.03 (0.96 to 1.10) for strawberries, and 1.10 (1.02 to 1.18) for cantaloupe.
   
   Who: 66,105 women (NHS), 85,104 women (NHS II) and 36,173 men (HPFS) free of major chronic disease
   Effect: per 3 servings/week: apples and pears HR 0.93 (0.90 to 0.96)
   Certainty: Self-reported intake; mutual adjustment for individual fruits.
   BMJ, 2013 · checked 2026-10-07 · we read the abstract
6. ev-aplbs-06 · Observational data · pooled analysis of three prospective cohort studies · n = 12,611 incident cases
   Consumption of anthocyanin-rich foods, particularly blueberries (pooled HR: 0.77 from a comparison of ≥2 servings/wk with <1 serving/mo; 95% CI: 0.68, 0.87; P-trend < 0.001) and apples/pears (pooled HR: 0.77 from a comparison of ≥5 servings/wk with <1 serving/mo; 95% CI: 0.65, 0.83; P-trend < 0.001), was also associated with a lower risk of type 2 diabetes.
   
   Who: 200,894 US adults in NHS, NHS II and HPFS free of diabetes, CVD and cancer
   Effect: apples/pears >=5 servings/week vs <1 serving/month: pooled HR 0.77 (95% CI 0.65 to 0.83)
   Certainty: Association only; anthocyanin-rich fruit framing; overlaps with ev-aplbs-05 cohorts.
   Am J Clin Nutr, 2012 · checked 2026-10-07 · we read the abstract
7. ev-aplbs-07 · Meta-analysis or systematic review · systematic review and meta-analysis of controlled intervention studies · n = 6 study comparisons
   Fruit accounted for 30% of the weighted benefit as the only food source, showing a significant decrease in HbA1c (six study comparisons, mean difference −0.19% (95% confidence interval −0.35 to −0.03), −25.6 mmol/mol (95% confidence interval −27.3 to −23.8), P=0.02, substantial heterogeneity (I2=78%, P<0.001)).
   
   Who: people with and without diabetes in controlled feeding trials of at least 7 days, energy-matched substitution
   Effect: fruit, substitution: HbA1c MD -0.19% (95% CI -0.35 to -0.03), I2 78%
   Certainty: Fruit in general, not apples alone; most evidence low quality by GRADE; substantial heterogeneity.
   BMJ, 2018 · checked 2026-10-07 · we read the fulltext
8. ev-aplbs-08 · Meta-analysis or systematic review · systematic review and meta-analysis of controlled intervention studies · n = 2 study comparisons
   We saw a significant interaction by food source in addition studies (P=0.01): SSBs (11 study comparisons, mean difference 0.12 mmol/L (95% confidence interval 0.03 to 0.22), substantial heterogeneity (I2=74%), P<0.001) and fruit juice (two, 0.29 mmol/L (0.09 to 0.49), no evidence of heterogeneity) showed a significant harmful effect.
   
   Who: controlled feeding trials adding excess energy from sugars; 2 fruit juice comparisons
   Effect: addition studies, fasting glucose: fruit juice +5.2 mg/dL (1.6 to 8.8; metric: 0.29 mmol/L, 0.09 to 0.49); SSBs +0.12 mmol/L (0.03 to 0.22)
   Certainty: Only two juice comparisons; juice type not limited to apple.
   BMJ, 2018 · checked 2026-10-07 · we read the fulltext
9. ev-aplbs-09 · Randomized controlled trial(s) · systematic review of human intervention studies · n = 38 studies
   Overall, the findings suggest that apples and apple-based products may beneficially modulate glycaemia, antioxidant capacity, and vascular endothelial function mainly in short-term interventions, while medium/long-term studies reported an apparent improvement in gut microbiota composition.
   
   Who: human intervention studies of apples and apple-based products: 13 postprandial, 22 medium or long term, 3 both
   Effect: possible benefit on glycemia, antioxidant capacity and endothelial function mainly in short-term studies; no pooled estimate
   Certainty: Narrative synthesis without meta-analysis; heterogeneous products and populations; rated B, not A, because nothing was pooled.
   Food Funct, 2026 · checked 2026-10-07 · we read the abstract
10. ev-aplbs-10 · Randomized controlled trial(s) · randomized crossover trial · n = 18
    Compared with rice reference, the PA+R achieved a 50% reduction of the iAUC0-120, a 51.4% reduction of the average peak value, and a 52.6% reduction of glycemic excursion in 240 min, while the PSS+R showed 29.7% and 31.6% reduction of peak value and glycemic excursion, respectively.
    
    Who: 18 healthy female subjects, apple preload of 15 g available carbohydrate before rice
    Effect: apple preload: iAUC0-120 -50%, peak -51.4%, glycemic excursion -52.6% vs rice alone; sugar-solution preload -29.7% and -31.6%
    Certainty: Single meal, healthy young women; no data in diabetes.
    Nutrients, 2019 · checked 2026-10-07 · we read the abstract
11. ev-aplbs-11 · Randomized controlled trial(s) · randomized crossover trial · n = —
    Apple elicited the lowest PGR among all test meals, as the A + 35R halved the IPG and slashed the incremental area under the curve in 180 min (iAUC0-180) by 45.7%, while the A + 50R reduced the IPG by 29.7%, compared with the W + 50R.
    
    Who: healthy female subjects, apple preload before a rice meal at equal or 30% higher total carbohydrate
    Effect: iso-carbohydrate apple preload: incremental peak glucose halved, iAUC0-180 -45.7%; with extra carbohydrate: peak -29.7% vs water preload
    Certainty: Same research group as ev-aplbs-10; sample size not given in abstract.
    Nutrients, 2021 · checked 2026-10-07 · we read the abstract
12. ev-aplbs-12 · Randomized controlled trial(s) · randomized double-blind crossover trial · n = 25
    AE significantly reduced iAUC 0-30 min (mean difference -26 mmol/L min, -35, -18, P<.0005) compared with CON, but the difference over 120 min was not significant.
    
    Who: 20 men and 5 postmenopausal women, healthy, starch and sucrose meal
    Effect: apple extract: iAUC0-30 -26 mmol/L·min (-35 to -18); iAUC0-120 not significant
    Certainty: Concentrated extract, not whole apple.
    J Nutr Biochem, 2017 · checked 2026-10-07 · we read the abstract
13. ev-aplbs-13 · Randomized controlled trial(s) · randomized crossover trial · n = 23
    There was no effect on HDL-cholesterol, TAG, weight, waist-to-hip ratio, blood pressure, inflammation (hs-CRP), composition of the gut microbiota or markers of glucose metabolism (insulin, IGF1 and IGFBP3).
    
    Who: 23 healthy volunteers; whole apples 550 g/day, pomace 22 g/day, clear or cloudy juice 500 ml/day, 4 weeks each
    Effect: no effect on insulin, IGF1 or IGFBP3 for any apple product
    Certainty: Healthy people with normal glucose; fasting glucose itself not reported in abstract.
    Eur J Nutr, 2013 · checked 2026-10-07 · we read the abstract
14. ev-aplbs-14 · Meta-analysis or systematic review · systematic review and updated meta-analysis of RCTs and prospective studies · n = —
    In summary, this meta-analysis confirmed that there was no difference between 100%FJ intake and the comparator on glucose metabolism.
    
    Who: RCTs and prospective studies of 100% fruit juice
    Effect: glucose metabolism markers: no difference vs comparator
    Certainty: Juice in general; contrasts with the harmful addition-study signal in ev-aplbs-08 and cohort signal in ev-aplbs-05.
    J Med Food, 2025 · checked 2026-10-07 · we read the abstract
15. ev-aplbs-15 · Randomized controlled trial(s) · randomized open-label crossover pharmacokinetic trial · n = 14
    One-time ingestion of apple juice significantly decreased the area under the plasma concentration-time curve (AUC0-24) for (R)- and (S)-fexofenadine by 49 and 59 %, respectively, and prolonged the time to reach the maximum plasma concentration (t max) of both enantiomers (P < 0.001).
    
    Who: 14 healthy Japanese subjects, 60 mg racemic fexofenadine with water or apple juice
    Effect: AUC0-24 of (R)- and (S)-fexofenadine -49% and -59%; tmax prolonged
    Certainty: Pharmacokinetic study; mechanism is intestinal OATP2B1 inhibition, relevant to other OATP substrates.
    Eur J Clin Pharmacol, 2014 · checked 2026-10-07 · we read the abstract
16. ev-aplbs-16 · Position of an expert body · WHO guideline definition · n = —
    However, as noted in the Remarks section under the Recommendations, the term has been further elaborated for this guideline by the WHO Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Diet and Health as follows: “Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates”.
    
    Who: adults and children
    Effect: free sugars include sugars in fruit juices and fruit juice concentrates; WHO advises free sugars below 10% of energy
    Certainty: Definition, not an effect estimate.
    WHO, 2015, Guideline: sugars intake for adults and children · checked 2026-10-07 · we read the section