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Two teaspoons of vinegar a day can improve blood sugar levels by 23%. Vinegar acid slows down the emptying of the stomach which may increase satiety span.

Table of Contents

Research Summary

  • Two teaspoons of vinegar a day can improve blood sugar levels by 23%.
  • Vinegar acid slows down the emptying of the stomach which may increase satiety span.
  • Taking apple cider vinegar before bedtime reduced sugar levels the next day.
  • Vinegar seems to block the enzymes that break down the sugar.
  • Vinegar lowers the rise of blood sugar, insulin, and lipid when taken with meals and good for people with insulin resistance.
  • Vinegar with a meal was used to treat diabetes before discovering diabetes drugs.
  • Vinegar added in high glycemic foods lowers blood sugar and insulin spike and helps the feeling of being full and in a longer period of time.
  • Two tablespoons of vinegar added to refined carbohydrate meals can already lower the blood sugar spike.
  • Vinegar drink lowers the fasting blood sugars in just 1 week. A tablespoon of vinegar taken twice daily performed better than the 2 leading drugs.
  • Vinegar has additional health effects that are also safe, cheap, and effective. See below.
  • Apple vinegar improves Fasting Blood Sugar and beneficial effects on oxidative stress.
  • Vinegar is historically used as a food preservative, manages wounds, and consumed by diabetics.
  • Vinegar can be made from almost any fermentable carbohydrate source.
  • Vinegar products must contain a minimum of 4% acidity in the US.
  • Distilled vinegar is generally 4% to 7% acetic acid whereas cider and wine vinegar are 5% to 6% acetic acid.
  • Vinegar has antimicrobial properties to fight infection.
  • Undiluted vinegar may be used effectively for cleaning dentures and does not cause mucosal damage.
  • Diluted vinegar (2% acetic acid solution at pH 2) treats ear infections.
  • Vinegar is commonly recommended for treating nail fungus, head lice, and warts.

What Is Vinegar?

Vinegar is an aqueous solution of acetic acid and trace chemicals that may include flavorings. Vinegar typically contains 5–8% acetic acid by volume. Usually, the acetic acid is produced by the fermentation of ethanol or sugars by acetic acid bacteria. There are many types of vinegar, depending on source materials. Vinegar is now mainly used in the culinary arts: as a flavorful, acidic cooking ingredient, or in pickling.

Vinegar, from the French vin aigre, meaning “sour wine,” can be made from almost any fermentable carbohydrate source, including wine, molasses, dates, sorghum, apples, pears, grapes, berries, melons, coconut, honey, beer, maple syrup, potatoes, beets, malt, grains, and whey. Initially, yeasts ferment the natural food sugars to alcohol. Next, acetic acid bacteria (Acetobacter) convert the alcohol to acetic acid. Commercial vinegar is produced by either fast or slow fermentation processes. For the quick methods, the liquid is oxygenated by agitation and the bacteria culture is submerged permitting rapid fermentation. The slow methods are generally used for the production of the traditional wine vinegars, and the culture of acetic acid bacteria grows on the surface of the liquid and fermentation proceeds slowly over the course of weeks or months. The longer fermentation period allows for the accumulation of a nontoxic slime composed of yeast and acetic acid bacteria, known as the mother of vinegar. Vinegar eels (nematodaTurbatrix aceti) feed on these organisms and occur in naturally fermenting vinegar. Most manufacturers filter and pasteurize their product before bottling to prevent these organisms from forming. After opening, mother may develop in stored vinegar; it is considered harmless and can be removed by filtering. Many people advocate retaining the mother for numerous, but unsubstantiated, health effects.

Credits: In advising our members, we filter thousands of research and fads, relying only on the credible worldwide science available for better health and weight reduction. Here we chose the interesting research of Dr. Michael Greger. Yet, no research replaces your own doctor's advice.
Thanks to NutritionFacts.org and Dr. Michael Greger

As I note in my chapter on greens in my book, “How Not to Die”, vinegar may be one condiment that’s actually good for you, though mustard could be another. Randomized controlled trials involving both diabetic and non-diabetic individuals found that adding two little teaspoons of vinegar to a meal may improve blood sugar control, effectively blunting the blood sugar spike after a meal by about 20 percent. 

But how?

Originally, we thought it was because vinegar delayed the gastric emptying rate, slowing the speed at which a meal leaves your stomach, which makes sense, because there’s acid receptors in the first part of the small intestine where the stomach acid is neutralized, and so if there is excess acid, the body slows down stomach emptying to give the intestine time to buffer it all. So the acid in vinegar was thought to slow the rate at which food leaves the stomach resulting in a blunted sugar spike. But then studies like this were published where taking apple cider vinegar before bedtime resulted in lower blood sugars the next day. 

How does vinegar work?

That’s obviously not some acid-induced stomach-slowing effect, and indeed anyone who actually went to the trouble of sticking an ultrasound probe on someone’s stomach could have told you that— no difference in stomach emptying times comparing vinegar to neutralized vinegar. So it’s not just an acid effect. Back to square one. Studies like this offered the next clue. Vinegar appeared to have no effect on blood sugars, but this was after giving people a straight glucose solution. Glucose is a byproduct of sugar and starch digestion, and so if vinegar blunts the blood sugar spike from cotton candy and Wonderbread, but not glucose, maybe it works by suppressing the enzymes that digest sugars and starches. And indeed vinegar appears to block the enzyme that breaks down table sugar. 

It’s not only the acid effect

But it wasn’t just an acid effect, there appears to be something unique about acetic acid, the acid in vinegar. But this was based on intestinal cells in a petri dish. What about in people? Feed people some mashed potatoes with and without vinegar, and glucose flows into the bloodstream at the same rate either way, so that’s another theory shot down. Okay, so let’s figure this out. If sugar enters the bloodstream at the same rate with or without vinegar, but vinegar leads to significantly less sugar in the blood, then logically it must be leaving the bloodstream faster, and indeed vinegar ingestion appears to enhance sugar disposal by lowering insulin resistance- the cause of type 2 diabetes. 

Indeed vinegar ingestion does appear to improve the action of insulin in diabetics. So the mystery of how vinegar works appears to have been solved, at least in part. So diabetics can add vinegar to their mashed potatoes, or just not eat mashed potatoes. If you add vinegar to a high fiber meal, nothing happens, explaining results like this. No effects of vinegar in diabetics in response to a meal. No surprise, because the meal was mostly beans. 

But if you are going to eat high glycemic index foods like refined grains, vinegar can help, though there are some caveats. Don’t drink vinegar straight, as it may cause intractable hiccups and can burn your esophagus… as can apple cider vinegar tablets, if they get lodged in your throat, not that apple cider vinegar tablets necessarily actually have any apple cider vinegar in them at all. Don’t pour it on your kid’s head to treat head lice. It’s not harmful— except when it leaks on to the face and penetrates the eyes, and it turns out it doesn’t even work. It can cause 3rd degree burns if you soak a bandage with it and leave it on. Though as many as a total of 6 tablespoons a day of vinegar was not associated with any side-effects in the short-term. Until we know more maybe we’d want to stick with more common culinary type doses, like two tablespoons max a day. For example, drinking a total of 2,000 cups of vinegar was found to be a bad idea.


Is Vinegar Good For You?

Thanks to NutritionFacts.org and Dr. Michael Greger

Vinegar is helpful, according to an examination of the anti glycemic properties of vinegar this year. It blunts the spike in blood sugar that occurs after a meal. If you eat a piece of white bread, this is what happens over the next three hours to your blood sugar. But if we eat that same bread dipped in balsamic vinegar, it looks like this. Vinegar reduces postprandial glycemia by about 20% compared to placebo. How? Well, we think it’s because vinegar slows down the speed at which food leaves the stomach— which is good because it can keep us feeling full, longer. How much do we have to take, though? Just two teaspoons with a meal. There are all sorts of wild vinegars out there— pomegranate vinegar, blood orange, black fig. They’re not just calorie-free; they’re good for us.


What Is The Best Vinegar Dose?

Thanks to NutritionFacts.org and Dr. Michael Greger

Consuming vinegar with a meal reduces the spike in blood sugar, insulin, and triglycerides. And it appears to work particularly well in those who are insulin resistant, on their way to type 2 diabetes. No wonder the consumption of vinegar with meals was used as a folk medicine for the treatment of diabetes before diabetes drugs were invented. 

Why Add Vinegar To Your Meal?

Many cultures have taken advantage of this fact, mixing vinegar with high glycemic foods like white rice in Japan, for example, to make sushi; dipping bread into balsamic in the Mediterranean; a variety of sourdough breads throughout Europe, which cause less blood sugar and insulin spikes; and you can do the same with boiled white potatoes by adding vinegar, and cooling them down to make potato salad.

Vinegar can make you feel full

Adding vinegar to white bread doesn’t just lower blood sugar and insulin responses, but increases satiety, the feeling of being full after a meal. If you eat three slices of white bread it may fill you up a little, but in less than two hours not only are you as hungry as you started but actually hungrier, less satiated than when you began. But if you eat that same amount of bread with some vinegar, you feel twice as full, and even two hours later, you’re still feeling nearly just as full as if you just ate the three pieces of bread plain. But this remarkable increase and prolongation of satiety took nearly two tablespoons of vinegar. That’s a lot of vinegar. It turns out even just small amounts of vinegar— two teaspoons with a meal— can significantly cut down on the blood sugar spike of a refined carb meal— a bagel and juice in this case. 

So you could have a little side salad or even just adding it to some tea with lemon— it’s only two teaspoons. Or scrap the bagel with juice and just have some oatmeal with berries instead. What if you consume vinegar every day for months? Researchers at Arizona State randomized pre-diabetics to drink a daily bottle of apple cider vinegar drink, a half bottle at lunch, a half bottle at supper— or take an apple cider vinegar tablet, which they pretty much considered a placebo control, since while the bottle contains two tablespoons of vinegar, two tablets would only add up to about a third of a teaspoon a day, so they were in effect comparing about 40 spoonfuls of vinegar a week to two for 12 weeks. This is what happened. 

Vinegar lowers fasting blood sugar

On the vinegar drink, fasting blood sugars dropped within one week. How significant is a drop of 16 points? A simple dietary tweak, a tablespoon of vinegar twice a day worked better than the leading drugs like Glucophage and Avandia. This effect of vinegar is particularly noteworthy when the cost, access, and toxicities that are associated with pharmaceutical medications are considered. So safer, cheaper, and more effective. No wonder it’s been used medicinally since antiquity. Interestingly, even the tiny amount of vinegar in pill form seemed to help a bit. That’s astonishing. And no, the study was not funded by the vinegar company. 

What about long-term vinegar use where it really counts: in diabetics. They were randomized into one of three groups. Two tablespoons of vinegar twice a day, with lunch and supper, two dill pickles a day, which each contained about a half tablespoon’s worth of vinegar, or an even smaller vinegar pill twice a day, each containing only 1/16th of a teaspoon’s worth of vinegar. So I wasn’t surprised the pill didn’t work, but neither did the pickles. Maybe the tablespoon a day isn’t enough for diabetics? 

Regardless, the vinegar did work all the more impressive because the diabetics were mostly well-controlled on medication and still saw an additional benefit from the vinegar.


The Effect Of Apple Vinegar Consumption On Glycemic Indices, Blood Pressure, Oxidative Stress, And Homocysteine In Patients With Type 2 Diabetes And Dyslipidemia

Some foods and drinks contain special ingredients, causing impressive effects on human health. The aim of the current study was to assess the health effects of apple vinegar in patients with diabetes and dyslipidemia.

How the vinegar research was conducted?

Seventy participants with type 2 diabetes and hyperlipidemia were randomly assigned into an intervention and control group in order to assess the effect of 20 ml apple vinegar per day using an 8-week parallel study. Fasting blood sugar (FBS), homeostasis model assessment for insulin resistance (HOMA-IR), homeostasis model assessment for b-cell function (HOMA-B), quantitative insulin sensitivity checks index (QUICKI), insulin, malondialdehyde (MDA), 2,20-Diphenyl-1- picrylhydrazyl (DPPH), homocysteine, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured at the beginning and end of the study.

Effects of vinegar on GI

The intervention with apple vinegar could significantly improve FBS (mean change: −10.16 ± 19.48 mg/dl, p = 0.006) and DPPH (mean change: 16.58 ± 11.56, p < 0.001) within intervention group and in comparison with control group (p < 0.001). Additionally, the significant increase of MDA in the control group (p < 0.05) caused a considerable difference between the two groups. Glycemic indices containing insulin, HOMA-IR, HOMA-B, and QUICKI decrease significantly in both groups (p < 0.05). No considerable effect was observed on blood pressure and homocysteine in the intervention group as well as a control group.

Conclusion: Apple vinegar may have an effect on GI and oxidative stress

This trial provided some evidence that apple vinegar consumption may cause beneficial effects on glycemic indices and oxidative stress in individuals with diabetes and dyslipidemia.


Vinegar: Medicinal Uses And Antiglycemic (Lowering GI) Effect

History of vinegar

Vinegar folklore is as colorful as it is practical. Legend states that a courtier in Babylonia (c. 5000 BC) “discovered” wine, formed from unattended grape juice, leading to the eventual discovery of vinegar and its use as a food preservative. Hippocrates (c. 420 BC) used vinegar medicinally to manage wounds. Hannibal of Carthage (c. 200 BC), the great military leader and strategist, used vinegar to dissolve boulders that blocked his army’s path. Cleopatra (c. 50 BC) dissolved precious pearls in vinegar and offered her love potion to Anthony. Sung Tse, the 10th-century creator of forensic medicine, advocated handwashing with sulfur and vinegar to avoid infection during autopsies. Based on the writings of US medical practitioners dating to the late 18th century, many ailments, from dropsy to poison ivy, croup, and stomachache, were treated with vinegar, and, before the production and marketing of hypoglycemic agents, vinegar “teas” were commonly consumed by diabetics to help manage their chronic aliment. This review examines the scientific evidence for medicinal uses of vinegar, focusing particularly on the recent investigations supporting vinegar’s role as an anti glycemic agent. Epidemiologic studies and clinical trials were identified by a MEDLINE title/abstract search with the following search terms: vinegar, glucose; vinegar, cancer; or vinegar, infection. All relevant randomized or case-control trials were included in this review.

How Is Vinegar Produced?

Vinegar, from the French vin aigre, meaning “sour wine,” can be made from almost any fermentable carbohydrate source, including wine, molasses, dates, sorghum, apples, pears, grapes, berries, melons, coconut, honey, beer, maple syrup, potatoes, beets, malt, grains, and whey. Initially, yeasts ferment the natural food sugars to alcohol. Next, acetic acid bacteria (Acetobacter) convert the alcohol to acetic acid. Commercial vinegar is produced by either fast or slow fermentation processes. For the quick methods, the liquid is oxygenated by agitation, and the bacteria culture is submerged permitting rapid fermentation. The slow methods are generally used for the production of the traditional wine vinegar, and the culture of acetic acid bacteria grows on the surface of the liquid, and fermentation proceeds slowly over the course of weeks or months. The longer fermentation period allows for the accumulation of a nontoxic slime composed of yeast and acetic acid bacteria, known as the mother of vinegar. Vinegar eels (nematodaTurbatrix aceti) feed on these organisms and occur in naturally fermenting vinegar. Most manufacturers filter and pasteurize their product before bottling to prevent these organisms from forming. After opening, mother may develop in stored vinegar; it is considered harmless and can be removed by filtering. Many people advocate retaining the mother for numerous, but unsubstantiated, health effects.

The chemical and organoleptic properties of vinegars are a function of the starting material and the fermentation method. Acetic acid, the volatile organic acid that identifies the product as vinegar, is responsible for the tart flavor and pungent, biting odor of vinegars. However, acetic acid should not be considered synonymous with vinegar. The US Food and Drug Administration (FDA) states that diluted acetic acid is not vinegar and should not be added to food products customarily expected to contain vinegar. Other constituents of vinegar include vitamins, mineral salts, amino acids, polyphenolic compounds (eg, galic acid, catechin, caffeic acid, ferulic acid), and nonvolatile organic acids (eg, tartaric, citric, malic, lactic).

In the United States, vinegar products must contain a minimum of 4% acidity. European countries have regional standards for vinegar produced or sold in the area. White distilled vinegar is generally 4% to 7% acetic acid whereas cider and wine vinegar are 5% to 6% acetic acid. Specialty vinegar is grouped as herbal or fruit vinegar. Herbal vinegar consists of wine vinegar or white distilled vinegar, which may be seasoned with garlic, basil, tarragon, cinnamon, clove, or nutmeg. Fruit vinegar is wine and white vinegar sweetened with fruit or fruit juice to produce a characteristic sweet-sour taste. Traditional vinegar is produced from regional foods according to well-established customs. The balsamic vinegar of Modena, Italy, is made from the local white Trebbiano grapes, which are harvested as late as possible, fermented slowly, and concentrated by aging in casks of various woods. Traditional rice wine vinegar is produced in Asia, coconut and cane vinegar are common in India and the Philippines, and date vinegar is popular in the Middle East.

Medicinal Uses Of Vinegar

Anti-infective properties

The use of vinegar to fight infections and other acute conditions dates back to Hippocrates (460-377 BC; the father of modern medicine), who recommended a vinegar preparation for cleaning ulcerations and for the treatment of sores. Oxymel, a popular ancient medicine composed of honey and vinegar, was prescribed for persistent coughs by Hippocrates and his contemporaries, and by physicians up to modern-day. The formulation of oxymel was detailed in the British Pharmacopoeia (1898) and the German Pharmacopoeia (1872), and, according to the French Codex (1898), the medicine was prepared by mixing virgin honey, 4 parts, with white wine vinegar, 1 part, concentrating and clarifying with paper pulp.

Recent scientific investigations clearly demonstrate the antimicrobial properties of vinegar, but mainly in the context of food preparation. Experts advise against using vinegar preparations for treating wounds. At concentrations nontoxic to fibroblasts and keratinocytes (≤ 0.0025%), acetic acid solutions were ineffective at inhibiting the growth of Escherichia coli, group D Enterococcus, or Bacteroides fragilis bacteria, and only slightly effective at inhibiting the growth of Staphylococcus aureus and Pseudomonas aeruginosa bacteria. Similarly, experts caution against using vinegar as a household disinfectant against human pathogens because chemical disinfectants are more effective. However, undiluted vinegar may be used effectively for cleaning dentures, and, unlike bleach solutions, vinegar residues left on dentures were not associated with mucosal damage.

Although investigations have demonstrated the effectiveness of diluted vinegar (2% acetic acid solution at pH 2) for the treatment of ear infections (otitis externa, otitis media, and granular myringitis), the low pH of these solutions may irritate inflamed skin and damage cochlear outer hair cells. Immediate vinegar application at the site of jellyfish stings is practiced at various coastal locations around the world because vinegar deactivates the nematocysts. However, hot-water immersion is considered the most efficacious initial treatment for jellyfish envenomation because the venom is deactivated by heat.

In the popular media, vinegar is commonly recommended for treating nail fungus, head lice, and warts, yet scientific support for these treatment strategies is lacking. Takano-Lee and colleagues demonstrated that of 7 home remedies tested, vinegar was the least effective for eliminating lice or inhibiting the hatching of eggs. Scattered reports suggest that the successive topical application of highly concentrated acetic acid solutions (up to 99%) alleviated warts, presumably due to the mechanical destruction of wart tissue. One treatment protocol, however, required local anesthesia, excision, and rapid neutralization at the site of application, thus limiting its use by the lay public.

Although not a treatment modality, vinegar washes are used by midwives in remote, poorly resourced locations (eg, Zimbabwe and the Amazon jungle) to screen women for the human papilloma virus infection. Contact with acetic acid causes visual alterations of the viral lesions permitting rapid detection of infection with 77% sensitivity and the option of immediate treatment with cryotherapy.

Effects of vinegar cardiovascular

Kondo and colleagues reported a significant reduction in systolic blood pressure (approximately 20 mm Hg) in spontaneously hypertensive (SHR) rats fed a standard laboratory diet mixed with either vinegar or an acetic acid solution (approximately 0.86 mmol acetic acid/day for 6 weeks) as compared with SHR rats fed the same diet mixed with deionized water. These observed reductions in systolic blood pressure were associated with reductions in both plasma renin activity and plasma aldosterone concentrations (35% to 40% and 15% to 25% reductions in renin activity and aldosterone concentrations, respectively, in the experimental vs control SHR rats). Others have reported that vinegar administration (approximately 0.57 mmol acetic acid, orally) inhibited the renin-angiotensin system in nonhypertensive Sprague-Dawley rats.

Trials investigating the effects of vinegar ingestion on the renin-angiotensin system have not been conducted in humans, and there is no scientific evidence that vinegar ingestion alters blood pressure in humans. In their report, Kondo and colleagues speculated that dietary acetic acid promoted calcium absorption and thereby downregulated the renin-angiotensin system. In the rat model, acetic acid administration enhanced calcium absorption and retention; moreover, in humans, calcium absorption in the distal colon was enhanced by acetate. Clearly, much work is needed to establish whether vinegar ingestion alters calcium absorption and/or blood pressure regulation in humans.

Whether chronic vinegar ingestion affects other risk factors for cardiovascular disease in humans is not known. Hu and colleagues reported a significantly lower risk for fatal ischemic heart disease among participants in the Nurses’ Health Study who consumed oil-and-vinegar salad dressings frequently (5-6 times or more per week) compared with those who rarely consumed them (multivariate RR: 0.46; CI: 0.27-0.76, P for trend = .001). Frequent consumption of mayonnaise or other creamy salad dressings was not significantly associated with risk for ischemic heart disease in this population (multivariate RR: 0.84; CI: 0.50-1.44, P for trend = .44). The study authors contend that because oil and vinegar dressings are a major dietary source of dietary alpha-linolenic acid, an antiarrhythmic agent, alpha-linolenic acid may potentially be the beneficial ingredient of this food. Yet, creamy, mayonnaise-based salad dressings are also rich in alpha-linolenic acid and did not show the same risk benefit as the oil and vinegar dressings.

Effects of vinegar on anti-tumor activity

In vitro, sugar cane vinegar (Kibizu) induced apoptosis in human leukemia cells, and traditional Japanese rice vinegar (Kurosu) inhibited the proliferation of human cancer cells in a dose-dependent manner. An ethyl acetate extract of Kurosu added to drinking water (0.05% to 0.1% w/v) significantly inhibited the incidence (−60%) and multiplicity (−50%) of azoxymethane-induced colon carcinogenesis in male F344 rats when compared with the same markers in control animals. In a separate trial, mice fed a rice-shochu vinegar-fortified feed (0.3% to 1.5% w/w) or control diet was inoculated with sarcoma 180 (group 1) or colon 38 (group 2) tumor cells (2 × 106 cells subcutaneously). At 40 days post-inoculation, vinegar-fed mice in both experimental groups had significantly smaller tumor volumes when compared with their control counterparts. A prolonged life span due to tumor regression was also noted in the mice ingesting rice-shochu vinegar as compared with controls, and in vitro, the rice-shochu vinegar stimulated natural killer cell cytotoxic activity.

The antitumor factors in vinegar have not been identified. In the human colonic adenocarcinoma cell line Caco-2, acetate treatment, as well as treatment with the other short-chain fatty acids (SCFA) n-butyrate and propionate, significantly prolonged cell doubling time, promoted cell differentiation and inhibited cell motility. Because bacterial fermentation of dietary fiber in the colon yields the SCFA, the investigators concluded that the antineoplastic effects of dietary fiber may relate in part to the formation of SCFA. Others have also documented the antineoplastic effects of the SCFA in the colon, particularly n-butyrate. Thus, because the acetic acid in vinegar deprotonates in the stomach to form acetate ions, it may possess antitumor effects.

Vinegar is also a dietary source of polyphenols, compounds synthesized by plants to defend against oxidative stress. Ingestion of polyphenols in humans enhances in vivo antioxidant protection and reduces cancer risk. Kurosu vinegar is particularly rich in phenolic compounds, and the in-vitro antioxidant activity of an ethyl acetate extract of Kurosu vinegar was similar to the antioxidant activity of alpha-tocopherol (vitamin E) and significantly greater than the antioxidant activities of other vinegar extracts, including wine and apple vinegar. Kurosu vinegar extracts also suppressed lipid peroxidation in mice treated topically with H2O2-generating chemicals. Currently, much interest surrounds the role of dietary polyphenols, particularly from fruits, vegetables, wine, coffee, and chocolate, in the prevention of cancers as well as other conditions including cardiovascular disease; perhaps vinegar can be added to this list of foods and its consumption evaluated for disease risk.

Epidemiologic data, however, is scarce and unequivocal. A case-control study conducted in Linzhou, China, demonstrated that vinegar ingestion was associated with a decreased risk for esophageal cancer (OR: 0.37). However, vinegar ingestion was associated with a 4.4-fold greater risk for bladder cancer in a case-control investigation in Serbia.

Effects of vinegar on blood glucose

The anti glycemic effect of vinegar was first reported by Ebihara and Nakajimain 1988. In rats, the blood glucose response to a 10% corn starch load was significantly reduced when coadministered with a 2% acetic acid solution. In healthy human subjects, although the glucose response curve was not significantly altered, the area under the insulin response curve following the ingestion of 50 g sucrose was reduced by 20% when coadministered with 60 mL strawberry vinegar. Several years later, Brighenti and colleagues demonstrated in normoglycemic subjects that 20 mL white vinegar (5% acetic acid) as a salad dressing ingredient reduced the glycemic response to a mixed meal (lettuce salad and white bread containing 50 g carbohydrate) by over 30% (P < .05). Salad dressings made from neutralized vinegar, formulated by adding 1.5 g sodium bicarbonate to 20 mL white vinegar, or a salt solution (1.5 g sodium chloride in 20 mL water) did not significantly affect the glycemic response to the mixed meal. Separate placebo-controlled trials have corroborated the meal-time, anti glycemic effects of 20 g vinegar in healthy adults.

While compiling a glycemic index (GI) table for 32 common Japanese foods, Sugiyama and colleagues documented that the addition of vinegar or pickled foods to rice (eg, sushi) decreased the GI of rice by 20% to 35%. In these trials, healthy fasted subjects ingested the reference and test foods, each containing 50 g carbohydrate, on random days, and the food GI was calculated using the areas under the 2-hour blood glucose response curves. In the vinegar-containing foods, the amount of acetic acid was estimated to be 0.3-2.3 g, an amount similar to that found in 20 g vinegar (approximately 1 g). Ostman and colleagues reported that substitution of a pickled cucumber (1.6 g acetic acid) for a fresh cucumber (0 g acetic acid) in a test meal (bread, butter, and yogurt) reduced meal GI by over 30% in healthy subjects.

Recently, the anti glycemic property of vinegar was demonstrated to extend to individuals with marked insulin resistance or type 2 diabetes. In this crossover trial, individuals with insulin resistance (n = 11, fasting insulin concentrations greater than 20 mU/mL) or with diagnosed type 2 diabetes (n = 10) consumed a vinegar test drink (20 g vinegar, 40 g water, 1 tsp saccharine) or placebo immediately before the consumption of a mixed meal (87 g total carbohydrate). In the insulin-resistant subjects, vinegar ingestion reduced postprandial glycemia by 64% as compared with placebo values (P = .014) and improved postprandial insulin sensitivity by 34% (P= .01). In individuals with type 2 diabetes, vinegar ingestion was less effective at reducing mealtime glycemia (−17%, P = .149); however, vinegar ingestion was associated with a slight improvement in postprandial insulin sensitivity in these subjects (+19%, P = .07). The lack of a significant effect of vinegar on mealtime glycemia in type 2 diabetics may be related to the use of venous blood sampling in this trial. Greater within-subject variation in glucose concentrations are noted for venous blood as compared with capillary blood; moreover, the concentration of glucose in venous blood is lower than that in capillary blood. Thus, capillary blood sampling is preferred for determining the glycemic response to food.

The marked anti glycemic effect of vinegar in insulin-resistant subjects is noteworthy and may have important implications. Multicenter trials have demonstrated that treatment with anti glycemic pharmaceuticals (metformin or acarbose) slowed the progression to diabetes in high-risk individuals; moreover, because these drugs improved insulin sensitivity, the probability that individuals with impaired glucose tolerance would revert to a normal, glucose-tolerant state overtime was increased.

In healthy subjects, Ostman and colleagues demonstrated that acetic acid had a dose-response effect on postprandial glycemia and insulinemia. Subjects consumed white bread (50 g carbohydrate) alone or with 3 portions of vinegar containing 1.1, 1.4, or 1.7 g acetic acid. At 30 minutes post-meal, blood glucose concentrations were significantly reduced by all concentrations of acetic acid as compared with the control value, and a negative linear relationship was calculated between blood glucose concentrations and the acetic acid content of the meal (r = −0.47, P = .001). Subjects were also asked to rate feelings of hunger/satiety on a scale ranging from extreme hunger (−10) to extreme satiety (+10) before meal consumption and at 15-minute intervals after the meal. Bread consumption alone scored the lowest rating of satiety (calculated as the area under the curve from time 0-120 minutes). Feelings of satiety increased when vinegar was ingested with the bread, and a linear relationship was observed between satiety and the acetic acid content of the test meals (r = 0.41, P = .004).

In a separate trial, healthy adult women consumed fewer total calories on days that vinegar was ingested at the morning meal. In this trial, which used a blinded, randomized, placebo-controlled, crossover design, fasting participants consumed a test drink (placebo or vinegar) followed by the test meal composed of a buttered bagel and orange juice (87 g carbohydrate). Blood samples were collected for 1 hour after the meal. At the end of testing, participants were allowed to follow their normal activities and eating patterns the remainder of the day, but they were instructed to record food and beverage consumption until bedtime. Vinegar ingestion, as compared with placebo, reduced the 60-minute glucose response to the test meal (−54%, P < .05) and weakly affected later energy consumption (−200 kilocalories, P = .111). Regression analyses indicated that 60-minute glucose responses to test meals explained 11% to 16% of the variance in later energy consumption (P < .05).Thus, vinegar may affect satiety by reducing the meal-time glycemic load. Of 20 studies published between 1977 and 1999, 16 demonstrated that low-glycemic index foods promoted postmeal satiety and/or reduced subsequent hunger.

It is not known how vinegar alters meal-induced glycemia, but several mechanisms have been proposed. Ogawa and colleagues examined the effects of acetic acid and other organic acids on disaccharidase activity in Caco-2 cells. Acetic acid (5 mmol/L) suppressed sucrase, lactase, and maltase activities in concentration- and time-dependent manners as compared with control values, but the other organic acids (eg, citric, succinic, L-maric, and L-lactic acids) did not suppress enzyme activities. Because acetic acid treatment did not affect the de-novo synthesis of the sucrase-isomaltase complex at either the transcriptional or translational levels, the investigators concluded that the suppressive effect of acetic acid likely occurs during the posttranslational processing of the enzyme complex. Of note, the lay literature has long proclaimed that vinegar interferes with starch digestion and should be avoided at mealtimes.

Several investigations examined whether delayed gastric emptying contributed to the anti glycemic effect of vinegar. Using noninvasive ultrasonography, Brighenti and colleagues did not observe a difference in gastric emptying rates in healthy subjects consuming bread (50 g carbohydrate) in association with acetic acid (ie, vinegar) vs sodium acetate (ie, vinegar neutralized by the addition of sodium bicarbonate); however, a significant difference in post-meal glycemia was noted between treatments with the acetic acid treatment lowering glycemia by 31.4%. In a later study, Liljeberg and Bjorck added paracetamol to the bread test meal to permit indirect measurement of the gastric emptying rate. Compared with reference values, postmeal serum glucose and paracetamol concentrations were reduced significantly when the test meal was consumed with vinegar. The results of this study should be carefully considered, however, because paracetamol levels in the blood may be affected by food factors and other gastrointestinal events. In rats fed experimental diets containing the indigestible marker polyethyleneglycol and varying concentrations of acetic acid (0, 4, 8, 16 g acetic acid/100 g diet), dietary acetic acid did not alter gastric emptying, the rate of food intake, or glucose absorption.

Safety of Vinegar Consumption

Vinegar’s use as a condiment and food ingredient spans thousands of years, and perhaps its use can be labeled safe by default. Yet there are rare reports in the literature regarding adverse reactions to vinegar ingestion. Inflammation of the oropharynx and second-degree caustic injury of the esophagus and cardia were observed in a 39-year-old woman who drank 1 tablespoon of rice vinegar in the belief it would dislodge a piece of crab shell from her throat. The use of vinegar in these situations is a popular Chinese folk remedy.) Her symptoms resolved spontaneously after several days. Esophageal injury by vinegar is likely very rare but deserves notice. Chronic inflammation of the esophagus is a cancer risk; but, as reported previously, vinegar use was inversely related to risk for cancer of the esophagus.

The unintentional aspiration of vinegar has been associated with laryngospasm and subsequent vasovagal syncope that resolved spontaneously. Hypokalemia was observed in a 28-year-old woman who had reportedly consumed approximately 250 ml apple cider vinegar daily for 6 years. Although speculative, the hypokalemia was attributed to elevated potassium excretion related to the bicarbonate load from acetate metabolism.

These complications attributed to vinegar ingestion are isolated occurrences, but with the increased interest in vinegar as adjunct therapy in diabetes, carefully controlled trials to examine potential adverse effects of regular vinegar ingestion are warranted.

Vinegar Is “Food as Medicine”

For more than 2000 years, vinegar has been used to flavor and preserve foods, heal wounds, fight infections, clean surfaces, and manage diabetes. Although vinegar is highly valued as a culinary agent, some varieties costing $100 per bottle, much scrutiny surrounds its medicinal use. Scientific investigations do not support the use of vinegar as an anti-infective agent, either topically or orally. Evidence linking vinegar use to reduced risk for hypertension and cancer is equivocal. However, many recent scientific investigations have documented that vinegar ingestion reduces the glucose response to a carbohydrate load in healthy adults and in individuals with diabetes. There is also some evidence that vinegar ingestion increases short-term satiety. Future investigations are needed to delineate the mechanism by which vinegar alters postprandial glycemia and to determine whether regular vinegar ingestion favorably influences glycemic control as indicated by reductions in hemoglobin A1c. Vinegar is widely available; it is affordable; and, as a remedy, it is appealing. But whether vinegar is a useful adjunct therapy for individuals with diabetes or prediabetes has yet to be determined.


Effects Of Vinegar On Artery Function

Thanks to NutritionFacts.org and Dr. Michael Greger

There was a famous study from Harvard published back in ’99 that found that women who used oil-and-vinegar salad dressing about every day went on to have fewer than half the fatal heart attacks compared to women who hardly ever used it. Less than half the risk of the #1 killer of women. They figured it was the omega-3s in the oil that explained the benefit, but I know what you’re thinking. Those who use salad dressing every day probably also eat salad every day. But no, they were able to adjust for vegetable intake so it didn’t appear to be the salad, but why does the oil get the credit and not the vinegar? If only there was a way we could test that.

Well, what about creamy salad dressing? They’re also made from omega-3 rich oils like canola— in fact even more so than oil and vinegar dressing. So if it’s the oil and not the vinegar, then creamy dressing would be protective too. But it’s not. No significant decrease in fatal heart attack rates or nonfatal heart attack rates for that matter. Now it could be the eggs or butterfat counteracting the benefits of the omega 3s, but maybe the vinegar is actually playing a role. But how? Well, if you were paying close attention to the vinegar weight loss video, the title of that paper was “Vinegar Intake Enhances Flow-mediated Vasodilatation Via Upregulation of Endothelial Nitric Oxide Synthase Activity.” 

Vinegar dilates arteries and improves blood flow

In other words, vinegar enhances arterial function by allowing our arteries to better dilate naturally by boosting the activity of the enzyme in our body that synthesizes nitric oxide, the open sesame signal to our arteries that improves blood flow. If you remember, acetate is cleared out of your blood within half an hour after consuming a salad with a tablespoon of vinegar in it, apparently not enough time to boost the AMPK enzyme but within just ten minutes, that kind of acetate levels can boost the activity of the nitric oxide synthesizing enzyme within human umbilical cord blood vessel cells in a petri dish. 

Vinegar from black rice has better dilation effects on arteries among others

But what about people? They measured the dilation of arteries in the arms of women after they had a tablespoon of rice vinegar, a tablespoon of brown rice vinegar, or a tablespoon of forbidden rice vinegar, in other words, vinegar made from black or purple rice. All the vinegar appeared to help, but it was the black rice one that most clearly pulled away from the pack. Black rice contains the same kind of anthocyanin pigments that make some fruits and vegetables blue and purple and may have independent benefits.

For example, if you give someone a big blueberry smoothie containing the amount of anthocyanins in a cup and a half of wild blueberries, you get a nice spike in arterial function that lasts a couple hours, Thus the highest maximum forearm blood flow in the forbidden rice vinegar intake group might be attributed to an additional or synergistic effect of anthocyanin with the acetate. But it could also just be the antioxidant power of anthocyanins, in which case balsalmic vinegar, which is made from red wine, may have a similar effect, as it was shown to have remarkably higher free radical scavenging activity than rice vinegar. Enough to counter the artery-constricting effects of a high fat meal? 

We’ve known for nearly 20 years that a single high fat meal – Sausage and egg Mcmuffins with deep fried hash browns can cripple our artery function, cutting the ability of our arteries to dilate normally in half, within hours of it going into our mouths, compared to frosted flakes. Even with that massive, unhealthy sugar load, no effect on the arteries because there was no fat. And not just animal fat we’re talking about, a quarter cup of safflower oil had a similar effect.

In fact, the very first study to show how bad fat was for our arteries, basically dripped highly refined soybean oil into people’s veins. But extra virgin olive oil isn’t refined. We know some whole food sources of plant fat such as nuts actually improve artery function, whereas oils, including olive oil worsen function, but they didn’t specify extra virgin here. 

You can see, smell, and taste the phytonutrients still left in extra virgin olive oil— are they enough to maintain arterial function? No. A significant drop in artery function within three hours of eating whole grain bread dipped in extra virgin olive oil. And the more fat in their blood, the worse their arteries did. Ah, but what if you ate the same meal but added balsamic vinegar on a salad. That seemed to protect the arteries from the effects of the fat. 

Now, balsamic vinegar is a product of red wine. Would you get the same benefits just by drinking a glass of red wine? No. No improvement in arterial function after red wine. Hmmm. Why does balsamic vinegar work, but red wine not? Maybe it’s because the red wine lacks the benefits of the acetic acid in vinegar or, maybe it’s because the vinegar lacks the negative effects of the alcohol. And a third option might be it was the salad ingredients and had nothing to do with the vinegar. 

To figure out this puzzle all we’d have to do is… test non-alcoholic wine. And nonalcoholic red wine worked! So maybe it was the grapes in balsamic vinegar, not the acetic acid. And indeed if you eat a cup and a quarter of seeded and seedless red, green, and blue-black grapes with your sausage and egg McMuffin, you can blunt the crippling of your arteries. So plants and their products may provide protection against the direct impairment in endothelial function unless those products are oil or alcohol.


Effects of Apple Cider Vinegar on Weight Loss

Thanks to NutritionFacts.org and Dr. Michael Greger

Vinegar has evidently been used as a weight-loss aid for nearly 200 years, but does it work? Well, like hot sauce, it can be a nearly calorie-free way to flavor foods, and there are all sorts of tasty exotic vinegar out there now like fig, peach, and pomegranate to choose from. But the question is: is there something special about vinegar that helps with weight loss? 

Vinegar is defined as simply a dilute solution of acetic acid, which takes energy for our body to metabolize, activating an enzyme called AMPK, which is like our body’s fuel gauge. If it senses that we’re low, it amps up energy production and tells the body to stop storing fat and start burning fat. And so given our obesity epidemic, it is crucial that oral compounds with high bioavailability are developed to safely induce chronic AMPK enzyme activation, which would potentially be beneficial for long-term weight loss. 

No need to develop such a compound, though, if you can buy it at any grocery store. We know vinegar can activate AMPK in human cells, but is the dose one might get sprinkling it on a salad enough? If you take endothelial cells, blood-vessel-lining cells, from umbilical cords after babies are born and expose them to various levels of acetate, which is what the acetic acid in vinegar turns into in our stomach, it appears to take a concentration of at least 100 to really get a significant boost in AMPK.

So how much acetate do you get in your bloodstream sprinkling about a tablespoon of vinegar on your salad? You do hit 100, but only for about 15 minutes. And even at that concentration, 10 or 20 minutes exposure doesn’t seem to do much. Now granted this is in a Petri dish, but we didn’t have any clinical studies until. . . we did! A double blind trial investigating the effects of vinegar intake on the reduction of body fat in overweight men and women. 

Now they call them obese, but they were actually slimmer than your average American. In Japan they call anything over a BMI of 25 obese, whereas the average American adult is about 28.6. But anyway, they took about 150 overweight individuals, and randomly split them up into one of three groups: a high dose vinegar group, where they drank a beverage containing 2 tablespoons of apple cider vinegar a day; a low dose group, where they drank a beverage containing only 1 tablespoon of apple cider vinegar a day; and a placebo control group where they had them drink an acidic beverage they developed to taste the same as the vinegar drink but using a different kind of acid, so there was no acetic acid. No other changes in their diet or exercise. 

In fact, they monitored their diets and gave them all pedometers so they could make sure that the only significant difference between the three groups was the amount of vinegar they were getting every day. This is where they started out. And within just one month, statistically significant drops in weight in both vinegar groups compared to placebo, with higher dose doing better than low dose, which just got better and better, month after month. 

In fact, by month three, the do-nothing placebo group actually gained weight, as overweight people tend to do, whereas the vinegar groups significantly dropped their weight. Now, was the weight loss actually significant or just kind of statistically significant? Well, that’s for you to decide. This is in kilograms, so compared to placebo, the 2 tablespoons of vinegar a day group dropped five pounds by the end of the 12 weeks. 

That may not sound like a lot, but they got that for just pennies a day, without removing anything from their diet. And they got slimmer, up to nearly an inch off their waist, suggesting they were losing abdominal fat, but the researchers went the extra mile and put it to the test. They put the research subjects through abdominal CT scans to actually directly measure the amount of fat before and after in their bodies. 

They measured the amount of superficial fat, visceral fat, and total body fat. Superficial fat is the fat under your skin that makes for flabby arms and contributes to cellulite. But visceral fat is the killer. That’s the fat, shown here in white, building up around your internal organs that bulges out the belly. And that’s the kind of fat the placebo group was putting on when they were gaining weight. Not good. But both the low dose and high dose vinegar groups were able to remove about a square inch of visceral fat off that CAT scan slice. Now like any weight loss strategy, it only works if you do it.

 A month after they stopped the vinegar, the weight crept back up, but that’s just additional evidence that the vinegar was working. But how? A group of researchers in the UK suggested an explanation: vinegar beverages are gross. They made a so-called palatable beverage by mixing a fruity syrup and vinegar in water, and then went out of their way to make a really nasty unpalatable vinegar beverage, both with white wine vinegar, which were so unpleasant the study subjects actually felt nauseous after drinking them, so ate less of the meal they gave it with.

 So there you go — vinegar helps with both appetite control and food intake, though these effects were largely due to the fruity vinegar concoctions invoking feelings of nausea. So is that what was going on here? Were the vinegar groups just eating less? No, the vinegar groups were eating about the same compared to placebo. Same diet, more weight loss, thanks perhaps, to the acetic acid’s impact on AMPK. 

Now the CT scans make this a very expensive study, so I was not surprised it was funded by a company that sells vinegar, which is good, since otherwise, we wouldn’t have these amazing data. But is also bad because it always leaves you wondering if the funding source somehow manipulated the results. But the nice thing about companies funding studies about healthy foods, whether it’s some kiwifruit company, or the National Watermelon Promotion Board — watermelon.org check it out — is that what’s the worst that can happen? Here, for example. If the findings turned out to be bogus, worse comes to worst, your salad would just be tastier.


Vinegar Controls Blood Sugar

Thanks to NutritionFacts.org and Dr. Michael Greger

A double-blind placebo-controlled randomized study found that body weight and belly fat were significantly reduced by adding just a single tablespoon of vinegar to one’s daily diet, but is there any benefit to vinegar consumption if you’re not overweight? Well, their triglycerides normalized, and on the two tablespoons a day dose, there was a dip in blood pressure, but those effects may have just been because of the weight loss.

 Other than taste, is there any benefit to normal-weight individuals sprinkling vinegar on their salads? What about vinegar for blood sugar control? If you feed people massive amounts of sugar a half a cup of table sugar, as their blood sugars spike, their artery function can become impaired, and the higher the blood sugars go the more the arteries take a hit.

 There’s a drug, though, that can block sugar absorption and by blunting the blood sugar spike with the drug you can prevent the arterial dysfunction, demonstrating that it’s probably good for your heart if you don’t have big blood sugar spikes after meals and indeed how high your blood sugars spike after a meal is a predictor for cardiovascular mortality. 

So do people who eat lots of high glycemic foods like sugary foods and refined grains tend to have more heart attacks and strokes? Yes. And they appear more likely to get diabetes, but maybe people who eat lots of frosted flakes and Wonderbread also have other bad dietary habits. The diets that have been put to the test in randomized controlled trials and proven to prevent diabetes are the ones focusing on cutting down on saturated fat and ramping up the consumption of fiber-rich whole plant foods such as fruits, vegetables, and whole grains without specific regard to lower or higher glycemic loads. 

The drug has been put to the test, though, and blunting one’s mealtime blood sugar spikes does seem to reduce the risk of developing diabetes, as well as reduce the risk of heart attacks and high blood pressure. So is there any way to prevent these blood sugar spikes without having to take drugs? Well, one way would be to not sit down to a half cup of sugar! Yes, the drug can slow the progression of your atherosclerosis. 

Instead of the arteries going to your brain narrowing this fast, on the drug, they only narrow this fast. But wouldn’t it be better to eat a diet that actually reverses heart disease? Reverses diabetes? The healthiest diet to prevent the meal-related blood sugar and fat spikes, the oxidation and inflammation, is a diet centered around whole plant foods. 

But what if you really want a bagel? Instead of spreading drugs on it, spreading on some almond butter may help blunt the blood sugar spike from refined carbs. Another option is to dip your baguette in some balsamic vinegar. The consumption of vinegar with meals is evidently used as a home remedy for diabetes before drugs came along, but it wasn’t put to the test until 1988. After all, how much money can you make from vinegar? 

According to the vinegar institute, millions of dollars, but a single diabetes drug, like Rezulin, can pull in billions; before it was pulled from the market for killing too many people by shutting down their livers. The drug company still made off like a bandit having to pay out less than a billion to the grieving families for covering up the danger. 

No liver failure from a peanut butter schmeared bagel though, cutting the blood sugar response in half, and the same with vinegar; if you chug down four teaspoons of apple cider vinegar diluted in water, you get that same blunting of the spike, and you get the additional advantage over the nuts of lowering insulin levels in the blood, something peanut butter apparently can’t do, but presumably better than a bagel with lox, as fish causes triple the insulin response, or red wine, which also increases insulin level, but not as much as fish, and also shoots up triglycerides, though dealcoholized red wine, non-alcoholic wine doesn’t have the same problem. What about vinegar? 

Not only may a tablespoon a day tend to improve cholesterol and triglycerides over time, vinegar can drop triglycerides within an hour of a meal, along with decreasing blood sugars and the insulin spike, potentially offering the best of all worlds.