There are some terrific health benefits of Apple Cider Vinegar, also known as ACV. We’ll go through the evidence for these benefits, but first, a bit about ACV itself!
How is ACV Made and What’s in it?
Apple cider vinegar or ACV is made by a process of fermentation—except that the alcohol level is very low because most of the alcohol produced during the process is converted into acetic acid (aka vinegar) by bacteria. These bacteria—Acetobacter aceti, tend to coalesce into a brownish biofilm, known as the “mother”. It can be used to turn fresh apple juice into ACV.
The use of ACV goes back at least to ancient Egyptian medical texts and early Samurai warriors. In both examples, ACV was used as a general tonic for strength and overall health, improved digestion, and as an antibiotic. There are reports that it was used by the ancient Egyptians as a tool to improve weight loss.(1)
ACV contains carbohydrates, vitamins A and C, and minerals, including calcium, iron, magnesium, potassium, and phosphorus.
ACV also contains a class of plant substances known as polyphenols. The polyphenols are a large class of nutrients and include:
- Flavonoidswhich in turn include isoflavones, proanthocyanidins, anthocyanins, and catechins (e.g., EGCG or epigallocatechin found in green tea); Other flavonoids are quercetin, kaempferol, and apigenin. As a class, it is flavonoids that give fruit and vegetables their vibrant colors.(2)
- Phenolic acidsincluding caffeic acid and lignans. Phenolic acids are among the most powerful known antioxidants as well as offering anti-cancer, anti-inflammatory, and antimicrobial actions.(3)
- Polyphenolic amidesand lignans. This group includes resveratrol, curcumin, capsaicin, and the lignans found in various seeds and whole grains.(4)
Polyphenols are potent antioxidants and are believed to improve digestion,(5) protect against heart disease (6) and Type 2 diabetes,(7) and to act as anti-inflammatory substances and immune-modulators.(8) There is also a great deal of research interest in the potential role of polyphenols to reduce the risk of various cancers.(9)
What Has ACV Been Used for in the Past?
Traditional uses of ACV have been as a digestive aid, a disinfecting skin treatment (primarily for acne), a general tonic, an aid to weight loss, to lower cholesterol, as a source of probiotics and prebiotics, and to help control blood sugar. Let’s take a look at some of the evidence for some of these uses.
ACV as a Digestive Aid
While it may seem a bit counterintuitive, increasing the amount of acid in the stomach by using ACV can improve digestion AND decrease the frequency and symptoms of “acid indigestion” or GERD (gastroesophageal reflux disease). Why?
Chewing and swallowing—as well as the presence of food in the stomach—are signals for the stomach to start producing acids. The aromas of food can also stimulate acid secretion—and sometimes even the thought of food is enough to start those gastric acids flowing. The acidic environment in the stomach begins the process of digesting your food—and is absolutely essential to healthy digestion.
Lower acid levels in the stomach can cause the lower esophageal sphincter (LES), found at the junction of the esophagus and the stomach, to open up, releasing some of the existing acid into the esophagus—causing the burning sensation often called “heartburn”. Symptoms of low acid in the stomach include heartburn, burbs, a sense of bloating, an upset stomach, and an overall sense of indigestion, sometimes including nausea and vomiting. The treatment of low stomach acid—is acid! ACV acts as that extra acid, stimulating even more acid secretion by the stomach, resulting in less heartburn and more efficient digestion.
One case study indicated that ACV, along with an improved diet, could improve the symptoms of GERD in an elderly woman with Parkinson’s Disease.(10) Another case study supported these results in a young woman with generalized digestive issues.(11)
ACV as an Aid in Weight Loss
There have been few studies in humans to test if ACV can support weight loss. It may do this by giving a person a sense of fullness, helping to regulate blood sugar and insulin levels, or by a combination of these effects. Not all studies have been very conclusive, but one study showed that ACV could decrease belly fat and help reduce weight.(12)
ACV to Help Regulate Blood Sugars
ACV was effective in both reducing blood sugar levels after a meal and improving the sensitivity of tissues to the presence of insulin. This may be especially important in people with prediabetes, because one of the earliest known markers of prediabetes is the lack of tissue sensitivity to insulin—this is known as insulin resistance. Another study emphasized this point, stating that “these mechanisms appear more effective in nondiabetics than in diabetics.”(13)
A recent animal study showed that, at least in mice, ACV supplemented with the probiotic bacteria B. coagulans could reduce food intake, lower blood sugar levels and improve blood fat (lipid) levels.(14)
Other Uses for ACV
For skin disorders, ACV is often used topically as a disinfectant—and usually for acne. Other skin diseases may be irritated by ACV because it IS acidic with a pH of around 2-3, and this may be irritating, especially for people with more sensitive skin.
Other uses for ACV need more research. It can be added to foods, used as a beverage (mixing up to 30 mL (2 tablespoons) in 8 ounces of water). ACV can also be taken as a tablet or a much tastier gummy, taking 1-2 a day or just before meals.
Safety
When taken as directed and in moderation, ACV is safe. In theory, long-term use may decrease blood levels of potassium. Drinking ACV may damage the enamel of teeth—so rinsing your mouth with water may be advisable. It may also interact with some medications, including diabetes and heart medications.
No studies have been done on pregnant or nursing women and ACV, so its safety profile for that population is not known. We recommend that you always talk to your healthcare professional and your pharmacist for the best advice.
Takeaways
Overall, ACV is safe to use in moderation. The best evidence exists for maintaining healthy digestion, healthy blood sugar levels, and normal responses to insulin. ACV may also be a useful part of a weight reduction or weight maintenance plan, along with a healthy diet and exercise.
Resources:
- https://www.google.com/books/edition/Natural_Standard_Herb_Supplement_Guide_E/WB8PDQAAQBAJ?hl=en&gbpv=1&pg=PA59&printsec=frontcover
- Panche AN, Diwan AD, Chandra SR. Flavonoids: an overview. J Nutr Sci. 2016 Dec 29;5:e47. doi: 10.1017/jns.2016.41. PMID: 28620474; PMCID: PMC5465813. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465813/
- Călinoiu LF, Vodnar DC. Whole Grains and Phenolic Acids: A Review on Bioactivity, Functionality, Health Benefits and Bioavailability. Nutrients. 2018 Nov 1;10(11):1615. doi: 10.3390/nu10111615. PMID: 30388881; PMCID: PMC6265897. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734135/
- Tsao R. Chemistry and biochemistry of dietary polyphenols. Nutrients. 2010 Dec;2(12):1231-46. doi: 10.3390/nu2121231. Epub 2010 Dec 10. PMID: 22254006; PMCID: PMC3257627. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257627/
- Sorrenti V, Fortinguerra S, Caudullo G, Buriani A. Deciphering the Role of Polyphenols in Sports Performance: From Nutritional Genomics to the Gut Microbiota toward Phytonutritional Epigenomics. Nutrients. 2020 Apr 29;12(5):1265. doi: 10.3390/nu12051265. PMID: 32365576; PMCID: PMC7281972. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281972/
- Cullen AE, Centner AM, Deitado R, Salazar JFA. The Impact of Dietary Supplementation of Whole Foods and Polyphenols on Atherosclerosis. Nutrients. 2020 Jul 12;12(7):2069. doi: 10.3390/nu12072069. PMID: 32664664; PMCID: PMC7400924.
- Guasch-Ferré M, Merino J, Sun Q, Fitó M, Salas-Salvadó J. Dietary Polyphenols, Mediterranean Diet, Prediabetes, and Type 2 Diabetes: A Narrative Review of the Evidence. Oxid Med Cell Longev. 2017;2017:6723931. doi: 10.1155/2017/6723931. Epub 2017 Aug 13. PMID: 28883903; PMCID: PMC5572601.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572601/ - Yahfoufi N, Alsadi N, Jambi M, Matar C. The Immunomodulatory and Anti-Inflammatory Role of Polyphenols. Nutrients. 2018 Nov 2;10(11):1618. doi: 10.3390/nu10111618. PMID: 30400131; PMCID: PMC6266803. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266803/
- Stevens JF, Revel JS, Maier CS. Mitochondria-Centric Review of Polyphenol Bioactivity in Cancer Models. Antioxid Redox Signal. 2018 Dec 1;29(16):1589-1611. doi: 10.1089/ars.2017.7404. Epub 2017 Dec 11. PMID: 29084444; PMCID: PMC6207154.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207154/ - Neiworth-Petshow EM, Baldwin-Sayre C. Naturopathic Treatment of Gastrointestinal Dysfunction in the Setting of Parkinson’s Disease. Integr Med (Encinitas). 2018 Aug;17(4):44-50. PMID: 31043910; PMCID: PMC6469461. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469461/
- Carter T, Goldenberg JZ, Steel A. An examination of naturopathic treatment of non-specific gastrointestinal complaints: comparative analysis of two cases. Integr Med Res. 2019 Sep;8(3):209-215. doi: 10.1016/j.imr.2019.08.001. Epub 2019 Aug 13. PMID: 31467841; PMCID: PMC6712490. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712490/
- Kondo, T, Kishi, M, Fushimi, T, Ugajin, S, Kaga, T. Vinegar Intake Reduces Body Weight, Body Fat Mass, and Serum Triglyceride Levels in Obese Japanese Subjects. BioSci,Biotech,Biochem, 73:8, 1837-1843, DOI: 10.1271/bbb.90231 https://doi.org/10.1271/bbb.90231
- Lim J, Henry CJ, Haldar S. Vinegar as a functional ingredient to improve postprandial glycemic control-human intervention findings and molecular mechanisms. Mol Nutr Food Res. 2016 Aug;60(8):1837-49. doi: 10.1002/mnfr.201600121. Epub 2016 Jun 27. PMID: 27213723. https://pubmed.ncbi.nlm.nih.gov/27213723/
- Urtasun R, Díaz-Gómez J, Araña M, Pajares MJ, Oneca M, Torre P, Jiménez M, Munilla G, Barajas M, Encío I. A Combination of Apple Vinegar Drink with Bacillus coagulans Ameliorates High Fat Diet-Induced Body Weight Gain, Insulin Resistance and Hepatic Steatosis. Nutrients. 2020 Aug 19;12(9):2504. doi: 10.3390/nu12092504. PMID: 32825073; PMCID: PMC7551919. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551919/