Natural Ingredients · Vinegar
Apple Cider Vinegar
Vinegar made from apples (Malus domestica); main acid is acetic acid · also called ACV, cider vinegar, apple vinegar, vinagre de manzana
Apple cider vinegar is a sour liquid made by fermenting apples; its main acid is acetic acid, about 5 percent in table-strength vinegar. It is acid, so it can wear away tooth enamel, burn the skin and injure the throat and food pipe, and very large amounts have been linked to low potassium. People who take insulin, diabetes pills or water pills should ask first. Pooled small trials suggest slightly lower blood sugar and weight, but the studies disagree and a well-known 2024 weight trial was retracted.
General information, not medical advice. Last substantive update · Not medically reviewed. A named clinician has not signed off on this page. How this page is made
About Apple Cider Vinegar
Apple cider vinegar is a sour liquid made from fermented apples, and its main acid is acetic acid. Safety first: it is an acid. Case reports describe worn tooth enamel, injury to the throat and food pipe from tablets, and skin burns, and one report links very large amounts to low blood potassium. Anyone taking insulin, diabetes medicine or water pills should ask a pharmacist or doctor first. Pooled small trials found slightly lower blood sugar, cholesterol and weight, but they differ a lot, and a widely quoted 2024 weight-loss trial was retracted.
What it is
Apple cider vinegar is vinegar made from apples (the cultivated apple, Malus domestica). A 2025 review calls it a naturally fermented beverage. Its main acid is acetic acid; one trial used a liquid vinegar of 5 percent acidity.
This page covers the food ingredient. Gummies, tablets and the trials in more detail are on their own guides, linked below.
What the research shows
Four pooled analyses of small, short trials found small average falls in fasting blood sugar, HbA1c, total cholesterol and body weight, with very large differences between studies. These are signals, not promises, and not a reason to change any prescribed medicine.
A 2024 trial in 120 Lebanese adults and teens that reported large weight effects was retracted in 2025 because its analyses could not be replicated and multiple errors were found. This page does not use it.
Skin soaks did not help eczema in a pilot, and no studies were found for hair extension rinses.
Liquid vinegar and tablets are not the same: in one small trial only the liquid lowered the after-meal blood sugar rise.
Quality and labels
In one study of eight apple cider vinegar tablet products, tablet size, acidity and acid content varied widely and the authors doubted apple cider vinegar was in all of them. Check labels and ask a pharmacist.
No regulator statement on apple cider vinegar was read for this page.
At a glance
Traditional uses history, not proof
- A Dutch dental report says women in North-African culture have used apple cider vinegar for weight loss for generations. This is not evidence it works.
- No other traditional use could be read in a source for this page.
Studied for research
- Blood sugar and HbA1c in type 2 diabetes: low
- Blood sugar and cholesterol in adults overall: mixed
- Body weight, BMI and waist: low (a 2024 trial was retracted)
- Metabolic syndrome in polycystic ovary syndrome (one trial, with metformin): low
- After-meal blood sugar, liquid versus tablets (12 healthy adults): low
- Slower stomach emptying in type 1 diabetes: low, a caution
- Eczema skin soaks: no benefit, against
- Hair extension rinse: insufficient
Main compounds
- Acetic acid, the main acid
Common forms
- Liquid vinegar used as a food
- Diluted vinegar drinks
- Tablets and capsules (they are not the same product)
- Gummies (see the separate guide)
Research links: Retraction notice for the 2024 weight trial (BMJ Nutrition, full text) · Weight meta-analysis, Nutrients 2025 (abstract) · Type 2 diabetes meta-analysis, Frontiers in Nutrition 2025 (abstract) · Esophageal injury by tablets (abstract) · Tooth erosion case report (abstract) · Slower stomach emptying in type 1 diabetes (abstract) · Research Library · Genes & Biomarkers Library
What it is and its history
- Accepted scientific name
- Apple cider vinegar (vinegar made from apples)
- Naming authority
- Source fruit: Malus domestica (Suckow) Borkh. (GBIF accepted name)
- Synonyms
- ACV; Cider vinegar; Apple vinegar
- Common names
- Apple cider vinegar (English); Vinagre de manzana (Spanish)
- Family or group
- Source fruit: Rosaceae (rose family). Vinegar itself is a fermented liquid, not a plant.
- Classification
- Plantae (source fruit) > Tracheophyta > Magnoliopsida > Rosales > Rosaceae > Malus > Malus domestica
- Native range
- Not checked.
- What it looks like
- Fruit: The vinegar is made from apples.
- Cultivation
- Not checked.
- Harvest and processing
- One 2025 review calls apple cider vinegar a "naturally fermented beverage". Details of how it is made were not read for this page.
- Look-alikes and adulterants
- Name: Concentrated white vinegar; Note: One hospital series describes white vinegar of about 85% acetic acid, which is far stronger than the table-strength product (5% acidity in one trial) and is corrosive. It is a different product.; Name: Vinegar tablets and gummies; Note: Not the same as the liquid: eight tablet brands varied widely in one study.
Traditional use and history history, not clinical proof
| Tradition or era | Documented use | Source |
|---|---|---|
| North-African culture (as reported in a Dutch dental article) | The English abstract says women in North-African culture have used apple cider vinegar for weight loss for generations, and that bodybuilders also use it. No other traditional use could be read. | p23373303 |
Traditional use shows how it was used. It does not show that it works or is safe today.
What is inside, and how it may work
What it contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.
Main compounds
| Compound | Family | Where it is concentrated | Activity studied | Level of evidence |
|---|---|---|---|---|
| Acetic acid PubChem 176 | short-chain carboxylic acid | Vinegar (formed by fermentation) About 5% acidity (1.25 g acetic acid in 25 g) in the liquid vinegar used in one trial. | Described by Japanese researchers as a main component of vinegar that suppressed body fat build-up in animal studies. Mechanism in people is not established. 21 16 8 | Animal study |
Mechanisms, receptors and pathways
| Target or pathway | Gene or receptor | What was found | Level |
|---|---|---|---|
| Stomach emptying | Vinegar reduced the gastric emptying rate in 10 people with type 1 diabetes and slow stomach emptying. The authors cite earlier healthy-volunteer work showing vinegar delays gastric emptying and lowers after-meal blood sugar and insulin. 14 | Human data | |
| After-meal blood sugar | Liquid vinegar lowered the 60-minute glucose rise in 12 healthy adults; whole tablets did not. 8 | Human data | |
| Body fat | The authors of a Japanese trial say acetic acid suppressed body fat accumulation in animal studies; this is background, not shown in people by that paper. 16 | Animal study |
Absorption, metabolism and elimination
- Absorption
- Not studied in the sources read.
- Distribution
- Not studied.
- Metabolism
- Not studied.
- Elimination
- Not studied.
- Bioavailability
- Not studied.
Isolated compounds versus whole extracts
Liquid vinegar and tablets are not the same: in one small trial only the liquid lowered the after-meal blood sugar rise.
Nutritional composition
No nutrient data on apple cider vinegar were read for this page.
1 mixed findings5 low certainty1 not enough evidence1 evidence against
What was looked at
The 8 benefits and uses checked for Apple Cider Vinegar, each with how strong the evidence is. Tap one to open it.
- Blood sugar and HbA1c in type 2 diabetesLow certainty
- Blood sugar and cholesterol in adults overallMixed findings
- Body weight, BMI and waist sizeLow certainty
- Metabolic syndrome and insulin resistance in polycystic ovary syndrome (with metformin)Low certainty
- Blood sugar after a meal: liquid vinegar versus tabletsLow certainty
- Stomach emptying in type 1 diabetes with slow stomach (gastroparesis)Low certainty
- Skin soaks for eczema (atopic dermatitis)Evidence against
- Rinse for synthetic hair extensionsNot enough evidence
Lab markers tracked in the studies
Fasting blood glucoseHbA1cTotal cholesterolBody weight, BMI and waist circumference
What is Apple Cider Vinegar good for?
What people ask about, and how strong the human evidence is. None of it is proof, and all of it should be read with the safety section first.
Benefits, one by one
Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.
Blood sugar and HbA1c in type 2 diabetes
Low certaintyPooled results of small, short trials found lower fasting blood sugar and HbA1c with apple cider vinegar by mouth in people with type 2 diabetes. The trials disagreed a lot with each other, so this is a signal and not a proven benefit. It is not a replacement for diabetes medicine.
2 studiesApple cider vinegar drinks and capsules of various kinds; no amount i…
Studies, doses and limits
What the trials found
A 2025 meta-analysis of 7 controlled trials in type 2 diabetes and a 2025 meta-analysis of 25 trials (1,320 adults) gave similar results.
Results
Fasting blood sugar fell by about 21 mg/dL in both analyses. HbA1c fell by 1.53 in the 7-trial analysis and by 0.91 in the 25-trial analysis. HOMA-IR (insulin resistance) did not change.
Effect sizes as reported
Fasting blood sugar WMD -21.9 mg/dL (7 trials); HbA1c WMD -1.53 (7 trials). Fasting glucose -21.20 mg/dL and HbA1c -0.91 with I2 of 95.8 and 98.9 percent (25 trials).
Why this rating
Small, short trials that differ in design and amount; very high variation between studies; the GRADE ratings are not in the abstract we read; benefit is for lab markers, not for complications.
Form and dose studied
Apple cider vinegar drinks and capsules of various kinds; no amount is advised here.
Who was studied
Adults with type 2 diabetes in controlled trials.
Limits
Very high heterogeneity; short trials; lab numbers, not long-term health outcomes.
Why researchers looked
Vinegar is thought to slow how quickly food leaves the stomach and so lower the blood sugar rise after meals.
Traditional use
The sources read describe no traditional use of apple cider vinegar for diabetes.
Proposed mechanism Human physiology
A small ultrasound study found vinegar slowed stomach emptying (see the stomach emptying entry). Whether this explains the pooled blood sugar results is not shown.
A proposed mechanism does not show that the effect happens in people.
Anyone taking insulin or other blood sugar medicine should ask the prescriber or pharmacist before using vinegar as a remedy. See the Safety tab.
Blood sugar and cholesterol in adults overall
Mixed findingsAcross all adults, pooled results show small average falls in total cholesterol, fasting glucose and HbA1c, but no clear change in LDL, HDL or insulin resistance. In healthy people fasting glucose may even rise.
2 studiesApple cider vinegar by mouth; trials of at least 2 weeks.
Studies, doses and limits
What the trials found
A 2021 meta-analysis of 9 studies (10 arms) and the 2025 meta-analysis of 25 trials.
Results
Total cholesterol fell by 6.06 mg/dL (2021) and 6.72 mg/dL (2025). Fasting glucose fell by 7.97 mg/dL in the 2021 analysis. No significant change in LDL, HDL, insulin or HOMA-IR in the 2021 analysis, nor in triglycerides, LDL, HDL, insulin or HOMA-IR overall in the 2025 analysis. The 2021 authors saw fasting glucose and HDL rise in healthy participants.
Effect sizes as reported
Total cholesterol -6.06 mg/dL (CI -10.95 to -1.17); fasting plasma glucose -7.97 mg/dL (CI -13.74 to -2.21); HbA1c -0.50 (CI -0.90 to -0.09).
Why this rating
Small average changes, very high variation between studies, and results point in different directions in healthy people versus people with diabetes.
Form and dose studied
Apple cider vinegar by mouth; trials of at least 2 weeks.
Who was studied
Adults of mixed health status.
Limits
The 2021 abstract does not give the number of people; heterogeneity up to 91 percent.
Why researchers looked
People ask whether a vinegar drink can help cholesterol and blood sugar.
Traditional use
The sources read describe no traditional use for these goals.
Proposed mechanism Unknown
No mechanism was established in the studies read.
A proposed mechanism does not show that the effect happens in people.
Not a reason to change a prescribed medicine.
Body weight, BMI and waist size
Low certaintyA 2025 pooled analysis of 10 randomised trials (789 adults) found small average reductions in weight, BMI and waist size over up to about 12 weeks. A Japanese trial of a vinegar drink (not named as apple cider vinegar) also found lower weight than placebo. The trials differed a lot, and a widely quoted 2024 weight trial was retracted.
3 studiesApple cider vinegar drinks in the pooled trials; no amount is advised…
Studies, doses and limits
What the trials found
2025 meta-analysis of 10 randomised trials (789 adults, at least 4 weeks); a 2009 Japanese trial of a vinegar drink.
Results
Body weight, BMI and waist circumference were lower with apple cider vinegar; other body measures did not change significantly. The authors call it a possible short-term add-on only. In the Japanese trial, weight, BMI, visceral fat, waist and triglycerides were lower in both vinegar groups than in placebo.
Effect sizes as reported
SMD -0.39 (weight), -0.65 (BMI), -0.34 (waist) in the meta-analysis; kilograms are not in the abstract.
Why this rating
Small average effects, I2 of 61 to 83 percent between studies, short duration; the 2024 trial that reported the largest effects was retracted and is not counted; the Japanese trial used a vinegar drink and has a vinegar-maker author.
Form and dose studied
Apple cider vinegar drinks in the pooled trials; no amount is advised here.
Who was studied
Adults with overweight, obesity or type 2 diabetes; Japanese adults with obesity (vinegar drink).
Limits
Mostly short trials; kilograms not given in the abstract; vinegar type not stated in the Japanese trial.
Why researchers looked
Apple cider vinegar is often sold as a weight-loss aid, and animal studies suggested acetic acid might reduce body fat.
Traditional use
A Dutch dental report says women in North-African culture have used apple cider vinegar for weight loss for generations and that bodybuilders use it. This is not evidence of benefit.
Proposed mechanism Animal study
The Japanese trial authors note that acetic acid was found to suppress body fat build-up in animal studies. That is not shown in people here.
A proposed mechanism does not show that the effect happens in people.
Teeth, throat and medicine risks are on the Safety tab. A tooth-erosion case report involved a teenager using apple cider vinegar for weight loss.
Metabolic syndrome and insulin resistance in polycystic ovary syndrome (with metformin)
Low certaintyOne 12-week trial in 94 women with polycystic ovary syndrome who already took metformin found more metabolic syndrome resolved with vinegar capsules than with placebo. It is one trial, using capsules, and it does not tell us whether vinegar is safe with metformin.
1 studiesApple cider vinegar capsules with metformin.
Studies, doses and limits
What the trials found
One randomised, placebo-controlled trial in Iran (94 women, 12 weeks).
Results
Resolution of metabolic syndrome was 74.5 percent with vinegar capsules versus 40.4 percent with placebo. Insulin resistance, hirsutism, sexual function and quality of life improved more with vinegar. No safety or low blood sugar results are in the abstract.
Effect sizes as reported
74.5 percent versus 40.4 percent (p = 0.001).
Why this rating
A single trial, published 2026, capsule form, no replication; adverse effects not reported in the abstract.
Form and dose studied
Apple cider vinegar capsules with metformin.
Who was studied
Women with polycystic ovary syndrome, metabolic syndrome and insulin resistance, taking metformin.
Limits
One trial; one country; blinding and adverse effects not described in the abstract.
Why researchers looked
Women with polycystic ovary syndrome often have insulin resistance, and researchers look for add-on options.
Traditional use
The sources read describe no traditional use for this.
Proposed mechanism Unknown
Not explained in the abstract.
A proposed mechanism does not show that the effect happens in people.
Anyone on metformin or other diabetes medicine should ask the prescriber or pharmacist first.
Blood sugar after a meal: liquid vinegar versus tablets
Low certaintyIn one small crossover trial in 12 healthy young adults, a drink of vinegar before a meal lowered the after-meal blood sugar rise, but commercial tablets swallowed whole did not.
1 studiesLiquid vinegar with 5 percent acidity versus tablets; not advice.
Studies, doses and limits
What the trials found
One 4-arm crossover trial, 12 healthy adults.
Results
The glucose rise was 31 percent lower with liquid vinegar than with water or whole tablets.
Effect sizes as reported
31 percent lower rise with liquid vinegar (p = 0.040 versus water, p = 0.049 versus tablets).
Why this rating
Only 12 healthy young adults and one meal each.
Form and dose studied
Liquid vinegar with 5 percent acidity versus tablets; not advice.
Who was studied
12 healthy young adults.
Limits
Tiny trial; short; healthy people only.
Why researchers looked
Many people take vinegar tablets or gummies instead of liquid and wonder if they work the same.
Proposed mechanism Unknown
Not tested in this trial.
A proposed mechanism does not show that the effect happens in people.
Results for liquid vinegar should not be assumed for tablets or gummies, and one case report links apple cider vinegar tablets to injury of the food pipe (see Safety).
Stomach emptying in type 1 diabetes with slow stomach (gastroparesis)
Low certaintyIn a 10-person pilot, apple cider vinegar slowed stomach emptying further in people whose stomach already emptied slowly. The authors say this might hurt blood sugar control.
1 studies30 mL apple cider vinegar in water daily for 2 weeks in the trial; no…
Studies, doses and limits
What the trials found
One 10-person blinded crossover pilot.
Results
Median gastric emptying rate was 17 percent with vinegar versus 27 percent with water.
Effect sizes as reported
17 percent versus 27 percent (p < 0.05).
Why this rating
Only 10 people; pilot study. It is a caution, not a benefit.
Form and dose studied
30 mL apple cider vinegar in water daily for 2 weeks in the trial; not advice.
Who was studied
People with type 1 diabetes and diabetic gastroparesis.
Limits
Very small; one condition.
Why researchers looked
Vinegar was known to slow stomach emptying in healthy people.
Proposed mechanism Human physiology
Vinegar reduced the gastric emptying rate on ultrasound in this small study.
A proposed mechanism does not show that the effect happens in people.
A possible disadvantage for people with type 1 diabetes and slow stomach emptying. Ask a doctor.
Skin soaks for eczema (atopic dermatitis)
Evidence againstA pilot of 22 people found dilute apple cider vinegar forearm soaks did not improve the skin barrier, and most people had mild irritation.
1 studies0.5 percent acetic acid soak of the forearm.
Studies, doses and limits
What the trials found
One pilot split-arm study, 22 people, 14 days.
Results
No sustained change in skin barrier or pH; 16 of 22 reported mild side effects.
Effect sizes as reported
72.7 percent mild side effects.
Why this rating
A small pilot found no benefit and frequent irritation.
Form and dose studied
0.5 percent acetic acid soak of the forearm.
Who was studied
11 people with atopic dermatitis and 11 healthy controls.
Limits
Small; one brand; forearm only.
Why researchers looked
People use vinegar soaks hoping to restore skin acidity.
Traditional use
Not described in the source.
Proposed mechanism Human physiology
Skin pH fell right after soaking but the effect was not sustained.
A proposed mechanism does not show that the effect happens in people.
Skin irritation was common; chemical burns from stronger vinegar on skin have been reported (see Safety).
Rinse for synthetic hair extensions
Not enough evidenceA review found almost no studies on apple cider vinegar rinses for synthetic hair extensions. It is an anecdotal remedy.
1 studiesNot applicable.
Studies, doses and limits
What the trials found
No trials; a literature review found a notable deficit in studies.
Results
Proper evidence not found.
Why this rating
No studies of the practice were found.
Limits
Nothing to assess.
Why researchers looked
A popular home practice.
Traditional use
Not described in the source.
Proposed mechanism Unknown
None established.
A proposed mechanism does not show that the effect happens in people.
Not described.
Connections to the rest of health
How Apple Cider Vinegar connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.
Explore every connection: goals, body systems, organs, symptoms, genes
B. Body systems
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Endocrine System | Biological association | Low certainty | Studied for: Blood sugar and HbA1c in type 2 diabetes Studied for: Blood sugar and cholesterol in adults overall | 3 22 12 7 16 5 19 8 14 |
| Cardiovascular System | Biological association | Mixed findings | Studied for: Blood sugar and cholesterol in adults overall | 12 22 |
| Reproductive System | Biological association | Low certainty | Studied for: Metabolic syndrome and insulin resistance in polycystic ovary syndrome (with metformin) | 19 |
| Digestive System | Biological association | Low certainty | Studied for: Stomach emptying in type 1 diabetes with slow stomach (gastroparesis) | 14 |
| Integumentary System | Biological association | Evidence against | Studied for: Skin soaks for eczema (atopic dermatitis) Studied for: Rinse for synthetic hair extensions | 18 20 |
C. Body parts and organs
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Teeth | Adverse effect or risk | Low certainty | Case report of tooth erosion; lab data on enamel with other vinegars. Case report of tooth erosion. Preparation or compound: Apple cider vinegar drink |
11 23 |
| Esophagus (food pipe) | Adverse effect or risk | Low certainty | Case report with tablets; strictures in children with concentrated vinegar. Preparation or compound: Apple cider vinegar tablets; strong vinegar |
13 4 |
| Liver | Adverse effect or risk | Very low certainty | One case report; a non-significant AST rise in a small trial. Preparation or compound: Vinegar, long-term |
2 15 |
I. Biomarkers
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Fasting blood glucose | Biological association | Low certainty | Measured in trials: lowered. A lab change is not the same as a health benefit. | 3 12 22 |
| HbA1c | Biological association | Low certainty | Measured in trials: lowered. A lab change is not the same as a health benefit. | 3 22 12 |
| Total cholesterol | Biological association | Low certainty | Measured in trials: lowered. A lab change is not the same as a health benefit. | 12 22 |
| Body weight, BMI and waist circumference | Biological association | Low certainty | Measured in trials: lowered. A lab change is not the same as a health benefit. | 7 16 |
L. Active compounds
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Acetic acid | Biological association | Animal study | Described by Japanese researchers as a main component of vinegar that suppressed body fat build-up in animal studies. Mechanism in people is not established. Preparation or compound: Vinegar (formed by fermentation) |
21 16 8 |
Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 30, 2026).
The evidence
The research centre for Apple Cider Vinegar. Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.
Evidence by outcome
Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).
How we rate evidence
High certainty
Several well-run trials or reviews agree; further research is unlikely to change the picture much.
Moderate certainty
Good trials point the same way, but some doubt remains.
Low certainty
Small, short or inconsistent trials. The finding could change with better research.
Very low certainty
Very little or very weak human data. Treat as a possibility only.
Mixed findings
Trials or reviews disagree with each other.
Not enough evidence
Not enough human research to say either way.
Evidence against
Good research found no benefit, or found harm.
We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We read 19 PubMed records (abstracts, plus the retraction notice in full text); two records (a 2012 burn letter and a 1998 potassium letter) have no abstract and only their titles were read. Fruit and acid names were checked in GBIF and PubChem. No regulator statement was read, so none is cited. Certainty ratings are the compiler's own reading unless a review gives its own.
Study library: every study we checked 23
| Study | Design | People | Product, dose, length | Result |
|---|---|---|---|---|
| Alvarez 2024 Unveiling a Sour Truth: Acute Pancreatitis Linked to Apple Cider Vinegar Supplement ACG Case Reports Journal · PMID 39238884 · DOI |
Case report |
1 An 84-year-old woman with acute pancreatitis |
A weight-loss supplement containing apple cider vinegar Supplement product Not given as advice here |
Acute pancreatitis was possibly linked to a recently introduced weight loss supplement containing apple cider vinegar. The authors say there is scant data on this risk. Case report; a possible link only Methods, limits and fundingOutcomes: Acute pancreatitis Limitations: One case; the supplement may contain other ingredients. Read: abstract |
| Andonie 2025 Apple Cider Vinegar-Induced Hepatotoxicity: A Rare Case Report Oxford Medical Case Reports · PMID 40666072 · DOI |
Case report |
1 A 60-year-old man with a long history of vinegar use |
Apple cider vinegar Apple cider vinegar (the liquid) Not given as advice here Long-term |
The authors describe a 60-year-old man with long-term vinegar use and liver damage that improved after he stopped. They call liver damage an uncommon side effect. Case report; liver injury possible, uncommon Methods, limits and fundingOutcomes: Liver injury Limitations: One case; the abstract calls it idiosyncratic and does not prove cause. Funding and conflicts: Authors declare no conflicts of interest. Read: abstract |
| Arjmandfard 2025 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 Frontiers in Nutrition · PMID 39949546 · DOI |
Meta-analysis |
People with type 2 diabetes in 7 controlled trials (number of people not in the abstract) | Apple cider vinegar by mouth Apple cider vinegar (the liquid) Not given as advice here |
Fasting blood sugar fell by 21.9 mg/dL and HbA1c by 1.53; insulin rose slightly; HOMA-IR did not change. The authors graded the certainty of the evidence with GRADE (the grades are not in the abstract). Lower fasting blood sugar and HbA1c in type 2 diabetes (Fasting blood sugar WMD -21.929 mg/dL (95% CI -29.19 to -14.67); HbA1c WMD -1.53 (95% CI -2.65 to -0.41)) Methods, limits and fundingOutcomes: Fasting blood sugar, HbA1c, insulin, HOMA-IR Limitations: Only 7 trials; the abstract does not give the GRADE ratings or the amount of heterogeneity; controlled trials, not all randomised. Funding and conflicts: Authors declare no commercial or financial relationships. Read: abstract |
| Atıcı 2023 Accidental ingestion of concentrated white vinegar in Hatay children in Turkey Archives of Industrial Hygiene and Toxicology · PMID 38146762 · DOI |
Case series |
11 11 children aged 11 to 89 months with oesophageal strictures after accidentally drinking white vinegar of about 85% acetic acid |
Concentrated white vinegar (about 85% acetic acid), not apple cider vinegar Concentrated white vinegar Not given as advice here |
All 11 children needed endoscopic oesophageal dilation (1 to 28 times each). Eight were healing well on follow-up, two were found healthy in the national database, and one died of massive gastrointestinal bleeding 24 hours after the first dilation. The authors note it is corrosive and can cause ulcerative injury to the mouth, throat and oesophagus, and want sales controlled and child-proof containers used. Strong vinegar can cause serious food-pipe injury in children Methods, limits and fundingOutcomes: Oesophageal strictures, treatment, outcome Limitations: Not apple cider vinegar: about 85% acetic acid is far stronger than the roughly 5% of a table or cider vinegar. 11 cases in one hospital. Read: abstract |
| BMJ Nutrition 2025 Retraction: Apple cider vinegar for weight management in Lebanese adolescents and young adults with overweight and obesity: a randomised, double-blind, placebo-controlled study BMJ Nutrition, Prevention & Health · PMID 41789013 · DOI |
Authoritative guidance n/a |
n/a (retraction notice for a 2024 trial of 120 people) | n/a Not given as advice here |
The journal retracted the 2024 trial because the authors analyses could not be replicated and multiple errors were found. The authors dataset also showed patterns inconsistent with random allocation and improbably small p-values for the number of participants. Other concerns listed include implausible values and no prospective trial registration. The authors say the discrepancies were honest mistakes and agree with the retraction. Methods, limits and fundingOutcomes: Explains why the journal retracted the 2024 trial Limitations: A retraction notice, not a study. The retracted trial itself is not used as evidence anywhere on this page. Funding and conflicts: n/a Read: full-text |
| Bunick 2012 Chemical burn from topical apple cider vinegar Journal of the American Academy of Dermatology · PMID 22980269 · DOI |
Case report |
1 A letter reporting a chemical burn from apple cider vinegar put on the skin (no abstract available; title read only) |
Apple cider vinegar Apple cider vinegar (the liquid) Not given as advice here |
Title only: a chemical burn from apple cider vinegar applied to the skin was reported. No further detail was read. Case report; harm possible Methods, limits and fundingOutcomes: Chemical burn of the skin Limitations: Only the title and PubMed record were read; there is no abstract. Read: title-only |
| Castagna 2025 Effect of Apple Cider Vinegar Intake on Body Composition in Humans with Type 2 Diabetes and/or Overweight: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Nutrients · PMID 41010525 · DOI |
Meta-analysis |
789 789 adults (18 and over) with overweight, obesity or type 2 diabetes in 10 randomised trials |
Apple cider vinegar daily for at least 4 weeks Apple cider vinegar (the liquid) Not given as advice here At least 4 weeks (up to 12 weeks in the subgroup finding) |
Body weight, BMI and waist circumference were lower with apple cider vinegar (standardised mean differences -0.39, -0.65 and -0.34). Other body measures did not change significantly. The authors call it a possible short-term add-on for adults with excess weight. Small average reductions in weight, BMI and waist; the amount of weight is not given in kilograms in the abstract (Body weight SMD -0.39 (95% CI -0.63 to -0.15); BMI SMD -0.65 (-1.05 to -0.26); waist SMD -0.34 (-0.67 to -0.02)) Methods, limits and fundingOutcomes: Body weight, BMI, waist circumference and other body measures Limitations: Large differences between studies (I2 61 to 83 percent); mostly short trials (up to 12 weeks); the abstract does not give kilograms lost. Funding and conflicts: Authors declare no conflicts of interest. Read: abstract |
| Feise 2020 Commercial Vinegar Tablets Do Not Display the Same Physiological Benefits for Managing Postprandial Glucose Concentrations as Liquid Vinegar Journal of Nutrition and Metabolism · PMID 33489366 · DOI |
Controlled trial |
12 12 healthy young men and women (average age 22.6) |
Liquid vinegar (5% acidity) versus commercial vinegar tablets Liquid vinegar; whole or crushed vinegar tablets 25 g of liquid vinegar (1.25 g acetic acid) or 4 tablets (1.50 g acetic acid), as described in the abstract; not advice One test meal per arm, one week apart · vs Water (control) |
The glucose rise was 31 percent lower with liquid vinegar than with water or with whole tablets. Crushed tablets were in between. Liquid vinegar lowered the after-meal glucose rise; swallowed whole tablets did not Methods, limits and fundingOutcomes: Blood glucose rise in the 60 minutes after a test meal Limitations: Only 12 healthy young adults, one meal each, 4-arm crossover; blood sugar over 60 minutes only. Funding and conflicts: Authors declare no conflicts of interest. Read: abstract |
| Feldstein 2015 Chemical Burn from Vinegar Following an Internet-based Protocol for Self-removal of Nevi Journal of Clinical and Aesthetic Dermatology · PMID 26155328 |
Case report |
1 An adolescent who followed an internet protocol to remove a mole (nevus) with apple cider vinegar |
Apple cider vinegar Apple cider vinegar (the liquid) Not given as advice here |
The abstract reports a case of an adolescent with a chemical burn after following an internet-based protocol for removing moles with apple cider vinegar. The authors warn that home remedies from the internet can be ineffective or dangerous, and that children and teens may try them without telling parents. Case report; harm possible Methods, limits and fundingOutcomes: Chemical burn Limitations: One case; no numbers on how often it happens. Read: abstract |
| GBIF 2026 GBIF Backbone Taxonomy: Malus domestica (Suckow) Borkh. n/a · Source |
Reference database n/a |
n/a | n/a Not given as advice here |
Malus domestica (Suckow) Borkh. is an ACCEPTED name in the family Rosaceae, order Rosales (GBIF species key 3001244, checked through the GBIF API on 2026-10-30). Methods, limits and fundingOutcomes: Accepted name of the cultivated apple Limitations: A name database, not about vinegar. Read: full-text |
| Gambon 2012 [Unhealthy weight loss. Erosion by apple cider vinegar] Nederlands Tijdschrift voor Tandheelkunde · PMID 23373303 · DOI |
Case report |
1 A 15-year-old girl with erosive tooth wear (Dutch dental report, English abstract) |
Apple cider vinegar Apple cider vinegar (the liquid) Not given as advice here Daily |
Erosive tooth wear in a 15-year-old girl was concluded to be caused by daily consumption of a glass of apple cider vinegar. The authors also write that in North-African culture women have used apple cider vinegar for weight loss for generations, and that bodybuilders use it too. Case report; tooth erosion possible Methods, limits and fundingOutcomes: Tooth erosion Limitations: One case; amounts and duration not stated in the English abstract. Read: abstract |
| Hadi 2021 The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials BMC Complementary Medicine and Therapies · PMID 34187442 · DOI |
Meta-analysis |
Adults in 9 studies (10 arms) of apple cider vinegar for at least 2 weeks; number of people not in the abstract | Apple cider vinegar by mouth (combination products excluded) Apple cider vinegar (the liquid) Not given as advice here At least 2 weeks |
Total cholesterol fell by 6.06 mg/dL, fasting plasma glucose by 7.97 mg/dL and HbA1c by 0.50. No significant effect on LDL, HDL, fasting insulin or HOMA-IR. In apparently healthy people fasting glucose and HDL seemed to rise. Small average falls with very high variation between studies (I2 up to 91 percent) (Total cholesterol -6.06 mg/dL (95% CI -10.95 to -1.17); fasting glucose -7.97 mg/dL (-13.74 to -2.21); HbA1c -0.50 (-0.90 to -0.09)) Methods, limits and fundingOutcomes: Total cholesterol, LDL, HDL, triglycerides, fasting plasma glucose, HbA1c, fasting insulin, HOMA-IR Limitations: Only 9 small studies; high heterogeneity; the abstract does not give the number of people; trials differ in design and length. Funding and conflicts: Authors declare no conflict of interest. Read: abstract |
| Hill 2005 Esophageal injury by apple cider vinegar tablets and subsequent evaluation of products Journal of the American Dietetic Association · PMID 15983536 · DOI |
Case report lab |
8 One reported adverse event, then 8 apple cider vinegar tablet products tested in a lab |
Apple cider vinegar tablets Tablets Not given as advice here |
After an adverse event was reported, eight tablet products were tested. There was considerable variability between brands in tablet size, pH, component acid content and label claims. The authors doubt whether apple cider vinegar was in fact an ingredient in all of the products, and call the labelling and recommended dosages inconsistent and inaccurate. Case plus product testing; esophageal injury possible; product quality varies Methods, limits and fundingOutcomes: Injury to the esophagus (food pipe); tablet pH, acid content, microbial growth Limitations: Eight products only; the case details are not in the abstract. Read: abstract |
| Hlebowicz 2007 Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: a pilot study BMC Gastroenterology · PMID 18093343 · DOI |
Controlled trial |
10 10 people with type 1 diabetes and diabetic gastroparesis (slow stomach emptying), Sweden |
Apple cider vinegar with water Apple cider vinegar (30 mL in 200 mL water daily for 2 weeks, as stated in the abstract) As described in the abstract; not advice 2 weeks with vinegar versus 1 week with water · vs Water |
Median gastric emptying rate was 17 percent with vinegar versus 27 percent with water, a statistically significant further slowing. The authors say this might be a disadvantage for blood sugar control. Stomach emptying slowed further in people whose stomach already empties slowly Methods, limits and fundingOutcomes: Gastric emptying rate measured by ultrasound after a rice pudding meal Limitations: Only 10 people; investigator-blinded crossover pilot (randomisation is not described in the abstract); only people with type 1 diabetes and gastroparesis. Funding and conflicts: Not stated in the abstract. Trial registration ISRCTN33841495. Read: abstract |
| Johnston 2008 A preliminary evaluation of the safety and tolerance of medicinally ingested vinegar in individuals with type 2 diabetes Journal of Medicinal Food · PMID 18361754 · DOI |
Controlled trial |
27 27 people with type 2 diabetes randomised to vinegar pills, pickles or vinegar for 12 weeks |
Vinegar (acetic acid), pickles, or commercial vinegar pills Vinegar, pickles or pills As described in the abstract: 30 mg, about 1,400 mg or 2,800 mg of acetic acid daily 12 weeks · vs Vinegar pills as the reference treatment |
Adverse events did not differ significantly by group, but 50 to 56 percent of pickle and vinegar participants reported at least one event at week 6 compared with 11 percent in the pill group. Urine pH fell 9 percent in the vinegar group. There was a tendency for the liver enzyme AST to rise in the vinegar group (+17 percent, p = 0.090, not significant). The authors say chronic vinegar may influence liver function and metabolic pathways beyond glucose. Possible liver signal; not statistically significant Methods, limits and fundingOutcomes: Adverse events, urine pH, liver and metabolic markers Limitations: Only 27 people; preliminary; vinegar not specified as apple cider in the abstract. Read: abstract |
| Kondo 2009 Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects Bioscience, Biotechnology, and Biochemistry · PMID 19661687 · DOI |
Controlled trial |
Obese Japanese adults; the abstract does not give the number of people | A vinegar drink (the abstract says vinegar, not apple cider vinegar specifically) Vinegar drink (type of vinegar not stated in the abstract) Drink containing 15 mL or 30 mL of vinegar in 500 mL a day (stated in the abstract) 12 weeks · vs Drink with no vinegar (placebo) |
Body weight, BMI, visceral fat area, waist circumference and triglycerides were significantly lower in both vinegar groups than in the placebo group. Lower body weight and fat measures than placebo over 12 weeks Methods, limits and fundingOutcomes: Body weight, BMI, visceral fat area, waist circumference, serum triglycerides Limitations: The abstract says vinegar, not apple cider vinegar, so it may not apply. The first author is from a vinegar company (Mizkan Group). Number of people not in the abstract. Funding and conflicts: The first author works at the Central Research Institute of the Mizkan Group, a vinegar maker; funding not stated in the abstract. Read: abstract |
| Lhotta 1998 Hypokalemia, hyperreninemia and osteoporosis in a patient ingesting large amounts of cider vinegar Nephron · PMID 9736833 · DOI |
Case report |
1 One patient (letter, no abstract; title read only) |
Apple cider vinegar Apple cider vinegar (the liquid) Not given as advice here |
Title only: a patient who drank large amounts of cider vinegar had low blood potassium (hypokalemia), raised renin and osteoporosis. No further detail was read. Case report; low potassium after large amounts Methods, limits and fundingOutcomes: Low potassium, high renin, osteoporosis Limitations: Only the title was read, so the amount, time and certainty of cause are unknown. Read: title-only |
| Luu 2019 Apple cider vinegar soaks [0.5%] as a treatment for atopic dermatitis do not improve skin barrier integrity Pediatric Dermatology · PMID 31328306 · DOI |
Controlled trial |
22 22 people (11 with atopic dermatitis, 11 healthy), forearm soaks |
Dilute apple cider vinegar soak (0.5% acetic acid) Diluted apple cider vinegar on the skin 10 minutes daily as described in the abstract; not advice 14 days · vs Plain water soak on the other arm |
Skin water loss rose and pH fell right after the soak but this was not sustained at 60 minutes. 72.7 percent (16 of 22) reported mild side effects that improved after stopping. The authors say the soaks do not improve skin barrier integrity and caused irritation in most people. No benefit for the skin barrier; irritation in most Methods, limits and fundingOutcomes: Skin water loss and skin pH Limitations: Only 22 people; one brand and one dilution; forearm soaks only; 14 days. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Najafi 2026 Adjunctive effects of apple cider vinegar on metabolic syndrome and insulin resistance in polycystic ovary syndrome patients receiving metformin: a randomized clinical trial Scientific Reports · PMID 42215584 · DOI |
Controlled trial |
94 94 women with polycystic ovary syndrome, metabolic syndrome and HOMA-IR above 2.5, all taking metformin, in Iran |
Apple cider vinegar capsules Capsules (1,500 mg/day stated in the abstract) 1,500 mg a day (as stated in the abstract; not advice) 12 weeks · vs Placebo capsules |
Metabolic syndrome resolved in 74.5 percent of the vinegar group versus 40.4 percent of the placebo group. Insulin resistance, hirsutism, sexual function and quality of life improved more in the vinegar group. The abstract reports no safety or low blood sugar results. More metabolic syndrome resolved with vinegar capsules plus metformin than with placebo plus metformin Methods, limits and fundingOutcomes: Resolution of metabolic syndrome, insulin resistance, testosterone, hirsutism, sexual function, quality of life Limitations: One 12-week trial in one country; capsule form, not liquid vinegar; the abstract does not report adverse effects; the abstract does not show how the groups were blinded. Funding and conflicts: Authors declare no competing interests. Read: abstract |
| Ogah 2025 Assessing the Merit of the Apple Cider Vinegar Rinse Method for Synthetic Hair Extensions Cutis · PMID 41524640 · DOI |
Review |
No people; literature review of studies of apple cider vinegar rinses for synthetic hair extensions | Apple cider vinegar rinse on synthetic hair extensions Diluted rinse on hair extensions |
The authors call the rinse an anecdotal remedy lacking data and found a notable deficit in studies on it. Proper evidence not found Methods, limits and fundingOutcomes: Whether the rinse changes the carcinogen content of synthetic hair extensions Limitations: A literature review that found almost no studies. Funding and conflicts: Not stated in the abstract. Read: abstract |
| PubChem 2026 PubChem: Acetic Acid (CID 176) n/a · Source |
Reference database n/a |
n/a | n/a Not given as advice here |
PubChem lists acetic acid as CID 176, formula C2H4O2 (checked through the PubChem API on 2026-10-30). Methods, limits and fundingOutcomes: Identity of acetic acid Limitations: A chemistry database; no health information used. Read: full-text |
| Tehrani 2025 The Effects of Apple Cider Vinegar on Cardiometabolic Risk Factors: A Systematic Review and Meta-analysis of Clinical Trials Current Medicinal Chemistry · PMID 37608660 · DOI |
Meta-analysis |
1320 1,320 adults in 25 clinical trials (33 arms) |
Apple cider vinegar by mouth Apple cider vinegar (the liquid) Not given as advice here |
Fasting glucose fell by 21.20 mg/dL, HbA1c by 0.91 and total cholesterol by 6.72 mg/dL. No significant change in BMI, HOMA-IR, insulin, triglycerides, LDL or HDL overall. In people with diabetes glucose, HbA1c, total cholesterol and triglycerides fell. Some blood sugar and cholesterol markers lower; extremely variable between trials (Fasting glucose -21.20 mg/dL (95% CI -32.31 to -2.21); HbA1c -0.91 (-1.62 to -0.21); total cholesterol -6.72 mg/dL (-12.91 to -0.53)) Methods, limits and fundingOutcomes: Fasting blood glucose, HbA1c, total cholesterol, triglycerides, LDL, HDL, BMI, insulin, HOMA-IR Limitations: I2 of 95.8 percent for glucose and 98.9 percent for HbA1c means the trials disagreed a great deal; the abstract does not give a quality grade. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Willershausen 2014 In vitro study on dental erosion caused by different vinegar varieties using an electron microprobe Clinical Laboratory · PMID 24839821 · DOI |
Lab analysis lab |
Enamel slices from human wisdom teeth in the lab; 5 of 30 vinegar varieties tested (apple cider vinegar not among the five named) | Five vinegars (a "Bio" vinegar, raspberry, balsamic, a white Modena vinegar and a sherry vinegar) Vinegar in a lab dish Up to 8 hours in a dish Up to 8 hours · vs Sodium chloride solution |
Vinegars released minerals from enamel depending on time and vinegar. Raspberry vinegar and the "Bio" vinegar caused significantly more mineral loss (about 20 percent in the upper layers of the enamel) than the others. The authors say this cannot be directly translated to real mouths. Lab: vinegars can dissolve tooth enamel Methods, limits and fundingOutcomes: Mineral loss from tooth enamel Limitations: Lab only; apple cider vinegar was not among the five named vinegars in the abstract. Read: abstract |
What we do not know yet
- No long-term trial shows apple cider vinegar prevents diabetes complications, heart disease or obesity-related illness.
- Pooled trials differ a great deal in vinegar amount, product and length, so no reliable typical effect can be stated.
- A widely quoted 2024 weight-loss trial from Lebanon was retracted in 2025 and is not used here, so the strongest-looking weight results are gone.
- The 2009 Japanese trial used "vinegar" not named as apple cider vinegar.
- No trial of apple cider vinegar was found for pregnancy, breastfeeding, children, older adults or kidney disease outcomes.
- Lab and animal-only studies (for example in rats, fish and shrimp) were not used because they do not show effects in people.
How new research is added
New studies are found by a saved PubMed search and are placed in a review queue. A person reads each one before it is added.
Lab markers
What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".
Metabolic 3
Fasting blood glucose
Lowered in trials
Blood sugar after a night without food.
Low certaintyResults and what it means
Why it was measured
To see whether vinegar changes baseline blood sugar.
Statistical vs. clinical meaning
Small average fall in diabetes; mixed in healthy adults.
Safety implication
A lab number is not a health outcome. Ask the prescriber before changing any medicine.
HbA1c
Lowered in trials
A blood test showing average blood sugar over about 3 months.
Low certaintyResults and what it means
Why it was measured
To see whether vinegar changes long-term blood sugar.
Statistical vs. clinical meaning
Small average fall, but the trials disagree a great deal.
Safety implication
A lab number is not a health outcome. Ask the prescriber before changing any medicine.
Total cholesterol
Lowered in trials
The total amount of cholesterol in the blood.
Low certaintyResults and what it means
Why it was measured
To see whether vinegar changes blood fats.
Statistical vs. clinical meaning
Very small average fall; LDL and HDL did not change significantly.
Safety implication
A lab number is not a health outcome. Ask the prescriber before changing any medicine.
Other 1
Body weight, BMI and waist circumference
Lowered in trials
Measures of body size used in weight trials.
Low certaintyResults and what it means
Why it was measured
To see whether vinegar changes body size.
Statistical vs. clinical meaning
Small average changes in short trials with large differences between studies.
Safety implication
A teenager with tooth erosion used apple cider vinegar for weight loss; see Safety.
| Study | Result | People | Product |
|---|---|---|---|
| 7 | Weight, BMI and waist were lower (SMD -0.39, -0.65, -0.34) in 10 trials; other body measures not significantly different. | 789 adults | Apple cider vinegar for at least 4 weeks |
| 16 | Weight, BMI, visceral fat, waist and triglycerides were lower than placebo with a vinegar drink at 12 weeks. | Obese Japanese adults | Vinegar drink (not named as apple cider vinegar) |
Safety
What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.
Main points to know 6
- Teeth: vinegar is acid and can wear away enamel. A case report linked a daily glass of apple cider vinegar to tooth erosion in a 15-year-old girl, and a lab study shows vinegars can dissolve enamel. Enamel does not grow back. A dentist can advise. Case report 11 23
- Throat and oesophagus: tablets and strong vinegar can injure the food pipe. A case report linked apple cider vinegar tablets to esophageal injury. Children who swallowed concentrated white vinegar (about 85% acetic acid, far stronger than cider vinegar) developed strictures and one died. Keep strong vinegar out of children's reach. Case report 13 4
- Potassium: very large amounts have been linked to low potassium. One case report (title only read) links a patient drinking large amounts of cider vinegar to low blood potassium, raised renin and osteoporosis. Whether this matters with water pills (diuretics) that also lower potassium has not been studied; this is a theory, not a tested interaction. Case report 17
- Medicines: insulin and other diabetes medicines. No study of apple cider vinegar with insulin was found. Vinegar slowed stomach emptying in a small group with type 1 diabetes and slow stomach emptying, which the authors say might disadvantage blood sugar control. Do not use vinegar to replace or adjust a diabetes medicine. Ask the prescriber or pharmacist. Controlled trial 14 19
- Skin: do not put vinegar on the skin to remove moles or skin spots. Chemical burns have been reported, including in a teenager following an internet method to remove a mole. Dilute soaks caused mild irritation in most of 22 people. Case report 6 9 18
- Liver and pancreas: rare case reports. A 60-year-old man had liver injury after long-term vinegar use that improved when he stopped, and an 84-year-old woman had acute pancreatitis possibly linked to a supplement containing apple cider vinegar. These are single cases and do not prove cause. Case report 2 1
Side effects 7
| Effect | How often | Severity and recovery | Evidence |
|---|---|---|---|
| Tooth enamel erosion A case report linked tooth erosion in a 15-year-old girl to a daily glass of apple cider vinegar. A lab study of other vinegars showed they can dissolve tooth enamel in a dish. | Not known | moderate Enamel does not grow back | Case report 11 23 |
| Injury to the throat and food pipe (esophagus) A case report linked apple cider vinegar tablets to esophageal injury. In a hospital series, 11 young children who drank concentrated white vinegar (about 85% acetic acid) had food-pipe strictures and one died. That product is much stronger than apple cider vinegar. | Not known | serious Not described | Case report 13 4 |
| Chemical burns on the skin Two case reports describe chemical burns from apple cider vinegar put on the skin, one after a teenager followed an internet method to remove a mole. In a 22-person soak study 16 had mild irritation. | Not known | moderate to serious Not described | Case report 6 9 |
| Skin irritation with dilute soaks 0.5 percent acetic acid soaks of the forearm. | 72.7 percent (16 of 22) in one 14-day pilot | mild Improved after stopping | Controlled trial 18 |
| Low blood potassium (hypokalemia) with very large amounts Only the title was read: a patient drinking large amounts of cider vinegar had hypokalemia, raised renin and osteoporosis. | One case report; frequency not known | serious Not described in the title | Case report 17 |
| Slower stomach emptying In people with type 1 diabetes and diabetic gastroparesis; may be a disadvantage for blood sugar control, say the authors. | Seen in all 10 people measured in one pilot, on average | mild to moderate Not studied | Controlled trial 14 |
| Digestive and other side effects (burping, reflux, bowel changes) People with type 2 diabetes taking vinegar daily for 12 weeks; the difference between groups was not statistically significant. | 50 to 56 percent of vinegar and pickle groups reported at least one event at week 6 in a 27-person trial | mild Not stated | Controlled trial 15 |
Liver
One case report describes liver injury in a 60-year-old man after long-term vinegar use, which improved when he stopped. In a 12-week trial in 27 people with type 2 diabetes, the liver enzyme AST tended to rise in the vinegar group (+17 percent at week 6, not statistically significant). These are signals, not proof of cause. LiverTox was not read for this page. 2 15
How often. No rate could be found.
Monitoring. No agency monitoring advice was read.
- A 60-year-old man with long-term vinegar use and liver damage that improved after stopping (Oxford Medical Case Reports, 2025).
This is a safety connection. It is not evidence that Apple Cider Vinegar supports liver health.
Medicines and supplements 3
| With | Why it matters | Importance | Evidence | What to do |
|---|---|---|---|---|
| Insulin and other blood-sugar-lowering medicines prescription | Vinegar may lower blood sugar and slow stomach emptying. | No study of apple cider vinegar with insulin was found. A small pilot found slower stomach emptying in type 1 diabetes with slow stomach emptying, which might make blood sugar control harder. | Pharmacological theory Not enough evidence 14 | Ask the prescriber or pharmacist before using apple cider vinegar regularly if you take insulin or other blood sugar medicine. Do not change a prescribed medicine because of vinegar. |
| Metformin prescription | Not described. | One 12-week trial in 94 women with polycystic ovary syndrome already taking metformin gave apple cider vinegar capsules or placebo. The abstract reports benefits and does not report low blood sugar or other adverse effects, so the safety question is not answered. | Clinical trial Not enough evidence 19 | Ask the prescriber or pharmacist. |
| Diuretics (water pills) and other potassium-lowering medicines prescription | A case report links large amounts of cider vinegar to low blood potassium; some diuretics also lower potassium. | No study of this combination was found, and a PubMed search for apple cider vinegar with diuretics or potassium found no relevant study. This is a theory only. | Pharmacological theory Not enough evidence 17 | Ask the prescriber or pharmacist, especially if you take a diuretic or have been told your potassium is low. |
Who should check first 4
| Situation | Advice | Evidence |
|---|---|---|
| Children and strong or concentrated vinegar | Keep concentrated vinegar out of reach. If a child swallows a large amount or has pain, drooling, vomiting or trouble breathing, get emergency help. | Case series 4 |
| Putting vinegar on the skin to remove moles or skin spots | Do not. Chemical burns have been reported. | Case report 9 6 |
| People with slow stomach emptying (gastroparesis), especially with type 1 diabetes | Ask a doctor first; vinegar slowed emptying further in a small study. | Controlled trial 14 |
| People taking insulin, diabetes pills or diuretics | Ask the prescriber or pharmacist first. | Pharmacological theory 14 17 |
Overdose, product quality and regulators
Summary. The risk is corrosion and acid injury rather than classic poisoning, and it rises with concentration. Apple cider vinegar for food is far weaker than concentrated white vinegar.
Animal. Lab and animal studies were not used.
Human doses studied. Not given as advice here.
High dose or long term signals. Case reports of low potassium and liver injury with large or long-term use; tooth erosion with daily use.
Overdose response. In a child who has swallowed a large amount of vinegar, emergency care is needed (see urgent signs).
Genotoxicity. Not studied in the sources read.
Tablet products varied widely, and the authors of one study doubted whether apple cider vinegar was in all of them.
Tablet quality and labelling. Eight tablet products differed in tablet size, pH, acid content and label claims, and the authors doubted whether apple cider vinegar was in all of them. 13
When to get medical help
- A child (or adult) who has swallowed a large amount of vinegar or any strong vinegar and has pain in the mouth, throat or chest, drooling, vomiting, cannot swallow or has trouble breathing: call your local emergency number or poison centre at once.
- Severe pain, blistering or a spreading burn on skin where vinegar was applied: wash with water and get medical care.
- Muscle weakness, cramps or an irregular heartbeat in someone using large amounts of vinegar or taking water pills: get medical advice.
- Yellow skin or eyes, dark urine or severe stomach pain with a vinegar supplement: get medical help.
Stop using the product and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.
General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.
Frequently asked questions
Can apple cider vinegar damage teeth?
Can it hurt the throat or food pipe?
Is it safe with insulin or diabetes medicine?
Does it interact with water pills (diuretics) or lower potassium?
Not tested. One case report (title only read) linked very large amounts of cider vinegar to low potassium, and some water pills also lower potassium, so this is a theory. Ask the prescriber or pharmacist.
Does apple cider vinegar help with weight loss?
Pooled trials found small average reductions in weight, BMI and waist over up to about 12 weeks, with large differences between studies. It may be a short-term add-on at most.
Why was the 2024 Lebanese weight-loss trial retracted?
The journal retracted it in 2025 because the authors' analyses could not be replicated and multiple errors were found, and the dataset showed patterns inconsistent with random allocation. The authors agreed with the retraction. We do not use its results.
Does it lower blood sugar?
Can I put it on my skin?
Are tablets and gummies the same as the liquid?
Can it affect the liver?
Is it safe in pregnancy, breastfeeding or for children?
Proper evidence not found for pregnancy and breastfeeding. For children, strong vinegar is dangerous if swallowed. Ask a doctor, midwife or pharmacist.
When should I get urgent help?
If someone has swallowed a large amount of vinegar, or has pain in the mouth, throat or chest, drooling, vomiting or trouble breathing, call your local emergency number or poison centre at once.
Explore by health goal
Editorial transparency
- Written by
- AlternativeMed editorial team. Research compiled with AI assistance, then checked against PubMed records.
- Medical review
- None. This page has not been reviewed by a physician or pharmacist.
- First published
- 2026-10-30
- Last substantive update
- 2026-10-30
- How we research
- We read 19 PubMed records (abstracts, plus the retraction notice in full text); two records (a 2012 burn letter and a 1998 potassium letter) have no abstract and only their titles were read. Fruit and acid names were checked in GBIF and PubChem. No regulator statement was read, so none is cited. Certainty ratings are the compiler's own reading unless a review gives its own.
- How we rate evidence
- See "How we rate evidence" in the Evidence tab.
- Independence
- No product is promoted on this page. No affiliate links are shown.
Sources 23
Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.
- Alvarez L, Colaco LB, Ali S, et al. Unveiling a Sour Truth: Acute Pancreatitis Linked to Apple Cider Vinegar Supplement. ACG Case Reports Journal. 2024. PMID 39238884. DOI 10.14309/crj.0000000000001482. (abstract)
- Andonie CR, AbuGhannam SI, Ruzayqat SMA. Apple Cider Vinegar-Induced Hepatotoxicity: A Rare Case Report. Oxford Medical Case Reports. 2025. PMID 40666072. DOI 10.1093/omcr/omaf097. (abstract)
- Arjmandfard D, Behzadi M, Sohrabi Z, Mohammadi Sartang M. 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. Frontiers in Nutrition. 2025. PMID 39949546. DOI 10.3389/fnut.2025.1528383. (abstract)
- Atıcı A, Miçooğulları L, Uğur B, Çelikkaya ME, Akçora B. Accidental ingestion of concentrated white vinegar in Hatay children in Turkey. Archives of Industrial Hygiene and Toxicology. 2023. PMID 38146762. DOI 10.2478/aiht-2023-74-3792. (abstract)
- BMJ Nutrition, Prevention and Health (editorial notice). Retraction: Apple cider vinegar for weight management in Lebanese adolescents and young adults with overweight and obesity: a randomised, double-blind, placebo-controlled study. BMJ Nutrition, Prevention & Health. 2025. PMID 41789013. DOI 10.1136/bmjnph-2023-000823ret. (full-text)
- Bunick CG, Lott JP, Warren CB, et al. Chemical burn from topical apple cider vinegar. Journal of the American Academy of Dermatology. 2012. PMID 22980269. DOI 10.1016/j.jaad.2011.11.934. (title-only)
- Castagna A, Ferro Y, Noto FR, et al. Effect of Apple Cider Vinegar Intake on Body Composition in Humans with Type 2 Diabetes and/or Overweight: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2025. PMID 41010525. DOI 10.3390/nu17183000. (abstract)
- Feise NK, Johnston CS. Commercial Vinegar Tablets Do Not Display the Same Physiological Benefits for Managing Postprandial Glucose Concentrations as Liquid Vinegar. Journal of Nutrition and Metabolism. 2020. PMID 33489366. DOI 10.1155/2020/9098739. (abstract)
- Feldstein S, Afshar M, Krakowski AC. Chemical Burn from Vinegar Following an Internet-based Protocol for Self-removal of Nevi. Journal of Clinical and Aesthetic Dermatology. 2015. PMID 26155328. (abstract)
- GBIF. GBIF Backbone Taxonomy: Malus domestica (Suckow) Borkh.. n/a. 2026. (full-text)
- Gambon DL, Brand HS, Veerman EC. [Unhealthy weight loss. Erosion by apple cider vinegar]. Nederlands Tijdschrift voor Tandheelkunde. 2012. PMID 23373303. DOI 10.5177/ntvt.2012.12.12192. (abstract)
- Hadi A, Pourmasoumi M, Najafgholizadeh A, et al. The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials. BMC Complementary Medicine and Therapies. 2021. PMID 34187442. DOI 10.1186/s12906-021-03351-w. (abstract)
- Hill LL, Woodruff LH, Foote JC, Barreto-Alcoba M. Esophageal injury by apple cider vinegar tablets and subsequent evaluation of products. Journal of the American Dietetic Association. 2005. PMID 15983536. DOI 10.1016/j.jada.2005.04.003. (abstract)
- Hlebowicz J, Darwiche G, Björgell O, Almér LO. Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: a pilot study. BMC Gastroenterology. 2007. PMID 18093343. DOI 10.1186/1471-230X-7-46. (abstract)
- Johnston CS, White AM, Kent SM. A preliminary evaluation of the safety and tolerance of medicinally ingested vinegar in individuals with type 2 diabetes. Journal of Medicinal Food. 2008. PMID 18361754. DOI 10.1089/jmf.2007.574. (abstract)
- Kondo T, Kishi M, Fushimi T, Ugajin S, Kaga T. Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects. Bioscience, Biotechnology, and Biochemistry. 2009. PMID 19661687. DOI 10.1271/bbb.90231. (abstract)
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