Hippocrates was famous for many things, but perhaps one of his most valued quotes was, “Let food be thy medicine and medicine be thy food.” Furthermore, he practiced what he preached—one of his daily rituals was said to be the use of vinegar as a health tonic and wound healing.1 Since that time, many home remedies have included apple cider vinegar. The main active ingredient in apples and apple cider vinegar is a class of phenols, including flavonoids and polyphenolic compounds. These phytonutrients are great for antioxidant support, but the acetic acid in the vinegar portion has been previously described as the active component responsible for its many health benefits.1 Several studies have shown that these compounds have a variety of biological functions, including antioxidant and detoxification support, blood sugar control, heart health and even aiding in weight management along with proper diet and exercise, to name a few.

Production

Vinegar is made from fermentable carbohydrate sources, including apples, molasses, dates, pears, grapes, berries, melons and many more.1 Specifically, with apple cider vinegar, apples are crushed, pressed and the juice is separated. Then yeast is added to the liquid, which ferments the food sugars in apple to alcohol. Next, acetic acid-forming bacteria (Acetobacter) convert the alcohol to acetic acid. Acetic acid is the compound responsible for the tart flavor and pungent odor of vinegar; it is also responsible for the beneficial effects of apple cider vinegar.1 The culture of acetic acid bacteria grows on the surface of the liquid, and fermentation proceeds for several weeks or months. The more extended fermentation period allows for the accumulation of a nontoxic slime composed of yeast and acetic acid bacteria, known as the mother of vinegar. Apple cider vinegar that is unfiltered contains the mother (i.e., strands of proteins, enzymes and friendly bacteria that give the product a cloudy appearance). This product can be consumed as a liquid or put into a capsule; the remaining liquid is then spray-dried with organic tapioca maltodextrin to form a powder for encapsulation.

The Mother & Acetic Acid

Acetic acid, the active ingredient in apple cider vinegar, is a byproduct of the metabolism of ethanol—that has many benefits for inflammation, antimicrobial benefits and alkalinity.1 Acetic acid bacteria (AAB) have, for centuries, been important microorganisms for the production of fermented foods and beverages like yogurt kefir, kombucha and apple cider vinegar. That said, the mother of vinegar is composed of cellulose and acetic acid bacteria that form the biofilm and is said to have the probiotic, prebiotic and enzyme benefits of apple cider vinegar. The mother is said to be responsible for further aiding digestion and soothing the digestive tract, while the acetic acid from apple cider vinegar restores the stomach’s pH balance.

Benefits

Antioxidant & Detoxification Support

Pollution, ozone, smoking, alcohol, processed foods, chemicals—these are just some lifestyle choices and environmental contaminants that contribute to inflammation and the generation of free radicals. Free radicals are highly unstable molecules produced during the inflammatory process that can cause oxidative stress within the body, ultimately leading to cellular damage. As cellular damage occurs, our immune systems are depleted, and cardiovascular disease and diabetes develop. Animal studies have investigated the potential beneficial effects of apple cider vinegar supplementation on serum triglycerides, total cholesterol, liver and kidney membrane lipid peroxidation, and antioxidant levels in ovariectomized mice fed high cholesterol diets.2 It was found that the administration of apple cider vinegar demonstrated a protective effect against oxidative injury and that protection might be due to its free oxygen radical scavenging effects.2 The subjects also experienced reduced lipids and lipid peroxidation and increased antioxidant enzyme and vitamin levels, but more on that in a moment.

Blood Sugar Support

For healthy individuals, insulin—an essential hormone produced by the beta cells of the pancreas—is released into the bloodstream and signals the cells of the muscle, body fat and liver to uptake glucose out of the blood to store or utilize it. This process controls
the metabolism of carbohydrates, fats and proteins. Insulin also regulates the functions of the body’s cells, including their growth and ability to use glucose as energy. While small, some studies suggest that vinegar consumption with carbohydrate-containing meals may help support blood sugar levels.3-5 For example, in one clinical trial, the consumption of apple cider vinegar (20 grams) with carbohydrate meals improved insulin sensitivity by 34 percent.6 In another trial, two tablespoons of apple cider vinegar at bedtime was found to reduce fasting glucose concentrations the next morning in individuals with type 2 diabetes.7 The authors also noted a reduction in fasting glucose of 4-6 percent the next morning after ingesting the apple cider vinegar.7 Interestingly, although 72 percent of the subjects in the study regularly used hypoglycemic medications and continued their medication use during the study, the apple cider vinegar still significantly impacted fasting glucose compared to placebo.7

Weight Management

Obesity has become a global public health problem, which affects millions of people worldwide. While not many studies concentrate on apple cider vinegar and weight loss, a few studies suggest that vinegar consumption overall may promote weight loss due to its impact on cravings, insulin and metabolism.8 In fact, one small study found that the consumption of apple cider vinegar (two tablespoons) along with a lower-calorie diet (i.e, 250 kcal deficit) for three months led to a significant reduction in visceral fat with an average weight loss of 4 kg. Further, the control group, who followed the same diet, but with no apple cider vinegar, experienced only an average weight loss of 2.3 kg.9 Another study found that vinegar consumption with each meal reduced cravings, even when participants consumed a caloric deficient diet (i.e., 200 to 275 fewer calories at the meal); however, weight loss was not measured.10 Lastly, a clinical trial completed in Japan investigated the effects of vinegar intake on reducing body fat mass in obese adults and found that consuming one or two tablespoons of vinegar daily led to lower body weight, waist circumference and visceral fat.11 Some animal studies have also found that acetic acid may lead to reductions in body fat.8,12

Heart Health

Heart disease is the number one health concern for men and women in the United States and is the leading cause of mortality. Risk factors associated with heart disease include age, gender, diet, exercise level, smoking, alcohol consumption, weight/BMI score, abdominal obesity, blood lipid levels (cholesterol, triglycerides and phospholipids), lipoprotein profiles (VLDL, LDL, IDL, HDL, chylomicrons), blood pressure, homocysteine levels, and genetic factors, as well. Because heart disease is multifactorial, many lifestyle changes can support heart health, including weight loss. In the study mentioned above, adults who consumed a daily 250 kcal deficit with or without apple cider vinegar also found that the apple cider vinegar group had significantly better cholesterol and lower triglyceride levels after 12 weeks.9 In other human clinical trials, various types of vinegar have been found to produce significant improvements in markers of heart disease.11,13 Also, in animal studies, the consumption of apple cider vinegar may improve measures of heart health, such as cholesterol levels, triglyceride levels, and blood pressure.14-16 For example, one animal study looked at apple cider vinegar’s active ingredient (i.e., acetic acid) ability to reduce measures of heart health like serum total cholesterol and triacylglycerol. For approximately three weeks, subjects were allowed free access to a diet containing either no cholesterol, 1 percent cholesterol without acetic acid, or 1 percent cholesterol with acetic acid (0.3 percent).15 Here, it was found that the cholesterol-fed group when compared to the cholesterol and acetic acid-fed group, serum total cholesterol and triacylglycerols levels and liver ATP citrate lyase activity were significantly improved.15 Further, the serum secretin level, liver acyl-CoA oxidase expression, and fecal bile acid content were also significantly higher.15 The researchers deduced that this result was due to vinegar consumption, thus inhibiting lipogenesis and increasing fecal bile acid excretion when subjects consumed a cholesterol-containing diet.15

Conclusion

There is no doubt that apple cider vinegar is red hot in the marketplace. Previous research highlights the benefits of its use, and many studies are in the pipeline because of its increased popularity. Plus, because apple cider vinegar is widely affordable and available on store shelves, it is appealing as a remedy to many consumers. However, much more work is required to determine its usefulness, but when used occasionally, its usage appears to be safe in most individuals. VR

References:

1 Johnston CS, Gaas CA. Vinegar: medicinal uses and antiglycemic effect. MedGenMed. 2006;8(2):61. Published 2006 May 30.

2 Nazıroğlu M, Güler M, Özgül C, Saydam G, Küçükayaz M, Sözbir E. Apple cider vinegar modulates serum lipid profile, erythrocyte, kidney and liver membrane oxidative stress in ovariectomized mice fed high cholesterol. J Membr Biol. 2014;247(8):667-673. doi:10.1007/s00232-014-9685-5.

3 Brighenti F, Castellani G, Benini L, et al. Effect of neutralized and native vinegar on blood glucose and acetate responses to a mixed meal in healthy subjects. Eur J Clin Nutr. 1995;49(4):242-247.

4 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;60(8):1837-1849. doi:10.1002/mnfr.201600121.

5 Shishehbor F, Mansoori A, Shirani F. Vinegar consumption can attenuate postprandial glucose and insulin responses; a systematic review and meta-analysis of clinical trials. Diabetes Res Clin Pract. 2017;127:1-9. doi:10.1016/j.diabres.2017.01.021.

6 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. 2004;27(1):281-282. doi:10.2337/diacare.27.1.281.

7 White AM, Johnston CS. Vinegar ingestion at bedtime moderates waking glucose concentrations in adults with well-controlled type 2 diabetes. Diabetes Care. 2007;30(11):2814-2815. doi:10.2337/dc07-1062.

8 Hernández MAG, Canfora EE, Jocken JWE, Blaak EE. The Short-Chain Fatty Acid Acetate in Body Weight Control and Insulin Sensitivity. Nutrients. 2019;11(8):1943. Published 2019 Aug 18. doi:10.3390/nu11081943.

9 Khezri SS, Saidpour A, Hosseinzadeh N, Amiri Z. Beneficial effects of Apple Cider Vinegar on weight management, Visceral Adiposity Index and lipid profile in overweight or obese subjects receiving restricted calorie diet: A randomized clinical trial.” Func Foods. 2018; 43:95-102.

10 Johnston CS, Buller AJ. Vinegar and peanut products as complementary foods to reduce postprandial glycemia. J Am Diet Assoc. 2005;105(12):1939-1942. doi:10.1016/j.jada.2005.07.012.

11 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. 2009;73(8):1837-1843. doi:10.1271/bbb.90231.

12 Kondo T, Kishi M, Fushimi T, Kaga T. Acetic acid upregulates the expression of genes for fatty acid oxidation enzymes in liver to suppress body fat accumulation. J Agric Food Chem. 2009;57(13):5982-5986. doi:10.1021/jf900470c.

13 Kadas Z, Akdemir Evrendilek G, Heper G. The Metabolic Effects of Hawthorn Vinegar in Patients with High Cardiovascular Risk Group. J Food Nutr Res. 2014;2(9):539-545. doi:10.12691/jfnr-2-9-2.

14 Setorki M, Asgary S, Eidi A, Rohani AH, Khazaei M. Acute effects of vinegar intake on some biochemical risk factors of atherosclerosis in hypercholesterolemic rabbits. Lipids Health Dis. 2010;9:10. Published 2010 Jan 28. doi:10.1186/1476-511X-9-10.

15 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. 2006;95(5):916-924. doi:10.1079/bjn20061740.

16 Na L, Chu X, Jiang S, et al. Vinegar decreases blood pressure by down-regulating AT1R expression via the AMPK/PGC-1α/PPARγ pathway in spontaneously hypertensive rats. Eur J Nutr. 2016;55(3):1245-1253. doi:10.1007/s00394-015-0937-7.

Trisha Sugarek MacDonald holds a Master of Science in nutrition and is also working toward a doctorate in nutrition from Texas Woman’s University. MacDonald has nearly a decade and a half of experience in nutraceutical manufacturing and is currently the senior director of research & development as well as the national educator at Bluebonnet Nutrition, Sugar Land, TX, where she investigates new ingredients, directs the launch of new products, and provides industry training on numerous subjects as they relate to the connection between nutrition and health. She is a frequent editorial contributor and lecturer on the benefits surrounding the responsible use of supplements. For more information, call (800) 580-8866.