Pineapple differs from traditional Texas Hold'em mainly in the number of hole cards each player receives and the way the hand develops. In Texas Hold'em, each player is dealt two hole cards, while in Pineapple, players are initially dealt three. After the flop, players must discard one of their hole cards, leaving them with two for the remainder of the hand. This adds a layer of complexity to decision-making, as players must evaluate their hand strength more carefully and choose the best card to discard.