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Vinegar intake is considered a food item that improves blood glucose in humans. This review aimed to discuss studies that investigated the impact of vinegar intake on the glycemic profile in humans and the putative mechanistic cellular pathways in both human and animal models. A search of literature was performed on the Cochrane, MEDLINE and Web of Science databases for articles published between 1995 and 2018. There is considerable support for vinegar having a positive acute effect on blood glucose levels when combined with carbohydrate-rich meals. Conversely, there are few chronic interventions analyzing the impact of vinegar intake on blood glucose. Based on available evidence, we hypothesize three pathways by which vinegar may improve blood glucose: The inhibition of α-amylase action; increased glucose uptake; and mediation by transcription factors. When evaluating the current body of literature, daily vinegar intake in amounts of ∼10-30 mL (∼2-6 tablespoons) appear to improve the glycemic response to carbohydrate-rich meals; however, there is a paucity of studies investigating chronic effects of vinegar intake.
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Vinegar (acetic acid) intake on glucose metabolism: A narrative
Heitor O. Santos
, Wilson M.A.M. de Moraes
, Guilherme A.R. da Silva
Jonato Prestes
, Brad J. Schoenfeld
School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil
Graduation Program on Physical Education, Catholic University of Brasilia (UCB), Brasília, Federal District, Brazil
Federal University of the State of Rio de Janeiro (UNIRIO), Brazil
Department of Health Sciences, CUNY Lehman College, Bronx, NY, USA
article info
Article history:
Received 16 May 2019
Accepted 17 May 2019
Vinegar intake is considered a food item that improves blood glucose in humans. This review aimed to
discuss studies that investigated the impact of vinegar intake on the glycemic prole in humans and the
putative mechanistic cellular pathways in both human and animal models. A search of literature was
performed on the Cochrane, MEDLINE and Web of Science databases for articles published between 1995
and 2018. There is considerable support for vinegar having a positive acute effect on blood glucose levels
when combined with carbohydrate-rich meals. Conversely, there are few chronic interventions analyzing
the impact of vinegar intake on blood glucose. Based on available evidence, we hypothesize three
pathways by which vinegar may improve blood glucose: The inhibition of
-amylase action; increased
glucose uptake; and mediation by transcription factors. When evaluating the current body of literature,
daily vinegar intake in amounts of ~10e30 mL (~2e6 tablespoons) appear to improve the glycemic
response to carbohydrate-rich meals; however, there is a paucity of studies investigating chronic effects
of vinegar intake.
©2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights
1. Introduction
For centuries, vinegar has been widely used as a dietary spice and
natural remedy for various ailments in folk medicine. Moreover, it is
considered a super foodby laypersons, purported to improve
weight loss, digestion and skin quality; so much so that there are
even vinegar diets. The earliest report dates back 2300 years
whereby Hippocrates (c. 420 BC) used vinegar for wound care [1].
Vinegar is a sour-tasting liquid obtained from the anaerobic
conversion of sugars to ethanol by yeasts and aerobic oxidation of
ethanol to acetic acid by bacteria. It may be classied in accordance
with raw materials grain vinegar, such as those obtained from rice
and wheat, or as fruitvinegars, including juices from grape, apple
and coconut [2].
Over the past few decades the prevalence of disorders related to
glucose homeostasissuch as Type 2 diabetes mellitus(T2DM), obesity
and nonalcoholic fatty liver disease has dramatically increased
throughout most of the world [3,4]. Despite many efforts, the current
therapeutic options for the treatment of these disorders remain far
from satisfactory, in part due to serious side effects following phar-
macologic treatment [5].Therefore,newcompoundswithpotential
preventive and therapeutic effects are continually being sought.
A plethora of benets have been proposed for the intake of
vinegar as a non-pharmacological alternative for subjects with
diabetes [1,6,7]. In addition, acetic acid, one of the major compo-
nents of vinegar, is a potential modulator of glucose metabolism in
horses and rodents [8e11]. Hence, the aim of this narrative review
is to provide an overview as to the impact of acute and chronic
vinegar intake on the glycemic prole.
2. Method
A search of literature was performed on the Cochrane, MEDLINE
and Web of Science databases for articles published between 1995
and 2018 using the following combinations of keywords: acetic
*Corresponding author. Federal University of Uberlandia, Av. Para, nº1720 Bloco
2U Campus Umuarama, 38400-902, Uberlandia, Minas Gerais, Brazil.
E-mail address: (H.O. Santos).
Contents lists available at ScienceDirect
Clinical Nutrition ESPEN
journal homepage:
2405-4577/©2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.
Clinical Nutrition ESPEN xxx (xxxx) xxx
Please cite this article as: Santos HO et al., Vinegar (acetic acid) intake on glucose metabolism: A narrative review, Clinical Nutrition ESPEN,
acid blood glucose,apple cider vinegar,apple cider vinegar
health,vinegar blood glucose,vinegar blood insulin,vinegar
diabetes. Human interventions that performed glycemic
analyses with vinegar ingestion were included. Moreover, animal
studies were included to help elucidate potential mechanisms
of action.
3. Mechanism of actions in animal studies
Nakao et al. [12] submitted rats to a protocol of exhaustive
swimming and observed that immediate post-exercise provision of
a combination of acetic acid plus glucose resulted in higher liver
glycogen stores than either glucose or acetic acid alone within 2 h
after exercise. This nding suggests that consumption of oral acetic
acid with glucose can facilitate liver glycogen restoration during the
early period of recovery. It should be noted that effects of acetic acid
on glycogen repletion were only apparent when simultaneously
consumed with glucose, a precursor of glycogen synthesis. Simi-
larly, Fushimi et al. [8] pre-conditioned rats to 7 days of swimming
exercise and then, after an overnight fast, submitted them to a 2-h
swimming bout. Following the bout, the rodents were fed glucose
with or without provision of acetic acid. Results indicated that
acetic acid led to a greater preservation of soleus and gastrocne-
mius glycogen content, and this effect was dependent on the acti-
vation of glycogen synthase.
Research by Fushimi et al. [8e10] found that acetic acid de-
creases the synthesis of the enzymes xylulose-5-phosphate and
fructose-2,6-biphosphatase in the liver, and also the ratio of fruc-
tose-1,6-bisphosphate to fructose-6-phosphate in skeletal muscle.
It hence decreases the activity of phosphofructokinase-1 and he-
patic malonyl-CoA (Fig. 1). Furthermore, since malonyl-CoA allo-
sterically inhibits carnitine palmitoyl-transferase, its inhibition
provides an increase in the action of carnitine palmitoyl-transferase
and consequently in
-oxidation. This increase of hepatic
tion is a possible mechanism that corroborates the results of Kondo
et al. [13], who reported a decrease in visceral fat in patients sub-
mitted to vinegar intake.
Pan et al. [14] demonstrated that oral administration of acetic
acid (10 mL/kg body weight once daily) in mice subjected to 8
weeks of treadmill exercise promoted a greater expression of AMP-
activated protein kinase (AMPK), phosphorylated AMPK (pAMPK),
peroxisome proliferator-activated receptor delta (PPAR
) mRNA,
and peroxisome proliferator-activated receptor gamma coactivator
1-alpha (PGC-1
) levels in the soleus muscle. Moreover, acetic acid
increased myosin heavy chain (MHC) oxidative type I and mixed
oxidative-glycolytic type IIa expression, while increasing the IIb
isoforms; results indicative of an enhanced endurance exercise
capacity. Taken together these ndings suggest that both acute and
chronic acetic acid ingestion can optimize the restoration of muscle
glycogen and increase fatty acid oxidation. The proposed mecha-
nisms are illustrated in Fig. 2.
4. Mechanism of actions in human studies
Mitrou et al. [15,16] showed that enhanced stimulation of
glucose uptake caused by apple cider vinegar consumption may, at
least partly, reduce the need for insulin secretion. To investigate
these mechanistic actions, eleven insulin-resistant individuals
were randomized to receive either 30 mL of apple cider vinegar or
placebo before a test meal consisting of bread, cheese, ham, orange
juice, butter and a cereal bar (equivalent to 75 g of carbohydrates).
Compared with placebo, results showed that vinegar intake
decreased insulinemia, while increasing blood ow and glucose
uptake [15]. Several studies corroborate the ndings of Mitrou
et al., lending support to the hypothesis that the glycemic benets
of vinegar may be attributed to an improvement in glucose uptake
[8e10]. Waller et al. (2009) provided horses with a hypertonic so-
dium acetate-acetic acid solution via nasogastric gavage followed
by a typical hay-grain meal (acetate treatment) or a hay-grain meal
alone (control treatment) after exhaustive exercise [11]. Acetate
supplementation resulted in an enhanced rate of muscle glycogen
resynthesis in skeletal muscle during the initial 4 h of the recovery
Fig. 1. Blood glucose improvement hypothesis through acetic acid action in the
musculoskeletal system and liver. Rats fed acetic acid, which is a substance found in
vinegars that improves glucose metabolism, exhibit lower glycolysis in the liver and
musculoskeletal system, thus improving the glycogen restoration [8e10]. The known
glycolysis inhibition by acetic acid in rats is represented by an X symbol.
Fig. 2. Exercise training, coupled with vinegar intake, may improve glucose uptake
and increase expression of genes involved in mitochondrial respiration and fatty acid
oxidation [14]. Acetic acid across vinegar may promote fatty acid oxidation, sparing of
muscle and liver glycogen utilization during exercise by AMPK stimulation, which
optimizes muscle glycogen replacement and enhances glucose uptake after exercise.
AMPK phosphorylation/activation results in GLUT4 translocation from intracellular
storage depots to the plasma membrane (1) and activation of PGC-1
and its trans-
location to the mitochondria (2) and nucleus (3). In the mitochondria, PGC-1
additional transcription factors, which thereby increases the expression of key mito-
chondrial proteins involved with mitochondrial biogenesis, potentially culminating in
improved endurance capacity. Among lipid pathways, elevated free fatty acids activate
the nuclear transcription factor PPAR-
(4), whereas increased expression of the CPT1,
HSL and UCPs proteins, as well as inhibition of muscle ACC2, mediate reduction in the
lipogenesis (5). AMPK, AMP-activated protein kinase; HSL, hormone-sensitive lipase;
mtDNA, mitochondrial DNA; nDNA, nuclear DNA; pAMPK, phosphorylated AMPK;
, peroxisome proliferator-activated receptor gamma coactivator 1-alpha; PPAR-
Peroxisome proliferator-activated receptor delta; UCP, uncoupling protein.
H.O. Santos et al. / Clinical Nutrition ESPEN xxx (xxxx) xxx2
Please cite this article as: Santos HO et al., Vinegar (acetic acid) intake on glucose metabolism: A narrative review, Clinical Nutrition ESPEN,
5. Vinegar action during carbohydrate digestion
Given that an alkaline condition is required for optimal carbo-
hydrate digestion [17], the acid properties of vinegar can result in
hindered absorption when consumed with a carbohydrate-rich
meal (Fig. 3). This is supported by in vitro data showing that a
decrease in pH below 4.0 inactivates
-amylase [18]. However, a
recent in vivo study found that
-amylase hydrolyzed up to 80% of
bread starch in the rst 30 min of gastric digestion [19]. Therefore,
given that the pH of commercially marketed vinegars is about 2e3
[1,20], its consumption may inactivate the salivary
-amylase ac-
tion and decrease its release until nutrients reach the small intes-
tine, whose passage is responsible for 30e40% of complex
carbohydrate digestion [17]. Furthermore, vinegar acid does not
appear to damage the stomach lining, since its pH is less acidic than
gastric juice and common acidic beverages (e.g. lemon Juice and
Coca-Cola®Classic) (Table 1).
6. Acute impact of vinegar intake following carbohydrate-
rich meals
Johnston et al. [24] sought to test the hypothesis that vinegar
intake decreases the postprandial glycemic response only in meals
composed of complex carbohydrates. Employing a crossover
design, diabetics (n ¼9) and non-diabetics (n ¼29) received 10 g of
apple cider vinegar added to the test meal of a bagel and orange
juice or dextrose and orange juice. Compared to placebo (without
vinegar), glycemia was 20% lower in the area under the curve
120 min after the meal, whilst the consumption of vinegar with
dextrose did not show any glycemic improvement [24].
Since publication of the seminal study by Brighenti et al. (1995),
in which vinegar in the form of salad dressing signicantly altered
the glycemic response to a mixed meal [25], a number of studies
have endeavored to further investigate this topic in healthy sub-
jects (Table 2) and in those with glucose disturbances (Table 3). As
noted in these tables, most of the studies supporting a role for
vinegar as a glucose-lowering nutraceutical are based on acute tests
on its interaction with carbohydrate-rich meals. The usual studied
dose is 20 g of vinegar per meal [25e30], which is equivalent to 1 g
of acetic acid [26]. Converting to homemade measures, 20 g of
vinegar corresponds to approximately 4 tablespoons [26].
7. Impact of vinegar intake based on chronic interventions
Chronic interventions show that vinegar can improve glycemic
and lipid proles in those with type 2 diabetes (T2DM) and dysli-
pidemia [37,38]. Mahmoodi et al. divided 60 patients with T2DM
into two groups: 15 mL intake of apple cider vinegar per day or
control [37]. After one month, subjects who ingested vinegar
decreased glycemia and glycated hemoglobin (HbA1c) from
175 mg/dL to 156 mg/dL and from 7.56% to 7.03%, respectively. In
another study, hyperlipidemic subjects (14 men and 5 women
subjects) who consumed 30 mL of apple cider vinegar twice daily
for 8 weeks decreased serum concentrations of total cholesterol
(45 in men and 51 mg/dL in women), triglycerides (105 in men
and 109 mg/dL in women) and LDL (39 in men and 20 mg/dL in
women) from baseline, whereas HDL levels did not change [39].
Alternatively, a parallel, randomized, double-blind, placebo-
controlled study of 97 participants found that daily consumption of
Fig. 3. Blood glucose improvement hypothesis through vinegar action in the
-amylase inhibition. When vinegar is ingested alongside carbohydrates-rich meals, a blood glucose
improvement is believed to occur due to the
-amylase inhibition. Hence, there should be lower carbohydrate digestion until the nutrients reach the stomach,which results in lower
blood glucose levels.
Table 1
pH of common vinegar types and other substances Adapted from Reddy et al.,
2016; Tawo et al., 2009; Zandim et al., 2004 [21e23].
Common food items and substances pH
Hydrochloric Acid (1 mol/L) <1.0
Gastric Juice 1e3
Lemon Juice 2.3
Coca-Cola®Classic 2.4
Rice Vinegar 2.5
White Wine 2.5
Apple Vinegar 2.7
Ethanol 2.8
Teas 2.9e5.2
Pineapple 3.3
Balsamic Vinegar 3.4
Orange 3.6
Tomato 4.2
Coffee 5.1
Urine 6.0
Distilled Water 5.9
Pure Water 7.0
Blood 7.4
Baking Soda Solution 8.4
Toothpaste 9.9
Milk of Magnesia 10.5
Sodium Hydroxide (1 mol/L) 14.0
H.O. Santos et al. / Clinical Nutrition ESPEN xxx (xxxx) xxx 3
Please cite this article as: Santos HO et al., Vinegar (acetic acid) intake on glucose metabolism: A narrative review, Clinical Nutrition ESPEN,
30 mL of apple cider vinegar for two months did not improve lipid
and HbA1c levels; however, the subjects were non-diabetics with
normal lipid concentrations [38].
The longest study analyzing vinegar intake lasted twelve weeks
[13]. Overweight Japanese patients were divided into one of three
groups: 15 mL of apple cider vinegar (n ¼51), 30 mL of apple cider
vinegar (n ¼54), or placebo (n ¼50). In contrast to most of the
acute studies and short-term studies, glycemic prole did not
change (glycemia remained ~90 mg/dL, insulinemia ~10
and HbA1c ~5.3%). However, there was a reduction of serum tri-
glycerides and visceral fat in the groups that ingested vinegar.
Interestingly, participants who consumed 30 mL of apple cider
vinegar showed a 41 mg/dL (157e116 mg/dL) reduction in serum
triglycerides, but levels returned to baseline four weeks after of the
end of intervention. Serum cholesterol levels also decreased in the
group consuming a higher vinegar intake (220e207 mg/dL), while
HDL and LDL levels did not change. Body weight decreased by two
kilograms (from 73 to 71 kg) in the group ingesting 30 mL of vin-
egar per day, while the group that ingested 15 mL/day lost one kg
(from 74 to 73 kg). Alternatively, the placebo group presented a
slight body weight increase (200 g). Notwithstanding, this study
had a number of controls that enhanced validity, including equating
caloric intake between groups (~1800 calories/d), limiting alcohol
intake, avoiding functional foods, and prohibiting vinegar con-
sumption other than that provided in the study. Thus, given the
greater fat loss reported in the vinegar groups compared to con-
trols, vinegar can be considered more effective than many ther-
mogenic supplements touted as fat burners [40,41].
Vinegar use shows promise for the treatment of polycystic ovary
syndrome (PCOS). Wu et al. [42] demonstrated that consumption of
a beverage containing 15 mL of apple cider vinegar for 90e110 d
resulted in decreased markers of insulin resistance in six of the
seven subjects and reduced the luteinizing hormone/follicle-
stimulating hormone ratio in ve of the subjects. Moreover,
ovulatory menstruation was restored within 40 days in four of the
subjects. While these ndings are intriguing, the study was limited
by a small sample size and lack of a control group.
8. Side-effects
Chronic intake of excessive amounts of vinegar can cause
serious health problems. A large administration of apple cider
vinegar regularly for 6 years was associated with high urinary
excretion of potassium, sodium and bicarbonate and stimulated
plasma renin activity in a 28-year-old patient admitted to the
hospital because of muscle cramps and hypokalemia. The patient
ingested ~250 mL of vinegar (i.e. 12.5 g of acetic acid) per day
diluted in water and as salad dressing [43]. Moreover, acute vinegar
intake was implicated as a causal factor of ulcerative injury to the
oropharynx and oesophagus in a case report of a 39-year-old
woman who drank one tablespoon of white vinegar to softencrab
shell stuck in her throat [44].
Unsubstantiated statements by the media may unduly inuence
the lay public to incorrectly administer vinegar therapeutically. For
example, a 72-year-old Caucasian man with history of dyslipidemia,
gastroesophageal reux disease and mild obesity added 2 table-
spoons daily of acetic acid (household vinegar) to his diet after
reading an article in a health magazine that claimed vinegar helps
to decrease food intake (by promoting satiety) and lowers choles-
terol. Nine days later, the individual was admitted to the hospital
with intractable singultus (hiccups), associated with anorexia and
epigastric pain [45]. In another instance, a 14-year-old girl received
chemical burns after following an Internet-based protocol for nevi
removal using apple cider vinegar [46]. Vinegar also caused
chemical burns to the face in an 8-year-old girl after her aunt
applied a vinegar-containing solution in an effort to alleviate
pediculosis capitis [47]. Topical incidents associated with vinegar
have been reported in adults, as well. A home-made poultice
Table 2
Acute effects of vinegar intake on glycemic parameters of health subjects.
Author and year n Study design Intervention meal Outcomes
Brighenti et al., 1995
5 Crossover, placebo-
100 g of chopped lettuce with olive oil, or olive oil
plus 1 g of acetic acid in vinegar form or vinegar
neutralized through sodium bicarbonate. After
ingestion of the seasoned lettuce, 50 g of white
bread was consumed
Blood glucose, analyzed before, and up to 95 min
after meals, was 31% lower when they ingested
lettuce salad with the dressing containing vinegar
than the other tested meals
Liljeberg and Bj
1998 [28]
10 Crossover, placebo-
On the rst day patients received 122 g of white
bread, 8 g of olive oil and 23 g of cheese; on the
second day they received the same meal with 20 g
of vinegar
When individuals ingested the sandwich with
vinegar, compared to that without vinegar, the
blood glucose and postprandial insulinemia were
reduced within 30e60 min
Johnston and Buller,
2005 [27]
11 Randomized, crossover,
20 g of apple cider vinegar added in test meals
composed of bread and orange juice (glycemic
load ¼81). Additionally a lower glycemic load meal
(glycemic load ¼48) was analyzed, which
contained 200 g of rice and 50 g of chicken breast,
both cooked
Higher glycemic load meals ingested with vinegar
resulted in postprandial glycemia 55% lower than
meals without vinegar. There was no glycemia
improvement when vinegar was ingested along
with the lower glycemic load meal
Ostman et al., 2005
12 Randomized, crossover 18, 23 and 28 g of vinegar with a white bread
serving (50 g of carbohydrates) after overnight
Postprandial glycemia response at 30 and 45 min,
and the insulinemia at 15 and 30 min, were
signicantly reduced after ingesting 28 g of vinegar,
in comparison with lower doses and the control
meal (without vinegar)
Salbe et al., 2009 [29] 5 Randomized, crossover,
Individuals randomly received placebo and 20 mL of
apple vinegar followed by mashed potatoes (0.75 g
of carbohydrate/kg body weight). Oral octreotide
was given for insulin suppression along with the
Glycemia levels, measured every 20 min along
180 min of testing, were signicantly higher after
vinegar ingestion when compared with placebo
Ishak et al., 2018 [32] 10 Randomized, cross-
over intervention
Intervention encompassed 4 trials: control, mixture
only, exercise only, and exercise þmixture. The
mixture consisted of 20 mL of garlic, ginger and
lemon juices honey and apple cider vinegar based
on a ratio of 1: 1: 1: 1: 1
Postprandial glucose response calculated as area
under curve for 120 min were 8%, 13% and 15%
lower than control in mixture only, exercise alone
and exercise þmixture, respectively
H.O. Santos et al. / Clinical Nutrition ESPEN xxx (xxxx) xxx4
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containing 4.5% acetic acid applied to the dorsum of the left foot
under occlusion with gauze in a 59-year-old woman resulted in a
deeply ulcerated lesion [48].
9. Perspectives and clinical view
The majority of studies to date have used apple cider vinegar
[13,15,16,24,27,29,30,37]. To the best of our knowledge, there are no
studies that used garlic vinegar in a human intervention. Given
evidence that garlic consumption improves lipid proles and in-
hibits production of advanced glycation end products (AGEs)
[49,50], future research should seek to determine if additional
benets are achieved through the consumption of garlic vinegar.
Interestingly, cooking meat marinated in vinegar to 150
C for
15 min per 1 h reduced the production of AGEs compared to
cooking the meat without marinating [51].
In vitro data showed vinegar to be a good dietary source of
antioxidants [52]. It should be noted however that the present re-
view did not address this issue as apple cider is the more studied
vinegar in human studies and its antioxidant effect is negligible.
Despite claims that vinegar is a good antioxidant source, various
fruits (e.g. orange, mango, cherry and banana) have an antioxidant
activity between 8- and 40-fold higher than apple cider vinegar
[53]. Thus, ingestion of fruits is a better alternative for attaining
antioxidants than vinegar.
Regarding glucose disturbances, the majority of research covers
the benets of vinegar ingestion in subjects with T2DM, whereas
only one study investigated its effects in subjects with T1DM.
Further research is therefore warranted to better understand the
relationship between vinegar intake and T1DM.
In addition to its use as a remedy for dysregulated glycemia,
vinegar also shows promise in ameliorating non-alcoholic fatty
liver disease, PCOS and weight loss. However, chronic interventions
Table 3
Acute effects of vinegar intake on glycemic parameters of subjects with glucose disturbances.
Author and year Subjects Study design Intervention meal Outcomes
Johnston et al., 2004
8 individuals without
diabetes, 11 with
prediabetes and 10 with
type 2 diabetes
Crossover, placebo- controlled Patients were randomized to intake
20 g of apple cider vinegar along with
40 g of water or placebo drink, followed
by a test meal consisting of white bread,
butter and orange juice
After 30 and 60 min postprandial, the
glycemic response was lower only in
those subjects with prediabetes
White and Johnston,
2007 [30]
11 type-2 diabetics
non-insulin users
Randomized, crossover,
Subjects were submitted to a
standardized dietary plan for two days,
which included adding 2 tablespoons of
apple cider vinegar to the supper along
with one slice of cheese (~30 g)
The fasting blood glucose level was
signicantly lower on the vinegar day,
but biologically it was a very low value,
in which glycemia decreased in only
5 mg/dL
Johnston et al., 2010
9 diabetics and 29
non-diabetics subjects
Double-blind, randomized,
crossover, placebo- controlled
2 g, 10 g, or 20 g of apple cider or red
raspberry vinegars were consumed
2 min or 5 h before the meal test, or
vinegar pill(sodium acetate)
administrated 2 min before the meal.
Vinegar doses were added to the test
meal of white bagel, 20 g butter and
200 g juice (3 trials) or dextrose
solution (1 trial). Placebo drinks were
prepared in an identical manner but
minus the vinegar
Compared to the placebo test, the
intake of 10 g of apple vinegar lower
20% the area under the curve 120 min
for glycemia after the meal, whilst the
consumption of vinegar with dextrose
did not show any glycemic
Mitrou et al., 2010 [33] 10 patients with type 1
Crossover, placebo-controlled The subjects were randomly assigned to
consume 30 mL vinegar þ20 mL water
or placebo (50 mL water) 5 min before a
meal composed of bread, cheese, turkey
ham, orange juice, butter, and a cereal
Compared to the placebo test, the meal
with vinegar lower by almost 20% the
area under the curve 240 min for
postprandial glycemia
Liatis et al., 2010 [34] 16 type-2 diabetic
Crossover, placebo-controlled In the rst group was given a high-
glycemic index meal 50 g (mashed
potatoes and 250 mL low-fat milk) on
two different days, with and without
the addition of 20 g wine vinegar. In the
second group, patients were given an
isocaloric meal with the same nutrient
composition, but low-glycemic index
(100 g whole grain bread, 55 g lettuce
and 20 g low-fat cheese)
Incremental area under the curve of
glucose for 120 min was lower after the
addition of vinegar in the high-glycemic
index meal, but not into low-glycemic
Kuzeyli kahraman,
2011 [35]
16 type-2 diabetic
patients who had been
treated with metformin
Crossover, placebo-controlled 275 g baked beans, 195 g rice,
106 g salad plus 50 g of grape vinegar
on the rst day, but not with vinegar on
the second day
Postprandial blood glucose and insulin
measurements were not different in the
vinegar group when compared with the
reference group
van Dijk et al., 2012
12 type well-controlled
2 diabetic patients
Randomized, crossover After an overnight fast, subjects
ingested either 75 g glucose beverage
with 25 g white vinegar or without
Vinegar co-ingestion did not attenuate
the postprandial rise in plasma glucose
or insulin
Panayota Mitrou et al.,
2015 [15]
11 insulin-resistant
Randomized crossover study 30 mL of apple vinegar or placebo
before a test meal, which consisted of
bread, cheese, ham, orange juice, butter
and a cereal bar (equivalent to 75 g of
Compared with placebo, the vinegar
intake decreased the serum insulin and
triglycerides, and increased the
musculoskeletal glucose uptake
performed through the arteriovenous
difference method during 300 min
H.O. Santos et al. / Clinical Nutrition ESPEN xxx (xxxx) xxx 5
Please cite this article as: Santos HO et al., Vinegar (acetic acid) intake on glucose metabolism: A narrative review, Clinical Nutrition ESPEN,
with more controlled diet are needed to draw better conclusions as
to its efcacy.
Ultimately, since high intake of acidic foodstuffs such as vinegar
can irritate mucous membranes, such as the mouth, it is important
to monitor any symptoms that may occur. Caution is required in
people with stomach disorders. Importantly, gastric problems are
often encountered in patients with diabetes mellitus [54], and there
is no support with respect to vinegar intake and stomach safety.
The recommendation of vinegar consumption in clinical practice
should be considered in line with individual preferences, e.g. taste
10. Conclusion
Acute and short-term studies show that vinegar intake has a
benecial effect on the glycemic prole, with apple cider the most
studied type of vinegar. Evidence suggests that chronic intake may
improve glycemia as well, especially in T2DM individuals. However,
while a considerable number of studies have acutely analyzed the
effects of vinegar intake co-ingested with meals rich in carbohy-
drate, only a few interventions have included relevant follow-ups
and diet control. Taken together, consumption of 10e30 mL
(~2e6 tablespoons) of vinegar as a dressing or diluted in beverages
appears to be adequate to acutely alter glycemic prole. In contrast,
this dose can be infeasible if used habitually.
Author's contributions
H.O.S. and W.M.A.M.M. conducted the literature search and
drafted and revised the manuscript. G.A.R.S., JP and B.J.S. critically
reviewed and revised the manuscript.
Declaration of interest
The authors have no interests to declare.
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Please cite this article as: Santos HO et al., Vinegar (acetic acid) intake on glucose metabolism: A narrative review, Clinical Nutrition ESPEN,
... Na podstawie danych literaturowych H.O. Santos i wsp. [66] wysnuli hipotezę, iż ocet zawdzięcza swoje właściwości kwaśnemu pH. Badania wskazują bowiem, że ocet, inaktywując działanie oraz zmniejszając uwalnianie α-amylazy ślinowej, ogranicza trawienie węglowodanów zawartych w posiłku. ...
... Wskazuje się, że umiarkowane spożycie octu, w ilości ok. 2-6 łyżek stołowych dziennie (10-30 ml) jest bezpieczne dla zdrowia [66]. Aby zminimalizować ryzyko wystąpienia skutków ubocznych, w niektórych badaniach sugeruje się spożycie octu w postaci rozcieńczonej [106] lub w formie dodatku do żywności [71]. ...
... Aby zminimalizować ryzyko wystąpienia skutków ubocznych, w niektórych badaniach sugeruje się spożycie octu w postaci rozcieńczonej [106] lub w formie dodatku do żywności [71]. Według obecnego stanu wiedzy spożywanie octów nie powoduje uszkodzeń śluzówki żołądka, ponieważ ich pH jest mniej kwaśne od pH soku żołądkowego oraz popularnych napojów gazowanych typu cola [66]. ...
... These properties have been attributed to acetic acid, which is capable of slowing down stomach emptying by inhibiting digestive enzymes (39,40,42). This way, the speed at which carbohydrates are digested is reduced, causing the GR to be lower (43). ...
... This way, the speed at which carbohydrates are digested is reduced, causing the GR to be lower (43). Based on available evidence, Santos hypothesized three pathways by which vinegar may improve blood glucose: the inhibition of α-amylase, increased glucose uptake and mediation by transcription factors (42). However, to understand mechanisms underlying the antihyperglycemic effects of acetic acid, further experiments are still required. ...
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Diet plays a critical role in the management of many chronic diseases. It is well known that individuals with type 2 diabetes (T2D) need to pay close attention to foods rich in carbohydrates to better manage their blood sugar. Usually, individuals are told to increase their dietary fiber intake which is associated with better glycemic control and limit their overall carbohydrate consumption. However, there are many other cooking strategies available to reduce the glycemic response to meals rich in carbohydrates and with a high glycemic index, such as adding fats, proteins, or vinegar, modifying the cooking or preparation processes, and even the selection and storage of foods consumed. The aim of the present narrative review is to summarize some of these existing strategies applied to the cooking process and their ability to modulate glycemic response to meals in individuals with T2D.
... This can be explained by the fact that vinegar is mainly composed of acetic acid, which can inhibit alpha-amylase, an important enzyme that initiates the digestion of carbohydrates (starch) [34]. This enzyme works preferentially under alkaline conditions, so the acidity of vinegar can impair with its action and lead to lower bioavailability of glucose in the bloodstream and various tissues [35]. In addition to acetic acid, polyphenols in vinegar may also inhibit alpha-amylase function [36]. ...
... In addition to acetic acid, polyphenols in vinegar may also inhibit alpha-amylase function [36]. Besides, acetic acid can also increase glycose saturation by decreasing the activity of phosphofructokinase-1 in skeletal muscle, while in the liver it decreases the synthesis of xylulose-5-phosphate and fructose-2,6-biphosphatase (F2,6BP) [37], leading to glycogen repletion and thereby directing more glucose to skeletal muscle and the liver than to the bloodstream [35]. A recent meta-analysis study found that consuming 15 mg of vinegar per day reduced FBG through reducing gastric emptying by 20% [38]. ...
Introduction Studies that investigated the association between the consumption of vinegar and various cardiometabolic parameters have yielded conflicting results. In this work, we investigated the effects of vinegar consumption on cardiometabolic risk factors using a meta-analysis. Methods Relevant studies were identified using four databases (Scopus, PubMed/MEDLINE, Embase, and Web of Science) up to January 2022. Of the 2806 articles from the initial search, 11 RCTs with 12 treatment arms were included in the meta-analysis. The RCTs focused on both healthy individuals and individuals with cardiometabolic disorders. Results Consumption of vinegar was associated with significant reductions in fasting blood glucose (WMD: -9.36 mg/dL, 95% CI: -14.82, -3.91) and glycated hemoglobin (WMD: -0.67, 95% CI: -1.36, - 0.01). In terms of lipid profile, there was a significant reduction in total cholesterol (WMD: -18.87 mg/dl, 95% CI: -34.44, -3.29) and low-density lipoprotein cholesterol (WMD: -21.37 mg/dl, 95% CI: -37.54, -5.20), but non-significant reductions in high-density lipoprotein cholesterol and triglycerides were noted, although the latter reduction was of clinical significance (WMD: -21.47 mg/dl, 95% CI: -49.72, 6.77). In addition, no significant changes in fat mass and waist circumference were observed, while significant reductions in body mass index (WMD: -0.39 kg/m², 95% CI: -0.74, -0.04, p = 0.028) and body weight (WMD: -0.73 kg, 95% CI: -1.45, -0.01) were noted with dubious clinical relevance. Conclusion In conclusion, the consumption of vinegar may have beneficial effects on some glycemic and lipid indices and could be considered as an intervention for weight loss.
... Food acetic acid has been used since the eighteenth century for its therapeutic benefits in the treatment of obesity, later being studied for other beneficial therapeutic effects in the fight against diabetes, cardiovascular diseases, or cancer (Santos et al. 2019, Samad et al. 2016. The mechanism of the antidiabetic effect of acetic acid has been explained by Ho et al. (2017), in that this may interfere with carbohydrate digestion, inhibiting the metabolism of polysaccharides into absorbable monosaccharides. ...
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Acetic acid is an organic acid that can be used in the food industry, which normally has an insignificant rate of adverse reactions when used rationally. However, irrational use can cause serious toxic effects and even death. In this context, the case of a death of a 52-year-old woman, involving the suspected voluntary use of food acetic acid, is presented, while toxicological and histopathological aspects were addressed for death mechanism elucidation. In this case, the pH value of 6.75 in blood, has shown severe metabolic acidosis after the ingestion of the large quantity of dietary acetic acid-about a liter. Also, the victim suffers from mental illness, carbamazepine being one of the treatment drugs. Liver damage, demonstrated by histopathological examination may be a consequence of both massive accumulation of carbamazepine in the liver and toxicity of food acetic acid. In conclusion, the hepatotox-icity induced by high level of carbamazepine was suspected of increasing the risk of multiple organ failure, in the context of acetic acid acute toxicity, highlighting the particularities of the case. ARTICLE HISTORY
... AcA is the primary ingredient in vinegar. It has been attracting attention as a food ingredient because of its preventive and therapeutic effects on metabolic syndromes such as obesity, diabetes, and hypertension (53)(54)(55). The content of another organic acid, AzA, was higher in PWBr2, which suggested that this mutant line might be used in the development of anti-acne natural cosmetics due to the antibacterial effect of AzA (56). ...
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Recently, wheat has attracted attention as a functional food, rather than a simple dietary energy source. Accordingly, whole-grain intake increases with an understanding of bioactive phytochemicals in bran. The development of colored wheat has drawn more attention to the value of bran owing to its nutritional quality, as well as the antioxidant properties of the colorant. The present ¹ H NMR-based chemometric study evaluated the compositional improvement of radiation-induced mutants in purple wheat by focusing on the predominant metabolites with high polarity. A total of 33 metabolites, including three choline derivatives, three sugar alcohols, four sugars, 13 amino acids, eight organic acids, and two nucleosides, were identified throughout the ¹ H NMR spectra, and quantification data were obtained for the identified metabolites via peak shape-based quantification. Principal component and hierarchical cluster analyses were conducted for performing multivariate analyses. The colored original wheat was found to exhibit improvements compared to yellow wheat in terms of the contents of primary metabolites, thus highlighting the importance of conducting investigations of polar metabolites. The chemometrics studies further revealed mutant lines with a compositional enhancement for metabolites, including lysine, proline, acetate, and glycerol.
... The difference in lipid correlation observed in diabetesspecific women (Fig. 8C) and men networks (Fig. 8D) further points to sex-specific differences in lipid metabolism [116,117]. In particular, in women we observe a disruption of the correlation between acetic acids and glucose; it is known that acetic acid can lower glucose level, and can improve insulin resistance and metabolic abnormalities in the atherogenic prediabetic state [118]: the mechanism are not yet fully understood [119] and, as shown here, may be differentially regulated in men and women. ...
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This study defines and estimates the metabolite-lipidic component association networks constructed from an array of 20 metabolites and 114 lipids identified and quantified via NMR spectroscopy in the serum of a cohort of 355 Italian nonagenarians and ultra-nonagenarian. Metabolite-lipid association networks were built for men and women and related to an array of 101 clinical and biochemical parameters, including the presence of diseases, bio-humoral parameters, familiarity diseases, drugs treatments, and risk factors. Different connectivity patterns were observed in lipids, branched chains amino acids, alanine, and ketone bodies, suggesting their association with the sex-related and sex-clinical condition-related intrinsic metabolic changes. Furthermore, our results demonstrate, using a holistic system biology approach, that the characterization of metabolic structures and their dynamic inter-connections is a promising tool to shed light on the dimorphic pathophysiological mechanisms of aging at the molecular level.
... Beyond macronutrients and calories, the intake of antioxidants has gained vast attention to global public health, which are nonenzymatic elements classified primarily as flavonoids, minerals, vitamins, and derivatives [20][21][22][23]. In this sense, several nutraceutical agents (e.g., some herbal medicines and supplements) and functional foods have been proposed in the management of glucose levels due to their antioxidant features [24][25][26][27][28][29]. Nevertheless, the antioxidant potential across the diet overwhelms those adjunctive strategies since long-term adherence is a cornerstone, in which hallmark foodstuffs such as fruits, vegetables, seeds, whole grains, oils, and particular beverages (e.g., coffee and tea) must be endorsed [30,31]. ...
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Background: The overall dietary quality, as well as the dietary total antioxidant capacity (DTAC), deserves central attention in the management of borderline high glucose levels since nonpharmacological strategies are imperative in this regard. Thus, we aimed to investigate the association between prediabetes with dietary quality and DTAC. Methods: A case-control study was conducted on 49 patients with prediabetes and 98 controls. Demographics, anthropometric measures, and fasting blood glucose levels of all participants were obtained. Participants completed a validated 80-item food frequency questionnaire (FFQ). DTAC scores were generated using FFQ data, and Healthy Eating Index-2015 (HEI-2015) was used as a diet quality index. The lowest tertile of HEI-2015 and DTAC was considered as the reference category, and logistic regression was used to estimate the relationship between prediabetes with HEI-215 and DTAC. Results: Mean age and body mass index of participants were 47.42 ± 15.98 years and 27.90 ± 4.96 kg/m2. Patients with prediabetes had lower DTAC scores when compared to controls (11.86 ± 5.77 and 17.81 ± 12.08, P = 0.01). There was a significant inverse association between the highest tertile of the DTAC score when compared with the lowest tertile in crude (OR = 0.11; 95% CI: 0.03-0.43), age-adjusted (OR = 0.13; 95% CI: 0.03-0.48), and fully adjusted (OR = 0.09; 95% CI: 0.02-0.53) models. In contrast, there was no difference between HEI-2015 in patients with prediabetes when compared to controls (74.41 ± 8.91 and 74.41 ± 9.35, respectively; P = 0.85). Correspondingly, no difference was observed between the highest tertile of the HEI-2015 score when compared with the lowest tertile in crude (OR = 1.23; 95% CI: 0.53-2.86), age-adjusted (OR = 1.17; 95% CI: 0.48-2.82), and fully adjusted (OR = 1.53; 95% CI: 0.56-4.16) models. Conclusion: This study demonstrates a clear association between prediabetes with less DTAC, but not with HEI-2015.
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Fermentation has been a significant food processing and storage method in human dietary culture since ancient times. Nowadays, an increasing number of research studies are intensely focusing on the health advantages that fermented beverages and foods have. Type 2 diabetes mellitus, known as the metabolic disorder with high blood glucose level, is prevailing in modern society and seriously harms publics’ well-being. However, several studies showcased the benefits of fermented food in the potential treatment and prevention of type 2 diabetes. Effect of animal-based fermented food, such as yogurt, on type 2 diabetes has been greatly explored, but insufficient studies specifically explored the relationship between plant-based fermented food and type 2 diabetes. This article investigated the health benefits of plant-based fermented beverage and food, including vegetables, tea, fruits, legumes, and grains, on type 2 diabetes. In conclusion, the fermentation process enhanced the nutritional value of the raw material. Fermented food and beverage are potentially diabetes-friendly and desirable, but they must be consumed in moderation.
Advanced glycation end products (AGEs) are glycated proteins or lipids derived from complex metabolic pathways involved in the pathophysiology of various diseases, especially diabetes and diabetes-related complications. These compounds are omnipresent in human life, with both endogenous and exogenous sources. Despite the well-elucidated disease mechanisms, little is known about the AGEs/nutrition nexus in the circles of clinical practice recommendations. This review seeks to translate the accumulated knowledge about the biochemistry and pathophysiology of AGEs into a nutritional intervention based on real-world prescriptions.
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Background Nonalcoholic fatty liver disease (NAFLD) is emerging as a public health issue worldwide and is highly prevalent in patients with type 2 diabetes mellitus (T2DM). However, there was a great disparity across studies in the estimated prevalence of NAFLD in T2DM patients. This meta-analysis, therefore, aimed to estimate the pooled prevalence of NAFLD in T2DM patients. Methods Electronic databases of PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure, and Wanfang were searched using MeSH terms to identify relevant studies. Eligibility assessment and data extraction were conducted independently by 2 investigators and a meta-analysis was performed to synthesize the data. Heterogeneity was evaluated using the Cochran Q test and quantified using the I² statistic. Publication bias was assessed using both the Begg and Egger tests. Subgroup analyses were performed to identify the possible sources of heterogeneity. Results Twenty-four studies involving 35,599 T2DM patients were included in this meta-analysis, of which 20,264 were identified with NAFLD. A high degree of heterogeneity (I² = 99.0%, P < .001) was observed among the eligible studies, with the reported prevalence ranging from 29.6% to 87.1%. The pooled prevalence of NAFLD in T2DM patients, by a random-effects model, was 59.67% (95% confidence interval: 54.31–64.92%). Sensitivity was low and both the Begg test and Egger test showed low possibility of publication bias. Subgroup analyses indicated that the prevalence of NAFLD in T2DM patients differed by gender, obesity, hypertension, dyslipidemia, coronary heart disease, and chronic kidney disease. Conclusions The high pooled prevalence of NAFLD in T2DM patients found in this study significantly underscores the need for early assessment of NAFLD and the importance of strengthening the management of NAFLD in T2DM patients.
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Purpose of review: There are currently over 40 different drugs in 12 distinct classes approved in the USA to treat patients with type 2 diabetes mellitus. This review summarizes our current knowledge about potential side effects of antidiabetic therapy and attempts to apply it to a clinical practice setting. Recent findings: Given the heterogeneity of both the patients and the disease, it is mathematically impossible to test every available drug combination in long-term outcome, prospective, randomized blinded fashion before a clinician decides which agent(s) to prescribe to a specific patient in a given situation. To complicate the clinician's dilemma, there is lack of available tests to predict an individual's response or propensity to side effects. Further, the data available are derived from small, short-term registration trials and typically focus on relative rather than absolute risks of any given drug and do not address the potential adverse outcomes if a patient's diabetes remains untreated. Clinicians have to personalize their choice of antidiabetic therapy based both on the specific characteristics of the patient in front of them (stage of diabetes and its complications, overall health status, socioeconomic situation, other medications present, desire to improve control of diabetes, etc.) and the current knowledge about the relative and absolute balance of benefits and risks of any individual medication in that specific patient. It has to be recognized that this requires constant re-evaluation as database of our experience with antidiabetic therapy expands.
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Vinegars are one of only a few acidic condiments throughout the world. Vinegars can mainly be considered grain vinegars and fruit vinegars, according to the raw materials used. Both grain vinegars and fruit vinegars, which are fermented by traditional methods, possess a variety of physiological functions, such as antibacteria, anti-infection, antioxidation, blood glucose control, lipid metabolism regulation, weight loss, and anticancer activities. The antibacteria and anti-infection abilities of vinegars are mainly due to the presence of organic acids, polyphenols, and melanoidins. The polyphenols and melanoidins also provide the antioxidant abilities of vinegars, which are produced from the raw materials and fermentation processes, respectively. The blood glucose control, lipid metabolism regulation, and weight loss capabilities from vinegars are mainly due to acetic acid. Besides caffeoylsophorose (inhibits disaccharidase) and ligustrazine (improves blood circulation), other functional ingredients present in vinegars provide certain health benefits as well. Regarding anticancer activities, several grain vinegars strongly inhibit the growth of some cancer cells in vivo or in vitro, but related functional ingredients remain largely unknown, except tryptophol in Japanese black soybean vinegar. Considering the discovering of various functional ingredients and clarifying their mechanisms, some vinegars could be functional foods or even medicines, depending on a number of proofs that demonstrate these constituents can cure chronic diseases such as diabetes or cardiovascular problems.
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Type 2 diabetes is one of the most prevalent endocrine disorders worldwide. Traditionally, herbal plants and their derivatives are used to lessen complications of type 2 diabetes. The hypoglycemic and hypolipidemic properties have been reported for vinegar, but some cases of discrepant effects were also observed. In the current study, the impact of apple vinegar on some hematological and blood biochemical factors in type 2 diabetic patients was investigated. In this trial study, sixty patients with type 2 diabetes were divided into two groups. The first group took 15 ml of vinegar with their middle meal for one month. The second group received water as placebo. At the beginning and end of the study, blood samples were collected and biochemical factors including fasting blood sugar (FBS), glycated hemoglobin (HbA1c), triglycerides (TG), total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), urea, creatinine (Cr), uric acid, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and complete blood count (CBC) were evaluated. Findings showed that FBS (P=0.006), HbA1c (P=0.002), MCV (P=0.0001) and mean cell hemoglobin (MCH; P=0.002) decreased where platelets (PLT) (P=0.005) increased significantly in first group. There was no significant difference in the studied parameters in placebo group. Based on the results of this study, it can be concluded that vinegar is a hypoglycemic agent that can be applied for treatment of type 2 diabetes.
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Introduction. Vinegar is known with its positive impact on post-prandial dysmetabolism. The aim of this study was to elucidate the acute effects of high amount vinegar on blood glucose and lipid parameters. Material and Methods. Sixteen type 2 diabetic patients who had been treated with metformin only, were served a standardized meal to which 50 g vinegar was added on the first day but not on the second day. Blood glucose, insulin and lipid levels were measured during fasting and at the second hour after intake of the meal. Results. Postprandial increase in the levels of venous blood glucose measurements was not different in the vinegar group when compared with the reference group (p=0.163). There was no significant difference on postprandial insulinemia (p=0.796). While investigating the effect of the vinegar on postprandial lipemia, no differences in triglyceride changes was found between vinegar and reference group (p=0.816). Conclusion. In this study in which we have tried to find an answer to the question about the effect of high amount grape vinegar on postprandial metabolism, no favorable or deleterious effect on postprandial changes of glycemia and lipemia was found. Key words: postprandial dysmetabolism, type 2 diabetes mellitus, vinegar.
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Background and aims: Vinegar has been shown to have a glucose-lowering effect in patients with glucose abnormalities. However, the mechanisms of this effect are still obscure. The aim of this randomised, crossover study was to investigate the effect of vinegar on glucose metabolism in muscle which is the most important tissue for insulin-stimulated glucose disposal. Materials and methods: Eleven subjects with DM2 consumed vinegar or placebo (at random order on two separate days, a week apart), before a mixed meal. Plasma glucose, insulin, triglycerides, nonesterified fatty acids (NEFA), and glycerol were measured preprandially and at 30-60 min for 300 min postprandially from the radial artery and from a forearm vein. Muscle blood flow was measured with strain-gauge plethysmography. Glucose uptake was calculated as the arteriovenous difference of glucose multiplied by blood flow. Results: Vinegar compared to placebo (1) increased forearm glucose uptake (p = 0.0357), (2) decreased plasma glucose (p = 0.0279), insulin (p = 0.0457), and triglycerides (p = 0.0439), and (3) did not change NEFA and glycerol. Conclusions: In DM2 vinegar reduces postprandial hyperglycaemia, hyperinsulinaemia, and hypertriglyceridaemia without affecting lipolysis. Vinegar's effect on carbohydrate metabolism may be partly accounted for by an increase in glucose uptake, demonstrating an improvement in insulin action in skeletal muscle. This trial is registered with NCT02309424.
The role of salivary α-amylase (HSA) in starch digestion is often overlooked in favour of that of pancreatic α-amylase due to the short duration of the oral phase. Although it is generally accepted that amylase of salivary origin can continue to be active in the stomach, studies ascertaining its contribution are lacking. This study aimed to address this issue by coupling in vitro oral processing with an in vitro dynamic system that mimicked different postprandial gastric pH reduction kinetics observed in vivo following a snack- or lunch-type meal. Digestion of both starch and protein from wheat bread, as well as the interplay between the two processes were studied. We have observed that the amylolytic activity of saliva plays a preponderant role hydrolysing up to 80 % of bread starch in the first 30 min of gastric digestion. Amylolysis evolved exponentially and nearly superimposing curves were obtained regardless of the acidification profiles, revealing its high efficiency.
Vinegar stands as a highly appreciated fermented food product due to several functional properties and multiple applications. This work focuses on vinegar production from fruit wines derived from fruit concentrates, to attain a food product with nutritional added value. Four fruit vinegars (orange, mango, cherry and banana), were produced and characterized, with total acidities of 5.3 ± 0.3% for orange, 5.6 ± 0.2% for mango, 4.9 ± 0.4% for cherry and 5.4 ± 0.4% for banana. Acetification showed impact on aroma volatiles, mainly related to oxidative reactions. Minor volatiles associated with varietal aroma were identified, monoterpenic alcohols in orange vinegar, esters in banana vinegar, C13-norisoprenoids in cherry vinegar and lactones in mango vinegar, indicating fruit vinegars differentiated sensory quality. Total antioxidant activity analysis by FRAP, revealed fruit vinegars potential to preserve and deliver fruit functional properties. Antioxidant activity of fruit vinegars, expressed as equivalents of Fe2SO4, was of 11.0 ± 1.67 mmol L−1 for orange, 4.8 ± 0.5 mmol L−1 for mango, 18.6 ± 2.33 mmol L−1 for cherry and 3.7 ± 0.3 mmol L−1 for banana. Therefore, fruit vinegars presented antioxidant activity close to the reported for the corresponding fruit, and between 8 and 40 folds higher than the one found in commercial cider vinegar, demonstrating the high functional potential of these novel vinegar products.
"Natural home remedies" for nevi removal found on the Internet can be ineffective, or worse, dangerous. Children and teens, in particular, may be more likely to attempt self-treatment in order to avoid discussing their concerns with their parents. Here, the authors report a case of an adolescent who presented with a chemical burn after following an Internet-based protocol for nevi removal using apple cider vinegar.