Apple Cider Vinegar

Apple cider vinegar (ACV) is an acidic solution produced by fermenting apple juice. It is used widely to flavor and preserve foods, and as a folk remedy for infections, insect bites, warts and scurvy. Recent claims of benefits include weight loss, sore throat, indigestion, glucose control in diabetes, dyslipidemia, arthritis, and skin conditions such as acne, eczema and dandruff.

Preclinical studies indicate ACV has antibacterial, antioxidant, anti-inflammatory, antidiabetic, and anti-hyperlipidemic effects ^{(1) (2) (3) (4)}.

Although ACV is widely used for dermatological conditions, it was ineffective in treating atopic dermatitis ^{(5) (6)}. Other findings suggest that ACV may help reduce the risk of cardiovascular diseases by regulating blood sugar and lipid levels ^{(7) (8)}; improve glycemic control in patients with diabetes mellitus ⁽⁹⁾; and manage weight in overweight and diabetic adults ⁽¹⁰⁾.
Overall, available evidence to support ACV use is not conclusive due to heterogeneity between studies, variations in duration, dosage, and different formulations. Larger, methodologically-robust trials are needed to generate more definitive data.

Of concern, ACV is being promoted as an alternative cancer treatment. A recent analysis of a popular search engine found it was among the ten most frequently mentioned natural remedies for skin cancer ⁽¹¹⁾. But there is no scientific evidence that ACV can prevent or cure skin or any other type of cancer.

• Cardiovascular disease
• Diabetes
• Hypercholesterolemia
• Weight Loss

The major components of ACV are polyphenolic compounds and acetic acid, which was shown to slow gastric emptying and increase the feeling of satiety, thereby reducing caloric intake in a murine model ⁽¹²⁾. ACV also improved the serum lipid profile in both normal and diabetic rats via lowering serum triglycerides and low-density lipoprotein-cholesterol (LDL-c) while elevating high-density lipoprotein-cholesterol levels (HDL-c) ⁽²⁾.

Additionally, ACV mitigated liver injury induced by high-fat diet in mice via remodeling of gut microbiota and restoring microbial metabolites ⁽⁴⁾. It also protected against erythrocyte, kidney, and liver oxidative injury, and reduced the serum lipid levels in mice that were fed a high-cholesterol diet by inhibiting lipid peroxidation and increasing the levels of antioxidant enzyme ⁽³⁾.

• Unpasteurized apple products, including apple cider and ‘raw’ apple cider vinegar, have been implicated in outbreaks of E. coli and Cryptosporidium infections. Therefore, it is best to avoid consuming raw or home‑fermented products ⁽²²⁾.

None known.

Case Reports

Hepatotoxicity: In a 60-year-old man with a history of vinegar consumption. His condition improved after stopping vinegar use ⁽¹³⁾.

Acute pancreatitis: In an 84-year-old woman, linked to the use of a weight loss supplement containing ACV. Her symptoms improved after symptomatic treatment and cessation of supplement use ⁽¹⁴⁾.

Chemical burns with topical use of ACV: In an 8-year-old boy, to treat a viral skin infection ⁽²⁰⁾; In an infant, to lower body temperature ⁽²¹⁾; In an 8-year-girl, to treat head lice infestation ⁽¹⁵⁾.

Scarring: In an 11-year-old girl, following use of topical ACV to treat melanocytic nevus, a benign skin lesion ⁽¹⁶⁾.

Hypokalemia, hyperreninemia and osteoporosis: In a 28-year-old woman after excessive consumption of ACV ⁽¹⁷⁾.

Esophageal injury: In a 48-year-old woman after ingesting ACV tablets. Analysis of the tablets revealed high concentration of ACV ⁽¹⁸⁾.

None known.