What Experts Want You to Know About Drinking Apple Cider Vinegar
Not to ruin the apple cider vinegar (ACV) celebration that’s booming in the wellness world, but there are possible negative side effects of ACV that could cancel out, or at least dampen, its hyped up perks (which include possible weight loss and blood sugar management, among others). “ACV has become trendy, driven by social media and wellness influencers promoting its potential health benefits,” explains Michelle Routhenstein, M.S., R.D., C.D.C.E.S., C.D.N., preventive cardiology dietitian at EntirelyNourished.com.
Meet the Experts: Michelle Routhenstein, M.S., R.D., C.D.C.E.S., C.D.N., preventive cardiology dietitian at EntirelyNourished.com and Raj Dasgupta, M.D., a quadruple board-certified physician and medical reviewer for the National Council on Aging.
As with any wellness trend, it’s super easy to hop on the bandwagon without doing much research, fingers crossed that its promised powers will work. However, it’s important to see both sides of the scale—and know how to consume ACV safely—before you start taking shots of the acidic pantry staple left and right. That’s why we outlined the side effects of ACV below, according to experts and research.
What is apple cider vinegar?
Apple cider vinegar (ACV) is a vinegar made from fermented apples, explains Raj Dasgupta, M.D., a quadruple board-certified physician and medical reviewer for the National Council on Aging. “It’s typically used in cooking and as a home remedy,” he adds (sometimes, for weight loss). Its “active ingredient” is acetic acid, which gives it its strong taste and proposed perks like blood sugar control, cholesterol management, fat-burning and weight loss, and increased insulin sensitivity. The evidence of those perks, though, is mostly rooted in animal-based studies, and more human studies are needed to validate them.
Apple cider vinegar side effects
The health benefits of ACV, though shouted ’round the world, are not thoroughly vetted by research. Its side effects warrant more research, too, but here’s what the science says right now.
Tooth decay
Long-term use of ACV can “damage your teeth by eroding the enamel, leading to sensitivity and cavities,” says Dr. Dasgupta. In a 2014 study, enamel from wisdom teeth was immersed in different vinegars, which led to a 1 to 20% mineral loss after four hours.
Throat burns
Undiluted ACV can be too acidic for the esophagus to handle and, if drank over time, can cause throat burns and irritation, says Dr. Dasgupta. In fact, that’s why ACV is on a list of caustic ingestions for children. Furthermore, drinking it regularly and undiluted caused throat ulcers and blood vomiting in one 15-year-old, per a 2020 case study.
Low potassium and bone loss
Dr. Dasgupta says consuming ACV “might lower potassium levels, which can cause muscle cramps.” If consumed in large amounts over time, it may also weaken bones, he adds, as evidenced by one case study conducted on a 28-year-old who drank a cup a day for six years and was diagnosed with low potassium, abnormal blood chemistry, and osteoporosis, a disease characterized by brittle bones that typically affects older adults.
Skin burns
Anecdotal evidence suggests apple cider vinegar’s high acidity can cause chemical burns. Such injuries were sustained by a 14-year-old girl who attempted to remove moles from her nose using ACV, and by a young boy whose mother treated a topical infection with it.
Gastrointestinal distress
There is mixed research on the gastrointestinal impacts of consuming ACV—some tout gut health benefits, and others go on to debunk them. So, while there is more research to be done, there is some evidence that says drinking too much ACV can upset your stomach and cause nausea, says Dr. Dasgupta. It may also cause delayed stomach emptying or slowed digestion, also called gastroparesis, which can lead to bloating and gas—a condition that is especially risky for people with diabetes.
Medication interaction
ACV can interact with certain medications, such as diuretics and insulin, says Routhenstein. “For individuals on diuretics such as furosemide or hydrochlorothiazide, consuming ACV may raise potassium levels in the body, potentially leading to imbalances that could cause symptoms like heart arrhythmias, muscle cramps, or weakness,” she explains.
“Individuals who are taking insulin might experience enhanced insulin sensitivity and lower blood sugar levels due to ACV, potentially leading to hypoglycemia with symptoms like dizziness, confusion, headache, or fainting,” she adds.
Lastly, when ACV is combined with aspirin or other blood thinners such as warfarin or clopidogrel, it “could amplify the blood-thinning effects, increasing the risk of bleeding or bruising,” Routhenstein concludes.
How to consume ACV safely
“To use ACV safely, drink one to two tablespoons a day mixed in at least one cup of water,” says Dr. Dasgupta. “Use a straw to protect your teeth, and rinse your mouth with water afterward. Avoid drinking it on an empty stomach to prevent discomfort.”
Routhenstein adds that you can also safely have ACV by incorporating it into your meals by mixing it into salad dressings or marinades.
Who should avoid apple cider vinegar?
“People with digestive problems like gastroparesis or acid reflux should avoid ACV, as it can make symptoms worse,” says Dr. Dasgupta. “Also, those with low potassium levels or sensitive teeth should be cautious. Pregnant or breastfeeding women and those with certain health issues should check with a doctor before using ACV.”
What medications cannot be taken with apple cider vinegar?
ACV may interact with medications affecting potassium or insulin, such as diuretics like furosemide, insulin, and certain blood pressure medications like lisinopril and losartan, says Routhenstein.
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