Assessment of hypoglycemic effects of apple cider vinegar in type 2 diabets

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INTERNATIONAL JOURNAL OF FOOD AND
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Research Paper Open Access
ASSESSMENT OF HYPOGLYCEMIC EFFECTS OF APPLE CIDER VINEGAR IN TYPE 2
DIABETES
P. Nazni1*, Ravinder Singh2, R. Shobana Devi1, Harpreet Singh, Swarnoor Singh,
Kamalpreet Singh and Harman deep Singh and Shiv Kumar4
1Department of Food Science and Nutrition, Periyar University, Salem, 2 Indian Council of Medical Research, New Delhi,
3Freinds Pharma, New Delhi, 4National Institute of Medical Statistics (ICMR), New Delhi.
*Corresponding Author: naznip@gmail.com
Received on: 25th March, 2015 Accepted on: 6th May, 2015
ABSTRACT
Type 2 diabetes is the most common metabolic disorder worldwide and its prevalence is growing at an
alarming rate in both developed and developing countries. It is characterized by abnormalities in carbohydrate, lipid
and lipoprotein metabolism, which lead to hyperglycemia and many complications such as hyperlipidemia,
hyperinsulinemia, hypertension and atherosclerosis. In order to prevent diabetes, in addition to oral hypoglycaemic
drugs, the dietary component such as Apple cider vinegar seems to be promising for glycemic control in patients with
type 2 diabetes as well as for diabetes related medical conditions. Apple cider vinegar is fermented juice from
crushed apples. Acetic acid in vinegar seems to suppress disaccharidase activity and increase glucose-6-phosphate
levels in skeletal muscle. Thus an attempt is made in the present study to find out the impact of apple cider vinegar in
patients with type 2diabetes. Apple cider vinegar was purchased from local market and 15ml was given before meals
– twice a day for 3 months. The study was conducted for three month with 40 individuals with type 2 diabetes and
divided randomly in to two equal groups are as vinegar group (n=20) and control group (n=20). Information
pertaining to the socio economic status, anthropometry assessment, biochemical assessment, dietary pattern, health
status and personal habits were collected from the selected subjects. There was a significant decrease in BMI, WHR,
fasting blood sugar, post prandial blood sugar levels and HbA1c in vinegar group after supplementation of apple
cider vinegar (p value <0.05). No such differences were found among the control group during study period. On
conclusion, the above results revealed that apple cider vinegar has got an exclusive antidiabetic property and help in
preventing diabetic complications. Vinegar is inexpensive, readily available, and a flavor enhancer. Apple cider
vinegar was most effective to decrease glucose, total cholesterol, triglycerides, LDL and increases HDL because of
its higher concentration of organic acids and phenolic compounds.
Keywords: Diabetes, hyperglycemia, hyperinsulinemia, disaccharidase, post prandial and Vinegar.
INTRODUCTION
Type 2 diabetes is the most common metabolic
disorder worldwide and its prevalence is growing at an
alarming rate in both developed and developing countries.
It is characterized by abnormalities in carbohydrate, lipid
and lipoprotein metabolism, which lead to hyperglycemia
and many complications such as hyperlipidemia,
hyperinsulinemia, hypertension and atherosclerosis. All
forms of diabetes increase the risk of long-term
complications. These typically develop after many years
(10–20), but may be the first symptom in those who have
otherwise not received a diagnosis before that time. The
major long-term complications relate to damage to blood
vessels. In order to prevent diabetes, in addition to oral
hypoglycaemic drugs, the dietary components such as
Apple cider vinegar seems to be promising for glycemic
control in patients with type 2 diabetes as well as for
diabetes related medical conditions. (Khan et al, 2003,
Anderson et al 1999 and Soltan SA et al , 2012).
Apple cider vinegar is fermented juice from
crushed apples. Like apple juice, it likely contains some
pectin; vitamins B1, B2, and B6; biotin; folic acid; niacin;
pantothenic acid; and vitamin C. There is interest in using
apple cider vinegar for diabetes and cardiovascular
diseases. Feeding apple cider vinegar to animals with
experimentally induced diabetes significantly reduces
hemoglobin A1C (HbA1C), lowers low-density lipoprotein
(LDL) cholesterol and triglycerides, and increases high-
density lipoprotein (HDL) cholesterol. In another animal
model, apple cider vinegar decreased triglycerides and
very low-density lipoprotein (VLDL) cholesterol.
Preliminary clinical research suggests that vinegar can
lower postprandial glucose levels in healthy volunteers.
Vinegar is thought to affect glucose levels by delaying the
gastric emptying rating. Acetic acid in vinegar also seems
to suppress disaccharidase activity and increase glucose-6-
phosphate levels in skeletal muscle.
(www.therapeuticresearch.com).

ASSESSMENT OF HYPOGLYCEMIC EFFECTS OF APPLE CIDER VINEGAR IN TYPE 2 DIABETES
P. Nazni, Ravinder Singh, R. Shobana Devi, Harpreet Singh, Swarnoor Singh, Kamalpreet Singh, Harman deep Singh
and Shiv Kumar
The article can be downloaded from http:/www.ijfans.com/currentissue.html
207
Many medicinal components that are good for
health have been reported in natural vinegar, such as
carbohydrates, organic acid (acetic, formic, lactic, malic,
citric, succinic and tartaric), alcohols and amino acids and
peptides (Cocchia et al., 2006), vitamins and mineral salts,
polyphenolic compounds (Gallic acid, catechin, caffeic,
ferulic acid). Different types of vinegar are available in
market. Traditional vinegar is produced from regional
foods according to well established customs. The balsamic
vinegar of Modena, Italy is made from the local white
Trebbiano grapes. Traditional rice wine vinegar is
produced in Asia, coconut and cane vinegar is common in
India and Phillippines and date vinegars are popular in the
Middle East. Some scientific investigation clearly states
the benefits of vinegar such as antimicrobial properties
(Vijayakumar and Wolf Hall., 2002.), prevent
inflammation and hypertension (Murooka and Yamshita,
2008), lower serum cholesterol (Fushimi et al., 2006),
reduction in systolic blood pressure (Kondo et al., 2000),
enhanced calcium absorption and retention (Kishi et
al.,1999), decrease the glycemic index of carbohydrate
food for people with and without diabetes (Sugiyama et al.,
2003; Johnston et al., 2004). Antiglycemic effects of
vinegar have been known for more than a century and have
been demonstrated in animal as well as human studies
(Salbe et al., 2009).
According to Soltan SA et al., 2012, Different
types of vinegar have protective effect on pancreas and
stomach with 15% concentration for 6 weeks. So that
using vinegar has a beneficial effect on diabetic patients.
Among all types of vinegar, apple vinegar was most
effective to decrease glucose, total cholesterol,
triglycerides, LDL and increases HDL followed by grape,
sugarcane, coconut, artificial and palm vinegar. These
results support a therapeutic effect for Apple cider vinegar
in individuals at risk for type 2diabetes. Thus an attempt is
made to supplement Apple cider vinegar in patients with
type 2diabetes.
MATERIALS AND METHODS
The present study was carried out in M.G.
Diabetes Hospital, Salem. This hospital was selected
because of the easy accessibility of the diabetic subjects
and convenience of the investigator. A total of 60 patients
with type 2 diabetes were selected to participate in the
study. From the 60 non insulin dependent diabetic
subjects, 40 NIDDM subjects aged 30-65 years of both
sexes with the range of Fasting blood glucose levels
between 120-190 mg/dl, HbA1c 6-8%, post prandial blood
glucose levels between 140-200mg/dl were selected for the
study. Exclusion criteria were alcohol consumption,
pregnancy and lactation women, allergy to vinegar,
existing with liver or renal or thyroid diseases and
haemolytic anaemia. Patients were informed and oriented
about the study and written consent form was taken from
them.
Apple cider vinegar was purchased from local
market and 15ml was given before meals – twice a day for
3 months. The study was conducted for three month with
40 individuals with type 2 diabetes and divided randomly
in to two equal groups. The experiment group are as
Group I (n=20) : Vinegar group - Consumption of 15 ml
of apple cider vinegar before meals twice a day for three
month. (Before breakfast and dinner)
Group II (n=20) : Control group – no intervention.
All medications were continued as usual and
subjects were advised to maintain their normal diets and
continue their habitual physical activity throughout the
study. On days 0, 30, 60, and 90, approximately 10ml of
fasting blood was collected from each subject and analysed
for Fasting blood glucose levels and HbA1c. On the same
day approximately 5ml of blood sample was collected
2hours after breakfast to analyse post prandial blood sugar
level. A detailed interview schedule was developed by
the investigator in order to elicit information pertaining to
the socio economic status, dietary pattern, health status and
personal habits of the selected subjects. The general
information such as age, sex, educational status, work
pattern, income level, type and composition of family were
collected from the selected subjects. The following
techniques were employed to carry out the assessment of
nutritional status. Anthropometric parameters like height,
weight, Body Mass Index (BMI) and Waist Hip Ratio
(WHR) were calculated for all the subjects. Precise
information on food consumption pattern was collected
through 24 hour recall method and food frequency method.
The biochemical parameters such as Fasting blood
glucose, post prandial blood glucose levels and
Glycosylated haemoglobin (HbA1c) were analysed for the
selected subjects. Clinical data regarding family history of
diabetes, duration and complications were collected from
selected diabetic subjects. Data collected by Interview
schedule were consolidated.
RESULTS AND DISCUSSION
Baseline characteristics of the participants were
shown in table 1. Significant decrease in the BMI was
observed in vinegar group when compared to control
group. No weight reduction was noticed in the control
group and they tend to have more or less same weight at
the end of the study. Waist Hip Ratio (WHR) is considered
as another important factor in assessing nutritional status
of an individual. Like BMI, Vinegar group shows the
decrease in the WHR at the end of the trial when compared
to that of Control group. Hence there is a significant
difference in the BMI and WHR in vinegar group before
and after supplementation (p value <0.05). This result
reveals that apple cider vinegar helps in weight reduction.

ASSESSMENT OF HYPOGLYCEMIC EFFECTS OF APPLE CIDER VINEGAR IN TYPE 2 DIABETES
P. Nazni, Ravinder Singh, R. Shobana Devi, Harpreet Singh, Swarnoor Singh, Kamalpreet Singh, Harman deep Singh
and Shiv Kumar
The article can be downloaded from http:/www.ijfans.com/currentissue.html
208
Table 1: Baseline Characteristics of the participants
Particulars
Vinegar group (n=20)
Control group (n=20)
0 day
30th day
60th day
90th day
0 day
30th day
60th day
90th day
Gender, F/M
5/5
-
-
-
4/6
-
-
-
Age in years
42.3±10.0
-
-
-
50.1±10.6
-
-
-
BMI (kg/m2)
27.6±2.9
27.2±1.5
26.6±2.0
25.8±2.2
28.1±2.4
28.3±3.4
27.9±2.6
28.2±2.1
WHR
1.05±0.5
1.01±0.2
0.99±0.4
0.95±0.3
1.24±0.23
1.245±0.35
1.25±0.28
1.248±0.19
Dietary intake of the participants was tabulated
in the table 2. As the month progress there was a gradual
fall in the food intake of the participants in vinegar group,
but they met their recommended daily allowances.
Carbohydrate is the main component in the diet which
influences the blood sugar levels. Gradual decrease in the
energy, carbohydrate and fat intake was noticed during
the period of the study. This might also be one of the
reasons in controlling the blood sugar levels. There was a
mild difference between the protein, fibre and calcium
intake among the participants in vinegar group. No
changes were observed in control group. The energy,
protein, carbohydrate, fat, calcium and fibre intake of
participants in control group almost remains the same at
the end of the study period. This result reveals that apple
cider vinegar also controls the appetite. Significant
decrease in energy and fat intake of the individuals in
vinegar group were observed at the end of the trail (p
value <0.05). The same was found by P.Nazni and
K.Ramya (2011).
Table 2: Dietary intake of the participants
Nutrients
Vinegar group (n=20)
Control group (n=20)
0 day
30th day
60th day
90th day
0 day
30th day
60th day
90th day
Energy
1958±349.5
1832±241
.2
1751±228.
9
1706±185.
4
2152±328.9
2133±287.4
2110±35
4.2
2087±321
.8
Protein
58.8±14.6
55±9.6
56±10.3
56±8.5
59.7±12.4
57±9.4
56±8.7
55±12.3
Carbohydrates
333.8±50.7
317±45.9
304±40.2
301±42.8
370.2±60.1
375±54.6
372±68.1
368±52.8
Fat
43±10.5
38±9.2
34.5±7.6
30±6.8
48.2±8.5
45±10.4
44±9.6
43.5±11.4
Calcium
1353.3±355.
6
1298±298
.4
1246±245.
8
1198±237.
2
1423±284.8
1398±250.4
1455±28
9.2
1418±278
.9
Fibre
6.45±1.78
6±1.4
5.8±0.9
5.8±1.2
6.94±1.64
6.7±1.6
6.43±1.2
3
6.78±1.42
Table 3: Clinical data of the participants
Particulars
Vinegar Group (n=20)
Control Group (n=20)
Family history of Diabetes, Yes/No
8/12
11/9
Duration of diabetes
5.83±2.63
5±2.82
Complications
Only Diabetic – 17
Diabetes + Hypertension – 3
Only Diabetic – 15
Diabetes + Hypertension – 5
Table 3 indicates the clinical data of the
participants. Out of 20 participants in vinegar and control
group, 8 and 11 participants respectively were found to
have family history of diabetes. Duration of diabetes in
both vinegar and control group vary from 2 to 10 years.
Among 20 participants 17 subjects in vinegar group and
15 subjects in control group were only diabetic. Whereas
the remaining 3 subjects in vinegar group and 5 subjects
in control group were both diabetic and hypertensive.
Table 4: Biochemical parameters of the participants before and after supplementation
Biochemical
parameters
Vinegar group (n=20)
Control group (n=20)
0 day
30th day
60th day
90th day
0 day
30th day
60th day
90th day
Fasting Blood
glucose (mg/ml)
169.6±18.5
155.8±22.
5
142.3±1
2.9
112.6±8.5
184.6±10.5
173.8±15.4
191.5±33.3
182.3±12.
5
Post Prandial
Blood Glucose
(mg/ml)
190.5±9.3
165.5±12.
6
149.7±1
0.9
126±16.5
188.3±7.31
203.7±34.8
253.5±48.5
224.2±26.
8
HbA1c (%)
8±0.2
-
-
6.08±0.22
7.98±0.19
-
-
8.86±0.62
Table 4 shows the results of biochemical parameters
such as fasting blood glucose levels, post prandial blood
glucose levels and HbA1c levels of the participants during
the study. Apple cider vinegar is thought to affect
glucose levels by delaying the gastric emptying rating.
Acetic acid in vinegar also seems to suppress
disaccharidase activity and increase glucose-6-phosphate
levels in skeletal muscle Soltan SA et al. (2012),

ASSESSMENT OF HYPOGLYCEMIC EFFECTS OF APPLE CIDER VINEGAR IN TYPE 2 DIABETES
P. Nazni, Ravinder Singh, R. Shobana Devi, Harpreet Singh, Swarnoor Singh, Kamalpreet Singh, Harman deep Singh
and Shiv Kumar
The article can be downloaded from http:/www.ijfans.com/currentissue.html
209
R Durgadevi and P Nazni (2012). This report
supports the current study findings. In the present study,
there was a significant decrease in the fasting blood sugar,
post prandial blood sugar and HbA1c levels in vinegar
group after supplementation of apple cidar vinegar (p
value <0.05). Whereas in control group no significant
changes was observed. Several mechanisms to account for
these effects have been proposed, including interference
with enzymatic digestion of complex carbohydrates,
delayed gastric emptying and enhanced peripheral glucose
uptake and conversion to glycogen. These results strongly
prove the antidiabetic activity of the apple cider vinegar.
CONCLUSION
These data reveals that daily consumption of
apple cider vinegar favorably influences fasting glucose
concentrations, post prandial blood sugar levels and
HbA1c levels in diabetic patients and contribute important
information to the growing evidence base supporting the
antiglycemic effects of vinegar. Vinegar is inexpensive,
readily available, and a flavor enhancer. Apple cider
vinegar was most effective to decrease glucose, total
cholesterol, triglycerides, LDL and increases HDL because
of its higher concentration of organic acids and phenolic
compounds. In conclusion, Apple cider vinegar has got an
exclusive antidiabetic property and help in preventing
diabetic complications.
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