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


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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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... (10) One of the benefits of consuming apple cider vinegar is weight loss. (10)(11)(12) Apple cider vinegar contains organic acids, (13) flavonoids, (13,14) and vitamins. (15) The biggest content in apple cider vinegar is acid. ...
... (10) One of the benefits of consuming apple cider vinegar is weight loss. (10)(11)(12) Apple cider vinegar contains organic acids, (13) flavonoids, (13,14) and vitamins. (15) The biggest content in apple cider vinegar is acid. ...
... Acetate. The acetic acid in apple cider vinegar (6-9%) has the effect of losing weight (13) by increasing satiety. (16) The mechanism of acetic acid in increasing satiety, among others, is by slowing gastric emptying, (17) affecting palatability, (18) and increased proopiomelanocortin mRNA expression in the hypothalamus. ...
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LATAR BELAKANG Obesitas telah menjadi masalah global dalam sepuluh tahun terakhir. Angka kejadian obesitas yang terus bertambah menyebabkan meningkatnya jumlah kematian akibat berbagai penyakit terkait obesitas. Farmakoterapi obesitas yang ada saat ini terbatas dan memiliki berbagai efek samping. Cuka apel merupakan salah satu jenis bahan alamiah yang digunakan oleh masyarakat umum untuk menurunkan berat badan. METODE Penelitian ini merupakan penelitian eksperimental dengan menggunakan hewan coba. Sebayak 36 ekor tikus Spraque Dawley berusia 1-2 bulan diberikan diit tinggi lemak selama 5 minggu. Tikus dengan obesitas dibagi dalam 3 kelompok, yaitu kelompok kontrol, kelompok P1 yang diberi cuka apel dosis 0,096ml/100g/kali dan kelompok P2 yang diberi cuka apel dosis 0,192ml/100g/kali, masing-masing 2 kali sehari. Perlakuan diberikan selama 4 minggu. Berat badan dan sisa makanan ditimbang selama perlakuan. Data berat badan akhir dianalisa dengan uji Kruskal-Wallis dan selisih berat badan dianalisa dengan uji one-way ANOVA yang dilanjutkan dengan uji post hoc Turkey. HASIL Tidak ada perbedaan yang bermakna berat badan akhir antara 3 kelompok (p=0,55), namun terdapat perbedaan selisih berat badan bermakna antara kelompok kontrol dengan kelompok P1 (p=0,001) dan kelompok kontrol dengan kelompok P2 (p=0,000). KESIMPULAN Pemberian cuka apel dengan dua dosis berbeda pada penelitian ini memberikan efek penurunan berat badan pada tikus dengan obesitas
... Consumption of "mother of vinegar" may be more beneficial than consumption without it. Acetic acid and chlorogenic acid have more promise for diabetes, lipid disorders, hypertension, and weight loss than the other components of ACV [35]. When random blood sugar and insulin values were measured after 2 hours of meal intake, vinegar was more effective in high glycaemic index meal (low-fat milk and mashed potato) than in low glycemic index meal (lowfat cheese, whole grain, lettuce, etc.) with the same composition of nutrients in iso-caloric meal [35]. ...
... Acetic acid and chlorogenic acid have more promise for diabetes, lipid disorders, hypertension, and weight loss than the other components of ACV [35]. When random blood sugar and insulin values were measured after 2 hours of meal intake, vinegar was more effective in high glycaemic index meal (low-fat milk and mashed potato) than in low glycemic index meal (lowfat cheese, whole grain, lettuce, etc.) with the same composition of nutrients in iso-caloric meal [35]. ...
... Attempting to reach normal blood levels of total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), and triglycerides is a part of managing the condition. Atherosclerosis is strongly linked to dyslipidemia [35]. Impairment of insulin secretion, hepatic glucose overproduction and insulin resistance are the main causes of diabetes. ...
... This might be due to the presence of various minerals like potassium, magnesium, many nutrients and a high amount of acetic acid 9,10 . It has been found to contain various activities like antioxidant activity, antimicrobial activity, anti-diabetic activity, anti-obesity activity 11 . ...
... The test was conducted in triplicates and all the test tubes were vortexed for even distribution of samples added. The size of the crystals was monitored every 2 days by morphological examination at 10x magnification in a monocular microscope 10,11,12 . ...
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Kidney stones are aggregations of minerals such as calcium, oxalate, phosphates, uric acid, cysteine, etc. which can obstruct any part of the urinary system. This can turn fatal if left untreated as the major route of excretion is blocked causing the toxicity level to rise in the body which might lead to organ failure, coma and death. Limonia acidissima (wood apple) and Apple cider vinegar were found to contain phytoconstituents which are the bioactive components responsible for the anti-urolithiatic activity. Nucleation and aggregation of Calcium oxalate crystals was performed in presence of test samples were based on the percentage inhibition calculated, the mixture of samples gave the highest inhibition (37%) followed by wood apple (25%) and apple cider vinegar (9%). Calcium oxalate crystals were allowed to grow similarly where wood apple (113%) gave better inhibition when compared to apple cider vinegar (82%). The crystals obtained were microscopically monitored to correlate with obtained spectrophotometric results. Brushite crystals were grown synthetically by single gel diffusion and were exposed to the extracts. It was found that the mixture of samples synergistically inhibited the growth of crystals and also contributed towards the dissolution of the crystals. Surgically obtained kidney stones were subjected to degradation studies in the presence of the test extracts where the weight of stones was monitored periodically. The highest dissolution of the stones was observed in presence of mixture test extracts followed by wood apple and apple cider vinegar. The present study was successful in proving the synergistic effect of wood apple and apple cider vinegar towards the anti-urolithiatic activity.
... Using alternative therapies, such as consumption of functional foods, is one way to control diabetes and its complications. The tendency of using natural supplements or foods to treat chronic diseases has increased significantly during the recent years (8). One of the oldest fermented food products is apple cider vinegar (9). ...
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Background Numerous medical costs are spent each year on treating and preventing the progression of diabetes. The positive effect of apple cider vinegar (ACV) has been shown on post-prandial hyperglycemia. This study aimed to evaluate the effects of prolonged consumption of ACV on blood glucose indices and lipid profile in patients with type 2 diabetes. Methods This study was a randomized clinical trial and the participants were adults with type 2 diabetes. Participants were divided into two groups: ACV and control. The ACV group was treated with 30 ml of ACV per day. Both the intervention and control groups received the same recommendation for a healthy diet. Before and after eight weeks, fasting blood glucose, insulin, hemoglobin A1C, insulin resistance, total cholesterol (Chol), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride were measured. Results Fasting blood glucose decreased after intervention in both groups, which was only significant in the ACV group (p = 0.01). There was a significant difference in hemoglobin A1C levels between the two groups (p < 0.001) after eight weeks. LDL was decreased in the ACV group (p < 0.001). Total Chol, LDL/HDL and Chol/HDL ratio decreased after the intervention period in the ACV group compared to the control group (p = 0.003, p = 0.001 and p = 0.001, respectively). Conclusion Daily consumption of ACV may have beneficial effects in controlling blood glucose indices and lipid profile in patients with type 2 diabetes. Clinical trial registration , identifier IRCT20140107016123N13.
... 6 Apple cider vinegar (ACV) is mostly made of malic acid, which has anti-inflammatory and antibacterial characteristics. 7 The mineral content of ACV combats free radicals that harm the immune system and may have a role in the periapical healing process. Researchers in the field of dentistry are continually testing it as a chelating agent. ...
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Aim The purpose of the study is to compare and evaluate the efficacy of different root canal irrigants—100, 75, 50, and 25% neem extract, 100, 75, 50, and 25% apple cider vinegar (ACV), a combination of 5.25% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA), and saline on smear layer removal using a scanning electron microscope (SEM). Materials and methods A total of 80 freshly extracted single-rooted teeth were collected and divided into 10 groups—group I: normal saline (negative control), group II: NaOCl with EDTA (positive control), group III: 100% neem extract, group IV: 75% neem extract, group V: 50% neem extract, group VI: 25% neem extract, group VII: 100% ACV, group VIII: 75% ACV, group IX: 50% ACV, and group X: 25% ACV. The samples were irrigated with a specific group of irrigants, then split in a longitudinal axis and processed for analysis in an SEM. Microphotographs were obtained and scored according to Torabinejad et al. Results Microphotographs were assessed and showed that 100% neem extract was similar to NaOCl with EDTA, followed by 75% neem extract and 100% ACV. Conclusion This study showed that 100% neem extract removed the smear layer, similar to the NaOCl with EDTA. How to cite this article Sudhakar S, Gupta N, Ghambir N, et al. Comparative Evaluation of Intracanal Smear Layer Removal by Different Root Canal Irrigants: A Scanning Electron Microscope Study. Int J Clin Pediatr Dent 2023;16(4):633–638.
... Rates of diabetes have increased more than 400% in the past 30 years, mostly as type 2 diabetes (T2D) (4). The near 15% prevalence rate of diabetes in the U.S. (5), as well as increased rates of diabetes in low-and middle-income countries throughout the world (6), has led to a determined search for dietary approaches that may reduce the burden of this disease (1,7,8). In particular, diets rich in fermented foods have been reported to be associated with reduced risk of T2D (9)(10)(11). ...
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Introduction Kombucha is a popular fermented tea that has attracted considerable attention due, in part, to its suggested health benefits. Previous results from animal models led us to hypothesize kombucha may reduce blood sugar levels in humans with diabetes. The objective of this pilot clinical study was to evaluate kombucha for its anti-hyperglycemic activities in adults with diabetes mellitus type II. Methods The study was organized as a prospective randomized double-blinded crossover study at a single-center urban hospital system. Participants ( n = 12) were instructed to consume either a kombucha product or a placebo control (each 240 mL) for 4 weeks. After an 8-week washout period, participants consumed the alternate product. Fasting blood glucose levels were self-determined at baseline and at 1 and 4 weeks during each treatment period. Secondary health outcomes, including overall health, insulin requirement, gut health, skin health, mental health, and vulvovaginal health were measured by questionnaire at the same time points. The kombucha microbiota was assessed by selective culturing and 16S rRNA gene (bacteria) and ITS (fungi) sequencing. Fermentation end products were assessed by HPLC. Statistical significance of changes in fasting blood glucose was determined using paired, two-tailed student’s t -tests. Results Kombucha lowered average fasting blood glucose levels at 4 weeks compared to baseline (164 vs. 116 mg/dL, p = 0.035), whereas the placebo did not (162 vs. 141 mg/dL, p = 0.078). The kombucha microbiota, as assessed by cultural enumeration, was mainly comprised of lactic acid bacteria, acetic acid bacteria, and yeast, with each group present at about 10 ⁶ colony forming units (CFU)/mL. Likewise, 16S rRNA gene sequencing confirmed that lactic acid and acetic acid bacteria were the most abundant bacteria, and ITS sequencing showed Dekkera was the most abundant yeast. The primary fermentation end products were lactic and acetic acids, both less than 1%. Ethanol was present at 1.5%. Discussion Although this pilot study was limited by a small sample size, kombucha was associated with reduced blood glucose levels in humans with diabetes. Larger follow-up studies are warranted. Clinical trial registration , identifier NCT04107207.
... Apple vinegars contain various bioactive components such as polyphenols (Budak et al., 2015;Bakır et al., 2016) showing anticancer activity (Abdal Dayem et al., 2016). The difference in antiproliferative activity between commercial and homemade vinegars may be attributed to the difference in vinegar composition, which is the result of many different variables in the production process (Morgan and Mosawy, 2016). ...
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Vinegar is an aqueous food product made by a succession of yeast and acetic acid bacteria activities from fruits that contain high carbohydrates such as apples and grapes. Vinegar has been used as a dietary spice and natural remedy since ancient times due to its therapeutic properties including antimicrobial, antidiabetic, and anticancer activities. It has been shown that some bioactive compounds exhibiting antioxidant activity in vinegars lead to anticancer activity. The aim of the present study was to investigate antiproliferative effect of commercial and home-made apple vinegars in native and neutralized form on myeloma cells. In order to neutralize the vinegars, sodium hydroxide (NaOH) was used. A serial twofold dilutions of the vinegars (50%, 25%, 12.5%, 6.25%, 3.12%, 1.56%, 0.78%, 0.39%) prepared with cell medium were treated to the cells. The MTT (3-(4.5-Dimethylthiazol-2-yl)-2.5-Diphenyltetrazolium Bromide) assay was used to determine the cellular viability in the cells treated with the vinegars. In this study, while commercial vinegar possessed a stronger antiproliferative activity than home-made vinegar, all native vinegars possessed stronger antiproliferative effect than neutralized vinegars. Interestingly, when home-made vinegar (both native and neutralized) concentrations were from 6.25 to 1.56%, the cell viability increased. Apple vinegar exhibited antiproliferative activity on myeloma cells; however, further studies are required to clarify the mechanisms underlying this activity.
... Insulin resistance is considered to be present when normal circulating concentrations of insulin are insufficient to appropriately regulate the distribution of glucose due to an impaired response to insulin (Hussain, Tan et al., 2020). Although numerous studies have shown that FAJ could prevent T2DM (Morgan & Mosawy, 2016, Kausar, Humayun et al., 2019, only very few studies have focused on the effect of FAJ on insulin resistance. For example, ACV ingestion raised wholebody insulin sensitivity during the 60-min postmeal interval in insulinresistant subjects (Johnston, Kim et al., 2004). ...
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Chronic non-communicable diseases are one of the major human health challenges in the 21st century. Fermented apple juice rich in polyphenols has a beneficial effect on the prevention of non-communicable diseases. This review illustrates that the fermentation process involved in biotransformation significantly changes the composition and content of polyphenols in cloudy apple juice related to apple varieties, fermentation types, and fermentation strains. The enzymatic transformation reaction converts polyphenols into small molecules phenolic compounds with higher biologically activity. These small molecular weight active substances could help prevent cardiovascular disease and type 2 diabetes mellitus by mediating the AMPK pathway, the Nrf2 signaling pathway, the polyol pathway, and the NF-κB pathway. Moreover, this review is intended to provide a systematic theoretical basis for researchers to further study the bioactive function of fermented apple juice for the first time.
MV was reported to have beneficial effects in ameliorating insulin resistance in db/db mice, but the intrinsic mechanisms for glucose homeostasis are unclear. This study examined the anti-diabetic mechanism of MV using HepG2 cells and C57BL/KsJ-db/db mice. MV increased insulin sensitivity by promoting insulin-dependent glucose uptake and activating glycogen accumulation in HepG2 cells. Furthermore, the glucose homeostasis was enhanced in db/db mice administered 1 mg/kg/day of MV for eight weeks by activating the IRS-1/PI3K/Akt and AMPK pathways in the skeletal muscle and liver tissue. In addition, MV promoted glycogen synthesis by regulating the key enzymes, including GSK-3β and GS, and suppressed gluconeogenesis by inhibiting the mRNA expressions of G6pase and PEPCK. These findings show that MV regulates both signaling pathways and improves the glucose metabolism disorder. Thus, MV might be an alternative functional food or nutraceutical in ameliorating T2DM. Supplementary information: The online version contains supplementary material available at 10.1007/s10068-022-01146-4.
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medicine and food preservation. The phytochemical content of AV has been reported to be influenced by several factors. This study was, therefore, conducted to investigate the effects of production methods and varietal profile on the phytochemical content and antioxidant activity of AV. Four varieties of apple; Red Delicious (V1), Gala (V2), Golden Delicious (V3), and Starking Delicious (V4) were employed for the study. The V3 variety was used to prepare AV using three different methods; cutting apple into small pieces (AP), filtering apple juice (AJ), and crushing apple (CA). Then, the vinegar samples were prepared using the AP method for fermenting the four varieties of apple. Free radical scavenging activity and total antioxidant capacity were evaluated. The results obtained showed that the V1 variety is rich in flavonoids, and the V2 and V3 varieties are rich in flavones and flavonols, while the V4 variety contains a significant amount of carotenoids. Also, it was observed that the highest antioxidant activity was obtained in the AV prepared from the V1 variety and by CA method with IC50 values of 770.333 and 75.507 µg/mL, respectively. The highest total antioxidant capacity value of 822.266 µg EAA/mL was recorded for the V4 variety. Therefore, the findings from this study elucidate that varietal profile and production methods influence polyphenol content and antioxidant activity of AV. Keywords: Antioxidant activity, Apple vinegar, Polyphenols, Production method.
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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.
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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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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
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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.
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.
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.
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.