Vinegar, a fermented acetic acid solution, is gaining attention for its potential health benefits, especially in managing blood sugar, insulin sensitivity, and overall metabolic health. Acetic acid is found in various food products, such as vinegar, dressings, and pickled products. It is also formed during fermentation processes, such as sourdough fermentation, and can be considered a constituent of a normal diet. Studies suggest that vinegar may play a significant role in improving post-meal blood sugar responses and reducing risks associated with diabetes and prediabetes.
Ostman et al. (1) explored whether adding acetic acid (vinegar) to a bread meal could lower its glycemic index and assess how different amounts could affect blood sugar, insulin levels, and feelings of fullness. Twelve healthy volunteers (22.9 ± 0.5 years) participated in the study. After fasting overnight, the volunteers ate white bread (providing 50 g of carbohydrates) with three levels of vinegar (18, 23, and 28 mmol acetic acid) or without vinegar (reference meal) as breakfast. Blood samples were collected over 120 minutes to measure glucose and insulin levels. The feeling of fullness was rated as a satiety score.
The results showed that higher vinegar levels led to lower blood sugar and insulin levels at 30 minutes after eating. The highest vinegar level significantly reduced blood sugar at 30 and 45 minutes and insulin at 15 and 30 minutes compared to the reference meal. The glycemic and insulinemic indices were significantly lower, with the highest vinegar dose at 90 minutes. Satiety scores were higher with vinegar, especially at the highest dose, at 30, 90, and 120 minutes. The meal with the highest amount of vinegar increased the late postprandial satiety more than two-fold, compared with the reference meal (1).
The study found that adding vinegar (acetic acid) to a white bread meal improved blood sugar and insulin responses while increasing and prolonging satiety. A clear dose-response relationship was observed: higher acetic acid levels reduced blood sugar and insulin spikes more effectively (1).
Johnston et al. (2) studied the effects of vinegar on insulin sensitivity in nondiabetic subjects who were either insulin-sensitive (control subjects, n = 8) or insulin-resistant (n = 11) and 10 subjects with type 2 diabetes. After overnight fasting, the study participants were randomly assigned to consume the vinegar (20 g apple cider vinegar, 40 g water, and one teaspoon saccharine) or placebo drink and, after a 2-min delay, the test meal, which was composed of a white bagel, butter, and orange juice (87 g total carbohydrates). The cross-over trial was conducted 1 week later. Blood samples were collected at fasting and 30- and 60-minutes post-meal for glucose and insulin analyses.
Fasting glucose concentrations were elevated ~ 55% in subjects with diabetes compared with the other subject groups (p< 0.01), and fasting insulin concentrations were elevated 95–115% in subjects with insulin resistance or type 2 diabetes compared with control subjects (p< 0.01). Compared with the placebo, vinegar ingestion raised whole-body insulin sensitivity during the 60-minute post-meal interval in insulin-resistant subjects (34%, p = 0.01) and slightly improved this parameter in subjects with type 2 diabetes (19%, p = 0.07). Postprandial fluxes in insulin were significantly reduced by vinegar in the control subjects, and postprandial fluxes in both glucose and insulin were significantly reduced in insulin-resistant subjects (2).
These data indicated that vinegar could significantly improve postprandial insulin sensitivity in insulin-resistant subjects. Acetic acid has been shown to suppress disaccharidase activity and to raise glucose-6-phosphate concentrations in skeletal muscle; thus, vinegar may possess physiological effects similar to acarbose or metformin (2).
Liatis et al. (3) examined the effect of adding vinegar to a carbohydrate-rich meal on glucose and insulin response in patients with type II diabetes. Sixteen patients with type II diabetes were divided into two groups, matched for age, gender, and HbA(1c). Patients in the first group (group A) were given a high-glycemic index (GI) meal (mashed potatoes and low-fat milk) on two different days, with and without the addition of vinegar, respectively. In the second group (group B), patients were given an isocaloric meal with the same nutrient composition but a low glycemic index (whole grain bread, lettuce, and low-fat cheese). Postprandial plasma glucose and insulin values were measured every 30 minutes for 2 hours.
In group A, the incremental area under the curve of glucose (GiAUC(120)) was lower after the addition of vinegar (181+/-78 mmol min/l vs 311+/-124 mmol min/l, p=0.04). The iAUC of insulin (IiAUC(120)) was also reduced, but the difference was of marginal statistical significance (2368+/-1061 microU min/ml vs 3545+/-2586 microU min/ml, p=0.056). In group B, the addition of vinegar did not affect either the GiAUC(120) (229+/-38 mmol min/l vs 238+/-25 mmol min/l, P=0.56) or the IiAUC(120) (2996+/-1302 microU min/ml vs 3007+/-1255 microU min/ml, p=0.98). The authors concluded that adding vinegar could reduce postprandial glycemia in patients with type II diabetes only when it was added to a high-glycemic index meal (3).
Sugiyama et al. (4) showed that using 50 g of white rice as a reference meal, adding vinegar or pickled cucumbers to white rice reduced its glycemic index. The use of vinegar in rice (sushi, glycemic index 67) and vinegar-pickled foods (glycemic index 75–77) decreases the glycemic index of rice by about 20–35%. This means that even high-carbohydrate meals can become less harmful to blood sugar levels with the addition of vinegar.
Gheflati et al. (5) evaluated the effects of consuming apple vinegar over 8 weeks on individuals with diabetes and dyslipidemia. Seventy participants were divided into two groups: one received 20 ml of apple vinegar daily, and the other acted as a control for an 8-week study.
Individuals in the treatment group were asked to drink a glass of water plus 2 spoons of apple vinegar, equal to approximately 10 mL/ day, before their lunch and dinner meal. Thus, participants in the treatment group were prescribed to drink a total of 20 mL of apple vinegar daily (5).
Apple vinegar consumption significantly decreased fasting blood sugar concentration from 138.62 ± 31.82 mg/dL at the beginning to 128.46 ± 29.74 mg/dL at the end of the study (mean change: -10.16 ± 19.48 mg/dL), which is considerably different compared with the control group with blood sugar concentration from 137.63 ± 40.04 mg/dL at the beginning to 153.70 ± 52.79 mg/dL at the end of the study (mean change: 16.07 ± 32.24 mg/dL )(p < 0.001). Adding apple vinegar daily could also significantly increase antioxidant capacity marker 2,20-Diphenyl-1-picrylhydrazyl (DPPH) (mean change: 16.58 ± 11.56, p < 0.001) within the treatment group and in comparison, with the control group (p < 0.001). The significant increase of Malondialdehyde (MDA), an oxidative stress biomarker, in the control group (p < 0.05) caused a considerable difference between the two groups. The trial concluded that apple vinegar may benefit blood sugar management and oxidative stress in people with diabetes and dyslipidemia (5).
Mitrou et al. (6) examined how vinegar may affect muscle glucose metabolism, blood vessel function, and blood fat levels in people with impaired glucose tolerance. Eight participants consumed vinegar (6% acetic acid) or a placebo before a meal, and researchers measured blood and muscle responses over 5 hours.
The results showed that vinegar consumption lowered insulin and blood fat (triglyceride) levels in the blood, improved blood flow, and enhanced glucose uptake. The study concluded that vinegar may improve insulin resistance, and muscle glucose metabolism, and reduce metabolic issues in individuals with prediabetes (6).
These studies showed that vinegar or acetic acid-containing fermented or pickled food has demonstrated promising effects on blood sugar management, insulin sensitivity, and overall metabolic health. The glucose-lowering benefits of vinegar are most effective when paired with high-glycemic index meals. Regular vinegar consumption may also enhance antioxidant defenses, reduce oxidative stress, and improve muscle glucose metabolism. These findings suggest that vinegar could be a valuable addition to dietary strategies for managing diabetes and prediabetes.
References:
1. Ostman E, Granfeldt Y, Persson L, Björck I. Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. Eur J Clin Nutr. 2005 Sep;59(9):983-8. doi: 10.1038/sj.ejcn.1602197. PMID: 16015276.
2. Johnston CS, Kim CM, Buller AJ. Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care. 2004 Jan;27(1):281-2. doi: 10.2337/diacare.27.1.281. PMID: 14694010.
3. Liatis S, Grammatikou S, Poulia KA, Perrea D, Makrilakis K, Diakoumopoulou E, Katsilambros N. Vinegar reduces postprandial hyperglycaemia in patients with type II diabetes when added to a high, but not to a low, glycaemic index meal. Eur J Clin Nutr. 2010 Jul;64(7):727-32. doi: 10.1038/ejcn.2010.89. Epub 2010 May 26. PMID: 20502468.
4. Sugiyama M, Tang AC, Wakaki Y, Koyama W. Glycemic index of single and mixed meal foods among common Japanese foods with white rice as a reference food. Eur J Clin Nutr. 2003 Jun;57(6):743-52. doi: 10.1038/sj.ejcn.1601606. PMID: 12792658.
5. Gheflati A, Bashiri R, Ghadiri-Anari A, Reza JZ, Kord MT, Nadjarzadeh A. The effect of apple vinegar consumption on glycemic indices, blood pressure, oxidative stress, and homocysteine in patients with type 2 diabetes and dyslipidemia: A randomized controlled clinical trial. Clin Nutr ESPEN. 2019 Oct;33:132-138. doi: 10.1016/j.clnesp.2019.06.006. Epub 2019 Jul 9. PMID: 31451249.
6. Mitrou P, Petsiou E, Papakonstantinou E, Maratou E, Lambadiari V, Dimitriadis P, Spanoudi F, Raptis SA, Dimitriadis G. The role of acetic acid on glucose uptake and blood flow rates in the skeletal muscle in humans with impaired glucose tolerance. Eur J Clin Nutr. 2015 Jun;69(6):734-9. doi: 10.1038/ejcn.2014.289. Epub 2015 Jan 28. PMID: 25626409.
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