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Does Apple Cider Vinegar Help with Bloating and Digestive Issues?

Written by Dr. Michael Ruscio, DC on December 21, 2019

Written by Dr. Michael Ruscio, DC on December 21, 2019 — Reviewed by Noora Alakulppi

A closer look at ACV as a “cure-all” for digestive health.

• Why Drinking Apple Cider Vinegar Might Help Bloating and Digestive Issues|
• What Else is Apple Cider Vinegar Good For?|
• The Problem With Low Stomach Acid|
• Apple Cider Vinegar: Best in Moderation|
• What About a Stomach Acid Supplement?|

Adequate stomach acid production is crucial for the digestive process. Some people don’t produce enough stomach acid for proper digestion. This may cause uncomfortable symptoms like bloating and gas. In the long term, low stomach acid can have serious consequences for your health. 

If you have an autoimmune disease or anemia, there is a 5–50% chance that you have low stomach acid. 

Apple cider vinegar has long been used as a home remedy for bloating and digestive symptoms. Recently, apple cider vinegar has become a popular superstar among health enthusiasts who claim that ACV can help to burn fat, lower blood sugar, and reduce inflammation. 

When it comes to bloating and digestive issues, however, it seems there’s still much we don’t know. So far the proven benefits of ACV supplementation seem modest. More importantly, there are more effective therapies for bloating and digestion. But ACV could still be a beneficial dietary staple according to its popular health claims, so let’s look into those claims in more detail.

Why Drinking Apple Cider Vinegar Might Help Bloating and Digestive Issues

Apple cider vinegar (AVC) does appear to have uses beyond salad dressing, but it also may not be the panacea it is claimed to be. There is not yet much research evidence to support claims that apple cider vinegar relieves bloating and digestive issues. But just because something hasn’t yet been researched, it doesn’t mean it’s not true. We can, however, make some inferences here.

There are two possible links between ACV and gut health. One is acetic acid, a mild acid that is found in all vinegars. The other is the probiotic bacteria which is found in some brands of apple cider vinegar.

Acetic Acid in ACV

Apple cider vinegar is commonly recommended as a type of digestive acid supplement for  patients with low stomach acid. This is based on the premise that supplementing with an acid will increase low acid levels. However, ingesting acid might actually down-regulate the body’s acid production through a negative feedback mechanism. 

Essentially, drinking something acidic like ACV could cause the body to think it’s creating more than enough acid, and thus produce less overall. It’s worth noting that neither of these therapies are confirmed by scientific evidence (yet). A recent literature review states, “A substantial gap persists between anecdotal and empirical understandings of the majority of non-pharmacologic remedies [like ACV] for esophageal symptoms.” [1] More research in the future may help to elucidate the true effects of ACV. 

Probiotics in ACV

Some brands of apple cider vinegar contain “the mother,” which is a naturally-formed, cloudy layer of acetic acid bacteria. While this bacteria is used to ferment all types of vinegar, most commercial vinegar brands filter it out. However, the mother is made up of good bacteria. 

There is plenty of good science that shows the benefits of probiotics for digestive issues, including SIBO [2, 3, 3, 4, 5].

On its own, small amounts of apple cider vinegar won’t provide a therapeutic dose of probiotics, and there are more probiotic-rich options like kefir. However, it’s one type of fermented food that you can add to your diet.

What Else is Apple Cider Vinegar Good For?

A lot of claims are made about the health benefits of apple cider vinegar. Here’s an overview of what the research has to say about ACV and how it could be helpful (or possibly not). Some of them are science-based and some of them are not.

Apple Cider Vinegar for Weight Loss

Can apple cider vinegar help you lose weight? Here we have some mixed results:

• A Japanese study followed 175 obese individuals who consumed either 0, 1, or 2 tablespoons of vinegar per day. Those who consumed vinegar had a modest weight loss of 2-4 lbs after 12 weeks [6]. 
• A later study suggests that vinegar does suppress appetite, however, this may be the result of nausea caused by consuming vinegar as a supplement [7]. 

So, not great for weight loss.  

Apple Cider Vinegar for Blood Sugar Control

There is good evidence to suggest that vinegar can help with blood sugar control for some people:

• A systematic review and meta-analyses (a detailed summary of available research) showed that vinegar consumption (both white vinegar and apple cider vinegar) can reduce glucose levels and insulin responses after a starchy meal. This effect was not seen after a non-starchy meal [8].
• Some studies show a moderate effect on blood sugar while other studies show little effect. It appears that the more insulin-resistant the patient, the stronger the effect of apple cider vinegar on blood sugar [9, 10, 11, 12].We should also speak to effect size.  Was the BS reduction notable or was is minimal and not meaningful?

If you are diabetic, insulin-resistant, or eat a very starchy meal, apple cider vinegar can provide moderate help with blood sugar control.

Apple Cider Vinegar as an Anti-inflammatory

Does apple cider vinegar have anti-inflammatory benefits? Let’s take a look at some of the research regarding supplementation of acetic acid for inflammation:

• A study of balsamic vinegar showed that it can reduce some inflammatory markers [13]. However, this was a cell study so it’s unknown how it would present in the human body.
• A 2017 study showed Nipa vinegar was better than synthetic acetic acid at improving inflammation and gut microbe composition in mice eating a high-fat diet [14] . 
• A 2022 study found 6 months of putting ACV on teeth with a cotton ball (instead of toothbrushing) reduced plaque and gum inflammation in kids with cerebral palsy [15]. 

It seems there’s more research that needs to be done before we know for sure whether ACV supplementation could help inflammation in humans. 

Apple Cider Vinegar for Reducing Triglycerides

Here we have some conflicting results:

• Two clinical studies found that 1 to 2 tablespoons of ACV per day led to a minor reduction in triglycerides [6, 16]. 
• Another study found that ACV consumption resulted in a small increase in triglycerides [17].

There’s not much here that suggests apple cider vinegar as an effective way to reduce triglycerides. 

The Problem With Low Stomach Acid

When food arrives in your stomach, your stomach produces acid to help start the digestive process. This is called stomach acid or hydrochloric acid (HCl). Stomach acid is important for a few reasons: the digestion of proteins, the absorption of minerals, the control of parasites/bacteria/fungi, and because it signals to other parts of the digestive tract that food is on its way.

Research into the long-term effects of drugs that lower stomach acid gives us some insights into the risks of low HCI production [18, 19, 20, 21]. Over the long term, inadequate stomach acid can:

• Increase the risk for SIBO and fungal infections. 
• Impair nutrient absorption (calcium, magnesium, iron, B12) which, in the long term, can lead to osteoporosis and complications such as hip fracture. 
• Cause problems in the digestive system, specifically in the esophagus and small intestine. 
• There is also the possibility of increased growth of stomach tumors, although it’s unclear whether these tumors are harmful.
  

Typical symptoms of too little stomach acid include

• Burping/belching
• Feeling excessively full after eating/feeling like food just sits in your stomach
• Feeling bloated
• Reflux, heartburn and indigestion
• Constipation

Who is at Risk for Low Stomach Acid?

Only 2% of the US population have documented low stomach acid [22].  However, the actual numbers may be higher. 

Some conditions and factors may increase the likelihood you have low stomach acid, including:

• Autoimmune conditions
• Anemia
• Being over sixty-five
• Chronic use of painkillers or antacids

Autoimmune Conditions and Anemia Increase The Risk of Low Stomach Acid

If you have anemia or an autoimmune condition, the chances you have low stomach acid range anywhere from 5% up to 50%. 

What’s the connection between autoimmune disease and stomach acid? Up to 50% of those with an autoimmune disease also have autoimmunity against their stomach cells. Over time, this stomach autoimmunity can interfere with your stomach’s ability to release the important digestive acid HCl [23].

This suggests that low stomach acid might be more common than previously thought. 

These autoimmune conditions are associated with low stomach acid: [24, 25, 26, 27, 28, 29, 30, 31, 32]:

• Rheumatoid arthritis
• Type 1 diabetes
• Celiac disease
• Crohn’s disease
• Thyroid disease—Hashimoto’s and Graves’
• Sjögren’s syndrome
  

This corresponds with what I see in the clinic: a subset of patients seems to benefit from supplemental acid.

Low Stomach Acid Increases Your Risk of Bacterial Overgrowth

Small intestinal bacterial overgrowth (SIBO) can develop when stomach acid is too low. While not a condition in itself, it is a lab finding that can help better understand any present dysbiosis (or an imbalance in the microbiome). If you test positive for SIBO, chances are that you may also have low stomach acid [33]. Additionally, the overlap in SIBO and irritable bowel syndrome (IBS) [34], also suggests that low stomach acid may be present in IBS patients as well.

Apple Cider Vinegar: Best in Moderation

If a little bit is good for you, more should be better, right?

Not necessarily. Since ACV is so acidic, there are some potential negative side effects if you drink apple cider vinegar to excess. 

In one extreme case, a young woman was admitted to hospital with low blood potassium levels and osteoporosis. She had been consuming about a cup of ACV per day for 6 years. The doctors concluded that the excess acid caused minerals to leach from her bones [35]. Consuming this quantity is unlikely to happen unintentionally, and is more so a cautionary tale of overdoing a supplementation in general.

While ACV has shown to be beneficial for some oral health purposes, overdoing it (like in the story above) can cause adverse effects. One teenager caused erosion of her tooth enamel by consuming large quantities of apple cider vinegar [36]. However, I wouldn’t let this deter you from drinking the popular apple cider vinegar, lemon juice, and honey blend as long as you do so in moderation. 

If you experience acid reflux or heartburn after consuming ACV, you should stop using it. While some people have low stomach acid, others have too much. The symptoms for both conditions are very similar. If consuming ACV makes your digestive symptoms worse, it’s possible that you have excess stomach acid.

How To Consume Apple Cider Vinegar Safely

If you want to drink ACV as a supplement, it’s best to dilute it in warm water. It’s also worth rinsing your mouth after you drink it, just to avoid possible erosion of the tooth enamel. It’s normally taken before a meal to help with digestion. Start with a small amount and if you tolerate it well, work up to putting 2 tablespoons in a glass of water per day.

You can also simply incorporate ACV as part of a healthy diet. 

A small amount of ACV works well in:

• Salad dressings
• Marinades
• Fruit smoothies
• Warm ginger tea with lemon juice and honey

If you have gastroparesis (a disease that prevents the stomach from emptying normally) you should avoid using apple cider vinegar as it can worsen the condition [37]. 

What About a Stomach Acid Supplement?

If you think that you may have low stomach acid, you may want to take a digestive acid supplement instead of ACV. These supplements contain betaine HCl, a digestive acid, and pepsin which is a digestive enzyme.

Taking digestive acid supplements can help you to achieve a more clinical and consistent dose. Also, they are safer for your tooth enamel than ACV.

While hydrochloric acid supplements can be helpful for some, they are not for everyone.

Those with low stomach acid can experience symptoms like burping, bloat, feeling excessively full after eating, reflux, heartburn, and indigestion, leading them to try acid supplementation. But what can be confusing is that these symptoms may also be a sign of too much stomach acid. It’s important to know how to take HCl properly and pay attention to how your body responds. 

Never Do This With HCI Supplements for Digestion

There’s a common recommendation for dosing digestive acid (HCl) that is not advisable. This practice suggests that you increase your dose until you feel a burning sensation and then decrease your dose slightly. For example, if you felt a burning sensation in your stomach when you took seven pills of HCl per meal, your ideal dose is six pills. 

But the issue with finding your dose this way is that by the time you’re feeling burning, damage may be occurring. 

Also, those with a healthy stomach lining may never feel burning. A very high intake of stomach acid supplements may lead to an increased risk of stomach and small-intestinal ulcers. The ideal dose is to take the minimum amount needed (sometimes called the “minimum effective dose”) to feel symptom relief.

Dosing Guidelines for Betaine HCI Supplements

There’s no readily available test for low stomach acid. However, if you have a risk factor like autoimmune disease, anemia or SIBO, you may want to try a digestive acid supplement to see if it helps your symptoms.

Take 1 to 2 capsules with each meal for a trial period of 1 to 2 weeks. 

• If you feel burning or have any other bad reaction, discontinue the product. 
• If you notice an improvement in your symptoms, continue to take the product.
• If you don’t notice any improvement in your symptoms after 2 weeks, discontinue the product.

The Bottom Line on Apple Cider Vinegar

Apple cider vinegar does have some therapeutic uses, but its benefits are modest. 

While it’s easy to get excited about promising natural remedies, please don’t think of ACV as a panacea for weight loss, blood sugar control, or digestive issues. You can take 1-2 tablespoons of diluted ACV per day as a supplement, however, for all of these conditions, there are more effective therapies. A better approach might be to use apple cider vinegar and other vinegars in moderation as part of your healthy diet. Be sure to talk to your doctor or dietitian about how to best incorporate ACV into your diet.

If you tried ACV and are still struggling with digestive symptoms, it may be a sign that you need other interventions such as prebiotics, probiotics, or antimicrobials to bring balance to your gut bacteria. Talk to your doctor or schedule a visit with us at the clinic to get started with the help you need to really make a difference for your digestive health.

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