Background

Apple cider vinegar is the fermented juice from crushed apples. It contains acetic acid and nutrients such as B vitamins and vitamin C.

Apple cider vinegar is popularly used in salad dressings and cooking. But it's also been used traditionally as medicine. It might help lower blood sugar levels after a meal by changing how foods are absorbed from the gut.

Apple cider vinegar is used for obesity, diabetes, athletic performance, kidney stones, and many other purposes, but there is no good scientific evidence to support any of these uses. There is also no good evidence to support using apple cider vinegar for COVID-19.

Safety Safety definitions

When taken by mouth: Consuming apple cider vinegar in food amounts is likely safe. Apple cider vinegar is possibly safe when used as a medicine, short-term. But it is possibly unsafe when used in large amounts, long-term. Consuming large amounts of apple cider vinegar long-term might lead to problems such as low levels of potassium.

When applied to the skin: Apple cider vinegar is possibly unsafe. Applying apple cider vinegar to the skin can cause chemical burns in some people.

Special Precautions & Warnings:

Pregnancy and breast-feeding: There isn't enough reliable information to know if apple cider vinegar is safe to use as a medicine when pregnant or breast-feeding. Stay on the safe side and stick to food amounts.

Low potassium levels in the blood (hypokalemia): Apple cider vinegar might lower potassium levels in the blood. If your potassium is already low, apple cider vinegar might make it too low. Don't use apple cider vinegar if you have this condition.

Effectiveness

Dosing & administration

Apple cider vinegar is commonly used in foods. In the US, there's no specific definition of what a product must contain to be called apple cider vinegar. Sometimes it's standardized to acidity, with concentrations ranging from 4% to 8%. But the amount of each component of apple cider vinegar may vary from product to product.

When used as medicine, there isn't enough reliable information to know what an appropriate dose of apple cider vinegar might be. Speak with a healthcare provider to find out what dose might be best for a specific condition.

Interactions with pharmaceuticals

Digoxin (Lanoxin)

Interaction Rating=Moderate Be cautious with this combination.

Large amounts of apple cider vinegar may decrease potassium levels in the body. Low potassium levels can increase the side effects of digoxin.

Insulin

Interaction Rating=Moderate Be cautious with this combination.

Insulin might decrease potassium levels in the body. Large amounts of apple cider vinegar might also decrease potassium levels in the body. Taking apple cider vinegar along with insulin might cause potassium levels in the body to be too low.

Medications for diabetes (Antidiabetes drugs)

Interaction Rating=Moderate Be cautious with this combination.

Apple cider vinegar might lower blood sugar levels. Taking apple cider vinegar along with diabetes medications might cause blood sugar to drop too low. Monitor your blood sugar closely.

Water pills (Diuretic drugs)

Interaction Rating=Moderate Be cautious with this combination.

Apple cider vinegar can decrease potassium levels. "Water pills" can also decrease potassium levels. Taking apple cider vinegar along with "water pills" might make potassium levels drop too low.

Interactions with herbs & supplements

Herbs and supplements that might lower blood sugar: Apple cider vinegar might lower blood sugar. Taking it with other supplements with similar effects might lower blood sugar too much. Examples of supplements with this effect include aloe, bitter melon, cassia cinnamon, chromium, and prickly pear cactus.
Herbs that contain cardiac glycosides: Apple cider vinegar can lower potassium levels. Some herbs contain cardiac glycosides, which can affect the heart. Using apple cider vinegar along with herbs that contain cardiac glycosides can increase the risk of serious side effects from low potassium levels. Examples of supplements that contain cardiac glycosides include black hellebore, foxglove, lily-of-the-valley, oleander, and pleurisy root.
Horsetail: Using apple cider vinegar along with horsetail could increase the chance that potassium levels might drop too low.
Licorice: Using apple cider vinegar along with licorice could increase the chance that potassium levels might drop too low.
Stimulant laxative herbs: Apple cider vinegar can lower potassium levels. Stimulant laxatives can cause diarrhea and also decrease potassium levels. Taking apple cider vinegar with stimulant laxative herbs might cause potassium levels to go too low.

Interactions with foods

There are no known interactions with foods.