Apple Cider Vinegar And It's Several Health Benefits!!
For a long time I have been promising my patients that I will write about Apple Cider Vinegar (ACV). I am glad I took time to do it, since research for this topic refined my knowledge about ACV as well.
In my practice as an ND, I am seeing quite impressive results by using ACV in conjunction with other treatments for specific digestive issues, skin conditions, allergies and sore throat etc.
As a medical doctor, I use to prescribe antacids or proton pump inhibitors (PPIs) often for several digestive issues. I would have never thought then, Apple cider vinegar could replace these medications in many of my treatment protocols. I agree that there are some conditions in which antacids are specifically indicated. However many of the times when we prescribe H2 blockers like ranitidines or PPIs like pantoprazole for gastritis, bloating or indigestion, these symptoms can also be due a low stomach acidity. If this is the case the above mentioned medications with all its side effect profile, will decrease stomach acidity further and can cause more problems in the future.
What are ACV made from?
ACV as the name indicates made from apples. Made by fermentation of apples where bacterias and yeasts in the ferment eats away all the sugars and alcohol. The final vinegar product has a high acetic acid component and almost 0 sugars. There is a some amount of vitamins, calcium, magnesium potassium, sodium, other mineral salts. The phenolic compounds such as gallic acid, catechins and caffeic acid in ACV acts as antioxidants 
The unfiltered raw organic ACV has sediments which are known as the ‘mother’. These sediments contains some amount of probiotic and prebiotics, specially Acetobacteraceae, lactobacillus, gluconobacter, few beneficial yeast and pectin. These can help in improving digestion, can inhibit pathogenic bacterias, liquefies thick bile secretions, helps with detoxification of the liver and many more other benefits.
The acid portion of ACV contains mainly acetic acid, malic acid and citric acid. Acetic acid component of ACV has antimicrobial effect, reduce inflammation, improves acidity of the stomach, helps to maintain an alkaline environment throughout the body, helps in improving insulin resistance, lowers blood sugar and can also suppress appetite. 
Malic acid in ACV helps fight of muscle fatigue, useful in fibromyalgia, prevention of gallstone and kidney stones, balances pH of the body, helps in the detoxification process. Malic acid plays an important role in the detoxification of aluminum. Apples are high in malic acid. However 1 tablespoon of ACV has higher amount of malic acid than two raw green apples.
Citric acid in ACV act as antioxidants and protects cells from damage caused by free radicals.
How to use ACV :
The best form of ACV is the organic unfiltered ACV with the 'mother' in it.
For drinking: 2 teaspoon to 1 tablespoon ACV in one cup of water can be used once or twice daily before major meals.
For fungal infection of the skin: 1/2 tsp ACV can be combined with a teaspoon of coconut oil and apply over the affected area.
Fungal infection of feet, toes, smelly feet : add 1/4 cup of ACV in 4 cups of water in a tub; soak feet in it for 10-15 minutes once a day for 2 weeks. Wash with normal water and pat dry after the treatment.
A question often asked is weather ACV can be added into protein smoothie. The answer is it depends on what we are aiming to balance and what type of smoothie it is added. If the aim is to increase acidity of the stomach combining ACV in thick smoothies does not serve the purpose.
Apart from its many medicinal use: Vinegar can be used as surface disinfectant, can use in kitchen countertop cleaning, odor removal from fridge and cooking utensils. Diluted ACV is also being used as facial toner to remove blemishes and acne. As a hair rinse to make hair shiny and to protect against dandruffs !!!.
Precautions: Always dilute ACV before drinking or applying on the skin.
Start at a lower dose if you have never ingested ACV before .
Discontinue use if there are any increase in symptoms when ingested, burning or irritation when applied on the skin.
Now Let's look into some Studies done that showed health benefits of ACV: The following are the conclusions from those studies.
ACV and Diabetes:
~ Study by P Mitrou et al (2015), published in European Journal of Clinical Nutrition:
“In individuals with impaired glucose tolerance, vinegar ingestion before a mixed meal results in an enhancement of muscle blood flow, an improvement of glucose uptake by the forearm muscle and a reduction of postprandial hyperinsulinemia and hypertriglyceridemia. From this point of view, vinegar may be considered beneficial for improving insulin resistance and metabolic abnormalities in the atherogenic prediabetic state”
~ Study by Farideh Shishehbor et al (2017) published in Diabetic Research and Clinical Practice:
“The findings suggest that vinegar can be effective in reducing postprandial glucose and insulin levels, indicating it could be considered as an adjunctive tool for improving glycemic control”
Andrea M. White et al (2007) studied “ACV ingestion in type II Diabetes patients and it was found to have a favourable impact on waking glucose concentration when given at bedtime. ”
ACV for weight loss and lowering lipid levels:
~ Solaleh Sadat Khezri et al (2018) study published in Journal of Functional Foods..
“ACV along with restricted calorie diet can be considered as an effective strategy for reducing body weight, BMI, hip circumference, Visceral Adipose Index, appetite, triglycerides, total cholesterol level and increasing HDL-C (high density lipoprotein cholesterol) concentration in overweight or obese individuals.”
Fushimi T. et al (2006) studied effects of Dietary acetic acid (in vinegar) and found that acetic acid reduced serum cholesterol and triglycerides in rats fed with high cholesterol diet.
ACV as antimicrobial and antifungal:
A study done by Shaymaa M.Hassan (2018) using vinegar for oral candidiasis in type II diabetes patients, concluded that ACV has antimicrobial and antifungal properties.
Another case study published by Ozen B et al, (2107) showed that vaginal candidiasis unresponsive to medical therapies was cured by using ACV.
Darshna Yagnik et al (2018) studied the effects of “ACV as antimicrobial against E. coli, staphylococcus aureus and candida albicans, and found ACV to have multiple antimicrobial potential with clinical therapeutic implications”. 
Very Important note: Even though ACV has several health benefits , do not substitute ACV in place of your prescription medications.
~Since ACV is so versatile and has so many health benefits, is there any side effects of using ACV?
Some Side effects of ACV: Increase acid reflux, burning in throat and stomach, nausea, lightheadedness, dizziness, sugar imbalances, tooth enamel erosions, burns when undiluted ACV is applied on the skin and mucous membranes.
When should you NOT use ACV? -Worsening of symptoms after taking ACV.
-Lower esophageal sphincter tone abnormalities.
-Stomach ulcers or esophageal ulcers.
-Increased stomach acidity
-Chronic kidney disease
-ACV can interact with absorption and metabolism of : herbal medications, supplements and prescription medications like diuretics, insulin, digoxin.
If you have any of the above discussed conditions and are on any prescription medications, herbs or had side effects with ACV it is always advisable to consult with your Naturopathic Doctor before introducing ACV. ****************************************************************************************************************** ********************************************* References:
1) Carol S. Johnston et al, Vinegar: Medicinal Uses and Antiglycemic Effect, Medscape General Medicine: 2006, 8(2)61 2)P Mitrou et al, The role of acetic acid on glucose uptake and blood flow rates in the skeletal muscle in humans with impaired glucose tolerance, European Journal of Clinical Nutrition 69, pages 734-739 (2015) 3)Farideh Shishehbor et al (2017) Vinegar consumption can attenuate postprandial glucose and insulin responses; a systematic review and meta-analysis of clinical trials, Diabetic Research and Clinical Practice, 2017: 127, pages 1-9 4) Andrea M. White et al, Vinegar Ingestion at Bedtime Moderates Waking Glucose Concentrations in Adults With Well-Controlled Type 2 Diabetes, Diabetes Care 2007, 30 (11):2814-2815 5)Solaleh Sadat Khezri et al (2018) Beneficial effects of Apple Cider Vinegar on weight management, Visceral Adiposity Index and lipid profile in overweight or obese subjects receiving restricted calorie diet: A randomized clinical trial, Journal of Functional Foods, 43 :95-102 6). Fushimi T et al, Dietary acetic acid reduces serum cholesterol and triacylglycerols in rats fed a cholesterol-rich diet, British Journal of Nutrition 2006 May;95(5):916-24 7) Shaymaa M. Hassan, The Effect of Apple Cider Vinegar (ACV) as an Antifungal in a Diabetic Patient (Type II Diabetes ) with Intraoral Candidiasis (A Case Report), International Journal of Dentistry and Oral Health, (2018) 4:5, 54-57 8) Ozen B et al (2107) Vaginal Candidiasis Infection Treated Using Apple Cider Vinegar: A Case Report, Altern Ther Health Med. 2017 Nov 7. pii: AT5751.( PMID: 29112940) 9) Darshana Yagnik et al (2018) Antimicrobial activity of apple cider vinegar against Escherichia coli, Staphylococcus aureus and Candida albicans; down regulating cytokine and microbial protein expression, Scientific Report, 2018; 8:1732