Buy or Bye: Apple Cider Vinegar

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Long before social media influencers and Dr. Google delivered instant suggestions on what to eat for better health apple cider vinegar (ACV) has been one of the leading word-of-mouth health remedies. The hype for ACV has not subsided. The promises are enthusiastic: increased weight loss, better blood sugar control, improved heart and immune health, reduced cancer risk, better gut functioning, to name a few. Much of which contributed to the metabolic impact of consuming fermented ACV. So, will a daily sour ACV shot do the trick?

The Upside: Some purported health perks may hold true. A systematic review and meta-analysis in the Journal of the Academy of Nutrition and Dietetics found that apple cider vinegar supplementation was associated with lower fasting blood glucose levels among patients with type 2 diabetes without adverse side effects, compared with placebo. Supplementation with ACV was also found to lower concentrations of triacylglycerol among those who had overweight or obesity and those with type 2 diabetes, which may result in cardiovascular benefits. Other research has also found enough evidence to suggest that ACV used for more than 2 months can improve blood sugar management and blood cholesterol levels. It appears that ACV use can improve the glycemic response to carbohydrate-rich meals like pasta, potatoes, and bread. So if someone wants to chow down on a high-carb meal a little bit of ACV beforehand could keep blood sugar more steady.

There is also a modicum of evidence suggesting ACV has some weight loss power. A randomized clinical study published in BMJ Nutrition, Prevention & Health found that consuming apple cider vinegar may be helpful in weight loss and reducing visceral fat. The study involved 120 participants with overweight or obesity, and researchers found that all doses of vinegar from 5 ml to 15 ml daily were linked to decreases in body weight as well as blood glucose levels over the 12-week study period compared with those who did not consume apple cider vinegar. The slower release of blood sugar into the bloodstream with ACV use and subsequent rise in hunger-reducing hormones could have an appetite-suppressing effect that may assist in calorie intake control that makes it easier for individuals to achieve weight loss.

Since apple cider vinegar is a fermented food it could, in theory, supply probiotics to improve our microbiome, the population of microbes in our digestive tract that appear to play a big role in overall health. However, because we’re typically consuming such small volumes, it doesn’t seem likely that ACV would be a significant source of probiotics in our diet compared to other fermented foods such as yogurt. To date, there are no studies specifically addressing apple cider vinegar’s impact on the human microbiome. 

The Downside: This all sounds promising but keep in mind that we don’t have any convincing evidence that ACV will benefit those without metabolic issues like diabetes. If you don’t have impaired insulin sensitivity or blood sugar control or elevated blood lipids then the impact on blood sugar and body weight might be muted. Several past studies have methodological concerns including small sample sizes and did not adequately control for the dose of acetic acid taken before and during trials. It’s also unclear how apple cider’s metabolic effects vary from any other kind of vinegar. Though most of the research has been conducted on cider vinegar, the blood sugar benefits may not differ a great deal among different varieties of vinegar like balsamic and red wine since they also contain acetic acid. 

As for other purported benefits like reducing bloating, cancer risk, and brain fog this remains unproven and likely just wishful thinking.

It’s risky to take ACV straight up since direct exposure to its acetic acid can burn the esophagus and degrade tooth enamel leading to increased risk for cavities and expensive dentist visits. The latter is also a problem when drinking any acidic drinks including sodas and kombucha. It’s best to dilute one ounce of ACV in about four ounces of water, herbal tea or other types of unsweetened beverages.

The Verdict: For people with poor metabolic health including those with type 2 diabetes, using apple cider vinegar, 10 to 30 mL daily, especially before meals, may be worth pursuing and doesn’t cost much. To date, there is little evidence of any negative health impacts of doing so. But for metabolically healthy people it can remain something that is used mainly to add flavor to dishes like salads. Ideally, you want to use an unfiltered cider vinegar that contains a cobweb-like floating substance referred to as the “mother” and has an amber color with a cloudy appearance. Most commercial ACVs on the market take shortcuts from the longer fermentation process so won’t have the same flavor nuances or potential for probiotics.