Apple Cider Vinegar

Patients periodically ask me about apple cider vinegar. I stay away from social media and news, so perhaps the interest waxes and wanes with marketing and propaganda, but regardless, since the topic seems to come in bursts and has reemerged lately, so I thought I would address it.

Apple cider vinegar is a type of vinegar made from fermenting apples and yeast. Yeast digests the sugars in apples and converts them into alcohol. Bacteria then turn the alcohol into acetic acid – a process called fermentation. The end result is a liquid containing the same vitamins you would get from eating an apple plus some probiotics (bacteria that live inside of us). I’m sure some people like the taste of the stuff, but to me, it tastes like funky vinegar – nothing that I would ever want to drink electively. However, we put ourselves through all kinds of unpleasantness in our attempts to improve our health, so who am I to judge!

Apple cider vinegar isn’t fairy dust that will cure everything, but it probably isn’t snake oil either. A small study in 2004 showed that it might help a little bit with blood sugar control in people with diabetes that are eating a high carbohydrate diet. That’s not a bad thing – although I would argue that simply changing the diet composition would be an easier fix than trying to drink down this foul-tasting stuff after eating something unhealthy!

Apple cider vinegar is widely touted as a weight-loss food. However, this is mostly marketing and hype and not good science. Valid studies correlating apple cider vinegar and weight loss are very limited and not super compelling. Studies in rats and mice suggest that acetic acid can prevent fat deposition and improve their metabolism. However, we don’t have a lot of evidence translating this to humans. It’s really difficult and expensive to study nutrition in people over a long time – not to mention time-consuming. We try to extrapolate short-term results in humans into long-term projections, but it’s not always super-helpful. The most widely quoted study of humans and apple-cider vinegar is from a 2009 study of 175 people that consumed either 0, 1, or 2 tablespoons of vinegar each day. After 3 months of observation, those that consumed vinegar had a weight loss of 2-4 pounds and slightly lower triglyceride levels. Both good things – but nothing that we can correlate to a recommendation for sustained weight loss or health improvements – especially since we have no idea if these people kept their weight off (something sadly lacking in almost every weight-loss study). Another small study found that vinegar consumption made people feel more full after eating, but that it did so by causing nausea. In addition, neither of these studies specifically studied apple cider vinegar.

The scientific evidence that vinegar consumption (whether of the apple cider variety or not) is an effective, long-term means of losing weight is not compelling. Even among proponents of apple cider vinegar for weight loss, it’s unclear when to drink it or how much is ideal. Despite the paucity of data, if you look at the market growth of apple cider vinegar, it has increased tremendously in the past 5 years – from $132 million to $215 million. More and more people are drinking the stuff. And, despite the increase in usage, the obesity epidemic keeps accelerating.

I don’t try to talk my patients out of consuming apple cider vinegar – especially if they love the taste of the stuff! There seems to be very little risk in consuming a small amount, but as with everything, you should always look at risks and benefits before deciding to ingest it. Here are a few of the risks:

• The high acidity of vinegar can damage tooth enamel when sipped straight. Consuming it as a component of vinaigrette salad dressing is a better way to get the potential benefits than chugging it straight from the bottle.
• Vinegar has been reported to cause or worsen low potassium levels. That’s particularly important for people taking medications that can lower potassium (such as diuretics used often to treat high blood pressure).
• As we touched upon earlier, vinegar can alter insulin levels in some people. People with diabetes that are taking medications that have the potential to hypoglycemia should always be cautious about doing things that affect their insulin levels.

So what?

If you are trying to lose weight, adding apple cider vinegar to your diet probably won’t do the trick. If you love it, by all means – indulge. It’s a good source of probiotics, which are a good thing. It’s just not the magic solution that we all keep looking for. As always, if it sounds too good to be true, it’s too good to be true.