Apple Cider Vinegar: A Modern Guide to Ancient Healing

Amy20MD 1

Medical reviewed by Amy Rogers, MD MPH FACPM

Preventive Medicine, Public Health, Lifestyle Medicine, Pandemic Response, Global Health

Apple cider vinegar, like other vinegar, has a long history of folk medicine. It has been used since ancient times as a preservative and tonic. Acetic acid is the key to its numerous health benefits.

Whether you love it for a tangy salad, to rinse your hair, or as a household cleaner, apple cider vinegar has many uses. We take a dive into what modern research has discovered. Also, find out how much apple cider vinegar is safe to drink and why some people should avoid it.

What is apple cider vinegar?

Apple cider vinegar is made from fermented, crushed apples. It contains various vitamins, minerals, acetic as well as other acids. Its most common food applications are dressings, marinades, and making pickles. 

Even in modern times, this special vinegar has gained a reputation as a ‘magic potion’ for fighting off harmful bacteria and fungi, preventing heartburn. 

Some research shows health benefits such as reducing blood sugar levels, aiding weight loss, and preventing kidney stones—but more investigation is needed. 

Apple cider vinegar’s nutritional values

Apple cider vinegar is rich in electrolytes such as magnesium, potassium, and sodium. Here are key nutritional values for 100 g or around half a cup of apple cider vinegar (1). The recommended daily dosage is 20 to 30 ml.

  • Calories: 21 kcal
  • Water: 93.8 g
  • Ash: 0.17 g
  • Carbohydrate: 0.93 g
  • Calcium: 7 mg 
  • Magnesium: 5 mg
  • Phosphorus: 8 mg
  • Potassium: 73 mg
  • Sodium: 5 mg
  • Manganese: 0.249 mg

Beyond these nutritional values, apple cider vinegar also contains around 5 to 6% acetic acid and various antioxidants. Antioxidants include phenolic acids, such as chlorogenic acid and caffeic acid, also flavonoids (2).

Health benefits of apple cider vinegar

Although apple cider vinegar is loved for its many uses, some people actually drink it as a tonic for various health benefits. It’s commonly understood as a natural remedy for diabetes, obesity, and reducing cholesterol. 

Here are some of its potential health benefits:

1. Rev up your digestion

Apple cider vinegar is believed to improve digestion and even relieve constipation. Possible compounds behind this are polyphenols (3). Polyphenols can act as prebiotics and improve good bacterial growth, such as lactobacillus and bifidobacteria (3, 4). 

2. Fend off pathogens

Research shows some antimicrobial properties in apple cider vinegar. As a folk remedy, topical apple cider vinegar is used to sanitize wounds, clear ear infections, and eradicate nail fungi. 

In lab studies, it has been shown to be effective against some bacteria and fungi. More research is needed to see if ingesting apple cider vinegar can have the same therapeutic benefits. 

One reason why this may work is the high acetic acid content which contains polyphenols and flavonoids. These act against pathogens by disturbing their cell metabolism, energy production, and integrity (5). 

3. Boost nutrient uptake

The key component in apple cider vinegar, acetic acid, is an organic acid. Organic acids have been shown to increase the acidity of the digestive tract, thus helping to break down nutrients as well as fats (6). Therefore, the digestive system works more efficiently. 

4. Soothe acid reflux

Although not yet proven, some believe acid reflux can be caused by too little acid in the stomach triggering an overproduction of acid. It’s believed apple cider vinegar can trick the body into thinking it actually has enough acid, thus preventing an overproduction.

It is well known, however, that symptoms of acid reflux can be a result of an infection of Helicobacter pylori bacteria in the gastrointestinal tract and stomach (7).

Research into white vinegar, also high in acetic acid, shows it has antimicrobial effects that kill the H. Pylori bacteria. Since apple cider vinegar is also high in acetic acid, it may have the same effect, but more research is needed (8). 

5. Reduce cholesterol levels

Your body’s metabolism can be affected by the food you eat. Acetic acid contained in apple cider vinegar can stimulate an increase in bile secretion. Bile plays an important role in eliminating cholesterol, stimulating fat breakdown, and decreasing fat formation (9).

6. Prevent kidney stones

The high acetic acid content of apple cider vinegar may be able to prevent kidney stones. An animal study found that regular intake increases citrate and reduces calcium in urinary excretion. This can suppress kidney stone formation (10). 

Regular intake also lowers the risk of kidney stone formation by increasing magnesium in urine, thereby reducing uric acid (11). Incorporating acetic acid into the diets of rats with kidney stones managed to reduce inflammation and kidney stone formation (10). 

7. Support for blood sugar

One of the most promising health benefits of apple cider vinegar is type 2 diabetes and insulin resistance. 

Polyphenols, flavonoids, vitamin C, and acetic acid in apple cider vinegar work together to inhibit α-Amylase and α-Glucosidase enzymes by lowering pH. These enzymes also break down carbohydrates and help in controlling blood sugar or blood glucose levels (12). 

8. Aid weight loss

Apple cider vinegar is often used to lose weight. It can reduce hunger, which leads to less food intake and possible weight loss (13). Furthermore, apple cider vinegar can also reduce body fat and impede fat formation (14). 

9. Strengthen immunity

Another health benefit of apple cider vinegar is to strengthen the immune system. It’s rich in antioxidants, including polyphenols, flavonoids, and vitamin C, which protect immune cells from free radicals (15). 

Moreover, acetic acid can support healthy gut bacterial growth (16). These bacteria stimulate the immune system via the intestinal immune cells. They also support antibodies that act against pathogens and toxins (17). 

Despite the need for further research, some of the more conclusive health benefits of apple cider vinegar are lowering blood sugar and cholesterol and assisting in weight loss. Apple cider vinegar may also help with digestion, acid reflux, and preventing kidney stones.

When to avoid apple cider vinegar?

Unfortunately, apple cider vinegar might not work for some people with underlying medical conditions. Here are a few health conditions to be aware of:

  • Low potassium levels. Apple cider vinegar might decrease potassium levels if consumed in large amounts (18). 
  • Sulfite sensitivity. Some unfiltered apple cider vinegar contains sulfite. It is estimated that 3–10% of asthmatics are sensitive to sulfites and can have symptoms of wheezing, tight chest, cough, and other asthmatic reactions (19). 
  • Acetic acid intolerance. Apple cider vinegar usually has around 5 to 6% acetic acid. Allergic reactions to this acid include nausea, headaches, skin irritation, and possible collapse of both respiratory and blood circulation systems (20). 
  • People on diabetes medication. Insulin or insulin-stimulating medications tend to lower sugar and potassium in the blood, and so does apple cider vinegar. Talk with your doctor before you add apple cider vinegar to your diet. 

When to take apple cider vinegar?

There is no agreement on the best time to drink apple cider vinegar. Some research suggests that taking it at bedtime can reduce fasting sugar blood levels in type 2 diabetes patients (23). 

In the other study, in the morning or before a meal can help reduce blood sugar levels and hunger (21, 24). Even drinking after a meal may also help in weight loss and body fat reduction (25). 

How much to drink per day

It’s best to start apple cider vinegar in small amounts by mixing 1 to 2 teaspoons (5‒10 mL) into a glass of water once per day. If you can tolerate this well, the dose can be increased by 1 to 2 tablespoons (15‒30 mL).  

This dosage has been used for controlling sugar blood levels in type 2 diabetes patients and in other scientific studies (14, 21, 22). 

Best ways of taking apple cider vinegar

People usually drink apple cider vinegar by diluting it with water. Drinking it undiluted may possibly irritate your throat due to the acidity. 

You can easily incorporate apple cider vinegar into your meals. Start by adding small amounts to salad dressings, warm honey-lemon tea, marinades, mayonnaise, and fruit smoothies. 

Drinking apple cider vinegar on an empty stomach

Although drinking apple cider vinegar on an empty stomach is generally fine, some studies suggest otherwise. 

Other research suggests that drinking in the morning on an empty stomach can help reduce blood sugar levels and appetite and thus might aid in weight loss (21, 26). 

On the other hand, drinking on an empty stomach can make some people feel sick and nauseous, or they may even throw up. If you have an ulcer, you should avoid apple cider vinegar because it can make things worse. 

Effects, therefore, differ from one person to another. If in doubt, consult a professional. 

Things to be aware of

Apple cider vinegar is considered safe to consume on a daily basis. Despite its benefits, there are a couple of things to be aware of:

  • Tooth erosion and sensitivity

Due to its acidity, apple cider vinegar may damage the outer layer of your teeth, leading to sensitivity. It’s best to dilute the vinegar and rinse your mouth afterward drinking it (27). Consuming apple cider vinegar with meals or using a straw may also help (28). 

  • Digestive issues

For some people, apple cider vinegar can cause nausea and indigestion. Therefore, if you have gastroparesis (a condition that delays the stomach emptying), it’s better to avoid taking it (29). 

  • Skin and lung irritation

Applying apple cider vinegar directly to the skin undiluted can cause irritation. Avoid getting any apple cider vinegar in your eyes. This can cause permanent damage if not immediately rinsed with water. Directly inhaling the vapor can likewise cause irritation to the respiratory system.

When using apple cider vinegar regularly, you need to be careful of tooth sensitivity, enamel erosion, nausea, delayed stomach emptying, and skin irritation. These side effects can usually be avoided by diluting the vinegar and using it in the recommended ways and dosage.

How to store apple cider vinegar

Correctly storing apple cider vinegar will extend the shelf life and preserve quality. Its antimicrobial and acidic properties mean there’s little chance of contamination.

The shelf-life of apple cider vinegar is around two years if unopened and one year once the seal is broken. Refrigerating is not necessary since vinegar itself is a preservative. 

Instead, you can just store it somewhere cool, dry, and dark such as a cabinet. Sunlight may degrade the quality and flavor. 


Apple cider vinegar has a number of proven health benefits, namely, lowering cholesterol blood, supporting type 2 diabetes, aiding in weight loss, and strengthening the immune system. It’s best to drink diluted apple cider vinegar. Start with small amounts of up to 2 tablespoons in a glass of water per day. Some people should avoid apple cider vinegar, and it is best to rinse your mouth after drinking it.

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Amy20MD 1

Medical reviewed by Amy Rogers, MD MPH FACPM

Preventive Medicine, Public Health, Lifestyle Medicine, Pandemic Response, Global Health

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