The Potential of Apple Cider Vinegar in the Management of Type 2 Diabetes

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DOI: 10.5923/j.diabetes.20160506.02
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Type 2 Diabetes represents a large burden on public health systems worldwide. The chronic metabolic condition is characterised by hyperglycaemia and insulin resistance and is frequently associated with obesity, hypertension and dyslipidaemia. There is a growing need for effective management techniques of these conditions that patients can utilise complementary to conventional therapy. Apple cider vinegar (ACV) has been the subject of growing interest in this field. The main component of ACV, acetic acid, has demonstrated effectiveness in reducing hyperglycaemia, correcting dyslipidaemia and assisting weight loss. The dominant polyphenol compound in ACV, chlorogenic acid may also be useful in managing the condition.
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International Journal of Diabetes Research 2016, 5(6): 129-134
DOI: 10.5923/j.diabetes.20160506.02
The Potential of Apple Cider Vinegar in the
Management of Type 2 Diabetes
Joanna Morgan1,2, Sapha Mosawy1,2,*
1School of Medical Science, Griffith University, Gold Cost Campus, Queensland, Australia
2Menzies Health Institute Queensland, Griffith University, Gold Cost Campus, Queensland, Australia
Abstract Type 2 Diabetes represents a large burden on public health systems worldwide. The chronic metabolic condition
is characterised by hyperglycaemia and insulin resistance and is frequently associated with obesity, hypertension and
dyslipidaemia. There is a growing need for effective management techniques of these conditions that patients can utilise
complementary to conventional therapy. Apple cider vinegar (ACV) has been the subject of growing interest in this field. The
main component of ACV, acetic acid, has demonstrated effectiveness in reducing hyperglycaemia, correcting dyslipidaemia
and assisting weight loss. The dominant polyphenol compound in ACV, chlorogenic acid may also be useful in managing the
Keywords Apple cider, Diabetes, Vinegar, Hyperglycaemia, Dyslipidaemia
1. Introduction
In Australia 280 people develop type 2 diabetes each day
which currently affects 1.7 million Australians. The burden
on the public health system is estimated at $14.6 billion [1].
Type 2 diabetes, accounting for 85% of all diabetes, is a
complicated chronic metabolic condition characterised by
insulin resistance and eventually insufficient insulin
production resulting in abnormal glucose metabolism. The
condition is generally associated with obesity, a sedentary
lifestyle, hypertension and dyslipidaemia. Type 2 diabetes
significantly increases the risk of cardiovascular disease.
Management of the condition involves managing the risks
of cardiovascular disease as well as managing blood
glucose levels [2, 3].
Apple cider vinegar (ACV) may be able to play a role in
the day-to-day management of type 2 diabetes as growing
research has demonstrated that certain aspects of the
beverage assist in controlling hyperglycaemia, as well as
reducing cardiovascular disease risks through weight loss,
lowering blood pressure and lowering blood lipids [4, 5].
Not all ACV, however, is made alike. There are several
techniques utilised in commercial vinegar production, from
slower more traditional methods to techniques that can
produce ACV within a day. There are many other factors in
production, from apple cultivar, yeast and bacterial cultures
used, to whether the product was filtered and pasteurised
* Corresponding author: (Sapha Mosawy)
Published online at
Copyright © 2016 Scientific & Academic Publishing. All Rights Reserved
[4, 6, 7]. Few studies have examined the effect different
production methods have on the final product and the
presence and quantity of organic components. Commercial
varieties also give limited information on package labelling
regarding production methods. The present review focuses
on ACV and its beneficial effects on type 2 diabetes.
2. Production of Apple Cider Vinegar
2.1. Two -Step Fermentation Process
ACV can be produced by a two-step fermentation process,
and this process is characterised by the presence of acetic
acid at a concentration equal to or above 4% [8]. Cider
vinegars are typically 5-6% acetic acid [9]. The pH of
vinegar will depend on acetic acid concentration and is
typically between 2 3.5 [10].
Yeasts initially ferment the sugars or starch in raw
materials to form ethanol, which is further fermented by
acetic acid bacteria (AAB) to produce acetic acid. This can
be accomplished with juices/mashes from apples, grapes,
coconuts, rice, potato and others. If a starch is the initial raw
material, it will first need to be hydrolysed into a sugar.
Depending on the method used for the second fermentation,
vinegar can be produced as quickly as within 24 hours or
may be left for months to years to ferment [4]. Figure 1
shows the chemical equations for the 2-step fermentation
process. The final product may be filtered and pasteurised
prior to consumption. This process removes and destroys
AAB, preventing formation of 'mother of vinegar'. Mother of
vinegar develops when unpasteurised vinegar is allowed to
remain in the product, forming an extracellular cellulose
130 Joanna Morgan et al.: The Potential of Apple Cider Vinegar in the Management of Type 2 Diabetes
layer which can be seen as a layer on the surface of the liquid,
or as a cloudy cobweb-like substance, making the fluid
appear murky. It is not unique to ACV.
Production of ACV can occur spontaneously via the
naturally occurring yeasts and bacteria on the surface of the
fruit, allowing the beverage to be easily made in the home
[11]. The product produced in the home will likely differ in
microbiota, acetic acid content and other molecules given
that the spontaneous process is not standardised. Filtering
and pasteurisation may not be done and the 'mother' may be
consumed or used to inoculate subsequent batches of
1) C6H12O6 → 2 CO2 + 2 C2H5OH
Alcoholic Fermentation by Yeasts
2a) 2C2H5OH → 2CH3CHO + 2H2
Oxidation (Anaerobic) by AAB
2b) 2CH3CHO + O2 → 2CH3COOH + 2H2O
Oxidation (Aerobic) by AAB
Figure 1. Chemical equations for 2-step fermentation process
2.2. Other Vinegar Production Techniques
2.2.1. Orleans Process (Traditional)
Orleans process is an early traditional process, in which
wine covered in a film (mother) of AAB, oxidises slowly in a
barrel. The barrel has holes, allowing for air flow and wine is
added beneath the mother. The mother causes the apparatus
to become slimy and slows the rate of vinegar production and
vinegar is removed through the bottom of the barrel [10].
2.2.2. Generator Process (Surface Culture/Quick Process)
The generator process is believed to date back to the 17th
century. AAB are grown in a thick layer on a
non-compacting material, such as beech wood shavings. A
pump circulates the liquid, allowing a slow trickle over the
bacterial culture while air is permitted to circulate through
the apparatus. While generator fermentation is used
commercially, it is considered to be slow and expensive
[10, 12].
2.2.3. Submerged-Culture
In the submerged-culture generator, a mechanical system
keeps the AAB submerged within the liquid in close contact
with aeration. The Frings acetator is a popular
submerged-culture generator. Submerged culture method
was designed for efficient commercial use [10].
2.2.4. Maceration
Maceration is a process already utilised in wine-making in
which the remaining pulp from extracted juice is left to soak
in the juice for a period of time. The phenolic and flavour
compounds within the skin and pulp are extracted via this
process. It has been shown that maceration in combination
with the surface production method yielded the ACV with
the highest phenolic content [6].
3. Production Methods, Apple Cultivar
and End Product
The production method utilised may affect the final
properties and composition of ACV. Different production
techniques have been demonstrated to affect pH, acidity and
phenolic content [6, 13]. Budak et al. [4] concluded that
production method affected the ability of ACV to alter
triglyceride levels in rats with some methods more effective
than others. The total content of phenolic compounds in
ACV and hence, production method, may also be relevant to
the ability of the beverage to promote good health.
The variety of apple (cultivar) used may affect the
phenolic content of the juice product [14] which, not
surprisingly, will also carry over to the cider vinegar [7]. The
level of ripeness that the apples achieved may also affect the
final product. A study that examined the ripening stage of
apples on phenolic compounds in apple cider (non-alcoholic)
found that unripe apples yielded a product with a lower
phenolic content compared to ripened apples. The apples
used in production can also affect the microbial content of
the end product, with organic apples found to produce a more
heterogeneous product compared with conventional apples
[15]. The variations in microbiota may in turn influence the
organic components of ACV which may affect the health
promoting properties.
4. Organic Components of ACV
Acetic acid is the most abundant compound. Organic acids
from an analysis of a commercially produced ACV using
high resolution H NMR spectroscopy are found in Table 1.
ACV is well established that various types of phenolic
compounds are found in cider apples, particularly the
hydroycinnamic acid derivatives, oligomeric flavan-3-ols,
dihydrochalcones, and flavonols [16]. The phenolic content
of ACV will vary with cultivar and processing [17]. Phenolic
content of ACV was determined to consist of gallic acid,
catechin, epicatechin, chlorogenic acid, caffeic acid and
p-coumaric acid. Chlorogenic acid is the dominant phenolic
substance in ACV [6]. The total phenol content and
chlorogenic acid content appear to vary significantly
between different studies, possibly attributed to the different
ACVs being used.
Dietary polyphenols are natural phytochemical
compounds and include the phenolic acid chlorogenic acid, a
hydroxycinnamic acid derivative. Studies demonstrate rapid
absorption of the polyphenolic compounds from the intestine.
Many healthful benefits are attributed to polyphenols, such
as antioxidant, antiallergic, anti-inflammatory, anti-viral
and anti-microbial, anti-proliferative, anti-mutagenic,
anti-carcinogenic, free radical scavenging, and induction of
International Journal of Diabetes Research 2016, 5(6): 129-134 131
antioxidant enzymes [19, 20]. There is also some evidence of
modulation of signalling pathways such as nuclear factor
kappa-B (NF-κB) and mitogen-activated protein kinases
(MAPK) [16].
Table 1. Organic acids in ACV
Compound Concentration (g/L)
Acetic Acid 50.9
Citric Acid 0.02
Formic Acid 0.28
Lactic Acid 0.38
Malic Acid 3.56
Succinic Acid 0.27
Fructose 6.83
Acetoin 0.21
2,3-Butanediol 0.37
Ethanol 1.03
Ethyl acetate 0.14
Values adopted from Caligiani et al (2007) [18]
5. Management of Hyperglycaemia
Using ACV
Hemoglobin A1c (HbA1c) level measures the glycation of
hemoglobin, accurately identifies the average plasma
glucose concentration over the previous three months. A
study which investigated the effect acetic acid had on HbA1c
in type 2 diabetics, found that Hb1Ac values fell by 0.16%
units over the course of the 12-week trial, compared with
controls who did not ingest any vinegar, where HbA1c levels
rose by 0.06% [21]. HbA1c in diabetic rats was also
significantly lowered with ACV consumption [22].
Several mechanisms may explain the ways in which acetic
acid lowers plasma glucose have been suggested. These
include inhibition of disaccharidase activity [23-25] and/or
decrease in the hydrolytic enzyme α-amylase [26], delayed
gastric emptying [27, 28] and an enhanced glucose uptake
and conversion to glycogen in the periphery [23, 29, 30].
Delayed gastric emptying was noted in healthy subjects
who consumed white bread along with a white vinegar
dressing which contained olive oil (18mmol acetic acid in
20g vinegar). White vinegar is an aqueous solution
containing approximaetly 6% acetic acid. Gastric emptying
rate was indirectly measured through consumption of
paracetamol baked into white bread; the blood paracetamol
level was lower in the vinegar group compared with the
control group. During the postprandial phase subjects who
had consumed vinegar had significantly lower blood glucose
levels and the insulin response in these subjects was also
noted to be significantly lower compared with the reference
meal [28]. Paracetamol however, may be absorbed and
metabolised at different rates. Other research has also found
a link to acetic acid consumption with delayed gastric
emptying [27].
Recent investigation found that ACV had a stronger
ability to lower plasma glucose levels than acetic acid alone
[26]. This study found that it was not until day 7 that ACV
significantly reduced plasma glucose levels in diabetic mice.
ACV had comparable antiglycemic effects to the positive
control group treated with the anti-diabetic agent
sulfonylurea Glibenclamide. It was found that ACV treated
groups had a significant decrease in α-amylase. The ability
of ACV to have a stronger effect than acetic acid alone
suggests a role for other components of ACV in controling
hyperglycemia. Another study found that consuming two
tablespoons of ACV prior to sleeping was found to reduce
fasting glucose the following morning [25].
Furthermore, acetic acid was demonstrated to significantly
decrease the activites of the diasscharides sucrase, maltase,
trehalase and lactase in Caco-2 cells, but did not affect the
enzymes at transcriptional or translational levels. It was
suggested that suppression of the disacharrides may occur in
the post-translational processes, such as trafficking of the
enzymes to the cell membrane [24]. Consumption of 100mL
ACV (5% acetic acid) in diabetic rats demonstated a
significant decrease in the activity of maltase, sucrase and
lactase [23]. In addition, vinegar ingestion (10g) was found
to have no effect on postprandial glycemia (PPG) when only
monosaccharides were ingested while a meal of complex
carbohydrates consumed with vinegar did result in decreased
PPG, further indicating that a acetic acid may inhibit
disaccharidase activity [31].
Glycogen uptake by the liver and skeletal muscle was
found to be enhanced in mice fed a diet containing 2g acetic
acid/kg, a contentration that corrosponds to foods prepared
with vinegar. Acetic acid ingestion may inhibit glycolysis
through accumulation of glucose-6-phosphate and a
corrosponding increase in glycogen synthesis, which was
seen in liver and skeletal muscle of rats supplemented with
acetic acid [29, 32, 33], causing an anti-hyperglycemic effect.
Modulation of GK, G6PD and PFK in the liver of rats
consuming ACV has been associated with decreased plasma
glucose levels [23].
The quantity of acetic acid needed to exert effects has been
investigated and a significant dose-response relationship was
found in a study that examined the effects of ingestion of 18,
23 or 28g of white vinegar (6% acetic acid; equivalent to 18,
23, 28 mmol acetic acid, respectively) [34]. Compared with
the control, the highest concentration of acetic acid caused a
significant decrease in plasma glucose and insulin response
postprandially while the lower acetic acid concentrations did
lower blood glucose and insulin response, it was not
signifiant [34].
Chlorogenic acid has been demonstrated to have some
antiglycemic effects that may be useful in the management
of type 2 diabetes. 1mM of chlorogenic acid was found to
significantly inhibit glucose-6-phosphatase (G-6-Pase)
activity in rat hepatocytes. G-6-Pase promotes glucose
production through catalyzing steps in both gluconeogenesis
and glycogenolysis and inhition of this step can decrease
plasma glucose concentration [35]. Synthetic derivatives of
132 Joanna Morgan et al.: The Potential of Apple Cider Vinegar in the Management of Type 2 Diabetes
chlorogenic acid also have been shown to inhibit G-6-Pase
[36]. Liver perfusion experiments, however, did not find a
decrease in glucose production at various chlorogenic acid
concentrations, perhaps due to insufficent uptake of
chlorogenic acid by hepatocytes. However, 1mM
chlorogenic acid was able to significantly reduce the plasma
glucose peak during the oral glucose tolerance test in rats and
this is thought to be due to reduced activity of Na+-dependant
D-glucose transporters in brush-border membrane vesicles,
as administration of chlorogenic acid intravenously was
unable to achieve the same result [35, 37].
Insulin sensitivity was improved in human subjects with
both insulin resistance or type 2 diabetes when 20g of ACV
was consumed with a high-carbohydrate meal [38]. Animal
studies also demonstrated results suggesting improved
insulin sensitivity with chlorogenic acid infusion [39].
Improved insulin sensitivity results in increased glucose
uptake and hence lowered plasma glucose levels. A diet
supplemented with chlorogenic acid has also been shown to
significantly lower insulin levels in mice [40].
6. Management of Hypertension and
Diabetes may affect the autonomic nervous system and
endothelium which results in microvascular complication,
which in turn impairs the autoregulation of blood flow.
Diabetic subjects have been shown to have lower levels of
the vasodilator nitric oxide and increased levels of the
vasoconstrictor endothelin-1 which results in a state of
vasoconstriction [41]. A consequence of elevated blood
pressure is vascular damage which leads to cardiovascular
Acetic acid combined with vinegar were found to
significantly decrease blood pressure (21-30mmHg lower
than the control) and renin activity compared with controls
and subjects consuming only vinegar. A decrease in renin
and the subsequent release in angiotension II may be the
reason for lowered blood pressure. A decrease in aldosterone
was also seen. Both rice vinegar and acetic acid were given at
a concentration of 46.2g/L [42]. Rice vinegar is generally 4%
acetic acid [43], therefore the acetic acid given alone would
be more potent then the vinegar solution. It was suggested
that acetic acid may cause an increase in calcium absorption,
which in turn may cause an calcium influx into renin
secretory cells, inhibiting renin secretion [42]. A
combination of red wine vinegar and grape juice was also
found to decrease activity of angiotensin converting enzyme
(ACE) [44].
Type 2 diabetes is commonly associated with obesity and
weight loss is considered to be an important component in
the management of diabetes [2]. Acetic acid has been
proposed to have a role in reducing food intake. This may
occur as a result of the taste of acetic acid in vinegar and the
nausea it may induce from ingestion [45]. A study found that
supplementation of a meal with white vinegar increased the
subjective rating of satiety compared with a control group.
Improved satiety may result in lowered food consumption
and hence, weight loss [34]. A 12 week study found that
ingestion of both 75g and 150g of acetic acid significantly
reduced the bodyweight, body mass index (BMI), visceral fat
and waist circumference in comparison with a control group
Chlorogenic acid has been demonstrated to halt the cell
cycle of mouse embryo 3T3-L1 preadipocytes and arrest the
G1 phase, hence preventing proliferation. Preadipocytes
were inhibited in this study in both time- and dose-dependant
manner at a concentration of 100μM. Decreased
preadipocyte differentiation is just one proposed method to
reverse obesity [47]. Another recent study supplementing the
diet of mice on a high fat diet with 0.02% (w/w) chlorogenic
acid resulted in a significant 16% weight loss compared with
the control group and increased adiponectin levels [40].
7. Management of Dyslipidaemia
Type 2 diabetes is frequently associated with
dyslipidaemia. Part of management of the condition involves
attempting to achieve normal blood levels of total cholesterol,
low density lipoprotein (LDL), high density lipoprotein
(HDL) and triglycerides. Dyslipidaemia is highly correlated
with atherosclerosis.
7.1. Dyslipidaemia and ACV
Ingestion of ACV improved lipid profiles in both normal
and diabetic rats, decreasing triglycerides, total cholesterol
and LDL while increasing HDL. These effects became
pronounced after 4 weeks of treatment [23]. Further animal
studies found similar effects on plasma total cholesterol,
triglycerides, HDL and LDL levels [22, 48]. Other research
focused on healthy humans has found the same improvement
in lipid profile with ingestion of 30ml of ACV (4% acetic
acid) [49].
7.2. Dyslipidemia and Acetic Acid
Research studies examining the effect acetic acid has on
blood lipids found that rats fed a diet supplemented with
1% (w/w) cholesterol combined with acetic acid had
significantly lowered total cholestrol and triglycaride levels
compared with controls. Acetic acid was found to lower
liver ATP citrate lyase (ATP-CL) activity, liver
3-hydroxy-3-methylglutaryl-CoA content, all of which are
involved in lipid synthesis. Liver mRNA levels of sterol
regulatory element binding protein-1, ATP-CL and fatty acid
synthase were also found to be decreased. Faceal bile content
was found to be higher in the group fed acetic acid. Blood
lipids in rats fed acetic acid were decreased by both the
inhibition of lipogenesis in the liver and the increased
increment of cholesterol in faecal bile acid [50].
7.3. Dyslipidemia and Chlorogenic Acid
Supplementation of mice on a high fat diet with
International Journal of Diabetes Research 2016, 5(6): 129-134 133
chlorogenic acid significantly lowered plasma triglyceride
and total cholesterol concetrations compared with the control
group on a high fat diet. Adipose tissue triglycerides were
also found to be significantly lowered. Hepatic activity of
HMG-CoA reductase was lowered and fatty acid β-oxidation
levels increased with chlorogenic acid intake [40]. Studies
using obese, hyperlipidemic and insulin resistant (fa/fa)
Zucker rats which were infused with chlorogenic acid
(5mg/Kg body weight/day) found significant decreases in
fasting plasma cholesterol and triglycerides [39].
8. Conclusions
The ACV is a readily available product that is easily able
to be incorporated into meals. Large body of research has
demonstrated its beneficial properties as an entire product, as
well as the abilities of the individual components acetic acid
and chlorogenic acid. ACV may assist in controlling blood
glucose and lipids, weight loss and hypertension and
therefore may be helpful in the management of type 2
diabetes. ACV as a whole may be more effective than acetic
acid alone, although there is little research directly
comparing acetic acid and ACV. Consumption of the
‘mother of vinegar’ may also increase beneficial effects
compared with ACV lacking this component. Production
method of ACV has been shown to alter the components of
ACV, which may in turn affect the beneficial qualities.
Further investigation may be beneficial here to determine the
extent of the effect of production method. Consumption of
ACV may indeed be beneficial in the management of type 2
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  • ... [44][45][46] On the other hand, the most common methods which are used for the synthesis of CoFe 2 O 4 nanoparticles are co-precipitation, 47 solvothermal, 6 hydrothermal, 48 micro-emulsion, 48 and sol-gel methods. 1 Among these methods, sol-gel auto-combustion is known as an efficient technique to produce high purity and homogeneity crystalline particles with relatively low reaction temperature, low reaction time, and simple manipulations. 1,8,9,49 On the other hand, apple cider vinegar (ACV) is known as one of the inexpensive and nontoxic agents, 50 which is used in medicine and biotechnology 51,52 due to its antimicrobial, antibacterial, and antioxidant activities. 50 In spite of acetic acid, various kinds of phenolic compounds such as hydroxycinnamic acid derivatives, oligomeric flavan-3-ols, dihydrochalcones, and flavonols are found in ACV, 51 which as a biocompatible agent can be effective on the size, morphology, phase evolution, and magnetic properties of MNPs synthesized by sol-gel method. ...
    ... 1,8,9,49 On the other hand, apple cider vinegar (ACV) is known as one of the inexpensive and nontoxic agents, 50 which is used in medicine and biotechnology 51,52 due to its antimicrobial, antibacterial, and antioxidant activities. 50 In spite of acetic acid, various kinds of phenolic compounds such as hydroxycinnamic acid derivatives, oligomeric flavan-3-ols, dihydrochalcones, and flavonols are found in ACV, 51 which as a biocompatible agent can be effective on the size, morphology, phase evolution, and magnetic properties of MNPs synthesized by sol-gel method. For instance, Zhao et al 53 demonstrated that the size of nanoparticles decreases by addition of acetic acid derived from ACV. Abe et al 54 studied the biological functions of apple vinegar and found that the constituent neutral medium-sized alpha-glycan acts as an antitumor agent. ...
    ... The results obtained from the quantification by the proton nuclear magnetic resonance (1H-NMR) spectroscopy on a commercially produced ACV are reported by others. 51,55 As seen in Figure 1, the initial solution was prepared by dissolving citric acid in deionized water at room temperature, under vigorous magnetic stirring followed by addition of ferric nitrate nonahydrate (Fe(NO 3 ) 3 ·9H 2 O) and cobalt nitrate hexahydrate (Co(NO 3 ) 2 ·6H 2 O) in a stoichiometric ratio of 2:1. To investigate the effect of ACV presence, various amounts of ACV (5, 10, 15, and 20 mL) were added drop wise under stirring to achieve a homogeneous solution. ...
    In the present study, spinel structure CoFe2O4 nanoparticles were successfully synthesized by the ‎sol-gel auto-combustion technique. The effect of apple cider vinegar (ACV) addition as an ‎organic biocompatible agent on the size, morphology, and magnetic properties of CoFe2O4 ‎nanoparticles was investigated in detail. The phase evolution, particle size, and lattice parameter ‎changes of the synthesized phase have been estimated by using Rietveld structure refinement ‎analysis of X-ray powder diffraction data. Also, Fourier transform infrared spectra (FTIR) of the ‎samples verified the presence of two expected bands correspond to tetrahedral and octahedral ‎metal-oxygen complexes within the spinel structure. Furthermore, microstructural observations ‎revealed that ultrafine particles have a semi-spherical morphology. It is shown that the particles ‎size decreased from ~49 to ~17 nm with an increase in the amount of ACV. Magnetic properties ‎were carried out by vibrating sample magnetometer (VSM) at room temperature. Both the ‎saturation magnetization (Ms) and coercivity (Hc) were found to be significantly dependent on ‎the crystallite size and the amount of ACV.‎
  • ... It also contains amino acids and peptides, minerals, vitamins and polyphenolic compounds (Akanksha & Sunita, n.d.; Cocchi et al., 2006;Pazuch, Siepmann, Canan, & Colla, 2015). This substance has been shown to have beneficial properties such as antimicrobial and antioxidant activities, as well as antidiabetic functions in humans and animals (Morgan & Mosawy, 2016). ...
    ... ACV contains polyphenols and organic acids such as acetic acid, citric acid, formic acid, lactic acid, malic acid and succinic acid (Morgan & Mosawy, 2016). These constituents have been reported to have immunomodulatory effects (Pourmozaffar et al., 2017;Safari et al., 2016) by adjusting the innate immune response through binding to G protein-coupled receptor (mainly expressed on inflammatory cells) (Maslowski & Mackay, 2010 The results of a study showed a significant increase in the total IG and lysozyme activities in the serum of the common carp (C. ...
    The present study was designed to investigate the effects of dietary apple cider vinegar (ACV) on digestive enzyme activity and growth performance as well as immune responses and antibacterial activity of skin mucus in green terror (Andinoacara rivulatus). Fish were fed diets supplemented with 0%, 1%, 2% and 4% of ACV (40.830 ppm acetic acid concentration) for 63 days. The final weight and weight gain values were observed to be significantly higher in fish fed with 2% of ACV compared to the control group (p < .05). ACV inclusion in the diets had significant effects on SGR (%) and FCR values (p > .05). ACV treatment resulted in a significant increase in the intestinal protease, α‐amylase, lipase and alkaline phosphatase activities compared to control (p < .05). The activities of digestive enzymes in fish fed with 2% and 4% of ACV diets were significantly higher than the other groups (p < .05). The total protein content, alternative haemolytic complement, alkaline phosphatase, total immunoglobulins and lysozyme activities of skin mucus increased significantly in fish fed with ACV diets (p < .05). In conclusion, administration of ACV enhanced digestive enzyme activity, growth performance, immune responses and the immune properties of skin mucus, and it can be used as a natural growth promoter and immunostimulant in green terror culture.
  • ... Acetic acid and chlorogenic acid have more potential than other components of ACV for management of diabetes, lipid disorder, hypertension and for weight control [54]. ...
    ... About 4% of acetic acid can be found in rice vinegar and acetic acid is more potent as compared to the vinegar solution. Calcium absorption can be increased by acetic acid, an increase in calcium absorption may be helpful for blood pressure control [54] (Table 4). ...
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    Diabetes mellitus is a world-widely public health issue associated with premature mortality, decreased quality of life and increased health-care expenditures. The aim of the review was to elevate the effect of apple cider vinegar on glycemic control, hyperlipidemia and obesity control in type 2 diabetes patients. Many clinical trials showed the hypoglycemic, hypolipidemic and anti-obesity effect of vinegar. Proposed mechanisms action of vinegar for the hypoglycemic, hypolipidemic effect are including slow gastric emptying, it promotes uptake of skeleton muscles glucose in the body and acetic acid may inhibit disaccharides activity in the small intestine blocking the complete digestion of starch molecules, suppression of hepatic glucose production and increased glucose utilization. Results of previous studies showed that apple cider vinegar has the potential of anti-diabetic, antihyperlipidemic and anti-obesity effects in diabetes mellitus patients. Objective of review: The objective of the current review study was to investigate the effect of apple cider vinegar on glycemic control, hyperlipidemia and control on body weight in type 2 diabetes patients and other therapeutic and commercial effect of apple cider vinegar. Data sources: To collect data for relevant literature PubMed, Google Scholar, science direct and Cochrane sources were used.
  • ... 53 Apple cider vinegar (ACV) produced antihyperglycemic effect by the reduction of inflammatory response, reduced the oxidative stress-related markers and normalized the lipid profiles in the complication of Diabetes. 54 In 2016, studies of Morgan et al. 55 observed the protective effect of ACV on type II diabetes management. Based on the Meta analysis, it has been reported that apple products consumption (apple juice, sauce) was connected with a lower prevalence of obesity. ...
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    Alzheimer's disease (AD) is a neurological degenerative condition described by a progressive decline in memory and associated with dementia. This disease arises usually after 65 years in individuals. Oxidative stress is the major cause of dementia connected with Alzheimer's disease. Here there is an imbalance between the creation and clearance of amyloid β protein, which leads to accumulation of amyloid β plaque in the brain and produces neuronal cell death. Anti-Alzheimer's medications help to cover the symptoms of disease but do not cure the cause of disease. Confirmatory studies suggest that a healthy diet of fruits and green vegetables containing phenolic combinations may reduce the risk of Alzheimer's disease (AD). Apple cider vinegar (ACV) contains phenolic compounds like catechin, caffeic acid, gallic acid, chlorogenic acids and p-coumaric acid having high antioxidant potential. Phenolic compounds are not essential for survival but it can protect against various chronic diseases. Various researches showed that phenolic compounds cure β amyloid and tau protein correlated problems associated with AD. Regular consumption of these healthy substances in the diet may prevent the neuronal cells from oxidative stress which leads to AD. The purpose of this review is to highlight the health benefit role, functional property and therapeutic uses of Apple Cider Vinegar.
  • ... Their sour apples are consumed as fresh fruit or used for traditionally produced apple vinegar (Josifović, 1974). Because of its many health benefits, apple cider vinegar is a product of increasing interest (Solieri and Giudici, 2009;Morgan and Mosawy, 2016). Additionally, in Serbian traditional medicine, vinegar from wild apple fruits is used to strengthen the immune system to ward against cold, digestive, and hypertensive ailments (Zlatković et al., 2014). ...
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    A simple and efficient ultrasound extraction method for phenolic compounds in the pulp and peel of Malus sylvestris (wild apples) was developed using multivariate methodology. Optimal extraction conditions were obtained using this methodology for peel and pulp samples (2.0 g), including solvent volume 100 mL and 79 mL, methanol concentration 100% (v/v) and 20% (v/v), extraction time 33 min and 40 min, extraction temperature 65 °C and 80 °C, respectively. The peel and pulp extracts were analysed by HPLC-PDA using a C18 Phenomenex Kinetex column. Among the phenolic compounds present in our samples, we quantified (mg/g fresh weight) chlorogenic acid, 0.791; epicatechin, 1.18; and phloridzin, 0.106 in the pulp extract, whereas the peel extract contained chlorogenic acid, 0.568; epicatechin, 1.36; phloridzin, 0.207; catechin, 0.187; hyperoside, 0.261; and quercitrin, 0.256 mg/g. The antioxidant activity of the extracts was measured by spectrophotometric methods Peel extract proved to be a better antioxidant than pulp extract. Additionally, the stability of the analysed phenolic compounds was tested by in vitro digestion procedures. Simulated in vitro digestion showed that the concentrations of all analysed phenolic compounds (except chlorogenic acid) decreased during the intestinal phase of digestion.
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    This randomized, double-blind, clinical trial was designed to compare the endurance capacity (ergogenic property) in healthy athletes after consumption of apple cider vinegar (ACV) and a commercial sports drink (CSD) before and during endurance exercise. Fourteen healthy participants were enrolled in this trial and were divided into two groups as ACV and CSD with seven participants in each. Participants were requested to consume 500 mL of either commercial ACV or CSD one hour before endurance exercise (bicycle ergometer). Blood samples were collected at baseline, 0, 20, 40, 60 minutes until exhaustion to assess glucose, lactate, ammonia and non-esterified fatty acids (NEFA). Respiratory exchange rate (RER) score was measured every 15 minutes and the heart rate (HR) was measured every 5 minutes. The outcome of the present trial clearly showed that no significant differences were observed between ACV and CSD except in the blood level of ammonia (only at exhaustion time). Thus, these results show that ACV and the CSD both possessing the ergogenic property, enhanced blood glucose, NEFA, and suppress the production of lactate as well as maintains normal RER score, and HR throughout the endurance exercise. Overall this trial showcases that ACV did not significantly improve the ergogenic activity over the CSD.
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    The green tea extract epigallocatechin gallate (EGCG) has been demonstrated to exert various biological activities including anti-inflammatory, anti-oxidative, and anti-carcinogenic effects, as well as cardiovascular benefits. A limited number of studies have reported antiplatelet effects of EGCG. Furthermore, few studies have investigated its effect on the blood coagulation pathways. The aim of this study was to investigate the effects of EGCG on platelet aggregation and activation and plasma coagulation times. EGCG at 50 or 100 µM significantly inhibited turbidimetric ADP stimulated platelet aggregation. Furthermore, the same concentrations significantly inhibited ADP induced platelet surface expression of P-selectin as measured by CD62P fluorescence. Coagulation studies were performed using platelet poor plasma in the presence of EGCG. At the concentrations tested, ECGC did not alter the coagulation times of both prothrombin time and activated partial thromboplastin time. These results demonstrate that EGCG has an antiplatelet action without affecting the plasma coagulation cascade, suggesting that this green tea component could be used as a preventative strategy to lower the risk of thrombotic complications
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    Quercetin (Que) is one of the most abundant and potent naturally occurring antioxidant. Que has been shown to exert many biological activities, including antiplatelet activity. Indeed, Que was shown to inhibit platelet aggregation in response to platelet agonists, such as ADP, collagen, thrombin and arachidonic acid. However, the lowest Que concentration that significantly inhibits agonist-induced platelet aggregation remains contradictory. In addition, to anti-aggregatory effects, Que was demonstrated to inhibit platelet dense and alpha granule exocytosis when stimulated by different platelet agonists. Que was also shown to inhibit multiple platelet protein kinases, including, PI3K, Akt, PLC and PKC. The main aim of this review focuses on the inhibitory effects of Que on human platelet function.
  • Article
    Background: Apple Cider Vinegar (ACV) is an ancient folk remedy and it is common for patients with diabetes daily because of its positive effect on blood glucose and insulin sensitivity. The present study was undertaken to investigate the possible antihyperglycemic and antihyperlipidemic effects of ACV, particularly in terme of its inhibitory effects on some carbohydrate metabolising enzymes in the intestine and the livers in normal and diabetic rats. Materials and Methods: The assays of the present study were conducted on adult male Wistar rats. The animals were fasted overnight and diabetes mellitus was induced by an intraperitoneal injection of freshly prepared streptozotocin (STZ). Control rats were injected with citrate buffer only. The ACV was administrated orally during 4 weeks. Results: Our findings indicated that the admnistration of ACV significantly decreased intestinal maltase, sucrase and lactase and hepatic glucokinase (GK) activities which led to a significant decrease in blood glucose rate and an increase in hepatic glycogen levels. In addition to that, significant increase in hepatic phosphofructokinase (PFK) and glucose 6 dehydrogenase (G6PDH) was observed. Moreover, the treatment with ACV potentially inhibited key enzymes of lipid metabolism and absorption such as lipase activity in small intestine which led to a notable decrease in serum Total Cholesterol (TC), Low Density Lipoprotein-cholesterol (LDL-c) and triglyceride (TG) rates and an increase in High Density Lipoprotein-cholesterol (HDL-c) levels. The ACV was also observed to protect the liver-kidney functions efficiently, which were evidenced by the significant decrease in the serum aspartate and lactate transaminases (AST and ALT) activities and the level of total and direct bilirubin, creatinine and urea. Conclusion: The present findings showed that ACV significant improves glucose and lipid homeostatis in diabetes by delaying carbohydrate and lipid digestion and absorption.
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    Organic apple cider vinegar is produced from apples that go through very restricted treatment in orchard. During the first stage of the process, the sugars from apples are fermented by yeasts to cider. The produced ethanol is used as a substrate by acetic acid bacteria in a second separated bioprocess. In both, the organic and conventional apple cider vinegars the ethanol oxidation to acetic acid is initiated by native microbiota that survived alcohol fermentation. We compared the cultivable acetic acid bacterial microbiota in the production of organic and conventional apple cider vinegars from a smoothly running oxidation cycle of a submerged industrial process. In this way we isolated and characterized 96 bacteria from organic and 72 bacteria from conventional apple cider vinegar. Using the restriction analysis of the PCR-amplified 16S-23S rRNA gene ITS regions, we identified four different HaeIII and five different HpaII restriction profiles for bacterial isolates from organic apple cider vinegar. Each type of restriction profile was further analyzed by sequence analysis of the 16S-23S rRNA gene ITS regions, resulting in identification of the following species: Acetobacter pasteurianus (71.90%), Acetobacter ghanensis (12.50%), Komagataeibacter oboediens (9.35%) and Komagataeibacter saccharivorans (6.25%). Using the same analytical approach in conventional apple cider vinegar, we identified only two different HaeIII and two different HpaII restriction profiles of the 16S-23S rRNA gene ITS regions, which belong to the species Acetobacter pasteurianus (66.70%) and Komagataeibacter oboediens (33.30%). Yeasts that are able to resist 30 g/L of acetic acid were isolated from the acetic acid production phase and further identified by sequence analysis of the ITS1-5.8S rDNA- ITS2 region as Candida ethanolica, Pichia membranifaciens and Saccharomycodes ludwigii. This study has shown for the first time that the bacterial microbiota for the industrial production of organic apple cider vinegar is clearly more heterogeneous than the bacterial microbiota for the industrial production of conventional apple cider vinegar. Further chemical analysis should reveal if a difference in microbiota composition influences the quality of different types of apple cider vinegar.
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    Background: In recent years, apple cider vinegar has been singled out as an especially helpful health remedy. It has been widely used in various dosage forms in alternative medicine for several conditions such as diabetes and obesity. In this study, the effect of apple cider vinegar on blood glucose level has been evaluated. Methods: Intraperitoneal (IP) injection of streptozocin 40 mg/kg/day for 4 days was used to induce diabetes in mice. The mice were divided in six groups (n=10). Two concentrations of 0.16% and 1.6% of apple cider vinegar were used in drinking water for 21 days. Normal saline and acetic acid were used as negative controls and glibenclamide by IP injection (5mg/kg) as positive control. For studying any possible combination effects, 0.16% apple cider vinegar and glibenclamide were used together. Also, the effects of apple cider vinegar on glucose tolerance test and amylase serum concentration were evaluated. Results: Our results indicated that apple cider vinegar in both concentrations was not effective after 3 days of the start of its administration. However, on day 7 it reduced blood glucose levels significantly and this was maintained on days 14 and 21. Glucose tolerance test showed that apple cider vinegar was effective in lowering blood glucose level after 60 minutes of glucose administration and this was maintained up to 120 minutes. Also, in both concentrations significantly reduced serum amylase levels 21 days after the start of its administration. Conclusions: Therefore, in this study it has been revealed that apple cider vinegar has considerable reducing effect on blood glucose levels in diabetic mice. The mechanism of this action and its significance remain to be elucidated in future investigations.
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    Williopsis saturnus var. subsufficiens NCYC 2728, W. saturnus var. saturnus NCYC 22 and W. saturnus var. mrakii NCYC 500 were used to carry out cider fermentation to assess their impact on the volatile composition of cider. The changes of yeast cell population, °Brix and pH were similar among the three yeasts. Strain NCYC 500 grew best, with the highest cell population of 1.14 × 108 CFU ml−1, followed by strains NCYC 2728 and NCYC 22 (8 × 107 CFU ml−1 and 3.19 × 107 CFU ml−1 respectively). Esters were the most abundant volatiles produced, followed by alcohols. Among the esters, ethyl acetate, 2-phenylethyl acetate, isoamyl acetate, cis-3-hexenyl acetate and hexyl acetate were the major volatiles. The major alcohols were ethanol, isoamyl alcohol, 2-phenylethyl alcohol and isobutyl alcohol. The three Williopsis yeasts transformed volatile compounds during cider fermentation with significant variations in terms of volatile production and degradation. This study implied that fermentation with Williopsis yeasts could result in cider with a more complex yet fruity aroma.
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    Model experiment was carried out to investigate the effect of apple cider vinegar (ACV) on the blood and liver cholesterol (Ch), triglycerides (TG) and one of a marker of antioxidant status of blood (FRAP) in laboratory mice. Animals consumed a basal mice diet (Control) served as the control group. The same diet was supplemented either 1% cholesterol (Ch) or 1% edible sunflower oil (SFO). All groups were duplicated and their animals were supplied drinking water containing ACV (50 mg l-1)(groups: Control+ACV, Chol+ACV, SFO+ACV).The feeding and drinking was ad libitum for 21 days. At the end of experiment the animals were exterminated. Blood and liver samples were analyzed for total cholesterol (tCh), triglycerides (TG) and ferric reducing antioxidant power (FRAP). The results show that the Ch supplemented group stored higher concentration of tCh in the liver (P
  • Article
    A variety of natural vinegar products are found in civilizations around the world. A review of research on these fermented products indicates numerous reports of health benefits derived by consumption of vinegar components. Therapeutic effects of vinegar arising from consuming the inherent bioactive components including acetic acid, gallic acid, catechin, ephicatechin, chlorogenic acid, caffeic acid, p-coumaric acid, and ferulic acid cause antioxidative, antidiabetic, antimicrobial, antitumor, antiobesity, antihypertensive, and cholesterol-lowering responses. The aims of this article are to discuss vinegar history, production, varieties, acetic acid bacteria, and functional properties of vinegars.
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    Apple cider vinegar has been traditionally used since many years ago to treat a certain number of diseases including hyperlipidemia which is known as a risk factor for atherosclerosis. Early prevention and treatment of atherosclerosis can prevent complications of cardiovascular diseases. Hence, the present study aimed to review the influence of apple cider vinegar consumption on reducing blood lipid levels. This quasi-experiment study(time series design) was carried out on 19 patients with hyperlipidemia. The subjects had been referred to a cardiologist and agreed to consume apple cider vinegar. At baseline, blood samples were obtained to measure cholesterol, triglyceride, low density lipoprotein (LDL), and high density lipoprotein (HDL). The tests were repeated at two, four, and eight weeks of vinegar consumption. The results were analyzed using repeated measurement analysis. There were significant reduction in the serum levels of total cholesterol (p < 0.001), triglyceride (p = 0.020), and LDL (p = 0.001) after eight weeks of consuming apple cider vinegar and with an increased HDL levels but the trend was not statistically significant (p = 0.200). Consumption of apple cider vinegar over a 8 week period had a beneficial effect in significant reductions in harmful blood lipids and is recommended as a simple and cost-effective treatment for hyperlipidemia. Introduction Plasma lipoprotein abnormalities and lipid metabolism disorder are known and proved risk factors for atherosclerosis. 1 Besides their impact on mortality, they have substantial, and in some cases modifiable, influences on disability rates.