Apple Cider Vinegar

Apple cider vinegar is apple juice fermented twice — first into alcohol, then into acetic acid — and a tablespoon of it is, in effect, about 750 mg of that acid in water. The acid has real, measurable effects: taken with a starchy meal it trims the after-meal rise in blood sugar by roughly a fifth, and it slows how quickly the stomach empties. Over months, though, the trials show modest changes — about 1 to 2 kg of weight in the best-known 12-week trial, largely regained within a month of stopping — not a cure for insulin resistance and not a belly-fat melter. Its documented harms are to tooth enamel and the throat, and it is a poor idea for people with gastroparesis or low potassium.


Table of Contents

  1. What It Is: Acetic Acid and the “Mother”
  2. Traditional and Historical Use
  3. What Is Actually in a Tablespoon
  4. After-Meal Blood Sugar and Insulin
  5. Fasting Glucose, HbA1c and “Insulin Resistance”
  6. Body Weight and Belly Fat: The Real Effect Sizes
  7. Slower Stomach Emptying and Gastroparesis
  8. How to Use It and Which Vinegar to Buy
  9. Myths and Overclaims in the Popular Videos
  10. Safety, Interactions and Who Should Avoid It
  11. Key Research Papers
  12. Connections
  13. Featured Videos

What It Is: Acetic Acid and the “Mother”

The word vinegar comes from the old French for “sour wine,” and that is exactly what it is: a drink that has fermented past alcohol into acid. Apple cider vinegar goes through two fermentations. First, yeasts turn the natural sugars in pressed apple juice into alcohol, making hard cider. Then a second group of microbes, the acetic acid bacteria (the best known is Acetobacter), use oxygen to turn that alcohol into acetic acid. The U.S. Food and Drug Administration’s labelling guidance puts it in one line: cider vinegar is “the product made by the alcoholic and subsequent acetous fermentations of the juice of apples” (FDA CPG Sec. 525.825).

Acetic acid is what makes vinegar sour, sharp-smelling and self-preserving, and it is the ingredient researchers treat as the active one. Vinegars generally contain about 4 to 8 percent acetic acid. The FDA expects vinegar sold in the U.S. to carry at least 4 grams of acetic acid per 100 mL, notes that natural vinegars normally come out of fermentation above that, and requires a watered-down product to say so on the label. At 5% acidity, one tablespoon (15 mL) carries about 750 mg of acetic acid — exactly the lower dose used in the Japanese weight trial described below.

The “mother” is the cloudy, cobweb-like strand floating in unfiltered bottles. It is a loose mat of cellulose that acetic acid bacteria spin as they work, with some of those bacteria living in it — the traditional starter for the next batch of vinegar. Filtered, pasteurised cider vinegar has had the mother removed but keeps the same acid. The mother is harmless and appeals to people who prefer less-processed food, but be clear about the evidence: we found no human trial that tested the mother itself, and the studies on this page point to the acetic acid, not the sediment, as what does the work. And unlike kefir or sauerkraut, it is not eaten for live cultures: none of the trials on this page tested vinegar as a probiotic.

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Traditional and Historical Use

Vinegar is almost as old as fermented drinks themselves, because wine or cider left open to the air slowly sours. A 2006 review of vinegar’s medicinal history by Johnston and Gaas recounts the legend that a courtier in Babylonia around 5000 BC “discovered” wine from grape juice left standing, which led in turn to vinegar and its use as a food preservative. The same review notes that Hippocrates, around 420 BC, used vinegar to manage wounds, and that American medical practitioners from the late 18th century onward treated a long list of complaints with it — dropsy (fluid swelling), poison ivy, croup and stomach ache among them.

One historical use foreshadows today’s research. Before drugs to lower blood sugar were produced, the review says, vinegar “teas” were commonly drunk by people with diabetes to help manage the disease. Modern trials, described below, found that vinegar really does blunt the rise in blood sugar after a starchy meal — so the folk practice had a grain of truth, even though vinegar was never a treatment for diabetes itself.

Vinegar has also always been a food first: it preserves pickles and sharpens dressings, sauces and marinades. In Japan, as the authors of the best-known weight trial point out, vinegar is a staple seasoning (think sushi rice) and drinks containing vinegar are commonly consumed. The recent wave of popularity is different in kind — short videos promoting a daily glass as a metabolic fix — and the rest of this page tests those claims against the trials.

Evidence tier for the historical uses: traditional use only.

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What Is Actually in a Tablespoon

Nutritionally, apple cider vinegar is close to acidified water. The U.S. Department of Agriculture’s FoodData Central lists cider vinegar, per 100 grams, at 21 calories, 0.93 g of carbohydrate (0.4 g of it sugar), 73 mg of potassium and 5 mg of sodium, with only traces of calcium, magnesium and iron — and zero for every vitamin it reports. A tablespoon weighs 14.9 g, so it provides roughly:

Two popular claims fall at this point. The first is that cider vinegar is a meaningful source of potassium. At about 11 mg a tablespoon it is not; a serving of almost any fruit or vegetable carries many times more. (It does keep a trace of the apple: FoodData Central lists white distilled vinegar at just 2 mg of potassium per 100 g, against cider vinegar’s 73 mg.) The second is that it is rich in vitamins or “living nutrients.” The vitamin figures are all zero. Unfiltered vinegar does carry small amounts of apple-derived plant compounds (polyphenols) that vary from bottle to bottle, but no trial has tied the results below to them. What a tablespoon reliably delivers is acid.

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After-Meal Blood Sugar and Insulin

This is where the evidence is strongest, and it is also where the popular claims begin. The question the trials asked is simple: if you take vinegar with a carbohydrate meal, does blood sugar rise less afterwards?

What the trials found

How it probably works

Two explanations have human support. First, vinegar slows how quickly the stomach empties (see the gastroparesis section), so starch reaches the intestine more gradually. Second, the acid appears to act on starch digestion itself: vinegar helped with starchy meals but not with a glucose drink, which needs no digestion. Brighenti’s small ultrasound substudy found no difference in stomach emptying, so how much each mechanism contributes is still debated.

Evidence tier: randomised controlled trials in humans — but small, short, single-meal studies, most with fewer than 20 participants. The effect is real and reproducible; it is also modest, and it lasts for one meal.

The Liatis result carries a practical lesson. A slower-digesting whole-food meal already produces a gentler glucose curve, and vinegar adds little to it. Vinegar helps most where the meal is a fast starch — white bread, potatoes, white rice — which is also exactly where swapping to brown rice, whole grains, beans and vegetables helps most. If your concern is prediabetes or diabetes, the food on the plate matters more than the vinegar beside it.

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Fasting Glucose, HbA1c and “Insulin Resistance”

Blunting one meal’s glucose spike is not the same as reversing insulin resistance, which is a slow change in how muscle, liver and fat respond to insulin over months and years. To see whether vinegar touches that, you need trials lasting weeks or months that measure fasting glucose, HbA1c, fasting insulin and HOMA-IR (an index calculated from fasting glucose and insulin).

So the honest summary is this: in people who already have type 2 diabetes, daily vinegar may nudge fasting glucose down a little over a few months. Nothing in the trials shows that a daily glass “stops” or reverses insulin resistance. For the measures with much stronger evidence — movement, weight loss, sleep and a whole-food diet — see our Insulin Resistance page.

Evidence tier: meta-analyses of small randomised trials in humans, mostly short and of mixed quality.

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Body Weight and Belly Fat: The Real Effect Sizes

The Japanese 12-week trial (Kondo, 2009)

This is the trial behind most “vinegar melts belly fat” claims, and it is a genuinely well-designed one: randomised, double-blind and placebo-controlled, run by the research institute of a Japanese vinegar maker. It enrolled 175 Japanese adults with a BMI between 25 and 30 (Japan’s definition of obesity) and gave them a 500 mL drink every day for 12 weeks, split between after breakfast and after supper, containing 0, 15 or 30 mL of apple vinegar (0, 750 or 1,500 mg of acetic acid). The placebo drink contained lactate so it tasted sour too. 155 people completed the study, and diet diaries and pedometers showed no differences in food intake or activity between the groups.

The results, taken from the paper’s own tables:

That is a real, statistically solid, dose-dependent effect — and a small one. One to two kilograms over three months is noticeable on a scale but far from the transformations promised in videos, and it lasted only as long as the vinegar did. Note also who was tested: mildly overweight adults who tolerated vinegar — anyone who got heartburn from vinegar was excluded before the trial began.

Newer trials and the 2025 meta-analysis

Since 2009 a handful of smaller trials, mostly from Iran, Pakistan, India and Tunisia, have tested 15 to 30 mL a day, some alongside calorie-restricted diets. In one Iranian trial of 44 overweight or obese adults, 30 mL a day plus a calorie-restricted diet for 12 weeks produced significantly more weight loss and better blood lipids than the same diet alone. A 2025 meta-analysis (Castagna and colleagues; 10 randomised trials, 789 participants) pooled these studies and found statistically significant reductions in body weight, BMI and waist circumference over up to 12 weeks, with no effect on the other body-composition measures and large inconsistency between trials.

There is an important caveat. One of those ten trials was a 2024 study from Lebanon that reported significant reductions in weight, BMI, waist and hip size, body fat, blood sugar, triglycerides and cholesterol at doses as small as 5 mL a day. On 23 September 2025 — four days after the meta-analysis was published, so through no fault of its reviewers — the journal retracted that trial, with the agreement of its authors, after its own review found that the analyses could not be replicated, that there were multiple errors, and that the data showed patterns inconsistent with genuine random allocation. The pooled figures therefore include results that no longer stand.

The earlier 2021 acetic-acid meta-analysis (Valdes and colleagues), which pooled 16 trials, found no significant effect on BMI or body fat. Put together, the best-controlled evidence supports a small weight effect, on the order of a kilogram or two over three months, that fades when you stop. For approaches with larger and more durable effects, see Obesity and Metabolic Syndrome.

Evidence tier: randomised controlled trials in humans, small and short; the most dramatic recent trial retracted.

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Slower Stomach Emptying and Gastroparesis

Studies in healthy people have shown that vinegar delays gastric emptying — the rate at which the stomach passes food on to the small intestine — which is one reason the after-meal glucose curve is flatter. For most people that is harmless. For people whose stomach already empties too slowly, it works in the wrong direction.

Gastroparesis (“stomach paralysis”) is a condition, often a complication of long-standing diabetes, in which the stomach empties too slowly and food sits there, causing fullness, nausea and vomiting and making blood sugar hard to predict. In a Swedish pilot study (Hlebowicz and colleagues, 2007), ten people with type 1 diabetes and diabetic gastroparesis had their stomach emptying measured by ultrasound after a rice-pudding meal — once after a week of plain water before breakfast, and once after two weeks of 30 mL of apple cider vinegar in water before breakfast, with vinegar also added to the test meal. With vinegar, the median emptying measure fell from 27% to 17%: stomachs that were already slow emptied more slowly still. The authors concluded that this “might be a disadvantage” for blood-sugar control.

Why does that matter? Mealtime insulin starts working on a schedule. If the meal stays in the stomach longer than expected, the insulin can arrive before the glucose does — a set-up for a low blood sugar followed by a late high. That is why people with gastroparesis, or with type 1 diabetes on insulin, should not start a daily vinegar habit without talking to their diabetes team.

Evidence tier: pilot crossover study in humans (10 patients). Small, but the direction matches the healthy-volunteer studies.

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How to Use It and Which Vinegar to Buy

Amounts in kitchen terms

Which vinegar to buy

Because acetic acid is the active ingredient, the choice matters less than the videos suggest. What to look for, as a category:

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Myths and Overclaims in the Popular Videos

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Safety, Interactions and Who Should Avoid It

In the amounts used in trials — one or two tablespoons a day, diluted, with food — vinegar is generally well tolerated; the 2021 acetic acid meta-analysis described it that way. The documented harms come from undiluted use, tablets, very large amounts, or particular medical conditions.

Teeth: enamel erosion

Vinegar is acidic enough to dissolve tooth enamel, which does not grow back. A Dutch dental journal described a 15-year-old girl whose erosive tooth wear was traced to drinking a glass of apple cider vinegar every day to lose weight; the report noted that drinking vinegar for weight loss is a long-standing practice in some communities and among bodybuilders. Dilute it, take it with a meal rather than sipping through the day, use a straw, rinse with water afterwards and do not brush straight away. See Tooth Decay for how acid and enamel interact.

Throat and oesophagus

The U.S. tablet study above began with a report of oesophageal injury caused by an apple cider vinegar tablet, and undiluted vinegar is acidic enough to irritate the throat. If you have trouble swallowing pills, or have reflux, tablets are a poor choice. Remember too that the Japanese weight trial excluded anyone who got heartburn from vinegar, so its participants were people who tolerated it. If vinegar gives you heartburn, treat that as a signal to stop; see GERD.

Low potassium (hypokalaemia)

An Austrian case report describes a woman who had drunk about 250 mL of apple cider vinegar a day for six years — roughly a cup of straight vinegar daily, far beyond kitchen use — and developed low blood potassium, high levels of the hormone renin, and osteoporosis. It is a single case at an extreme dose, but low potassium is dangerous for the heart and muscles, and it underlies the medicine cautions below. See Hypokalemia (Low Potassium).

Medicine interactions

These cautions rest on how the drugs work, the potassium case report and the gastric-emptying study, rather than on trials of the combinations. They are worth taking seriously because the consequences can be serious:

If you take any of these, keep vinegar to culinary amounts, or talk it through with your prescriber or pharmacist before drinking it daily.

Who should avoid it or take extra care

Evidence tier for the harms: case reports, a product analysis and a pilot study — thin as numbers go, but consistent with the chemistry of an acid.

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Key Research Papers

  1. Johnston CS, Gaas CA (2006). Vinegar: medicinal uses and antiglycemic effect. MedGenMed: Medscape General Medicine. — PubMed PMID: 16926800
  2. Johnston CS, Kim CM, Buller AJ (2004). Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care. — PubMed PMID: 14694010
  3. Johnston CS, Steplewska I, Long CA, Harris LN, Ryals RH (2010). Examination of the antiglycemic properties of vinegar in healthy adults. Annals of Nutrition & Metabolism. — PubMed PMID: 20068289
  4. Brighenti F, Castellani G, Benini L, Casiraghi MC, Leopardi E, Crovetti R, et al. (1995). Effect of neutralized and native vinegar on blood glucose and acetate responses to a mixed meal in healthy subjects. European Journal of Clinical Nutrition. — PubMed PMID: 7796781
  5. Liatis S, Grammatikou S, Poulia KA, Perrea D, Makrilakis K, Diakoumopoulou E, et al. (2010). Vinegar reduces postprandial hyperglycaemia in patients with type II diabetes when added to a high, but not to a low, glycaemic index meal. European Journal of Clinical Nutrition. — PubMed PMID: 20502468
  6. Kondo T, Kishi M, Fushimi T, Ugajin S, Kaga T (2009). Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects. Bioscience, Biotechnology, and Biochemistry. — PubMed PMID: 19661687
  7. Hadi A, Pourmasoumi M, Najafgholizadeh A, Clark CCT, Esmaillzadeh A (2021). The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials. BMC Complementary Medicine and Therapies. — PubMed PMID: 34187442
  8. Valdes DS, So D, Gill PA, Kellow NJ (2021). Effect of Dietary Acetic Acid Supplementation on Plasma Glucose, Lipid Profiles, and Body Mass Index in Human Adults: A Systematic Review and Meta-analysis. Journal of the Academy of Nutrition and Dietetics. — PubMed PMID: 33436350
  9. Castagna A, Ferro Y, Noto FR, Bruno R, Aragao Guimaraes A, Pujia C, et al. (2025). Effect of Apple Cider Vinegar Intake on Body Composition in Humans with Type 2 Diabetes and/or Overweight: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. — PubMed PMID: 41010525
  10. [No authors listed] (2025). Retraction: Apple cider vinegar for weight management in lebanese adolescents and young adults with overweight and obesity: a randomised, double-blind, placebo-controlled study. BMJ Nutrition, Prevention & Health. — PubMed PMID: 41789013
  11. Hlebowicz J, Darwiche G, Björgell O, Almér LO (2007). Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: a pilot study. BMC Gastroenterology. — PubMed PMID: 18093343
  12. Gambon DL, Brand HS, Veerman EC (2012). Unhealthy weight loss. Erosion by apple cider vinegar [article in Dutch]. Nederlands Tijdschrift voor Tandheelkunde. — PubMed PMID: 23373303
  13. Hill LL, Woodruff LH, Foote JC, Barreto-Alcoba M (2005). Esophageal injury by apple cider vinegar tablets and subsequent evaluation of products. Journal of the American Dietetic Association. — PubMed PMID: 15983536
  14. Lhotta K, Höfle G, Gasser R, Finkenstedt G (1998). Hypokalemia, hyperreninemia and osteoporosis in a patient ingesting large amounts of cider vinegar. Nephron. — PubMed PMID: 9736833

PubMed Topic Searches

  1. PubMed: Vinegar and after-meal blood sugar
  2. PubMed: Apple cider vinegar trials on body weight
  3. PubMed: Vinegar and gastric emptying

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Connections

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