Apple Cider Vinegar Side Effects: What You Need to Know
Discover the potential risks and side effects of apple cider vinegar consumption and how to use it safely.
Apple cider vinegar (ACV) has gained significant popularity as a natural health tonic, with proponents claiming it can aid weight loss, regulate blood sugar, and lower cholesterol. However, while ACV does offer certain health benefits supported by scientific research, consuming it comes with potential risks that should not be overlooked. Understanding these side effects is essential for anyone considering incorporating apple cider vinegar into their daily routine.
Understanding Apple Cider Vinegar’s Acidity
The primary concern with apple cider vinegar stems from its high acidity levels. ACV falls between a pH of 2 and 3 on an acidity scale of zero to seven, with zero being the most acidic. This acidic nature, while potentially beneficial in small amounts, can cause serious digestive distress in some people depending on consumption amounts. The acetic acid in vinegar is responsible for both its purported health benefits and its potential adverse effects on the body.
Common Side Effects of Apple Cider Vinegar
Digestive Distress and Upset Stomach
One of the most frequently reported side effects of apple cider vinegar is gastrointestinal discomfort. Because vinegar is acidic, many people do not tolerate it well. Those with ulcerative colitis, inflammation in the digestive tract, or a predisposition to stomach aches should particularly avoid ACV. Registered dietitians emphasize that drinking a whole shot of apple cider vinegar on an empty stomach is definitely too much for those with sensitive digestive systems.
Research has found that in the short term, acetic acid decreases appetite, but more studies are needed to understand if this effect is sustained long-term. In some cases, appetite and food intake may decrease due to indigestion rather than a beneficial appetite-suppressing effect.
Worsened Acid Reflux Symptoms
For individuals who already suffer from acid reflux or GERD (gastroesophageal reflux disease), apple cider vinegar can exacerbate symptoms. Introducing more acid into the diet negatively affects previously occurring reflux issues in most people. More ACV consumption equals more stomach acid, which can heighten or increase the burning sensation for those who already experience heartburn or reflux.
Delayed Stomach Emptying (Gastroparesis)
Apple cider vinegar can lead to delayed stomach emptying, a condition known as gastroparesis. This becomes especially problematic for individuals taking medications that need to pass through the body and be absorbed within a specific timeframe. Extra caution is needed if you’re taking diuretics, insulin, blood pressure medication, and laxatives.
This side effect is particularly concerning for people with type 1 and 2 diabetes, since gastroparesis can lead to difficulty controlling blood sugar levels.
Low Potassium Levels
Another significant potential side effect is hypokalemia, which occurs when potassium levels drop too low. Low potassium can lead to cardiac arrhythmia (an irregular heartbeat) and muscle cramps, weakness, and fatigue. This concern is even more pronounced for people taking blood pressure medications such as diuretics, which can also lower potassium.
While there are no controlled studies on apple cider vinegar’s effects on blood potassium levels at this time, one notable case report documented a 28-year-old woman who consumed 8 ounces of apple cider vinegar diluted in water daily for 6 years. She was admitted to the hospital with low potassium levels and other abnormalities in blood chemistry, and was diagnosed with osteoporosis—a condition rarely seen in young people. Doctors believed the large daily doses led to minerals being leached from her bones to buffer the acidity of her blood.
Tooth Enamel Erosion
The acidic nature of apple cider vinegar can break down tooth enamel over time. Those with enamel erosion should avoid consuming ACV unless directed by their dentist. The acid erodes the protective layer of your teeth, potentially leading to sensitivity, discoloration, and structural damage. After consuming apple cider vinegar, it’s advisable to rinse your mouth with water.
Throat and Esophageal Burns
Apple cider vinegar has the potential to cause esophageal (throat) burns due to its acetic acid content. A review of harmful liquids accidentally swallowed by children found that acetic acid from vinegar was the most common acid causing throat burns, leading researchers to recommend that vinegar be considered a “potent caustic substance” and kept in childproof containers. Case reports of people drinking large volumes of vinegar beverages for prolonged periods found they required medical attention for throat burns.
Skin Burns
Due to its strongly acidic nature, apple cider vinegar may cause burns when applied directly to the skin. One documented case involved a 14-year-old girl who developed erosions on her nose after applying several drops of apple cider vinegar to remove moles based on an internet protocol. In another case, an 8-year-old boy with multiple health problems developed leg burns after his mother treated his leg infection with apple cider vinegar. Several anecdotal reports online also document burns caused by applying apple cider vinegar to the skin.
Bone Loss
High acid levels can reduce the formation of new bone, contributing to bone loss over time. The case of the woman who consumed excessive amounts of apple cider vinegar daily for 6 years illustrates this risk, as she developed osteoporosis despite her young age.
Drug Interactions and Complications
Apple cider vinegar can interact with several medications, potentially reducing their effectiveness or causing adverse effects. The delayed stomach emptying caused by ACV means medications may not be absorbed at the proper rate or in the proper sequence. This is particularly important to consider if you take:
- Diuretics
- Insulin
- Blood pressure medications
- Laxatives
If you are currently taking any medications, consult with your healthcare provider before adding apple cider vinegar to your routine.
Who Should Avoid Apple Cider Vinegar?
Apple cider vinegar is generally safe for most people when consumed in moderation, but certain groups should avoid it entirely. Those with the following conditions should not use ACV:
- Gastroesophageal reflux disease (GERD)
- Irritable bowel syndrome (IBS)
- Crohn’s disease
- Gastritis
- Ulcerative colitis
- Chronic kidney disease
- Gastroparesis
- Enamel erosion
Additionally, individuals with pre-existing kidney issues should avoid apple cider vinegar, as foods with higher levels of acid have been linked to the progression of kidney failure. Those with kidney disease may experience additional damage from ACV consumption.
Safe Consumption Guidelines
If you choose to consume apple cider vinegar, doing so safely is crucial. Generally, 12 tablespoons (1530 milliliters) with water or food is considered a moderate daily amount. Key safety practices include:
- Dilute thoroughly: Never drink apple cider vinegar straight; always dilute it with water or consume it with food
- Limit quantity: Stick to recommended amounts of 12 tablespoons daily
- Avoid empty stomach: Do not consume ACV on an empty stomach, especially if you have a sensitive digestive system
- Rinse your mouth: After consuming ACV, rinse your mouth with water to protect tooth enamel
- Monitor symptoms: Stop consumption immediately if you experience stomach upset, nausea, or other adverse reactions
- Consult your doctor: Speak with your healthcare provider before using ACV if you take medications or have existing health conditions
Potassium and Long-Term Effects
If you’re concerned about low potassium or present symptoms such as muscle twitches, muscle cramps, lightheadedness, or excessive urination, it’s best to stop ACV consumption and check in with your doctor. While the extreme case of the woman who consumed 8 ounces daily for 6 years represents an unusually high intake, it demonstrates the potential for serious consequences with prolonged, excessive consumption.
The Bottom Line
While apple cider vinegar can provide certain health benefits when used appropriately, it is not a miracle cure and carries real risks for some individuals. Apple cider vinegar is relatively safe to consume, but it can cause side effects in some people, so awareness of any stomach upset or other adverse reactions is important. To stay safe and prevent side effects, it’s essential to monitor the amount you consume and be careful with how you take it. While a small amount of vinegar can be good, more isn’t better and may even be harmful.
Like any supplement, ACV won’t replace a healthy lifestyle. It may have some benefits, but overall, more studies are needed to truly understand the health benefits and side effects associated with ACV.
Frequently Asked Questions
Q: How much apple cider vinegar is safe to drink daily?
A: Generally, 12 tablespoons (1530 milliliters) of apple cider vinegar diluted in water or consumed with food is considered a safe moderate daily amount.
Q: Can apple cider vinegar damage my teeth?
A: Yes, the acidity in apple cider vinegar can erode tooth enamel over time. If you consume ACV, rinse your mouth with water afterward and consider using a straw to minimize contact with your teeth.
Q: Is apple cider vinegar safe if I have acid reflux?
A: No, those with acid reflux or GERD should avoid apple cider vinegar, as it can exacerbate symptoms.
Q: Can apple cider vinegar interact with my medications?
A: Yes, apple cider vinegar can interact with several medications, including diuretics, insulin, blood pressure medications, and laxatives, by delaying stomach emptying. Consult your healthcare provider before using ACV if you take any medications.
Q: What should I do if I experience side effects from apple cider vinegar?
A: If you experience stomach upset, nausea, muscle cramps, or other adverse reactions, discontinue use immediately and consult your doctor.
Q: Is it safe to apply apple cider vinegar directly to my skin?
A: No, applying apple cider vinegar directly to skin can cause burns and erosions. There are documented cases of both children and adults experiencing skin damage from topical application.
References
- Apple Cider Vinegar Side Effects To Know And How To Use It Safely 1 Women’s Health Magazine. 2024. https://www.womenshealthmag.com/weight-loss/g19732667/apple-cider-vinegar-diet-side-effects/
- 7 Potential Side Effects of Apple Cider Vinegar 1 Healthline. 2024. https://www.healthline.com/nutrition/apple-cider-vinegar-side-effects
- Debunking the Health Benefits of Apple Cider Vinegar 1 University of Chicago Medicine. 2018. https://www.uchicagomedicine.org/forefront/health-and-wellness-articles/2018/august/debunking-the-health-benefits-of-apple-cider-vinegar
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