Topical Apple Cider Vinegar for Treating Varicose Veins

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

In searching for the latest and greatest science on vinegar, I came across this study on “Lime Juice and Vinegar Injections as a Cheap and Natural Alternative to Control COTS Outbreaks.” I was all intrigued until I realized COTS stands for crown-of-thorns seastar, these crazy looking starfish. But just when I thought that was an unusual title, “To Pee, or Not to Pee: A Review on Jellyfish Envenomation and Treatment in European Jellyfish Species.” Due to an increase in jellyfish blooms, jellyfish envenomation has become an increasing public health problem, amounting to as many as 150 million jellyfish stings every year. But no, research does not support the use of the most infamous sting treatment: urine. It is unclear exactly when the use of urine for jellyfish stings became popular (though certainly, the scene from Friends didn’t help). But it has become one of the most persistent myths in toxicology. What does help? The topical application of vinegar for 30 seconds may be effective.

Are there any other conditions where topical vinegar may help? What about for eczema, also known as atopic dermatitis? Not only did dilute vinegar soaks yield no benefit, but it caused substantial adverse effects, skin irritation in the majority of subjects. Okay, scratch that.

 What about topical vinegar for uremic pruritus, one of the most common disabling symptoms in patients with end-stage kidney disease? It’s a chronic itching sensation that frequently accompanies chronic kidney disease. You could imagine how it could cause depression, insomnia, and anxiety. So, these researchers tried randomizing sufferers to try applying an oatmeal lotion or dilute vinegar (about one tablespoon per cup of water), versus taking an antihistamine drug. The oatmeal lotion significantly reduced the intensity of itching, but not the frequency or surface area affected, whereas both the vinegar and the drug accomplished all three.

What else? What about a randomized controlled trial on the effect of topical apple cider vinegar on varicose veins? Between 25 and 50 percent of adults have varicose veins in their legs, which can be more than just an aesthetic concern. Varicose veins can cause pain, swelling, cramps, irritability, fatigue, itching, tingling, burning, a heavy feeling, bleeding, and even ulceration. What can we do about them?

Apple cider vinegar, which is known to have legit healing properties, is stressed in many websites to help, but you don’t know, until you put it to the test. Patients were randomized to apply vinegar to the affected area of the leg. Now, here are the before and after symptoms in the vinegar group versus the control group. Those in the vinegar group appeared to do better than the control group. But the whole point of having a control group is to directly compare the groups to each other, not to where they started. Before-and-after comparisons against baseline within randomized groups is a common statistical mistake that can be highly misleading, biased, and invalid. So, we really don’t know if apple cider vinegar works better than nothing after all.

And, there are potential risks. A 14-year-old girl presented with two erosions on her nose. She found something on the internet about using vinegar to remove moles and removed part of her nose instead. I don’t recommend applying undiluted vinegar to your skin, and you should never drink it straight, which can land you in the emergency room, vomiting blood with an esophagus that looks like this. The only time I’d consider using straight vinegar is in tiny doses up the nose. “Intranasal Vinegar as an Effective Treatment for Persistent Hiccups in a Patient With Advanced Cancer Undergoing Palliative Care.”

Persistent, intractable hiccups are normally rare. However, in patients with advanced cancer, it can affect about 1 in 25. It’s bad enough you’re dying from cancer, but then to have unending hiccups keeping you awake, or preventing you from connecting with your loved ones. So, they tried a very small amount of vinegar, and, by very small, we’re talking two drops. This is what it looks like—just two little drops at the tip of a needleless syringe, and…the patient’s hiccups resolved within a few seconds. What they think is going on is that the same nerve root that goes to the nose also goes to the hiccup area, and the irritation is thought to then interrupt the hiccup reflex. In the past, nonpharmacological remedies, such as vinegar, were largely used for this kind of thing, but then they fell out of favor with the widespread use of drugs––which in this case were ineffective.

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• Moutardier G, Gereva S, Mills SC, et al. Lime Juice and Vinegar Injections as a Cheap and Natural Alternative to Control COTS Outbreaks. PLoS One. 2015;10(9):e0137605.
• Montgomery L, Seys J, Mees J. To Pee, or Not to Pee: A Review on Envenomation and Treatment in European Jellyfish Species. Mar Drugs. 2016;14(7):127.
• Wilcox CL, Headlam JL, Doyle TK, Yanagihara AA. Assessing the Efficacy of First-Aid Measures in Physalia sp. Envenomation, Using Solution- and Blood Agarose-Based Models. Toxins (Basel). 2017;9(5):149.
• Luu LA, Flowers RH, Kellams AL, et al. Apple cider vinegar soaks [0.5%] as a treatment for atopic dermatitis do not improve skin barrier integrity. Pediatr Dermatol. 2019;36(5):634-639.
• Nakhaee S, Nasiri A, Waghei Y, Morshedi J. Comparison of Avena sativa, vinegar, and hydroxyzine for uremic pruritus of hemodialysis patients: a crossover randomized clinical trial. Iran J Kidney Dis. 2015;9(4):316-322.
• Atik D, Atik C, Karatepe C. The Effect of External Apple Vinegar Application on Varicosity Symptoms, Pain, and Social Appearance Anxiety: A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2016;2016:6473678.
• Bland JM, Altman DG. Comparisons against baseline within randomised groups are often used and can be highly misleading. Trials. 2011;12:264.
• Feldstein S, Afshar M, Krakowski AC. Chemical Burn from Vinegar Following an Internet-based Protocol for Self-removal of Nevi. J Clin Aesthet Dermatol. 2015;8(6):50.
• Chang J, Han SE, Paik SS, Kim YJ. Corrosive Esophageal Injury due to a Commercial Vinegar Beverage in an Adolescent. Clin Endosc. 2020;53(3):366-369.
• Kako J, Kobayashi M, Kanno Y, Tagami K. Intranasal Vinegar as an Effective Treatment for Persistent Hiccups in a Patient With Advanced Cancer Undergoing Palliative Care. J Pain Symptom Manage. 2017;54(2):e2-e4.
• Gonella S, Gonella F. Use of vinegar to relieve persistent hiccups in an advanced cancer patient. J Palliat Med. 2015;18(5):467-470.

Motion graphics by Avo Media

• apple cider vinegar
• eczema
• hiccups
• skin health
• varicose veins
• vinegar