Apple cider vinegar (ACV) has been touted as a health tonic for thousands of years. In ancient times, it was used as a treatment for coughs and infections. Today, it’s lauded as a weight loss aid, a remedy for acid reflux and a way to help manage blood sugar. But can it do all of those things? There’s room for doubt, with further research needed to support any possible apple cider vinegar benefits.
What is Apple Cider Vinegar?
Apple cider vinegar (ACV) is made by fermenting the sugars from apples, which turns them into acetic acid - the active ingredient in vinegar. Vinegar comes from the French phrase vin aigre, meaning sour wine. The sourness comes from the acetic acid. Yeast digests the sugars in apples and converts them into alcohol. A bacteria, acetobacter, then turns the alcohol into acetic acid. The "mother" refers to the combination of yeast and bacteria formed during fermentation. Many people attribute apple cider vinegar’s effects to the "mother." There’s some truth to this since the mother counts as a probiotic.
ACV is made by mixing crushed apples with yeast, sugar or another carbohydrate. After a few weeks, natural bacteria and yeasts ferment the juice, changing the carbohydrates into alcohol. The second fermentation process changes the alcohol into acetic acid.
If you look at the nutrition facts label, apple cider vinegar doesn’t show high amounts of vitamins, minerals or even calories,” says registered dietitian Beth Czerwony, RD, LD. “Its potential health benefits are found in substances that aren’t part of the standard nutrition label.”
Raw apple cider vinegar contains:
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- Acetic acid, which can kill harmful bacteria - ACV is about 5% to 6% acetic acid
- Natural probiotics (good bacteria), which can improve your immune system and gut health
- Antioxidants, naturally occurring substances that can prevent damage to your body’s cells
Both pasteurized and raw apple cider vinegar are sold in stores. But for health purposes, most people use raw apple cider vinegar - the kind that’s a little bit cloudy. The cloudy sediment at the bottom of the bottle, sometimes known as “the mother,” contains more natural bacteria and yeasts.
Potential Health Benefits of Apple Cider Vinegar
Some studies suggest that apple cider vinegar could boost your health. But Czerwony says most of the studies are small and need further research to support their claims. Still, it’s worth talking about ACV’s possible benefits.
Blood Sugar Management
One of the biggest health claims for apple cider vinegar is related to diabetes and blood sugar management. When you have Type 2 diabetes, your body’s cells can’t properly take up sugar (glucose) from the foods you eat. Research has shown that consuming acetic acid-the active ingredient in ACV-affects the way starches are broken down during digestion. The delayed absorption of sugar from carbohydrates improves the insulin response to blood sugar and thus promotes better blood sugar control. Though the main study was small (only 21 participants), the results were pretty significant. Vinegar increased insulin sensitivity by 34% in participants with type 2 diabetes.
An analysis of studies shows evidence that apple cider vinegar may decrease fasting plasma glucose levels when taken with a meal full of complex carbohydrates. It does that by slowing down food’s journey from your stomach to your small intestine (gastric emptying) and the absorption of glucose molecules.
“Apple cider vinegar might lower your glucose a little, but not enough,” cautions Czerwony. “To prevent or manage diabetes, it’s really important to follow a healthy diet and exercise plan.”
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If you take medication to lower your blood sugar, it’s best to check in with your doctor before you incorporate apple cider vinegar into your everyday life.
Cholesterol Reduction
That same meta-review also suggests that apple cider vinegar decreases total cholesterol and triglycerides (a fat found in your blood) while raising “good” cholesterol (HDL). But Czerwony stresses that larger studies are needed to fully understand the role ACV may play in cholesterol management.
“Research has shown that ACV can improve blood sugars by delaying gastric emptying, which slows down the release of carbohydrates in your body. This may also help with weight loss, particularly belly fat,” explains Czerwony. “It has also been shown that ACV improves cholesterol levels, which is more pronounced in people who have Type 2 diabetes.”
Acid Reflux Relief
Gastroesophageal reflux disease, GERD, acid reflux, heartburn - no matter what you call it, it’s unpleasant. And if it happens to you on the regular, you’re probably desperate for a remedy. Some people swear by apple cider vinegar for acid reflux. The idea is that because ACV is a probiotic, it can introduce “good” bacteria into your gut and lead to digestive balance that lessens your GERD symptoms.
“There’s no real science to back up the claims about ACV’s anti-heartburn power,” Czerwony states. “But if your healthcare provider says it’s OK for you to take, then there’s likely no harm either.”
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Weight Loss Aid
Some people claim that apple cider vinegar has helped them lose weight, but the science isn’t solid. Researchers once thought that acetic acid could help you burn more fat and change your body’s appetite-stimulating hormones. That’s no longer thought to be true.
But a systematic review of studies shows that apple cider vinegar can help you stay full for longer, which can curb the urge to snack for about two hours after eating. And another study of 120 adolescents and young adults with overweight and obesity shows that ACV may contribute to a decrease in body weight and body mass index (BMI).
Still, don’t count on ACV to help you shed pounds. “There’s no concrete evidence that it has any long-term appetite suppression benefits,” Czerwony clarifies.
In a 12 week study of 144 Japanese adults, those who consumed 1 tablespoon of vinegar each day lost 2.6 pounds, decreased their body fat percentage by 0.7% and lost a ½ inch around their waist. Those who consumed 2 tablespoons of vinegar each day lost 1 more pound in the 12 week period, decreased their body fat by 0.9% and lost ¾ of an inch around their waist. These are not newsworthy results, but if combined with a healthy diet and exercise pattern, could be a perfectly acceptable way to promote additional body fat and weight loss.
Immune System Boost
Because it’s fermented, ACV is chock-full of natural probiotics, which Czerwony says can balance gut microbiota and improve immune health.
“The high levels of polyphenols neutralize free radicals in our bodies,” she shares. “Because of its antibacterial properties and improvement of gut microbiota, this ultimately will improve gut health, which indirectly improves cellular health.”
Cell Damage Prevention
ACV contains antioxidants that protect your cells against free radicals, which are atoms, molecules and ions that can alter your cellular DNA.
Anti-Microbial Properties
Traditionally used for cleaning the home and as a food preservative, vinegar does have anti-microbial properties. Specifically, ACV may be affective in inhibiting the growth of Escherichia coli (E.coli), Staphylococcus aureus and Candida albicans.
The Apple Cider Vinegar Diet
Although it's commonly referred to as a “diet,” the apple cider vinegar diet has no menus, lists of foods to eat or avoid, supplements or rules of any kind other than adding a vinegar-based drink to your menu a few times a day. Different variations include adding lemon, cinnamon, honey, maple syrup or stevia.
Even among apple cider proponents, there's no consensus when to drink apple cider vinegar or how much should be taken for best effects. This simplicity is both a pro and a con of the plan. The choices you make will dramatically affect not only your weight loss, but also your overall health.
Risks and Side Effects
In most cases, ACV is relatively harmless, but there are some risks to be aware of. Consuming more than 1-2 tablespoons in a day can cause irritation of the esophagus, erode tooth enamel and most dangerously, decrease potassium levels. Those taking diuretics and/or insulin should consult their doctor before changing any dietary practices. Low potassium can cause weakness, constipation, nausea, muscle cramps and abnormal heart rhythms.
Apple cider vinegar is highly acidic, which can present some problems:
- Erosion of tooth enamel: Its acidity can erode your tooth enamel, the protective shield on the outside of your teeth. Once it wears away, you can’t get it back. The acetic acid in straight, undiluted ACV can also burn your esophagus.
- Low potassium levels: Apple cider vinegar may affect potassium levels. Czerwony says you shouldn’t use it if you already have low potassium levels (hypokalemia), as it could make the condition worse.
- Drug interactions: If you take any medications, ask your doctor whether you can safely take apple cider vinegar. It can interact with some types of medicines, including insulin, diuretics (water pills), laxatives and certain medications for high blood pressure.
- Nausea and vomiting: “Some people quite literally just can’t stomach the taste and acidity of apple cider vinegar,” Czerwony warns. “If it makes you feel sick, stop using it.”
- Gastroparesis: If you have gastroparesis (a disorder that makes it hard for food to move through your digestive tract), it’s important to be mindful that apple cider vinegar slows down gastric emptying.
It has been reported to cause or worsen low potassium levels. Vinegar can alter insulin levels.
You should also keep pure ACV out of reach of kids so they can’t drink it or get it on their skin, which may cause a burn.
How to safely add vinegar to your diet:
- Consume only 1-2 tablespoons per day.
- Dilute vinegar by mixing with oil and using as a salad dressing on leafy greens or other veggies.
- Try mixing 1 Tbsp. of vinegar with 1 cup of water and split into three doses, one before each meal.
- Avoid ACV pills. They don't seem to have the same effect and in one case, a woman experienced throat burns after a tablet became lodged in her esophagus.
How to Use Apple Cider Vinegar
There’s no standard dosage of apple cider vinegar, so ask a healthcare provider how much is safe for you and always be sure to follow the directions on the product label.
“The evidence so far says apple cider vinegar is safe for most people in small amounts,” Czerwony says. “But keep in mind that it hasn’t been approved to treat any health conditions.”
If you’re curious about the potential benefits, you can start with just a few drops mixed in water. You can work your way up, if you want, to no more than two tablespoons per day. You can also:
- Put a tablespoon of ACV in a warm cup of tea to water down the taste.
- Add a bit of it to your favorite sauce, salad dressing or marinade for a tangy zip.
- Use it in jarring and pickling. Food and Drug Administration (FDA) doesn’t regulate these supplements.
Apple Cider Weight Loss Recipes
Below are two recipes that use ACV.
Lemon Vinaigrette Recipe
Drizzle on your favorite green salad, but it can also be used as a marinade for chicken, fish or shrimp. Just combine the ingredients in a large bowl, add the protein and refrigerate for about 30 minutes before cooking.
- In a medium bowl, whisk together the apple cider vinegar, lemon zest, lemon juice mustard, garlic, oregano, parsley, salt and pepper.
- Slowly drizzle in the olive oil, whisking constantly until incorporated.
Roasted Vegetable Soup
- In a medium skillet, heat 1 tbsp (15 mL) olive oil over medium heat until shimmering. Add the eggplant and sprinkle with 1⁄4 tsp (1 mL) salt and 1⁄8 tsp (0.5 mL) black pepper. Cook, stirring occasionally, until the eggplant is browned on all sides, about 6 minutes. Using a slotted spoon, transfer the eggplant to a bowl.
- In a large saucepan, heat the remaining 2 tbsp (30 mL) olive oil over medium heat until shimmering. Add the onion and garlic; cook, stirring occasionally, until the onion is translucent, about 3 minutes. Add the zucchini, squash and bell pepper; cook, stirring occasionally, until softened, about 7 minutes. Add the cabbage, farro, vegetable broth, water, diced tomatoes (with juice), apple cider vinegar, thyme, bay leaves and the remaining 1⁄4 tsp (1 mL) salt and 1⁄8 tsp (0.5 mL) black pepper; stir to combine. Increase the heat to high and bring the mixture to a boil. Reduce the heat to medium-low, cover and simmer, stirring occasionally, until the flavors meld, about 30 minutes. Remove the bay leaves and discard.
- Ladle 1¾ cups (425 mL) soup into each of 8 bowls. Spoon about 1⁄2 tsp (2 mL) capers into the center of each soup. Serve warm.