Can Apple Cider Vinegar Lower Blood Glucose Levels in Diabetics?
Sara Son and Daniel Atwood
Background
Apple Cider Vinegar comes from the fermented juice of apples and gets its acidic portion from acetic or citric acid. Apple Cider Vinegar is well known as a salad dressing and food additive. It has historically been used as a wound disinfectant. Apple Cider Vinegar is still used as a food additive but has gained popularity as a natural medicine. Current proposed uses of Apple Cider Vinegar include Diabetes, Hyperlipidemia, and Osteoporosis, among many others. This research poster aimed to look at the potential benefit Apple Cider Vinegar may have in lowering blood glucose levels in diabetic patients.
Studies
A systematic review of meta-analyses by Siddiqui et al. was conducted to determine the effects of vinegar on diabetic markers. The primary outcomes looked at were fasting blood glucose, postprandial blood glucose, and A1c levels. The authors looked at randomized and nonrandomized controlled clinical trials that included adults with type 1 and type 2 diabetes who were treatment naïve or on medication. The studies also had to report at least one of the primary outcomes, and the control intervention had to be a placebo or no intervention. The authors found small reductions in mean A1c levels were observed after 8 to 12 weeks and long-term, short-term, and adverse effect profiles favoring vinegar though the outcomes seen were not significant. The authors concluded the promise of vinegar in diabetes mellitus management and suggestions for future research, including long-term effectiveness and safety studies and more extensive and diverse studies.
Liljeberg et al. looked at the influence of acetic acid on postprandial glucose and insulin response. They did this using different bread types, one as a reference meal and another with acetic acid. They then measured blood glucose and insulin levels in ten healthy volunteers involved with the study. The authors found that the bread with acetic acid in the thirty- and seventy-minute postprandial phase resulted in lower blood glucose levels, and insulin responses were closely associated with the glucose levels. The authors concluded that acetic acid reduces postprandial glucose levels and insulin responses to bread meals in healthy subjects and that food products with organic acids should be included in the diet to reduce blood sugar levels and insulin demands.
A study done by Johnston et al. aimed to assess the effectiveness of vinegar in reducing postprandial glycemia and insulinemia in subjects with insulin sensitivity. It included eight insulin-sensitive subjects and eleven insulin-resistant subjects as controls and compared them to ten subjects with type two diabetes. Subjects were randomly assigned to consume either vinegar or a placebo drink along with a test meal 2 minutes later. Blood tests were collected to measure fasting and postprandial glucose levels. The authors found that acetic acid can improve postprandial insulin sensitivity in resistant subjects and concluded that it should be studied further to determine if it could be used as an antidiabetic therapy.
Conclusions
The studies used in our review do show a benefit when using apple cider vinegar in diabetes. However, common areas of concern in all the studies were the small sample size and lack of detail regarding study type and controlling for bias. More studies with larger sample sizes and increased quality are needed to ensure the efficacy and safety of Apple Cider Vinegar use in diabetes. Apple Cider Vinegar should not be used as a first-line treatment for diabetes. Still, it may be beneficial in some instances where patients struggle taking prescription medications and if potential interactions with other prescriptions and other supplements can be ruled out.
References
- 1. Liljeberg H, Björck I. Delayed gastric emptying rate may explain improved glycaemia in healthy subjects to a starchy meal with added vinegar. Eur J Clin Nutr. 1998 May;52(5):368-71. doi: 10.1038/sj.ejcn.1600572. PMID: 9630389.
- 2. Johnston CS, Kim CM, Buller AJ. Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care. 2004 Jan;27(1):281-2. doi: 10.2337/diacare.27.1.281. PMID: 14694010.
- 3. Siddiqui, Fahad Javaid et al. “Diabetes Control: Is Vinegar a Promising Candidate to Help Achieve Targets?.” Journal of evidence-based integrative medicine 23 (2018): 2156587217753004. doi:10.1177/2156587217753004
- Natural Medicines. (9/22/2020). Apple Cider Vinegar [Monograph]. http://naturalmedicines.therapeuticresearch.com
- Streit, L. (2018, July 31). Apple cider Vinegar Pills: Should you take them? https://www.healthline.com/nutrition/apple-cider-vinegar-pills.
- Wong, C. (2020, December 4). The health benefits of apple cider vinegar. Verywell Health. https://www.verywellhealth.com/apple-cider-vinegar-88768.
- Kennedy, M. (2020, June 26). Apple cider vinegar may help with weight loss – Here’s what the research says. Insider. https://www.insider.com/what-is-apple-cider-vinegar-good-for.
- (2019, October 3). Apple cider Vinegar: Benefits, Uses, risks, and dosage. WebMD. https://www.webmd.com/diet/apple-cider-vinegar-and-your-health#1.
- Vinegar Ingestion at Bedtime Moderates Waking Glucose Concentrations in Adults With Well-Controlled Type 2 Diabetes Andrea M. White, Carol S. Johnston Diabetes Care Nov 2007, 30 (11) 2814-2815; DOI:2337/dc07-1062
Responses
Hello Sara and Daniel – what are the two main things you learned from preparing and developing this topic?
I found the wide array of dosage forms like capsule and gummies available for apple cider vinegar interesting and proof that the use of apple cider vinegar may be going more mainstream. Also, the potential acidic effects it could have on a patient, like tooth enamel damage, were not things I had given any thought to when counseling patients on using it.
Interesting topic. What doses were used in these studies? What would you say to persons with diabetes that wanted to use this product in terms of what to expect? Who should avoid this product?
Studies that I used in the poster indicates that they used vinegar solution mixed in water (study 3)or a vinaigrette sauce that was made from 20 grams of white vinegar + 20 gram water + 8 gram olive oil (study 1) and measuring postprandial glucose and insulin sensitivity in both healthy subject and Type II diabetic subjects. There was many heterogeneity differences between the study population and intervention. However, all three studies reported that moderate consumption of apple cider vinegar helped lower blood glucose levels. Most research recommends a daily dosage of approximately 1-2 tablespoons (15-30ml) mixed with water, taken before or after meals daily. However, the exact dosage may vary from patient’s medical conditions such as if they are a healthy individual or if they have multiple medical conditions. For persons with pre-diabetes or Type 2 diabetes who are currently taking oral antidiabetic medications, they could take apple cider vinegar with low to moderate consumption. However, they need to monitor signs and symptoms of hypoglycemia when combined with other antidiabetic medications or other over the counter supplements that can cause hypoglycemia. People with Type I diabetes who are using insulin and pregnant women (not enough data) should avoid taking apple cider vinegar product for any serious side effects. I would recommend people to check with a pharmacist or provider prior to starting apple cider vinegar for any drug-drug interaction and always follow the package directions on the product.
Great poster Sara! I have heard of people using apple cider vinegar for digestion but not as much for lowering glucose. Very interesting! One question I have is if the adverse effect of damaging tooth enamel is more associated with one preparation as compared to others? For example, with the liquid and gummy preparation as compared to the tablets?
Good question Tiffani,
It is only for high concentration of apple cider vinegar liquid due to high concentration level of acetic acid in the solution. Also, long-term consumption of the product likely to increase the risk of damaging tooth enamel. To help reduce the risk of tooth enamel erosion, a person should dilute vinegar in plenty of water before consumption.
I hope this was helpful.
Thanks.
Great information! I have heard apple cider vinegar being used for a plethora of reasons so I am curious to see if your research mentioned any positive reasons to use it or did it just focus on glucose control?
Good question James,
Unfortunately, I do not have any other positive information about the benefits of apple cider vinegar besides glucose control in my poster. The antidiabetic properties are the most promising because of the backing of several meta-analyses on clinical trials supporting vinegar’s ability to lower postprandial glucose and improve insulin sensitivity. However, several studies reported that people who were taking apple cider vinegar to lower their glucose level had some weight loss at the same time.
I hope this was helpful.
Hello Sara and Daniel!
This looks great. It’s interesting to see the results you found regarding apple cider vinegar’s use for lowering postprandial levels.
Were there any studies or data you found regarding the use of apple cider vinegar to lower a patient’s A1c?
Thanks for the question Ryle.
Study #3 clinical trial indicates that there were small significant reduction in mean HbA1c was observed after 8 to 12 weeks of vinegar administration: -.39% (95% CI=-0.59, -0.18; i^2=0%). The study shows that an in vitro study showed that acetic acid suppressed sucrase activity. Though promising, the study had small sample sizes and does not include the patient’s initial baseline HbA1c level when they participated in the study.
Ryley, the majority of the studies we found looked at blood glucose levels over the period of a few hours due to the ease of measuring and recording those results. We did find a meta-analysis that discussed some studies that measured A1c at anywhere from 8 to 12 weeks, and they found a decrease in A1c of at least 0.14 percent. So, small decreases but changes were observed.
Weird fact: I love apple cider vinegar. I’ve heard people say it’s good for you but never knew why. Do you know if taking the diluted vinegar mixture or a capsule is better?
Thanks for the question Laura.
According to Consumer Lab.com bottled apple cider vinegar typically contains about 4 to 5 % acetic acid and about 700 to 800 mg of acetic acid. The amounts of acetic acid found in apple cider vinegar supplements (in gummy, capsule, or tablet form), is just a small fraction of that in the bottled products. Anything less than 400 mg of apple cider vinegar is not effective according to one of the clinical data sets. I would recommend gummies over the solution of apple cider vinegar to reduce side effects. Not to mention, it is easier to take than trying to dilute the vinegar solution.
I hope this was helpful.
Very interesting poster! I feel like I see a lot about apple cider vinegar for diets. I was curious were the findings of the Liljeberg study significant? Thanks!
Thank you for the question Jake.
The “Liljeberg” study was done only in healthy volunteers, seven women and three men, aged 22-51 years old, with normal body mass index. The aim of the study was to evaluate the possible influence of acetic acid on the postprandial glucose and insulin responses in healthy subjects. The authors trying to analyze the mean incremental blood glucose responses and serum insulin responses (see figure) in healthy subjects following ingestion of white wheat bread(WWB) and WWB with added vinegar. Like as the graph indicates that the values with values are significantly different, P <0.05. The author states that in the study, the effect of vinegar was neutralized with Na-bicarbonate, thus forming Na-acetate. The meal with added vinegar, the meal with Na-acetate displayed the high postprandial responses in glucose.
I hope this was helpful.
Really great poster! Is there any interactions between this and other medications used to control blood sugar such as metformin and insulin?
Feng, thanks for the question! That was one of the biggest potential interactions we found as combining oral antidiabetic agents, and apple cider vinegar could cause hypoglycemia
Daniel. What dose of ACV would cause hypoglycemia in a patient suffering from diabetes?
Tyler, I think that would depend on many factors as it is more of a theoretical interaction. If a patient were combining ACV with oral antidiabetics, there would definitely be a higher risk of hypoglycemia vs. just taking ACV on its own. We didn’t see massive changes in blood glucose in our studies, so I would say maintaining doses around what was described in our listed studies along with good blood glucose monitoring would be the best way to avoid any hypoglycemic events until more studies are done.
Hi Sara and Daniel
Nice work on the poster! This is an interesting topic. I actually had a question on it this week! Lady who was also on Eloquis and BP Rxs. I told her to avoid it due to the lack of study with coagulation drugs and possible low K+ with BP Rx. I liked the format of the poster; really easy to hit high points and then detail. I wonder if this product over time would lend to gastric erosion?
Dr. Orlando,
That is really great question. I was wondering about that too because some studies show that high concentrations of acetic acid can lead to erosion in tooth enamel in long term usages. Maybe I should look into it and see if there are any clinical trail studies that have been done relating to the development of gastric erosion from acetic acid products.
Thank you Dr. Orlando
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