Apple cider vinegar (ACV) is a remedy that has been used for weight loss and general health promotion for over 200 years. It's one of the most frequently asked about dietary ingredients in my practice, and many patients come to me already taking it “just in case”, unsure of it helps in any way. So, does this ancient folk remedy actually have health benefits? The short answer is yes, and there is plenty of science to back it up.

ACV is touted for its anti-glycemic effects, meaning, it helps to blunt the spike in blood sugar that occurs after consuming carbohydrates. When we eat carbs, the digestive tract breaks them down into simple sugars and absorbs them into the bloodstream. These sugars are sources of energy for our cells. But problems occur when we consume excess amounts of carbohydrates that exceed what the body needs for energy. This mostly happens when we consume starchy or processed carbs, with alcohol, flour and sugar of any kind being the worst offenders. Carbohydrates also include whole grains like rices, quinoa, buckwheat, millet, fruits, and vegetables. Although these are more healthy than other sources, they will still raise your blood sugar. Each carbohydrate has a different “glycemic load” which is the measure of how quickly and sharply your blood sugar rises following consumption. Regardless of which carbohydrates you are consuming, by also consuming ACV at some point during your day it seems to benefit blood sugar levels. When blood sugar is regulated, the whole system is subsequently impacted; better blood sugar regulation means better health overall.

Insulin is the hormone that is released by the pancreas in response to sugar in the blood. It helps get the sugar into our cells where it can be utilized as energy or, if it is in excess, to be stored as fat. ACV helps to blunt blood sugar levels by helping the cells utilize the sugar through a hormone called insulin. When blood sugar levels remain too high, we are prone to greater dysfunction of this hormone leading to insulin resistance, a condition that is a precursor for diabetes.

Randomized, controlled trials suggest that adding two teaspoons of vinegar to a meal may improve blood sugar regulation up to 20%. Another study found that diabetic individuals who consumed two tablespoons of ACV at bedtime woke with better blood sugar measures in the morning. Either way, taking ACV with or without food seems to provide some level of benefit.

Other conditions that arise from insulin resistance include heart disease, fatty liver disease, polycystic ovarian syndrome (PCOS), among others. Apple cider vinegar may be beneficial in any preventative or treatment strategy for these conditions. Some research has also shown an improvement in arterial function which leads to improved blood pressure measures.

Although we are not completely certain on how ACV works physiologically, it is postulated that because vinegar is a diluted solution of acetic acid and acetic acid takes energy for our bodies to metabolize, vinegar puts the body into a state of burning energy instead of storing it. Hence why it seems to help with weight loss. In one study, the consistent consumption of one to two tablespoons of ACV showed a reduction in approximately one square inch of visceral fat (i.e. the dangerous fat that builds around internal organs) compared to subjects taking a placebo, despite maintaining the same diet. When the ACV was stopped, the weight returned.

All in all, this research is compelling enough for me to recommend this inexpensive, low risk dietary ingredient for many of my patients. Generally, a total dose of two tablespoons each day is sufficient. Considering studies have shown that taking ACV in liquid-form yields a greater benefit compared to pills, I always recommend taking ACV in water or drizzled over food. Do not take it on its own, as you risk esophageal irritation.

As always, speak with your licensed health care provider before making any changes to your diet or lifestyle, including adding in medicinal foods or supplements, especially if you suffer from chronic conditions. Although ACV shows some compelling benefit in the research, do not use this remedy to delay going to your family physician or in place of medications.

Resources:
https://nutritionfacts.org/video/optimal-vinegar-dose/
https://nutritionfacts.org/video/vinegar-mechanisms-side-effects/
https://nutritionfacts.org/video/apple-cider-vinegar-help-weight-loss/