Introduction
Apple cider vinegar (ACV) is a popular home remedy made by fermenting crushed apples with yeast and bacteria, producing acetic acid, the main active compound believed responsible for its potential health benefits (Johnston & Gaas, 2006). ACV has been used as a traditional remedy for centuries to treat various ailments, and recent scientific studies have begun to investigate its effectiveness. This article will provide an in-depth review of the current evidence on the health benefits of apple cider vinegar, focusing on findings from high-quality human clinical trials and systematic reviews.
Composition and Active Compounds
Apple cider vinegar contains acetic acid as its main active compound, which is produced during the fermentation process. In addition to acetic acid, ACV also contains flavonoids such as gallic acid, catechin, caffeic acid, and ferulic acid (Hadi et al., 2021). These compounds are known for their antioxidant properties and may contribute to the health benefits of ACV.
Another important component of ACV is the “mother” of vinegar, which consists of proteins, enzymes, and friendly bacteria that form during the fermentation process. The “mother” is believed to have probiotic properties, although more research is needed to confirm its specific health effects.
Blood Sugar Management
One of the most promising areas of research on apple cider vinegar is its potential to help manage blood sugar levels. A systematic review and meta-analysis by Hadi et al. (2021) found that ACV consumption significantly decreased fasting plasma glucose (FPG) and HbA1c levels, especially in studies lasting eight weeks or longer. The authors analysed 10 randomised controlled trials (RCTs) involving 500 participants and found that ACV intake reduced FPG by an average of 11.32 mg/dL (95% CI: -16.29, -6.35; p < 0.001) and HbA1c by 0.28% (95% CI: -0.44, -0.12; p = 0.001) compared to control groups.
The mechanisms behind ACV’s blood sugar-lowering effects are not fully understood, but some researchers suggest that the acetic acid in ACV may slow carbohydrate digestion and improve insulin sensitivity (Petsiou et al., 2014). However, it is important to note that while these findings are promising, more research is needed to establish the optimal dosage and duration of ACV supplementation for blood sugar management. Additionally, ACV should not be used as a replacement for medical treatment in individuals with diabetes or other blood sugar disorders.
Weight Loss
Another area of interest in ACV research is its potential to aid in weight loss. Some small human studies have suggested that ACV intake may increase feelings of fullness and reduce calorie intake, leading to modest weight loss over time. For example, a randomised clinical trial by Khezri et al. (2018) found that overweight or obese individuals who consumed 15 mL of ACV daily along with a reduced-calorie diet lost an average of 2.6 kg over 12 weeks, compared to 1.2 kg in the placebo group.
However, it is important to note that the evidence for ACV’s weight loss benefits is limited and inconsistent. A systematic review by Petsiou et al. (2014) concluded that while some studies showed modest weight loss with ACV consumption, others found no significant effect. Similarly, the meta-analysis by Hadi et al. (2021) did not find a significant effect of ACV on body weight or BMI.
Given the mixed evidence, it is clear that ACV should not be relied upon as a sole weight loss strategy. Instead, it may be viewed as a complementary approach to support weight management when combined with a balanced diet and regular physical activity.
Cholesterol and Triglycerides
In addition to its potential effects on blood sugar and weight management, some studies have investigated the impact of apple cider vinegar on cholesterol and triglyceride levels. The meta-analysis by Hadi et al. (2021) found that ACV consumption significantly reduced total cholesterol levels, with a trend towards lower triglycerides. These effects were more pronounced in studies involving individuals with type 2 diabetes and those lasting eight weeks or longer.
The authors reported that ACV intake reduced total cholesterol by an average of 6.32 mg/dL (95% CI: -11.38, -1.25; p = 0.01) and triglycerides by 8.18 mg/dL (95% CI: -17.08, 0.72; p = 0.07) compared to control groups. While the reduction in triglycerides did not reach statistical significance, the trend suggests that ACV may have a beneficial effect on this lipid parameter as well.
The mechanisms behind ACV’s cholesterol-lowering effects are not fully understood, but some researchers have proposed that the acetic acid in ACV may increase bile acid excretion and reduce lipogenesis (the formation of new fat molecules) in the liver (Petsiou et al., 2014). However, more research is needed to confirm these mechanisms and establish the optimal dosage and duration of ACV supplementation for cholesterol management.
Antimicrobial Effects
Apple cider vinegar has been traditionally used as a natural disinfectant and preservative due to its antimicrobial properties. While there is limited human evidence for ACV’s ability to prevent infections, some in vitro studies have shown that ACV can inhibit the growth of certain bacteria.
For example, a study by Yagnik et al. (2018) found that ACV effectively inhibited the growth of Escherichia coli and Staphylococcus aureus in laboratory settings. The authors suggested that ACV’s antimicrobial activity may be due to its acetic acid content and other bioactive compounds.
However, it is important to note that these findings are based on in vitro studies, and the effects may not necessarily translate to the human body. More research is needed to determine whether ACV consumption can help prevent or treat bacterial infections in humans.
Risks and Precautions
While apple cider vinegar is generally considered safe when consumed in moderation, there are some potential risks and side effects to be aware of. The acidity of ACV can erode tooth enamel and irritate the throat if consumed undiluted (National Capital Poison Center, n.d.). To minimise these risks, it is recommended to dilute ACV in water and rinse the mouth after consumption.
ACV may also interact with certain medications, such as diuretics and insulin, potentially leading to low potassium levels or hypoglycemia (National Capital Poison Center, n.d.). Individuals taking these medications should consult with their healthcare provider before adding ACV to their diet.
Additionally, excessive consumption of ACV may lower potassium levels in the body, which can cause muscle weakness, cramps, and other adverse effects (Launholt et al., 2020). It is important to consume ACV in moderation and not exceed the dosages used in clinical studies.
Dosage and Consumption
Currently, there are no official guidelines for the optimal dosage of apple cider vinegar. However, most studies that have shown beneficial effects used dosages ranging from 15 to 30 mL (1-2 tablespoons) per day, diluted in water. Consuming larger amounts of ACV may increase the risk of side effects and is not recommended without the guidance of a healthcare professional.
To incorporate ACV into the diet, it can be added to salad dressings, marinades, or consumed as a beverage by mixing 1-2 tablespoons with water or other liquids. Some people also choose to consume ACV supplements in the form of capsules or gummies, although the evidence for their effectiveness is limited.
Conclusion
In conclusion, apple cider vinegar has shown potential health benefits in areas such as blood sugar management, weight loss, and cholesterol reduction. However, it is important to note that the evidence is still limited, and more high-quality human clinical trials are needed to confirm these effects and establish optimal dosing and duration.
While ACV can be a useful complementary approach to support overall health, it should not be viewed as a replacement for medical treatment or a balanced diet and lifestyle. Individuals with pre-existing health conditions or those taking medications should consult with their healthcare provider before adding ACV to their diet.
As with any dietary supplement, it is important to consume apple cider vinegar in moderation and be aware of potential risks and side effects. By incorporating ACV into a healthy lifestyle and following evidence-based guidelines, individuals may be able to reap the potential benefits of this traditional remedy while minimising the risks.
References
Hadi, A., Pourmasoumi, M., Najafgholizadeh, A., Clark, C. C., & Esmaillzadeh, A. (2021). The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials. BMC Complementary Medicine and Therapies, 21(1), 179. https://doi.org/10.1186/s12906-021-03351-w
Johnston, C. S., & Gaas, C. A. (2006). Vinegar: medicinal uses and antiglycemic effect. MedGenMed: Medscape General Medicine, 8(2), 61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1785201/
Khezri, S. S., Saidpour, A., Hosseinzadeh, N., & Amiri, Z. (2018). Beneficial effects of apple cider vinegar on weight management, visceral adiposity index and lipid profile in overweight or obese subjects receiving restricted calorie diet: A randomized clinical trial. Journal of Functional Foods, 43, 95-102. https://doi.org/10.1016/j.jff.2018.02.003
Launholt, T. L., Kristiansen, C. B., & Hjorth, P. (2020). Safety and side effects of apple vinegar intake and its effect on metabolic parameters and body weight: a systematic review. European Journal of Nutrition, 59(6), 2273-2289. https://doi.org/10.1007/s00394-020-02214-3
National Capital Poison Center. (n.d.). Vinegar: Not Just for Salad. Poison Control. https://www.poison.org/articles/vinegar-164
Petsiou, E. I., Mitrou, P. I., Raptis, S. A., & Dimitriadis, G. D. (2014). Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight. Nutrition Reviews, 72(10), 651-661. https://doi.org/10.1111/nure.12125
Yagnik, D., Serafin, V., & J Shah, A. (2018). Antimicrobial activity of apple cider vinegar against Escherichia coli, Staphylococcus aureus and Candida albicans; downregulating cytokine and microbial protein expression. Scientific Reports, 8(1), 1732. https://doi.org/10.1038/s41598-017-18618-x
Key Highlights and Actionable Tips
- Apple cider vinegar (ACV) contains acetic acid and other beneficial compounds like flavonoids, which may contribute to its potential health benefits.
- ACV may help manage blood sugar levels by slowing carbohydrate digestion and improving insulin sensitivity. Consume 15-30 mL of ACV daily, diluted in water, for at least 8 weeks to see potential benefits.
- Some studies suggest ACV may aid in modest weight loss when combined with a reduced-calorie diet and regular physical activity. However, evidence is limited and inconsistent.
- ACV consumption may help reduce total cholesterol levels and show a trend towards lowering triglycerides, especially in individuals with type 2 diabetes.
- While ACV has antimicrobial properties in vitro, more research is needed to determine its effectiveness in preventing or treating infections in humans.
- To minimise risks, dilute ACV in water before consumption and rinse your mouth afterwards to protect tooth enamel. Consult your healthcare provider if you take medications like diuretics or insulin.
- Incorporate ACV into your diet by adding it to salad dressings, marinades, or consuming 1-2 tablespoons diluted in water daily. Do not exceed dosages used in clinical studies without guidance from a healthcare professional.
Can apple cider vinegar interact with any medications?
Yes, apple cider vinegar may interact with certain medications, such as diuretics and insulin. Diuretics can lower potassium levels in the body, and consuming large amounts of ACV may further decrease potassium, potentially leading to muscle weakness and cramps. Insulin helps regulate blood sugar levels, and ACV may enhance its effects, increasing the risk of hypoglycemia (low blood sugar). If you take any medications, it’s essential to consult your healthcare provider before adding ACV to your diet to ensure safety and avoid potential interactions.
How can I incorporate apple cider vinegar into my diet without drinking it straight?
There are several ways to incorporate apple cider vinegar into your diet without drinking it straight, which can be harsh on your throat and tooth enamel. One option is to use ACV as an ingredient in salad dressings or marinades for meat and vegetables. You can also dilute 1-2 tablespoons of ACV in a glass of water or other beverages like tea or juice. Some people enjoy mixing ACV with honey or other natural sweeteners to improve the taste. Another option is to consume ACV supplements in the form of capsules or gummies, although the evidence for their effectiveness is limited compared to liquid ACV.
Are there any specific types of apple cider vinegar that are more beneficial than others?
While there is no conclusive evidence that one type of apple cider vinegar is more beneficial than others, some experts recommend choosing raw, unfiltered, and organic ACV. This type of ACV contains the “mother,” which consists of proteins, enzymes, and friendly bacteria that form during the fermentation process. The “mother” is believed to have probiotic properties and may contribute to the health benefits of ACV. However, more research is needed to confirm the specific effects of the “mother” and whether it provides additional benefits compared to filtered ACV.
Can apple cider vinegar help with skin conditions like acne or eczema?
Some people claim that apple cider vinegar can help with skin conditions like acne or eczema due to its antimicrobial properties. However, there is limited scientific evidence to support these claims. While ACV may have antibacterial effects in vitro, it’s unclear whether these effects translate to improved skin health when applied topically or consumed orally. Additionally, the acidity of ACV may cause skin irritation in some people, especially those with sensitive skin. If you’re considering using ACV for skin conditions, it’s best to consult with a dermatologist or healthcare provider first to discuss potential risks and benefits.
Is it better to consume apple cider vinegar in the morning or at night?
There is no conclusive evidence that consuming apple cider vinegar at a specific time of day is more beneficial. Some people prefer to drink ACV diluted in water first thing in the morning on an empty stomach, while others consume it before meals or at bedtime. The most important factor is to find a time that works best for you and to consume ACV consistently to potentially see benefits. However, it’s generally recommended to avoid consuming ACV right before lying down, as its acidity may cause throat irritation or worsen acid reflux symptoms in some people. If you experience any discomfort, try adjusting the timing or dilution of your ACV consumption.
References
Hadi, A., Pourmasoumi, M., Najafgholizadeh, A., Clark, C. C., & Esmaillzadeh, A. (2021). The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials. BMC Complementary Medicine and Therapies, 21(1), 179. https://doi.org/10.1186/s12906-021-03351-w
Johnston, C. S., & Gaas, C. A. (2006). Vinegar: medicinal uses and antiglycemic effect. MedGenMed: Medscape General Medicine, 8(2), 61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1785201/
Khezri, S. S., Saidpour, A., Hosseinzadeh, N., & Amiri, Z. (2018). Beneficial effects of apple cider vinegar on weight management, visceral adiposity index and lipid profile in overweight or obese subjects receiving restricted calorie diet: A randomized clinical trial. Journal of Functional Foods, 43, 95-102. https://doi.org/10.1016/j.jff.2018.02.003
Launholt, T. L., Kristiansen, C. B., & Hjorth, P. (2020). Safety and side effects of apple vinegar intake and its effect on metabolic parameters and body weight: a systematic review. European Journal of Nutrition, 59(6), 2273-2289. https://doi.org/10.1007/s00394-020-02214-3
National Capital Poison Center. (n.d.). Vinegar: Not Just for Salad. Poison Control. https://www.poison.org/articles/vinegar-164
Petsiou, E. I., Mitrou, P. I., Raptis, S. A., & Dimitriadis, G. D. (2014). Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight. Nutrition Reviews, 72(10), 651-661. https://doi.org/10.1111/nure.12125
Yagnik, D., Serafin, V., & J Shah, A. (2018). Antimicrobial activity of apple cider vinegar against Escherichia coli, Staphylococcus aureus and Candida albicans; downregulating cytokine and microbial protein expression. Scientific Reports, 8(1), 1732. https://doi.org/10.1038/s41598-017-18618-x
