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Apple Cider Vinegar: its uses and benefits

ACV's science-backed uses

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First published: 11.Oct.2018


Vinegar has been used in medicine since the days of Hippocrates of Kos, the founder of medical science back in ancient Greece (420 BC).

It is still touted as a "cure-all" with endless benefits ranging from a cure for nail fungus and lice to diabetes and heart disease.

In this article, we will review the science, sort through the facts and the baseless myths, and try to define what are the real medicinal uses of Apple Cider Vinegar.

In this Article (Index)

apples and bottles of apple cider vinegar
Apple cider vinegar

Vinegar's Ancient History

Vinegar has a very long history (1). It is mentioned in the Bible several times (both Old and New Testaments), we will cite one: (Ruth 2:14) "At mealtime Boaz said to her, 'Come over here. Have some bread and dip it in the wine vinegar.'When she sat down with the harvesters, he offered her some roasted grain."

This use is similar to the one mentioned in 70 AD by Pliny the Elder in his Natural History (Book XXIII), who also adds some medicinal uses "Taken by itself, it dispels nausea and arrests hiccup, and if smelt at, it will prevent sneezing... It is used as a beverage also, in combination with water." The beverage was known as "Posca" and was popular among the lower classes and soldiers of Rome.

As mentioned further up, in the Athens of Pericles, Hippocrates used vinegar to heal wounds and ulcers. In the 10th century, Chinese doctor Sung Tse, founder of forensic science, used it to disinfect his hands during autopsies.

Pliny also mentions the use of vinegar in Oxymel (Book IX), and Moses ben Maimon (Maimonides) writes about it in the XII century. Pliny's recipe contains 10 lbs. of honey, 0.37 gallons of old vinegar, 1 lb. of sea-salt and, 0.37 gal. of rainwater, all of which are boiled and bottled.

Later versions used during the 1800s were made by mixing 1 part of white wine vinegar with 4 parts of virgin honey (2).

Let's explore its modern uses and the studies that have backed them or disproved them. But first, let's learn what it is.

What is vinegar?

The name "vinegar" comes from the French words "vin" = "wine" and "aigre" = "sour" because one of its main sources in Europe was wine which had gone sour.

Acetic acid (whose correct name is ethanoic acid) has the following formula:


Vinegar's tart and pungent taste, and also its biting smell are due to an acid called "ethanoic acid" or "acetic acid."

It also contains vitamins, salts, minerals, antioxidants (polyphenolic compounds such as gallic acid, caffeic acid, ferulic acid, and catechin), and other organic acids such as tartaric, lactic, malic, and citric. These compounds give vinegar some health benefits.

Vinegar can be made from many types of fermentable raw materials such as grapes or apples in Europe and America, rice, coconut or sugar cane in Asia, and dates in the Middle East.

The most common vinegar in the US is apple cider vinegar.

There are no standards of identity for vinegar in America under the Federal Food, Drug, and Cosmetic Act, however, if it bears the label "Vinegar, Cider Vinegar or Apple Vinegar", it must be made from apple juice. It must also have more than 4% of acetic acid weight ⁄ volume to be labeled as vinegar. And if it is diluted with water, the label must say so too (3)

Clarification and filtering of vinegar remove some of its beneficial compounds and pasteurization is also deemed to damage its healthy properties so it is often sold as unpasteurized "raw" cider.

Health Benefits of Vinegar

In the following sections we will check the different health related benefits and risks of ACV:

A. Infections (microbes, fungus, bacteria, and lice)

1. Antimicrobial properties of Vinegar

Since most bacteria grow and thrive in a narrow range of pH from 6.5 to 7.5, an acidic environment should curtail their growth and development, therefore an acidic product like vinegar should be effective as a biocide, killing microbes.

It has been used for centuries to preserve food, but despite this effective antimicrobial behavior, Rund (1996) does not recommend it for treating wounds; the team found that vinegar solutions were not effective in inhibiting the growth of group D Enterococcus, Escherichia coli or Bacteroides fragilis bacteria; it had very limited effectiveness when applied to Staphylococcus aureus and Pseudomonas aeruginosa bacteria (4).

But Chen (2016) found that it was an effective disinfectant on other bacteria: "apple vinegar strongly inhibits the growth of pathogenic bacteria such as Staphylococcus epidermidis, Pseudomonas aeruginosa, Proteus mirabilis, and Klebsiella pneumoniae" (5).

2. Denture Cleaner

Its antiseptic properties are ratified by Shay (2000) who showed that it can be used to clean and remove bacteria from the small micropores of dentures because the residue it leaves on them does not harm the mouth's mucose. Furthermore, "vinegar [is] effective as are the commercial, effervescent products sold for denture soaking" (6).

3. Ear Infections

Aminifarshidmehr (1996) reports that otitis externa and otitis media can be treated by irrigation with diluted vinegar (2% acetic acid solution with a very acidic pH of 2) (7).

According to Dohar (2003) (8), the high acidity of these solutions may irritate the ear's skin and cause damage to the cochlear outer cells.

4. Nail fungus

According to Yam et al. (2014), fungal infections to toenails and fingernails (also known as onychomycosis) are on the rise globally affecting 14% of the global population, especially men and the elderly (9).

Yam found that to be effective against the fungus Trichophyton rubrum the pH has to be below 3.0 and in their trials, with a prolonged application they were unable to attain this value of pH 3.0 at the nail bed so they concluded that there were "Problems with using vinegar (5% acetic acid) in treating superficial fungal infections".

However, a patent filed by Stal (2012) mentions a preparation effective for treating onychomycosis formulated as follows (10):

  • Acetic acid 5% (or 4% acetic acid plus 1% lactic acid)
  • Ethyl acid ethyl ester 95%

Applied as a tonic it reduces the pH on the nail to a value between 2 and 4.

5. Head lice

According to the Centers for Disease Control and Prevention (CDC) children between 3 and 11 years of age are afflicted by 6 to 12 million infestations each year in the US (11).

The scientific support for treating lice with vinegar is lacking, but some studies have been done:

  • Takano-Lee (2004) tested seven home remedies to kill lice eggs, these included vinegar, isopropyl alcohol, olive oil, mayonnaise, melted butter, and petroleum jelly. The petroleum jelly was most effective as only 6% of the eggs hatched (12).
  • Ortega Insaurralde (2014) compared different removers (to soften the adhesive that bonds egg to hair), they found that "The vinegar... solution of acetic acid 7 %... showed a significant removal activity" (13).
  • Mumcuoglu (1999) reported that acetic acid formulations with 5% concentration are effective in detaching eggs from the hair (14).

6. Warts

The studies on wart removal (15) involved very concentrated acetic acid (99%) far more dangerous and toxic than the 5% concentration found in vinegar. They were reported as effective but required local anesthesia and special techniques which puts them beyond the scope of typical home remedies.

Homemade Disinfectant and Cleaning Product

A study by Goodyear (2015) compared a commercial bleach, an environmentally preferable (EP), and a do-it-yourself DIY disinfectant formulated with white vinegar, club soda, and tea tree oil. The outcome showed that (16):

  • They were all ineffective cleaning ceramic, but the DIY performed best in this test.
  • Only the DIY failed to clean the stainless surface.
  • EP and commercial bleach achieved reductions greater than 5 log10 reductions (meaning that the number of germs after cleaning was 100,000 times smaller). The vinegar DIY managed to do so when it was freshly prepared. A 50% vinegar solution also achieved a 5 log 10 reduction.
  • DIY and its components separately were more effective against Escherichia coli than Staphylococcus aureus.

So a vinegar-based disinfectant prepared freshly each 31 is a good alternative for cleaning ceramic surfaces.

Yang (2009) found that white distilled vinegar with 5% acetic acid, undiluted applied for 10 minutes at room temperature (77°F - 25°C) was only effective against Salmonella, but not against Listeria monocytogenes or E. coli (17).

They ranked domestic compounds by decreasing order of effectiveness: 0.0314% sodium hypochlorite > 3% hydrogen peroxide > undiluted vinegar - 5% acetic acid > 5% citric acid > baking soda (50% sodium bicarbonate).

In case you want to experiment: Never mix vinegar with hydrogen peroxide

The EPA -Environmental Protection Agency of the U.S. Government (see their recipes and tips here) suggests using:

  • Vinegar and sodium bicarbonate to clean greasy ovens.
  • Olive oil plus vinegar to restore furniture
  • Window glass cleaner based on vinegar
  • Heating vinegar to remove strong smells

Cardiovascular Health

1. Reduces Blood Pressure

For those suffering from hypertension, there are some positive tentative results, Kondo (2001) fed rats with vinegar (or diluted acetic acid) and reported a drop of 20 mm Hg compared to the control group (18).

Trials conducted by Kajimoto (2003) with aged black vinegar or 15% apple vinegar reported a drop in systolic blood pressure with no observable side effects (19). Tomato vinegar had a similar effect according to Sado (2006) (20). As did apple vinegar Kajimoto (2001) (21).

2. Lowers Cholesterol

Hengye (2016) (5) reported that consuming 1 fl. oz (30 ml) twice a 31 over a period of 8 weeks, significantly reduced total cholesterol, triglycerides, and "bad" cholesterol LDL levels of patients suffering from hyperlipidemia (abnormally high levels of all lipids-fats- in the blood), it also improved (increased) levels of HDL "good" cholesterol.

Budak (2011) found that apple cider vinegar, regardless of how it was produced lowered triglycerides and VLDL levels in rats on a high-cholesterol diet (22).

Cancer: Antitumoral Activity

Antioxidant effects

Vinegars are fermented products obtained mainly from fruits and therefore their raw materials contain large amounts of natural antioxidants known as Polyphenols.

But first, let's explain what they are and what they do:

What is an antioxidant?

The human body functions by means of chemical reactions that link and split molecules. This process also generates compounds known as Free Radicals.

Free radicals are ions (they have an electric charge) and therefore unstable which due to this charge can react with other molecules. If they react with DNA these reactions can disrupt their structure, and free radicals can also generate more free radicals as they react.

The body also has antioxidants which are compounds that neutralize the electric charge of free radicals, deactivating them.

Some situations called "oxidative stress" promote the formation of too many free radicals, which overcome the balance of antioxidants to wreak havoc in our bodies.

Stress factors are:

  • Air Pollution
  • Drinking alcohol
  • Excessive exercise
  • Cigarette smoke
  • Infections (virus, bacteria, fungi)
  • UV radiation
  • Toxins, drugs, pesticides
  • Inflammation, high blood sugar
apples and apple cider vinegar
Apple cider vinegar, source

Antioxidants in Vinegar

There are many types of antioxidants such as glutathione, Vitamins E and C, and beta carotene, just to mention some.

Vinegar, according to Hengye (2016) (5) has antioxidant capacities similar to those of 0.1% and 0.2% vitamin C solutions.

Vinegars contain polyphenols such as gallic acid and catechins. Apple vinegars also contain chlorogenic acids with anti-inflammatory and antioxidant properties (5).

Nishino (2005) reported that "Vinegar contains polyphenols, and these have been shown to reduce cancer risk" (23).

Nakamura (2010)(24) identified 4 kinds of organic acids, 20 kinds of amino acids, 3 kinds of sugars, 4 kinds of minerals, and phenols in apple vinegar.

The processing of Vinegar reduces its Antioxidant content

However, the type of fermentation process and the processing steps can significantly reduce the polyphenol content in vinegars:

Milling and pressing the apples to obtain their juice decreases the content of phenolic compounds in the juice due to oxidization. Clarification with flocculants removes polyphenols from the suspension.

Bakir (2016) found that depending on the method used the loss of antioxidant capacity was very significant. The table below shows the concentration of different antioxidants as the apple juice concentrate (AJC) becomes packed apple vinegar (AV) in mg ⁄ 100 ml (25).




Gallic acid






Syringic acid



Caffeic acid



p-coumaric acid



Cancer Risk may increase due to Vinegar

Radosavljevic (2004) found that the consumption of vinegar was a risk factor for bladder cancer, with more than a fourfold increase in risk odds (4.41 times) (26).

Vinegar, Diabetes and Blood Sugar Control

Johnston (2004) reported its anti glycemic properties: in other words, it controls the content of glucose in the blood (27). This study found that "Vinegar improves insulin sensitivity to a high carbohydrate meal in subjects with insulin resistance or type 2 diabetes mellitus... even in individuals with marked insulin resistance."

Shishehbor (2017) found 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" in other words, glucose spikes after a meal (postprandial = after a meal) are muted (28).

Shen (2016) summarizes vinegar's positive effects as follows: "...the intake of apple vinegar also increases the insulin sensitivity of patients with type 2 diabetes... and the intake of apple vinegar at bedtime can help patients with type 2 diabetes to control their fasting blood glucose concentration and prevent "diabetes mellitus dawn phenomenon" in the next morning" (5).

There is a very positive correlation between the ingestion of apple cider vinegar and the control of blood sugar.

A study involving rats fed on a high-calory diet with glucose by Ousaaid et al. (2020) found that if they also received ACV, it improved their blood sugar, liver enzymes, urea, and cholesterol levels (33).

Weight Loss effects of Vinegar

Appetite suppressor?

According to Johnston (2005), healthy adult women consumed fewer calories on 31s that they ingested vinegar with their breakfast. The calorie reduction was approximately 200 to 275 Calories (29).

Roberts (2000) evaluated the satiety effect of vinegar, which may be due to its effect of reducing glucose levels in the blood. The study found that it "... promoted postmeal satiety and ⁄ or reduced subsequent hunger" (30).

The satiating effects of vinegar were also proven by Bouderbala (2016)(31) who studied rats ingesting apple cider vinegar (7 ml per kg per 31).

This dose is equivalent to just over 2 cups of ACV daily for a person weighing 177 lbs. In our opinion impractical and even dangerous for humans -see the osteoporosis case we mention in Apple Cider Vinegar Side Effects.

Bouderbala observed "a highly significant decrease in body weight and food intake". The study also confirmed its beneficial effects mentioned further up (lower blood sugar, better serum lipid (cholesterol) profile, lower abdominal circumference, and Body Mass Index).

Vinegar and Weight loss

Its weight loss properties were also shown by Kondo (2009) who conducted a 12-week study in which three groups were given 500 ml (1 pint) daily of a beverage that contained either one-half fl. oz (15 ml) of vinegar; 1 fl. oz (30 ml) of vinegar or zero vinegar (placebo-control group). At the end of the study, they found that both vinegar intake groups had a lower body weight, visceral fat load, Body Mass Index (BMI), waist circumference, and triglyceride levels in their blood, in comparison to the placebo group (32).

It seems reasonable to assume that a "daily intake of vinegar might be useful in the prevention of metabolic syndrome by reducing obesity" (32).

Closing comments

Vinegar has some outstanding properties. It seems to have many positive health benefits treating conditions such as high blood pressure, cholesterol, blood sugar, and body weight issues.

It can also be used as a DIY home-made cleaner.

Yet it has certain risks that should not be overlooked. Please visit our webpage where we discuss its Side Effects:

References and Further Reading

(1) Carol S. Johnston, Cindy A. Gaas, (2006). Vinegar: Medicinal Uses and Antiglycemic Effect, MedGenMed. 2006; 8(2): 61.

(2) Felter HW, Lloyd JU. King's American Dispensatory, 1898

(3) US Food and Drug Administration, (2018). CPG Sec. 525.825 Vinegar, Definitions - Adulteration with Vinegar Eels. Accessed 09.20.2018

(4) Rund CR. (1996). Nonconventional topical therapies for wound care. Ostomy Wound Manage, 1996;42:22-24.h

(5) Hengye Chen, Tao Chen, Paolo Giudici, Fusheng Chen, (2016). Vinegar Functions on Health: Constituents, Sources, and Formation Mechanisms, Comprehensive Reviews in Food Science and Food Safety Vol 15:6 Nov 2016, 1124-1138

(6) Shay K., (2000). Denture hygiene: a review and update, J Contemp Dent Pract. 2000;15(1):28-41

(7) Aminifarshidmehr N., (1996). The management of chronic suppurative otitis media with acid media solution, Am J Otol. 1996;17:24-25

(8) Dohar JE, (2003). Evolution of management approaches for otitis externa, Pediatr Infect Dis J. 2003;22:299-308

(9) Yam, Cheung, H. C. Lee, S, Hui, M and N. M. Luk, T. (2014). Effect of pH on fungal growth: Problems with using vinegar (5% acetic acid) in treating superficial fungal infections, Hong Kong Journal of Dermatology and Venereology. 22. 57-64

(10) Robert Sebastian Stal , (2010). Patent application Number: 13/509,447, filed: Nov 11, 2010

(11) CDC (2013). CDC - Lice - Head Lice - Epidemiology & Risk Factors, September 24, 2013

(12) Takano-Lee M, Edman JD, Mullens BA, Clark JM., (2004). Home remedies to control head lice: assessment of home remedies to control the human head louse, Pediculus humanus capitis (Anoplura: Pediculidae), J Pediatr Nurs. 2004;19:393-398

(13) Ortega Insaurralde, Isabel and Toloza, Ariel and Picollo, Maria and Vassena, Claudia. (2014). Influence of the formulations in removing eggs of Pediculus humanus capitis (Phthiraptera: Pediculidae), Parasitology research. 113. 10.1007/s00436-014-4012-8

(14) Mumcuoglu KY, (1999). Prevention and treatment of head lice in children, Paediatr Drugs. 1999 Jul-Sep;1(3):211-8

(15) Conzuelo-Quifada AE, Rodriguez-Cuevas SA, Labastida-Almendaro S., (2003). Treatment of large lower genital tract condylomata acuminate with local excision plus topical acetic acid. A preliminary study, J Reprod Med. 2003;48:506-508

(16) Goodyear N, Brouillette N, Tenaglia K, Gore R, Marshall J., (2015). The effectiveness of three home products in cleaning and disinfection of Staphylococcus aureus and Escherichia coli on home environmental surfaces, J Appl Microbiol. 2015 Nov;119(5):1245-52. doi: 10.1111/jam.12935

(17) Yang, H., Kendall, P., Medeiros, L., Sofos, J. (2009). Inactivation of Listeria monocytogenes, Escherichia coliO157:H7, and Salmonella Typhimurium with compounds available in households, I. J. Food Prot. 72(6); 1201-1208

(18) Kondo S, Tayama K, Tsukamoto Y, Ikeda K, Yamori Y, (2001). Antihypertensive effects of acetic acid and vinegar on spontaneously hypertensive rats, Biosci Biotechnol Biochem. 2001;65:2690-2694

(19) Kajimoto O, Oshima Y, Tayama K, Hirata H, Nishimura A, Tsukamoto Y., (2003). Hypotensive effects of drinks containing vinegar on high normal blood pressure and mild hypertensive subjects, J Nutr Food. 2003;6:51-68

(20) Sado T, Arita J, Miyamoto S, Iwasaki H, Nishimura A, Kajimoto Y, Kajimoto O., (2006). Antihypertensive Effect and Safety of a Drink Containing Tomato Vinegar in Case of Long-term Intake for Subjects with High-normal Blood Pressure or Mild Hypertension Jpn Pharmacol Ther. 2006;34:723-35

(21) Kajimoto O, Tayama K, Hirata H, Takahashi T, Tsukamoto Y., (2001). Effect of a drink containing vinegar on blood pressure in mildly and moderately hypertensive subjects J Nutr Food. 2001;4:47-60

(22) Budak NH, et al., (2011). Effects of apple cider vinegars produced with different techniques on blood lipids in high-cholesterol-fed rats, J Agric Food Chem. 2011 Jun 22;59(12):6638-44. doi: 10.1021/jf104912h

(23) Nishino H, Murakoshi M, Mou XY, et al., (2005). Cancer prevention by phytochemicals, Oncology. 2005;69(Suppl 1):38-40

(24) Kozo Nakamura et al., (2010). Phenolic Compounds Responsible for the Superoxide Dismutase-like Activity in High-Brix Apple Vinegar, J. Agric. Food Chem., 2010, 58 (18), pp 10124-10132 DOI: 10.1021/jf100054n

(25) Sena Bakir, Gamze Toydemir, Dilek Boyacioglu, Jules Beekwilder, Esra Capanoglu. (2016). Fruit Antioxidants during Vinegar Processing: Changes in Content and in Vitro Bio-Accessibility, Int J Mol Sci. 2016 Oct; 17(10): 1658. doi: 10.3390/ijms17101658

(26) Radosavljevic V, Jankovic S, Marinkovic J, Dokic M., (2004). Non-occupational risk factors for bladder cancer: a case-control study, Tumori. 2004;90:175-180

(27) Johnston CS, Kim CM, Buller AJ, (2004). Vinegar improves insulin sensitivity to a high carbohydrate meal in subjects with insulin resistance or type 2 diabetes mellitus, Diabetes Care. 2004;27:281-282

(28) Shishehbor F, Mansoori A, Shirani F., (2017). Vinegar consumption can attenuate postprandial glucose and insulin responses; a systematic review and meta-analysis of clinical trials. Diabetes Res Clin Pract. 2017 May;127:1-9. doi: 10.1016/j.diabres.2017.01.021. Epub 2017 Mar 2

(29) Johnston CS, Buller AJ, (2005). Vinegar and peanut products as complementary foods to reduce postprandial glycemia, J Am Diet Assoc. 2005;105:1939-1942

(30) Roberts SB., (2000). High-glycemic index foods, hunger, and obesity Is there a connection?, Nutr Rev. 2000;58:163-169

(31) Bouderbala H, Kaddouri H, Kheroua O, and Saidi D, (2016). Anti-obesogenic effect of apple cider vinegar in rats subjected to a high fat diet, Ann Cardiol Angeiol (Paris). 2016 Jun;65(3):208-13. doi: 10.1016/j.ancard.2016.04.004

(32) Kondo T, Kishi M, Fushimi T, Ugajin S, Kaga T, (2009). Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects, Biosci Biotechnol Biochem. 2009 Aug;73(8):1837-43. Epub 2009 Aug 7

(33) Ousaaid, D., et al. (2020). Beneficial Effects of Apple Vinegar on Hyperglycemia and Hyperlipidemia in Hypercaloric-Fed Rats. Journal of diabetes research, 2020, 9284987.

About this Article

Apple Cider Vinegar uses, A. Whittall

©2023, 31 Aug. 2023. Update scheduled for 31 Aug. 2025.

Tags: Apple Cider Vinegar (ACV), ACV side effects, cancer, warts, diabetes, cholesterol, dentures, cleaners

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