Dr Rupy: Vinegar shots, gummies and acetic acid based drinks. These are everywhere, but what is the evidence behind them and can they live up to the claims of things like improving blood sugar regulation, flattening the blood glucose curve, preventing type two diabetes, even lowering cholesterol, or what about burning weight, specifically fat. Well, the team and I decided to do a deep dive into the subject and surprisingly, we found some interesting results that we thought was worthy of a podcast. Is it worth a shot? Well, listen to find out to get our take on vinegar for these health benefits and more and how to source and prepare your vinegar if you're interested in giving it a go yourself. And remember, you can watch this podcast on YouTube where you can subscribe or just hit the follow button if you're listening on Spotify or Apple as well. And you can download the Doctor's Kitchen app where you can access all of our recipes and try that free trial, whether you're on Google or Apple or just using the web based platform for your iPad or your desktop. You can find all of our recipes there and we've got hundreds of recipes all across different health goals as well. So make sure you check that out. And I'd love to know your thoughts on vinegar and whether this is something that you've been doing already, whether it's something that perhaps was handed down to you from a family member, from your older ancestor, at the ancestry, like where this has sort of come for you and what types of vinegar if you are using it, you are using yourself as well. I'd love to know in the comments on YouTube, that's where you're going to find me more often these days. On to my podcast about vinegar.
Dr Rupy: Just two tablespoons of vinegar every single day can help with weight loss, blood sugar control and cholesterol levels. Now I was really sceptical about how such a simple strategy every single day could have these seemingly miraculous effects, but we're going to go into some of the studies that demonstrate the effectiveness of vinegar every day and the potential mechanisms behind how just such a simple thing that you do in the morning or with meals can have this pretty large effect. It's been used for centuries as a natural remedy in folk medicine, but now it's having a moment and with good reason actually, there are some studies as early as 2024 looking at these pretty large effects. So, you know, I hasten to use the word superfood, but there is something super about vinegar. And you know, now there are even vinegar diets, which I don't think is as necessary, but you know, it is pretty impressive. So I'm going to tell you a bit about what the research is showing and we're going to go in order starting with a deep dive into improving blood sugar levels after a meal. Now if you check out this diagram, you'll see here that after ingesting 20 to 30 grams or mils of vinegar every single day, which is about four tablespoons or so, there are quite a few studies showing that vinegar could have this positive effect on blood glucose levels. There was a systematic review and meta analysis of 11 clinical trials that were published in 2017, so a couple of years old now, but that was published in diabetes research and clinical practice and they found that vinegar consumption lowered glucose and insulin levels, so that's the hormone that's produced from your pancreas that drives sugar from your bloodstream into your muscle cells and your liver cells and your fat cells after a meal in response to normal glucose excursions or rises in your bloodstream, which is completely normal physiology, we don't want to get rid of that completely. But that was demonstrated in both healthy adults and patients with diabetes as well, type two diabetes. There was another more recent systematic review of randomized control trials published in the European Journal of Integrative Medicine and they found again that consumption of vinegar was associated with significant reductions in fasting blood glucose levels. So that's the glucose level, i.e. the sugar level in your bloodstream that you have after not eating anything. So just your general baseline sugar level in your bloodstream. But they also looked at something called glycated haemoglobin, which is a marker that we use to determine whether someone's average blood glucose level is high or low and we also use it as an indicator for diagnosis of type two diabetes. So really interesting studies looking at a collection of different studies. The amount that was most often studied in terms of the amount of vinegar used ranged from 10 to 30 mils of vinegar per day. So as little as 10 mils of vinegar per day to 30 mils per day. And the type used in these studies is often white wine vinegar or apple cider vinegar. So we'll get into some of the details as to why they use white wine or apple cider vinegar, but it is quite important to use the right type of vinegar. There are other sorts of vinegars that have less of the acetic acid, which is the organic acid that potentially explains some of these effects.
Dr Rupy: So this shows some short term effects. When we're looking at these studies, they're usually ranging from between four weeks or as long as 12 weeks, but mainly four to eight weeks. These results show the potential acute effects, so short term effects of vinegar, but we don't actually have much long term evidence on the chronic effects of vinegar intake. And this is really important to remember that the reductions in peaks of glucose, so peaks of sugar levels in your bloodstream and then the corresponding troughs of glucose, also known as glucose excursions or oscillations because of the up and down nature of it, and flattening those curves doesn't necessarily mean protection against type two diabetes or other metabolic health issues. So it's really important to just recognise that just because your oscillations are flatter or your up and down is flatter, does not necessarily mean that you're having a protection against type two diabetes. It stands to reason that you would, but there is no evidence to actually suggest that, at least at the time of this recording anyway. Most of the studies that we've discussed so far are short and they can't pretend to demonstrate that protective effect. However, there was one systematic review published in 2019 that included just six studies with around 300 people in total. And if you look at this diagram that I'll pull up for the folks watching on YouTube, you'll see the reduction in fasting glucose and HBA1C, this glycated haemoglobin, and this points in the general direction of protection against type two diabetes. It doesn't prove that there is protection against type two diabetes, but there is an indication that when you lower this glycated haemoglobin level that you can measure quite easily in the blood, that you are protecting against type two diabetes. Nothing can be said definitively, but it might be worth a shot. And hopefully people get that what I'm talking about with a shot of vinegar. Did you get that? No. Okay, fine. Okay. It might be worth a shot. And this diagram that I've got up on YouTube, you can read it in your own time, but it basically says it favours vinegar in terms of its protective effect against type two diabetes. On to the next one after my poor joke there. Heart health. So lowered blood pressure. This is another reason why in both folk medicine and more recent sort of health influencers, they're using vinegar to lower blood pressure. And there was a 2022 systematic review and meta analysis of randomized control trials that found that vinegar at a dose again of 30 mils per day significantly reduced both systolic and diastolic blood pressure. So a little bit of blood pressure physiology for you, the systolic is the high number on top and the diastolic is the lower number on the bottom. So when you go to your general practitioner and they say your blood pressure is 130 over 90, that is the systolic is the 130 number and the diastolic is the lower number of 90. And this showed an average reduction of around three millimoles of mercury per number. So that's quite a significant effect. And actually the authors of that study suggested that it might be considered as an adjunct, i.e. a pal to hypertensive treatment that we usually recommend. So the drugs that we recommend, the different types of antihypertensive medications that your GP might prescribe to you, in combination with lifestyle measures. I'm hoping most GPs are giving that good advice around nitrate rich foods. We've done a whole podcast episode on nitrate rich foods and how that has a blood pressure lowering effect, as well as exercise. Exercise is probably one of the most effective tools that we have against blood pressure and reducing blood pressure as well. If you look at this diagram that I'll pull up on on the screen for folks watching on YouTube and I'll describe for those listening on the podcast, you will see a general trend of lowering blood pressure at the 30 mils of vinegar per day threshold. And this is fairly significant. I was really surprised. Honestly, I did not expect to see anything, anything at all, let alone anything pointing in the general direction of improvement for heart health. And in addition, whilst we're talking about heart health, improving cholesterol profiles or lipid profiles. There was also a significant reduction in total cholesterol and low density lipoprotein cholesterol in another meta analysis that was published in the European Journal of Integrative Medicine. Now, I know that LDL cholesterol is not as fashionable as it was and actually a lot of people, I've read on the YouTube comments and in response to podcasts that I've done before on LDL cholesterol, that this is outdated advice. Actually, if you look at more recent studies, particularly something called Mendelian randomization studies where they look at natural levels of people who have naturally high LDL cholesterol as measured in their blood and low LDL cholesterol as measured in their blood, there is a clear difference in their risk of cardiovascular disease that includes heart attacks, strokes, etc. So this idea that we should be reducing low density lipoprotein, which is a carrier of cholesterol that ferries cholesterol around the body to parts where it needs to be used, it definitely needs to be lower. And there are more recent measures of cardiovascular risk profiles like apolipoprotein B. We've done a full podcast episode on this explaining the differences in terminology. We do need to be lowering it as much as possible. And that's why this is so interesting around vinegar and apple cider vinegar and all these different types of vinegar. If it can lower low density lipoprotein, it stands to reason that there might be a cardiovascular risk reduction effect. And coupled with what we've seen with blood glucose and protection against metabolic disease and reductions in blood pressure, this is really, really interesting stuff. So, again, potentially worth a shot. Worth a shot of apple cider vinegar. The third thing, weight loss. Now a lot of people anecdotally claim that apple cider vinegar a day keeps them nice and trim. It can help with weight loss, it helps them keep off the pounds. And so far, the evidence, I'll be honest, is limited. But more recently, as recently as this year, published in the BMJ, I was really surprised to see this. I'll pull up the abstract for folks watching on YouTube. It doesn't say much, but I just thought it was funny to see apple cider vinegar for weight loss management in published in the BMJ. They assigned 120 adolescents and young adults with overweight and obesity to either drink a placebo, 5, 10 mils or 15 mils of apple cider vinegar per day, diluted in water, first thing in the morning for 12 weeks. And overall, those who drank apple cider vinegar showed reduced weight, reduced BMI, which is a crude measure of of of weight, it's called body mass index. But they also looked at waist hip circumferences and body fat ratios as well. They also had reduced blood glucose, reduced triglycerides and reduced cholesterol levels. So pretty impressive. I know it was a small study, it was 120 people, it hasn't been replicated so far as I can see. But it did prompt the authors to write this conclusion. I just want to pull this up on the screen in italics actually. The consumption of apple cider vinegar in people with overweight and obesity led to an improvement in the anthropometric and metabolic parameters, as I've just described. ACV could be a promising anti obesity supplement that does not produce any side effects. That's pretty amazing. And for that to be published in the BMJ, I was pretty impressed as well. There are some other small scale studies that have shown promising results, but we do need larger, and I do mean larger studies, and we should be talking about thousands of people and long term studies to make these conclusions. The reason why we won't see that, unfortunately, is because there's no money in vinegar. Vinegar, you can make yourself. In fact, a lot of these studies even made the vinegar themselves. They didn't use any brands. They controlled the acetic acid levels that we'll talk about in a second. But there is no money to be made in a vinegar supplement, unfortunately. I will say that there is no compelling evidence right now to claim that vinegar consumption is reliable as a long term means of losing excess weight, but again, might be worth that shot. Might be worth that shot. Who knows?
Dr Rupy: So what is going on when we consume vinegar? Let's talk about the potential mechanisms. How can drinking vinegar every day improve blood sugar levels, heart health, etc, etc. So what why don't we talk a bit about what vinegar actually is. So it's one of the oldest fermented products. People talk about sauerkraut and kimchis and tepache and kefir and stuff. Vinegar, just bog standard vinegar is a fermented product. It's been used as a traditional method of preserving food dating back to around 2000 BC, probably even longer than that. It's been it's made from the fermentation of different carbohydrates, whether that's rice or wheat or fruits, apples, obviously, pomegranates, grapes, in wine. It involves two steps, the anaerobic conversion of sugars to ethanol by yeasts. So that's anaerobic, so that's without oxygen. And that basically converts it into the alcohol. And then the aerobic oxidation of ethanol to acetic acid by bacteria. So that's with oxygen essentially. So if you have a bottle of wine, for example, and you leave it out, the oxygen gets into the wine and it turns it into vinegar. That's essentially the the latter step of how vinegar is produced. Why on earth does this have health benefits? So vinegar is mainly organic acids, especially one called acetic acid. That's 30 to 50% of the total of the organic acids that you find in vinegar. But it also contains some polyphenols derived from the raw materials. So whether that's in the grapes or the pomegranates or the apples, there is going to be some polyphenol preservation in there, particularly phenolic acids like gallic acid and caffeic acid. You find these in teas and coffee and that kind of stuff as well. These compounds could be having this sort of agonist effect, this synergistic effect with the acetic acid itself, could be working together when we consume vinegar. But acetic acid is considered the main guy, the main player in the benefits of vinegar. And importantly, the acid levels in apple cider vinegar and white vinegar, they're pretty similar. So it contains anywhere between 5 and 7%. So that is the acetic acid level that you are going for when you're choosing a vinegar. So I've got a couple here, I'll just describe what I've got for the folks listening on the podcast. I've got white wine vinegar in my hand, my right hand. So this is 5 to 7% acetic acid. And then apple cider vinegar, and you'll see in this one there is a mother, we'll talk about that in a second. These are basically the initial products that are fermented to create the vinegar itself. This is around 4 to 6% or so of acetic acid. These in the background, which I love to use, balsamic vinegar, and I've also got a Chinkiang vinegar, which is like a sweeter vinegar. These don't have as much acetic acid and these won't be appropriate for the benefits that we're looking for in everything that I've just described because they do have lower amounts of acetic acid. And actually some vinegars, even though they are vinegars, will have added sugar as well, mainly from a flavour point of view. So the Chinkiang vinegar that I've got here, this has actually got water, glutinous rice, sugar, salt, wheat bran. So a few extra products in this rather than just the vinegar and water that we've got here as well. So let's talk about its effect on blood glucose levels first. When we eat vinegar alongside the carbohydrate rich meal, so let's say I'm having a plate of pasta and I have some vinegar with it after it or before it, the acetic acid and potentially the other bioactive compounds, the phenolic acids that I've just mentioned, they temporarily inactivate a digestive enzyme called alpha amylase. And alpha amylase has the job to break down carbs into individual glucose molecules. So you can imagine that if my alpha amylase is trying to break down this carb rich meal that I've got in front of me into the smaller glucose molecules, the smaller sugar molecules, if I slow that down, it's going to slow down the release of those sugar molecules from my digestive tract when I consume it into the bloodstream. So you're slowing down the release of that sugar from the carb rich meal into my bloodstream. That's quite an extreme example. I wouldn't just have pasta on its own. But you know, just for the example here, it's going to slow that process down. The other thing it does is it literally slows down gastric emptying, which again slows down the absorption of the sugars into the bloodstream. Gastric emptying is the the process by which we actually remove the contents from your stomach into the remainder of your digestive system. And the other thing it does is it increases glucose uptake from the bloodstream by your skeletal muscles. And this is a key mechanism by which insulin, the hormone that's released by your pancreas that has the job of clearing all the blood sugar from your bloodstream up, that's the job that it essentially does. So essentially what acetic acid is doing or the vinegar is giving insulin a bit of a helping hand in removing the blood sugar from the bloodstream and putting it into the skeletal muscles. So it's having a two pronged effect. So not only is it slowing the process of putting the sugar from your food into the bloodstream, but it's also quickening the removal of the sugar from your bloodstream into muscle cells where it can be used as well. An interesting side point is that insulin's activity is dampened in type two diabetes because your cells become insulin resistant. So they lose the sort of responsiveness to the hormone insulin, which is doing a job of like putting the sugar into your skeletal muscle cells or your fat cells or your liver cells as well. It's almost like insulin is knocking on the door of your cells and no one's answering. You can't really hear it. You know, it needs to knock a little bit louder. That's essentially insulin resistance going on. You're resistant to the person knocking at the door. So the net effect is that we get a more gradual rise in blood glucose after eating and less circulating in the bloodstream. That's the theory anyway for how vinegar can help with blood sugar levels. When it comes to cholesterol levels, the compounds in vinegar could have a beneficial effect by stimulating bile acid secretion, which comes from your liver, your gallbladder, and increasing lipolysis and decreasing lipogenesis. Fancy words for increasing the breakdown of the fats in your system and decreasing the generation of fats. So essentially it lowers the amount of the cholesterol that is required or the LDL cholesterol that is required to ferry around the fats around your bloodstream as well. When it comes to blood pressure, vinegar might reduce blood pressure by improving calcium absorption. And this has an effect on a fairly complicated system called the renin angiotensin system. This is a system that operates within your kidneys and is responsible for blood pressure regulation. It does this by vasoconstricting, so reducing the diameter of your vessels, which increases the pressure. So if you ever think of like a garden hose and you put your thumb over the end of it, it increases the pressure. That increased pressure basically raises your blood pressure. So vinegar helps with the calcium absorption that helps reduce that constriction, creating vasodilation and thus reducing your blood pressure as well. So again, interesting effect. To summarize everything that I've just suggested there, I've got a diagram where vinegar can potentially have its effects and it includes some other ones that I haven't mentioned, including the pancreas and the liver as well. But for folks watching on YouTube, you can check that out and I'll put a link to the study where that comes from as well. So, to recap, the main two benefits that we have evidence for are improved blood sugar levels, as I've just mentioned, and heart health, both on blood pressure and lipid profiles. And the third is potentially weight. I just want to highlight that, potentially weight. But the results, like I've said, are inconsistent, they're based on short term studies, so it's unclear whether apple cider vinegar or your vinegar of choice would work in the long run. I do want to talk about precautions and downsides because this is sort of sounded like an advert for vinegar and I should start making Doctor's Kitchen vinegar. Actually, that might be a good idea. I should start making Doctor's Kitchen vinegar. I can make it delicious. There's no money in vinegar. But if you're having a moderate amount each day, so 30 mils or two tablespoons as a drink or as part of a meal, I really don't see many problems, but I would take a few precautions. So vinegar, first of all, should be diluted. You do not want to be, I know I've just been talking about shots and stuff, but you don't want to be taking a shot of this stuff every single day. It is very, very acidic, so it can damage your tooth enamel. It can also have an effect on your oesophagus. It can cause oesophagitis, so essentially burning of your cells in your oesophagus, which are quite sensitive, even though you do have acid in your in your mouth. That level of acidity is quite high. Instead, I would add it to a vinaigrette, dilute it with water, put it in your drink of choice. Don't add it to coffee or tea, it just tastes disgusting. And I would 100% dilute it. Do not take this straight off the bat. I wouldn't take vinegar gummies or vinegar sort of shots that you buy from cafes because they tend to add sugar to it, which completely negates any potential benefits of the blood sugar lowering effects that you're taking it for. So please just do it the old fashioned way. Don't buy any fancy sort of shots from your, I don't want to name any names. Actually no, I will. Pret a Manger. They always mix the stuff with like sugar. They should know better. I don't know why people fall for it either. I wouldn't do a vinegar diet because chronic intake, and a vinegar diet is where they're just shotting loads of vinegar all day long. Excessive amounts of vinegar can definitely cause health problems. And it's important for people taking medications that can lower potassium, for example, like diuretics, to ensure that they're not having too much vinegar because it can influence your electrolyte levels and it can interfere with the medications as well at high levels. Not at like a couple of tablespoons a day, but certainly at high levels as well. There is a suggestion that because vinegar can influence insulin levels, I haven't gone into that into too much detail, that you should be careful about taking vinegar if you are taking insulin. I think it's really unlikely to have a significant effect, but for people who have diabetes, be conscious about a high vinegar diet nonetheless. Just be conscious about its potential effect on insulin, but I really don't, I haven't seen anything to suggest that it's going to have a miraculous effect on insulin levels as well. And if you do have an ulcer or you do have gastritis, I would definitely be very careful. It can exacerbate symptoms, it can worsen the damaged cells, particularly if you're not diluting it, but even if you are diluting it and you do have gastritis, be really careful. I'd speak to your doctor before trying any vinegar hacks because of the acidity as well.
Dr Rupy: So would I try it? Probably, yeah. If I was in the market for reducing my cholesterol levels, reducing my blood pressure levels and reducing blood glucose oscillations, peaks and troughs, maybe. I mean, my diet is generally low in refined carbohydrates. And big picture thinking here, the thing you really want to dial in is the amount of exercise you do and trying to make that consistent every single week. I personally exercise five to six times a week. I personally have a very good diet. I'm focusing on greens, beans, berries, nuts and seeds. These are the things that you should be majoring in. Vinegar is a nice little add on if you wanted to try it as a little experiment. But certainly if I wanted to try and reduce my cholesterol levels, I might want to try this as a little hack. Like I said, the range of doses that were used in studies range from 10 to 30 mils, so you can start with 10 mils and then titrate up to 30, always diluted and using either white vinegar or apple cider vinegar because the others don't really have enough acetic acid in and diluting it as well. When I would take it is up for a bit of debate because the studies when we looked into how they actually conducted them suggested different times for when to take the vinegar. So the weight study that was published in the BMJ, for example, that was in the morning on waking and diluted. But it is unclear when to drink apple cider vinegar, for example, with regards to the sugar regulation. Anecdotal evidence suggests 10 minutes before eating. Some other studies suggest with the meal or straight after it as well. So again, there isn't much consensus on that. I would choose whatever feels most comfortable to you. Perhaps with the meal is probably better because if you're doing it always before on an empty stomach, again, you might have some symptoms associated with gastritis as well. When you're in the shop and you want to look for a high quality vinegar, start off with a high quality starting ingredients. It should only have a couple of ingredients in this. This is just, for example, if I look at the ingredients here, ingredients, organic apple cider vinegar. There you go. That's all you need. Not sugar, not any flavourings, not any additives, like just the simple thing. It should have a clear, crisp taste. There is some evidence for the slow fermentation process being a little bit better from a phenolic acid and maybe having some more of those bioactive compounds. And several studies have actually suggested that aged vinegar might have a high concentration of polyphenols because of the aging process and indicates that this process is important for reserving some of those polyphenols in vinegar. So what I personally look for in the shop is raw and unfiltered, no added ingredients, and ensuring that you're having at least 5% acidity. That's a standard indicator of quality. There are some other things like, you know, glass bottle, production method, sediment and cloudiness. Like I just said, you've got the sediment here, so you know you've got the mother in there. This is basically just a mass of yeast and bacteria cells. It doesn't sound very nice when I describe it like that, but that's essentially what it is. And so it is an indication that this has been naturally grown, the vinegar has undergone a proper fermentation process and it's a natural byproduct of fermentation. So it may might indicate less processing as well. And the other thing is brand reputation. So research suggests that reputable brands or producers known for high quality vinegars might be slightly better than others. So, I really hope that gave you an indication as to whether you want to use vinegar in your day to day. You know, I, like I said at the start of this, I was really sceptical, really sceptical about whether vinegar could have these miraculous effects that you've heard some influencers talk about on TikTok and online and all that kind of stuff, but there is some. And so it might be worth a try if, like I said, you're interested in weight loss, cholesterol lowering, blood pressure lowering and glucose oscillation flattening. And just remember that glucose spikes up and down are completely normal. We shouldn't be afraid of those. But if it does have this effect on lowering your glycated haemoglobin, so a measure of how up and down your sugar is in your bloodstream over the preceding 120 days, then yes, it could potentially have some benefits. So try some if you want. Remember what I said and let me know if I've missed anything about vinegar. If you have any questions about vinegar, let me know in the comments on YouTube, that's where you'll find me.
