Is apple cider vinegar actually good for gut health? Hear from dietetics student Amy Pun (post reviewed and updated by Andrea Hardy, registered dietitian) on what’s fact and what’s fiction when it comes to the benefits of apple cider vinegar. Like whether it prevents inflammation, improves the gut microbiome, and what the most recent research shows.
In recent years, society has become increasingly health-conscious. To a fault. We’ve become obsessed with food. Attaching morality to food (which it shouldn’t have). We will even pay extra dollars for specialty products. Like ‘apple cider vinegar for gut benefits’ that frankly, have little, if any science behind them. Frustrating as it is for a registered dietitian – it makes sense. We’re inherently lazy. Why CAN’T one pill, one potion, be a cure-all? I’ll let you sit on that one for a while.
Table of Contents
- Does ACV Reduce Inflammation
- Scientifically Proven Benefits of ACV
- Is ACV Good for my Gut Microbiome
- Does ACV Have Antimicrobial Properties?
- Should ACV be used to treat SIBO?
- Can ACV help with bloating?
- Risks associated with taking ACV
- Should I take ACV for gut health?
- How to use ACV
Should I Take Apple Cider Vinegar for Gut Health?
One of the most popular products gracing the shelves today is Apple Cider Vinegar (ACV). Apple cider vinegar has long been touted as a natural health remedy for gut repair. But what are the actual benefits of consuming ACV? When you Google ACV, the search engine will yield endless beneficial claims of ACV. From detoxifying your body, to conditioning your hair and whitening your teeth. People are even putting it on open wounds (no, really… ) Let’s talk about facts versus fiction – especially around gut health.
Does ACV prevent inflammation in the gut?
Little research has been done on the anti-inflammatory properties of ACV in the gut. Of the studies conducted, NONE have been able to prove that ACV is effective against gut inflammation.
If everyone’s shooting ACV, there’s someone with a big name who spews a ton of crap behind it. Let’s get this straight now. If it seems too good to be true, and there is NO real research behind it – it probably is too good to be true. Rinse and repeat.
Is ACV an antibiotic?
Claimed benefits hail from several compounds within the vinegar. Including acetic acid, potassium, magnesium, probiotics and enzymes. Some *ahem* – less reputable sources with poor ability to interpret research but yet are comfortable providing blanket claims, with it seems yet a new supplement each week (cough cough Dr. Axe), believe that that the acetic acid within the ACV can reduce “bad” bacteria and increase “good” bacteria. Acting as a natural antibiotic to improve gut health and aid in gut repair without adverse effects on your body.
Can ACV improve gut health?
If you actually want to learn how to improve gut health check out our top posts. (Spoiler alert: ACV probably isn’t going to do it).
Can apple cider vinegar treat arthritis?
One animal study found ACV is NOT an effective anti-inflammatory agent in arthritic rats2. Funny. When animal studies confer a products’ results – people jump on them. As soon as the results are negative, they seem to be largely ignored. (Really we shouldn’t be basing our health decisions solely on rat studies anyway).
In studies that looked at the effect of acetic acid on the body, it was found that acetic acid has little effect on gastric emptying, rate of food intake and glucose absorption3,4. The antimicrobial properties of acetic acid claimed may be effective only in fermented food products rather than in the human body4,5.
What are the scientifically-proven benefits of ACV?
There are many varieties of vinegar products produced around the world. Different vinegars contain different types and amounts of bioactive compounds that may defend against oxidative stress, diabetic progression, microorganisms, tumor growth, obesity, and high blood pressure and cholesterol5
There are 2 main scientific benefits associated with ACV:
ACV contains polyphenol and vitamins, which are powerful antioxidants that defend your body against cellular damage. There IS research coming out supporting the role in antioxidants and polyphenols in improving gut health. However, you can get these powerful nutrients from food, or by using ACV in a recipe, rather than drinking it10.
ACV can contain live bacteria, if you chose one that has not been pasteurized, and it contains the mother. Fermented foods have been shown to introduce bacteria to the gut that may provide valuable metabolic byproducts, which may improve gut health9. The TRICKY thing with fermented foods is, we often don’t know what bacteria we’re getting, if those bacteria survive the trip through the gut, and if they’re truly beneficial.
Is ACV a probiotic? No. To be called a probiotic – the bacteria HAS to have the right strain, and amount of bacteria proven in research to have benefit. They’re fermented foods. Which is great! Include fermented foods in your diet! But do we need to drink it, straight up? I’m gonna say that’s a big no.
Let’s talk claimed ACV benefits.
Does ACV reduce bad bacteria and improve good bacteria? Is it good for my gut microbiome?
Maybe. Maybe not. Raw unfiltered ACV contains fermented apples and pectin. Pectin is a prebiotic fiber found in fermented apple that promotes good digestion by clearing away excess cholesterol in your gut6. Pectin is the key ingredient that encourages growth of good bacteria and can then help those bacteria outcompete “bad” bacteria1. However, the amount of the prebiotic fibre, pectin, found in a whole apple will be WAY more than in ACV. Much larger quantity than a tablespoon of vinegar. Get our list of prebiotic foods for gut health here, or try our Apple Cinnamon Pancake recipe for a pectin-boost!
Does ACV have antimicrobial properties?
Well, I guess, if you’re making pickles. Guys. Let’s talk basic physiology. Your gut has a pH of 1-2.5. VERY acidic. Its JOB is to help digest AND protect you from dangerous pathogens. Your stomach acid is up to the task. Not to mention – the pH of ACV is around 3. Meaning it’s actually LESS acidic than the stomach.
You take an ounce of ACV. Your body produces 2 litres of gastric secretions a day. I don’t typically recommend peeing into the wind… but ya know, if you’re taking ACV as a shot, you may as well.
Should you use ACV to help with SIBO?
This question is becoming more and more popular. With the touted benefits of its anti-microbial action, many patients are shooting ACV like its going out of style. However, like we discussed above, ACV is not only unlikely to alter the pH of your stomach significantly, your body is going to manage pH going through your small bowel, where those microbes are residing. Skip the ACV for SIBO, and discuss with your doctor an appropriate treatment plan for SIBO that has been shown to work. As well as a plan to prevent recurrence.
Can ACV help with bloating?
One of the most popular claims is that ACV reduces bloating by aiding in digestion. As we discussed above, ACV is acidic. It can help to begin to break down foods (its why it can be used in a marinade as a meat tenderizer!). However – the amount of ACV you’d consume, versus the amount of stomach acid you have dwarfs in comparison. Anecdotally, people feel like ACV helps bloating. But, the placebo effect is real. (Have Andrea tell you about the time she thought she was getting tipsy drinking beer. Until she found out it was non-alcoholic!) In the natural health community, they’ll often try to ‘sell you’ that you might suffer from low stomach acid. This is rare unless you are on medications to suppress stomach acid production or have a rare condition called ‘hypochlorhydria’ (often due to autoimmune gastritis).
Are there risks associated with consuming ACV?
YES. There are definitely some risks associated with ingestion of ACV or any type of vinegar. Below are 3 scientifically proven risks associated with ACV ingestion. (Read – there is no great evidence supporting taking it, but mounds supporting that maybe you don’t drink the stuff.)
Dental Erosion from ACV
Contrary to the popular claim that ACV is a natural teeth whitening agent, studies have found that weekly consumption of apple cider vinegar increased the risk of dental erosion. The risk was positively associated with a habit of swishing and holding acid in the mouth, enhancing the contact surface area and time with the teeth. This means that frequent ACV ingestion may increase the risk of damage to your teeth enamel and cause dental cavities11, 12.
Injury to Esophagus and Vocal Cords
Consumption of acid such as ACV may result in acid burns that damage your esophagus and vocal cords. In one case report, a woman reported severe pain and difficulty swallowing after an apple cider tablet was trapped in her throat for 30 minutes. A study that examined 8 different brands of apple cider vinegar tablets found varying concentrations of acetic acid in the tablets. ACV tablets with high concentration of acetic acid have a higher risk of acid burn to the throat compared to lower concentrations13. In another case report, a woman who consumed a teaspoon of vinegar resulted in inflammation of her oropharynx and second-degree caustic injury in her esophagus. This report confirmed the danger of ulcerative injury to the throat and gut. Furthermore, acid reflux from vinegar ingestion may damage the vocal cords as well14.
ACV May help blood sugars – but diabetics need to be aware of this
While research shows that consuming ACV alongside a starchy meal can reduce the glucose level in the blood in diabetics7,8, you would be wise to check with your physician prior to taking apple cider vinegar in therapeutic doses. If you take insulin, you may need to consider how ACV may influence your insulin dosing. The blood glucose lowering effect of vinegar without adjusting dosage of insulin-injection before meal may result in low-blood sugar in these patients. If you have diabetes and are taking insulin or oral hypoglycemics, you should consult your physician prior to any ACV consumption to reduce risks of unexpected lows15.
Ok – so should I be taking ACV for its gut benefits or not?
Yes and no. The risks associated with ACV in therapeutic doses (in pill form or as a straight up shot) appear be far greater than their benefits.
My professional advice is – don’t drink it and no need for ACV in pill form either. That’s just silly. If you’re having gut problems – don’t self diagnose or treat with apple cider vinegar. See a doctor or talk with your dietitian about your gut issues.
However! It’s still a food. I say, using ACV as part of your cooking makes a heck of a lot more sense.
How to use Apple Cider Vinegar Like a Champ
- Use ACV in your salad dressing. I like a simple 1 part acid, 1 part oil, salt, pepper, dill, and a bit of honey or sugar
- Try our Low-FODMAP Simple Salmon Salad recipe dressed with ACV dressing
- Add ACV as part of the marinade for your steak
- When cooking stir fry – use ACV to de-glaze the pan and add flavor.
- Pickle your own veg! I love to pickle carrots and cabbage in vinegar, alongside spices, and top my tacos with it.
If you are currently taking prescribed medication, please consult your healthcare practitioner or doctor before using ACV products of any kind. This can prevent any risks on your body associated with herb-drug interactions13.
FAQ About Apple Cider Vinegar for Gut Health
While unpasteurized apple cider vinegar is a source of both prebiotics and live bacteria, dietitians do not recommend drinking it. Rather, enjoy it in recipes, like our simple salmon salad for its gut-healthy benefits.
Typically, no, apple cider vinegar will not help with bloating. However, there may be a few cases where it might influence a bloated tummy. Learn more in our ‘ACV for Gut Health‘ post here.
While apple cider vinegar does have some pectin, a prebiotic fibre that feeds good bacteria, there are other foods WAY higher in good-for-your gut prebiotics. Get a list of prebiotic foods here.
- Shinohara, K., Ohashi, Y., Kawasumi, K., Terada, A., & Fujisawa, T. (2010). Effect of apple intake on fecal microbiota and metabolites in humans. Anaerobe, 16(5), 510-515.
- Ross, C. M., & Poluhowich, J. J. (1984). The effect of apple cider vinegar on adjuvant arthritic rats. Nutrition research, 4(4), 737-741.
- Kondo, S., Tayama, K., Tsukamoto, Y., Ikeda, K., & Yamori, Y. (2001). Antihypertensive effects of acetic acid and vinegar on spontaneously hypertensive rats. Bioscience, biotechnology, and biochemistry, 65(12), 2690-2694.
- Johnston, C. S., & Gaas, C. A. (2006). Vinegar: medicinal uses and antiglycemic effect. Medscape General Medicine, 8(2), 61.
- Budak, N. H., Aykin, E., Seydim, A. C., Greene, A. K., & Guzel‐Seydim, Z. B. (2014). Functional properties of vinegar. Journal of food science, 79(5), R757-R764.
- Miettinen, T. A., & Tarpila, S. (1977). Effect of pectin on serum cholesterol, fecal bile acids and biliary lipids in normolipidemic and hyperlipidemic individuals. Clinica Chimica Acta, 79(2), 471-477.
- Johnston, C. S., Kim, C. M., & Buller, A. J. (2004). Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care, 27(1), 281-282.
- Liatis, S., Grammatikou, S., Poulia, K. A., Perrea, D., Makrilakis, K., Diakoumopoulou, E., & Katsilambros, N. (2010). Vinegar reduces postprandial hyperglycaemia in patients with type II diabetes when added to a high, but not to a low, glycaemic index meal. European journal of clinical nutrition, 64(7), 727-732.
- Parvez, S., Malik, K. A., Ah Kang, S., & Kim, H. Y. (2006). Probiotics and their fermented food products are beneficial for health. Journal of applied microbiology, 100(6), 1171-1185.
- Nazıroğlu, M., Güler, M., Özgül, C., Saydam, G., Küçükayaz, M., & Sözbir, E. (2014). Apple cider vinegar modulates serum lipid profile, erythrocyte, kidney, and liver membrane oxidative stress in ovariectomized mice fed high cholesterol. The Journal of membrane biology, 247(8), 667-673.
- Jarvinen, V. K., Rytomaa, I. I., & Heinonen, O. P. (1991). Risk factors in dental erosion. Journal of dental research, 70(6), 942-947.
- O’Sullivan, E. A., & Curzon, M. E. (1999). A comparison of acidic dietary factors in children with and without dental erosion. ASDC journal of dentistry for children, 67(3), 186-92.
- Hill, L. L., Woodruff, L. H., Foote, J. C., & Barreto-Alcoba, M. (2005). Esophageal injury by apple cider vinegar tablets and subsequent evaluation of products. Journal of the American Dietetic Association, 105(7), 1141-1144.
- Chung, C. H. (2002). Corrosive oesophageal injury following vinegar ingestion. Hong Kong medical journal= Xianggang yi xue za zhi/Hong Kong Academy of Medicine, 8(5), 365-366.
- Hlebowicz, J., Darwiche, G., Björgell, O., & Almér, L. O. (2007). Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: a pilot study. BMC gastroenterology, 7(1), 46.
Good article. Thank you for breaking it down.
I just read this article below which seems to be a scientific study showing benefit. Is this a good source? I appreciate your input on the article.
Here is the link to “Modulation of the intestinal microbiota by apple cider vinegar in rats subjected to cafeteria diet”: https://www.sciencedirect.com/science/article/pii/S1878648019304392
Great question! I should turn this into an IG post because there’s a lot to unpack there! A few things – I’m not able to get access to the full study to really analyze its methodology, statistical analysis and results (do you have access to the full study if so email my way I could only get the abstract!)
When it comes to animal studies like this, we need to be careful in generalizing to humans, especially since the study group was 8 rats in each – it makes it hard to really believe they had adequate sample size to show effect as they’ve stated in the abstract conclusion- just because there was a significant difference doesn’t give us a clue into whether this was due to chance, or whether the study was adequately powered with enough subjects to determine a true difference due to intervention. As well – their conclusions are really concerning in that they state ‘This work can be a successful strategy for weight loss and obesity prevention’ – I would NOT draw that conclusion from the abstract but perhaps there’s more nuance in the discussion section. At 7 ml/kg, a 70 kg man would be drinking 2 cups of ACV a day – so definitely not appropriate to recommend in humans as an obesity strategy – especially since we have no human trials – a more appropriate conclusion (again with out reading the full paper) may have been ‘further studies looking into the role of ACV and its unique properties in weight management in humans should be considered’.
Probably not for the abstract but what I hope is addressed in the full paper is, ACV is a fermented product – there’s no discussion as to the role the actual microbes play in this effect on the rats health markers and microbiome – that again would hopefully be in the discussion section and proposed as an avenue to explore for therapies to manage body weight.
So while it definitely leaves us with some questions as to the potential role it may have in health, it would not change my recommendations for humans at this point. Hope that helps (and would love to see the full study if you have it!)
Wow! Your most recent reference is 2010. A lot has gone on in 12 years. Your offensive tone about apple cider vinegar doesn’t help anyone.
How recent the references are doesn’t invalidate the article; please feel free to cite some more recent studies if you have an opposing scientific argument.
So many articles out there – on the internet, touting the benefits of products without without any real research.
Have you thought of writing or written anything on the benefits/effects of Korozu (EK) the Japanese vinegar made from fermented brown rice?
Apparently it’s supposed to have Anticarcinogenic and Anti-Colitis properties.
Hello I have not seen any evidence that shows that korozu has anti-carcinogenic and anti-colitis properties. I recently did a big lit review of fermented products on human health and didn’t see anything on this I assume if it exists – its ‘in-vitro’ (test tube) research which can’t directly be applied to humans unfortunately! However, if you enjoy it include it in your meals as you wish 🙂