Some patients swear by apple cider vinegar to achieve regular bowel movements and to lose weight (by decreasing appetite). The dosage is two to three teaspoonfuls three to four times a day in salads or beverages. Is there any scientific basis for this, and what, if any, are the side effects or complications of daily vinegar use?
—Adeola Akeredolu, MD, Detroit

The purported benefits of vinegar consumption are many and go back at least as far as Hippocrates, who used it to disinfect wounds. Not surprisingly, the herbal industry has since made vinegar into tablets carrying such colorful claims as “fat flushing,” removal of “unwanted heavy metals,” and help with pain and “circulatory problems.” There is no evidence for the majority of these claims (nor is it likely that any large long-term placebo-controlled, randomized studies will ever be done given that vinegar is cheap and widely available).

There is, however, some intriguing evidence, with a few small studies from Europe, showing decreased insulin and glucose responses and increased satiety with vinegar supplementation. Ostman et al gave 12 patients a fixed amount of bread along with three different amounts of acetic acid and found a dose-response relationship with decreases in serum glucose and insulin and a direct relationship between satiety and the amount of vinegar ingested (Eur J Clin Nutr. 2005;59:983-988).

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In terms of safety, vinegar has been used for so long and so commonly that it can be considered safe. There are a few isolated case reports of complications, mostly following unintentional aspiration or long-term consumption of large amounts, such as the case of a 28-year-old woman who developed hyperkalemia after drinking 250 mL cider vinegar daily for six years (Nephron. 1998;880:242-243).
—Susan Kashaf, MD, MPH (105-3)