Apple Cider Vinegar Woo

Health fads and miracle superfoods will always be with us, it often seems. Do a web search for "apple cider vinegar" and you'll find articles with such grandiloquent headlines as:

6 Proven Health Benefits of Apple Cider Vinegar, Backed by Science
Ways Apple Cider Vinegar Benefits Your Health
19 Benefits of Drinking Apple Cider Vinegar + How To Drink It
How much apple cider vinegar should you have in a day to lose weight fast?

For the fact is that a huge industry has exploded into place around belief that apple cider vinegar is a miracle health product, a simple sip or two of which will replace diet, exercise, and guard against all manner of diseases. Today we're going have a look at the claims and see whether or not we should speed off to Whole Foods.

Let's get started, as we usually do, with the basics. Exactly what is vinegar, and is there anything special about it? Vinegar can be made from anything that starts out with a lot of sugar. Apple juice has a lot of sugar in it, so it's a perfect candidate. Making vinegar is a two-step process. The first is to ferment the apple juice by adding yeast — a fungus that eats sugar and excretes ethanol. This turns it into apple cider; let the process go longer to achieve an even higher alcohol content, and we get apple wine. When it's just right, stop the fermentation by either heating it to kill the yeast, or by adding a chemical such as potassium sorbate. Now comes the second step, which converts the alcohol into acid. This is done by adding bacteria called Acetobacter which consume alcohol and excrete acetic acid. It's usually added in the form of a culture called "mother of vinegar", a sort of self-sustaining colony similar to the sourdough starters used in bread making. This stops by itself naturally when the bacteria run out of alcohol. This whole process usually takes anywhere from a few weeks to a few months based on a number of different methods, but however you do it, you end up with a bottle of vinegar. Vinegar consists mainly of acetic acid plus whatever else besides sugar was in the original liquid you started with, usually mostly water. Since vinegar can be made from so many different kinds of liquids, there are a huge number of types of vinegar with very different characteristics. Many of these will go bad, so most vinegars are pasteurized by heating it to at least 77°C (170°F) for at least 10 minutes. Still, all vinegars have a shelf life, since there are always some kind of chemical and/or biological reactions going on among all those other ingredients.

So it's these other elements left over from the original liquid that differentiates vinegars. White vinegar, the kind available in big jugs at the supermarket and often used as a cleaning product, is made from just water and sugar or cheap grain alcohols or even vodka, and is intended to have no other elements in it except water and acetic acid. White wine vinegar and red wine vinegar are made from — well, it's obvious what they're made from — and they will contain all that stuff from the original grapes except their sugar. Balsamic vinegar is the same except it was also made using the grape stems, skins, and seeds. Rice vinegar comes from rice wine. Malt vinegar comes from malted barley liquor. And today, we have countless craft vinegars being produced from anything and everything. But with all these endless varieties out there, apple cider vinegar is the one overwhelmingly touted as having the most health benefits.

Why? What's different about it? Most obviously, that it's made from apples, and we have the old "An Apple a day" adage. Drinking apple cider vinegar is like eating an apple along with a swig of white vinegar. Or at least, it is ideally; but in reality — especially considering the type of apple cider vinegar sold to cater to the health food market, labeled as raw, organic, or unfiltered — the production methods vary. They may be less filtered, less purified, more or less fermented; these will have more impurities and more biological and chemical reactions, resulting in a less predictable product. It's often these unpredictable, unknown characteristics — often including active bacterial cultures — that are trumpeted as the source of the positive health effects. So in point of fact, the chemical and biological load you're going to ingest does differ to some degree from what you'd get from that apple and white vinegar.

This brings us back to that "mother of vinegar". A mother will often develop inside a bottle of vinegar, especially in the less purified or unfiltered varieties. This manifests as a jellylike glob that can look like some kind of weird alien. It consists mostly of live bacteria and yeast. It's harmless and you can still drink or use the vinegar in the bottle. While most recommend filtering to remove any particles of the mother, some aficionados recommend mixing it up to make sure you get some of the mother in every sip. This recommendation is often accompanied with the claim that this live probiotic culture is where apple cider vinegar's health benefits come from.

So what are those health benefits? Well, let's have a look at some of the most popularly claimed:

Help diabetics control blood sugar?

There actually is some weak evidence from one small clinical trial that consuming a little bit of vinegar each day, like a couple teaspoons or an average sip, can improve blood sugar control in type 2 diabetes patients. It's biochemically plausible; the acetic acid can interfere with absorption of starches, reducing their ability to change blood sugar levels. But there are three important provisos: first, this has to do with acetic acid found in all vinegars, there is nothing special about apple cider vinegar; second, this is of no benefit at all to anyone who doesn't have type 2 diabetes; and third, the effect is very very small, not comparable to diabetes medications. It won't hurt you, but it also won't help enough if you rely on it alone without conventional medical treatment.

Helps you lose weight?

There have also been a few small studies in Japan finding that weight loss patients, who were already on diet and exercise regimens, did lose small but statistically significantly more weight than did those in control groups when they added small amounts of apple cider vinegar to their strict diet. It was only about 1 kilogram, basically at the threshold of noise in the data.

Nevertheless, many people swear by it as a miracle weight loss treatment. One blogger credited her improved abdominal definition to the two tablespoons of apple cider vinegar with each meal, despite also changing her diet to "no sugar, no processed foods, no junk and a lot of leafy greens, veggies, minimal fruit, whole grains and lean protein from varied sources" plus also "training regularly". Basically, the evidence shows that apple cider vinegar only helps you lose weight if you also do everything else needed to lose that same amount of weight without the vinegar.

But beyond any biochemical mechanism, many people — including the authors of that Japanese study — say that adding apple cider vinegar reduces their appetite, resulting in their eating less food. There's no harm in trying this, and if it does indeed have that effect on you, then you may have a winner.

Prevents or cures cancer?

Be very clear on this point: there is neither evidence nor plausible theory suggesting that apple cider vinegar treats or prevents any cancer diseases. None. Some proponents claim that the polyphenols in vinegar do it, but a huge number of foods have polyphenols and people still get cancers. Something else that perpetuates the myth is that a popularly trumpeted study from China found that people who drink a lot of rice vinegar — not apple cider vinegar — have lower rates of esophageal cancer. However this study has never been replicated. If minimizing your risk of getting esophageal cancer is your goal, then you have a very easy option backed by plenty of evidence: don't smoke or drink too much. Rice vinegar should not be at the top of your list.

Good for washing produce?

There is one thing vinegar is good for — apple cider or not — and that's disinfecting produce tainted with Salmonella, at least when it's combined with lemon juice. Neither by itself is quite as effective, but a mixture of both does the job. The downside is that you are then stuck with disgusting lemon-and-vinegar soaked produce. Sprinkling apple cider vinegar by itself on your veggies, at least in any normal amount, does not provide significant protection if the produce is indeed infected.

Topical antiseptic?

Some believe that apple cider vinegar is an effective antimicrobial wash for the skin. If you have a cut or scrape, or even just a bacterial condition like acne, wipe that apple cider vinegar on for a miraculous natural healing.

Or don't. Vinegar — at least, the acetic acid in vinegar — is indeed an antimicrobial. But apple cider vinegar contains other things, lots of organic compounds from the original apple, which — once that acetic acid evaporates — become a lasting petri dish of nutrients for the microbes. And if you pour it into an open cut or other wound, not only will it burn like all sin, it will fill that wound with contaminants and other nutrients.

Don't do it, unless you confine yourself to white vinegar. Even then, it's going to be less effective and hurt a whole lot more than an actual medical antimicrobial. Even just an alcohol wipe would be better on both counts.

Drinking vinegar in the hope that it will have a systemic effect inside your body, like killing disease pathogens or whatnot, is poorly informed. When an acidic compound hits your duodenum just after the stomach, it's neutralized by sodium bicarbonate and its antimicrobial properties vanish.

So is it safe?

Drinking apple cider vinegar — or any other vinegar — in modest amounts is generally safe, and there are no serious concerns that people who pull this particular cork need to worry about. Any vinegar (apple cider included) is hard on your tooth enamel, but unless your habit is an extreme one, the effects will probably not be noticeable. For people who suffer from acid reflux, vinegar will probably always trigger it and be uncomfortable. And finally, vinegars are a bit harsh on your kidneys. But like with the tooth enamel thing, you will most likely be just fine unless you go over the top with your vinegar consumption, apple cider or not. The exception here is for people with chronic kidney disease. Check with your doctor, but any vinegar habit is probably one that you're better off skipping.

So to summarize, a small amount of vinegar added to your diet may possibly have minor benefits. The evidence supporting this is weak, but non-zero; but even those claimed benefits are so small that they're hardly worth it. Factor in that the risks are also non-zero, and you can probably safely leave that bottle of mother-muddied apple cider vinegar on the shelf at Whole Foods where it belongs. Whenever you hear a miraculously easy solution to a complicated problem, you should always be skeptical.

By Brian Dunning
Follow @BrianDunning