The airways are piped with contents of apple cider vinegar (ACV). Yes, this seeming combination of fermented carbohydrate sources such as wine, apples, pears, and dates among others, is said to be a household must-have now and even centuries ago.  

ACV is produced from fermented crushed apples and is said to have a low acidity. Some of the purported benefits of apple cider vinegar include its mucus-removing possibilities, detoxifying the body and the most talked about – weight loss.  But are the benefits of ACV scientifically proven? Let’s discuss!

The Discussion

The word vinegar is derived from the French syllabi ‘ven aigre’ which means ‘sour wine.’  The product can be the fermentation of several carbohydrate sources including wine, pears, beets and apples, which is the main source of ACV (Johnston et. al. 2006).  For commercial use, the product goes through several different steps which include fermenting the natural sugars of the particular carbohydrate source into alcohol. The alcohol is then converted to acetic acid via acetic acid bacteria (Acetobacter).  Fermentation can either be slow or fast, with slower methods often being used for most of the traditional wine vinegar on the market and even some ACV products.  Additionally, the slower fermented products may have the familiar non-toxic slime – the mother.

The mother of the vinegar is due to the accumulation of a non-toxic slime that comprises yeast and acetic acid bacteria due to the longer fermentation periods (Johnston et. al. 2006; Vinegar International Symposium, 2005).  Nonetheless, you may not see this substance in many vinegar products, as it is said that most manufacturers usually filter and pasteurize their products before they are bottled for sale (Johnston et. al. 2006). 

However, this does not mean that your vinegar product is not nutrient-rich or ‘healthy’ as the ‘mother’ does not necessarily dictate the benefits of the product health-wise. Further, research denotes no substantiated health effects of this substance being part of a vinegar product (Johnston et. al. 2006). 

The acetic acid in vinegar is what helps us to identify a product as being vinegar.  As such, it is responsible for the tart flavour and pungent odour (Johnston et. al. 2006).  However, acetic acid should not be the primary descriptor of a vinegar product according to the United States Food and Drug Administration (FDA). This is because diluted acetic acid is not regarded as vinegar and should not be sold as such (FDA, 2006).

Apart from the acetic acid which contributes to most of its benefits, vinegar comprises several other constituents such as vitamins, minerals, salts, amino acids, polyphenols, and compounds such as gallic acid (which is found in fruits such as grapes and strawberries), catechins and ferulic acid.  It is also said to comprise acids such as tartaric acid, malic and lactic acid, which are classified as nonvolatile organic acids (Natera et. al. 2003; Morales et. al. 2002). These properties have made vinegar a staple product in many households, for weight loss or overall health.

In this article, we will be discussing five (5) scientific proven health benefits of consuming vinegar. These include its anti-microbial properties, possible anti-tumour effects, cardiovascular benefits, its effects on glucose and thus diabetes and the one that makes it a much-loved product, globally – its purported weight loss effects.

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Five (5) ‘must-know’ Health Benefits of Apple Cider Vinegar (ACV):

• It may possess anti-microbial properties.
• It may have Anti-diabetes effects.
• Cardiovascular effects.
• Weight loss.
• Possible anti-tumour effects.

Apple Cider Vinegar (ACV) and Anti-microbial Properties

With the pending global crisis of antibiotic resistance, the case is now being made for alternative anti-microbial and thus – ACV (Yagnik et al 2018).  According to the World Health Organization (2017), there are a growing number of pathogens that are proving to be resistant to available drugs. To this extent, the World Health Organization (WHO) has forecasted that anti-biotic resistance to certain infections will pose a major threat to patient care management in the future.  This could ultimately have a daunting effect on the healthcare sector in many ways, including hospital stay, cost and mortality incidences.

As such, scientists have been studying various concentrations of ACV on microbial growth, particularly against strains such as E. coli, S. Aureus and C. Albicans.  It is also been touted to be able to eliminate harmful intestinal bacteria (Avci, A. et al 2007; Pourmouzaffar et. al. 2017; Nazıroğlu, M. et al. 2014). These and other nutritional benefits have been highlighted mostly in vivo studies.

In a study conducted by (Yagnik et al 2018), it was found that ACV consumed at different doses could have a restricted growth effect on particular bacterial strains. For example, the minimum concentration to restrict the growth of C. albicans was neat or undiluted ACV with a 5% acidity. For S. aureus, it was found that ½ dilution with an acidity of 2.5% could suffice and for E.coli, an even significant dose of ACV of dilution one-fiftieth (1/50) which equates to 0.1% acidity was sufficient for fighting this type of bacterial strain.

For tablets, concentrations ranging from Four Hundred (400) ug/ml to the lowest of 3.1 ug/ml were found to be effective in restricting microbe growth for all the strains listed above. Therefore, no growth was observed for tablet dosages of Sixty-two (62) ug/ml for E.coli, 125 ug/ml for S.aureus and Two Hundred and Fifty (250) ug/ml for C. albicans.

Severe infections can compromise the immune system and thus lead to ineffective immunity in individuals, especially those with an already compromised immunity due to diseases (Vazeille et. al.2015).  For example, patients with Chron’s disease were found to have a defective response to E. coli due to Chron’s related systemic immune suppression (Vazeille et al.2015).  As such, supplementing with ACV could prove beneficial in acute infections or the breakdown of the immune system processes.  Nonetheless, additional research is recommended especially as it relates to dietary ACV supplementation.

Apple Cider Vinegar (ACV) and Diabetes

Diabetes is considered one of the most common types of disease, globally, particularly type 1 (Sami et. al 2017). Several factors have been attributed to the development of diabetes, including physical activity, smoking and one’s diet (Sami et. al 2017).  Research has shown that diet plays a major role in its development. This was confirmed by a study by Seidell (1998) who observed that persons who consumed excess oil, sugar and flour were likely to develop the disease. 

According to research, eating habits of this nature can lead to postprandial hyperglycemia, which reportedly plays a decisive role in the development of chronic metabolic disorders like diabetes (Shishehbor et. al. 2017).  While studies on vinegar and postprandial glucose have been controversial, a study by Shishehbor et. al. (2017) has shown that it could be proven effective in reducing postprandial glucose and insulin levels and thus an excellent alternative in improving glycemic control.

In this study, it was found that participants who consumed vinegar experienced a reduction in mean glucose and insulin when compared to an uncontrolled group.  It must be noted that the study did not denote if the vinegar used was ACV as it just stated ‘vinegar.’  Recent studies have also shown that vinegar consumption could improve insulin sensitivity in both healthy individuals as well as those suffering from diabetes (Johnston et. al. 2010; Leeman et. al. 2005; Petsiou et. al. 2014).

While the mechanism of vinegar and its glucose-reducing effect is still being explored, studies have shown that its main constituent – acetic acid has shown to delay gastric emptying in healthy individuals (Liljeberg and Bj¨orck, 1998)  as well as those with type 1 diabetes (Hlebowicz et. al, 2007).  It was also shown to suppress the absorption of enteral carbohydrates (Ogawa et. al. 2000), hence certain recommendations to consume it before a meal.  Enteral carbohydrates are a special liquid food mixture administered by a tube (tube feeding) (nutritioncare.org).

Studies have also shown that ACV would be a good addition to any nighttime routine as it has been shown to decrease fasting glucose levels in individuals with type 2 diabetes when taken at bedtime (White and Johnston, 2007).  It must be noted that these studies found vinegar to be well-tolerable by participants.

 Apple Cider Vinegar (ACV) and Cardiovascular Health

Vinegar has been shown to have a positive effect on serum lipids and cholesterol in general. Serum lipid or serum cholesterol levels are the amount of total cholesterol in one’s blood.  As such, this will reveal the amount of high-density lipoprotein (HDL) cholesterol, which is denoted as the ‘good’ cholesterol and low-density lipoprotein (LDL) cholesterol or what is denoted as ‘bad’ cholesterol as well as triglycerides in the blood (heart.org).  Triglycerides are the most common type of fat that is found in the body.  These fats come from both our diets or are produced naturally by the body (heart.org).  These levels can indicate one’s risk of developing heart disease as well as other cardiovascular issues.

Studies have shown that acetate that is found in vinegar may be able to decrease circulating lipid levels (Fushimi et. al. 2006; Lozano et. al. 2012).  It was also found to protect against the accumulation of lipids in the liver and skeletal muscle (Yamashita et. al. 2009).  However, these studies are said to be taken from animal studies or limited human studies with controversial limitations.

ACV effects on cholesterol were also observed in a study by (Setorki et. al. 2010) with rabbits. The rabbits were grouped into four (4) groups.  Each group was fed a particular diet (one normal diet, high cholesterol diet (1% cholesterol), another one (1%) per cent cholesterol with 5 ml vinegar which was considered a low-dose and the find group, 1% cholesterol with 10 ml vinegar which was considered a high dose.

The group with the cholesterol and high-dose vinegar (10%) experienced a significant reduction in LDL-cholesterol as well as total cholesterol, while the group with cholesterol and low-dose vinegar (5%) also experienced a decrease in fibrinogen and glucose in comparison to the high cholesterol diet group.  As such, the researchers contend that vinegar might have an acute effect on the risk factors of heart disease – cholesterol levels.

Apple Cider Vinegar (ACV) and Weight loss

Several researches on ACV and weight loss have been conducted. This is because it is one of the most common reasons for many to use the product.  But, this is not a fad, as several researchers have shown that it was able to suppress body fat accumulation (Kondo et. al. 2009). 

In a double-blind trial with overweight Japanese, the participants were assigned to 1 of 3 groups.  The group’s assignments were as follows – those with similar body weight, body mass index (BMI) and waist circumference.  Each group were provided with 500 ml daily of a drink containing either 15 ml vinegar (750 mg), 30 ml vinegar (1,500 mg) or a beverage with no vinegar at all (the placebo group).  The vinegar group experienced a reduction in body weight, BMI, visceral fat area, waist circumference and serum triglyceride levels than in the placebo group. It must be noted that the study duration was 12 weeks. (Kondo et. al. 2009).

In another randomized, clinical trial by Khezri et al. (2018) with Thirty-nine (39) participants, it was found that ACV significantly reduced body weight, BMI and hip circumference as well as visceral adiposity index.   The adiposity index is a method used to estimate the amount of body fat of an individual (Dictionary.com).  In this study, the participants were randomly assigned to a controlled group that was subjected to a restricted caloric diet of 250 kcal per day energy deficit and 30 ml per day of ACV or a control group of restricted-calorie diet only for 12 weeks.

Along with a reduction in body weight, the ACV group also experienced a suppressed appetite and a reduction in plasma triglyceride and total cholesterol levels.  Importantly, there was also an increase in cholesterol-HDL in comparison to the group that did not consume any ACV.

Apple Cider Vinegar (ACV) and Tumour reduction possibilities

The studies of ACV being anti-cancer are debatable.  This is due in large to how some of these researches were conducted. However, a report on vinegar production and the risk of cancer was done on vinegar factories in China.  According to the report, these factories reported a near absence of cancer cases and the few cases that arose did not experience the degree of malignancy that would otherwise be observed.  Additionally, these persons even had a longer lifespan (An et al. 2018; Du et al. 2018; Shi et al. 2018; Wan et al. 2018).

The hypothesis for this observation is that the strong acetic acid opposes the strong acids and reduces local acidity, this then leads to a good prognosis for the few cancer cases that did arise.  Overall, the almost cancer-free cases were said to be due to the evaporation of acetic acids from the manufacturing of vinegar products (Wan et. al. 2018).  As such, the researchers contend that foods rich in acetic acid or lactic acid could serve to be beneficial for cancer patients.

However, in vitro, sugar cane vinegar was found to induce apoptosis (cell death) in human leukaemia cells (Mimura et. al. 2004).  Additionally, Japanese rice vinegar was also found to inhibit the proliferation of cancer cells in humans, but in a dose-dependent manner (Nanda et. al. 2004).

Most other studies of apple cider vinegar and cancer were controversial, as they implied actually injecting cancer cells with the substance, which would certainly not be safe and could prove severely harmful.  Therefore, ACV and its effects on cancer are still largely undecided and would require focused clinical trials for any definitive conclusions.

Are there any side effects in consuming Apple Cider Vinegar (ACV)?

While most of the studies have denoted ACV as being well-tolerated, especially at low concentrations, some have noted side effects such as acid influx, burning of the throat, and nausea as well as delayed digestion as ACV has a PH of 4.2. However, you can neutralize its acidic effect with baking soda (Yagnik et al 2018).

Additionally, it is not recommended to be taken undiluted if you are using a liquid version. Taking it undiluted can cause serious issues such as the esophagus and cardia injury (Chung, 2002).  It can also cause issues in the throat. So, always dilute it before consumption. 

If you are on medications such as those for diabetes or other health conditions, it is best to consult with your healthcare provider before consuming vinegar or to take it up as a supplement.  Additionally, large doses have reportedly caused low potassium levels or what is known as hypokalemia. This was observed in a Twenty-Eight (28) year-old female who consumed 250 ml (8 oz) of ACV daily for six (6) years (Lhotta et. al. 1998). Large amounts of vinegar have also been shown to be able to cause dental erosion and thus damage tooth enamel (Manaf et. al. 2012).

Can I take Apple Cider Vinegar (ACV) daily?

The use of ACV as a condiment and food ingredient dates back thousands of years, as such, its safety now is largely by default. While there are no reportedly standardised dosages, it is always best to start low and avoid taking it in large doses.  The most common dosages range from 1 or 2 teaspoons which are about 5-10 ml mixed in water or drink or added to your preferred dishes.  Also, rinse your mouth after consuming it in water or drink as its lingering effects on the mouth may cause tooth erosion over time (Manaf et. al. 2012).

How can I add Apple Cider Vinegar (ACV) to my diet?

ACV can be added in various ways to the diet.  The most common is room temperature water or warm water for an early morning flush. You can also add it to beverages as seen in some of the research explored above. ACV can also be added to salad dressing, tomato sauces, in meat dishes as well as jarring and pickling vegetables.

Illustrative Summary

Here is a summary of the Five (5) must-know health Benefits of APPLE CIDER VINEGAR (ACV)

Let’s Sum Up!

The seeming craze about Apple Cider Vinegar (ACV) is certainly without merit. This is due to the plethora of scientific research to support many of its purported benefits. This includes its effects on blood glucose, cholesterol and weight loss.

Its main constituent, acetic acid has been attributed to many of its health benefits along with other properties such as polyphenols, vitamins and minerals.  So, while it is not a magic potion, it does have some proven health benefits which have allowed it to be graduated from the realm of being another snake oil merchandise. As such, it is certainly one of those products to have in your wellness pantry, not only to aid in weight loss but for overall health and well-being.

So, are you a fan of Apple Cider Vinegar or Vinegar in general? How do you use it? Share it with us nuh!

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Editor’s Note: Article was updated in December 2023 and on July 9, 2024.