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Is Vinegar an Effective Treatment for Glycemic Control or Weight Loss?

      Over the years, much has been written about vinegar and its numerous proposed health benefits. Vinegar as a weight-loss aid was reported as early as the 1820s,

      Academy of Nutrition and Dietetics. FadDiet Timeline. National Nutrition Month website. http://www.nationalnutritionmonth.org/nnm/games/timeline/index.html. Accessed March 27, 2015.

      and more recently it has received attention for its possible role in lowering blood glucose levels.
      • Liatis S.
      • Grammatikou S.
      • Poulia K.-A.
      • et al.
      Vinegar reduces postprandial hyperglycaemia in patients with type II diabetes when added to a high, but not to a low, glycaemic index meal.
      • Johnston C.S.
      • Steplewska I.
      • Long C.A.
      • Harris L.N.
      • Ryals R.H.
      Examination of the antiglycemic properties of vinegar in healthy adults.
      • Petsiou E.I.
      • Mitrou P.I.
      • Raptis S.A.
      • Dimitriadis G.D.
      Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight.
      • Johnston C.S.
      • Quagliano S.
      • White S.
      Vinegar ingestion at mealtime reduced fasting blood glucose concentrations in healthy adults at risk for type 2 diabetes.
      • Darzi J.
      • Frost G.S.
      • Montaser R.
      • Yap J.
      • Robertson M.D.
      Influence of the tolerability of vinegar as an oral source of short-chain fatty acids on appetite control and food intake.
      Vinegar can be derived from beer or wine—or in the case of apple cider vinegar, cider—and is a result of bacterial fermentation that yields acetic acid.
      • Herbst S.T.
      • Herbst R.
      The New Food Lover’s Companion, 5th edition.
      Although “no standards of identity” exist for vinegar, the US Food and Drug Administration (FDA) has defined the amount of acetic acid for a product to be labeled as vinegar to be 4 g of acetic acid per 100 mL.
      • Johnston C.S.
      • Quagliano S.
      • White S.
      Vinegar ingestion at mealtime reduced fasting blood glucose concentrations in healthy adults at risk for type 2 diabetes.

      US Food and Drug Administration. CPG Sec. 525.825 Vinegar, Definitions - Adulteration with Vinegar Eels. http://www.fda.gov/ICECI/ComplianceManuals/CompliancePolicyGuidanceManual/ucm074471.htm. Accessed March 27, 2015.

      Many of the trials evaluating the effectiveness of vinegar and glycemic control were small in scale, and the amount of vinegar, type of vinegar, its acidity, timing of consumption, and composition of the meal varied.
      • Petsiou E.I.
      • Mitrou P.I.
      • Raptis S.A.
      • Dimitriadis G.D.
      Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight.
      The participants ranged from healthy adults to people at risk for diabetes to those with a diagnosis of prediabetes or diabetes controlling their condition either with diet or with medication.
      An improvement in fasting blood glucose was observed in one pilot study, yet no significant favorable effect was noted on 2-hour postprandial glucose, insulin concentration, or glycated hemoglobin.
      • Johnston C.S.
      • Quagliano S.
      • White S.
      Vinegar ingestion at mealtime reduced fasting blood glucose concentrations in healthy adults at risk for type 2 diabetes.
      A separate study found that postprandial blood glucose levels were affected favorably only when vinegar was ingested at mealtime and along with a complex carbohydrate–containing meal. In this same study, when vinegar was consumed with a monosaccharide (ie, dextrose beverage), postprandial levels were considerably greater when compared with placebo.
      • Johnston C.S.
      • Steplewska I.
      • Long C.A.
      • Harris L.N.
      • Ryals R.H.
      Examination of the antiglycemic properties of vinegar in healthy adults.
      Another trial involving adults with type 2 diabetes revealed that the glycemic content of the meal influenced vinegar’s effect on postprandial glucose levels,
      • Liatis S.
      • Grammatikou S.
      • Poulia K.-A.
      • et al.
      Vinegar reduces postprandial hyperglycaemia in patients with type II diabetes when added to a high, but not to a low, glycaemic index meal.
      • Petsiou E.I.
      • Mitrou P.I.
      • Raptis S.A.
      • Dimitriadis G.D.
      Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight.
      yet there is still much debate about the reliability of a glycemic index.
      Its role in promoting satiety for weight loss has also been researched; however, the use of vinegar as an appetite suppressant was not well tolerated, according to one study, due to the amount of nausea reported.
      • Darzi J.
      • Frost G.S.
      • Montaser R.
      • Yap J.
      • Robertson M.D.
      Influence of the tolerability of vinegar as an oral source of short-chain fatty acids on appetite control and food intake.
      While some studies have included acetic acid in pill form, the supplements available to consumers have varied greatly in their “contents and acidity.”
      Although vinegar’s specific influence on metabolism has yet to be determined, it has been proposed that vinegar may delay gastric emptying,
      • Liatis S.
      • Grammatikou S.
      • Poulia K.-A.
      • et al.
      Vinegar reduces postprandial hyperglycaemia in patients with type II diabetes when added to a high, but not to a low, glycaemic index meal.
      • Johnston C.S.
      • Steplewska I.
      • Long C.A.
      • Harris L.N.
      • Ryals R.H.
      Examination of the antiglycemic properties of vinegar in healthy adults.
      • Petsiou E.I.
      • Mitrou P.I.
      • Raptis S.A.
      • Dimitriadis G.D.
      Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight.
      • Darzi J.
      • Frost G.S.
      • Montaser R.
      • Yap J.
      • Robertson M.D.
      Influence of the tolerability of vinegar as an oral source of short-chain fatty acids on appetite control and food intake.
      and has been shown to worsen this condition in people with gastroparesis and type 1 diabetes mellitus. Other theories equate vinegar’s antiglycemic effects to the suppression of disaccharidase activity, thereby influencing carbohydrate absorption.
      • Liatis S.
      • Grammatikou S.
      • Poulia K.-A.
      • et al.
      Vinegar reduces postprandial hyperglycaemia in patients with type II diabetes when added to a high, but not to a low, glycaemic index meal.
      • Johnston C.S.
      • Steplewska I.
      • Long C.A.
      • Harris L.N.
      • Ryals R.H.
      Examination of the antiglycemic properties of vinegar in healthy adults.
      • Petsiou E.I.
      • Mitrou P.I.
      • Raptis S.A.
      • Dimitriadis G.D.
      Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight.
      • Johnston C.S.
      • Quagliano S.
      • White S.
      Vinegar ingestion at mealtime reduced fasting blood glucose concentrations in healthy adults at risk for type 2 diabetes.
      Vinegar’s effects on glucose production in the liver, glucose uptake in skeletal muscle, and insulin secretion are also being explored.
      • Petsiou E.I.
      • Mitrou P.I.
      • Raptis S.A.
      • Dimitriadis G.D.
      Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight.
      • Johnston C.S.
      • Quagliano S.
      • White S.
      Vinegar ingestion at mealtime reduced fasting blood glucose concentrations in healthy adults at risk for type 2 diabetes.
      Although there is a lack of evidence at this time to recommend vinegar as an adjuvant treatment for diabetes, vinegar is considered to be safe when consumed in reasonable amounts. There have, however, been adverse events reported with apple cider vinegar tablets, and with vinegar ingested daily for several years.
      • Petsiou E.I.
      • Mitrou P.I.
      • Raptis S.A.
      • Dimitriadis G.D.
      Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight.
      The risks for hypoglycemia or hypokalemia are also concerns with long-term oral use or when used concomitantly with some prescription medications, over-the-counter medications, and herbal supplements.
      The good news is that vinegar is low in calories (3 kcal per tablespoon)

      United States Department of Agriculture, Agricultural Research Service. National Nutrient Database for Standard Reference Release 27. Basic Report: 02048, Vinegar, cider. http://ndb.nal.usda.gov/ndb/foods/show/278?fg=&manu=&lfacet=&format=&count=&max=35&offset=&sort=&qlookup=Vinegar. Accessed March 27, 2015.

      and an easy way to flavor foods. While it contributes minimally to the nutrient composition of a meal, the use of vinegar as an ingredient can be part of a healthy meal pattern and a way to limit calories, which can ultimately help with both weight loss and diabetes.

      References

      1. Academy of Nutrition and Dietetics. FadDiet Timeline. National Nutrition Month website. http://www.nationalnutritionmonth.org/nnm/games/timeline/index.html. Accessed March 27, 2015.

        • Liatis S.
        • Grammatikou S.
        • Poulia K.-A.
        • et al.
        Vinegar reduces postprandial hyperglycaemia in patients with type II diabetes when added to a high, but not to a low, glycaemic index meal.
        Eur J Clin Nutr. 2010; 64: 727-732
        • Johnston C.S.
        • Steplewska I.
        • Long C.A.
        • Harris L.N.
        • Ryals R.H.
        Examination of the antiglycemic properties of vinegar in healthy adults.
        Ann Nutr Metab. 2010; 56: 74-79
        • Petsiou E.I.
        • Mitrou P.I.
        • Raptis S.A.
        • Dimitriadis G.D.
        Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight.
        Nutr Rev. 2014; 72: 651-661
        • Johnston C.S.
        • Quagliano S.
        • White S.
        Vinegar ingestion at mealtime reduced fasting blood glucose concentrations in healthy adults at risk for type 2 diabetes.
        J Funct Foods. 2013; 5: 2007-2011
        • Darzi J.
        • Frost G.S.
        • Montaser R.
        • Yap J.
        • Robertson M.D.
        Influence of the tolerability of vinegar as an oral source of short-chain fatty acids on appetite control and food intake.
        Int J Obes (Lond). 2014; 38: 675-681
        • Herbst S.T.
        • Herbst R.
        The New Food Lover’s Companion, 5th edition.
        Barron’s Educational Series, Inc, Hauppauge, NY2013
      2. US Food and Drug Administration. CPG Sec. 525.825 Vinegar, Definitions - Adulteration with Vinegar Eels. http://www.fda.gov/ICECI/ComplianceManuals/CompliancePolicyGuidanceManual/ucm074471.htm. Accessed March 27, 2015.

      3. Natural Medicines Comprehensive Database. Apple Cider Vinegar. http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=&s=ND&pt=100&id=816&ds=&name=APPLE+CIDER+VINEGAR&searchid=50955425. Accessed March 27, 2015.

      4. United States Department of Agriculture, Agricultural Research Service. National Nutrient Database for Standard Reference Release 27. Basic Report: 02048, Vinegar, cider. http://ndb.nal.usda.gov/ndb/foods/show/278?fg=&manu=&lfacet=&format=&count=&max=35&offset=&sort=&qlookup=Vinegar. Accessed March 27, 2015.