Apple Cider Vinegar

• Overview
• Uses
• Side Effects
• Precautions
• Interactions
• Dosing

Apple cider vinegar is fermented juice from crushed apples. Like apple juice, it probably contains some pectin; vitamins B1, B2, and B6; biotin; folic acid; niacin; pantothenic acid; and vitamin C. It also contains small amounts of the minerals sodium, phosphorous, potassium, calcium, iron, and magnesium. Apple cider vinegar can also contain significant quantities of acetic acid and citric acid. It is used to make medicine.

Apple cider vinegar is taken by mouth alone or with honey for diabetes, indigestion (dyspepsia), delayed gastric emptying (gastroparesis), weak bones (osteoporosis), weight loss, leg cramps and pain, sore throats, sinus problems, high blood pressure, osteoarthritis, to help rid the body of toxins, stimulate thinking, slow the aging process, reduce cholesterol, and fight infection.

Some people apply apple cider vinegar to the skin for acne, as a skin toner, to soothe sunburn, for shingles, insect bites, and to prevent dandruff. It is also used in the bath for vaginal infections.

In foods, apple cider vinegar is used as a flavoring agent.

It can be hard to know what's in some apple cider vinegar products. Laboratory analysis of commercially available apple cider vinegar tablets shows wide variation in what they contain. Amounts of acetic acid ranged from about 1% to 10.57%. Amounts of citric acid ranged from 0% to about 18.5%. Amounts of ingredients listed on the product labels didn't match the laboratory findings. In the US, there is no real definition in the law of what apple cider vinegar must contain to be called apple cider vinegar. So, it is impossible to tell from these analyses whether these commercial products actually contain any apple cider vinegar.

How does it work?

Apple cider vinegar is the fermented juice of crushed apples. It contains acetic acid and nutrients such as B vitamins and vitamin C. Apple cider vinegar might help lower blood sugar levels in people with diabetes by changing how foods get absorbed from the gut. Apple cider vinegar might prevent the breakdown of some foods.

Insufficient Evidence to Rate Effectiveness for...

• Diabetes. Early research shows that taking apple cider vinegar with a meal improves insulin sensitivity and insulin levels after the meal in people with insulin resistance. But it doesn't seem to have a significant benefit in people with type 2 diabetes.
• Slow digestion (gastroparesis). Early research shows that taking apple cider vinegar worsens gastric emptying rate in people with type 1 diabetes and slow digestion.
• Acne.
• Arthritis.
• Bites.
• Dandruff.
• High blood pressure.
• Improving circulation.
• Infection.
• Leg cramps and pain.
• Lowering cholesterol.
• Shingles.
• Sinus problems.
• Sore throats.
• Sunburn.
• Unsettled stomach.
• Vaginal infections (vaginitis).
• Weak bones (osteoporosis).
• Weight loss.
• Other conditions.

More evidence is needed to rate apple cider vinegar for these uses.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).

Consuming apple cider vinegar in food amounts is LIKELY SAFE. Apple cider vinegar is POSSIBLY SAFE for most adults when used short-term for medical purposes. Apple cider vinegar is POSSIBLY UNSAFE when applied to the skin or when taken by mouth in large amounts, long-term.

Consuming large amounts of apple cider vinegar long-term might lead to problems such as low potassium. There has been one report of a person who developed low potassium levels and weak bones (osteoporosis) after taking 250 mL apple cider vinegar daily for 6 years. In another report, a woman who had an apple cider vinegar tablet lodged in her throat for 30 minutes developed tenderness and pain in her voice box and difficulty swallowing for 6 months following the incident. This was thought to be due to the acid content of the tablet.

Applying apple cider vinegar to the skin has been reported to cause chemical burns even after one use.

Pregnancy and breast-feeding: Not enough is known about the safety of using apple cider vinegar as medicine during pregnancy and breast-feeding. Stay on the safe side, and don't use it.

Diabetes: Apple cider vinegar might lower blood sugar levels in people with diabetes. Therefore, blood sugar levels need to be monitored closely. Dose adjustments may be necessary for diabetes medications that are taken.

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Digoxin (Lanoxin)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Large amounts of apple cider vinegar can decrease potassium levels in the body. Low potassium levels can increase the side effects of digoxin (Lanoxin).

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InsulinInteraction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Insulin might decrease potassium levels in the body. Large amounts of apple cider vinegar might also decrease potassium levels in the body. Taking apple cider vinegar along with insulin might cause potassium levels in the body to be too low. Avoid taking large amounts of apple cider vinegar if you take insulin.

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Medications for diabetes (Antidiabetes drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Apple cider vinegar might decrease blood sugar in people with diabetes. Diabetes medications are also used to lower blood sugar. Taking apple cider vinegar along with diabetes medications might cause your blood sugar to go too low. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.

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Water pills (Diuretic drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Large amounts of apple cider vinegar can decrease potassium levels in the body. "Water pills" can also decrease potassium in the body. Taking apple cider vinegar along with "water pills" might decrease potassium in the body too much.

Some "water pills" that can deplete potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Microzide), and others.

The appropriate dose of apple cider vinegar depends on several factors such as the user's age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for apple cider vinegar. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.