How much apple cider vinegar should you drink each day

Apple cider vinegar (ACV) has been touted as a cure-all in recent years, with far-ranging health benefits being described. But what are the real benefits of ACV, and what’s the best way to take it?

myDr helps you weigh up the pros and cons of ACV to your diet. Find out which health benefits are supported by science and which aren’t, and get the low-down on the negative effects of ACV.

What is apple cider vinegar?

Apple cider vinegar isn’t new – it’s been around for a long time and has been used for centuries as a tonic for various ailments and even as a cleaning product. Like all types of vinegar, apple cider vinegar contains acetic acid as the key ingredient.

As the name suggests, ACV is made from apple cider. The cider is made by fermenting the sugar in apples. ‘Good’ bacteria called acetobacter then convert the alcohol in the cider into acetic acid to form vinegar.

In addition to acetic acid, ACV may also contain a small amount of malic acid and citric acid. The pH of apple cider vinegar is about 2-3, which is considered mildly acidic. (pH is a measure of acidity, with 1 being the most acidic and 7 being neutral.)

A substance known as ‘the mother’ (or vinegar mother) forms during the vinegar-making process. The vinegar mother is made up of proteins, enzymes and ‘good’ bacteria. It may look like strands or cobwebs in the vinegar or like a gelatinous blob, and gives unstrained apple cider vinegar its cloudy-brown appearance. It can be used to kick-start further batches of ACV because it triggers the fermentation process. ‘The mother’ is thought by some to be the substance that’s responsible for the health benefits of apple cider vinegar.

What are the possible health benefits?

A wide range of health benefits have been linked to ACV, ranging from treatment of dandruff to athlete’s foot. More general claims that ACV improves vitality, energy and the absorption of nutrients from food have also been made. But not all of these claims have been proven by scientific studies on humans.

Let’s examine some of the claims to see what evidence there is to support them.

Apple cider vinegar lowers blood sugar levels

A 2017 review of several clinical studies found that vinegar (but not necessarily ACV) may help reduce a spike in blood sugar levels after a meal. It may also help stabilise insulin levels after eating. These effects were seen in people with diabetes and pre-diabetes, as well as healthy people, when they had 1-2 tablespoons of vinegar with a meal.

It should be noted, however, that there were only 11 studies included in this review, and each of these studies had small number of participants. Also, the effect of vinegar on glucose levels may depend on the glycaemic load of the meal – vinegar seems to have a greater effect in lowering glucose levels when taken with meals with a high GI (glycaemic index).

It’s thought that vinegar may lower glucose and insulin levels by slowing both stomach emptying and the digestion of carbohydrates. Further research is needed to confirm these effects and their benefits.

People with diabetes, especially those who also have gastroparesis (a complication of diabetes that causes delayed stomach emptying), should not have vinegar drinks without consulting their doctor.

Apple cider vinegar helps you lose weight

There is some evidence from clinical trials showing that ACV may be useful for weight loss. But the effects seem to be small at best.

One small study showed that drinking ACV diluted in water resulted in about a kilogram of weight loss in overweight people, but only in the short term. Another study found that vinegar suppressed appetite, but this was mainly due to study participants feeling nauseated after drinking vinegar solution. In these studies, different vinegars (not just ACV) were used.

It seems that as with most other quick-fix weight loss ideas, vinegar is not the easy answer. Diet and exercise are still the most effective and well-studied ways to reach a healthy weight and keep the weight off.

Unproven health effects of ACV

While apple cider vinegar is widely used for many ailments and conditions, most of its effects have so far not been scientifically proven. It has not been shown to prevent cancer or heart disease or reduce high blood pressure. It does not whiten teeth and has not been shown to be effective against dandruff, leg cramps, acne or head lice. Taking apple cider vinegar does not change or ‘balance’ the pH of your body (which is very strictly controlled by your body when you are healthy).

Some of the reasons that the health benefits of ACV remain unproven is that many of the studies done so far are small and/or of poor quality. Quite a few of the studies have involved animal subjects, not humans, and several of the human studies did not specifically use apple cider vinegar – many different types of vinegar were used.

Of course, when something is unproven it doesn’t mean that it won’t be shown to be true at some point in the future. New discoveries are being made all the time. But for now, the available evidence cannot be relied on.

But what’s the harm?

You may still be thinking of taking apple cider vinegar even if many of the purported benefits are not proven. It’s natural, so what harm can there be in taking it just in case it works? Well, it turns out that there are some side effects.

Side effects from drinking apple cider vinegar

Drinking apple cider vinegar ‘neat’ (on its own) can damage your throat and oesophagus (food pipe), causing pain and inflammation. It can also worsen heartburn and acid reflux. If you are going to drink apple cider vinegar, it’s important that you dilute it by adding water (see below).

Drinking apple cider vinegar (even when diluted) can also erode the enamel on your teeth – the hard outer coating that protects your teeth from decay.

Taking apple cider vinegar may also interfere with some medicines, including diabetes medicines and diuretics (fluid tablets). Always check with your doctor before starting any new supplements, especially if you take regular medicines.

Problems with applying vinegar to your skin

Some people have applied apple cider vinegar to their skin to treat acne and other skin conditions. This can cause significant irritation, possibly leading to scarring and unusual skin pigmentation. Sometimes vinegar can even cause skin burns.

Others have used it in an attempt to remove unwanted skin lesions, including moles. In addition to the side effects mentioned, it’s very important that you see your doctor about any skin lesions, especially those that are new or look different. Treating skin lesions yourself can put your health at risk.

How can you incorporate apple cider vinegar into your diet?

Most people who recommend taking apple cider vinegar for health benefits suggest you have 1-2 tablespoons each day. If you drink it, you should dilute this amount in a glass of water. But don’t forget that apple cider vinegar doesn’t taste sweet like apple cider – it tastes like vinegar, which is sour. So, taking it as a drink is not everyone’s cup of tea, so to speak.

If you do enjoy or intend to drink diluted ACV, drinking it through a straw is recommended to help protect your teeth. Rinsing your mouth afterwards is also a good idea. You can drink if before or during meals but listen to your body – if it is making you feel sick or causing indigestion, stop taking it and see your doctor.

Perhaps a better way to add apple cider vinegar into your diet is mixed with olive oil and used as a salad dressing. It tastes pretty good when used in this way and there is a very low risk of any ill effects.

Does apple cider vinegar contain many calories?

Apple cider vinegar, like other types of vinegar, is very low in calories, or kilojoules. Adding it to your diet would make very little difference to your overall energy intake. But flavoured drinks that contain apple cider vinegar may be a different story – always check the nutrition label on any product you buy.

Is ACV a good source of potassium?

Some people recommend the use of apple cider vinegar as a good source of potassium. However, there is only a small amount of potassium in most brands of apple cider vinegar, and there are some concerns that it may actually lower potassium levels when taken in large amounts.

Where can you buy it?

There are many different brands of ACV available in Australia. Some are organic and some contain ‘the mother’. Apple cider vinegar can be bought in supermarkets and health food stores. Flavoured drinks that have apple cider vinegar as one of the ingredients are also available.

Apple cider vinegar supplements that come as capsules or tablets are also available in health food stores, pharmacies and supermarkets. These are made of dried apple cider vinegar and sometimes also contain other ingredients. (Always read the package of any supplement to see what it contains.)

So, should I be taking apple cider vinegar to improve my health?

Overall, there is currently no strong evidence to support the health benefits of apple cider vinegar and there are some harms associated with regularly using it specifically for this purpose. But if you enjoy using vinegar in cooking, by all means try apple cider vinegar for a slightly different flavour – just don’t expect it to cure all your ailments.

1. Rosemary Stanton. Is apple cider vinegar really a wonder food? The Conversation (24 Nov 2017). https://theconversation.com/is-apple-cider-vinegar-really-a-wonder-food-86551 (accessed May 2019).
2. 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(8):1837-43.
3. 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. doi: 10.1016/j.diabres.2017.01.021.
4. 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. International Journal of Obesity 2013;38:675–681.

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