Vinegar is one of the oldest and most common household products in the world. According to folklore, it was discovered around 5000 BC in Babylonia, when grape juice was left unattended and fermented.1
Since then, this wine-gone-bad product has become a household staple for a multitude of purposes, from cleaning windows to use in salad dressing. But does vinegar offer special health benefits? In the past decade, researchers have become extremely interested in some of vinegar’s possible health-enhancing properties.
Background
Ancient history includes some very dramatic descriptions of vinegar use. Hannibal used it to dissolve boulders in his path, and Cleopatra dissolved “precious pearls” in it to create her love potion for Mark Antony.
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The medicinal applications of vinegar stretch back to Hippocrates, who used it to manage wounds. In the 10th century, Sung Tse made an antiseptic wash of sulfur and vinegar for protection during autopsies. Obviously, the veracity of many of these stories is highly suspect. What is known, however, is that vinegar rapidly became a highly versatile and useful substance in almost every aspect of ancient society.
By the late 18th century, vinegar served crucial functions as a food preservative, a cleanser, and a general remedy for ailments including poison ivy, croup, indigestion, and diabetes.1
Evidence of effectiveness
Acetic acid is the volatile organic acid that gives vinegar its tart, sour flavor. Because it is produced by the fermentation of fruit, vinegar flavors and colors vary widely.1 FDA regulations require vinegars to contain a minimum of 4% acetic acid. White vinegar ranges from 4%–7% acidity, while cider and wine vinegars are usually in the 5%–6% range.2
One of the earliest medicinal uses for vinegar was in topical wound treatment. The basic efficacy of this practice has not changed over the centuries but is now tempered with caution, since acetic acid can also damage the dermal fibroblasts and keratinocytes essential for the wound to heal.3
Dilute vinegar solutions are also frequently used for otitis externa (so-called swimmer’s ear). However, a 2003 pediatric study found this practice to be potentially damaging to outer cochlear hair cells, as well as to the skin lining the ear canal.4
The most promising medical data for vinegar is in diabetes management. It seems to decrease systemic pH, which in turn alters serum concentrations of insulin. This antiglycemic effect has been the subject of several studies.
One study was a crossover trial at the University of Arizona in Mesa involving 29 individuals with either known insulin resistance or type 2 diabetes. Participants were given a drink of vinegar, water, and saccharine followed by a meal that included 87 g of carbohydrates. Postprandial serum glucose declined by 64% over placebo in the insulin-resistant subjects and by 19% in the diabetics.5
Other research has examined the effect of lowered postprandial glucose and insulin response on metabolism later in the day. One study gave healthy women a morning drink of either vinegar or placebo followed by a buttered bagel and glass of orange juice. An hour later, the test group had a 54% lower glucose response than those who drank a placebo.6 Furthermore, women who drank the vinegar cocktail showed an 11%–16% overall reduction in caloric intake throughout the rest of the day.6 These results seem to indicate that blunting postprandial glucose and insulin surges can have an increased satiety effect for several hours after the meal.
Researchers are now exploring vinegar’s possible role in mitigating cardiovascular disease (CVD). Studies in rats have shown a significant reduction in systolic BP when the animals were fed standardized solutions of acetic acid. A Japanese study found a decline of 20 mm Hg in systolic BP after a six-week trial of daily acetic acid intake compared with a control group fed distilled water. These results were associated with reductions in both plasma renin and plasma aldosterone activity.7 But no human trials to date have validated these findings, so the safety and efficacy of vinegar in CVD prevention is not determined.
Safety and side effects
For conveying the benefits of acetic acid, foods such as salad dressings are as effective as vinegar capsules or a dilution of at least one tablespoon of plain vinegar to taste in water or juice.
Care should be taken when selecting vinegar, since some apple cider vinegars are “raw,” or unpasteurized, and can be a source of bacterial contamination. There has been at least one reported incident of lower esophageal burning from ingestion of acetic acid capsules.8 Another verified report discussed hypokalemia and osteoporosis in a patient who had consumed more than a cup of vinegar daily for several years.9
Drug interactions are possible, and patients who are sensitive to gastric pH levels are most at risk. Digoxin, insulin, and potassium-depleting diuretics are the most common medications to exhibit pH and potassium sensitivity. Patients who are taking any of these medications or who have any renal impairment need guidance from a health-care provider about a daily vinegar intake.
The regimen is not recommended for pregnant or lactating women, or for young children.
Summary
A vinegar cocktail each morning may not sound appealing, but growing evidence indicates it has impressive qualities and might make a big difference in the current obesity and diabetes epidemics. Although not appropriate for every patient, the idea certainly bears consideration.
References
1. Johnston CS, Gaas CA. Vinegar: medicinal uses and antiglycemic effect. Medscape Today. Available at medscape.com/viewarticle/531649?src=mp.
2. Vinegar. FDA Code of Regulations. Sec. 525.825. Available at www.fda.gov/ICECI/ComplianceManuals/Compliance PolicyGuidanceManual/ucm074471.htm.
3.White RJ, Cutting K, Kingsley A. Topical antimicrobials in the control of wound bioburden. Ostomy Wound Manage. 2006;52:26-58. .
4. Dohar JE. Evolution of management approaches for otitis externa. Pediatr Infect Dis J. 2003;22:299-305.
5. 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;27: 281-282.
6. Johnston CS, Buller AJ. Vinegar and peanut products as complementary foods to reduce postprandial glycemia. J Am Diet Assoc. 2005;105:1939-1942.
7. Kondo S, Tayama K, Tsukamoto Y, et al. Antihypertensive effects of acetic acid and vinegar on spontaneously hypertensive rats. Biosci Biotechnol Biochem. 2001;65:2690-2694.
8. Hill LL, Woodruff LH, Foote JC, Barreto-Alcoba M. Esophageal injury by apple cider vinegar tablets and subsequent evaluation of products. J Am Diet Assoc. 2005;105:1141-1144.
9.Lhotta K, Höfle G, Gasser R, Finkenstedt G. Hypokalemia, hyperreninemia and osteoporosis in a patient ingesting large amounts of cider vinegar. Nephron. 1998;80:242-243.
All electronic documents accessed June 9, 2009
