Vinegar, literally sour wine (vin aigre), is more than dilute acetic acid with an array of flavors, acids, and fermented products (Bhat, Akhtar, Amin, et al. 2014). Produced through double fermentation with yeast to generate ethanol and typically with Acetobacter, which produces acetic acid from ethanol, it is a liquid product that contains at least 4% or 5% weight per volume of acetic acid and not more than 0.5% ethanol, depending on the country. In plain terms, yeast digests and ferments sugars and converts them into alcohol; Acetobacter then turns the alcohol into acetic acid.
Raw materials for vinegar production include fruits, fruit juices, grains, proteins, honey, and many other sugary substrates for fermentation by yeasts, such as those from the class of saccharomycetes. These anaerobic organisms utilize glucose to ethanol and carbon dioxide at an approximate 60%–65% efficiency conversion. Subsequent action by select bacteria in the presence of oxygen can transform a spoiled fruit or fruit product into a practical product suitable for human consumption. These transformations are sensitive to the specific strain of yeast, the pH, and temperature of the biofermentation environment. These variations affect the production of volatile compounds as well as ethanol production (Ho, Lazim, Fazry, et al. 2017).
Vinegar’s possible health-promoting benefits seem rather sparse, small scale, and generally dubious in quality. Relative to glycemic control, a small study among nondiabetic and diabetic subjects suggested that the consumption of 20 g of apple cider vine-gar significantly improved postprandial glucose response following a challenge with orange juice (Johnston, Kim, and Buller 2004). Upon further examination, these authors note the absence of any effect of vinegar on postprandial glucose, insulin concentration, or glycated hemoglobin (Johnston, Quagliano, and White 2013). An earlier study among 7 subjects challenged with 50 g sucrose with and without 60 mL of strawberry vinegar that contained 5% acetic acid and 6% sugar indicated a 20% lower insulin response following consumption of the test meal (Ebihara and Nakajima 1988). These latter results were similar to a 2010 study that suggested the timing of vinegar consumption and meal com-position may be important (Liatis, Grammatikou, Poulia, et al. 2010). Statistical significance appears to be demonstrated in small populations, but there is no evidence that these kinds of ciders or other vinegars could be a safe or effective substitute for established medications.
A short review examining the potential of vinegar consumption contributing to weight loss indicated considerable interest to under-stand how vinegar may influence metabolic processes. A recent 12-week Iranian study among 44 subjects suggested that an intervention of white vinegar over the study period enhanced the magnitude of weight loss achieved with a reduced-calorie diet. It was postulated that vinegar suppresses appetite, but no mechanism was suggested (Khezri, Saidpour, Hosseinzadeh, et al. 2018). An earlier study among 16 healthy, normal weight adults evaluated the potential impact on appetite and food intake. The subjects found that the beverage with 25 g of vinegar and 25 g of squash was unpalatable and recorded nausea (Darzi, Frost, Montaser, et al. 2014). Other than some unacceptable palatability, mechanism(s) as a potential appetite suppressant were not advanced.
In a case report, several investigators described hypokalemia and osteoporosis in an otherwise young, healthy patient who had consumed large amounts of cider vinegar (250 mL) daily over a 6-year period (Lhotta, Höfle, Gasser, et al. 1998). The patient reported muscle cramps and hypokalemia. Expected metabolic disturbances associated with the chronic acid load, which is typically buffered by bone and renal functions, included diminished osteoblastic activity and stimulated osteoclastic activity. The renal bicarbonate excretion would be accompanied by urinary potassium and sodium excretion. The patient’s low osteocalcin validates this suggested mechanism of hypokalemia and osteoporosis.
In today’s expensive and frightening world, the search for stand-alone and effective “natural” remedies in the form of commonly available nutrients seems increasingly widespread. Consumers and healthcare providers alike understandably strive for simple, safe alternatives to expensive medications that are targeted at some of our most vexing chronic diseases. In so many of these remedies, the data and the theory fall short of demonstrating both meaningful clinical impact and, even more importantly, basic safety. Vinegar’s apparent resurfacing in the public’s awareness as one such highly touted ingredient requires critical examination. The emerging health claims that associate vine-gar with a weight loss aid, a blood glucose- lowering agent, and valuable source of potassium do not appear to be substantiated with consistent evidence. However, the objective reality seems to be that, in moderation, vinegar may be a desirable and delicious ingredient in many foods.
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