Real Food Profile: Apple Cider Vinegar

by | Aug 8, 2023 | Nutrition, Real Food

Image: Shutterstock

Can apple cider vinegar be the answer to all your ailments? Find out what the science says about this tangy sour cider derivative.

If there’s ever been a magical health elixir, it’s apple cider vinegar. Health headlines claim that it can help shed weight, lower cholesterol, improve acne, prevent diabetes, and even whiten teeth. That’s a heavy burden for a simple vinegar to carry. Let’s investigate how ACV is produced and what it’s made of, and delve into the science to discover its potential benefits. 

ACV is produced by a 4-step process, with some variations. Brands differ due to factors such as the type of apple used, the fermentation process, and any other additional processing or filtering that may occur. These are the basic steps:

  1. Apple selection and crushing: Fresh, ripe apples are carefully selected and crushed to obtain the juice. Both sweet and tart apples may be used, as they contribute different flavors and characteristics to the final product.
  2. Fermentation: The apple juice is then fermented by adding yeast, which converts the sugars into alcohol. This initial fermentation process produces hard cider.
  3. Acetobacter conversion: To transform hard cider into vinegar, beneficial bacteria called Acetobacter are added. These bacteria convert the alcohol into acetic acid through a process known as aerobic fermentation (when a chemical process occurs in the presence of air, specifically oxygen, it’s called aerobic). The presence of oxygen is vital for this conversion, which occurs during a slow fermentation process.
  4. Maturation: The vinegar is left to mature for several weeks to months, allowing the flavors to develop and the acetic acid content to increase. During this maturation period, a murky substance called the mother may form, which consists of beneficial bacteria and enzymes.

ACV has a vitamin profile similar to apple juice, containing B-vitamins and polyphenols. Let’s focus on the two defining compounds of ACV that are produced during fermentation: acetic acid and “the mother.” The acetic acid concentration is usually around 4-6%, and gives vinegar its characteristic sour taste and pungent smell. The mother is the cloudy stringy substance found in raw unfiltered ACV, which is a collection of bacteria, enzymes, and strands of proteins, all of which make it a probiotic. Because it contains active bacteria and enzymes, the vinegar may continue to ferment and change over time, especially if not stored in a cool, dark place. 

While many benefits are attributed to ACV, current research provides evidence that it can help with blood sugar control, may boost weight loss, and has antimicrobial properties1. A 2021 meta-analysis reviewed 9 randomized clinical trials and yielded significant findings that ACV can decrease total cholesterol, fasting glucose, and hemoglobin A1c2. There are several proposed potential mechanisms for how this occurs: 

  • Delay of gastric emptying
  • Enhancement of sugar utilization in cells and the breakdown of fats 
  • Suppression of liver glucose and fat production 
  • Facilitation of insulin secretion 

Hyperlipidemia (too much fat) and hyperglycemia (too much sugar) are widespread metabolic disorders, and the findings summarized above tell us that ACV, in conjunction with healthy lifestyle choices, may be helpful to manage these health abnormalities. While the findings were significant, the authors noted that they should be interpreted with caution and considered a secondary, rather than primary, therapy in the management of metabolic issues.

That’s what we know about the potential benefits of ACV. Are there any drawbacks? Yes—it’s very important to keep in mind that it contains acid, too much of which can damage the teeth and upper part of the digestive system, including the esophagus. Direct application to skin can also cause damage. You’ll want to be sure to do your research about how best to consume it.

In short, vinegar has been used as a food preservative, condiment and therapeutic elixir since ancient times3. Apple cider vinegar is a fermented product with a unique production process and a diverse range of compounds. Current science suggests that it may be effective in lipid and glucose management, further studies are needed for conclusive evidence. And it should be consumed with some caution. As with any dietary supplement, it is advisable to consult with a healthcare professional before implementing.

Fundamentals of Health Alliance

Fundamentals of Health Alliance


The Fundamentals of Health Alliance works to publish useful and reliable information about nutrition and health. Their mission is to empower readers to be informed with honest, non-biased information about food, nutrition and the vital components of health.


  1. Debunking the Health Benefits of Apple Cider Vinegar Website: University of Chicago Medicine URL: 
  2. Hadi A, Pourmasoumi M, Najafgholizadeh A, Clark CCT, Esmaillzadeh A. The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials. BMC Complement Med Ther. 2021 Jun 29;21(1):179. doi: 10.1186/s12906-021-03351-w. PMID: 34187442; PMCID: PMC8243436. 

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