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Apple Cider Vinegar

What is it?

Apple cider vinegar is fermented juice from crushed apples. Like apple juice, apple cider vinegar may contain various vitamins and minerals, as well as dietary fiber. Apple cider vinegar may also contain acetic acid and citric acid. But it can be hard to know exactly what's in some apple cider vinegar products. In the U.S., there's no real definition of what a product must contain to be called apple cider vinegar. For this reason, the amount of each component of apple cider vinegar may vary from product to product.

Apple cider vinegar is used for obesity, diabetes, problems related to hair and skin, and other conditions, but there is no good scientific evidence to support these uses.

Coronavirus disease 2019 (COVID-19): There is no good evidence to support using apple cider vinegar for COVID-19. Follow healthy lifestyle choices and proven prevention methods instead.

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:

Insufficient evidence to rate effectiveness for...

  • Athletic performance. Early research shows that drinking apple cider vinegar prior to exercise is no more effective for improving endurance than drinking a sports drink.
  • Diabetes. Early research shows that taking apple cider vinegar with a meal improves insulin sensitivity and insulin levels after the meal in people with insulin resistance. But it doesn't seem to have a significant benefit in people with type 2 diabetes.
  • Delayed emptying of food from the stomach into the intestines (gastroparesis). Early research shows that taking apple cider vinegar worsens gastric emptying rate in people with type 1 diabetes and slow digestion.
  • Obesity. Early research shows that taking apple cider vinegar along with a reduced-calorie diet may slightly decrease body weight, body mass index (BMI), and appetite compared to dieting alone in overweight adults.
  • Acne.
  • Aging.
  • Dandruff.
  • Eczema (atopic dermatitis).
  • High blood pressure.
  • High levels of cholesterol or other fats (lipids) in the blood (hyperlipidemia).
  • Indigestion (dyspepsia).
  • Infection of the intestines by parasites.
  • Insect bites.
  • Kidney stones.
  • Leg cramps.
  • Memory and thinking skills (cognitive function).
  • Osteoarthritis.
  • Shingles (herpes zoster).
  • Sore throat (pharyngitis).
  • Sunburn.
  • Swelling (inflammation) of the nasal cavity and sinuses (rhinosinusitis).
  • Vaginal yeast infections.
  • Warts.
  • Weak and brittle bones (osteoporosis).
  • Other conditions.
More evidence is needed to rate apple cider vinegar for these uses.

How does it work?

Apple cider vinegar is the fermented juice of crushed apples. It contains acetic acid and nutrients such as B vitamins and vitamin C. Apple cider vinegar might help lower blood sugar levels in people with diabetes by changing how foods get absorbed from the gut. Apple cider vinegar might prevent the breakdown of some foods.

Are there safety concerns?

When taken by mouth: Consuming apple cider vinegar in food amounts is LIKELY SAFE. Apple cider vinegar is POSSIBLY SAFE for most adults when used as a medicine, short-term. Apple cider vinegar is POSSIBLY UNSAFE when taken by mouth 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 when applied to the skin. Applying apple cider vinegar to the skin has been reported to cause chemical burns even after one use.

Special precautions & warnings:

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

Low potassium levels in the blood (hypokalemia): Apple cider vinegar might lower potassium 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 (Lanoxin).
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. Avoid taking large amounts of apple cider vinegar if you take insulin.
Medications for diabetes (Antidiabetes drugs)
Apple cider vinegar might decrease blood sugar in people with diabetes. Diabetes medications are also used to lower blood sugar. Taking apple cider vinegar along with diabetes medications might cause your blood sugar to go too low. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.
Water pills (Diuretic drugs)
Large amounts of apple cider vinegar may decrease potassium levels in the body. "Water pills" can also decrease potassium in the body. Taking apple cider vinegar along with "water pills" might decrease potassium in the body too much.

Some "water pills" that can deplete potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Microzide), and others.

Are there interactions with herbs and supplements?

Herbs and supplements that might lower blood sugar
There is some evidence that apple cider vinegar might lower blood sugar levels. Using it along with other herbs or supplements that can also lower blood sugar might cause blood sugar levels to drop too low. Some of these herbs include bitter melon, cowhage, ginger, goat's rue, fenugreek, kudzu, willow bark, and others.
Herbs that contain cardiac glycosides
Large amounts of apple cider vinegar may decrease potassium levels in the body. Other herbs that contain chemicals called cardiac glycosides might also lower potassium levels. Using apple cider vinegar along with any of these herbs might increase the risk of lowering potassium levels too much. This can be very dangerous for the heart. Some of these herbs include black hellebore, Canadian hemp roots, digitalis leaf, hedge mustard, figwort, lily of the valley roots, motherwort, oleander leaf, pheasant's eye plant, pleurisy root, squill bulb leaf scales, and strophanthus seeds.
Horsetail
There is a concern that using apple cider vinegar along with horsetail could increase the chance that potassium levels might drop too low.
Licorice
There is a concern that using apple cider vinegar along with licorice could increase the chance that potassium levels might drop too low.
Stimulant laxative herbs
There is concern that overuse of apple cider vinegar along with stimulant laxative herbs might increase the risk of potassium levels dropping too low. Stimulant laxative herbs include aloe, alder buckthorn, black root, blue flag, butternut bark, colocynth, European buckthorn, fo ti, gamboge, gossypol, greater bindweed, jalap, manna, Mexican scammony root, rhubarb, senna, yellow dock.

Are there interactions with foods?

There are no known interactions with foods.

What dose is used?

The appropriate dose of apple cider vinegar depends on several factors such as the user's age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for apple cider vinegar. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.

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.
  9. Krueger, D. A. and Krueger, H. W. Isotopic composition of carbon in vinegars. J Assoc Off Anal.Chem. 1985;68:449-452. View abstract.
  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 - 03/11/2021