Apple cider vinegar

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.

Related Terms:

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

Dosing:

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:

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

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:

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, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Rae Abrams, PharmD (University of Rhode Island); Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Heather Boon B.Sc.Phm, PhD (University of Toronto); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Nicole Giese, MS (Natural Standard Research Collaboration); Mary Giles, PharmD (University of Rhode Island); Karta Purkh Singh Khalsa, CDN, RH (AHG, Bastyr University); Catherine DeFranco Kirkwood, MPH, CCCJS-MAC (MD Anderson Cancer Center); Christine Park, PharmD (Northeastern University); Adrianne Rogers, MD (Boston University); Erica Rusie, PharmD (Nova Southeastern University); Joshua Sklar, PharmD (University of Rhode Island); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Jennifer Woods, BS (Natural Standard Research Collaboration).

References:

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 www.naturalstandard.com. 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.
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.

Disclaimer :

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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