Why apple cider vinegar is an age-old remedy

Mention apple cider vinegar to a doctor and it’s likely the only positive reaction you’ll get is laughter. Yet if you ask your healthfood shop owner what they think of it, they will probably go on about the many things for which folks swear by the stuff. For apple cider vinegar (ACV) is one of those natural remedies with little science to back up the claims, yet mountains of anecdotal reports, going back thousands of years, praise its powers.

Take the experience of Cate, who works in a medically related field. Unsightly and uncomfortable red welts began to appear under her eyes. As someone who works physically close to people all day long, she was embarrassed and distressed by this problem. Her natural response was to see a doctor, then a specialist, then another specialist, who all prescribed expensive creams, none of which had any effect at all.

At a friend’s suggestion, Cate went to her local healthfood shop to ask about topical natural remedies and was told that what she needed was to take a tablespoon of apple cider vinegar in water every day. But, importantly, it had to have “the mother” — more on that later.

Though extremely dubious, Cate thought she had nothing to lose so gave it a go. The welts disappeared after a few days, only to return when she stopped taking the ACV. Cate now takes the vinegar when the welts come back, then lays off it when they go. “I have no idea why it helps, but I know it does,” she says.

Helen swears by drinking it in water as a morning remedy for mucus buildup in her throat. She says it clears her throat completely and, as a bonus, she can’t remember the last time she had a sore throat, even though she used to be quite prone to throat and upper respiratory tract infections.

Vicky names it one of the top weapons in her arsenal of natural treatments for thrush and urinary tract infections; she takes it in water several times a day — as well as bicarb soda (not at the same time), coconut oil and cranberry or the supplement D-mannose — whenever she feels either condition coming on. “I haven’t had to take antibiotics or use chemists’ anti-fungals for years,” she says.

These are just a few examples. Among a seemingly endless list of claims for the powers of ACV are that it: induces weight loss; helps to lower blood sugar, blood pressure and cholesterol; relieves arthritis, skin complaints, stomach ailments and other inflammatory and autoimmune conditions; shrinks an enlarged prostate; slows ageing; controls head lice and fleas; gets rid of warts — and cleans the kitchen benches!

From Hippocrates to now

The medicinal use of cider vinegar dates back to the father of medicine himself, Hippocrates (around 400 BCE), who used it to control bacterial infections — ie as an antibiotic. Even before then, as early as 3000 BCE, the ancient Egyptians used it for preserving food. It’s said that both Roman armies and Japanese samurai took it for strength, and that Christopher Columbus took barrels of it on sea voyages to prevent scurvy.

In modern times, apple cider vinegar became well known in the US in the late 1950s, when a mixture of ACV and honey in water was promoted by Dr DC Jarvis in his bestselling book Folk Medicine: A Vermont Doctor’s Guide to Good Health. Dr Jarvis was also a proponent of the health benefits of seaweed, fish, honey, corn and apples. An eye, ear, nose and throat specialist, he took notes over the years about the folk remedies his older patients used.

Dr Jarvis was particularly convinced of the benefits of the cider vinegar and honey mixture and even claimed those same benefits could be seen in vinegar-fed cattle, which “were generally healthier in every way”. Indeed, horse owners commonly give their steeds ACV for a range of ailments, from intestinal stones called enteroliths, to skin rashes and thrush under their feet, to keeping flies at bay. Some use it on open wounds followed by manuka honey, a combination they claim produces fast healing.

 Nutrients, acids & the mother

The word “vinegar” comes from the French words “vin aigre”, meaning sour wine. Vinegar is often made from grapes but it can be made from any number of fruits and grains — basically any fermentable carbohydrate source. In addition to the familiar grape and malt vinegars of Europe, there are the traditional rice-wine vinegars of Asia, coconut and cane vinegars of India and the Philippines, and date vinegars of the Middle East, among countless others.

In the making of vinegar, the first fermentation occurs when yeasts convert the natural food sugars to alcohol — cider in the case of ACV. Then, in a second fermentation, acetic acid bacteria (Acetobacter) convert the cider to acetic acid. The bacterial culture grows slowly over weeks or months and produces a cloudy sediment known as “the mother”.

In most commercial vinegar manufacture, the mother is seen to be offputting and is filtered out; the vinegar is then pasteurised to prevent more forming. Even though there may be some health benefits to be gained from using vinegar without the mother, many of the anecdotal (but scientifically unsubstantiated) benefits come from the live culture as well as the acetic and other acids. These include antibacterial and anti-fungal properties.

So when buying ACV, look for organic, raw (ie unpasteurised) and unfiltered “with the mother”. If you can’t see that cloudy sediment comprising nutrients, enzymes and beneficial bacteria, don’t buy it because it is no longer a living culture.

Other constituents of the vinegar include vitamins, mineral salts, amino acids, polyphenolic compounds (gallic acid, catechin, caffeic acid, ferulic acid), and non-volatile organic acids (tartaric, citric, malic, lactic), though ACV sceptics like to point out that the levels of some of the nutrients, such as pectin or potassium, are too low to take seriously.

Science says…

As mentioned, there are few studies on ACV and some relate to vinegar generally; some have been on rats and mice, so it’s not clear whether the results would apply in the same way to humans. It’s not uncommon for natural foods to go unresearched, though, because there is no money to be made from products that can’t be patented. There have, however, been some studies showing that perhaps the curative claims for this folk remedy are not all hippie hype.

Blood glucose & type 2 diabetes
Several studies have shown vinegar to be useful in lowering the glycaemic response in healthy adults and those with either insulin resistance or type 2 diabetes. In one study, 20mL of white vinegar in salad dressing reduced by 30 per cent the glycaemic response to a mixed meal containing 50g of carbohydrate. This has been corroborated by other placebo-controlled trials.

Even substituting a fresh cucumber with one pickled in vinegar has been shown to have a similar effect. A Japanese study also found that the addition of vinegar or pickled foods to rice (as in sushi) decreased the glycaemic index of the rice by 20–35 per cent.

In 2004, a study published in Diabetes Care found that taking vinegar before meals significantly increased insulin sensitivity and dramatically reduced the insulin and glucose spikes that occur after meals. The study involved 29 people; one-third had been diagnosed with type 2 diabetes, one-third had insulin resistance (pre-diabetic) and one-third were healthy. All three groups had better blood glucose readings with the vinegar than with a placebo. Those with insulin resistance saw the most benefit with their blood glucose cut by nearly 50 per cent and, surprisingly, lower blood glucose than the healthy participants after both groups consumed vinegar. 

Weight loss
There’s nothing new about using vinegar for weight loss, but does it work? One small study published in the European Journal of Clinical Nutrition found that vinegar might help people to feel full. In the study, people who ate a piece of bread along with a small amount of vinegar felt fuller and more satisfied than the group who had only the piece of bread.

In a double-blind Japanese study, obese adults were separated into three groups based on similar body weights, body mass indexes (BMI) and waist measurements. Each group drank a 500mL drink containing 30mL, 15mL or no vinegar every day for 12 weeks. All groups consumed a similar number of calories and did the same amount of exercise.

Those in the vinegar-drinking groups had modest weight loss, averaging 1.2kg in the 15mL group and 1.7kg in the 30mL group. They also had lower BMI, visceral fat area, waist measurement and serum triglycerides. The conclusion was that vinegar consumption may reduce obesity.

Cholesterol
Speaking of triglycerides, some studies have shown that consumption of apple cider vinegar may increase “good” cholesterol (HDL) and reduce triglycerides. This was confirmed in a 2006 study on rats, published in the British Journal of Nutrition. The rodents were given acetic acid, the main component of vinegar. The Japanese researchers concluded that the acetic acid reduced serum total cholesterol and triacylglycerol.

Blood pressure
A 2001 Japanese study, published in Bioscience, Biotechnology, and Biochemistry, found that vinegar significantly lowered high blood pressure in rats. It was suggested that this effect was caused by the significant reduction in renin activity and the subsequent decrease in angiotensin II, a peptide that constricts blood vessels and so contributes to high blood pressure. It was also suggested that the antihypertensive effect of vinegar is mainly due to acetic acid.

One analysis of the Nurses’ Health Study, a very large and long-running study of women’s health, noted a very strong association between consumption of oil-and-vinegar salad dressings 5-6 times a week and a lower cardiovascular risk. It’s not clear, though, whether it was the oil or the vinegar that was the hero of the piece.

It has been suggested that the potassium in apple cider vinegar balances sodium levels, which may help maintain blood pressure within healthy limits; and that the magnesium in vinegar helps to relax blood vessel walls and so lower high blood pressure.

Anti-tumour effect
A 2007 Japanese study abstract, Generation of antitumor active neutral medium-sized alpha-glycan in apple vinegar fermentation, reported that ACV produced anti-tumour activity in mice. According to the researchers, “We studied the biological functions of apple vinegar produced from crushed apples and found that the constituent neutral medium-sized alpha-glycan (NMalphaG) acts as an antitumor agent against experimental mouse tumors.” Again it’s not clear whether the same effect would occur in humans.

Mother load

What is clear is that, although it has only a light stamp of science, apple cider vinegar has a mighty status in folk medicine. It also has a solid, enduring reputation as a cure-all for both humans and animals that makes the sceptics bring out the numbers and add up the vitamins and minerals to total … not very much. But can they account for the effect of the mother?

The mother (Mycoderma aceti) is a culture of a form of cellulose and acetic acid bacteria (Acetobacter), which convert alcohol to acetic acid, thus turning cider or wine (or beer) into vinegar. The mother looks like a cloudy sediment at the bottom of the bottle and is an excellent source of live microbials, which incidentally means the vinegar should not be heated with boiling water or cooking if you want the benefits of the living culture.

While some of the positive health benefits may be largely attributed to the acetic and other acids, which are also present in other vinegars including those that are filtered and pasteurised, what sets apple cider vinegar apart is that it is easily available with the live culture intact.

If the mother must be present for ACV to do its work, then understanding what the live bacterial fermentation does in the body, along with the function of the acetic and other acids, is perhaps the key to understanding why it may have those myriad curative and preventive effects that science is yet to investigate.

Whether you need science to tell you if something works or you love a bit of anecdotal evidence — or, like Cate, you are willing to try it for yourself — perhaps the last word can go to Dr DC Jarvis, who said of apple cider vinegar and other folk remedies: “They are safe remedies, for if they do not do any good, they will not do any harm.”

Four thieves vinegar

Vinaigre des quatre voleurs has a fascinating legend behind it. During one of the periods when the bubonic plague terrorised Europe, four infamous thieves went about Marseille (or Toulouse — stories vary) robbing corpses and the sick. They escaped capture for a long time but were eventually sentenced to be burnt at the stake. The judge wondered how they had handled so many infected bodies without catching the disease, and offered to convert their sentence to hanging if they gave up their secret. The thieves confessed to washing themselves all over with a herbal vinegar mixture each time they came into contact with a victim.

To make the thieves’ vinegar, place in a wide-mouthed jar a mix of roughly equal parts lavender flowers, rosemary, mint, sage and lemon balm, along with two peeled and smashed cloves of garlic. Cover completely with raw, unfiltered, organic ACV and seal with a lid. Allow to macerate for at least two weeks in a cool, dark place, then strain into a clean bottle. Use in salad dressings or take diluted in water for general wellbeing. For cleaning, dilute with water in a spray bottle.

Best dressed

If, like many people, you don’t enjoy the taste of apple cider vinegar, you can use it to make a really delicious vinaigrette dressing by adding pomegranate molasses to a mixture of olive oil and ACV. Experiment a little to work out how much to use to your own taste. Some people like to add a teaspoon of honey instead of the molasses.

How much?

Because ACV has not been studied in any detailed and thorough way, there is no recommended dosage. As a general tonic, many people down a tablespoon a day, either mixed in water or in salad dressing. If you’re turning up your nose at that idea, see Best dressed box. Never take it undiluted as it can damage tooth enamel and burn on its way down. Don’t add it to hot water, though, or you’ll kill the mother.

Many ACV fans increase their intake for acute complaints and then drop it back when the problem has passed. There are some suggestions that high doses over a long period of time may be harmful. Ultimately, as with anything, taking amounts that are more or less in line with what you could reasonably incorporate into your diet, either as a drink or condiment, with temporary increases when appropriate, is probably the sensible way to go.