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Effect of Apple Cider Vinegar on Glycemic Control, Hyperlipidemia and Control on Body Weight in Type 2 Diabetes Patients

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Diabetes mellitus is a world-widely public health issue associated with premature mortality, decreased quality of life and increased health-care expenditures. The aim of the review was to elevate the effect of apple cider vinegar on glycemic control, hyperlipidemia and obesity control in type 2 diabetes patients. Many clinical trials showed the hypoglycemic, hypolipidemic and anti-obesity effect of vinegar. Proposed mechanisms action of vinegar for the hypoglycemic, hypolipidemic effect are including slow gastric emptying, it promotes uptake of skeleton muscles glucose in the body and acetic acid may inhibit disaccharides activity in the small intestine blocking the complete digestion of starch molecules, suppression of hepatic glucose production and increased glucose utilization. Results of previous studies showed that apple cider vinegar has the potential of anti-diabetic, antihyperlipidemic and anti-obesity effects in diabetes mellitus patients. Objective of review: The objective of the current review study was to investigate the effect of apple cider vinegar on glycemic control, hyperlipidemia and control on body weight in type 2 diabetes patients and other therapeutic and commercial effect of apple cider vinegar. Data sources: To collect data for relevant literature PubMed, Google Scholar, science direct and Cochrane sources were used.
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International Journal of Medical Research &
Health Sciences, 2019, 8(5): 59-74
59
ISSN No: 2319-5886
ABSTRACT
Diabetes mellitus is a world-widely public health issue associated with premature mortality, decreased quality of
life and increased health-care expenditures. The aim of the review was to elevate the effect of apple cider vinegar
on glycemic control, hyperlipidemia and obesity control in type 2 diabetes patients. Many clinical trials showed
the hypoglycemic, hypolipidemic and anti-obesity effect of vinegar. Proposed mechanisms action of vinegar for the
hypoglycemic, hypolipidemic effect are including slow gastric emptying, it promotes uptake of skeleton muscles
glucose in the body and acetic acid may inhibit disaccharides activity in the small intestine blocking the complete
digestion of starch molecules, suppression of hepatic glucose production and increased glucose utilization. Results
of previous studies showed that apple cider vinegar has the potential of anti-diabetic, antihyperlipidemic and anti-
obesity effects in diabetes mellitus patients. Objective of review: The objective of the current review study was to
investigate the effect of apple cider vinegar on glycemic control, hyperlipidemia and control on body weight in type 2
diabetes patients and other therapeutic and commercial effect of apple cider vinegar. Data sources: To collect data
for relevant literature PubMed, Google Scholar, science direct and Cochrane sources were used.
Keywords: Hyperlipidemia, Hyperglycemia, Vinegar, Obesity, Diabetes, Nutraceutical
Effect of Apple Cider Vinegar on Glycemic Control, Hyperlipidemia
and Control on Body Weight in Type 2 Diabetes Patients
Soa Kausar
1
*, Muhammad Arshad Abbas
2
and Zaheer Ahmed
3
1 Department of Liver Transplant Unit, Shaikh Zayed Hospital Lahore, Shaikh Zayed Medical
Complex, Lahore, Pakistan
2
Department of Public Health and Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical College
Medical College and Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan
3 Department of Environmental Design, Health and Nutritional Sciences, Allama Iqbal Open
University, Islamabad, Pakistan
*Corresponding e-mail: Soa.kausar@yahoo.com
INTRODUCTION
Diabetes mellitus (DM) has been considered as one of the most universal endocrine, metabolic disorders which
is characterized by the irregular metabolism of fat, protein, and carbohydrate due to decreased efcacy of insulin
secretion or altered insulin activity. Its occurrence worldwide has been increasing with the passage of time. About
14 million patients were suffering in DM in the United State and this ratio has been increasing by about 700,000
each year [1]. Diabetes has been categories into 3 major types: type I diabetes known as insulin dependent diabetes
mellitus (IDDM) which result in deciency of insulin, insulin resistance known as type II diabetes, it’s also called
non-insulin dependent diabetes (NIDDM) and gestational diabetes is known as type III diabetes which results in
glucose intolerance during pregnancy [2].
DM is a global health issue and one of the 5th main mortality and morbidity causes in many areas of the world. More
than 171 million people were affected by diabetes globally in the year 2000 and this gure is predicted to reach
366 million by the years 2030 [3,4]. Main causes of diabetes are impaired insulin secretion, insulin resistance and
overproduction of hepatic glucose. Insulin resistance is not only a major contributor to diabetes development but
also play a merely role in hypertension, dyslipidemia, and atherosclerosis [5]. A complication of diabetes includes
cataract, nephropathy, retinopathy, wound infection and atherosclerosis [6]. Diabetes mellitus is a worldwide public
health issue associated with premature mortality, decreased quality of life and increased health-care expenditures. The
results of previous studies showed that diabetes prevalence is increasing with the passage of time in Pakistan. The
4
Sofia Kausar *, Ayesha Humayun , Zaheer Ahmed , Muhammad Arshad Abbas
and Aroosha Tahir3
Department of Public Health and Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical College
Department of General Surgery, Shahida Islam Medical and Dental College Lodhran, Pakistan
44
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60
Kadhim, et al.
numbers of people affected with diabetes in Pakistan is 6.9 million and this will grow to 11.5 million according to the
International Diabetes Federation by 2025 and urgent measures are required to control [7].
Natural food additives have been more popular in recent year for many ailments even showing without any evidence
of medical benets. Traditional beliefs of different racial groups and internet information are easy to access for
preference and choices of different natural treatment for various diseases [7]. Natural food products have fewer side
effects of this food as compared to medical therapies. Individuals with diabetic are prevailing about more than 1.6
times prone to use a substitute for medical products and complimentary food as compared to non-diabetics individuals
[8]. Obese individuals are more prone, who are reluctant usually to decrease their intake of daily calories and use
dietary supplements or alternative products for the reduction of their body weight and other benecial metabolic
effects [7].
A lot of medications are accessible for control of diabetes however common herbs are developing the interest of the
general population for prevention and management of diabetes, apple juice vinegar have curing characteristic which
can possibly control the blood glucose level, acetic acid an active component in apple juice vinegar with anti-glycemic
effects. Actually simple inexpensive diet strategies are greatly needed for diabetes control. In the present study, the
effect of oral apple cider vinegar consumption on blood biochemical factors in type 2 diabetic and hyperlipidemic
patients were investigated.
Global Estimation of Diabetes
Diabetes mellitus is a common health issue all over the world and has been increasing with the passage of time in
numbers and in its signicance due to changing in lifestyle, decrease physical activities and developed obesity. To
estimate the present and future situation of diabetes it is very important to improve the health of the community and
resolve the health issues at all national and international level. There is a number of previous estimations of diabetes
published by World Health Organization (WHO) for the years 2000 and 2030 with the help of 40 countries data [9-12].
According to the estimation by international diabetes federation in 2011, about 565 different data sources were
reviewed of 110 countries and it has been found that 366 million people were suffering from diabetes mellitus and it
is expected to rise to 552 million by the year 2030. Most people suffering from diabetes were living in those countries
which have low and middle economic status and the burden of diabetes will increase in next 19 years and this global
diabetes epidemic continues to grow in future by IDF estimation [13].
Prevalence of diabetes is increasing in all age group but the highest prevalence with specic age group 60-79 years
is about 18.6% and the largest numbers of people with diabetes about 184 million is in the age group 40-59 years. In
2013, data of 130 countries were extracted by using 744 different data sources estimated by IDF, 382 million people
were suffering from diabetes and also expected that it should be increased to 592 million by the year 2030. The reason
for the diabetes epidemic is low and poor economic status and will rise in this epidemic in the future over the next 22
years [11].
Diabetes mellitus is also growing burden in Pakistan. A cross-sectional survey was conducted in rural and urban areas
of 4 provinces of Pakistan. The diabetes prevalence in the rural and urban was 3.5% in women and 6.0% in men and
newly diagnosed with diabetes was 5.1% in men and in women was 6.8% in urban and 5.0% in men and 4.8% in
women in the rural areas. Obesity especially central obesity, age factors, and positive family history is a major risk
factor for diabetes development [14].
A study was conducted to estimate the cost-effectiveness of diabetes mellitus in Pakistan. It is a rst study conducted
to estimate the cost of diabetes mellitus illness among 6 out patient’s department clinics in Karachi. The direct cost of
a patient with diabetes estimated was 11,580 Pakistani rupees per year, medicines expenses are a major share of direct
cost (46%) and laboratory tests cost (32%) due to longer duration of disease. About 18% of the total family income is
been spend on diabetes care among the poorest segment of society [15].
Prevention of Diabetes with Nutraceutical
Curcumin is a popular spice used in all over the Asian cuisine. Curcumin known as curcuminoid found in turmeric
(Curcuma longa Linn) has anti-inammatory and anti-diabetes effects [16]. A study was conducted on uses of curcumin
extract for prevention of the diabetes type 2, this study shows that curcumin extract delay type 2 diabetes development
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and improve beta cell functions, reduce insulin resistance and also reduced the numbers of pre-diabetes individual
who are going to develop type 2 diabetes [17]. A double-blind placebo randomized cohort trial for 9-months show that
16.4% diabetic individual was diagnosed in placebo group signicantly and none were diagnosed with type 2 diabetes
in the curcumin treatment group, also better improvement in beta cell functions in the curcumin-treated group was
observed as compared to the placebo group [18].
Polyphenols have unique properties of nutraceutical and supplementary treatment for various aspects of diabetes
mellitus type 2. Polyphenols consisting of avonoids, phenolic acids, and lingams stilbenes have potential efcacies for
reduction of disorders and complication of diabetes mellitus. Polyphenols dietary plants and polyphenol-rich products
attenuate hyperglycemia, insulin resistance, and dyslipidemia, improve adipose tissue metabolism and modulate
carbohydrate, and alleviate oxidative stress. Long term diabetes complications like retinopathy, cardiovascular
diseases nephropathy and neuropathy can be prevented by polyphenol compounds [19].
Many recent studies indicated that dietary polyphenol and polyphenol-rich fruits and vegetables are helpful for
managing and preventing diabetes [20].
A single-blind randomized cross over study indicated that ber-rich and polyphenol (PFRF) containing food have
potential to effect on the glycemic index by lowering glucose absorption and also decreasing the glycemic response of
polyphenol and ber-rich food. The mechanism of PFRF inhibited alpha-amylase (strawberry, green tea, blackberry,
and black currant) and activities of alpha-glycosidase (green tea) in vitro [21]. Fruits and vegetables that contain
bioactive compound have been consider for the prevention of diabetes, cancer, cardiovascular diseases and is also
used as an antibacterial, anti-aging and anti-inammation agent [22].
A double-blind randomized control trial showed that cinnamon extracts water soluble for the prevention of pre-
diabetes and diabetes as lowering glucose level, blood pressure, lipids and also decreases inammatory markers and
work as an insulin sensitizer in type 2 diabetes patients [23].
Water extract of cinnamon (insulin) 250 mg/capsules twice a day of spray dried have insulin potentiating activity
lowering blood glucose, decreasing total cholesterol, LDL and enhanced insulin sensitivity in subjects with elevated
blood glucose plasma in double-blind placebo randomized control trial [24].
A comprehensive review indicate that cinnamon can be an effective therapy for the reduction of blood sugar fasting
and HbA1C in type 2 prediabetes, and diabetes patients result in 6 clinical trials indicate lowering potential for
HbA1C and 10 clinical trials indicates reducing fasting blood glucose by using recommended dose of cinnamon (1 g
to 6 g (500 mg BID)) with meal [25]. Cinnamon 1 g daily work as insulin sensitizer both in human and animals studies
and can be a safe supplement for the prevention of diabetes type 2 as lowering HbA1C (<7.0%) 0.83% in randomized
control trial [26].
High-fat diet develops obesity, hyperinsulinemia, hyperglycemia, insulin resistance, and hepatic steatosis, but chenpi
(dry peel of the plant citrus reticulate) contain high fat which can reduce the hyperglycemia, hyperinsulinemia, hepatic
steatosis, and insulin resistance. Administration of 0.25% to 0.5% of oral chenpi for 15 weeks prevented symptoms of
diabetes and also reduced obesity and hepatic steatosis [27].
Fenugreek seeds (Trigonella foenum graecum) have hypoglycemia, antioxidant, and nephroprotective effects. About
500 mg daily dose bid showed signicant reduction in fasting blood glucose in trail group (83%) and placebo group
(62%), postprandial plasma glucose in study group (89%), placebo subjects (72%) and reduction in HbA1c in both
group signicantly as compared to baseline values in double-blind multicenter randomized control trial [28].
Fenugreek is a natural herb used widely for the prevention of diabetes showed hypoglycemic, lowering effects of
total cholesterol. Fenugreek signicantly reduced fasting blood glucose, HbA1C, total cholesterol but results for low-
density lipoprotein, high-density lipoprotein, and triglyceride of fenugreek were controversial in many randomized
controlled trials (RTC) showed by meta-analysis of 10 studies due to low quality of studies because no renal and liver
efcacy were checked, side-effect of fenugreek is discomfort for gastrointestinal tracts and further clinical trials are
needed [29].
A randomized control trial showed a positive effect of chromium on biomarkers of type 2 diabetes such as fasting
blood glucose, HbA1c after taking 200 ug of chromium for 3-month, clinical sign and symptoms, anthropometric
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also improve after dietary consoling in newly diagnosed diabetes and no toxicity can be found in renal and liver
functioning. These biomarkers improved but did not come to the normal range [30].
Review of 9 randomized control studies indicated a positive effect of ginger (Zingiber ofcinale) on biomarkers of
diabetic and hyperlipidemic subjects supplementation of ginger which signicantly increased HDL-C and decreased
fasting blood glucose and total triglycerides [31]. A double randomized control trial indicates a signicant effect of
ginger 3 capsules 1 g daily in the ginger group and in placebo group taking 3 capsules containing 1 g microcrystalline
for 8-weeks on BSF effects (10.5%), and HbA1C variation was in line in type 2 diabetic patients [32].
Uses of garlic as food spices are very popular all over the world it’s very helpful for the prevention of diabetic
dyslipidemia in patients with raised lipid prole. A cross-sectional study showed that local herbal product of garlic
had a lowering capacity of serum cholesterol and low-density lipoprotein and increased high-density lipoprotein
signicantly, but no change occurred in triglyceride when it’s taken 300 mg/day for 8-weeks [33]. Anti-oxidant
and anti-glycation properties are more potent in old garlic than in fresh garlic. Inhabitation of aged garlic by AGEs
(Advanced glycation end products) were 56.4% to 33.5% as compared to fresh garlic, phenolic content is higher
(129+1.8 mg/g) in old as compared to (56+1.2 mg/g) in fresh garlic [34].
Physical and Chemical Properties of Vinegar
Vinegar is an aqueous solution mainly dilution of acetic acid which is reected by its physical and chemical properties.
The product which is called vinegar is formed by 2 biochemical processes [35].
Alcoholic fermentation process: In this process, the natural sugar converts into alcohol by acid fermentation.
6 12 6 2 5 2
C H O 2C H OH+2COyeast

Acid fermentation process: In this process of fermentation the microorganism acetobacter is present in the air which
converts alcohol into acid when we breathe.
25 2 3 2
C H OH+O acetobacter acetic CH COOH+H O

Due to sour taste vinegar has antiseptic, cleaning and killing of germs properties and it also contains various amount
of vitamins, minerals, enzyme, ber and other organic compound depending on its process of production [35].
Chemical Formula of Vinegar
Vinegar is a diluted acetic acid solution which has the same formula of acetic acid containing 4 hydrogen atoms, 2
carbons, and 2 oxygen atoms formula is often as CH3COOH [35,36].
H O
H C C
H O H
Mechanism Action of Apple Cider Vinegar on Glucose Metabolism
Apple cider vinegar has been used as a natural remedy for the management of diabetes for many years in the different
areas of the world. Several mechanisms have been reported for mechanism action of glucose metabolisms such as
delayed gastric emptying and enteral absorption, increased utilization of glucose, suppression of production of hepatic
glucose, up-regulation of ow-mediated vasodilatation, increase in lipolysis and reduced in lipogenesis, insulin
secretion facilitation. Other mechanisms are reported including fecal acid bile excretion facilitation, enhanced energy
uses and increased satiety [7].
Gastric emptying: A pilot study showed a positive effect of apple cider vinegar in diabetic patients with gastroparesis
to delayed gastric emptying. The gastric emptying rate was measured by ultrasonography. GER gastric emptying
rate measured after every 15-90 minutes in the antral cross-sectional way after 300 g rice budding ingestion with
200 ml water in group 1 and in group 2 rice budding 300 g and 200 ml water with 30ml apple cider vinegar. For
measuring GER 1 the subject drank water 200 ml before breakfast and the second group also drinks water (200 ml)
with 30 ml apple cider vinegar. This pilot study indicates further clinical trials [37]. Metformin drug also works
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C C
H O
H
H O H
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as an antiglycemic agent and decreased effectively fasting plasma glucose and gluconeogenesis in type 2 diabetic
patients. Metformin effect on fat content and muscle in the liver and effect remain controversial on insulin resistance
in this study. Rosiglitazone and Pioglitazone can also reduce the hepatic, muscle glucose and fat content and insulin
resistance can also be improved [38].
The concentration of postprandial blood glucose can be determined by the clearance and appearance rates of glucose
and the blood glucose maintained in a narrow range after meal intake. Regulation of postprandial blood glucose by
the gastric emptying and other factors, lowering of postprandial glucose level can be occurred due to gastric emptying
rates reduction. Hypoglycemia leads to rising in gastric emptying rates in both healthy and diabetic individual.
Emptying of stomach occur in liquid food immediately and a few minutes after in solid and semi-solid food [39].
Enteral absorption of carbohydrate: Enteral carbohydrate absorption is another mechanism of vinegar antiglycemic
effect, the vinegar suppresses the disaccharide activities and not glucose transport inactivation in the cells of the
intestine. A study in vitro showed suppression of sucrose, maltose, lactose, and trehalase when treated with acetic acid
for 15 days but acetic did not affect sucrose is maltase de novo synthesis either at translational or nor transcriptional
level, probably suppression occurs during processing of post-translational, inhabitation of post-translational may be
by acetic acid like intracellular trafcking and disaccharidases synthesized de novo [7,40]. Digestion of molecules of
starch interferes by acetic acid which reduced the amount of glucose absorption into the steam of blood after a meal.
Many other studies showed apple cider vinegar consumption lead to slow down the high blood sugar after a high
carbohydrate breakfast with vinegar [41]. A study conducted in rats showed acetic acid containing diet may not induce
super compensation but enhance the glycogen repletion, a major increase of glycogen level is benecial for improving
performance in skeletal muscle and in the liver by transitory glycolysis inhibition. There may also be a possibility of
fatty acid oxidation by acetic acid diet in the liver [42].
Metabolism of glucose in skeletal muscles: For disposal of glucose skeletal muscles can be considered as an
important issue in the response to insulin especially in the status of postprandial [43]. The metabolic effect of acetic
acid on glucose on skeletal muscle is the same as in the liver according to previous studies. Glycogen repletion is
enhanced by acetic acid in skeletal muscles [44]. Within the tissue of skeletal muscle the mechanism action of acetic
acid is different, it enhances the utilization of fatty acid and decreases the glycolysis ratio in the liver and in skeletal
muscle glycogen content which is increased due to glucose-6-phosphate accumulation and suppression of glycolysis
without fatty acid oxidation enhancement [7].
Production of endogenous glucose by the liver: Exact mechanism of endogenous glucose production is not clear
few mechanisms are identied such as consumption of acetic acid in vinegar enhanced the storage of hepatic glycogen
by gluconeogenic/glycolysis decreasing in the liver. Digestion of vinegar at bedtime showed reduced in fasting blood
glucose in patients with type 2 diabetes having fasting blood glucose >7.2 mmol/L [45].
Acetic acid has a benecial effect on glucose metabolism and it works as fatty acid of a short chain. Diabetes rats were
fed with acetic acid 0.3% containing acetic acid (ACOH) to KK-A(Y) (type 2 diabetic mice elevated glucose with
obesity) for 8-weeks and another group is fed with the standard diet for the same period and AOCH fed rat’s plasma
glucose and HbA1C was lower as compared to the control group. Gluconeogenesis and lipogenesis were also reduced
in acetic acid treated group and also (AMPK) activated protein kinase in the liver by the 5-AMP, so hypoglycemic
effect has been noted of acetic acid result from activation of AMPK directly in the liver [44].
Insulin secretion: Hypercholesterolemia can leads to beta cells dysfunction or death of the cells in hypercholesterolemic
patients. The pathology of beta cells dysfunction or death of the cell in excessive cholesterol accumulation in
pancreases. Accumulation of hypercholesterolemia causes impairment of exocytosis of the insulin granule to lead to
modulating granule morphology this condition ultimately causes diabetes. Over cholesterol accumulation in beta cell
cause of cell by apoptotic mechanism [46].
Insulin resistance also has been one of the suggested etiologies for the development of polycystic ovaries syndrome in
female and this PCOS can be prevented by intake of apple cider vinegar 15 g daily for 90-110 days. Follicle stimulating
hormone (FSH), luteinizing hormone (LH), testosterone hormone, fasting insulin level and fasting glucose has been
decreased signicantly when compared before and after vinegar indigestion. The nding of this study suggested that
the uses of vinegar not only improve the insulin sensitivity but also improve the ovarian functions in PCOS patients.
Vinegar reduced the cost and time of medical treatment in insulin resistance and polycystic ovaries syndrome [47]
(Figure 1).
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Figure 1 Proposed mechanism of action of vinegar on glucose metabolism
Uses and Health Benets of Apple Cider Vinegar
Uses of vinegar are known from last 10,000 years and varieties of products of natural vinegar are found all around
the world civilization. There are 2 types of vinegar usage, therapeutic usage which can be antibacterial, anti-diabetic,
anti-tumor, anti-oxidative, antihypertensive, anti-obesity, and is also used as cholesterol-lowering therapy due to its
organic compounds including gallic acid, acetic acid, chlorogenic acid, ferulic acid, caffeic acid, and p-coumaric acid.
The second use of vinegar is commercial usage like used as the preservation of different food, pickling of vegetables
and fruits preparation of salad dressing, mayonnaise and mustard [48].
Therapeutic Effect of Vinegar
Vinegar can be used for therapeutic purposes for many ailments. Numbers of the therapeutic effect of apple cider
vinegar are described below.
Anti-Diabetic Effects or Uses of Vinegar for Diabetes Management
Diabetes mellitus is a metabolic disorder characterized by high blood sugar due to impaired insulin secretion, insulin
resistance and overproduction of hepatic glucose [49]. It may be a high blood glucose level in the state of hunger and
after meal consumption. Hyperglycemia may occur due to the destruction of the beta cell which results in not enough
insulin in type 1 diabetes. Insulin is present in type 2 but tissues are resistant to the insulin which result in high blood
glucose level, 19% insulin sensitivity has been improved in type 2 through vinegar uses and 34% in an individual with
pre-diabetic [48]. Postprandial blood glucose and insulin response can be inuenced by dose and type of vinegar. Uses
of vinegar with carbohydrate-rich food are more effective as compared to low glycaemic food in healthy individual
[50-52]. Meal oxidative stress is not only improved by vinegar addition in standard meal but it also reduced post-
prandial glucose level, and satiety period also prolonged which should be helpful to reduced food cravings and
lowering the intake of calories by intake of 1 to 2 spoons of vinegar with high glycaemic index foods like white bread,
white rice, etc. which lower the random blood glucose by 25% to 30% in diabetic patients [53]. Apple cider vinegar
is a nutraceutical which can be used for the management of diabetes, whole apple cider vinegar is more effective than
alone acetic acid. “Mother of vinegar” consumption may be more effective than without this component.
Acetic acid and chlorogenic acid have more potential than other components of ACV for management of diabetes,
lipid disorder, hypertension and for weight control [54].
Addition of vinegar in diet can reduce the postprandial glucose level in healthy individual but it is more effective
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in high glycaemic index meal (low-fat milk and mashed potato) than in low glycaemic index meal (low-fat cheese,
whole grain, lettuce, etc) with the same composition of nutrients in isocaloric meal when random blood sugar and
insulin values measured after 2 hours of meal intake [50].
Apple cider vinegar has been used in various doses widely being a helpful health remedy for various conditions like
diabetes and obesity control in alternative medicine. A randomized control trial in mice showed that apple cider has
been used in 2 concentrations 0.16% and 1.6%, which were more effective on 7th day onwards to 21st day and not
on the 3rd day of administration of vinegar in the interventional group as compared to control group. Apple vinegar
signicantly lowers the blood glucose level in diabetic mice after 60 min of glucose intake and was maintained up to
120 min [55].
An open crossover randomized placebo control trial was conducted in subjects with impaired glucose tolerance
by using different arteriovenous techniques for the effects of vinegar on endothelial function and muscle glucose
metabolism. This study showed that there was an improvement in blood glucose level uptake by the forearm muscles
and reduced the hypertriglyceridemia and postprandial hyperinsulinemia, in this way vinegar may be benecial for
improving metabolic disorder and insulin resistance in human with impaired insulin resistance [56].
It is evident that vinegar has antiglycemic properties, vinegar attenuated postprandial glucose by 20% when compared
to the placebo group when ingested with meal in small amount composed of complex carbohydrate, vinegar is more
effective in 10 g amount as compared to 20 g and is also more effective when vinegar is taken during meal as compared
to 5 hours before meal [57]. Vinegar, pills, and pickles are used for diabetes control but vinegar is more effective than
pills and pickle. Values of HbA1c fell 0.16% for vinegar group and 0.06% for pills and 0.22% for pickles group over
12-weeks but no change occurred in blood lipids, mean of body weight and plasma insulin [58].
Biochemical and pathological changes are associated with diabetes mellitus. Apple cider vinegar has benecial
properties for decreasing LDL-C, total cholesterol concentration, and blood glucose have also increased HDL-C in
diabetic rats signicantly. Apple cider vinegar treated group showed minimal toxicity in diabetic-induced rats due to
streptozotocin. Recovery of injured hepatocytes has been noted in diabetic rats by histopathological examination of
the liver [41].
A double-blind randomized controlled trial was conducted in patients with type 2 diabetes, in this some biochemical
and hematological factors have been evaluated like BSF, HbA1c, fasting lipid prole, CBC and LFTs apple cider
vinegar signicantly reduced the HbA1c (p=0.002) fasting blood glucose (p=0.006), MCV (p=0.0001), and platelet
(p=0.005) increase signicantly and decrease mean cell hemoglobin (p=0.002) in vinegar treated group who were
taking 15 ml of vinegar during middle meal as compared in placebo (water) treated group. So hypolipidemic and
hypoglycemic properties have been noted for apple cider vinegar [49].
A pilot study was conducted in a pre-diabetic healthy individual (n=14). This study showed signicant (p=0.05)
reduction in HbA1C (0.91+0.27 versus -0. 26+0.17 mmol/l in apple cider vinegar drink containing 750 mg acetic
acid) treated the group as compared to pill (40 mg acetic acid) treated as a control group and average change occurs in
fasting blood glucose [45]. Another pilot study was conducted in patients with type 1 diabetes, with gastroparesis to
evaluate the effect of vinegar in delayed empty gastric. Result of this study showed statistical signicance in delaying
gastric empty. GER measured in group 1 took 300 g rice pudding and 200 ml water, in group 2 300 g rice pudding and
200 ml water with 30 ml of apple cider vinegar was taken. Gastric empty rate in group 1 was 27% and gastric empty
rate in group 2 were 17% [37].
Studies of the comprehensive review indicate that apple cider vinegar can reduce obesity, hyperglycemia,
hyperlipidemia, and hyperinsulinemia in many clinical trials. Several mechanisms for therapeutics effect of apple cider
vinegar is proposed like its delay gastric empty, increased glucose utilization and enteral absorption, up-regulation of
ow-mediated vasodilatation, suppress the hepatic glucose production, increase in lipases, decrease in lipogenesis,
insulin secretion facilitation, fecal bile acid execration stimulation, enhanced energy expenditure, increase satiety.
In spite of these results still, further clinical trials are needed [7]. A randomized control study conducted in alloxan-
induced diabetic and non-diabetic rats showed that continued reduction in blood glucose by active component of apple
cider vinegar enhanced the insulin secretion of the beta cell of the pancreas. This study showed that apple vinegar is
helpful for diabetes management as a complementary agent in the diet [59] (Table 1) .
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Table 1 Summary of clinical trials evaluating the effects of vinegar on hyperglycemia in diabetes individual and rats
S.
No References Participants Trial Design Intervention Placebo Duration Outcome
1 [55] Diabetes mice n=60 Placebo RCT
Apple cider vinegar in
two concentration 0.16%
and 1.6%
Acetic acid
and water 21 days Signicantly reduced
blood glucose level
2 [56] Healthy individual
n=8
Open cross
over placebo
RCT
50 ml apple cider vinegar
(5% acidity containing) 50 ml water 2 weeks
Signicantly
reduced postprandial
hyperinsulinemia,
hypertriglyceridemia
3 [57]
Diabetic individual
trial 1 and healthy
individual 3 trials
n=9
Double-blind
RCT
2 spoons 10 g vs 20 g
ACV, timing After meal
vs 5 hrs before a meal
Neutralized
salt in water
in the same
dose
1 week
Signicantly reduced
PPG after a meal as
compared to before
meal
4 [58] Diabetic individual
n=27 RCT
1 vinegar pill (15 mg
acetic acid 1 pickle (700
mg acetic acid) 2 spoons
ACV (1400 mg acetic
acid)
No placebo
group 12 weeks
HbA1c reduced in
vinegar group as
compared to pills and
pickle groups
5 [41] Diabetes rats n=30 Single
Placebo RCT
ACV 2 ml/kg body wt
with concentration 1:5
Plain water
in the same
dose
30 days Signicantly reduced
blood glucose level.
6 [49] Type 2 diabetes
individual
Double blind
placebo RCT
15 ml ACV containing
5% acidity
15 ml plain
water 1 month
Signicantly reduced
HbA1C, blood sugar
fasting
7 [45] At risk of type 2
diabetes individuals Plot study 750 mg acetic acid as
ACV
40mg acetic
acid as
control pills
12 weeks
Postprandial blood
glucose decrease in
vinegar indigested
group.
8 [59] Diabetes-induced
rats RCT
2 ml/kg body wt ACV
through a nasogastric
tube
10 ml tap
water 14 days
Signicantly reduced
blood sugar level
and produced
hypoglycemia in
vinegar treated group
9 [60] n=110 diabetic
individuals
Single blind
RCT 15 ml ACV
The
articial
avor of
ACV in
water
12 weeks
HbA1C and blood
sugar fasting
signicantly reduced
RCT: Randomized Control Trial; ACV: Apple Cider Vinegar; n=Number of samples/participants; PPG: Post Prandial Glucose;
HbA1C: A Form of Hemoglobin (a blood pigment that carries oxygen) mg milligram and ml milliliter
Hypolipidemic Effects or Management of Hyperlipidemia with Apple Cider Vinegar
An apple cider vinegar used traditionally has been reported for various diseases since many years ago. A quasi-
experimental study showed the hypolipidemic property of apple cider vinegar in hyperlipidemic patients. ACV
signicantly reduced total cholesterol and LDL (p<0.001) but not signicantly affect HDL and triglyceride after
8-weeks of ACV intervention. So ACV can be recommended cost-effective and simple diet strategy for hyperlipidemic
patients for the prevention of cardiovascular diseases [61]. Apple cider vinegar produced by different technique
signicantly decreased VLDL, triglyceride and increased HDL, LDL cholesterol level in high cholesterol diet-treated
rats with vinegar supplementation as compared with only high cholesterol diet treated group without vinegar and
high-fat diet also result in hepatic steatosis [62].
A herbal mixture consisting of ginger, garlic, honey, apple cider vinegar, and lemon extract has the property of
lowering the cardiometabolic risk factors. It has reduced signicantly plasma triglyceride (TG) (p<0.05), very low-
density lipoprotein (VLDL) and also decreased total plasma cholesterol (p<0.05), high-density lipoprotein (HDL)
and low-density lipoprotein were raised (p<0.05). Change in blood glucose, and ALT result is not signicant [63]. A
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67
Kadhim, et al.
study conducted in female rats fed with high cholesterol diet through a nasogastric tube and produced hyperlipidemia
than these rats were treated with apple cider vinegar (0.6%) containing acetic acid for 28 days. Biomarkers of this
study showed a protective effect of apple cider vinegar against liver and kidney oxidative injury and also lowering
the serum lipid, inhibits lipid peroxide and antioxidant enzymes, vitamin level is also improved in vinegar treated
group [64]. An animal study showed that vinegar intake with diet can lower the triglyceride levels (TG), low-density
lipoprotein cholesterol (LDL-C) and raise the high-density lipoprotein cholesterol (HDL-C) [65]. The result of
previous experiments studies conducted on animals getting 1:10+0 dilutions of the ACV in drinking water indicates
that total cholesterol (TC) and triacylglycerols (TG) had been decreased in serum blood [66].
Several animals and few human studies showed hyperlipidemic, hyperglycemic, hyperinsulinemia and obesity control
effect of apple cider vinegar. Reduction in lipogenesis raised in lipolysis, acid bile excretion stimulation and increase
the expenditure of energy reduced the energy intake due to increase in satiety is the mechanism of lipid metabolism,
fat accumulation, and body fat reduction also. Reducing total cholesterol and triglyceride also has been reported in
several animals and little human studies by the uses of vinegar regularly in diet [7].
Type of different vinegar including apple, sugarcane, grape, coconut, and other articial vinegar has been used for
different ailments and has health benets. Study conduct in rats showed a signicant decrease in LDL-C, TC, glucose
and also raised in HDL-C (p<0.05) when administrated 15% with the diet for 6-weeks. No histopathological change
was found in the stomach and pancreas when administrated different vinegar in rats [67]. Acetic acid is an active
component of vinegar which signicantly effect on hyperlipidemia in hyperlipidemic rats. These rats were given
a cholesterol-containing diet with vinegar and without vinegar for 19 days in 2 groups. Serum triglyceride, serum
total cholesterol, ATP citrate lyase activity, 3-methyl glutaryl, 3-hydroxy element, and fatty acid synthesis, protein
binding-1 is signicantly reduced in those rats which were taking vinegar and cholesterol containing diet and raised
these values in only cholesterol. The mechanism of action of vinegar in the liver is lipogenesis inhabitation and
increment of excretion of fecal acid bile in the cholesterol-containing diet of the rats [68] (Table 2).
Table 2 Summary of clinical trials evaluating the effects of vinegar on hyperlipidemia in human and animals
Sr no References Participants Trial Design Intervention Placebo Duration Outcome
1 [61]
n=19
hyperlipidemic
individual
Quasi-
experimental
study
30 ml ACV No placebo group 8 weeks
Signicantly reduced
total cholesterol. LDL
triglyceride levels but not
signicantly increased in
HDL
2 [62]
n=54
hyperlipidemic
rats
RCT 1 ml ACV via
oral gavage
1ml physiological
saline via oral
gavage
7 weeks Triglyceride and VLDL
reduced signicantly
3 [64]
n=10 female
hyperlipidemic
rats
RCT
1 ml ACV
containing 0.6%
acetic acid orally
Plain water 1 ml
orally 28 days Serum lipid level improved
signicantly
4 [66] n=60 RCT
ACV 1 ml in
100 ml water in
1:100 ratio
Water in same
quantity 21 days Helpful in lowering lipid
plasma
5 [67] n=48 RCT
1 ml ACV (5%
acetic acid)
diluted in 10 ml
water
Articial vinegar
in the same dose 6 weeks
ACV was most effective in
lowering glucose LDL, TC
increasing HDL as compare
to other vinegar
6 [60] n=110 obese
individual
Single blind
RCT 15 ml ACV
The articial
avor of ACV in
water
12 weeks
Total cholesterol and
triglyceride signicantly
reduced but no signicant
change in LDL, HDL
RCT: Randomized control trial; ACV: Apple cider vinegar; n=number of samples/participants; PPG postprandial glucose; HbA1C:
A form of hemoglobin (a blood pigment that carries oxygen) mg milligram and ml milliliter
Uses of Vinegar for Weight Control
The prevalence for overweight among teenage noted in Sri Lanka is 11.0% and in India is 19.0% and obesity ranged
in Sri Lanka is 2.4% and in Pakistan is 11.0%. Prevalence range of overweight in young adult is 7.9% in Nepal and
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Kadhim, et al.
15.0% in Pakistan and obesity ranged is much higher in Nepal of about 0.005%, in India is 22.8% and identied risk
factors for overweight and obesity are low consumption of fruits and vegetable, high intake of fast food and soft drink,
total vegetarian diet and breakfast skipping [69].
Apple cider vinegar can also be used as a supplement for weight reduction. A study conducted in obese and normal
weight rats. There were 2 groups of rats, one group was fed with conventional diet and another group was fed with the
high caloric diet for 4-week than obese and normal rats further divided into 2 groups: control group (water treated) and
interventional group (vinegar treated) which used 0.8 ml/kg body weight. The signicant reduction has been found in
plasma glucose, total cholesterol in both groups normal and obese rats group. But no change occurs in HDL and LDL
so which gains excessive body weight and high concentration of plasma glucose which might be avoided by apple
cider vinegar uses in obese and normal weight rats [70]. Vinegar containing 6% acetic acid signicantly reduced body
weight and also inuence appetite and reduced the postprandial glycaemic [71].
A study was conducted to assess the effect of acetic acid with water on body weight in fatty mice. The dose of acetic
acid 0.3 or 1.5% for 6-weeks showed a signicant reduction in fat cells in both higher and low dose of vinegar in the
area of perinephric, mesenteric tissue and retroperitoneal tissue when compared with a control group of mice. No
change occurs in skeletal muscle weight in both groups, no dose dependency was needed even the lowest dose can be
effective for fat cells reduction [72].
A double-blind study was conducted in obese Japanese to investigate the effect of vinegar on obesity. Three doses of
vinegar have been used in 3 group’s: group 1, 30 ml vinegar with 500 ml daily intake of beverage, for group 2, 15 ml
of vinegar with 500 ml of daily beverage, and 0 ml of vinegar with 500 ml beverage for control group for 12-weeks.
All these 3 groups have the same body mass index (BMI), body weight, and wrist circumference. The result of this
study showed a signicant reduction in serum triglyceride and body weight. This study also showed no side effect of
vinegar on the health status of human [73] (Table 3).
Table 3 Summary of clinical trials evaluating the effects of vinegar on obesity in human and animals
Sr no References Participants Trial Design Intervention Placebo Duration Outcomes
1 [70]
n=20
10=normal wt
10=obese rats
RCT animal
study 0.8 ml ACV 0.8 ml plain
water 4 weeks Fat cell reduced signicantly
in ACV group
2 [72] n=9-10 obese
rats
RCT animal
study
Acetic acid
1.5% or 0.3 ml Water as placebo 6 weeks
Signicantly observed
Suppression of fat cell
accumulation
3 [73] n=175 Obese
individual
Double blind
RCT
30 ml ACV 15
ml ACV
Articial avor
of ACV in water 6 weeks Signicantly decrease in
body weight
4 [60] n=110 obese
individual
Single blind
RCT 15 ml ACV
The articial
avor of ACV in
water
12 weeks
Weight not signicantly
reduced but the H/W
ratio and mid-upper arm
signicantly reduced
RCT: Randomized Control Trial; ACV: Apple Cider Vinegar; n: Number of samples
Management of Hypertension with Apple Cider Vinegar
Dietary vinegar has the potential to prevent hypertension when consumed it for a long time. A study conducted in
spontaneously hypertensive rats showed a signicant reduction in blood pressure (p=0.05) and rennin activity which
is (p=0.01) in vinegar treated group for 8-weeks as compared to control group which has no use of acetic acid and
vinegar. Reduced in rennin activity is a suggestive mechanism for the reduction in blood pressure and further clinical
trials are needed to investigate the exact mechanism for lowering the blood pressure [74].
Autonomic nervous system and endothelium may be affected by diabetes result in complications of microvascular
which impairs the blood ow auto-regulation. The lower level of vasodilator nitric oxide and raised vasoconstriction
endothelin-1 level can be seen in diabetes subjects [75]. About 4% of acetic acid can be found in rice vinegar and
acetic acid is more potent as compared to the vinegar solution. Calcium absorption can be increased by acetic acid, an
increase in calcium absorption may be helpful for blood pressure control [54] (Table 4).
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Table 4 Summary of clinical trials evaluating the effects of vinegar on hypertensive in human and animals
S. No References Participants Trial
Design Intervention Placebo Duration Outcomes
1 [74] Hypertensive
rates n=18 RCT Acetic acid 4%
solution (46.2 g/l) Deionized water 8-weeks HTN, rennin activity
Signicantly reduced
2 [76] Hypertensive
rates n=6 RCT Red wine vinegar No placebo 2-weeks HTN signicantly
reduced
HTN: Hypertension; RCT: Randomized Control Trial
Antimicrobial Effect of Vinegar
Vinegar work as an antimicrobial agent in many conditions. Acetic acid is an active component in organic vinegar
which can penetrate the cell membrane of bacteria and bring the death of cells of bacteria. It is also used in many
conditions like oral hygiene, cleaning agent, killing head lice, ear infection, treating nails fungus and warts [48].
Vinegar also has the ability to treat the site infection caused by Pseudomonas in peritoneal dialysis patients and it
also reduces antibiotics use, prevents the antibiotics resistance in PD patients by using organic vinegar containing 4%
acidity (acetic acid) [77].
A study was conducted against 5 oral organisms (Lactobacillus, Streptococcus mutans, Staphylococcus aureus,
Streptococcus salivarius, and Enterococcus faecalis) in vitro to compare the effectiveness of vinegar and mouth
rinses (chlorhexidine gluconate containing 0.12%) at 37°C all dishes were incubated for 24 hours. Four out of ve
organisms were found to be sensitive to vinegar and chlorhexidine gluconate signicantly (p=0.01) but vinegar was
more effective as compared to chlorhexidine gluconate [78]. A study was conducted to evaluate the effectiveness
of vinegar with different concentrations 5%, 10% and 15% with 6% acetic acid against E. coli and MNV-1 count in
vinegar green laver salad during storage of refrigerator of Korean food. Values decreased gradually in the proportion
of MNV-1 and E. coli when increased the concentration of vinegar and storage time but MNV-1 was resistant when
compared to E. coli to vinegar [79].
Buffered dry vinegar can also have antimicrobial properties for inhibition of microorganism like Listeria monocytogenes
in sodium reduced readily to eat uncured Turkey sh when the sample was stored for 12-weeks at 48°C. The sample
was taken from a different side and then incubated with buffered vinegar with sodium base and dry vinegar with
potassium base for 2-weeks then L. monocytogenes population were count in the control group and vinegar treated
group. 1 log L. monocytogenes increase in count in the control group and the buffered dry vinegar treated group
showed signicant (p=0.05) inhabitation of L. monocytogenes growth at the end of the 2-week [80].
Salmonella is commonly found in animal region food and also even in fresh fruits and vegetables in 100-400 cases.
Salmonella can be eliminated signicantly with lemon juices, vinegar and mixture of vinegar and lemon in carrot
with different exposure times (0 min, 15 min, 30 min and 60 min) which result in reduction of Salmonella count
signicantly ranging from 0.79-3.95 CFU/g and 1.57-3.58 log CFU/g and also reduced in count of pathogens in the
lemon and vinegar mixture group after 30 min treatment to an undetectable level [81] (Table 5).
Table 5 Summary of clinical trials evaluating the effects of vinegar against microbial growth
S. No References Organisms Trial Design Intervention Placebo Duration Outcomes
1 [78]
Streptococcus
mutants,
Enterococcus
faecalis,
Staphylococcus
aureus, Candida
albicans, and
Lactobacillus
salivarius
Experimental
Study (in
vitro)
White vinegar
0.12%
chlorhexidine
gluconate
Incubation
period
24hrs at
37°C
Both kinds of vinegar
were signicantly
effective as compare
to chlorhexidine
gluconate
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Kadhim, et al.
2 [80]
Two different ve-
strain inoculums of
L. monocytogenes
Experimental
Study (in
vitro)
dry buffered vinegar
with a potassium
base (BDV-PB)
at 0.7 and 0.9%
controlled
Unbuffered
dry vinegar 12 weeks
L. monocytogenes
growth signicantly
decreases as compared
with the untreated
control group
3 [81]
Salmonella
typhimurium
(inoculated)
Experimental
Study (in
vitro)
Lemon juices
vinegar
No
comparative
group
(0, 15, 30
and 60 min)
Salmonella
typhimurium growth
signicantly reduced
Commercial Uses of Vinegar
Vinegar has the potential of health benets if used for a long time, is its avor and functional properties vinegar can
be used for the preparation of salad dressing, for fruits and vegetable pickling and for preparation of mayonnaise in
markets [48].
Vinegar has antibacterial properties against Salmonella, Staphylococcus aureus, and Escherichia coli which cause
food poising in human when compared to antibiotics and can be used for food preservation in different concentration
20%, 14%, 10%, 5%, 7%, 3%, and 1%, 0.5%, 0.25% but 20% concatenation was more effective against selected 3
microorganisms and 0.25%, 0.5% did not show any inhibitory effect against anyone from the 3 organisms [82].
Acetic acid has properties of food safety and preservative ability against microorganism (anaerobic bacteria, yeasts,
and molds) growth in refrigeration in breast chicken with different concentration 1%, 2% and 3% of acetic acid. After
examination of 0, 7, 14, and 21 days refrigeration of breast meat showed signicant improvement of microbial growth
in acetic acid treated group as compared to control group (no acetic acid treatment) with all concentration of acetic
acid [35].
CONCLUSION
The current review study concluded that the results of many clinical trials showed an active component of apple cider
vinegar which has the potential for lowering hyperglycemia, hyperlipidemia, and reduced body weight. Hypertension
should be control with the intervention of apple cider vinegar. Results of many studies also showed the anti-microbial
effect of apple cider vinegar. Commercial and another therapeutic effect also has been reported in many studies.
Few studies showed the controversial effect of apple cider vinegar. These discrepancies could be attributed to many
factors such as doses of vinegar, the timing of vinegar digestion, duration of studies, physiological character cities of
human and animals, the acidity of the vinegar, level of remaining pancreatic secretion, level of insulin secretions and
glycemic index of the meal. Several mechanisms have been reported for mechanism action of glucose metabolisms
such as delayed gastric emptying and enteral absorption, increased utilization of glucose, suppression of production
of hepatic glucose, up-regulation of ow-mediated vasodilatation, increase in lipolysis and reduction in lipogenesis,
insulin secretion facilitation. Other mechanisms are reported including fecal acid bile excretion facilitation, enhanced
energy uses and increased satiety.
DECLARATIONS
Conict of Interest
The authors declared no potential conicts of interest with respect to the research, authorship, and/or publication of
this article.
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Kausar , et al.
... According to the similarities between the mentioned symptoms and hypothyroid symptoms, warm remedies such as ginger are recommended by traditional medicine practitioners for these patients [20]. Besides, several scientific investigations have confirmed the therapeutic effects of ginger on hyperlipidemia [21,22], insulin resistance [23,24], and obesity [22,25], which are all common comorbidities in hypothyroid patients. Recent studies also have shown the protective effect of ginger against thyroid damage in animals and humans [16,26,27]. ...
... According to the similarities between the mentioned symptoms and hypothyroid symptoms, warm remedies such as ginger are recommended by traditional medicine practitioners for these patients [20]. Besides, several scientific investigations have confirmed the therapeutic effects of ginger on hyperlipidemia [21,22], insulin resistance [23,24], and obesity [22,25], which are all common comorbidities in hypothyroid patients. Recent studies also have shown the protective effect of ginger against thyroid damage in animals and humans [16,26,27]. ...
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Primary hypothyroidism is a common disease. Some patients have persistent symptoms despite normal serum thyroid-stimulating hormone (TSH) levels. Ginger is reported to be beneficial in relieving similar symptoms. Our aim was to evaluate the efficacy of ginger supplementation in relieving persistent symptoms in these patients. In this randomized, double-blind, placebo-controlled clinical trial, 60 hypothyroid patients aged 20–60 years with normal serum TSH concentrations were randomly allocated to two equal parallel study groups of ginger (500 mg twice a day) or placebo for 30 days. Hypothyroid symptoms were evaluated as the primary outcome using the Thyroid Symptom Rating Questionnaire (ThySRQ) before and after the intervention. Anthropometric measures and laboratory indices including TSH, triglyceride (TG), total cholesterol (TChol), and fasting blood sugar (FBS) were considered as secondary outcomes. A significant lower mean total ThySRQ score (8.63 ± 5.47 vs. 15.76 ± 6.09, P < 0.001 ) was observed in the ginger group compared to the control group. Ginger led to significant improvements in the mean scores of the weight gain, cold intolerance, constipation, dry skin, appetite, memory loss, concentration disturbance, and feeling giddy or dizzy domains ( P < 0.001 ). However, no significant improvements were observed in hair loss, nail fragility, hearing, hoarseness, speech, and depression or feeling down ( P > 0.05 ). Ginger supplementation also led to a significant decrease in body weight, body mass index, waist circumference, serum TSH, FBS, TG, and TChol levels compared to the placebo. In summary according to preliminary results of this study, ginger supplementation can help relieve persistent hypothyroid symptoms. Also, it may have beneficial effects in terms of weight reduction and regulation of the FBS and lipid profile in hypothyroid patients.
... The mechanism of the ACV effect on lipid profiles and glycemic related markers has not been well defined; however, empirical studies have suggested several potential mechanisms. Indeed, ACV can improve glycemic status by delaying gastric emptying, enhancing cellular glucose utilization and lipolysis, suppressing hepatic glucose production and lipogenesis, and facilitating insulin secretion [21,35]. Furthermore, in our study, the beneficial effect of ACV on FPG levels was more pronounced when the duration of studies lasted > 8 weeks. ...
... These findings suggest that higher baseline values of FPG and HbA1C might contribute to a greater reduction in these markers following ACV intake. This study revealed that ACV consumption might reduce serum TC concentrations; where the effect of ACV on lipid profiles might be attributed to its stimulation of acid bile excretion, increasing lipolysis and decreasing lipogenesis [21,35]. Subgroup analysis indicated a greater beneficial effect on both TC and TG levels among type 2 diabetics patients. ...
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Background Elevated lipid profiles and impaired glucose homeostasis are risk factors for several cardiovascular diseases (CVDs), which, subsequently, represent a leading cause of early mortality, worldwide. The aim of the current study was to conduct a systematic review and meta-analysis of the effect of apple cider vinegar (ACV) on lipid profiles and glycemic parameters in adults. Methods A systematic search was conducted in electronic databases, including Medline, Scopus, Cochrane Library, and Web of Knowledge, from database inception to January 2020. All clinical trials which investigated the effect of ACV on lipid profiles and glycemic indicators were included. Studies were excluded if ACV was used in combination with other interventions or when the duration of intervention was < 2 weeks. To account for between-study heterogeneity, we performed meta-analysis using a random-effects model. Results Overall, nine studies, including 10 study arms, were included in this meta-analysis. We found that ACV consumption significantly decreased serum total cholesterol (− 6.06 mg/dL; 95% CI: − 10.95, − 1.17; I²: 39%), fasting plasma glucose (− 7.97 mg/dL; 95% CI: − 13.74, − 2.21; I²: 75%), and HbA1C concentrations (− 0.50; 95% CI: − 0.90, − 0.09; I²: 91%). No significant effect of ACV consumption was found on serum LDL-C, HDL-C, fasting insulin concentrations, or HOMA-IR. The stratified analysis revealed a significant reduction of serum TC and TG in a subgroup of patients with type 2 diabetes, those who took ≤15 mL/day of ACV, and those who consumed ACV for > 8-weeks, respectively. Furthermore, ACV consumption significantly decreased FPG levels in a subgroup of studies that administered ACV for > 8-weeks. Further, ACV intake appeared to elicit an increase in FPG and HDL-C concentrations in apparently healthy participants. Conclusion We found a significant favorable effect of ACV consumption on FPG and blood lipid levels.
... 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.
... Various studies [39,40] have shown that vinegar consumption can reduce the lipid profile. It has also been shown that ZM causes a significant reduction in TG and total cholesterol levels [41,42]. ...
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Purpose: To determine the effects of dates vinegar on blood biochemical and hematological parameters in type 2 diabetic subjects. Methods: Current research focused on fifty-five subjects having blood sugar more than126 mg/dL. Participants ingested dates vinegar (20 mL) daily into their normal diets for a period of 10 weeks. Glycated hemoglobin (HbA1c), fasting blood sugar (FBS), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), creatinine (Cr), urea, complete blood count (CBC), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), potassium and folate levels were analyzed before, after 5 weeks and after the experiment Results: Dates vinegar improved the blood concentrations of HbA1c (6.80 ±2.34 to 6.17 ± 2.14 (%)), FBS (171.43 ±36.74 to 147.56 ± 38.86 mg/dL,p=0.001), TC (218.10 ± 16.9 to 191.14 ± 14.23 mg/dL, p<0.001), ALT (24.94 ± 5.03 to 21.88±5.08 IU/L, p=0.002) and ALP (264.32± 45.26 to 257.30 ±44.21 IU/L) and folate (34.6 ± 6.6 to 41.7 ± 6.5 nmol/ L,p<0.001). Conclusion: Dates vinegar significantly improved the total cholesterol.The other blood biochemical and hematological factors were also improved however; the improvements were not significant.
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Diabetes represents an enormous and growing clinical and public health problem. Its financial burden is huge and growing and likely to be unsustainable. Lifestyle interventions are safe and effective for preventing diabetes, are associated with improved quality of life, and are cost-effective. Metformin is effective, safe, and costeffective, if not cost-saving. National and international efforts are needed to identify at-risk individuals and to systematically apply these interventions. Research must focus on how best to implement diabetes prevention in diverse populations and settings.
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Peritoneal dialysis exit site infections caused by Pseudomonas spp. are difficult to treat and can lead to peritonitis and/or modality failure. Effective alternative or adjunct non-antibiotic antimicrobial agents could improve treatment as well as reduce the use of antibiotics and contribute to a reduction in antibiotic selection pressure and the further development of antibiotic resistance. Vinegar is popularly promoted as a topical antimicrobial agent and has been recommended as an adjunct treatment for Pseudomonas exit site infections in PD patients. Systematic empirical data on the susceptibility of pseudomonads to vinegar are lacking. This study aimed to determine the susceptibility to vinegar of 57 isolates of Pseudomonas. The MICs and MBCs of four vinegars were determined for clinical, environmental and/or reference isolates of P. aeruginosa (n = 34), P. fluorescens (n = 11) and P. putida (n = 12) using a broth microdilution method. The MIC90 and MBC90 were also determined for each species. The MIC90 of all four vinegars against P. aeruginosa was 2% (vol/vol). The MBC90 was 8%. The MIC90s for P. fluorescens and P. putida were also 2%. The MIC90s were 4%. Dilutions of vinegar recommended for the treatment of Pseudomonas exit site infections have in vitro activity against these notoriously resistant bacteria. In light of increasing rates of antibiotic resistance and the need to reduce antibiotic selection pressure as part of good antibiotic stewardship, the efficacy of vinegar, or its active constituent acetic acid, for the treatment of Pseudomonas exit site infections should be investigated further.
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Objective The aim of our study was to assess the effect of ginger (Zingiber officinale) on blood glucose and lipid concentration in subjects with diabetes or hyperlipidemia. Methods The literature search was conducted in PubMed and Scopus up to 30 October 2016. A total of nine randomized controlled trials were included in the meta-analysis. Weighted mean difference (WMD) and its 95% confidence interval were calculated for net changes in blood glucose (fasting blood-glucose [FBG]) and lipid concentrations (total cholesterol [TC], triglyceride [TG], low-density lipoprotein cholesterol [LDL-C], high density lipoprotein cholesterol [HDL-C]). Subgroup analyses were performed by clinical condition (hyperlipidemia and T2DM) and quality assessment (high and low quality). Results Compared to the controls, ginger intake significantly reduced the concentrations of TG (WMD, −8.84; 95% CI: −11.95 to −5.73), TC (WMD, −4.42; 95% CI: −8.70 to −0.13), HDL-C (WMD, 2.87; 95% CI: 0.88–4.86) and FBG (WMD = −14.93; 95% CI: −19.83 to −10.04). Subgroup analyses by clinical condition of hyperlipidemia and high quality studies showed consistent results with the overall analysis, whereas, the subgroup analysis by clinical condition of diabetes showed a significant difference in the mean change of TG and FBG levels. Moreover, the high risk studies showed a significant change in the mean of FBG. Examining the funnel plot, suggests no publication bias. Conclusions Ginger supplementation (tablet, capsules, powder or rhizomes) significantly reduced FBG, TG and TG and significantly increased HDL-C. But the changes were related to the clinical condition. More clinical trials evaluating the effects of ginger are warranted.