Apple Cider Vinegar
Summary
Apple cider vinegar lowered fasting glucose in small, mostly unblinded type 2 diabetes trials (grade C) and trimmed body weight by 1–2 kg in a 12-week trial funded by a vinegar maker (grade C). Effects on cholesterol are small. It is acidic: it can erode teeth, tablets have injured the esophagus, and it slows stomach emptying.
Key facts
- Vinegar from the alcoholic and then acetous fermentation of apple juice; FDA guidance expects at least 4 g of acetic acid per 100 mL[1]
- About 1–2 kg lower body weight than placebo after 12 weeks of 15–30 mL a day in obese Japanese adults[5]
- A meta-analysis of 9 trials found total cholesterol about 6 mg/dL lower, with no change in LDL or HDL[2]
- 30 mL a day slowed stomach emptying further in people with type 1 diabetes and gastroparesis[6]
- Testing of eight ACV tablet brands found inconsistent acid content and labels, and doubt that some contained ACV at all[7]
- 3 graded human outcomes on this page
- October 10, 2026
How it works
ProposedAcetic acid slows stomach emptying and blunts the rise in glucose and insulin after a meal; a meta-analysis of meal studies found lower post-meal glucose and insulin responses with vinegar.[4][6]
What the human research says
Human trials only, one row per outcome. The form column shows what each trial actually tested. Grades follow our evidence-grading policy.
At a glance: strongest evidence per outcome
| Outcome | Grade | Effect | Strongest evidence | Rows |
|---|---|---|---|---|
| Blood sugar | Grade C | Improved | Meta-analysis of 7 trials · n = 463 · 2025 | 1 row |
| Weight | Grade C | Improved | RCT · n = 175 · 2009 | 1 row |
| PCOS | Grade D | Improved | RCT · n = 94 · 2026 | 1 row |
Every graded row
| Outcome | Effect | Grade | Best evidence | PMID |
|---|---|---|---|---|
| Blood sugar in type 2 diabetes | Improved | Grade C | Meta-analysis · n = 463 · 2025 Adults with type 2 diabetes in 7 controlled trials Form: Liquid apple cider vinegar · Dose: 15–30 mL/day · Duration: 4–12 weeks Fasting glucose fell 22 mg/dL versus control; HbA1c fell 1.5 points in 4 trials (319 people) with high heterogeneity; insulin resistance (HOMA-IR) did not change. | 39949546 (opens PubMed)Source [3] |
| Body weight and visceral fat | Improved | Grade C | RCT · n = 175 · 2009 Obese Japanese adults (BMI 25–30), aged 25–60 Form: Apple vinegar in a 500 mL drink · Dose: 15 or 30 mL/day (750 or 1,500 mg acetic acid) · Duration: 12 weeks Body weight, BMI, visceral fat area, waist and triglycerides were lower in both vinegar groups than placebo; weight fell by about 1–2 kg. | 19661687 (opens PubMed)Source [5] |
| Metabolic syndrome and insulin resistance in PCOS | Improved | Grade D | RCT · n = 94 · 2026 Women with PCOS, metabolic syndrome and insulin resistance, all on metformin 1,500 mg/day Form: Apple cider vinegar capsules · Dose: 1,500 mg/day · Duration: 12 weeks Metabolic syndrome resolved in 74.5% on ACV capsules versus 40.4% on placebo; insulin resistance and hirsutism scores also fell. | 42215584 (opens PubMed)Source [11] |
Forms
| Form | Elemental % | Absorption (human data) | GI tolerance | Studied for |
|---|---|---|---|---|
| Liquid apple cider vinegar (diluted) | Varies[1][3] | No human absorption data in our sources.[1] | Acidic; weekly apple vinegar use was linked to dental erosion in a case-control study.[9] | Blood sugar and weight trials (15–30 mL/day) |
| ACV tablets and capsules | Varies[7][11] | No human absorption data in our sources.[7] | A reported esophageal injury from ACV tablets prompted product testing, which found wide variation in acid content and labeling.[7] | Metabolic syndrome in PCOS (1,500 mg/day capsules) |
Studied doses
Doses studied in human trials ranged from 15 to 30 mL/day of liquid vinegar (about 750–1,500 mg of acetic acid) for 4 to 12 weeks; one PCOS trial used 1,500 mg/day of ACV capsules for 12 weeks.[3][5][11]
Interactions
Published interactions only: each row cites a source. No row means none was found in our sources, not that a combination is safe.
None found in our sources.
Who should be careful
- Type 1 diabetes with gastroparesis
- Daily vinegar slowed stomach emptying further in people with diabetic gastroparesis, which could make blood sugar harder to manage around insulin doses.[6]
- Tooth enamel
- Weekly apple vinegar intake was linked to tenfold higher odds of dental erosion, and vinegars dissolved enamel minerals in the lab.[9][10]
- Swallowing tablets
- Esophageal injury from ACV tablets has been reported; product testing found inconsistent acid content and labels.[7]
- Large daily amounts and low potassium
- A case report describes low potassium, high renin and osteoporosis in a person ingesting large amounts of cider vinegar.[8]
- People on glucose-lowering medicines
- Vinegar lowered fasting glucose in diabetes trials, so readings may fall further when combined with diabetes medicines.[3]
Talk to your pharmacist or clinician before starting a supplement, especially if you take prescription medicines.
Safety
Generally safe as a diluted food; concentrated or tablet forms carry acid-related risks.
- Teeth
- Weekly apple vinegar intake was a strong risk factor for dental erosion in a case-control study.[9]
- Esophagus
- A reported esophageal injury from an ACV tablet prompted product testing that found poor quality control.[7]
- Stomach emptying
- 30 mL a day reduced the gastric emptying rate in people with type 1 diabetes and gastroparesis.[6]
- Potassium and bone
- One case report links long-term heavy cider vinegar intake to low potassium and osteoporosis.[8]
How to read the label
- Label dose vs clinical doseTrials used 15–30 mL of liquid vinegar a day, about 750–1,500 mg of acetic acid. Tablet products varied widely in acid content, so their dose cannot be compared.[5][7]
- Acid strengthFDA guidance expects cider vinegar to contain 4 g of acetic acid per 100 mL; diluted vinegar must state its acid strength and should not fall below 4%.[1]
- Tablet qualityIn one analysis of eight ACV tablet brands, tablet size, pH, acid content and label claims varied widely.[7]
Frequently asked questions
Does apple cider vinegar lower blood sugar?
In 7 small trials in type 2 diabetes, 15–30 mL a day lowered fasting glucose by about 22 mg/dL; most trials were small and several were unblinded.[3]
Does apple cider vinegar help with weight loss?
In a 12-week trial in obese Japanese adults run by a vinegar maker, 15–30 mL a day lowered weight by about 1–2 kg more than placebo.[5]
Does apple cider vinegar lower cholesterol?
A meta-analysis of 9 trials found total cholesterol about 6 mg/dL lower, with no change in LDL or HDL; in apparently healthy people, fasting glucose rose slightly.[2]
Are ACV gummies or pills as good as the liquid?
Unknown. Trials mostly used liquid vinegar, and testing of eight tablet brands found inconsistent acid content and labels.[7][3]
Can apple cider vinegar damage teeth?
Yes. Weekly apple vinegar intake was linked to much higher odds of dental erosion.[9]
Sources
- [1]CPG Sec. 525.825 Vinegar, Definitions - Adulteration with Vinegar Eels (revised March 1995). U.S. Food and Drug Administration, 1995. guideline
- [2]The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials.. BMC Complement Med Ther, 2021. meta-analysis
- [3]Effects of apple cider vinegar on glycemic control and insulin sensitivity in patients with type 2 diabetes: A GRADE-assessed systematic review and dose-response meta-analysis of controlled clinical trials.. Front Nutr, 2025. meta-analysis
- [4]Vinegar consumption can attenuate postprandial glucose and insulin responses; a systematic review and meta-analysis of clinical trials.. Diabetes Res Clin Pract, 2017. meta-analysis
- [5]Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects.. Biosci Biotechnol Biochem, 2009. RCT
- [6]Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: a pilot study.. BMC Gastroenterol, 2007. open-label
- [7]Esophageal injury by apple cider vinegar tablets and subsequent evaluation of products.. J Am Diet Assoc, 2005. observational
- [8]Hypokalemia, hyperreninemia and osteoporosis in a patient ingesting large amounts of cider vinegar.. Nephron, 1998. observational
- [9]Risk factors in dental erosion.. J Dent Res, 1991. observational
- [10]In vitro study on dental erosion caused by different vinegar varieties using an electron microprobe.. Clin Lab, 2014. observational
- [11]Adjunctive effects of apple cider vinegar on metabolic syndrome and insulin resistance in polycystic ovary syndrome patients receiving metformin: a randomized clinical trial.. Sci Rep, 2026. RCT
What changed
- First draft. Every PMID checked against NCBI E-utilities esummary (title and year taken from the record) and abstracts read for the cited rows.
- Adversarial review pass: every evidence row re-read against its PubMed abstract; trial size (175 randomized, 155 analyzed), apple vinegar use, the 1–2 kg effect and Mizkan Group affiliations confirmed in the J-STAGE full text; meta-analysis participant totals and blinding confirmed in PMC11821484. Official source opened before citing: FDA Compliance Policy Guide Sec. 525.825 (vinegar definitions, 4 g acetic acid per 100 mL). No ODS fact sheet, NCCIH page or EMA monograph exists for apple cider vinegar (NCCIH A–Z checked; NCCIH diabetes supplements page does not mention vinegar). Integrity: the 2024 Lebanese ACV weight trial (PMID 38966098) is retracted (notice 41789013) and is not cited; a 2025 body-composition meta-analysis (PMID 41010525) pools that retracted trial (confirmed in PMC12472926), so it is excluded too. Industry ties: Kondo 2009 authors are Mizkan Group Corporation employees; the T2D meta-analysis lists its trials as investigator-initiated or funding not reported. Retraction, expression-of-concern, erratum and withdrawn checks on all 10 PMIDs: none flagged. Page set indexable. Independent browser review (4 parallel reviewers, every evidence row checked against its abstract and official sources on the Vercel preview) found: no issues (FDA CPG, retraction exclusions and all rows verified).