Apple cider vinegar for weight loss (2024)

I’ve actually been recently taking apple cider vinegar (ACV) since I noticed that it can be used as a diuretic. This was interesting in that as a recent pre-diabetic, I was hoping to drive some excess fluid out of my system specifically at the beginning of winter. Although I have a bottle of ACV which is imported from Italy (Mazzetti), I have been leaning more towards taking a capsule supplement combined with “garcinia” for weight loss in order to keep my fluid intake down over the Southern Hemisphere cold season. This has been particularly appealing since, as a supplement, it is really affordable. While I didn’t actually know much about ACV at the time, I was surprised during some basic research to find that as a supplement it is quite controversial since while it has a buzz around its reputation, the scientific data is still relatively unavailable outside of a small number of trials. In then also becoming curious as to what “the mother” was all about which is advertised on the bottle, I decided to try and tease out what information I could with the limited amount of data available.

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Take-away: in this article I will begin by exploring three main factors that seem to contribute to the purported health benefits of apple cider vinegar (ACV) which are acetic acid, probiotic yeast, and antioxidants. I then try and piece together what information that there is available in order to discern whether the benefits of ACV are really just the benefits of common vinegar, or whether there are other factors contributing to its reputation. I then link the claims about ACV’s antioxidant properties to the flavonoid "quercetin" which is found in the apples from which it is derived, and then suggest that it is a combination of factors which might enhance the positive effects of ACV.

In then exploring the evidence for whether ACV is an effective weight loss remedy, I find that there is a lot of professional scepticism specifically because it is such a popular supplement, but where I also find that there is a growing number of smaller trials which might just be onto something, but where more research needs to be done. In then reading between the lines, I put forward the theory that ACV is most likely an effective weight loss supplement, but only when used in combination with a diet and exercise regime that is already taking place.

I then wrap-up the blog by considering whether AVC, which is reported to be able to lower blood glucose, might be dangerous to ketogenic dieters who are already restricting their carb intake. However, I find that the only cautions that need to be considered are mainly for type 2 diabetics who are on medication, as well as for people on prescription diuretics since ACV also acts as a blood thinner. Furthermore, ketogenic dieters have been clinically found, although perhaps only based on one study, not to be affected by the blood glucose regulating action of ACV, and where they might even be aided by this supplement which can help with ketone production. Finally, I consider the precautions that need to be taken with ACV so as not to lead to the erosion of tooth enamel and other obvious damage that can come about from consuming too much acetic acid.

What is apple cider vinegar?

It is always good to start with the most simple question and build things up from there. Yet what actually is apple cider vinegar? Is it just a common vinegar like white vinegar, but which has a tangy apple kick to it, or is there something more going on? While this sounds like a basic proposition to investigate, the answer is actually much more obscure than what most people would realise. In order to find a starting point in this investigation, a brief overview from the website Eating Well will first be considered:

This type of vinegar is made from the fermentation of apples. Once the apples are juiced, the liquid is fermented with bacterial and yeast cultures. This transforms the sugars in the apple juice into alcohol, and then to vinegar.

Some ACV varieties have “the mother” advertised on their label, which refers to the combination of yeast and bacteria formed during the fermentation process. This substance, which looks like a cloudy sediment, is often visible at the bottom of the bottle, and it is believed to be rich in health-boosting natural proteins, healthy bacteria and acetic acid.

If you look at the ingredient label on apple cider vinegar, you will likely see one, or maybe two, ingredients: apple cider vinegar and water.

But within apple cider vinegar, there are many components.

“Apple cider vinegar contains water, acetic acid, potassium, probiotics and polyphenols. It also contains negligible amounts of micronutrients.” Wohlford says.

Here’s how she says some of the components in apple cider vinegar can impact the body.

- Acetic acid can help kill harmful bacteria.

- Probiotics boost the healthy bacteria in our microbiome.

- Polyphenols are an antioxidant that can reduce cellular damage by free radicals.

Apple cider vinegar (ACV) is one of the three most common types of vinegar, produced by fermenting apples. This acidic solution is consumed throughout the world as a flavouring and preservative agent in foods. ACV contains a variety of flavonoids, such as gallic acid, catechin, caffeic acid, and ferric acid. Animal experiments have reported that ACV has a variety of pharmacological functions, including anti-oxidant, anti-inflammatory, anti-diabetic, anti-hypertensive, and anti-hyperlipidemic properties.

As can be seen here, what begins as a description of something as just being really healthy then expands out into ACV becoming a pharmacological powerhouse. It is actually interesting what is occurring here. For instance, the heyday of big pharmaceutical companies perhaps from the 1960’s onwards, while I am not at all trying to be controversial here about the flaws of big business models, is not so much starting to fade, but where a certain glow is starting to appear around less costly options for wellbeing. This “certain glow” around the benefits of something like ACV is perhaps coming about from the internet where people can talk about their anecdotal findings with this supplement, along with discussing a myriad of other beneficial health products which the broader public is only now becoming more aware of. At the same time, while ACV is purported to have all of these impressive benefits, the question that stands out is about the extent of these benefits, ie. are such medicinal benefits substantial or negligible? Do such benefits occur immediately or do they require an accumulation of time to take effect? Have the benefits been proven in clinical trials or are they all just anecdotal? Does research into cheaper medicinal options lag because such research might impact the profits of pharmaceutical companies, thus leading to a paucity of information available about such options? While I definitely cannot answer the last question presented here without being controversial, I can at least consider all of the other questions leading up to it, and particularly in the context of weight loss to which ACV has been linked with some promise.

The vinegar process and acetic acid

It seems that “the mother” that occurs in the production of ACV is a rather vague proposition, and that it is most often described as a combination of yeast and bacteria. In this regard, “the mother” might just sound like a probiotic, or beneficial bacteria for the gut. However, other sources also mention that the magic of “the mother” lies in the content of acetic acid that it contains, but what exactly is acetic acid? In order to find out, a detour into the mists of time via Wikipedia is required:

Vinegar was known early in civilisation as the natural result of exposure of beer and wine to air because acetic acid-producing bacteria are present globally. The use of acetic acid in alchemy extends into the third century BC, when the Greek philosopher Theophrastus described how vinegar acted on metals to produce pigments useful in art, including white lead (lead carbonate) and verdigris, a green mixture of copper salts including copper(II) acetate. Ancient Romans boiled soured wine to produce a highly sweet syrup called sapa. Sapa that was produced in lead pots was rich in lead acetate, a sweet substance also called sugar of lead or sugar of Saturn, which contributed to lead poisoning among the Roman aristocracy.

Togas aside, it can be seen from this passage that “the mother” produced in ACV is part of a long tradition of alcohol fermentation giving rise to interesting byproducts, although thankfully this no longer involves lead pots. At the same time, it can be seen that acetic acid is not something unique just to “the mother” in ACV since this type of acid is the hallmark of all types of vinegar. For instance, the Virginia Department of Health outlines acetic acid as follows:

Acetic acid is also known as ethanoic acid, ethylic acid, vinegar acid, and methane carboxylic acid. Acetic acid is a byproduct of fermentation, and gives vinegar its characteristic odour. Vinegar is about 4-6% acetic acid in water. More concentrated solutions can be found in laboratory use, and pure acetic acid containing only traces of water is known as glacial acetic acid. Dilute solutions like vinegar can contact skin with no harm, but more concentrated solutions will burn the skin. Glacial acetic acid can cause skin burns and permanent eye damage, and will corrode metal.

This effect of acetic acid is important regarding ACV only being taken in low doses. Interestingly, the same source states that acetic acid might play a beneficial role in both metabolism and the production of ketones (see the blog “Prepping for weight loss 02 - Know your metabolism”):

Acetates (salts of acetic acid) are common constituents of animal and plant tissues and are formed during the metabolism of food substances. Acetate is readily metabolised by most tissues and may give rise to the production of ketones as intermediates. Acetate is used by the body as a building block to make phospholipids, neutral lipids, steroids, sterols, and saturated and unsaturated fatty acids in a variety of human and animal tissue preparations.

While acetic acid alone is being considered here, could it be the case that health benefits from “the mother” in ACV occurs specifically from apples being fermented, or else all vinegar, and not just ACV, would be able to make the same claim to the health benefits based just on containing acetic acid? If there is something special about apples as an original ingredient, then this would not be so strange to consider since apples are famous for their health benefits, and where everyone knows the “an apple a day… ” saying. For instance, Cleveland Clinic states that “the combination of antioxidants and fibre makes apples a nutritional powerhouse”. If it can be recalled from earlier in this blog, MD Anderson Cancer Clinic also maintains that the polyphenols found in ACV “are an antioxidant that can reduce cellular damage by free radicals”. Therefore, as a separate factor to acetic acid, it might be the case that the antioxidant properties of ACV derive directly from the same properties found in apples, and where the fermentation process might even enhance these antioxidant effects (see the Saudi study further below).

If an extra clue is being looked for regarding the antioxidant factor besides acetic acid being present, Cleveland Clinic provides another interesting tidbit of information:

Antioxidants: Apple peels are rich in antioxidants, most notably quercetin. This nutrient is found in highly pigmented (colourful) foods, including citrus fruits, berries, green tea and red wine.

Most people who are interested in supplements have probably encountered quercetin sitting on the chemist shelf, and where it seems to be one of those semi-mystical products that promises to be a kind of highly beneficial cure-all (and which might actually be supported by the above video). Mount Sinai then provides the following information about specific types of antioxidants that are known as “flavonoids”:

Flavonoids, such as quercetin, are antioxidants. They scavenge particles in the body known as free radicals which damage cell membranes, tamper with DNA, and even cause cell death. Antioxidants can neutralise free radicals. They may reduce or even help prevent some of the damage free radicals cause. In test tubes, quercetin has strong antioxidant properties. But researchers are not sure whether taking quercetin (and many other antioxidants) has the same effects inside the body.

While the dreaded “lack of clinical trials syndrome” seems to be in effect here, and which seems to be the case with most mundane kitchen-shelf items that might have significant health benefits, the same source does mention something interesting regarding research into heart disease:

Test tube, animal, and some population-based studies suggest that the flavonoids quercetin, resveratrol, and catechin (all found in high concentrations in red wine) may help reduce the risk of atherosclerosis, plaque build up in arteries that can lead to heart attack or stroke. These nutrients appear to protect against the damage caused by LDL (bad) cholesterol and may help prevent death from heart disease. However, most human studies have looked at flavonoids in the diet, not as supplements. Animal studies have used extremely large amounts of flavonoids (more than you could get through a supplement). More studies in people are needed to see if flavonoid supplements can be effective.

On a relevant note, Cleveland Clinic maintains that apples themselves are known to lower cholesterol:

Multiple studies in people with high cholesterol show that consuming a few apples a day can reduce total cholesterol levels by about 5% to 8%. Can’t down that many apples in 24 hours? Try a daily serve of 3 ounces of dried apples (no sugar added). One study’s participants reduced their total cholesterol by 13% in six months after eating that much.

This might sound like a job for the juicer! While there have been some quick leaps here from apples to acetic acid to antioxidants and to cholesterol effects, there is unfortunately a dearth of much detailed information about ACV, that at least isn't anecdotal, in order to have a precise presentation, and where more of a patchwork approach is required that tends to leap between subjects in order to connect the dots. Having said this, the link between quercetin being found in high concentrations in red wine is also interesting since alcohol relates to the vinegar fermentation process, thereby presenting a common thread between different vinegars besides acetic acid. There is also some really useful information here if someone on a ketogenic diet is worried about the effects of LDL cholesterol from consuming high amounts of fat (see the blog “The ketogenic diet - still a new frontier for science?”). However, the reason that this information is mentioned is because it correlates with what the previously quoted NIH paper from BMC Complementary Medicine outlines as being the beneficial compounds found in ACV, and where these benefits would seem to have more to do with apples than with the common factor of acetic acid found in all vinegars:

ACV contains a variety of flavonoids, such as gallic acid, catechin, caffeic acid, and ferric acid. Animal experiments have reported that ACV has a variety of pharmacological functions, including anti-oxidant, anti-inflammatory, anti-diabetic, anti-hypertensive, and anti-hyperlipidemic properties.

What might then be of further significance here is that Mount Sinai mentions “grapeseed, bilberry, Ginkgo biloba, and green tea” as all being “flavonoid-rich” extracts, but where none of these, with the exception of grapes themselves for wine, might be made into vinegar. Therefore, it might be the case that while there are other fruits that are more flavonoid-rich than apples, that apples simply lend themselves better to the fermentation process which enhances their health benefits. The conclusion as to what exactly constitutes “the mother” in ACV then most likely pertains to the combination of the antioxidant properties derived from apples with the byproducts of bacteria and yeast arising from fermentation, and which then adds to the health benefits of acetic acid as previously outlined by MD Anderson Cancer Centre for ACV:

- Acetic acid can help kill harmful bacteria.

- Probiotics boost the healthy bacteria in our microbiome.

- Polyphenols are an antioxidant that can reduce cellular damage by free radicals.

Yet for something that might detract from the apple-derivation theory, it is also important to mention at this point that such bacteria from the fermentation process does not derive from apples per se, but as Wikipedia has stated: “acetic acid-producing bacteria are present globally” when the fermented alcohol made from apples is exposed to the air, and which is beginning to present a picture of ACV as being a combination of positive health factors rather than its benefits being attributable to just one ingredient. Similarly, it is also important to clarify that polyphenols are indeed a type of flavonoid (source: NIH):

Flavonoids are a family of polyphenolic compounds which are widespread in nature (vegetables) and are consumed as part of the human diet in significant amounts. There are other types of polyphenols, including, for example, tannins and resveratrol.

Furthermore, Eating Well states that the “total phenolic contents of ACV” might account for its possible antimicrobial and sanitizing properties. However, it is unclear whether this antimicrobial property would derive from the acetic acid of all vinegar or specifically from the flavonoids of apples, although the reference to polyphenols would indicate the latter scenario. The other possibility is that the antibacterial properties of both acetic acid and the antioxidants derived from apples combine to give ACV its reputation. At the same time, Cleveland Clinic specifically refers to quercetin in an article related to the health benefits of apples rather than to ACV, thereby confirming another link in my apple-derivation theory:

Quercetin stops those harmful microbes growing in your gut.

Why wouldn’t these health properties of apples be transferred into ACV during the fermentation process? Indeed, this speculation is cofirmed by a PubMed paper (source: NIH):

The antioxidant effect of apple cider vinegar may also be linked to the presence of potent antioxidants such as phloretin and quercetin, which both increase during the fermentation process.

Yet in having said this, and which once again points to ACV perhaps involving a constellation of different health factors fortuitously combining, the same paper specifically attributes a number of ACV health benefits not only to apples being used, but to the specific types of apples. It could almost be the case that ACV turns into its own branch of science:

This study provides new information concerning the impact of processing various Moroccan cultivars (Golden Delicious, Red Delicious, Starking Delicious, and Gala) on the composition and biological properties of vinegar. Additionally, this research provides novel findings regarding the antidepressant and anti-inflammatory activities exhibited by the studied vinegars. The apple variety seems to influence the total acidity, aromatic volatiles, polyphenolic, and organic profiles of vinegar... Golden Delicious vinegar exhibited significant anti-inflammatory and antidepressant effects. The same vinegar displayed remarkable antimicrobial activities. In contrast, Red Delicious and Gala vinegars were, in particular, more involved in inhibiting lipid oxidation due to their phenolic content.

The paper then ends on the following note:

Conclusively, the vinegar studied can be considered a good natural source of bioactive molecules, especially organic acids and polyphenols, which certainly have multiple nutritional and health benefits and can be adopted in combination to combat many public health challenges, including antimicrobial resistance.

The interesting thing about this Saudi paper is that it has only been published recently in November 2023 (as of the time of writing in June 2024), although I didn't find any other references to it in mainstream articles during my research. In this regard, these findings seem to stand by themselves, and if true would be groundbreaking. There is also another similar paper that will be quoted below which is a very recent study from Lebanon (March 2024). It seems that there might be a cultural interest in ACV in the Middle East that could be promising for future research.

Apple cider vinegar for weight loss

Since this is indeed a dieting website, the most significant effect of ACV would need to be weight loss. Yet a problem emerges here of going into a borderland where ACV might enable weight loss although the research hasn’t been conducted, and the confusion that can often occur where a lack of research does not necessarily mean that the health benefits have been debunked - the actual links to weight loss just haven’t been proven yet. However, this borderland between anecdotal evidence and the official science not being in yet can lead to things like health supplements being marketed as though their effects have been scientifically proven when they haven’t. Therefore, it is important to tread carefully here so as not to take the anecdotal evidence as scientific proof, while at the same time not throwing out the baby with the bathwater just because long-term trials have not yet been conducted. For example, a scenario could arise where someone seeking a reliable health supplement at age 30 might dismiss the purported benefits of ACV as being misleading, only to read an article headline years later at age 50 saying something like “Scientists discover that apple cider vinegar prolongs lifespan by 40% if taken every day from age 30. New human ‘super-age’ predicted for people currently in their 20’s”. While this example might sound outlandish, in having made it to my 40’s I have seen this type of thing happen many times where there is the impression of something having been debunked, only for science to perform a complete turnaround a decade later following new research results. In this regard, at present there is an obvious anecdotal buzz around the health benefits of ACV which is most likely for a reason, but where it is up to the individual if they wish to see if ACV does indeed present such results. If there is perhaps any foundation of empirical evidence that might act as a support in this case, this might lie in the well-known health benefits of apples in the first place from which ACV is derived.

In terms of the information available about ACV and weight loss, the first port of call here is the always reliable Healthline:

In one 2009 study, 1 or 2 tbsp. (15 or 30mL) of apple cider vinegar daily for 3 months helped people with overweight lose an average of 2.6 and 3.7 (lbs.), or 1.2 and 1.7 kilograms (kg), respectively.

Taking 2 tbsp. each day have also been found to help people lose nearly twice as much weight in 3 months compared to people who didn’t consume apple cider vinegar.

However, a recent review concluded that there is insufficient evidence to support the use of apple cider vinegar for weight loss. Therefore, more high quality research is needed.

In accordance with the previous discussion concerning how acetic acid is common to all vinegars, Eating Well seems to subtly be referring to vinegar rather than to ACV specifically:

Apple-cider vinegar is often cited as a natural tool for weight loss. The thought behind this claim primarily revolves around the presence of acetic acid, which some research, such as a review in Nutrients in 2019, says may suppress appetite.

A 2022 meta-analysis in Current Developments in Nutrition evaluated short- and long-term studies conducted on apple-cider vinegar and appetite and calorie intake. Results showed four of the six short-term studies reported that vinegar suppressed appetite. However, none of the long-term studies reported any appetite-suppressing benefit.

Could it be the case that taking ACV is really just the taking of vinegar in a more palatable form since apples are involved? Having said this, the antioxidant properties of ACV, which are not linked to acetic acid, are not being discussed in the context of weight loss, and where acetic acid possibly acting as an appetite suppressant seems to be the main topic here. This could mean that any vinegar, if consumed, might have an indirect effect leading to weight loss rather than, say, acetic acid working directly in somehow dissolving body fat.

In then scouring the internet further for definitive information about ACV and weight loss, and where there doesn’t seem to be much information out there, the fine folk at Alaska Regional Hospital cited the following study:

In a 2018 small, randomised clinical trial published in The Journal of Functional Food, half of participants drank one tablespoon of ACV with both lunch and dinner for 12 weeks. The rest of the participants didn’t receive ACV. In addition to incorporating ACV, the participants also restricted their calorie intake and exercised. Those who drank the ACV lost an average of 8.8 pounds, while those who didn’t, lost an average of 5. However, since participants were on a calorie restricted diet and exercised regularly, ACV alone may not have had much of an effect.

While it is stated here that ACV alone might not have had much of an effect during this trial, the limited evidence seems to suggest that ACV might play a role in accelerating weight loss if a diet and exercise regime is already in place, and rather than being a standalone weight loss supplement. It is then perhaps important to consider here that, as a consumer, while such online articles are prohibited from leaping to conclusions without further research taking place, there are still dots that can be connected about what might possibly be the case until the research evidence is in at some future date. Therefore, while many public institutions cannot officially endorse various health supplements without more rigorous evidence being collected, this does not necessarily mean that such supplements should be dismissed out-of-hand. Yet in having said this, Harvard Health seems to dash these hopes somewhat:

One 2018 study randomly assigned 39 study subjects to follow a restricted calorie diet with apple cider vinegar, or a restricted calorie diet without apple cider vinegar, for 12 weeks. While both groups lost weight, the apple cider vinegar group lost more. As with many prior studies, this one was quite small and short-term.

In all, the scientific evidence that vinegar consumption (whether of the apple cider variety or not) is a reliable, long-term means of losing excess weight is not compelling.

Even among proponents of apple cider vinegar for weight loss or other health benefits, it’s unclearwhento drink apple cider vinegar (for example, whether there is particular time of day that might be best) or how much apple cider vinegar per day is ideal.

The same author then concludes the article by stating:

If you are trying to lose weight, adding apple cider vinegar to your diet probably won’t do the trick. Of course, you’d never suspect that was the case by the way it’s been trending on Google health searches. But the popularity of diets frequently has little to do with actual evidence. If you read about a new diet (or other remedy) that sounds too good to be true, a healthy dose of skepticism is usually in order.

As I have cautioned about previously in this blog, when it comes to health supplements still being scientifically unproven, the mistake can be made of mistaking scepticism for valid knowledge, although I understand the angle which this author is taking and am not actually criticising it. The date of this article being published is 15th of June 2023. However, as of this year (currently June 2024 as of the time of this writing), a new study out of Lebanon, although still far from conclusive, seems to provide the kind of evidential support for ACV contributing to weight loss that has so far been lacking. The website Health.com reports the following information about the recent Lebanese study from late March 2024:

The team recruited 120 participants aged 12 to 25. They divided them into four groups and instructed people in three of the groups to drink either 5, 10, or 15 millilitres (ml) of apple cider vinegar in the morning. (For reference, 15 ml is equal to about one tablespoon.) The fourth group drank a placebo.

When the study began, the average weight of participants was about 173 pounds. After 12 weeks, researchers found that the apple cider vinegar groups shed weight overall.

The group that drank 15 ml daily lost the most, dropping its average to about 155 pounds. Those who drank 10ml reduced their average weight to 159 pounds, and the group that consumed 5 ml dropped to an average of 163 pounds. All three groups had a decline in waist and hip circumference and body mass index (BMI).

The team also discovered significant improvements in blood glucose, triglyceride, and cholesterol levels.

The study is the first to assess apple cider vinegar’s impact on health besides weight. It’s also the only one to examine how the drink affects younger people - though other research has tested whether it helps older adults shed pounds.

A small (but often-cited) 2009 trial found that consuming 1 or 2 tablespoons of the tangy drink daily resulted in modest weight loss of 2 to 4 pounds after three months. In another small study, researchers gave apple cider vinegar to people on both calorie-restricted and regular diets. After 12 weeks, both groups had lost weight, but this who consumed ACV had lost more.

However, while this study seems to be more optimistic, there is still the air of caution in the article’s (and not the study’s itself) conclusion:

A daily dose of apple cider vinegar may help you lose weight, but other strategies are far more tried and true.

“To lose weight, you need to be in a calorie deficit, ie., take in fewer calories than you burn,” Mitri explained. “You can do this by reducing your calorie intake in your diet, exercising more, or, ideally, combining both.”

Ultimately, these old standbys are probably a surer path to long-term weight loss than jumping on the apple cider vinegar trend.

Readers of my blog article “Prepping for weight loss 02 - Know your metabolism” might find the advice here strange given that reducing the intake of calories is also a short-term and unreliable weight loss strategy since it slows down the metabolism, thereby leading to a higher likelihood of even more weight gain once the person starts eating again. Then again, there perhaps needs to be a health caution mentioned in this article about dieting since drinking ACV in excess can be dangerous. However, it must be said that the entire imperative of “You Must Eat” has arisen from the experience that cutting food intake is not necessarily the way to go for weight loss (see my blog “Introduction to ‘You Must Eat’” for more about this regarding a nitroglycerin pill eventually having to be taken while I was fasting). There was also a link to a Sydney University article in the metabolism blog possibly refuting the calorie-restriction method of weight loss, although of course it is still a legitimate way to lose weight. At the same time, and as mentioned previously, it must be realistically taken onboard that such articles cannot appear to positively endorse a supplement like ACV in case a desperate person gets the wrong idea and starts drinking an entire bottle everyday, thereby burning out their oesophagus and losing all of their tooth enamel due to the high amounts of acetic acid they would consume. However, another article about the same Lebanese study from The Conversation seems to strike a more objective note:

This study provides us with some evidence of a link between apple cider vinegar and weight loss. But before health professionals can recommend this as a weight loss strategy we need bigger and better conducted studies across a wide range.

Such research would need to be done alongside a controlled background diet and exercise across all participants. This would provide more robust evidence that apple cider vinegar could be a useful aid for weight loss.

Still, if you don’t mind the taste of apple cider vinegar then you could try drinking some for weight loss, alongside a healthy balanced and varied dietary intake. This study does not suggest people can eat whatever they like and drink apple cider vinegar as a way to control weight.

What is interesting here is the recurrence of the theme that ACV might only be effective in accelerating the weight loss of people already dieting and exercising, rather than being a standalone weight loss supplement. Could this small detail, eked out from these various sources, be the secret to using ACV as a weight loss supplement? While I myself cannot point to any rigorous empirical evidence, since ACV is one of the cheapest supplements on the market, not to mention at the supermarket, a dieter could easily work a moderate amount of ACV into their daily intake of fluids to see if this enhances their weight loss, and instead of ACV perhaps being falsely considered to be a standalone weight loss supplement. Indeed, the accessibility of ACV was one of the primary reasons that the Lebanese study took place (source: Health.com):

Abou-Khalil said the researchers set out to assess a potential solution to obesity that would align with the growing interest in non-pharmaceuticals. “We were motivated to explore potential natural remedies for weight reduction that could offer safe and effective alternatives to traditional interventions,” he said.

The same researcher then goes on to make an educated guess as to what the effective mechanisms in ACV might pertain to, although it is still unclear whether these positive effects would be attributable specifically to ACV or to vinegar in general:

Abou-Khalil said it’s unclear what’s behind apple cider vinegar’s potential effect on weight loss, but he has some theories.

“One proposed mechanism is that ACV may help to increase feelings of satiety, leading to reduced calorie intake,” he noted. “Additionally, ACV has been suggested to influence metabolism and insulin sensitivity, potentially contributing to fat oxidation and reduced fat storage.”

Therefore, while it might be said that Harvard’s scepticism has not been dealt a decisive blow here, it might be the case that all of the small studies concerning cheap and easily available ACV, if there are enough of them carried out, might begin to add-up and provide the impetus for long-term studies that might, or might not, eventually prove something substantial. The other factor that might be emerging here is that there is just something special health-wise about apples and the vinegar that gets made from them.

Apple cider vinegar, blood glucose, and blood thinning

Readers of this website might be familiar with my series about kidney health, in particular the article “Do you have weak kidneys?”, and to a certain extent “The difference between pre-diabetes and diabetes”. These have actually been important articles for myself to research since one of the greatest dangers of dieting, in particular with ketogenic dieting, is that of hypoglycaemia occurring where blood glucose levels end up being too low from cutting out as much sugar as possible. For instance, earlier in this blog I speculated upon the notion that taking ACV might be beneficial for someone on a ketogenic diet since ACV can contribute to the production of ketones, but where I would need to be careful in making these kinds of connections in that ACV might also lower blood glucose levels, thereby possibly causing hypoglycaemia in a ketogenic dieter. For example, the following passage from Eating Well would most likely apply to someone who is not specifically on a ketogenic diet which vastly restricts the intake of carbs, but which might still be relevant:

The acetic acid found in apple-cider vinegar is believed to slow the digestion of carbohydrates, thereby reducing the rate at which sugars enter the bloodstream and helping to maintain more consistent blood sugar levels. It may also improve insulin sensitivity, which plays a key role in the body’s ability to effectively use glucose for energy.

A systematic review and meta-analysis, published in the aforementioned BMC Complementary Medicine and Therapies research, evaluated nine studies to determine whether ACV may affect blood sugar management. Results showed that consumption is linked to improved fasting plasma glucose and haemoglobin A1C concentrations (a measure of your average blood sugar over three months). While results did not show that ACV impacts fasting insulin, the authors did conclude that ACV appears to be a safe natural supplement that may help control blood sugar.

The study mentioned here from BMC Complementary is the same one from NIH that is quoted at the beginning of this blog. Alaska Regional Hospital then mentions ACV specifically in the context of diabetes:

Some studies do show a slight correlation between apple cider vinegar and better control of blood sugar. One 2018 review looked at clinical trials involving adults with type 1 and type 2 diabetes who were given vinegar orally. The reviewers concluded that ACV did lead to slightly lower HbA1c, the measure of blood sugar levels over several months.

While the numbers slightly improved both after a meal, and 8 to 12 weeks later, they didn’t improve by much. One theory is that the vinegar may thwart blood sugar spikes by blocking the absorption of starches. Vinegar might also slow the digestion of complex carbohydrates, which may be a part of it, too.

Keep in mind that ACV isn’t a treatment for diabetes and it’s important that you don’t overdo it. If you’re insulin dependent or if you are taking diabetic medications that reduce your glucose levels, vinegar may reduce your blood sugar levels even further, causing risk of hypoglycaemia, a dangerous condition that could be fatal, says Zylberglait.

The article which this came from is actually from 2019, but where the BMC Complementary study cited by Eating Well is from 2021. Therefore, it might be the case that ACV has more of a role in possibly lowering blood glucose levels than previously thought. At the same time, my initial precaution about ACV having a negative impact on ketogenic dieters might be unfounded since Healthline states:

Apple cider vinegar does not significantly lower blood sugar when taken before a low carb or high fibre meal.

The information that the effects of ACV only seem to involve people on a standard carb-based diet is then confirmed by the website Diet Doctor:

Strong evidence supports the use of apple cider vinegar for lowering blood sugar levels.

There’s an important caveat, though. Vinegar has only been found to reduce post-meal blood sugar increases when it is consumed with a high-carb meal.

Additionally, results from a small study in people with type 2 diabetes suggests that vinegar has stronger anti-glycemic effects when consumed with a meal high in rapidly digested carbs compared to a high-carb meal that is digested slowly.

If you’re following a keto or low-carb diet, at this point there aren’t any studies investigating if taking apple cider vinegar will lead to further reductions in blood sugar after meals.

However, results from one study in people with type 2 diabetes suggest that consuming apple cider vinegar with a high-protein, very-low-carb snack before bed may improve fasting blood sugar levels. This was a small study of only 11 people, so additional studies are needed to confirm these findings.

At any rate, if you take insulin or other medication for type 2 diabetes, be aware that your doctor may possibly need to reduce your dosage if you begin taking apple cider vinegar.

It might then be the case that my hesitation about ACV, in terms of lowering blood glucose levels, would apply more to type 2 diabetes rather than to a ketogenic dieter. Having said this, owning a blood glucose monitor is probably a good idea for any serious dieter, especially if you find yourself becoming dizzy on a low-carb diet which might indicate low-blood glucose.

As another interesting aside to this particular line of investigation, ACV is also held to be a diuretic by some sources, although this is refuted by a number of other sources. Yet all seem to agree that taking ACV while being on any prescription diuretics is a bad idea. According to Livestrong.com:

Apple cider vinegar is a diuretic, but it is also a blood thinner and has the potential to lower blood glucose levels. As such, it has the potential to interact with prescription drugs designed to treat the same conditions. Dehydration and hyponatremia, a condition in which the body does not have enough sodium, are both real dangers when taking vinegar and diuretics together. This is why you should inform your physician about all natural supplements you are taking when discussing prescription drug therapy.

This passage would at least indicate that ACV has some kind of tangible effect on the human system if it can interact with various medications, or else it would just be a placebo pill.

How not to take apple cider vinegar

It must be constantly kept in mind that while ACV might potentially have all of the health benefits that have been discussed, that it is also a type of cleaning fluid that can be used on various types metals. Therefore, a “more is better” approach definitely does not work here, and where irreparable damage can take place if too much ACV is regularly consumed with the hope of better results. In other words, if not taken wisely and with a certain application of intelligence, ACV can cause dramatically worse health issues than it can potentially solve.

In terms of the negative effects of ACV taken in large quantities, almost all of the sources that have been referenced in this blog mention the same things that can occur, and all of which would arise from too much acetic acid being consumed:

• The loss of tooth enamel (drinking through a straw can prevent this)
• Damage/burning to the oesophagus
• Stomach upset
• Kidney damage if diabetic

It can be clearly seen that common-sense would need to be applied here, and that any positive effects would be accumulative from taking as little as 1 tsp (15mL) every day, and no more than 2 tsp (30mL) daily. As another example that is related to ACV, while a glass of its close-cousin wine every day is considered to be beneficial, a “more is better” approach to alcohol is generally out of the question. Therefore, restraint and patience would also seem to be the order of the day when taking ACV.

Conclusion

If apple cider vinegar does indeed have all of the health benefits that are regularly attributed to it, then it seems that these benefits arise from the matrix of a number of factors combining within the one product, and which makes it difficult to hold just one ingredient responsible for any given effect. The result of this matrix of factors is that any one health issue benefited by ACV seamlessly blends into another health benefit as though a common underlying cause is being addressed for both of them.

Overall, while there are many health benefits for ACV that are promoted which might otherwise be considered exclusively anecdotal, there is at least some clinical evidence that ACV could be effective for weight loss, but only when combined with a diet regime. Whether or not ACV should be taken then becomes a case of whether the you would wish to hedge your bets on ACV being the real deal, or if you would prefer to wait until more comprehensive research is done, but where such research might take years before it is forthcoming. In the meantime, since ACV is just about one of the most affordable supplements out there, it is certainly easy enough to get a bottle from the supermarket to test its effects responsibly.

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I really enjoyed researching this article since ACV seems to be a hidden powerhouse of health benefits with promising evidence to back up its claims, and where it is available right on the supermarket shelf. Youmusteat.com provides both a series of informal blog posts about dieting as well as some medical articles covering key health issues related to dieting and to health in general. Please feel free to visit the blog page as well as to provide any feedback to admin@youmusteat.com

Daniel Larson - YME blogger