Apple Cider Vinegar: The Magic Bullet?

I can remember as a child that we always made apple butter and cider in the last summer in West Virginia. We would gather at the family farm to pick apples and press them for cider. I love the stuff and miss those simpler days of my youth, but we are here to discuss the weight loss properties and not cider and apple butter.

Why did I start the discussion with cider? Cider is unique in that if is aged a little too much, it often fermented and became vinegar. It is made by just crushing apples to make cider, adding yeast, and then letting it sit. The bacteria turn the cider I loved as a kid into acetic acid. Acetic is a pretty simple compound, but could the vinegar help with weight loss?

Vinegar comes from the Latin for “sour wine. Most people consume it somewhere in their meal plan every week and are a common part of most condiments, dressings, and sauces. Acetic acid or vinegar has many uses in our society. We can clean pennies. We can pickle cucumbers. It is a primary ingredient in many dressings, sauces, and condiments. Its trip from spoiled cider or wine to food ingredients spans over 5000 years. Hippocrates used acetic acid to prevent infection by treating wounds with it and today it is recommended for anything from warts to jellyfish stings, but research shows that we may be missing a key element in the treatment of obesity in some patients.

Research on Acetic Acid and Weight Loss:

1. Apple cider vinegar might help with glucose control.  In 1988, Nakajima first published an article on the effects of vinegar on blood sugar. The study revealed that blood sugar dropped in rats when given acetic acid with a starch load​[1]​. Multiple other studies have confirmed similar results in humans and with various types of vinegar and may reduce blood sugar up to 55% one hour after eating​[2]​,​[3]​,​[4]​,​[5]​,​[6]​,​[7]​,​[8]​. One thing is for certain; there is plenty of research out there that supports that vinegar water added to your diet likely improves post-meal blood sugar of glycemia.  If vinegar reduces blood sugar after meals, it will reduce insulin spikes and potentially reduce fat storage and hunger (insulin can stimulate hunger).
2. Apple cider vinegar likely increases insulin sensitivity.  One study by Lim looked at vinegar and its effects on insulin sensitivity.  The study revealed that not only did glucose uptake increase in these subjects but also that it also increased satiety​[9]​.  The results were stronger in non-diabetics.  Mitrou found similar results by looking a sugar of forearm muscles in diabetic patients uptake with vinegar consumption​[10]​.  
3. The apple cider vinegar may boost your metabolism. Thus, increase the calories you burn leads to weight loss.
4. Vinegar slows gastric emptying. Studies show a decrease in gastric emptying.  One study, in particular, looked at people with diabetes that were given 20 ml of vinegar followed by a potato meal​[11]​.  Another study by Hlebowicz with a similar methodology found that vinegar water reduced the rate of gastric emptying by almost 40%​[12]​.  This study found that apple cider vinegar decreased the rate of gastric emptying.   Two studies on healthy adults without diabetes s that vinegar followed by a starchy meal also showed decreased both insulin responses and blood sugar level​[13]​,​[14]​.  Both concluded that these reductions were due to the slowing of gastric emptying.    
5. Vinegar increases the feeling of fullness or satiety.  Because vinegar slows gastric emptying, people with diabetes should not drink vinegar and pre-diabetics should discuss it with a physician. Researchers postulate that this decreased gastric emptying increases satiety and this is likely true because if you induce stretch on the stomach walls, leptin will be release and increase satiety (fullness)​[15]​.  This could be a secondary cause of increased satiety could be the reduction in insulin spike by reducing the ability of insulin to increase appetite.  
6. Subjects that drink vinegar water once a daily eat fewer calories during the day.  One study of 11 dieters found that they ate nearly 300 fewer calories a day. This reduction is likely due to increased satiety[56],[57].
7. Drinking vinegar water helps with weight loss and fat loss.  In one study that spanned twelve weeks performed by Kondo in Japan in 2009, obese adults consumed either one tablespoon of vinegar, two tablespoons of vinegar, or a placebo drink every day​[16]​.  They were instructed to restrict their alcohol intake, but otherwise ate their usual diet and made no change in their activity.  The test subjects in this study lost waist circumference, weight, and fat percentage.  See figure to the right to see results.  In another relevant study in Cell Metabolism from 2012, two groups of rodents were fed diets high in fat. The first group was allowed to eat throughout the day, while the second group was restricted to eating only for eight hours per day, which meant they fasted the other 16 hours. After 100 days, the free-feeding mice had gained weight, while the restricted-feeding mice weighed 28 percent less​[17]​. 
8. Vinegar reduces fat deposition.  Another study by Kondo found that subjects who drank vinegar reduce fatty acid oxidation and thus reduces fatty acid availability for deposition into adipose or fat tissue[18].  

Recommendations for apple cider vinegar:

1. Stick with raw vinegar. Raw or unprocessed apple cider vinegar contains “mother of vinegar.” The “mother” which is the solid material that makes raw vinegar cloudy look. “Mother” is made up of proteins, enzymes, and bacteria. Most of the advocates of the benefits of vinegar claim most of those benefits to include the vitamins, minerals, probiotics, and enzymes, come from the “mother” portion.

2. Pucker up.  If you can handle the pucker factor of vinegar in water, limit your intake to 15-30ml in 500 ml or 1-2 tbsp in 16-17 ounces fo water. A person with diabetes should not drink vinegar. See #4 above.
3. Watch for side-effects. Dieting with vinegar drinks goes against the guidelines for proper nutrition. Apple cider vinegar should only be used intermittently. Side-effects include fatigue, hair loss, intolerance to cold, depression, loss of taste, muscle wasting, numbness, oral ulcers, rashes, skin discoloration, and vision problems.
4. Vinegar may assist with fat and weight loss. It is not the magic bullet or elixir of the gods that will cure all that ails you. While apple cider vinegar probably won’t make you skinny by itself, it does appear to help with weight and fat loss and blood sugar stabilization. The bottom line is if you want to lose weight, you’ll still need to exercise and practice portion control but vinegar might help.
The bottom line: Vinegar may help you lose weight, but not every one should try it.

References:

1. Brighenti, F, G Castellani, L Benini, MC Casiraghi, E Leopardi, R Crovetti, and G Testolin. “Effect of Neutralized and Native Vinegar on Blood Glucose and Acetate Responses to a Mixed Meal in Healthy Subjects.” European Journal of Clinical Nutrition 49, no. 4 (April 1, 1995): 242–47. [PubMed]
2. Darzi, J, GS Frost, R Montaser, J Yap, and MD Robertson. “Influence of the Tolerability of Vinegar as an Oral Source of Short-Chain Fatty Acids on Appetite Control and Food Intake.” International Journal of Obesity (2005) 38, no. 5 (May 1, 2014): 675–81. [PubMed]
3. Ebihara , Kyoshi , and Akira Nakajima. “ Effect of Acetic Acid and Vinegar on Blood Glucose and Insulin Responses to Orally Administered Sucrose and Starch.” Agric. Biol. Chem. 52, no. 5 (1988): 1311–12.
4. Fushimi, T, and Y Sato. “Effect of Acetic Acid Feeding on the Circadian Changes in Glycogen and Metabolites of Glucose and Lipid in Liver and Skeletal Muscle of Rats.” The British Journal of Nutrition 94, no. 5 (November 1, 2005): 714–19. [PubMed]
5. Hlebowicz, J, G Darwiche, O Björgell, and LO Almér. “Effect of Apple Cider Vinegar on Delayed Gastric Emptying in Patients with Type 1 Diabetes Mellitus: A Pilot Study.” BMC Gastroenterology 7 (December 20, 2007): 46. [PubMed]
6. Johnston, CS, and AJ Buller. “Vinegar and Peanut Products as Complementary Foods to Reduce Postprandial Glycemia.” Journal of the American Dietetic Association 105, no. 12 (December 1, 2005): 1939–42. [PubMed]
7. Kondo, T, M Kishi, T Fushimi, and T Kaga. “Acetic Acid Upregulates the Expression of Genes for Fatty Acid Oxidation Enzymes in Liver to Suppress Body Fat Accumulation.” Journal of Agricultural and Food Chemistry 57, no. 13 (July 8, 2009): 5982–86. [PubMed]
8. Kondo, T, M Kishi, T Fushimi, S Ugajin, and T Kaga. “Vinegar Intake Reduces Body Weight, Body Fat Mass, and Serum Triglyceride Levels in Obese Japanese Subjects.” Bioscience, Biotechnology, and Biochemistry 73, no. 8 (August 1, 2009): 1837–43. [PubMed]
9. Leeman, M, E Ostman, and I Björck. “Vinegar Dressing and Cold Storage of Potatoes Lowers Postprandial Glycaemic and Insulinaemic Responses in Healthy Subjects.” European Journal of Clinical Nutrition 59, no. 11 (November 1, 2005): 1266–71. [PubMed]
10. Liatis, S, S Grammatikou, KA Poulia, D Perrea, K Makrilakis, E Diakoumopoulou, and N Katsilambros. “Vinegar Reduces Postprandial Hyperglycaemia in Patients with Type II Diabetes When Added to a High, but Not to a Low, Glycaemic Index Meal.” European Journal of Clinical Nutrition 64, no. 7 (July 1, 2010): 727–32. [PubMed]
11. Liljeberg, H, and I Björck. “Delayed Gastric Emptying Rate May Explain Improved Glycaemia in Healthy Subjects to a Starchy Meal with Added Vinegar.” European Journal of Clinical Nutrition 52, no. 5 (May 1, 1998): 368–71. [PubMed]
12. Lim, J, CJ Henry, and S Haldar. “Vinegar as a Functional Ingredient to Improve Postprandial Glycemic Control-Human Intervention Findings and Molecular Mechanisms.” Molecular Nutrition & Food Research 60, no. 8 (August 1, 2016): 1837–49. [PubMed]
13. Mitrou, P, E Petsiou, E Papakonstantinou, E Maratou, V Lambadiari, P Dimitriadis, F Spanoudi, SA Raptis, and G Dimitriadis. “Vinegar Consumption Increases Insulin-Stimulated Glucose Uptake by the Forearm Muscle in Humans with Type 2 Diabetes.” Journal of Diabetes Research 2015 (January 1, 2015): 175204. [PubMed]
14. Mitrou, Panayota, Eleni Petsiou, Emilia Papakonstantinou, Eirini Maratou, Vaia Lambadiari, Panayiotis Dimitriadis, Filio Spanoudi, Sotirios A. Raptis, and George Dimitriadis. “Vinegar Consumption Increases Insulin-Stimulated Glucose Uptake by the Forearm Muscle in Humans with Type 2 Diabetes.” Journal of Diabetes Research. Hindawi Publishing Corporation, 2015. doi: 10.1155/2015/175204
15. Ostman, E, Y Granfeldt, L Persson, and I Björck. “Vinegar Supplementation Lowers Glucose and Insulin Responses and Increases Satiety after a Bread Meal in Healthy Subjects.” European Journal of Clinical Nutrition 59, no. 9 (September 1, 2005): 983–88. [PubMed]
16. Salbe, AD, CS Johnston, MA Buyukbese, PD Tsitouras, and SM Harman. “Vinegar Lacks Antiglycemic Action on Enteral Carbohydrate Absorption in Human Subjects.” Nutrition Research (New York, N.Y.) 29, no. 12 (December 1, 2009): 846–49. [PubMed]