Submitted: April 12, 2021 | Approved: April 23, 2021 | Published: April 26, 2021
How to cite this article: Sirotkin AV. Could apple cider vinegar be used for health improvement and weight loss? New Insights Obes Gene Beyond. 2021; 5: 014-016.
Copyright License: © 2021 Sirotkin AV. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Obesity; Adipocyte; Vinegar; Apple; metabolism
This non-systematic review outlines the current knowledge concerning provenance, chemical composition and properties of apple cider vinegar, its general health effects, as well as the currently available knowledge concerning its action on fat storage, physiological mechanisms of its effects, as well as its safety and recommended dosage for treatment of obesity.
Obesity is one of the most common physiological dysfunction, which, via several signalling pathways can promote development of metabolic syndrome, cancer, cardiovascular, inflammatory and other illnesses [1,2]. Apple cider vinegar could be promising food additive for prevention and treatment of obesity. The present non-systematic review outlines the current knowledge concerning provenance, chemical composition and properties of apple cider vinegar, its general health effects, as well as the currently available knowledge concerning its action on fat storage, physiological mechanisms of its effects, as well as its safety and recommended dosage for treatment of obesity.
Search for literature was performed in agreement with the PRISMA (= preferred reporting items for systematic review) criteria  (http://prisma-statement.org/). To search the related articles, Pubmed, Web of Science and SCOPUS databases between the year 2000 and 2021. In cases of repeated or conflicting information or references, more recent sources have been preferred. Words used to search were Cider, vinegar, fat, obesity, weight loss and mechanisms.
Provenance and properties
Apple cider vinegar is made of apples (Malus domestica), which have undergone bacterial fermentation – a process in which sugar is first converted to alcohol (for example in production of cider) and that is then fermented to acetic acid. Besides apple cider vinegar, the product of apple fermentations contains also other biologically active components – gallic acid, catechin Y, epicatechins and chlorogenic acid, caffeic acid, p-Coumaric acid, ferulic acid, citric acid, and folic acid. It also contains phosphor, calcium, copper, sodium, potassium, vitamins A, B1, B2, B6, C, E, pectin, mineral salts, amino acids and flavonoids with antioxidant effect  https://www.zdravieastyl.sk/potraviny-a-vyziva/193-sila-jablcneho-octu.
Positive effects on human health
Apple cider vinegar has antioxidant, antimicrobial, anti-tumour, antidiabetic and other effects beneficial to health . It lowers blood pressure and treats hypertonia . Thanks to its antioxidant effect, it prevents oxidative stress and the related damage to internal organs and diseases linked to oxidative stress . It can improve the condition of gastrointestinal tract and digestion , http://dni.skwww.plusden.sk/zena/chudnutie/dieta-tento-tyzden/jablcny-ocot-naozaj-roztopi-tuk-potvrdili-aj-vedci.html).
It reduces the concentration of glucose and insulin in blood, especially after meals high in carbohydrates [8-16]. Therefore, it is considered a prospective natural treatment against diabetes [13,15,17,].
Positive effects on weight reduction
It can serve as an efficient tool in weight loss [17-19] as it reduces weight through several mechanisms:
• It suppresses the centre of hunger in the central nervous system  and reduces appetite [18,21]
• It reduces the level of saccharides and lipids in blood, which act on the centre of hunger (see above)
• It is assumed that it could slow faecal output after a meal and therefore extend the sensation of satiety 
• It activates genes and the enzyme AMPK (activated protein kinase), which stimulates burning of fat [11,17]
• It reduces production and accumulation of lipids in the body and liver [17,18,21].
In both the obese  and healthy  people, consumption of apple cider vinegar reduced body weight, volume of fat and level of triacylglycerols in blood. Nazıroğlu, et al. , on the other hand, determined in mice that this vinegar, due to its antioxidant effect, prevented oxidation of lipids in internal organs.
In addition to acetic acid, involved in weight reduction might be also another component of apple cider vinegar – vitamin C. People with higher concentration of vitamin C oxidate 30% more lipids during physical activity than people with lower concentration .
On the other hand, the systematic review of Launholt, et al.  indicated, that due to inadequate research of high quality, the evidence for the health and anti-obesity effects of vinegar are insufficient. Therefore, more large-scale, long-term clinical studies with a low risk of bias are needed before definitive conclusions can be made.
Possible adverse side-effects
Excessive doses of acetic acid can cause adverse side-effects such as stomach irritation, heartburn, and irritated throat ,(https://sk.thefreespiritedwoman.com/1888-5-side-effects-of-apple-cider-vinegar-nobody-told-you-about), tooth decay , https://sk.thefreespiritedwoman.com/1888-5-side-effects-of-apple-cider-vinegar-nobody-told-you-about), nausea  and increased risk of diabetes (https://sk.thefreespiritedwoman.com/1888-5-side-effects-of-apple-cider-vinegar-nobody-told-you-about). Hypocalcaemia can cause osteoporosis (reduced bone density, bone thinning) as well as constipation, muscle weakness, abnormal heart rhythm and exhaustion (https://sk.simpleaslife.com/20805-side-effects-of-apple-cider-vinegar-tablets.html). There are historical evidence of death after overconsumption of vinegar for weight loss .
Acetic acid can alter the effects of some medication – insulin, digoxin, diuretics, furosemide, torsemide and bumetanide, there it is not recommended to combine them (https://sk.simpleaslife.com/20805-side-effects-of-apple-cider-vinegar-tablets.html).
General evaluation and eecommendations
Previous research carried out on laboratory animals and livestock as well as humans (both healthy and suffering from obesity and diabetes) conclusively validated the application of apple cider vinegar and its molecules had positive effects on numerous physiological processes and health. In particular, reduction of fat stores and body weight. Application of apple cider vinegar at a dose of 45 ml a day should be beneficial for normalization of fat stores and body weight without adverse side-effects.
- Aparecida Silveira E, Vaseghi G, de Carvalho Santos AS, Kliemann N, Masoudkabir F, et al. Visceral Obesity and Its Shared Role in Cancer and Cardiovascular Disease: A Scoping Review of the Pathophysiology and Pharmacological Treatments. Int J Mol Sci. 2020; 21: 9042. PubMed: https://pubmed.ncbi.nlm.nih.gov/33261185/
- Heyn GS, Corrêa LH, Magalhães KG. The Impact of Adipose Tissue-Derived miRNAs in Metabolic Syndrome, Obesity, and Cancer. Front Endocrinol (Lausanne). 2020; 11: 563816. PubMed: https://pubmed.ncbi.nlm.nih.gov/33123088/
- Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med. 2009; 6: e1000097. PubMed: https://pubmed.ncbi.nlm.nih.gov/19621072/
- Budak NH, Aykin E, Seydim AC, Greene AK, Guzel-Seydim ZB. Functional properties of vinegar. J Food Sci. 2014; 79: R757-764. PubMed: https://pubmed.ncbi.nlm.nih.gov/24811350/
- Kondo S, Tayama K, Tsukamoto Y, Ikeda K, Yamori Y. Antihypertensive effects of acetic acid and vinegar on spontaneously hypertensive rats. Biosci Biotechnol Biochem. 2001; 65: 2690-2694. PubMed: https://pubmed.ncbi.nlm.nih.gov/11826965/
- Nazıroğlu M, Güler M, Özgül C, Saydam G, Küçükayaz M, et al. Apple cider vinegar modulates serum lipid profile, erythrocyte, kidney, and liver membrane oxidative stress in ovariectomized mice fed high cholesterol. J Membr Biol. 2014; 247: 667-673. PubMed: https://pubmed.ncbi.nlm.nih.gov/24894721/
- Suiryanrayna MV, Ramana JV. A review of the effects of dietary organic acids fed to swine. J Anim Sci Biotechnol. 2015; 6: 45. PubMed: https://pubmed.ncbi.nlm.nih.gov/26500769/
- Liljeberg H, Björck I. Delayed gastric emptying rate may explain improved glycaemia in healthy subjects to a starchy meal with added vinegar. Eur J Clin Nutr. 1998; 52: 368-371. PubMed: https://pubmed.ncbi.nlm.nih.gov/9630389/
- Fushimi T, Sato Y. Effect of acetic acid feeding on the circadian changes in glycogen and metabolites of glucose and lipid in liver and skeletal muscle of rats. Br J Nutr. 2005; 94: 714-719. PubMed: https://pubmed.ncbi.nlm.nih.gov/16277773/
- Johnston CS, Buller AJ. Vinegar and peanut products as complementary foods to reduce postprandial glycemia. J Am Diet Assoc. 2005; 105: 1939-1942. PubMed: https://pubmed.ncbi.nlm.nih.gov/16321601/
- Sakakibara S, Yamauchi T, Oshima Y, Tsukamoto Y, Kadowaki T. Acetic acid activates hepatic AMPK and reduces hyperglycemia in diabetic KK-A(y) mice. Biochem Biophys Res Commun. 2006; 344: 597-604. PubMed: https://pubmed.ncbi.nlm.nih.gov/16630552/
- Petsiou EI, Mitrou PI, Raptis SA, Dimitriadis GD. Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight. Nutr Rev. 2014; 72: 651-661. PubMed: https://pubmed.ncbi.nlm.nih.gov/25168916/
- Russell WR, Baka A, Björck I, Delzenne N, Gao D, et al. Impact of Diet Composition on Blood Glucose Regulation. Crit Rev Food Sci Nutr. 2016; 56: 541-590. PubMed: https://pubmed.ncbi.nlm.nih.gov/24219323/
- Shishehbor F, Mansoori A, Shirani F. Vinegar consumption can attenuate postprandial glucose and insulin responses; a systematic review and meta-analysis of clinical trials. Diabetes Res Clin Pract. 2017; 127: 1-9. PubMed: https://pubmed.ncbi.nlm.nih.gov/28292654/
- Siddiqui FJ, Assam PN, de Souza NN, Sultana R, Dalan R, et al. Diabetes Control: Is Vinegar a Promising Candidate to Help Achieve Targets? J Evid Based Integr Med. 2018; 23: 2156587217753004. PubMed: https://pubmed.ncbi.nlm.nih.gov/29756472/
- Launholt TL, Kristiansen CB, Hjorth P. Safety and side effects of apple vinegar intake and its effect on metabolic parameters and body weight: a systematic review. Eur J Nutr. 2020; 59: 2273-2289. PubMed: https://pubmed.ncbi.nlm.nih.gov/32170375/
- Yamashita H. Biological Function of Acetic Acid-Improvement in Obesity and Glucose Tolerance by Acetic Acid in Type 2 Diabetic Rats. Crit Rev Food Sci Nutr. 2016; 56: S171-175. PubMed: https://pubmed.ncbi.nlm.nih.gov/26176799/
- Johnston CS. Strategies for healthy weight loss: from vitamin C to the glycemic response. J Am Coll Nutr. 2005; 24: 158-165. PubMed: https://pubmed.ncbi.nlm.nih.gov/15930480/
- Kondo T, Kishi M, Fushimi T, Ugajin S, Kaga T. Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects. Biosci Biotechnol Biochem. 2009; 73: 1837-1543. PubMed: https://pubmed.ncbi.nlm.nih.gov/19661687/
- Frost G, Sleeth ML, Sahuri-Arisoylu M, Lizarbe B, Cerdan S, et al. The short-chain fatty acid acetate reduces appetite via a central homeostatic mechanism. Nat Commun. 2014; 5: 3611. PubMed: https://pubmed.ncbi.nlm.nih.gov/24781306/
- Darzi J, Frost GS, Montaser R, Yap J, Robertson MD. 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. PubMed: https://pubmed.ncbi.nlm.nih.gov/23979220/
- 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. PubMed: https://pubmed.ncbi.nlm.nih.gov/15983536/
- Gambon DL, Brand HS, Veerman EC. Unhealthy weight loss. Erosion by apple cider vinegar. Ned Tijdschr Tandheelkd. 2012; 119: 589-591. PubMed: https://pubmed.ncbi.nlm.nih.gov/23373303/
- Almenara CA, Aimé A, Maïano C. Vinegar and weight loss in women of eighteenth-century France: a lesson from the past. Hist Psychiatry. 2020; 31: 232-236. PubMed: https://pubmed.ncbi.nlm.nih.gov/31755313/
- 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. PubMed: https://pubmed.ncbi.nlm.nih.gov/9736833/
- Zero DT, Lussi A. Erosion--chemical and biological factors of importance to the dental practitioner. Int Dent J. 2005; 55: 285-290. PubMed: https://pubmed.ncbi.nlm.nih.gov/16167607/