Dear Dietitian – What’s the real story with apple cider vinegar?

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Published Thursday, May 7, 2020
PICT Leanne McCrate Dear Dietitian
by Leanne McCrate, RDN, LD, CNSC

Dear Dietitian,

Can you settle a bet between my sister and me? She says apple cider vinegar has many health benefits and that it even can help with weight loss. I say that's bologna. What do you say?


Dear Jenny,

If you check out apple cider vinegar (ACV) on the internet, you will find uses for it from weight loss to blood sugar management to cancer treatment. How is one to know what to believe?

Apple cider vinegar, or just cider vinegar, is made from apples and water that have fermented over time, producing alcohol. Then a bacterium known as Acetobacter converts the alcohol to acetic acid, and the concoction becomes vinegar. Some claim that ACV is rich in micronutrients and antioxidants. The truth is it contains mostly water, about 4% acetic acid, and small amounts of potassium and carbohydrate.

Cider vinegar has a long and rich history. It is said that Hippocrates, the Father of Medicine, prescribed it along with honey to alleviate a cough. It was also used as a disinfectant to clean wounds. The acetic acid would eliminate bacteria, which would help prevent infections.

Vinegar was also used to make posca, a drink common in ancient Greece and Rome. Posca was made from wine vinegar, diluted with water, and flavored with herbs. It was consumed by soldiers, the lower economic classes, and slaves. The acid in the vinegar destroyed germs in otherwise unclean water.

Vinegar is still used today as an inexpensive cleaning agent. It cleans windows and floors and can even help remove the unpleasant odor of pet urine in carpet by neutralizing uric acid. Of course, ACV is used in salad dressings and other recipes.

As far as ACV health studies, there are few and they are small. A randomized, controlled trial of 39 participants studied its effect on weight loss. All the volunteers were put on a calorie-restricted diet for twelve weeks. One group was given 30 mL/day of ACV, while the other group was given placebo. The ACV group lost more weight and had reduced levels of triglycerides and total cholesterol compared to the control group (1). This study is greatly limited by its small size. It is too small to draw any real scientific conclusion. If the study contained 100 people in the control group and 100 in the ACV group, it might attract attention.

In another small study of 29 people, ACV was found to improve post-meal blood sugar levels in those who were insulin resistant or had type 2 diabetes.  It was proposed that vinegar prevented the breakdown and absorption of some starches, thereby decreasing blood sugar (2). The same limitation of small study size applies here.

A misconception exists that the acid in vinegar can treat or prevent cancer. Although a study found that tumor cells died when treated with cider vinegar, these tests were done in a laboratory and have no indication of its use in the human body. The same goes for the theory that cancer grows more quickly in an acidic environment. These tests were performed on cancer cells in a lab. The human body has a built-in mechanism that constantly regulates pH balance, and it is not affected by what we eat or drink.

As with just about anything, ACV has potential harmful effects. Full-strength ACV can cause erosion of tooth enamel, which may lead to decay. It can also cause mouth sores and trigger gastric reflux. Proponents recommend diluting ACV with water before drinking it.

In summary, apple cider vinegar has versatile uses as a cleaning agent and food ingredient. However, there is no significant clinical evidence to support any health claims of ACV, and its use is not recommended in medical guidelines of any major public health organization (3).

That should settle the bet.

Until next time, be healthy!

Dear Dietitian


  1. Khezri, S, et al. Beneficial effects of apple cider vinegar on weight management, visceral adiposity index and lipid profile in overweight or obese subjects receiving restricted calorie diet: a randomized clinical trial. Journal of Functional Foods 2018 Apr (43): 95-102.
  2. Johnston, C, et al. Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care 2004 Jan; 27 (1): 281-282.
  3. Apple Cider Vinegar. Retrieved from

Leanne McCrate, RDN, LD, CNSC, aka Dear Dietitian, is an award-winning dietitian based in Missouri. Her mission is to educate consumers on sound, scientifically-based nutrition. Do you have a nutrition question? Email her today at Dear Dietitian does not endorse any products, health programs, or diet plans. may earn an affiliate commission if you purchase products or services through links in an article. Prices, when displayed, are accurate at the time of publication but may change over time. Commissions do not influence editorial independence.

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