For a salad dressing ingredient, apple cider vinegar, or ACV, sure gets a lot of credit. The vinegar is made from fermented apple juice, and its active ingredient is acetic acid. Although this ingredient is found in all types of vinegar, ACV has a reputation as a health tonic.
Now it’s being added to prebiotic sodas like Poppi and other canned drinks that tout digestive health benefits. Some claim ACV is a prebiotic, and others claim it’s a probiotic. It’s neither.
Cider vinegar is also showing up in powdered drink mixes, jars of honey and shots with cayenne, turmericand ginger. Apple cider vinegar gummies and other supplements are popular offerings at health food stores and are heavily promoted online.
Celebrities are sharing how they routinely start their day with a spoonful of ACV as a shot or mixed with water.
Additionally, there’s an onslaught of books promoting ACV detox cleanses and praising the benefits of this “healing elixir,” claiming it can cure diabetes, promote weight loss, kill cancer cells and even reverse arthritis.
One of the first books about the health benefits of apple cider vinegar was written by the late Paul C. Bragg, a naturopath who began selling raw, unpasteurized ACV at his Hollywood health store in 1912. There, he first distributed his book “Apple Cider Vinegar: Miracle Health System.” His vinegar is still sold today and is one of the biggest brands of raw, unfiltered ACV with “the mother,” the murky cloud that floats around in the bottle. This is a mixture of yeast and bacteria from the vinegar’s fermentation process.
Even though many of the claims are overstated or flat-out wrong, some scientific studies have been conducted on ACV, including a recent study suggesting potential weight loss benefits.
Here’s a look at the common claims attributed to ACV and the supporting — or lack of — scientific evidence.
[Related:Best Foods to Eat for Gut Health]
Does Apple Cider Vinegar Help Weight Loss?
Several studies have looked at apple cider vinegar and weight loss with inconsistent findings. Researchers don’t have enough evidence to say for certain what the benefits of ACV are when it comes to weight loss.
New evidence from a group of scientists in Lebanon found encouraging results. Rony Abou-Khalil and colleagues from the Holy Spirit University of Kaslik in Jounieh, Lebanon found that teenagers and young adults who drank up to 1 tablespoon of ACV daily for 12 weeks dropped an average of 15 pounds and reduced their BMI by about three points. They also experienced significant decreases in waist and hip circumference, along with improvements in blood sugar, cholesterol and triglyceride levels.
The reasons behind the reported benefits are unknown, yet several hypotheses have been proposed, Abou-Khalil told U.S. News & World Report in an email.
“ACV contains acetic acid, which may help to increase feelings of fullness and reduce calorie intake by slowing gastric emptying,” he says. “Additionally, ACV has been suggested to improve insulin sensitivity and regulate blood sugar levels, potentially influencing fat metabolism and storage.”
Study participants in Lebanon were ages 12 to 25 and the sample size was limited, so it’s unclear if the results will apply to everyone. Additionally, the intervention lasted just 12 weeks, which Abou-Khalil says may mean that the study did not capture long-term effects or changes in the measurements of metabolism.
It was also difficult to determine if variations in lifestyle habits could have influenced the outcomes observed, he says. “Despite these limitations, our study provides valuable insights into the potential effects of ACV on weight management and metabolic health, laying the groundwork for future research in this area.”
[READ: Apple Cider Vinegar Diet for Weight Loss.]
Can ACV Help Blood Sugar Management?
While far from a cure for diabetes, ACV has been shown to have a positive effect on blood sugar levels. Carol Johnston, a professor and associate dean at Arizona State University, has conducted multiple studies on cider vinegar. Her research suggests daily cider vinegar (1 to 2 tablespoons twice a day for 12 weeks) can reduce blood sugar levels and A1C values — the blood marker used to monitor blood sugar managementin individuals with Type 2 diabetes.
However, the benefits were only observed after eating a high-carbohydrate meal, such as a bagel and orange juice. Johnston suspects the acetic acid in vinegar interferes with the enzymes that digest carbohydrates. So the simple carbohydrates pass through without stopping, similar to fiber.
“A limitation is that most of the published trials on vinegar have small sample sizes. However, nearly all the trials have shown this benefit in diverse samples of individuals worldwide,” she says.
Since all vinegar contains acetic acid, Johnston says any vinegar would have the same anti-glycemic response. Vinegar is not recommended for those with Type 1 diabetes taking insulin because it may reduce blood glucose to dangerously low levels, she adds.
[READ: Tips for Monitoring and Controlling Blood Sugar Levels.]
Can ACV Reduce Blood Cholesterol?
In a meta-analysis of nine randomized clinical trials, apple cider vinegar was shown to significantly reduce total cholesterol. One of the small studies included in the review found that taking apple cider vinegar every day for 12 weeks, combined with a reduced-calorie diet, lowered total cholesterol and triglyceride levels and led to improvements in HDL (“good”) cholesterol levels.
While these results may be promising, it doesn’t mean ACV alone should be used to reduce cholesterol.
“Apple cider vinegar can be part of a heart-healthy diet, but it’s important not to isolate one food or ingredient,” says Penny M. Kris-Etherton, the Evan Pugh University Professor of Nutritional Sciences at Penn State University and a volunteer for the American Heart Association.
There are dietary changes recommended by the American Heart Association that can have an even bigger impact on cholesterol levels.
“It’s not just about apple cider vinegar as an ingredient, it’s what is eaten alongside it,” she says. “Eating apple cider vinegar with foods high in saturated fat is different than eating apple cider vinegar as part of dressing on a salad full of leafy greens, lean protein and other vegetables. What is important is the total dietary pattern, which certainly can include ACV, that can significantly affect major risk factors for cardiovascular disease.”
[See: 7 Healthy Smoothies: Recipes and Benefits]
Is Apple Cider Vinegar a Probiotic or Prebiotic?
While apple cider vinegar is a fermented product, it does not contain probiotics. Neither do the raw, unpasteurized versions that contain “the mother.” Not all fermented products are probiotics, even those with live and active cultures.
Probiotics are live microbes that provide health benefits when they survive the journey in our digestive tract, according to the International Scientific Association for Probiotics and Prebiotics. ACV does not live up to that scientific definition. Buy the raw, unfiltered ACV if you want the live microbes and prefer the stonger apple taste compared to the clear filtered varieties, but don’t mistake it for a probiotic.
Not only is ACV often mistakenly referred to as a probiotic food, but now products also market the vinegar as a prebiotic, which is the carbohydrate-containing fuel for probiotic bacteria in the gut. That’s also not true, according to Robert Hutkins, professor of food science and technology at the University of Nebraska-Lincoln and one of the country’s leading experts on prebiotics.
“(ACV) is mainly acetic acid, with trace amounts of polyphenolics that may contribute color and flavor, but there will be little if any pectin or other carbohydrates,” he says.
Is Apple Cider Vinegar Nutritious?
Some articles and books refer to the many nutrients in ACV, including:
— Thiamin
— Riboflavin
— Folate
— Potassium
— Iron
— Calcium
However, the amounts of each are so small that a tablespoon serving provides 0% of the daily value of any of these nutrients.
Of all these nutrients, the potassium content is the highest, yet a serving provides a mere 11 milligrams of the mineral. For comparison, a banana contains about 400 mg of potassium. You’d need to consume 1 cup of apple cider vinegar to get 2% of the daily value, which means it’s considered a poor source of the nutrient.
In addition, while apples are packed with pectin, there’s little or no pectin in ACV. Yet this fiber is credited for many of cider vinegar’s purported benefits.
Apple Cider Risks and Side Effects
Tooth enamel damage
Like soda, vinegar is very acidic and can cause damage to teeth enamel for some, according to some studies. The loss of tooth enamel isn’t just unattractive. It can also be painful and expensive, as it increases the risk for tooth decay that can lead to fillings, root canals, crowns and other dental procedures. If you’re going to drink ACV (or other acidic beverages), dentists recommend:
— Diluting it in water
— Using a straw
— Swishing and spitting water afterward
— Waiting at least one hour after eating before brushing your teeth
Esophageal burns
The acidity of vinegar is so severe that drinking it undiluted — or even not diluted enough — can result in ulceration and burning of the esophagus.
Slowed digestion
Vinegar delays gastric emptying, severe cases of which are called gastroparesis — literally stomach paralysis. Because people with diabetes are among those most likely to try ACV and are at a higher risk for gastroparesis due to diabetes, this is a possible side effect to keep in mind. If you’ve already been diagnosed with gastroparesis, your doctor will likely recommend avoiding vinegar for weight loss.
Low potassium
According to health experts, ACV might lead to low potassium levels in the blood. If you’ve been diagnosed with low blood potassium (hypokalemia), you should avoid using apple cider vinegar as a supplement.
Medicine interactions
Apple cider vinegar can interact with many types of medications, including:
— Digoxin (Lanoxin): This drug for heart failure and arrhythmias also decreases potassium levels in the blood.
— Insulin: Both insulin and ACV decrease blood potassium and glucose levels.
— Diabetes medication: Because both decrease blood sugar, it’s possible that your sugar level will drop too low.
— Diuretics: Certain types of diuretics can decrease potassium levels, as can ACV.
— Herbal supplements: Ensure that other supplements you take don’t also lower potassium, as licorice and horsetail do. Also, keep in mind that other supplements, including bitter melon and chromium, might decrease blood sugar.
In addition to unproven benefits, regular vinegar consumption may carry some risks. The high acidity of apple cider vinegar could damage tooth enamel if ingested undiluted in large amounts, says Dr. Edmond R. Hewlett, professor at the UCLA School of Dentistry and consumer advisor to the American Dental Association.
With mindful consumption, however, the damage can be prevented, he notes. A quick spoonful of ACV may produce only a minuscule amount of erosion, yet prolonged exposure to acid — such as regularly sipping from a glass of ACV or other acidic beverage throughout the day — can lead to severe tooth damage.
If you are consuming ACV, it’s important not to brush your teeth immediately afterward, Hewlett says. Minerals in our saliva help to replace those dissolved out of the enamel from the spoonful of ACV.
“Brushing immediately after an acid exposure can scrub away this acid-softened outer layer, and it is lost forever, unavailable to be repaired by our saliva,” he says. “We should wait one hour before brushing to let our saliva do its job — rehardening our enamel as well as washing away the residual acid so that it doesn’t linger in the mouth.”
Other issues from regular or excessive consumption of cider vinegar have included digestive discomfort, low potassium levels and throat burns.
“We recommend diluting 1 to 2 tablespoons in 8 to 12 ounces of water and drinking with the first bites of a meal,” says Johnston. “This allows the food matrix to mix with the vinegar and reduce the contact of the acid with the lining of the esophagus as it is ingested.”
In her research, they have also limited the dosage to 4 tablespoons or less daily per participant.
Apple Cider Vinegar Pills and Gummies
When it comes to ACV supplements, you can find them available in pill, tablet, powder or gummy form. There is not much research on taking ACV in pill, powder or other forms. As such, recommendations on dosage is not well established and can vary between brands.
As the FDA does not closely regulate supplements, it is important to look for third-party supplement testing to check for quality. A study published in the Journal of the American Dietetic Association examined eight apple cider vinegar tablet products and tested the pH, component acid content and microbial level of each. The results found that there was considerable variability between the brands in tablet size, pH, component acid content and label claims.
Researchers doubted as to whether apple cider vinegar was in fact an ingredient in the evaluated products. That is why third party testing has been established as it helps regulate the purity and safety of the supplement and to ensure that the ingredients in the amounts listed on the label are actually in there. Third party approvals are conducted by ConsumerLab, Informed Choice, United States Pharmacopeia, NSF Certified for Sport and NSF International.
In addition, the supplement (and ACV itself) should be avoided if you have a severe allergy to apples.
Vinegar Cooking Ideas
Vinegar — derived from the French “vin aigre,” or sour wine — has been traced back to 5,000 B.C.E. in Babylon. It was used in cooking as well as for preservation and medicinal purposes.
Vinegar is a major staple of the Mediterranean diet, and there are many ways to enjoy ACV that don’t involve drinking a spoonful or chewing apple cider vinegar gummies. Also check out other vinegars, such as balsamic, white wine, red wine, rice, champagne and sherry vinegar.
It’s good to regularly consume vinegar since it’s the only dietary source of acetic acid, which is converted to acetate once it hits our bloodstream. Acetate has been known for decades as important in human metabolism, says Johnston.
— Skip bottled salad dressings and make your own simple vinaigrette by whisking together vinegar, Dijon mustard, extra-virgin olive oil, salt and pepper.
— Use vinegar to make quick pickled vegetables, including pickled red onions that are a tasty addition to salads, sandwiches and bowls.
— Add vinegar to sauces, glazes and marinades for meat.
— Combine vinegar with olive oil and herbs to make a dip for bread.
— Make your own switchel — a vinegar-based Colonial-era drink that is enjoying a resurgence as a mocktail. Combine ACV with water, honey or maple syrup, and fresh ginger.
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Apple Cider Vinegar: Myths vs. Facts originally appeared on usnews.com
Update 07/22/24: This story was published at an earlier date and has been updated with new information.
