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Apple cider vinegar

Last Updated on May 19, 2021 by MyFormulary

Alternate Title

  • Cider vinegar

Related Terms

  • Acetic acid, ACV, apple cider vinegar plus honey cocktail, apple cider vinegar tablets, cider vinegar, Malus sylvestris, Mother Nature’s perfect food.

Background

  • Apple cider vinegar (ACV) is prepared by pulverizing apples into a slurry of juice and pulp and then adding yeast and sugars.
  • Reports of the healing properties of apple cider vinegar date to 3300 BC. In 400 BC, Hippocrates supposedly used apple cider vinegar as a healing elixir, an antibiotic, and for general health. Samurai warriors purportedly used a vinegar tonic for strength and power. U.S. Civil War soldiers used a vinegar solution to prevent gastric upset and as a treatment for pneumonia and scurvy.
  • Apple cider vinegar has been used alone and in combination with other agents for many health conditions. Anecdotally, ancient Egyptians used apple cider vinegar for weight loss. During the diet “craze” of the 1970s, proponents suggested that a combination of apple cider, kelp, vitamin B6, and lecithin could “trick” the body’s metabolism into burning fat faster. Claims of preventing viral and bacterial infections, as well as allergic reactions to pollen, dander, and dust, stem from the proposed ability of apple cider vinegar to prevent alkalinization of the body. However, there is not enough scientific evidence to form a clear conclusion about the efficacy or safety of apple cider vinegar for any health condition.
  • There may be long-term risks associated with the acidity of apple cider vinegar, including low blood potassium levels (hypokalemia) or diminished bone mineral density.

Evidence Table

    Disclaimer

    These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

*Key to grades:

Tradition

    Disclaimer

    The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

    Disclaimer

    The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

  • Adults (over 18 years old)

    • No specific doses are supported by well-designed clinical trials. In general, 2 teaspoons of cider vinegar have been taken in 1 cup water three times daily. Also, 285-milligram tablets have been taken with meals. Topical and rectal preparations have also been used but safety is unclear.
  • Children (under 18 years old)

    • Not enough available evidence.

Safety

    Disclaimer

    The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

  • Allergies

    • Caution should be exercised in patients with known allergy or hypersensitivity to apple cider vinegar or any of its ingredients, including apples and pectin.
  • Side Effects and Warnings

    • There is little scientific study of the safety of apple cider vinegar. The acidity of undiluted apple cider vinegar may destroy tooth enamel when sipped orally. Use cautiously in patients with low potassium levels or taking potassium-lowering medications. Use cautiously in patients with diabetes since apple cider vinegar may contain chromium, which may affect insulin levels. Use cautiously in patients with osteoporosis, based on one case report. Avoid sipping or drinking undiluted apple cider vinegar.
  • Pregnancy and Breastfeeding

    • Not recommended due to lack of sufficient data. Likely safe when taken orally as food flavoring. Possibly unsafe when used in larger amounts.

Interactions

    Disclaimer

    Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

  • Interactions with Drugs

    • Note: Theoretical interactions are based on potential pH altering effects of apple cider vinegar. The degree to which apple cider vinegar affects blood pH is currently not established.
    • Theoretically, long-term oral use of apple cider vinegar can decrease potassium levels, increasing the risk of toxicity of cardiac glycoside drugs such as digoxin (Lanoxin®). Long-term use may also add to the potassium-lowering effects of insulin, laxatives, and diuretics such as furosemide (Lasix®).
  • Interactions with Herbs and Dietary Supplements

    • Note: Theoretical interactions are based on potential pH altering effects of apple cider vinegar. The degree to which apple cider vinegar affects blood pH is currently not established.
    • Theoretically, long-term oral use of apple cider vinegar can decrease potassium levels. This may increase the risk of toxicity of cardiac glycoside herbs, add to the potassium-lowering effects of diuretics, and/or add to the potassium-lowering effects of laxative herbs.

Attribution

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration ().

Bibliography

    Disclaimer

    Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to . Selected references are listed below.

  • Lhotta K, Hofle G, Gasser R, et al. Hypokalemia, hyperreninemia and osteoporosis in a patient ingesting large amounts of cider vinegar. Nephron 1998;80(2):242-243.
    View Abstract
  • Shindea UA, Sharma G, Xu YJ, et al. Insulin sensitising action of chromium picolinate in various experimental models of diabetes mellitus. J Trace Elem Med Biol 2004;18(1):23-32.
    View Abstract
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