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Apple Cider Vinegar

What is it?

Apple cider vinegar is the fermented juice from crushed apples. It contains acetic acid and nutrients such as B vitamins and vitamin C.

Apple cider vinegar is popularly used in salad dressings and cooking. But it's also been used traditionally as medicine. It might help lower blood sugar levels in people with diabetes by changing how foods are absorbed from the gut. It might also prevent the breakdown of some foods.

Apple cider vinegar is used for obesity, diabetes, athletic performance, kidney stones, and many other purposes, but there is no good scientific evidence to support any of these uses. There is also no good evidence to support using apple cider vinegar for COVID-19.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for APPLE CIDER VINEGAR are as follows:

How does it work?

Are there safety concerns?

When taken by mouth: Consuming apple cider vinegar in food amounts is likely safe. Apple cider vinegar is possibly safe when used as a medicine, short-term. But it is possibly unsafe when used in large amounts, long-term. Consuming large amounts of apple cider vinegar long-term might lead to problems such as low levels of potassium.

When applied to the skin: Apple cider vinegar is possibly unsafe. Applying apple cider vinegar to the skin can cause chemical burns in some people.

Special precautions & warnings:

Pregnancy and breast-feeding: There isn't enough reliable information to know if apple cider vinegar is safe to use as a medicine when pregnant or breast-feeding. Stay on the safe side and stick to food amounts.

Low potassium levels in the blood (hypokalemia): Apple cider vinegar might lower potassium levels in the blood. If your potassium is already low, apple cider vinegar might make it too low. Don't use apple cider vinegar if you have this condition.

Are there interactions with medications?

Moderate
Be cautious with this combination.
Digoxin (Lanoxin)
Large amounts of apple cider vinegar may decrease potassium levels in the body. Low potassium levels can increase the side effects of digoxin.
Insulin
Insulin might decrease potassium levels in the body. Large amounts of apple cider vinegar might also decrease potassium levels in the body. Taking apple cider vinegar along with insulin might cause potassium levels in the body to be too low.
Medications for diabetes (Antidiabetes drugs)
Apple cider vinegar might lower blood sugar levels. Taking apple cider vinegar along with diabetes medications might cause blood sugar to drop too low. Monitor your blood sugar closely.
Water pills (Diuretic drugs)
Apple cider vinegar can decrease potassium levels. "Water pills" can also decrease potassium levels. Taking apple cider vinegar along with "water pills" might make potassium levels drop too low.

Are there interactions with herbs and supplements?

Herbs and supplements that might lower blood sugar
Apple cider vinegar might lower blood sugar. Taking it with other supplements with similar effects might lower blood sugar too much. Examples of supplements with this effect include aloe, bitter melon, cassia cinnamon, chromium, and prickly pear cactus.
Herbs that contain cardiac glycosides
Apple cider vinegar can lower potassium levels. Some herbs contain cardiac glycosides, which can affect the heart. Using apple cider vinegar along with herbs that contain cardiac glycosides can increase the risk of serious side effects from low potassium levels. Examples of supplements that contain cardiac glycosides include black hellebore, foxglove, lily-of-the-valley, oleander, and pleurisy root.
Horsetail
Using apple cider vinegar along with horsetail could increase the chance that potassium levels might drop too low.
Licorice
Using apple cider vinegar along with licorice could increase the chance that potassium levels might drop too low.
Stimulant laxative herbs
Apple cider vinegar can lower potassium levels. Stimulant laxatives can cause diarrhea and also decrease potassium levels. Taking apple cider vinegar with stimulant laxative herbs might cause potassium levels to go too low.

Are there interactions with foods?

There are no known interactions with foods.

What dose is used?

Apple cider vinegar is commonly used in foods. In the US, there's no specific definition of what a product must contain to be called apple cider vinegar. Sometimes it's standardized to acidity, with concentrations ranging from 4% to 8%. But the amount of each component of apple cider vinegar may vary from product to product.

When used as medicine, there isn't enough reliable information to know what an appropriate dose of apple cider vinegar might be. Speak with a healthcare provider to find out what dose might be best for a specific condition.

Other names

ACV, Cider Vinegar, Vinagre de Manzana, Vinagre de Sidra de Manzana, Vinaigre de Cidre.

Methodology

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

References

  1. Chiu HF, Chiang M, Liao HJ, et al. The ergogenic activity of cider vinegar: a randomized cross-over, double-blind, clinical trial. Sports Medicine and Health Science. 2020;2:38-43.
  2. Luu LA, Flowers RH, Kellams AL, et al. Apple cider vinegar soaks [0.5%] as a treatment for atopic dermatitis do not improve skin barrier integrity. Pediatr Dermatol. 2019;36:634-639. View abstract.
  3. Zeng G, Mai Z, Xia S, et al. Prevalence of kidney stones in China: an ultrasonography based cross-sectional study. BJU Int. 2017 Jul;120:109-116. View abstract.
  4. Khezri SS, Saidpour A, Hooseinzadeh 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. J Functional Foods 2018;43:95-102.
  5. Feldstein S, Afshar M, Krakowski AC. Chemical Burn from Vinegar Following an Internet-based Protocol for Self-removal of Nevi. J Clin Aesthet Dermatol. 2015 Jun;8:50. View abstract.
  6. Beheshti Z, Chan YH, Nia HS, et al. Influence of apple cider vinegar on blood lipids. Life Sci J. 2012;9:2431-2440.
  7. Bunick CG, Lott JP, Warren CB, et al. Chemical burn from topical apple cider vinegar. J Am Acad Dermatol 2012;67:e143-4. View abstract.
  8. Lhotta, K., Hofle, G., Gasser, R., and Finkenstedt, G. Hypokalemia, hyperreninemia and osteoporosis in a patient ingesting large amounts of cider vinegar. Nephron 1998;80:242-243. View abstract.
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  10. Budak NH, Kumbul Doguc D, Savas CM, et al. Effects of apple cider vinegars produced with different techniques on blood lipids in high-cholesterol-fed rats. J Agric Food Chem 2011;59:6638-44. View abstract.
  11. 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;27:281-2. View abstract.
  12. Liljeberg H, Björck I. Delayed gastric emptying rate may explain improved glycaemia in healthy subjects to a starchy meal with added vinegar. Eur J Clin Nutr 1998;52:368-71. View abstract.
  13. 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;49:242-7. View abstract.
  14. Hlebowicz J, Darwiche G, Björgell O, Almér LO. Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: a pilot study. BMC Gastroenterol 2007;7:46. View abstract.
  15. Shishehbor F, Mansoori A, Sarkaki AR, et al. Apple cider vinegar attenuates lipid profile in normal and diabetic rats. Pak J Biol Sci 2008;11:2634-8. View abstract.
  16. Hill LL, Woodruff LH, Foote JC, Barreto-Alcoba M. Esophageal injury by apple cider vinegar tablets and subsequent evaluation of products. J Am Diet Assoc 2005;105:1141-4. View abstract.
  17. Nutrition Search. Nutrition Almanac, Revised Edition. New York: McGraw-Hill Book Company. 1979.
  18. Lhotta K, Hofle G, Gasser R, Finkenstedt G. Hypokalemia, hyperreninemia, and osteoporosis in a patient ingesting large amounts of cider vinegar. Nephron 1998;80:242-3.
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Last reviewed - 08/17/2021