Apple Cider Vinegar: Its Metabolic Effects and Health Benefits

Have you heard that apple cider vinegar could help you lose weight, lower you blood sugar, or lower your cholesterol?

My clients, especially those with insulin resistance, would frequently ask this question, “Would drinking apple cider vinegar help lower my blood sugar?” To answer this question, I decided to review the scientific literature to validate the proclaimed health benefits of apple cider vinegar and to learn more about how it affects our sugar metabolism.

Active Constituents

Apple cider vinegar (ACV) is commonly used as vinegar in salad dressing, marinades, and sauce. It has been used as far back as 3300 B.C. during Hippocrates era as antifungal and antibacterial agent for wound and ear infection, head lice, insect bites, and warts. 1 In recent years, there has been an increasing interest in the metabolic and health effects of ACV. The main component of vinegar is acetic acid, which give it its sour taste. Additional components include other organic acids, such as formic, lactic, malic, citric, succinic, and tartaric acid, pectin, vitamins B and C, and small quantities of sodium, potassium, calcium, iron, phosphorous, and magnesium.

Effect of ACV on Blood Sugar (glucose)

Over the past 25 years, several studies have examined the effect of ACV on glucose or sugar metabolism in healthy people and in those with type 2 diabetes. In a recent systematic review and meta-analysis study, ACV has been found to be associated with greater management of blood sugar (glycemic control) in patients with type 2 diabetes compared with other vinegar products.2 Another randomized cross over studies found ingesting two teaspoons of vinegar (10 grams) effectively reduced the sugar levels after meals (postprandial glucose) by 20% in healthy adults compared to placebo.3 One study found that adding high amounts of vinegar (50 grams) to high carbohydrates meal did not affect blood glucose levels 2-hour after meal consumption in patients with type 2 diabetes.2

Discrepancies in study findings suggest that dosage, acidity, the timing of ingestion, meal content, and glycemic index, as well as the level of insulin secretion and resistance may play a role in the effectiveness of ACV. The positive effect of ACV depends on several factors.

1. The time the ACV is ingested

Anti-glycemic effect is pronounced when ACV is ingested immediately before a meal and with a meal versus after meals.3

2. Acidity

The higher the acetic acid level, the higher the satiety level and the lower the postprandial glucose and insulin level.4

3. Meal content

Adding vinegar to a meal with high glycemic index and high glycemic load has been reported to lower blood sugar after a meal (postprandial glucose) and insulin response.

On contrary, vinegar does not have such effect, which is called anti-glycemic effect, when added to a meal composed of monosaccharide dextrose, basically a single sugar molecule. This suggests that the anti-glycemic effect of ACV is related to the digestion of carbohydrates.2

4. Dosage

10 gram of vinegar was more effective in reducing postprandial (23–28% reduction) than 20 grams or 50 grams of vinegar (6–10% reduction).3

5. The forms of ACV

Commercial vinegar tablets taken whole at mealtime are not as effective as liquid vinegar for reducing blood sugar after meals.5

6. Individual health condition

People with type 1 diabetes should not be using ACV as it can result in low blood sugar (hypoglycemia).

How ACV affects sugar metabolism and its antiglycemic effect?

Several mechanisms have been suggested to explain the effect of ACV on glucose metabolism.

  1. Delayed gastric emptying
  2. Suppression of carbohydrates absorption by suppressing the activity of some enzymes like maltase, sucrase, lactase and trehalase.
  3. Decreased liver glucose production
  4. Increased glucose utilization in skeletal muscles
  5. Increased blood flow and thus stimulates sugar uptake
  6. Improved insulin sensitivity

Effect of ACV on Lipid (fat) Metabolism and Body Weight

Most data on the lipid-lowering effect of vinegar are derived either from animal models or from a few human studies that had important limitations. Some animal studies showed that chronic use of acetic acid reduces total serum cholesterol and triglycerides, whereas other studies showed no effect.6 Therefore, a well-designed, long term clinical trials are necessary to investigate the long-term effects of vinegar on lipid.

As for the effect of vinegar on body weight, study in rats showed that acetic acid added to a cholesterol-rich diet for 19 days had no effect on body weight or food intake.7 In humans, there is one double-blind, placebo-controlled trial investigated the effect of vinegar intake on reducing body mass index (BMI)and weigh in obese Japanese for 12-week period.8 The results showed a decrease in body weight and BMI; however, the reduction is not high (1-2 kg of body weight, and 0.4-.07 points of BMI).

Safety and Adverse Effects of ACV9

  1. When ACV is consumed undiluted or taken as vinegar tablets, it might cause damage to the esophagus.
  2. When vinegar is consumed in larger quantities, it might cause damage to the teeth enamel.
  3. High doses of ACV (4 tablespoons daily) might cause frequent bowel movements and a higher frequency of burping or flatulence.
  4. People with peptic ulcer should avoid taking ACV.
  5. People with type 1 diabetes or those who are insulin dependent should not use ACV as it can increase their risk of low blood sugar (hypoglycemia).

The findings of those studies suggest that vinegar can be effective in reducing postprandial glucose and insulin levels, indicating it could be considered as an adjunctive tool for improving glycemic control. However, further studies with a greater number of participants and a longer (at least 3 months) period of vinegar intake are warranted to investigate the effect of long-term use of ACV on health.

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  1. Johnston CS, Gaas CA. Vinegar: medicinal uses and antiglycemic effect. MedGenMed. May 30 2006;8(2):61.
  2. Cheng LJ, Jiang Y, Wu VX, Wang W. A systematic review and meta-analysis: Vinegar consumption on glycaemic control in adults with type 2 diabetes mellitus. Journal of Advanced Nursing. 2020;76(2):459-474. doi:
  3. Johnston CS, Steplewska I, Long CA, Harris LN, Ryals RH. Examination of the antiglycemic properties of vinegar in healthy adults. Ann Nutr Metab. 2010;56(1):74-9.
  4. Ostman E, Granfeldt Y, Persson L, Björck I. Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. Eur J Clin Nutr. Sep 2005;59(9):983-8. doi:10.1038/sj.ejcn.1602197
  5. Feise NK, Johnston CS. Commercial Vinegar Tablets Do Not Display the Same Physiological Benefits for Managing Postprandial Glucose Concentrations as Liquid Vinegar. J Nutr Metab. 2020;2020:9098739. doi:10.1155/2020/9098739
  6. 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. Oct 2014;72(10):651-61. doi:10.1111/nure.12125
  7. Fushimi T, Suruga K, Oshima Y, Fukiharu M, Tsukamoto Y, Goda T. Dietary acetic acid reduces serum cholesterol and triacylglycerols in rats fed a cholesterol-rich diet. Br J Nutr. May 2006;95(5):916-24. doi:10.1079/bjn20061740
  8. 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 Biotechnol Biochem. Aug 2009;73(8):1837-43. doi:10.1271/bbb.90231
  9. Launholt TL, Kristiansen CB, Hjorth P. Safety and side effects of apple vinegar intake and its effect on metabolic parameters and body weight: a systematic review. Eur J Nutr. Sep 2020;59(6):2273-2289. doi:10.1007/s00394-020-02214-3

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