What Are the Benefits of Apple Cider Vinegar?
ACV looks and feels harmless, making it easier for people to believe its holistic benefits.
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This article originally appeared on Tonic US
Prior to having my daughter Claire, I rarely had indigestion with the exception of the occasional night where I went a little heavy on the pesto and pasta. I certainly didn’t own a bottle of TUMS, let alone carry one in my tote bag. But when Claire arrived, my digestive system took note. That’s right—burping, reflux, and stomach upset paired with postpartum depression made me one sexy mama.
I tried cutting coffee and alcohol, and even “alkalinising” the shit out of my body with everything green. I am, after all, the kind of person who tries to find a natural healing method before I call on the medical community. But ten months in, I still had no relief. So I finally caved and went to a gastroenterologist, who suggested an endoscopy. When I woke up in the recovery room, he said he couldn’t find any inflammation or other red flags that pointed at an issue with my digestive tract. Perhaps, he said, I was just dealing with an imbalance of stomach acid and would need to right the ship with an over-the-counter drug like Prilosec. I asked him about apple cider vinegar, a suggested natural remedy for indigestion on many of the health websites I had scoured looking for answers. He smirked and said, “you can give it a shot,” then handed me the prescription for Prilosec and walked away.
Feeling defiant, I took the doctor’s advice to “give it a shot” and did exactly that—a small shot of ACV while standing in the middle of my kitchen. My throat lit up as if I’d swallowed fire. I then tried it again. It hit my digestive system, and everything started to feel fizzy and terrible. Thinking I had maybe gone about it wrong, I looked up a prescribed method for taking apple cider vinegar. Turns out you’re supposed to dilute ACV shots with water to avoid the whole my-insides-are-ablaze feeling. But even with the addition of water and other dietary measures—like continuing abstinence from coffee and alcohol—the ACV didn’t do a thing. In fact, all it did was leave me un-caffeinated and sober with a constantly burning stomach that, while I had hoped indicated progress, was absolutely not progress. And I was still burping like a maniac.
What do people use apple cider vinegar for?
ACV has a long history as a home remedy and has been used to treat everything from a sore throat to high blood pressure. People with diabetes use it in hopes of keeping their blood sugar in check. Others say it's good for keeping "bad" cholesterol levels low. And then there are those who go on about how apple cider vinegar can help with digestion, and reflux issues in particular.
When I inquired on my various social mediums about other people’s successes and failures with incorporating ACV into their diets, I got a lot of responses from people who said it did “wonders” for their skin when applied topically for issues ranging from eczema to acne. Others, of course, were ingesting it: One woman wrote that it had even helped her maintain a 15-pound weight loss. But others reported that ACV had upset their stomachs so much so that they threw up or had diarrhoea that sent them running for the toilet. One London-based commenter said she tried a shot a day for about two weeks, but it would cause severe bloat and gurgling noises that kept her up at night. (She eventually found relief by seeking treatment for her underlying anxiety—likely the real culprit behind her digestive issues.)
Part of the reason for this craze is the heavy focus on fermented foods within the natural health community, says Elizabeth Trattner, a Florida-based alternative medicine specialist and acupuncturist. Because let’s be honest: If you don’t drink kombucha or make your own sauerkraut, then are you really living naturally? (P.S.: I may or may not have three kraut jars smelling up my house at this very moment.)
Has apple cider vinegar been proven to have health benefits?
Here's the short answer: Nope. “There’s no great evidence supporting taking ACV, but mounds of evidence supporting that maybe you shouldn’t drink it,” says Rudolph Bedford, a gastroenterologist at Providence Saint John’s Health Center in Santa Monica, California. “Studies have found that weekly consumption of apple vinegar increased the risk of dental erosion. The risk was positively associated with a habit of swishing and holding acid in the mouth, enhancing the contact surface area and time with the teeth.”
“I love natural remedies,” Will Bulsiewicz, a South Carolina-based gastroenterologist, says. “[But] in the case of apple cider vinegar, if you consider it to be a ‘cure all,’ you need to slow your roll.”
Bulsiewicz says there may be some health benefits to ACV, but they are modest at best and the data aren't specific to ACV at all. “There are no studies to support ACV lowering cholesterol, eliminating toxins in the blood, or improving allergies, acne, arthritis, hiccups, leg cramps, or acid reflux,” he says.
The strongest data thus far, Bulsiewicz says, comes from a randomised, placebo controlled study in Japan in which, over the course of 12 weeks, subjects were given one to two tablespoons of apple cider vinegar per day. The results showed weight loss and decreased visceral fat stores.
“What's interesting, though, is that subsequent studies have shown this effect is not specific to ACV, but instead is related to acetic acid, which is the dominant acid in all types of vinegar, even kombucha,” Bulsiewicz says. “They also discovered that the more repulsive the vinegar drink is, the greater the weight loss is. That doesn't bode well for ACV compared to other types of [more potent] vinegar.”
The deal with ACV for digestion: Teeth aside, I was hoping the vinegar could do something for my digestive issues. According to some ACV advocates, apple cider vinegar works to balance your stomach pH (which is typically 1.5 to 3.5) and alkalise the environment, therefore keeping digestive upset in check. But if you’re all, “wait, but I thought apple cider vinegar was acidic” and feel like that claim is a bit confusing, then you’re not wrong, Bulsiewicz says.
“[In the case of using] ACV for reflux, there is a theory in the naturopathic world that reflux is driven by too little acid,” he says. “With all due respect to those who hold this theory, it's hard for me to fathom.”
Bulsiewicz explains that countless studies on the effectiveness of proton pump inhibitors (e.g. Prilosec, Nexium, Prevacid) showed that when you reduce stomach acid, you heal the esophagus. Period.
“So it's hard for me to rectify that the opposite of this would also be true,” Bulsiewicz says, adding that many of his patients inquire about the use of ACV for reflux. “In addition to most of the patients telling me that their reflux got worse, I have the added benefit of being able to perform endoscopy on my patients so that I can directly visualise the lining of their oesophagus,” he says. “And what I found was that consistently, my ACV patients were doing far worse harm to their oesophagus.” Most of the time, Bulsiewicz says, he would discover that ACV-using patients had an ulcerated lower oesophagus.
A 2007 study also pointed at ACV significantly slowing stomach emptying, Bulsiewicz says, which in the medical community, is known as gastroparesis. “These patients, who often have type 1 diabetes, suffer with chronic nausea, fullness and discomfort after meals, and even reflux,” he says. “If the food doesn't go down, then it has a tendency to go back up.”
The gist? Chill with trying to reboot your digestive system with apple cider vinegar. By slowing gastric emptying, you will only unmask symptoms like reflux, nausea, bloating and general digestive discomfort. “To me, the results were indisputable,” he says. “So I no longer allow my patients to use ACV to treat their acid reflux.”
For blood sugar and cholesterol: “I am constantly combing PubMed for definitive clinical meta-analyses and random double blind tests on any food or supplement to recommend to patients,” Trattner says. “Apple cider vinegar was really hot back in the '80s and I am seeing a huge resurgence in it again with unreasonable health claims. There is a small amount of clinical data—in mice, at that—that demonstrates some benefit for lipid [fat compounds found in blood] reduction, but that is all.”
There’s also a small smattering of human studies when it comes to the benefits of apple cider vinegar for cholesterol reduction and blood sugar control. One at Arizona State University showed that a combination of 20 grams of ACV, 40 grams of water and 1 teaspoon of saccharine lowered blood sugar after meals for its 19 subjects. A Harvard study showed that women (without previously diagnosed cancer or cardiovascular disease) who ate vinegar and oil salad dressing had a decreased risk of heart disease. The 10-year long observational study was done through questionnaire and the type of vinegar used was not specified.
But Bulsiewicz says these small nods to the benefits just aren’t enough to outweigh the potential harm that regular ACV use can cause. Whether your looking to nix digestive issues, reduce fat, or get your type 2 diabetes under control, Bulsiewicz says a perfectly safe, healthier option is to supplement your diet with prebiotic soluble fiber. “Of course, supplements can augment but are never a substitute for a healthy diet that maximises the consumption of fresh fruits and vegetables,” he adds.
For skin issues: I apparently didn’t learn my lesson when apple cider didn’t work for me the first time (and a solid mix of acupuncture and Lexapro for my reflux-inducing anxiety did), so I tried it once more when my on-again, off-again eczema cropped up a few months ago.
Like I do with any ailment, I did an online search that more or less reads “natural treatment for [ailment here].” It had been a bit since I had experienced an eczema flare up, so I was hopeful there was something new I might try. Lo and behold, it was ACV. Countless articles and natural health sites said apple cider vinegar could not only cool down my eczema, but wipe out my breakouts. Sold.
Turns out, if your insides are ablaze from ACV, then your skin will be too. I touched an apple-cider-vinegar-soaked cotton ball to my face (yes, I diluted it this time) and winced as my eczema became raised and redder than it already had been. I thought maybe it was all part of the healing process––pain first, then the results––so I tried it a several more times. No dice.
“I have no faith in apple cider vinegar,” says Charles Crutchfield, a clinical professor of dermatology at the University Minnesota Medical School and medical director of Crutchfield Dermatology in Eagan, Minnesota. “I know of no placebo-controlled medical studies that demonstrate it is effective.”
Crutchfield explains that it’s common for many skin conditions to wax and wane, meaning they most likely would have improved with or without the ACV.
“It’s cheap, readily available, stings and stinks, and it is something to do when nothing else seems to work, so that is why people use it or think it has some type of healing power,” he says. “[But] when my family has acne, eczema or other skin issues, I would never tell them to use apple cider vinegar.”
As for acne, the thought process is that ACV may be useful in killing acne-related bacteria, but the research really isn’t there. If you’re determined to try it for a breakout, then be sure to dilute it first. Take note that if you have sensitive skin or an open wound, then ACV may only make the problem worse.
The bottom line: “I think ACV looks and feels harmless, like your grandmother—it’s not slick,” Trattner says, making it easier for people to believe its holistic benefits. “Fermented foods are great in some cases and vinegar is part of that crew, but ACV is similar to kombucha in that there is some promise, but, again, little clinical evidence that the multibillion dollar industry produces actual results.” Shoot, if a natural health enthusiast shuts down ACV, then perhaps it’ll finally be enough to get people to stop guzzling it.
Barbie Boules, a registered dietitian in Illinois, says she’s even been game to search for those results by experimenting with natural health remedies for the sake of her clients. “Assuming, of course, that the practice in question is presumed to be at worst ineffective, but safe, I often guinea-pig myself because while I am an evidence-based practitioner,” she says, “I love hearing about legitimate alternatives to pharmaceuticals.”
But this one, Boules says, just doesn’t measure up. “In 16 years of practice, I have never had a client who benefitted in any measurable or perceived way from taking ACV as a supplement, nor did I,” she says. Trattner says, as opposed to apple cider vinegar, there are foods that have clinical evidence for helping various health issues, including turmeric, fish oil and ginger, all of which were studied through meta-analysis (a study of studies, essentially), the “gold standard of clinical evidence,” she says. There is even a 2013 study of more than 200 studies of ginger that shows its ant-oxidative and anti-inflammatory effects.
“Random double-blind studies and meta-analyses are what you look for when checking the efficacy of a product,” Trattner says. So, yeah, health professionals aren’t exactly trying to be naysayers about the idea that food can indeed “be thy medicine.” They just need a little proof before doing so. As for ACV, it can certainly safely be incorporated as part of a healthy diet. But as Bedford bluntly put it: “It’s calorie-free and adds flavour to food, but there are no real health benefits.”
Boules says the hype surrounding apple cider vinegar is akin to that pegged to any single food or vitamin, mineral, or herb is the result of “a perfect storm of nonsense.” She maintains that optimal health is dependent upon what she calls the four pillars of wellness: nourishing food, sleep, moving your body, and managing stress.
“Like a table with four legs, you gotta keep them all strong or you'll topple,” she says. “If one is weak, then apple cider vinegar isn't going to fix that.”