Apple Cider Vinegar

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Research affirms that a primary element in all types of vinegar is acetic acid (AcOH).1 Vinegar produced for commercial sale can be created using a rapid, modern fermentation method or the more gradual, traditional fermentation technique. The longer, traditional fermentation process provides time for the accumulation of yeast and a naturally occurring acetic acid bacteria, referred to as the mother of the vinegar, believed by many to have healing and restorative properties. However, there is no scientific proof supporting this  viewpoint.2

Making ACV3 is a fairly simple two-step process: Yeast is combined with apple juice in order to break down all of the natural sugars, allowing them to ferment, and when bacteria is introduced, acetic acid is created (vinegar).

Recognized criteria1 mandated by the Food and Drug Administration (FDA) defines a vinegar as any food product made from a variety of sources ranging from wines, fruits and malt. To be labeled a vinegar, the end product is required to have a minimum ratio of 4 g of food source/100 ml of acetic acid (the primary element of any vinegar). A maximum ratio of food source to acetic acid has not been instituted; this latitude has allowed the concentration of acetic acid in commercially available apple cider vinegar (ACV) products, derived from European crab apple (Malus sylvestris) to vary substantially.

Different Forms of ACV

ACV is sold commercially in liquid form with or without its mother; it is also available in tablets and/or capsules, in a wide variety of strengths.

Benefits

The use of ACV as a nutritional supplement has become controversial, in large part because numerous individuals and businesses have made unsubstantiated claims alleging that regular ACV use achieves a plethora of desirable outcomes, from amplified, rapid weight loss to promises of health benefits by improving serious medical conditions such as heart disease and type 2 diabetes. ACV has also been credited with aiding in the natural healing of wounds and for promoting a generally positive sense of well-being.

ACV and Type 2 Diabetes

While recent research studies have noted a significantly diminished glucose reaction when participants are given a diet purposely loaded with carbohydrates to trigger a sudden rise in blood sugar level, additional scientific investigations are necessary to adequately determine if and how apple cider vinegar (AVC) and similar types of vinegar can be credited for these preliminary positive findings. It will also be necessary for researchers to ascertain whether it is safe for pre and diabetic patients to take ACV as an ongoing preventative and treatment for diabetes given the risks associated with long-term continuous use of ACV (see Risks Associated with Overconsumption/Supplemental Use of ACV).

A small 2015 study gives reason for further research into ACV and its possible positive side effects for blood glucose levels in adults with diabetes. Participants who were given acetic acid (the primary ingredient in all vinegars) following meals, showed substantially lowered total blood glucose levels.

ACV and Weight Loss

Scientific findings1 suggesting a causal link between acetic acid absorption and the inhibition of body fat buildup in animals led to a 2009 double-blind research trial to determine what affects if any, daily vinegar consumption would have on the lessening of body fat mass among random participants in a Japanese study concentrated on obese individuals over a period of twelve weeks. Subjects were placed into three groups, with two out of the three groups receiving daily doses of vinegar — 15 ml or 30 ml of vinegar given in a 500 ml beverage. The control or placebo group received no vinegar in their daily 500 ml beverage administrations. Significant improvements were observed in multiple areas through a lessening of body weight, BMI (body mass index), waist circumference, visceral/abdominal fat, blood pressure and serum triglyceride levels (TG) in participants from both groups who had been given daily dosages of vinegar throughout the trial. These results led the researchers to conclude that daily ingestion of vinegar may be helpful in preventing obesity and aid in controlling comorbid health conditions associated with obesity.

Notwithstanding the positive patient outcomes noted in the 2009 Japanese obesity study above, the overwhelming preponderance of scientific evidence concurs that despite the plentiful and frequent claims made that ACV supplementation done in a host of innovative ways will decrease your appetite and cause you to lose weight at a rapid rate are simply false. Often, proponents of ACV quick weight loss plans recommend a home remedy such as drinking apple cider vinegar mixed in a glass of water to speed up the body's metabolic rate.

Risks of Overconsumption/Supplemental Use of ACV

Scientists warn4 studies repeatedly confirm that the vast majority of ACV supplements do not meet minimum standards of quality, effectiveness or assurances of patient safety. In each of these three key categories, ACV supplements failed to meet the basic criteria required for caregiver recommendation for patient use. In fact, health care providers were advised to caution patients against taking these supplements; and, in cases where patients expressed determination to use the products against the care provider's advice, it was recommended that those patients be monitored carefully.

There is particular cause for concern regarding ACV tablets/capsules and potential for esophageal injury. A research study was commissioned in 2005 to investigate conformity levels among ACV capsules/tablets after a report surfaced that year stating a woman had sustained esophageal injury following use of commercial ACV supplemental tablets. Comparison of eight different brands of the supplemental tablets established serious variability issues: malic acid content among the brands differed drastically, from 0% to 49.12%. There were instances where the tablets were found to have  3-5 times higher acid content than found in the liquid vinegar. Due to this documented high volume of acid in ACV tablets, their use is contraindicated for patients with gastroparesis and acid reflux. Supplementation with ACV tablets, capsules, or liquid  can cause sore throat because of vinegar's naturally high acidic content.

Studies suggest a link between ACV supplementation and decreased potassium levels. This can be dangerous for individuals with certain preexisting health conditions. It may be caused by an interaction between ACV and medications  or other supplements you are taking such as insulin or  diuretics. Be aware of any signs of low potassium levels and alert your health care provider to any supplements you are taking.

Daily Recommended Allowance

The Food and Drug Administration (FDA) has no set recommended daily allowance for acetic acid, the primary component of ACV.

Foods that Contains Acetic Acid/Vinegars

Historians note1 the varied use of vinegars in the culinary arts of numerous and diverse cultures for thousands of years. A high rate of vinegar consumption continues regularly around the globe as a fundamental ingredient in widely popular seasonings and condiments, including a variety of salad dressings, ketchup and mayonnaise.

Citations and Sources

1.
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. [PubMed]
2.
Johnston C, Gaas C. Vinegar: Medicinal Uses and Antiglycemic Effect. MedGenMed. 2006;8(2):61. [PMC]
3.
Štornik A, Skok B, Trček J. Comparison of Cultivable Acetic Acid Bacterial Microbiota in Organic and Conventional Apple Cider Vinegar. Food Technol Biotechnol. 2016;54(1):113-119. [PMC]
4.
Saper R, Eisenberg D, Phillips R. Common dietary supplements for weight loss. Am Fam Physician. 2004;70(9):1731-1738. [PubMed]