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7 Benefits and Side Effects of Apple Cider Vinegar [Updated Jan/2023]

Apple cider vinegar is a popular home remedy. People have used it for centuries in cooking and medicine.

Many people claim it can relieve a wide range of health complaints, but you may wonder what the research says.

Apple cider vinegar has various healthful properties, including antimicrobial and antioxidant effects. What’s more, evidence suggests it may offer health benefits, such as aiding weight loss, reducing cholesterol, lowering blood sugar levels, and improving the symptoms of diabetes.

However, little research exists, and further studies are needed before it can be recommended as an alternative therapy.

Apple cider vinegar is regarded as one of the best health foods today and has many health benefits.

The following will introduce why apple cider vinegar and its acetic acid are important, and discuss the effects of ingestion.


What is apple cider vinegar?

In human history, vinegar can be traced back to the Kingdom of Babylon in 5000 BC. It is often used for flavoring, antiseptic and medical purposes.

Apple cider vinegar is made by fermenting apple juice or chopped apples. The production process is mainly divided into two steps.

The first step is to expose the chopped apple to yeast, which ferments the sugar and converts it into alcohol.

The second step is to add acetic acid bacteria to further ferment the alcohol and turn it into acetic acid (a short-chain fatty acid, the main active substance in apple cider vinegar).

Like apple juice, apple cider vinegar may contain some pectin, vitamin B1 B2, biotin, folic acid, niacin, and vitamin C. It also contains a small amount of minerals: sodium, phosphorus, potassium, calcium, iron, and magnesium.


What are the benefits of apple cider vinegar?

  1. Apple cider vinegar benefits emotional state

Depression, characterized by low mood, anhedonia and loss of interest, affects physical and mental health, places a heavy burden on individuals, families and society, and is expected to be in the top three of all disease burdens by 2030.

At present, the treatment methods of depression mainly include drug treatment, psychotherapy, biological intervention (electroconvulsive therapy, transcranial direct current stimulation, transcranial magnetic stimulation) and natural therapy intervention

A randomized placebo-controlled study (4-week study of 27 healthy college students) showed that apple cider vinegar (2 tablespoons twice daily, 5% acidity, with meals) reduced melancholic scores (as measured by the Centre for Emotional State (POMS) and Depression Epidemiology Research Center (CES-D) questionnaire). Note 1

*Conclusion: For adults in good health, apple cider vinegar consumption may bring positive help to emotional state, but limited by the small sample size, more studies are needed to further validate

  1. Apple cider vinegar benefits varicose veins (topical)

Varicose veins and venous insufficiency are the most common diseases affecting adults. It is estimated that 25% of women and 15% of men in people over 15 years old are affected by them.

The occurrence of varicose veins is related to a variety of predisposing factors, such as age, gender, pregnancy, heredity, physical fitness, and lifestyle.

When venous valves fail and venous insufficiency, it can lead to local venous hypertension, venous filling/enlargement, tissue edema and changes in tissue perfusion.

One randomized controlled trial (1 month, 120 patients with varicose veins classified between 1 and 3 CEAP) with an uninterventional control group (receiving only conventional conservative treatment) and one receiving external application of apple cider vinegar to the affected area in addition to usual conservative treatment. Note 1

The results showed that compared with the control group, the subjects with apple cider vinegar applied externally had statistically significant improvements in a number of measures, including: cramps, pain, leg fatigue, edema, itching, pigmentation, leg weight perception, pain visual analog scale, and social appearance anxiety scale

*Conclusion: In addition to the conservative treatment of varicose veins, combined with external application of apple cider vinegar may improve the therapeutic effect, but it is limited by the small number of samples, and more studies are needed for further verification

  1. Apple cider vinegar benefits blood sugar control

Type 2 diabetes is a chronic and progressive disease. The hyperglycemia state is caused by the imbalance between the human body’s demand for insulin and its ability to produce, especially postprandial hyperglycemia as the initial sign, which will then develop into early morning hyperglycemia, and eventually Hyperglycemia persists into the night.

Relevant evidence suggests that postprandial hyperglycemia may be an independent risk factor for cardiovascular disease, stroke, retinopathy, renal failure and neurological complications.

A literature review and meta-analysis (11 controlled trials, 204 participants) showed that participants who drank vinegar with meals had significantly lower mean glucose and area below curve compared with controls. Note 1

The mechanism behind it may be related to the ability of vinegar to slow down gastric emptying rate, inhibit the disaccharide activity of small intestinal epithelium, promote glucose absorption and utilization, and inhibit digestion of amylase

*Conclusion: Ingesting apple cider vinegar during or after a meal may significantly reduce postprandial blood glucose and insulin response, and is a viable auxiliary option for improving blood glucose control

  1. Apple cider vinegar benefits polycystic ovary syndrome

Polycystic ovary syndrome is one of the most common endocrine diseases in women. It is a disease characterized by excessive androgen, ovulation dysfunction and polycystic ovary morphology.

Prevalence estimates range from 6.5% to 8%, with common symptoms such as infertility, menstrual irregularities, hirsutism, or other external manifestations of excess androgens, such as acne or hair loss.

In addition, evidence shows that 50% to 70% of people with PCOS have insulin resistance, which not only increases the risk of infertility, dysfunctional uterine bleeding, metabolic syndrome, type II diabetes, cardiovascular disease, but also often accompanied by obstructive sleep apnea, depression, nonalcoholic fatty liver and other diseases.

A pilot study (90 to 110 days in seven people with PCOS) suggested that apple cider vinegar intake helped improve insulin resistance index, LH/FSH (luteinizing hormone/follicle-stimulating hormone ratio), and ovulatory menstrual events. Note 2

*Conclusion: For patients with polycystic ovary syndrome, ingesting apple cider vinegar can restore ovulation function by improving insulin sensitivity, but it is limited by the small number of samples, and more large-scale trials are needed to prove it.

  1. Apple cider vinegar benefits vascular endothelial function

The endothelium is one of the largest organs in the human body. It is mainly located on the inner walls of blood vessels and lymphatic vessels. It is composed of as many as one trillion cells and weighs more than 1 kilogram. There are nearly 3 square meters of endothelial tissue in a 70 kilogram male body.

The endothelium is involved in many physiological and pathological processes, including: thrombosis, anticoagulation, regulation of vascular tension, vasoconstriction and dilation, angiogenesis, wound healing, fibrosis, barrier function and inflammatory response

Endothelial Dysfunction is an early indicator of atherosclerosis. The factors that cause endothelial abnormalities include smoking, obesity, age, hypertension, hyperlipidemia, lack of exercise and poor eating habits.

A cell and human study pointed out that vinegar has the effect of stimulating the synthesis of endothelial nitric oxide synthase and regulating vasodilation. Note 3

*Conclusion: Ingestion of apple cider vinegar can achieve the effect of preventing cardiovascular disease by improving vascular endothelial function, but the relevant evidence is still insufficient, and more studies are needed to support it

  1. Apple cider vinegar benefits cystitis (reduce urinary tract infection related to urinary catheter)

Urinary tract infection is the most common type of hospital-acquired infections, most of which are related to indwelling catheters. About 15% to 25% of patients have received indwelling catheters in emergency care. Cystitis is a common type of urinary tract infection (UTI), particularly in women.

Due to the high incidence of cystitis catheter-associated urinary tract infections, the total cost of medical intervention is staggering. The United States spends approximately US$424 to 451 million annually to control these infections.

Once catheter-related urinary tract infections develop into symptomatic infections, complications can range from mild (fever, urethritis, and cystitis) to severe (acute pyelonephritis, renal scarring, stone formation, and bacteremia).

A single-blind randomized controlled trial (4 weeks, 60 patients with long-term catheterization) noted that vinegar improved urine pH, bacterial titers, and turbidity and reduced symptomatic urinary tract infection events compared with the control group receiving water. Note 4

*Conclusion: Ingestion of apple cider vinegar may reduce urinary tract infections related to urinary catheters, but more large-scale trials are needed to support this

  1. Apple cider vinegar benefits weight loss

In the history of biological evolution, both humans and animals have evolved a redundant mechanism that promotes fat accumulation when there is food to help survive the famine.

However, in the current “pathological environment” or “fatogenic environment”, assets in the evolutionary process have become liabilities, and excess fat accumulation and obesity have become the root causes of chronic diseases.

A randomized, double-blind, placebo-controlled trial (12 weeks, 175 obese participants) showed that apple cider vinegar consumption reduced body weight, body mass index (BMI), visceral fat, waist circumference, and serum triglyceride levels compared with placebo. Note 5

The mechanism behind it may be related to the fact that acetic acid in apple cider vinegar inhibits fat production and stimulates fatty acid oxidation

*Conclusion: Intake of apple cider vinegar may be able to reduce obesity and reduce metabolic diseases, but more large-scale studies are still needed to prove it


What are the side effects of apple cider vinegar?

Apple cider vinegar is a commodity that has recently gained fame in the field of health and wellness, and the word vinegar, which comes from the French vin aigre, meaning “sour wine,” can be made from almost any fermentable carbohydrate source, including grapes, sorghum, apples, pears, berries, melons, coconut, honey, potatoes, beets, malt, grains, and whey.

The vinegar production process is divided into 2 stages, initially, yeast ferments natural food sugars into alcohol. Next, acetic acid bacteria convert alcohol into acetic acid, a fermentation process that takes weeks or months

For most people, apple cider vinegar is very safe in moderation, but there have been some literature on apple cider vinegar side effects or harms, especially in large doses or improper use, which are listed below.

  1. Apple cider vinegar side effect: reduces appetite

Satiety refers to the feeling of fullness gained during eating, which prompts people to stop eating.

Gastric diastolic receptors detect the expansion of the stomach wall in the presence of food, directly stimulating nerve pathways in the brain, triggering satiety and decreased appetite.

Studies have found that apple cider vinegar and acetic acid may reduce appetite and increase feelings of fullness, leading to a natural decrease in calorie intake. Note 1Note 2

  1. Apple cider vinegar side effect: tooth erosion

Tooth erosion refers to the progressive, chronic loss of the hard tissues (enamel and dentin) of the tooth, caused by acid of intrinsic or extrinsic origin.

Over the past decade, tooth erosion has increased significantly among younger people due to changes in diet, behaviour and hygiene.

This leads to an increasing number of non-caries lesions, especially tooth erosion, with prevalence ranging from 1.8% to 34.1%.

Studies have shown that long-term ingestion of apple cider vinegar may lead to tooth erosion and even tooth decay (gargling with water after use can reduce the risk). Note 3

  1. Apple cider vinegar side effect: esophageal (throat) burns

Ingestion of acidic or alkaline corrosive substances can cause severe esophageal and gastric damage.

The degree of damage depends on the nature of the substance, the amount of ingestion or its concentration and state (solid or liquid) and the time of contact with the mucosa of the gastrointestinal tract.

While most cases occur in children, some involve adults who attempt suicide, those with mental illness, and alcoholics.

Studies have shown that ingestion of undiluted stock solutions or preparations may cause esophageal (throat) burns, and there was a case of a woman who developed sensitivity and pain in the throat after swallowing apple cider vinegar lozenges and still felt difficulty swallowing up to 6 months after the event. Note 4

  1. Apple cider vinegar side effect: skin burning injury

Skin burning injuries are a widespread and burdensome intensive care problem and one of the most destructive, causing not only physical deformities but also enormous psychosocial and emotional damage.

Studies have pointed out that topical apple cider vinegar on the skin may cause erythema, irritation, severe and even erosion, and there was a case of skin ulceration caused by a 14-year-old girl using apple cider vinegar to remove moles. Note 5

  1. Apple cider vinegar side effect: delay gastric emptying

Gastroparesis (also known as delayed gastric emptying) is a gastric retention phenomenon without mechanical obstruction, the main symptoms of which include postprandial satiety (premature satiety), nausea, vomiting, and bloating.

Because apple cider vinegar has the effect of delaying gastric emptying, it may worsen symptoms in patients with gastroparesis with type 1 diabetes and make blood sugar control difficult due to the inability to accurately grasp the timing of medication. Note 6

  1. Apple cider vinegar side effect: low blood potassium and bone loss

Potassium is an essential nutrient. It is the most abundant cation in the intracellular fluid and plays a key role in maintaining cell function.

Adequate dietary potassium reduces the risk of stroke, prevents the development of damage to renal vessels, glomeruli and tubules, reduces urinary calcium excretion, reduces the formation of kidney stones, reduces osteoporosis.

In one case, a 28-year-old woman who drank 8 ounces (250 milliliters) of diluted apple cider vinegar daily for six years was hospitalized with low blood potassium and osteoporosis after being unwell. Note 7

The reason behind this is that drinking large doses of vinegar may increase bone mineral loss (to neutralize blood acidity) and reduce osteogenesis

  1. Apple cider vinegar side effect: inhalation laryngospasm

Laryngospasm is a sudden flaming of the vocal cords, making it temporarily difficult to speak or breathe, and may be related to anxiety, stress, asthma, gastroesophageal reflux disease, or vocal cord dysfunction

In one case, inhalation of high concentrations of vinegar may lead to laryngospasm and subsequent vasovagal syncope. Note 8

  1. Apple cider vinegar side effect: parasitic infections

It is estimated that nearly one-third of the world’s population has suffered from parasitic infections, making them the most prevalent infectious disease in the world today.

Chronic helminths infecting the intestines are associated with dangerous, persistent health conditions such as anemia, growth retardation, calorie deficit protein, fatigue, and poor cognitive development.

In Europe, several patients developed anisakiasisis with abdominal pain or intestinal obstruction after eating herring impregnated in vinegar. Note 9

The factors behind it are related to improper storage or undercooked raw ingredients, so don’t ignore the hygiene and safety of ingredients because vinegar has a sterilizing effect.

Safety Precautions

  1. Do not use by pregnant and lactating women (due to unknown safety)
  2. Diabetics or those taking related hypoglycemic drugs should use with caution (because apple cider vinegar may lower blood sugar levels)
  3. Do not use it with Digoxin (digoxin, a drug for heart failure), because long-term drinking of a large amount of apple cider vinegar will cause hypokalemia, and hypokalemia will increase the drug-related side effects of Digoxin
  4. Overdose of insulin may lower blood potassium, and excessive use of apple cider vinegar is also associated with hypokalemia, so the combination of the two may cause hypokalemia, causing an unknown danger
  5. Do not use it in combination with diuretics, because diuretics will reduce blood potassium concentration, so the parallel of the two may cause low blood potassium, causing unknown danger, related drug names are: chlorothiazide, chlorthalidone, furosemide, hydrochlorothiazide

How to drink apple cider vinegar?

The appropriate dosage of apple cider vinegar varies according to the age, health and other conditions of the drinker.

It is recommended to follow the relevant instructions on the product label before use. If there is any discomfort during use, please consult a pharmacist, doctor or medical professional immediately.

The best way to incorporate apple cider vinegar into your diet is to use it in cooking. It is generally used to make salad dressings, mayonnaise, or to add to cooking.

Or you can dilute the original solution with water and drink it as a drink. The general dosage ranges from 5 to 30 ml per day

It is best to start with a small dose and avoid large amounts, because too much vinegar may cause gastrointestinal irritation.


How to choose apple cider vinegar?

The longer the fermentation time of natural brewed vinegar is, a layer of white non-toxic slime (showing wavy suspension) will appear on the surface of the liquid. These substances are called “mother of vinegar” and are produced by apple cider vinegar during the fermentation process. Composition of beneficial bacteria and natural enzymes.

Most manufacturers filter and pasteurize the product before bottling to prevent the formation of these microorganisms. The most important feature of this type of product is its clearer color.

These versions of vinegar can still be used for cleaning, drinking, and cooking purposes, but because the ingredient called mother of vinegar is eliminated by sterilization or filtration, the benefits are greatly reduced

Therefore, it is better to choose a brand labeled Unpasteurized and Unfiltered at the time of purchase.

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