Is Apple Cider Vinegar a Health and Weight-Loss Tonic?

Apple cider vinegar (ACV) isn’t just for salad dressings anymore. Small but highly publicized studies combined with the powerful sway of personal testimonials on social media have weight-loss and gut-health seekers drinking the acidic cooking condiment as a daily tonic.

A quick internet search finds ACV in liquid, pill, powder and gummy form, with a 16-ounce bottle of the same simple mix Hippocrates reportedly drank – vinegar and honey – going for $25. Records indicate the Greek physician and father of Western medicine used ACV as a health tonic, cough suppressant and antiseptic for wounds, among other things.

“In certain cultures, it’s been viewed as medicinal for thousands of years,” said Dan Bessesen, MD, a professor of endocrinology, metabolism and diabetes in the University of Colorado School of Medicine. “So, this didn’t come out of nowhere.”

A recent search of the literature by Bessesen revealed a few studies that reinforce at least three of the claims made today about apple cider vinegar: that it can lower cholesterol and blood sugar levels and promote weight loss.

But before people add a drug or nutritional supplement to a daily routine for an expected health benefit, Bessesen said they should weigh two main things: How good is the evidence, and is the change sustainable?

Show me the proof

Bessesen found no large epidemiological studies on the claimed health benefits of ACV, a popular research method for evaluating nutritional questions with large groups of people over extended periods of time. He did find animal studies and short-term, interventional human trials that showed lowered weight, cholesterol and blood sugar levels when adding ACV to a daily routine.

“These are modest effects, and the doses that have been used in the animal studies appear to me to be much higher than what a person would typically use,” said Bessesen, an expert in weight loss and human nutrition and director of the CU Anschutz Health and Wellness Center. “That’s a problem with animal studies.”

Most of the human studies had relatively small numbers of participants, Bessesen said. “Virtually all of the studies are of very short duration: eight to 12 weeks,” he said.

“The thing about using nutritional supplements as medicines is they only work as long as you take them. If I took cholesterol medicine for 12 weeks, and my cholesterol went down, that’s good. But it’s not going to help unless I keep taking it,” he said.

Is it sustainable?

“If you are going to do this, and you think it’s going to help you, you’re probably going to have to do it for years – and for chronic metabolic problems such as diabetes or weight, for the rest of your life perhaps.”

Common ACV dosages in studies are one to two tablespoons a day, sometimes divided into smaller doses before each meal. It’s almost always mixed with water to help the medicine go down, Bessesen said.

“Are you going to do that for the rest of your life? Or should you just take a prescription diabetes medicine that has been studied for safety and efficacy and lowers the blood sugar substantially?”

Bessesen said he has few safety concerns about small doses of ACV, other than possibly some erosion of tooth enamel. “I don’t think you are going to hurt yourself with apple cider vinegar, especially a tablespoon a day. Is it going to help you? Maybe a little bit. But these potential health benefits have not been particularly well-established.”

Why not just eat the food?

Although he could find no studies on gut health and ACV specifically, Bessesen noted that ACV is a fermented food. “There is recent data that fermented foods have beneficial effects on the body’s immune system and the body’s gut microbiome,” he said.

“There’s a growing interest in a whole range of fermented food: vinegar; yogurt; sauerkraut.” With ACV, apples are soaked in water until the natural microbes convert sugars into other chemicals, Bessesen said. “The main compound in vinegar is acetic acid.”

Bessesen said he could back a trend more easily if it involved whole foods and thinking about diet in a holistic way, such as adding fermented foods routinely or following a Mediterranean diet. “I think we should be thinking about our diet as an overall approach to how we eat in a way that we can continue long term.”

A gummy bear is not a whole food

Studies are mostly on adding whole vinegar to a regimen rather than using any of the slew of products on the market. One study linked higher concentrations of pure vinegar with better health results than tablets.

Although he would rather people add ACV to their foods, such as with pickles or in a dressing on a salad, he would choose pure vinegar in water over a gummy, Bessesen said.

“With foods, we don’t know what the key ingredient is that’s having the effects. Foods are complex mixtures of many chemicals, especially these fermented foods. So are there small concentrations of unusual compounds in the apple cider vinegar that convey these health benefits, and what happens to those in supplements? Or is it just the acetic acid? I think we don’t know.”

But he does know that vinegar is a whole food, and a gummy is not, Bessesen said. “What happens when you process foods? Usually, you simplify them and get rid of other things. That’s why they taste better.”

Bessesen said he understands that people want something that’s easy to do for their health.

“But I think there should be a pretty high level of evidence before you spend money on something. I know it takes time to prepare your own food. It’s hard to stock fresh fruits and vegetables. They go bad. And the gummy will stay in your cupboard for a year,” he said. “And that says something, too, doesn’t it?”