Have you ever wondered if there’s a natural way to lower your high blood pressure, guard against Alzheimer's, lose weight, and feel better? Well as it turns out there is. Michael Greger, M.D. FACLM, founder of NutritionFacts.org, and author of the instant New York Times bestseller “How Not to Die” celebrates evidence-based nutrition to add years to our life and life to our years.

The Sour Power of Vinegar

It may pucker your lips but it delivers a healthy dose of nutrition benefits.

This episode features audio from Does Apple Cider Vinegar Help with Weight Loss?, Vinegar & Artery Function, and Can Vinegar Help with Blood Sugar Control?. Visit the video pages for all sources and doctor’s notes related to this podcast.


I know what you’re thinking – VINEGAR? That stuff you hide in the back of your kitchen cabinet? In our first story, we look at how daily vinegar consumption can lead to a significant loss of abdominal fat.

Vinegar has evidently been used as a weight-loss aid for nearly 200 years, but does it work? Well, like hot sauce, it can be a nearly calorie-free way to flavor foods, and there’s all sorts of tasty exotic vinegars out there now, like fig, peach, and pomegranate, to choose from, but the question is: is there something special about vinegar that helps with weight loss? Vinegar is simply defined as a dilute solution of acetic acid, which takes energy for our body to metabolize, activating an enzyme called AMPK, which is like our body’s fuel gauge. If it senses that we’re low, it amps up energy production, and tells the body to stop storing fat and start burning fat. And so, given our obesity epidemic, it is crucial that oral compounds with high bioavailability are developed to safely induce chronic AMPK enzyme activation, which would be potentially beneficial for long-term weight loss. No need to develop such a compound, though, if you can buy it in any grocery store. We know vinegar can activate AMPK in human cells, but is the dose one might get sprinkling it on a salad enough?

If you take endothelial cells—blood-vessel-lining cells—from umbilical cords after babies are born and expose them to various levels of acetate, which is what the acetic acid in vinegar turns into in our stomach, it appears to take a concentration of at least 100 to get a really significant boost in AMPK. So, how much acetate do you get in your bloodstream sprinkling about a tablespoon of vinegar on your salad? You do hit 100, but only for about 15 minutes. And even at that concentration, 10 or 20 minutes exposure doesn’t seem to do much. Now granted, this is in a petri dish, but we didn’t have any clinical studies until…we did!

A double blind trial investigating the effects of vinegar intake on the reduction of body fat in overweight men and women. They call them obese, but they were actually slimmer than your average American. In Japan, they call anything over a BMI of 25 obese, whereas the average American adult is about 28.6. But anyway, they took about 150 overweight individuals, and randomly split them up into one of three groups, a high dose vinegar group, where they drank a beverage containing two tablespoons of apple cider vinegar a day, a low dose group, where they drank a beverage containing only one tablespoon of apple cider vinegar a day, and a placebo control group where they had them drink an acidic beverage they developed to taste the same as the vinegar drink but using a different kind of acid; so, there was no acetic acid.

No other changes in their diet or exercise—in fact, they monitored their diets and gave them all pedometers so they could make sure that the only significant difference between the three groups was the amount of vinegar they were getting every day. This is where they started out, and within just one month, statistically significant drops in weight in both vinegar groups compared to placebo, with high dose doing better than low dose, which just got better and better month after month. In fact, by month three, the do-nothing placebo group actually gained weight, as overweight people tend to do, whereas the vinegar groups significantly dropped their weight. Was the weight loss actually significant or just statistically significant? Well, that’s for you to decide. This is in kilograms; so, compared to placebo, the two tablespoons of vinegar a day group dropped five pounds by the end of the 12 weeks. That may not sound like a lot, but they got that for just pennies a day without removing anything from their diet.

And they got slimmer, up to nearly an inch off their waist, suggesting they were losing abdominal fat, but the researchers went the extra mile and put it to the test. They put the research subjects through abdominal CT scans to actually directly measure the amount of fat before and after in their bodies. They measured the amount of superficial fat, visceral fat, and total body fat. Superficial fat is the fat under your skin that makes for flabby arms and contributes to cellulite, but visceral fat is the killer—that’s the fat, shown here in white, building up around your internal organs that bulges out the belly. And that’s the kind of fat the placebo group was putting on when they were gaining weight. Not good. But both the low dose and high dose vinegar groups were able to remove about a square inch of visceral fat off that CT scan slice.

Now, like any weight loss strategy, it only works if you do it. A month after they stopped the vinegar, the weight crept right back up, but that’s just additional evidence that the vinegar was working, but how?

A group of researchers in the UK suggested an explanation: vinegar beverages are gross. They made a so-called palatable beverage by mixing a fruity syrup and vinegar in water and then went out of their way to make a really nasty, unpalatable vinegar beverage, both with white wine vinegar, which were so unpleasant that the study subjects actually felt nauseous after drinking it; so, they ate less of the meal the researchers gave it with. So, there you go—vinegar helps with both appetite control and food intake, though these effects are largely due to the fruity vinegar concoctions invoking feelings of nausea. So, is that what was going on here? Were the vinegar groups just eating less? No, the vinegar groups were eating about the same compared to placebo. Same diet, more weight loss, thanks, perhaps, to the acetic acid’s impact on AMPK.

Now, the CT scans make this a very expensive study; so, I was not surprised it was funded by a company that sells vinegars, which is good, since otherwise we wouldn’t have these amazing data, but is also bad because it always leaves you wondering if the funding source somehow manipulated the results. But the nice thing about companies funding studies about healthy foods, whether it’s some kiwifruit company, or the National Watermelon Promotion Board—watermelon.org, check it out—is that what’s the worst that can happen? Here, for example, even if the findings turned out to be bogus, worst comes to worst, your salad would just be tastier.

Next up – we look at how sprinkling vinegar on greens may augment their ability to improve artery function.

There was a famous study from Harvard published back in ’99, which found that women who used oil-and-vinegar salad dressing about every day went on to have fewer than half the fatal heart attacks compared to women who hardly ever used it. Less than half the risk of the #1 killer of women.

They figured it was the omega-3’s in the oil that explained the benefit, but I know what you’re thinking. Those who use salad dressing every day probably also eat salad every day. But no, they were able to adjust for vegetable intake; so, it didn’t appear to be the salad, but why does the oil get the credit and not the vinegar? If only there was a way we could test that. Well, what about creamy salad dressing? They’re also made from omega-3 rich oils like canola—in fact, even more so than oil and vinegar dressing. So, if it’s the oil and not the vinegar, then creamy dressing would be protective too. But it’s not. They found no significant decrease in fatal heart attacks or nonfatal heart attacks for that matter. Now, it could be the eggs or butterfat counteracting the benefits of the omega-3’s, but maybe the vinegar is actually playing a role. But how? 

Well, if you were paying close attention in the vinegar weight loss video, the title of that paper was “Vinegar Intake Enhances Flow-mediated Vasodilatation Via Upregulation of Endothelial Nitric Oxide Synthase Activity.” In other words, vinegar enhances arterial function by allowing our arteries to better dilate naturally by boosting the activity of the enzyme in our body that synthesizes nitric oxide, the open sesame signal to our arteries that improves blood flow. If you remember, acetate is cleared out of your blood within a half hour after consuming a salad with a tablespoon of vinegar in it, apparently not enough time to boost the AMPK enzyme, but within just ten minutes, those kind of acetate levels can boost the activity of the nitric oxide synthesizing enzyme within human umbilical cord blood vessel cells in a petri dish, but what about in people? They measured the dilation of arteries in the arms of women after they had a tablespoon of rice vinegar, a tablespoon of brown rice vinegar, or a tablespoon of forbidden rice vinegar, in other words, vinegar made from black or purple rice. All the vinegars appeared to help, but it was the black rice one that mostly clearly pulled away from the pack.

Black rice contains the same kind of anthocyanin pigments that make some fruits and vegetables blue and purple and may have independent benefits. For example, if you give someone a big blueberry smoothie containing the amount of anthocyanins in a cup and a half of wild blueberries, you get a nice spike in arterial function that lasts a couple hours. Thus, the higher maximum forearm blood flow in the forbidden rice vinegar intake group might be attributed to an additional or synergistic effect of anthocyanin with the acetate. But it could also just be the antioxidant power of anthocyanins, in which case balsamic vinegar, which is made from red wine, may have a similar effect, as it was shown to have remarkably higher free radical scavenging activity compared to rice vinegar.

Enough to counter the artery-constricting effects of a high fat meal? We’ve known for nearly 20 years that a single high fat meal – Sausage and Egg McMuffins with deep fried hash browns – can cripple our artery function, cutting the ability of our arteries to dilate normally in half, within hours of it going into our mouths, compared to Frosted Flakes. Even with that massive, unhealthy sugar load, there was no effect on the arteries, because there was no fat. And not just animal fat; a quarter cup of safflower oil had a similar effect. In fact, the very first study to show how bad fat was for our arteries basically dripped highly refined soybean oil into people’s veins. But extra virgin olive oil isn’t refined. We know some whole food sources of plant fat, such as nuts, actually improve artery function, whereas oils, including olive oil, worsen function, but they didn’t specify extra virgin here. You can see, smell, and taste the phytonutrients still left in extra virgin olive oil—are they enough to maintain arterial function? No, a significant drop in artery function within three hours of eating whole grain bread dipped in extra virgin olive oil. And the more fat in their blood, the worse their arteries did.

Ah, but what if you ate the same meal but added balsamic vinegar on a salad. That seemed to protect the arteries from the effects of the fat. Now, balsamic vinegar is a product of red wine. Would you get the same benefits just drinking a glass of red wine? No. No improvement in arterial function after red wine. Why does balsamic vinegar work, but red wine not? Maybe it’s because the red wine lacks the benefits of the acetic acid in vinegar or, maybe it’s because the vinegar lacks the negative effects of the alcohol. And a third option might be that it was the salad ingredients, and had nothing to do with the vinegar. To figure out this puzzle, all we’d have to do is…. test non-alcoholic wine. And non-alcoholic red wine worked! So, maybe it was the grapes in balsamic vinegar, not the acetic acid. And indeed, if you eat a cup and a quarter of seeded and seedless red, green, and blue-black grapes with your Sausage and Egg McMuffin, you can blunt the crippling of your arteries. So, plants and their products may provide protection against the direct impairment in endothelial function, unless those products are oil or alcohol.

Finally, today – we look at how vinegar can help control blood sugar.

A double blind, placebo-controlled, randomized study found that body weight and belly fat were significantly reduced by adding just a single tablespoon of vinegar to one’s daily diet. But is there any benefit to vinegar consumption if you’re not overweight? Well, their triglycerides normalized, and on the two tablespoons a day dose, there was a dip in blood pressure. But those effects may have just been because of the weight loss.

Other than taste, is there any benefit to normal weight individuals sprinkling vinegar on their salads? What about vinegar for blood sugar control?

If you feed people a massive amount of sugar, a half cup of table sugar, as their blood sugars spike, their artery function can become impaired, and the higher the blood sugars spike, the more their arteries take a hit. There’s a drug, though, that can block sugar absorption, and by blunting the blood sugar spike with the drug, you can prevent the arterial dysfunction, demonstrating that it’s probably good for your heart if you don’t have big blood sugar spikes after meals. And indeed, how high your blood sugars spike after a meal is a predictor for cardiovascular mortality. So, do people who eat lots of high-glycemic foods, like sugary foods and refined grains, tend to have more heart attacks and strokes? Yes. And, they appear more likely to get diabetes. But, maybe people who eat lots of Frosted Flakes and Wonder Bread also have other bad dietary habits as well.

The diets that have been put to the test in randomized controlled trials and proven to prevent diabetes are the ones focusing on cutting down on saturated fat and ramping up the consumption of fiber-rich whole plant foods, such as fruits, vegetables, and whole grains, without specific regard to lower or higher glycemic loads.

The drug has been put to the test, though, and blunting one’s mealtime blood sugar spikes does seem to reduce the risk of developing diabetes, as well as reduce the risk of heart attacks and high blood pressure. So, is there any way to prevent these blood sugar spikes without having to take drugs? Well, one way would be to not sit down to a half cup of sugar!

Yes, the drug can slow the progression of your atherosclerosis. Instead of the arteries going to your brain narrowing this fast, on the drug, they only narrow this fast. Wouldn’t it be better to eat a diet that actually reverses heart disease? Reverses diabetes? The healthiest diet to prevent the meal-related blood sugar and fat spikes, the oxidation and inflammation, is a diet centered around whole plant foods.

But what if you really want a bagel? Instead of spreading drugs on it, spreading on some almond butter may help blunt the blood sugar spike from refined carbs. Another option is to dip your baguette in some balsamic vinegar.

The consumption of vinegar with meals was evidently used as a home remedy for diabetes before drugs came along, but it wasn’t put to the test until 1988. After all, how much money can be made from vinegar? According to The Vinegar Institute, millions of dollars, but a single diabetes drug, like Rezulin, can pull in billions—that is, before it was pulled from the market for killing too many people by shutting down their livers. The drug company still made off like a bandit, having to pay out less than a billion to the grieving families for covering up the danger.

No liver failure from a peanut butter-schmeared bagel, though, cutting the blood sugar response in half, and the same with vinegar. If you chug down four teaspoons of apple cider vinegar diluted in water, you get that same blunting of the spike. And, you get the additional advantage over the nuts of lowering insulin levels in the blood, something peanut butter apparently can’t do. But, presumably better than a bagel with lox, as fish causes triple the insulin response. Or red wine, which also increases insulin levels—but not as much as fish—and also shoots up triglycerides, though de-alcoholized red wine, non-alcoholic wine, doesn’t have the same problem. What about vinegar?

Not only may a tablespoon a day tend to improve cholesterol and triglycerides over time, vinegar can drop triglycerides within an hour of a meal, along with decreasing blood sugars and the insulin spike, potentially offering the best of all worlds.

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