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Vinegar for Health – Does it Help?

            Perhaps you have heard that vinegar aids in weight loss and in lowering blood sugar.  As with many folk remedies, no one bothered to test this until 1988 when the Vinegar Institute put it to the test.  Well, that’s a red flag.  How seriously can you take an industry-funded study to sell more vinegar?

            Industry nutrition studies are the reason one week you find coffee, cheese, and red wine to be protective against heart disease and cancer, and the next week a new crop of studies pronounce that they cause it.  Unfortunately, it’s not just the food industry that deserves a bad rap; even university researchers are often suspected. One recent analysis found that thousands of scientists publish a paper every five days.  So long as misinformation in nutrition studies remains the norm rather than the exception, most will remain confused if they depend on popular news outlets and publications for their information.

            A classic example of misinformation is the egg industry’s claims that eggs don’t raise cholesterol levels.  In recent years, the egg industry has sought to neutralize eggs’ unhealthy image as a cholesterol-raising product by funding more studies to help skew public perceptions.  Want to know if hot dogs are healthier than spam?  Don’t be surprised to see headlines proclaiming “Hotdogs found healthier than alternatives!”  The food industry keeps the headlines tantalizing and people confused.  Confusion is an effective marketing strategy.  When people are confused, they tend to accept information in advertisement more easily.

            Fortunately, in one study about vinegar that was not funded by a company tied to the vinegar industry, two daily tablespoons of apple cider vinegar mixed into a drink was found to reduce fasting blood sugars in prediabetics by an average of sixteen points within one week.  Amazingly, this is better than what is often seen with antidiabetic drugs like Glucophage or Avandia.  Given that vinegar is safer, cheaper, and more effective you might wonder why it’s not prescribed more often.  As you might guess, there isn’t much profit in promoting vinegar when anyone can make it at home.  Obviously, no company is going to spend billions on clinical trials and advertising to sell vinegar pills?

            Amazingly, by adding two teaspoons of vinegar to a high-glycemic meal, you may reduce the blood sugar spike by 23 percent.  While you may be thinking this has something to do with vinegar from apples, it doesn’t matter what type of vinegar is used.  In a review of eleven studies, vinegar taken with a meal demonstrated improved both blood sugar and insulin responses.  Vinegar taken at bedtime also lowered blood sugars the next morning.  Adding vinegar to refined foods like white bread lowers blood sugar, lowers insulin spikes, and increases the feeling of being full after a meal.  When test subjects ate the same amount of bread with some vinegar, they felt twice as full and two hours later still felt nearly as full as they had when they had just eaten bread without vinegar.

            Many recipes take advantage of the synergy vinegar offers.  In Japan, foods made with rice often have vinegar added.  Compared with plain bread, sourdough bread offers an advantage. The same can be said for adding vinegar to potatoes (think potato salad).  So, if you must eat white bread, first dip it in a vinegar sauce.  Fortunately, for the gourmet, there are many types of vinegar to choose from. For weight loss, oil and vinegar dressing is going to be counterproductive for weight loss given that oil is fat with nine calories per gram.

            You may wonder if vinegar is this good, how much is too much?  In general, two to six tablespoons a day seems to be tolerated by most people.  However, I would recommend no more than two tablespoons a day taken over the course of the day.  Taken with food, that would be two teaspoons per meal.  Of course, always dilute vinegar, never drink it straight. In concentrated form, vinegar can burn your esophagus.  As for vinegar tablets, when eight different brands were tested, few were found to contain what was listed on the label.

            If curious about how vinegar can produce so many health effects, the explanation might surprise you.  Vinegar is mostly a dilute solution of acetic acid, in essence, what a chemist would call a short-chain fatty acid. These short-chain fatty acids are what the good bacteria naturally make in our colon when you eat foods with fiber and resistant starch.  Interestingly, our gut flora does this naturally when we eat plant-based whole foods.  Therefore, taking vinegar as a supplement, if already eating fiber-rich plant-based whole foods, may still be helpful, but is more likely to be redundant. In other words, if you have an excellent plant-based whole food diet, don’t be surprised if taking vinegar as a supplement has a negligible effect. Also, if your diet is poor, don’t expect a vinegar supplement to fix the problem.

            As for weight loss, in one study that lasted three months, the group taking one daily tablespoon of vinegar steadily lost about a pound a month, and the group taking two daily tablespoons was down a total of about five pounds.  Keep in mind, these were people eating the Standard American Diet (SAD).  When subjects stopped taking daily vinegar, the weight returned.

            Had the subjects been eating a plant-based whole food diet, their weight loss would have been expected to have been far greater and would have been far less affected by taking vinegar as a supplement. This simply means, if long term weight loss is the goal, start eating more plant-based whole foods.

            As for why short-chain fatty acids like vinegar stimulate the body to burn fat without making you feel hungry, it has to do with an enzyme called ‘AMP-activated protein kinase’ or just AMPK, one of the most important biomedical breakthroughs in the last few decades. The short story is that the fiber in plant-based whole foods is the preferred food for gut bacteria that make short-chain fatty acids that in turn stimulate the production of AMPK.

            For more about the science of AMPK and how vinegar and health are related, Dr. Michel Greger has four short videos about the advantages of vinegar and why it has taken so long to tease out its beneficial effects.

  1. Vinegar & Artery Function (6 min) – Sprinkling vinegar on greens may augment their ability to improve endothelial function
  2. Does Apple Cider Vinegar Help with Weight Loss? (7 min)- CT scans confirm that daily vinegar consumption can lead to a significant loss of abdominal fat.
  3. Can Vinegar Help with Blood Sugar Control? (5 min) – Before drugs came along, the consumption of vinegar with meals was used as a folk remedy for diabetes, but it wasn’t put to the test until recently.
  4. Optimal Vinegar Dose (4.5 min)  – How much vinegar should you consume with a meal to improve satiety and reduce the spike in blood sugar, insulin, and triglycerides?

            Nancy Neighbors, MD

What Is Apple Cider Vinegar?

            Apple cider vinegar is made in a two-step fermentation process.  In the first step, apples are crushed and combined with yeast, which converts the sugar in the apple into alcohol. In the second step, bacteria is added to ferment the alcohol into acetic acid.  The end product is mostly water with about 5–6% acetic acid.  Depending on the bacteria present in the second step, it may also contain small amounts of other acids.

            Acetic acid is the main active component of apple cider vinegar.  One tablespoon of apple cider vinegar contains about three calories and virtually no carbohydrates.

Effects of Vinegar

            Some studies have shown that people, on average, consume 200–275 fewer calories per day as the result of consuming two tablespoons of vinegar.

            Apple cider vinegar has been shown to slow the rate at which food leaves the stomach. Taking apple cider vinegar with a starchy meal significantly delays stomach emptying. This can increase feelings of fullness, lower blood sugar, and improved insulin sensitivity.

            The effects of improved insulin sensitivity can have positive effects on many health issues.  For example, in a small study of women with polycystic ovary syndrome who took vinegar, they resumed ovulation, again, likely due to improved insulin sensitivity

            Although the effect is modest, apple cider vinegar does stimulate the body to burn stored fat.  Interestingly, it does this by the same mechanism as nicotine, but without the harmful effects of nicotine.

            Apple cider vinegar kills harmful bacteria and viruses: As a result, vinegar helps the body resist some bacteria that cause food poisoning, including E. coli. In one study, vinegar reduced the numbers of certain harmful bacteria by 90% and some viruses by 95%.

Potential problems

            Apple cider vinegar helps promote fullness in part due to delayed stomach emptying. This may naturally lead to lower calorie intake. However, this could worsen gastroparesis (delayed stomach emptying), a common complication of type 1 diabetics needing to time insulin with food intake since it becomes difficult to predict how long it will take for blood sugar to rise after a meal.

            Taking more than two tablespoons per day isn’t recommended because of potentially harmful drug interactions or the erosion of tooth enamel. It’s best to begin with one teaspoon per day to see how well it’s tolerated.

            Taking more than one tablespoon at a time may cause nausea, especially when taken without a meal.

            Undiluted vinegar may burn the inside of your mouth and esophagus. It’s important to dilute it with water.

            Taking apple cider vinegar in tablet form is not recommended.  If a tablet gets lodged in her esophagus, the high acetic acid content can cause burns.

Use Vinegar as a Salt Substitute

            Vinegar adds sourness to a dish that often works well as a salt substitute for sauces, soups, and stews.  Adding a touch of vinegar, just before serving food, amps up the complexity of its flavors, much the same as salt or a squeeze of lemon.

            Begin by adding a dash (less than 1/8th of a teaspoon) to your dish and stir before adding salt. You may discover that salt isn’t needed.  The vinegar tends to reduce any bitterness that would normally been cancelled with salt.  As a bonus, vinegar adds a subtle complexity to the other flavors in your dish.  Remember, just a little is all that’s needed.

            For the best result, use a vinegar whose ingredients pair with the ingredients of the recipe you’re using.  If making a sauce that calls for red wine, then pair it with red wine vinegar.  For dishes that include sweeter flavors, use apple cider vinegar. In general, mild white wine vinegars are the best choice for an all-purpose vinegar seasoning.

            Low sodium diets don’t have to be lackluster.  By using a variety of vinegars as the finishing touch you might find the salt easy to skip. Best or course, your heart will thank you.  For more about the effects of salt in foods, read “Does Salt Cause High Blood Pressure” and “The Cheese Conundrum.”

Other Uses and Tips

            The Vinegar Institute provides a comprehensive list of uses for vinegar that have been reported as useful.  These tips include using vinegar around the home, food preparation, health, beauty, and more.  While the many possible uses are interesting, it would be wise to further research whether it’s the best or, for that matter, even safe for the specific uses promoted.  What we do know is that humans have been using vinegar for over 10,000 years with few reported problems when used in a dilute solution.  For a complete list of the Vinegar Institute’s list of suggested uses and tips, click here.

By Nancy Neighbors, MD

... Dr. Neighbors provides a blend of traditional family medicine and evidence-based lifestyle medicine in Huntsville, Alabama. When indicated, lifestyle change is recommended as the first line of therapy.

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