For hundreds of years, and perhaps even more of late, people have touted supposed health benefits of apple cider vinegar (ACV) — everything from curing a cold to alleviating digestive disorders to halting the progression of chronic diseases. We’ll explore many of these health claims, focusing on the constellation of them that pertain especially to those individuals at risk for or diagnosed with diabetes. These individuals strive to manage their blood sugar, body weight and cardiovascular risk (among other concerns) because this disorder represents a complex metabolic syndrome gone awry. So, does apple cider vinegar help with diabetes?

Our conclusions: Based on still-preliminary research, ACV consumption could result in a few, limited health benefits — such as modestly lower blood glucose, weight and cholesterol levels. However, large-scale trials are still needed to solidify these and other claims of great medical significance. And, while apple cider vinegar could be one component of a dietary and lifestyle program aimed at better metabolic management, ACV’s impact in such an overall program is likely to be minimal at best. Plus, we all should be aware that there are potential side effects from consuming too much apple cider vinegar.

What is apple cider vinegar?

Essentially, apple cider vinegar is apple juice that has been fermented twice. First, crushed apples are mixed with yeast and a carbohydrate (usually sugar) to produce an alcohol. In the second fermentation process, natural bacteria convert the alcohol to acetic acid (which lends the sour, vinegar taste). Active ingredients aside from the acetic acid include other acids (ascorbic, citric, succinic and oxalic acids) and polyphenols.

Stores carry both pasteurized and raw ACV, the latter containing more natural bacteria and yeasts which usually make the ACV look more cloudy (from a sediment known as “the mother”).

How is apple cider vinegar consumed?

Apple cider vinegar is most often consumed as an ingredient in a sauce that you cook or top food with, such as a salad dressing. When attempting to consume it more regularly for medicinal benefits, people often dilute ACV in water and drink it as a beverage. Common dosages range from 1–2 teaspoons to 1–2 tablespoons per day mixed in a large glass of water.

What are the health benefits of apple cider vinegar?

Below we summarize the value of each apple cider vinegar health claim, starting with the constellation of issues that pertain particularly (but not exclusively) to those with diabetes — blood sugar, weight management, cardiovascular health and gut health, followed by summary assessments of other common ACV health claims.

Does apple cider vinegar lower blood sugar? – possible small potential benefit:

Apple cider vinegar won’t cure diabetes, but several small studies indicate it may moderately lower blood sugar (glucose) levels. When your blood glucose stays within a healthy range, it’s called glycemic control — which is one part of the more complex metabolic equation that involves triglycerides, insulin, tissue inflammation and gut disturbances. When your levels are chronically high, that’s called hyperglycemia. Learn more in The Link Between Blood Sugar and Diabetes; Blood Sugar, Diabetes and Inflammation; and What Is Postprandial Blood Sugar?

In a 2021 meta-analysis (of clinical studies relevant to date), it was concluded that ACV consumption significantly decreased fasting plasma glucose (FPG) levels in a subgroup of studies that administered ACV for > 8-weeks. This benefit was observed in diabetic subjects, but not in non-diabetic individuals. Study authors theorize that ACV can improve glycemic status by delaying gastric emptying, enhancing cellular glucose utilization and lipolysis, suppressing hepatic glucose production and lipogenesis, and facilitating insulin secretion. However, the lowering effect of ACV on HbA1C was non-significant in all subgroups, and no significant effect of ACV consumption was found on serum insulin levels. Bear in mind that the number of studies that were designed well enough to be analyzed was low, and the authors admit that “between-study heterogeneity was high for some outcomes, and most studies did not control the participant’s dietary intake, which might influence study outcomes… precluding reliable conclusions to be drawn.”

A small 2019 study (single arm; so no control group) looked at daily consumption of apple cider vinegar (for 12 weeks) along with metformin (a pharmacological treatment) for newly diagnosed type 2 diabetic patients, and found that glycemic control improved.  

Thus, preliminarily it would seem that (as long as you don’t have kidney disease) ACV can be incorporated into a diabetes treatment plan, although it very likely won’t take the place of any recommended medications… and it’s just one food source out of a long list of others (high-fiber vegetables, whole grains, healthy fats, lean proteins) that can help you better manage blood glucose levels. Learn more: How Consuming More Fiber Can Benefit Diabetes Management; and Non-Pharmacological Treatments For Diabetes.

Apple cider vinegar for weight loss - possible small benefit:

Leading medical organizations like Mayo Clinic and Cleveland Clinic caution that there’s only very limited scientific proof that ACV promotes weight loss, and most of the research is from animal studies. A 2016 study, for example, found that apple cider vinegar prevents obesity in rats. Many of these animal studies have linked acetic acid, the main component of ACV, to reduced fat storage and improved metabolism — but these effects don't necessarily apply to humans. 

On a more positive note, a 2009 study of 10 people found that drinking 1 to 2 tablespoons of apple cider vinegar every day for three months was associated with losing 2 to 4 pounds; and a 2018 study of 39 people also found that sipping ACV can increase satiety and supports weight loss when combined with a low-calorie diet. But these studies were small and the results don't represent a wide segment of the population. Thus, while these preliminary findings could be considered promising, larger, better-controlled trials are needed to know with any assurance that ACV has significant weight management benefits.

It’s also most important to step back and realize that adding one food source (such as ACV) to your diet, or for that matter subtracting one, is unlikely to have a significant impact, long-term, on your weight. Rather, it’s an overall healthier diet and other lifestyle modifications (such as daily movement/activity) that produce lasting and substantial results. That being said, ACV consumed in moderation (see risks, below) probably won’t hurt you and can be one added element of your healthy dietary plan.

Apple cider vinegar as a heart health aid – possible small benefit:

Cardiovascular diseases (CVDs), collectively, are regarded as the number one cause of early mortality, worldwide. Hyperlipidemia (along with the previously discussed hyperglycemia, or high blood sugar) is one of the common metabolic disorders that can lead to CVD. Since individuals with diabetes are at substantially higher risk of having CVD, and CVD’s impact can worsen other problems associated with diabetes, it is imperative that this population address any and all lifestyle modifications — as the recommended first line of therapy — to try to reduce hyperlipidemia.

The 2021 meta-analysis of ACV consumption did conclude that ACV, consumed daily for more than 8 weeks, had a beneficial effect on serum total cholesterol (TC) levels. In addition, a trend toward a significant favorable effect was also observed in serum triglyceride (TG) concentrations. 

Once again, though, it’s important to understand that a wide variety of foods, particularly high-fiber vegetables and whole grains, have been shown to have beneficial effects in controlling lipid profiles. Individuals need to ask themselves: which of these food sources is easier to incorporate, regularly, into a diet that can be adhered to over the long term?

On the blood pressure front, another important cardiovascular health indicator, there's some human research that suggests ACV may help lower blood pressure, but the research is still very preliminary. 

Apple cider vinegar as a probiotic – limited:

Much like kombucha or other fermented drinks, raw, unfiltered ACV contains bacteria that could help support a healthy gut, and gut health can aid you in fighting off pathogens, breaking down fiber from food and producing molecules — including short-chain fatty acids (SCFAs) — that keep your intestines healthy and help regulate and maintain metabolic and immune health. (See our report: Why the Gut Microbiome Is Key To Your Health.) As such, ACV has probiotic properties. However, probiotic foods have not been proven to do much for people who are already healthy; rather, they beneficially enhance treatments of certain diseases: learn more in  Probiotics vs. Prebiotics: What’s the Difference? 

But if you still want to eat probiotics for gut health, you’ll find that yogurt, kefir, even sourdough bread have been studied much more extensively than ACV, and they are likely better bets for daily consumption given their probiotic profiles and, most importantly, their other nutritional benefits. 

Apple cider vinegar as a prebiotic – limited:

Most research studies conclude that prebiotics, which are high-fiber foods (such as broccoli, oats, kiwi, almonds and pumpkin seeds — just to name a few), do more to improve your gut health than foods only rich in probiotics. While ACV contains some fiber, as well as the prebiotic benefit of the pectin from the apples, whether you have diabetes or not, you’re really better off eating whole food sources such as non-starchy vegetables, certain low-glycemic fruits and whole grains — both because the latter contain much higher amounts of fiber and also more vitamins and minerals. Learn more about the benefits of prebiotics and a high-fiber diet.

Apple cider vinegar as a “cleansing” or “detoxifying” agent in the body - none:

Many types of vinegar, including ACV, are used for their cleaning and disinfecting properties because they do have “antimicrobial” properties. For that reason, too, apple cider vinegar is also used as a preservative when added to other foods. But while it can help stop bacteria from spreading and even multiplying on surfaces and in jars, it’s not “antibacterial” — which means it’s highly unlikely to work like an antibiotic drug (which can kill pathogens) inside your body. 

Furthermore, the notion that it can “cleanse” your body is not borne out by science. In fact, the entire concept of ingesting various food sources or drinks in the hopes of “detoxifying” your GI tract or other bodily systems is, frankly, one that the vast majority of leading physicians frown upon because there is no proven efficacy and, in fact, there are risks associated with the process.

Apple cider vinegar as a heartburn aid - none:

As summed up by Cleveland Clinic, “there’s no science to back up ACV’s anti-heartburn power.” In fact, acidic foods or liquids like vinegar may exacerbate acid reflux; and if you have chronic kidney disease, your kidneys may not be able to process the excess acid that comes along with drinking apple cider vinegar.·    

Can apple cider vinegar help prevent cancer? – limited:

Vinegars like ACV contain chemicals known as polyphenols, which have rich antioxidant properties. Certain polyphenols may help stop the cell damage that can lead to certain chronic diseases, and to date their cardiovascular benefits have received the most attention and promising study results. However, while early research shows that polyphenols can help block the growth and development of cancer cells, particularly in breast and prostate cancers, other studies show no link — so more research is needed.

What are the risk of consuming apple cider vinegar?

In small quantities like those typically consumed in food, apple cider vinegar is well tolerated and relatively safe. However, ingestion of larger quantities carries these potential health risks:

• Damage to teeth: Due to its acidity, drinking apple cider vinegar undiluted may destroy tooth enamel.
• Potential drug interactions: ACV can interact unfavorably with certain diabetes drugs (e.g., insulin), heart disease drugs (e.g., digoxin), diuretics and laxatives — especially since ACV may increase the risk of serious hypokalemia (low potassium). Certainly, any individuals on medications should consult with their medical provider before consuming a new food source like ACV, especially in higher-than-average quantities.
• Throat irritation: Due to the high acidity, drinking ACV may result in throat irritation.
• Skin burns: Topical application of ACV may result in chemical burns.
• Exacerbation of chronic kidney disease: the excess acid that comes along with drinking apple cider vinegar may be difficult to process if you have kidney disease or other ailments.

Key takeaways

So, does apple cider vinegar help with diabetes? Does vinegar lower blood sugar? Large-scale trials still need to be conducted to solidify claims of apple cider vinegar’s medical significance. Preliminary research suggests that ACV, consumed in moderation, can be a part of a dietary and lifestyle program that results in modestly lower blood glucose levels, weight and cholesterol levels. However, ACV’s impact in such an overall program is probably minimal at best — and there are potential side effects from consuming too much apple cider vinegar. The optimal program for improving overall metabolic health centers around increased consumption of high-fiber vegetables and fruits, 100% whole grains, healthy fats and lean proteins; avoidance of processed foods containing added sugars and saturated fats; and daily physical activity and adequate sleep.