Reality check: Does apple cider vinegar have health benefits?

Globe and Mail

19-05-2025

For centuries, apple cider vinegar has been used to treat a range of ills such as fever, coughs and colds.
Today, social media influencers and celebrities praise the tart, sour-tasting liquid for its ability to detox the body, lower blood sugar and cholesterol, banish bloating, burn body fat, get rid of acne and more.
Sounds too good to be true?
There is reason to be skeptical about many of apple cider vinegar's health claims.
For one or two, though, the evidence, while not robust, suggests it may be helpful. Here's what to know.
Apple cider vinegar (ACV) is made by fermenting crushed apples with yeast, which turn the sugars into alcohol.
A second fermentation then allows bacteria to convert the alcohol into acetic acid, the compound that gives vinegar its characteristic sour taste and smell.
Pasteurized apple cider vinegar is heat-treated to kill bacteria and extend shelf life. Unpasteurized apple cider vinegar is cloudy and contains the 'mother', a sediment of gut-healthy microbes.
Apple cider vinegar is available as a liquid, and also as tablet and gummy supplements; studies have focused on the liquid form.
Here's where the evidence stands on ACV's purported health and wellness benefits.
A 2025 review of clinical trials involving 463 adults with type 2 diabetes concluded that taking one to two tablespoons of ACV daily for at least eight weeks significantly reduced fasting blood glucose and hemoglobin A1c compared to placebo. (A hemoglobin A1c test measures your average blood sugar level over the previous three months.)
Two earlier meta-analyses of mostly low-quality clinical trials conducted in adults with overweight, obesity and/or Type 2 diabetes found that taking ACV daily for up to 12 weeks improved fasting glucose, hemoglobin A1c, total cholesterol and blood triglycerides. However, these beneficial effects were limited to participants with Type 2 diabetes.
There was no effect of ACV on LDL (bad) cholesterol levels in the bloodstream.
A clinical study from Iran involving 80 adults with Type 2 diabetes did find that, compared to the placebo treatment, taking two tablespoons of ACV daily for eight weeks significantly lowered LDL cholesterol.
Bottom line: ACV may lower blood glucose in people with Type 2 diabetes. It's unclear, though, whether it's beneficial for high blood cholesterol.
Acetic acid in ACV is thought to slow the rate that food empties from the stomach into the small intestine, causing a slower release and rise of glucose into the bloodstream. Acetic acid may also increase the body's ability to metabolize glucose and fats.
Studies investigating the impact of ACV on weight loss are few, small in size and of short duration.
A 2018 study found that taking one tablespoon of ACV twice daily for 12 weeks, while eating a calorie-restricted diet, reduced appetite and resulted in a modest weight loss compared to dieting alone.
It was unclear, though, whether eating fewer calories or taking apple cider vinegar influenced the findings.
A 2024 clinical study from Lebanon involving 120 participants, ages 12 to 25, who were overweight or living with obesity found that consuming one, two or three teaspoons of ACV daily for 12 weeks resulted in a significant reduction in body weight compared to placebo.
Measures of fasting blood glucose, cholesterol and triglycerides also improved in the ACV group.
Participants kept food diaries, but calorie and nutrient intakes weren't analyzed by the researchers. It's not known if participants changed the quantity or types of foods they ate during the study.
Consuming acetic acid with a meal may increase satiety, possibly helping you consume fewer calories during the day. Even so, ACV is not a magic bullet for weight loss.
There's no scientific evidence that ACV improves bloating, indigestion or acid reflux.
It's possible that consuming unpasteurized ACV, a natural source of probiotics, can benefit gut health by increasing the diversity and richness of the gut microbiome.
When it comes to clearing up acne, there's not enough reliable evidence to assess ACV's effectiveness. Ditto for using it topically to treat eczema or remove warts.
ACV is considered safe when consumed in food amounts.
It may, though, interact with some medications for diabetes and congestive heart failure, as well as certain diuretics. Consult your doctor before using ACV.
Don't drink ACV straight. Its high acidity can irritate your throat and esophagus, worsen acid reflux and damage tooth enamel.
Dilute one tablespoon of vinegar in eight ounces of water. Drink it before a meal once or twice a day. Or consume it as part of a meal in a vinaigrette salad dressing.
Acetic acid isn't unique to ACV. All vinegars contain it; balsamic, red wine, white wine and distilled white vinegar can be a substitute for apple cider vinegar.
Leslie Beck, a Toronto-based private practice dietitian, is director of food and nutrition at Medcan. Follow her on X @LeslieBeckRD