5 bottles with brass coloured lids, full of apple cider vinegar. Golden and cloudy almost looking like honey.

Apple Cider Vinegar Health Benefits: My Brief Review

What is Apple Cider Vinegar?

Apple cider vinegar seems to have a cult following based on its purported benefits. ACV is made from fermenting apples into alcoholic cider followed by a second fermentation into vinegar. The variety, climate and ripeness characterises the vinegar flavours and aromas. Much like red wine vinegar is made from red wine and shares its characteristics in the vinegar.

 

 

Are there scientifically proven actions on blood glucose? Yes

Are there scientifically proven actions on insulin spikes? Yes

Are the exact mechanisms understood? No, far from it.

Is it safe? Yes, totally if used correctly.

 

 

What is Vinegar?

Apple cider vinegar (ACV) is a popular clear or cloudy liquid condiment. Vinegar has a distinctive pungent aroma and sharp sour taste. Vinegars are used as a drink flavouring, seasoning, preserving, therapeutic or cleaning agent. ACV along with a myriad of vinegars contain potent phenolic compounds.1

 

 

How long have humans been using vinegar?

Historically, like many other concoctions made from plant parts or foods into tonics, vinegar has been used medicinally for thousands of years. This was predominantly as an anti-fungal and antibacterial.2 Vinegars use dates back 10,000 years.3 As scientific research progresses evidence for possible therapeutic uses have been found. Further studies on phytochemicals may shed more light in the future. Apple cider vinegar benefits could be on the way.

Photo by Pierpaolo Riondato

 

 

How is vinegar made?

Vinegar is a two step process. Firstly alcohol is made by the breakdown of sugar, starch or any natural carbohydrate source. Alcohol from grain is how the majority of vinegar is made.3 ACV is the second stage of fermentation of alcoholic apple cider (hard cider) into vinegar through the addition of alcohol degrading aerobic bacteria. 

Found anywhere in the environment, this species of acetic acid bacteria (AAB) of the genus Acetobacter are responsible for the aerobic fermentation into vinegar. This makes acetic acid or also known as ethanoic acid. In an anaerobic environment or without oxygen, creating vinegar would be rarely possible.

However vinegar is mostly water. It is a dilute solution of ~92-96% water and ~4-8% acetic acid. Acetobacter can be found in the air, your hands, face, on apples or grapes and even on fruit flies. ACV is ~5-6% acetic acid. Rice wine vinegar in comparison is ~4% acetic acid.

Carbohydrates that are used to make vinegar include but not limited to potatoes, yacon, rice, barley, sugar beets, cane sugar, prickly pear, pomegranate, grape, apple, plum, dates, figs, persimmon, coconut, pineapple, tomato, milk whey, along with beer, red wine, white wine, rice wine, champagne, sherry, kombucha, hard cider, and distilled grain alcohol. 

Vinegars can further be flavoured or finished with fruit, honey, maple, oak, malt, herbs, spices, wine, and other spirits. There is no limit except the imagination, patience and love.

 

 

What is a shrub?

A shrub is an old preservation method of using vinegar to further ferment other ingredients into it, or flavour it as a tonic, drink flavouring, cocktail addition or a therapeutic. You can use all sorts of ingredients such as medicinal herbs, aromatic herbs, fruits, flowers, and vegetables. Much like Kombucha you can flavour your shrub with almost anything. Try this Delicious recipe here.

 

 

What is cleaning vinegar?

Cleaning vinegar is a modern processed distilled vinegar which can be made in a day through modern express methods. It has a higher (~7-8%) acetic acid content which can help with cleaning mould, scum, grease, and limescale. Even higher concentrations of acetic acid vinegars are used agriculturally for killing weeds. These vinegars should never be consumed and will have a warning label. 

 

 

What is Glacial acetic acid?

Glacial acetic acid is simply concentrated acetic acid, with very minimal water (less than 1%), which you do not want to touch. Even as a weak acid it is still poisonous and corrosive to the skin. This will be found in laboratories and not in any food stores.

 

 

Interesting thing about vinegars?

The interesting thing isn’t just the ratio of acetic acid and water and the abundance of flavouring possibilities. Vinegars contain many different types of acids. None of these are dangerous to human health. Apple cider vinegar for example contains acetic, citric, formic, lactic, malic, and succinic acids. It is predominantly acetic acid (and water). For an expanded list check out table three here.1 Vinegar contains a whole host of other bioactive compounds too.

5 bottles with brass coloured lids, full of apple cider vinegar. Golden and cloudy almost looking like honey.

Image by Jenny Bayon

 

 

What are the therapeutic properties of vinegar?

Historically vinegar was used medicinally and as a home remedy. Some will claim it is a cure all but nothing in the world can be. But it may have some benefits as it has been used as an antiseptic for managing wounds, skin infections, ear infections,2 warts, nail fungus,1 and hand washing. It is also claimed to be used for treating poison ivy, croup,2 stomach ache, high fever, oedema (swelling of the skin). The list goes on with constipation, diarrhoea, sunburn, sore throat, head lice, insect bites, warts, ear infections,2 dementia, headache, hiccups and morning sickness to name a few. Apparently Hippocrates used honey and vinegar to help with coughing. Give it a go!

 

 

Vinegar has been called an antioxidant, anti-diabetic, anti-tumor, anti-cancer, anti-obesity, anti-lipidemic, antibacterial, and antimicrobial.1,2,3

No matter what the evidence says there is no harm in adding vinegar to your daily food or health protocol. In fact I suggest it. Not everything in the world can be scientifically proven because not everything is being scientifically tested. If it makes you feel good and you feel you get benefit, keep enjoying ACV and every other type of vinegar you like. I wouldn’t treat it as medicine though. As research tries to keep up with the quadrillion things that humans eat, drink, apply, inhale, supplement, bath in, you and I can (unless we miss the information) then be more informed with what we do daily.

The good news is ACV and many other types of vinegars are being researched and there are some positive results. In saying this the handful of papers I have read refrain from definitive health claims.

Image by Franz W. 

 

 

So, what evidence is there for these claims?

Vinegar contains acetic acid, other organic acids and various bioactive substances like amino acids, peptides, mineral salts,2 phytochemicals (polyphenols, indoles, retinoids, tocopherols, glucosinolates, carotenoids and phytosterols), vitamins and minerals. 

Many of these bioactive compounds not just in vinegar, but in food have antioxidant properties. For a great source of known antioxidants found in everyday foods see here

Studies on these bioactive compounds and their effects as antidiabetic, antitumour, anticancer, antiobesity, anti-lipidemic and antimicrobial properties are ongoing with many suggesting further studies are warranted. 

Studies are wide and varied but have shown benefits of ingesting vinegar against inflammation, hypertrophy and fibrosis in obesity-induced heart injury.4 This study though is on rats and further studies on humans is warranted.

 

 

One of the benefits of acetic acid is antioxidants. 

Antioxidants are substances that can prevent cell damage from oxidation in the body. Antioxidants defend against oxidative stress and unwanted inflammation. ACV and other vinegars like Kurosu, aJapanese origin black vinegar made from rice contain polyphenols which are known helpful bioactive compounds, such as quercetin and catechins. One study claims the extracts of Kurosu vinegar may inhibit cancer cell proliferation.11

There are over 8000 known polyphenols6 of which many are being researched to discover roles in disease prevention or cure. These phenolic compounds found in ACV include gallic acid, catechin, epicatechin, chlorogenic acid, caffeic acid, and p‐coumaric acid.1

There is a strong link between polyphenols antioxidant action and lower rates of disease and mortality.(6,7) Polyphenols have been shown in vivo studies to act as powerful antioxidants.(1,4,6) Studies have repeatedly shown inverse correlation between eating high quantities of polyphenols from foods and lower disease rates in humans.7

Polyphenols may be beneficial in reducing blood pressure, cardiovascular disease prevention, aiding blood sugar regulation in diabetes.(1,6,7,8)

Consuming ACV as an aid to reducing blood glucose and insulin response is well documented though more studies are needed. ACV is capable of reducing both the insulin response and blood glucose response.(2,8,9) In saying this varied responses are found in non-diabetics compared to people with type 1 or 2 diabetes.

Variables within studies included different composition of meals, meal timings, ACV concentrations, other types of vinegars used, without or with  diabetes and individual responses. See table 1 & 2.2

Vinegar consumption has also been noted to increase satiety thus further lowering consumption of food throughout the day.2

Different vinegars have potentially different benefits because each has different concentrations of certain acids and bioactive compounds. It does seem that traditionally slow made vinegars according to Budak (2014) have a higher antioxidant capacity than industrial vinegars. Unpasteurised, unfiltered vinegars still contain the ‘mother’ or starter culture of acetic acid bacteria. 

 

 

Antimicrobial

Studies have shown that vinegar or vinegar mixed with lemon juice can inhibit pathogenic bacteria on fruits and vegetables.1 For us at home this isn’t an issue as the food chain is generally free of harmful bacteria through their own strict hygiene processes. In saying this our own hands or especially children’s hands breed bacteria. Hand washing in warm soapy water will suffice. 

If however you grow your own food and use manure this may be a useful tip. Salmonella typhimurium and Escherichia coli were killed by normal vinegar with at least a 60min exposure.1 Vinegar has antimicrobial properties meaning it kills bacteria, viruses, some yeast infections like Candida albicans and fungus. It literally destroys their cell structures. This is why it is used for lice, skin conditions and wound healing.

 

 

How much ACV should I drink?

The general recommendation is two teaspoons (10 ml) up to 30ml. 

One paper said that a specific dose of ≥1400 mg of acetic acid was most effective. 2 This equates to just less than 30 ml of ACV. 

To be honest when I’ve tried ACV at 30 ml it was pretty hard to take based on its flavour and acidity. 

~15 ml with a large glass (~400ml) occasionally warm, but mostly room temperature filtered tap does perfectly fine for me.

I personally do not measure, as I free pour, eye ball it. Remember vinegar without honey and sweetness is virtually calorie free.

  • 15 ml in a glass of water once or twice daily
  • Eat it with your meals

 

 

How should I consume vinegar?

As above, in water, a cocktail, shrub, or salad dressing. If we are to forget about attaining therapeutic benefits from acetic acid and aiming for flavour the possibilities are endless, so experiment away.

Vinegar should not be taken with any form of salt (including bicarbonate of soda) as it reduces or completely cancels out (neutralises) the effects of the acid. (10,2)

This is of course not possible while having a salad with vinegar on it and salt is present. It is hard to say if you’re still getting the benefit. My gut tells me you still are. 

 

 

Precaution or benefit for apple cider vinegar?

Apple cider vinegar and its benefits may be hard to pin down. Therefore let’s look at the precautions and work back from there.

Because of vinegars acidity it should always be used sparingly. It’s acidity can corrode and damage teeth even if diluted with water or other drinks. 

Some people do not tolerate vinegar or simply hate it. 

If you love to drink vinegar straight, um, that’s weird and you may just burn your throat, oesophagus and damage your teeth.

Various medical sites warn people taking medication to be careful consuming apple cider vinegar. One medical site claimed to not take vinegar with your Metformin or insulin as it might lower your blood sugar too much. If vinegar really has that power I think I know which one I would lean to. Consult your physician of course.

You will easily find on various reputable medical and government health department websites that consuming too much ACV may lead to low levels of potassium over the long term. Yes true, but the case in mention of every single quote here is from a 28 year old woman in 1998 who consumed a full cup (~250ml) of ACV per day for 6 years. She presented to the doctor with muscle cramps, hypokalemia (low blood potassium) and in turn osteoporosis (loss of bone mass).12

In short, consuming a tablespoon here and there 30 min before a meal is safe. 

 

 

My final thoughts on apple cider vinegar.

This brief article does not come close to the amount of studies on acetic acid, ACV, and other types of vinegars. I have seen benefits for apple cider vinegar in the research.

I have not found any evidence of vinegar being a good pre or probiotic regardless of how much bacteria is in it. There are good studies on prebiotics such as fermented milk or Kefir which are beneficial. See my article on Microbiome, Probiotics, Prebiotics, Fibre and Resistant Starch

Our palates have changed continuously to select high sweet, high fat, high salt foods or just bland home cooked meals washed down with soft drinks. Most of us avoid vinegar, choose a crap diet and look for a ‘health kick’ of fad to reverse our choices. Vinegars in my opinion should be an integral part of our diets, sometimes in some form or another. When I say integral I mean as a seasoning, flavour to salads, vegetables, pickles or dipping sauces. 

Vinegar like most things are safe in a measured dose and if used as intended. If you’re trying to heal something and not getting the results consult your doctor, naturopath, accredited dietician or registered nutritionist. Sometimes simply stopping something you are already doing might work also.

As always, I value feedback on all my posts especially if I have made a mistake or you’d like further clarification. 

Yours in Health and fitness,

Jerome

 

 

References

[1] Budak NH, Aykin E, Seydim AC, Greene AK, Guzel-Seydim ZB. Functional properties of vinegar. J Food Sci [Internet]. 2014 May [cited 2021 Jan 11];79(5):R757-64. Available from: https://doi.org/10.1111/1750-3841.12434

[2] Petsiou EI, Mitrou PI, Raptis SA, Dimitriadis GD. Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight. Nutr Rev [Internet]. 2014 Oct [cited 2021 Jan 11];72(10):651-61. Available from: https://doi.org/10.1111/nure.12125

[3] Tan SC. Vinegar fermentation [Master’s thesis]. Baton Rouge (LA): Louisiana State University; 2005. Available from: https://digitalcommons.lsu.edu/gradschool_theses/1225

[4] Bounihi A, Bitam A, Bouazza A, Yargui L, Koceir EA. Fruit vinegars attenuate cardiac injury via anti-inflammatory and anti-adiposity actions in high-fat diet-induced obese rats. Pharm Biol [Internet]. 2017 Dec [cited 2021 Jan 11];55(1):43-52. Available from: https://doi.org/10.1080/13880209.2016.1226369

[5] Nanda K, Miyoshi N, Nakamura Y, Shimoji Y, Tamura Y, Nishikawa Y, Uenakai K, Kohno H, Tanaka T. Extract of vinegar “Kurosu” from unpolished rice inhibits the proliferation of human cancer cells. J Exp Clin Cancer Res [Internet]. 2004 Mar [cited 2021 Jan 11];23(1):69-75. Available from: https://pubmed.ncbi.nlm.nih.gov/15149153/

[6] Tsao R. Chemistry and biochemistry of dietary polyphenols. Nutrients [Internet]. 2010 Dec [cited 2021 Jan 11];2(12):1231-46. Available from: https://doi.org/10.3390/nu2121231

[6] Pandey KB, Rizvi SI. Plant polyphenols as dietary antioxidants in human health and disease. Oxid Med Cell Longev [Internet]. 2009 Nov-Dec [cited 2021 Jan 11];2(5):270-8. Available from: https://doi.org/10.4161/oxim.2.5.9498

[7] Better Health Channel. Antioxidants [Internet]. Victoria (AU): Victoria State Government. [Updated 2020 June]; [cited 2021 Jan 11]; [about 4 screens]. Available from: https://www.betterhealth.vic.gov.au/health/HealthyLiving/antioxidants

[8] Johnston CS, Kim CM, Buller AJ. Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care [Internet]. 2004 Jan [cited 2021 Jan 11];27(1):281-2. Available from: https://doi.org/10.2337/diacare.27.1.281

[9] Mitrou P, Raptis AE, Lambadiari V, Boutati E, Petsiou E, Spanoudi F, Papakonstantinou E, Maratou E, Economopoulos T, Dimitriadis G, Raptis SA. Vinegar decreases postprandial hyperglycemia in patients with type 1 diabetes. Diabetes Care [Internet]. Feb 2010 [cited 2021 Jan 11];33(2)e27. Available from: https://doi.org/10.2337/dc09-1354

[10] Shi Y, An S, Wan Y, Yang F, Liu Q. How to best use acetic acid for the prevention of heart disease and cancer. Eur J Prev Cardiol [Internet]. 2019 March [cited 2021 Jan 11]; 26(4):437–438. Available from: https://doi.org/10.1177/2047487318784356

[11] Nanda K, Miyoshi N, Nakamura Y, Shimoji Y, Tamura Y, Nishikawa Y, Uenakai K, Kohno H, Tanaka T. Extract of vinegar “Kurosu” from unpolished rice inhibits the proliferation of human cancer cells. J Exp Clin Cancer Res [Internet]. 2004 Mar [cited 2021 Jan 11];23(1):69-75. Available from: https://pubmed.ncbi.nlm.nih.gov/15149153/

[12] Lhotta K, Höfle G, Gasser R, Finkenstedt G: Hypokalemia, Hyperreninemia and Osteoporosis in a Patient Ingesting Large Amounts of Cider Vinegar. Nephron [Internet]. 1998 [cited 2021 Jan 11];80:242-243. Available from: https://doi.org/10.1159/000045180

 

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