Apple cider vinegar (ACV) has transitioned from a simple salad dressing ingredient to a popular health supplement. Available in various forms such as liquid, pills, powders, and gummies, ACV is marketed for its potential health benefits, including weight loss, improved blood sugar control, and cholesterol reduction. This article explores the evidence-based benefits, potential risks, and overall effectiveness of using ACV, particularly in pill form, for dietary purposes.
What is Apple Cider Vinegar?
Apple cider vinegar is produced through a fermentation process involving crushed apples, yeast, and sugar. First, the apples are crushed, and yeast is added to convert the sugars into alcohol. Then, bacteria break down the alcohol into acetic acid, which gives vinegar its characteristic tangy taste and odor.
Apple Cider Vinegar with "The Mother"
Most commercially available ACV is clear, pasteurized, and filtered. However, raw, unfiltered ACV contains a cloudy sediment known as "the mother," composed of settled bacteria and yeast. Some believe that "the mother" is responsible for ACV's purported health benefits, attributing it to the presence of probiotics that are beneficial for gut health. Despite these claims, research has yet to confirm any specific health benefits from "the mother."
Forms of Apple Cider Vinegar
While ACV is commonly consumed in liquid form, it is also available in pills, powders, and gummies. Liquid ACV is often used in salad dressings, pickles, and marinades.
Apple Cider Vinegar Supplements
ACV supplements, including pills, powders, and gummies, offer an alternative for those who dislike the taste of liquid ACV. However, these supplements have undergone limited research, and their effectiveness remains uncertain. Because the Food and Drug Administration (FDA) does not regulate dietary supplements, the exact composition and quality of ACV supplements can vary.
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Potential Health Benefits of Apple Cider Vinegar
ACV contains nutrients similar to those found in apple juice, including B vitamins and antioxidants called polyphenols. Acetic acid, the primary component of vinegar, is thought to contribute to its health benefits.
Weight Loss
Some studies suggest that ACV may aid in weight loss. A small study involving 39 participants over 12 weeks found that consuming 1-2 tablespoons of ACV daily, along with a reduced-calorie diet, led to modest weight loss. However, the study had limitations, including a small sample size and a lack of blinding, which could have influenced the results. It's important to note that ACV is not likely to cause significant weight loss on its own.
Cholesterol Reduction
The same study that reported weight loss benefits also found that ACV lowered total cholesterol levels, increased "good" cholesterol (HDL), and reduced triglycerides (fats in the blood). Other studies have reported similar findings. However, more research is needed to fully understand the link between ACV and cholesterol levels.
Blood Sugar Control
Several small studies have indicated that consuming one to two tablespoons of ACV could lower blood sugar levels after meals. While the effect is moderate, ACV may be a safe addition to a diabetes treatment plan, but it should not replace prescribed medications or a healthy lifestyle. A meta-analysis of 44 trials including 3,130 participants found ACV outperformed other herbs in lowering fasting blood glucose (FBG) in participants with type 2 diabetes.
Other Potential Benefits
ACV has been explored for various other uses, although research is limited or inconclusive:
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- Blood Pressure: One study in rats suggested that ACV could help with high blood pressure, but human studies are lacking.
- Acid Reflux: Many people use ACV as a remedy for heartburn and acid reflux, but there is no scientific evidence to support this claim.
- Eczema Relief: Some individuals with eczema use ACV to alleviate skin symptoms, but studies have reported mixed results, with some showing irritation.
- Germ Killing: ACV may help prevent the growth of bacteria like salmonella on salad greens, but it does not protect wounds against infection.
- Hair Health: ACV is used by some as a hair rinse to reduce dandruff or remove product buildup. While it contains antibacterial and antifungal properties that could promote hair health, there is no direct proof of its effectiveness for these purposes.
Risks and Side Effects
Consuming ACV can lead to negative side effects, including indigestion, throat irritation, and low potassium levels. These effects are primarily due to the acidity of vinegar. Long-term consumption of ACV may disrupt the body's acid-base balance and erode tooth enamel.
Potential Interactions
ACV may interact with certain medications, such as diuretics, laxatives, and insulin. It is essential to consult a healthcare provider before using ACV, especially if you have existing health conditions or are taking medications.
Dosage and Consumption
There are no official dosage recommendations for ACV due to limited research. However, some studies have provided clues about amounts that may be helpful for certain conditions:
- Weight Control: Two tablespoons a day, one before lunch and one before dinner, have been used in studies.
- Blood Sugar and Cholesterol Control: About 1½ tablespoons after a meal have shown improvement.
- Acid Reflux: A teaspoon or two diluted in a mug of warm water after a meal may help.
To minimize potential side effects, it is crucial to dilute ACV with water and drink it through a straw to protect tooth enamel. Avoid consuming ACV on an empty stomach.
Apple Cider Vinegar Pills: An Alternative?
Apple cider vinegar pills are marketed as a convenient alternative to liquid ACV, particularly for those who dislike its taste. These pills contain a dehydrated form of vinegar.
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Effectiveness of ACV Pills
Research on the effects of ACV pills is very limited. The supposed benefits are primarily based on studies of liquid ACV or acetic acid. It is difficult to determine if ACV pills have the same effects as liquid ACV. One 2020 study compared the effect of vinegar, in general, to vinegar capsules on blood sugar.
Dosage of ACV Pills
Due to the lack of research, there is no standard dosage recommendation for ACV pills. The amount of ACV in pills varies by brand, but typically, one capsule contains about 500 mg, equivalent to two teaspoons (10 ml) of liquid ACV. While the recommended dosages of ACV pills may be similar to those used in liquid form, it is unknown whether the pills have the same properties.
Quality and Regulation
The FDA does not regulate supplements, so the reported amount of apple cider vinegar in pills may not be accurate. One study analyzed eight different apple cider vinegar pills and found that their labels and reported ingredients were inconsistent and inaccurate.
Risks of ACV Pills
Given the limited research and lack of regulation, there are potential risks associated with ACV pills. It is best to look for brands that have been tested by a third party and include a logo from NSF International, NSF Certified for Sport, United States Pharmacopeia (USP), Informed-Choice, ConsumerLab or the Banned Substances Control Group (BSCG).
A Study on ACV for Weight Management
A study was conducted to assess the efficacy and safety of ACV in reducing weight and improving lipid and glycemic profiles in overweight and obese adolescents and young adults in Lebanon. The study involved 120 participants with BMIs between 27 and 34 kg/m2, who were divided into four groups: three treatment groups and a placebo group. The treatment groups consumed 5, 10, or 15 mL of ACV daily for 12 weeks. The control group received a placebo.
Methods
The study included participants aged 12 to 25 years with no chronic diseases or medication use. Subjects were divided randomly into four groups: three treatment groups and a placebo group. A simple randomisation method was employed using the randomisation allocation software. Groups 1, 2 and 3 consumed 5, 10 and 15 mL, respectively, of ACV (containing 5% of acetic acid) diluted in 250 mL of water daily, in the morning on an empty stomach, for 12 weeks. The control group received a placebo consisting of water with similar taste and appearance. In order to mimic the taste of vinegar, the placebo group’s beverage (250 mL of water) contained lactic acid (250 mg/100 mL). Identical-looking ACV and placebo bottles were used and participants were instructed to consume their assigned solution without knowing its identity. Subjects consumed their normal diets throughout the study. The contents of daily meals and snacks were recorded in a diet diary. The physical activity of the subjects was also recorded. Daily individual phone messages were sent to all participants to remind them to take the ACV or the placebo. Body weight was measured in kg, to the nearest 0.01 kg, by standardised and calibrated digital scale. Height was measured in cm, to the nearest 0.1 cm, by a stadiometer. The waist circumference measurement was taken between the lowest rib margin and the iliac crest while the subject was in a standing position (to the nearest 0.1 cm). The body fat ratio (BFR) was measured by the bioelectrical impedance analysis method (OMRON Fat Loss Monitor, Model No HBF-306C; Japan). Serum glucose was measured by the glucose oxidase method.19 Triglyceride levels were determined using a serum triglyceride determination kit (TR0100, Sigma-Aldrich). Cholesterol levels were determined using a cholesterol quantitation kit (MAK043, Sigma-Aldrich). The study protocol was reviewed and approved by the research ethics committee. The participants were informed of the study objectives and signed a written informed consent before enrolment.
Results
The addition of ACV to the diet resulted in significant decreases in body weight and BMI at weeks 4, 8, and 12 compared to baseline (week 0). The circumferences of the waist and hip, along with the Body Fat Ratio (BFR), decreased significantly in the treatment groups at weeks 8 and 12 compared to week 0. The consumption of ACV also led to a time and dose-dependent decrease in serum glucose, triglyceride, and cholesterol levels.
Conclusion
The findings of this study indicate that ACV consumption for 12 weeks led to significant reductions in anthropometric variables and improvements in blood glucose, triglyceride, and cholesterol levels in overweight/obese adolescents/adults. These results suggest that ACV might have potential benefits in improving metabolic parameters related to obesity and metabolic disorders in obese individuals.