Apple Cider Vinegar holds the title for the most popular type of vinegar throughout natural health communities. There are dozens of claimed apple cider vinegar benefits, many of which have science backing them. It's common in food flavoring and preservatives, and it has decades of use as a folk remedy for various ailments. But is it as useful as everyone claims it to be?
According to our research, the short answer is yes! There is a broad range of uses of apple cider vinegar, and we're going to go in-depth with science-backed evidence to prove it.
What is Apple Cider Vinegar?
Apple cider vinegar is juice from crushed apples that has been fermented. It is a pale-yellow color and can come in either a pasteurized form or an unpasteurized, raw form that contains what is known as “the mother” of vinegar. It contains pectin from the apples, Vitamin C, Vitamin B1, Vitamin B2 and B6, niacin pantothenic acid, and folic acid.  The vinegar contains between 5 and 20-percent acetic acid, trace elements, minerals, amino acids, water, flavorings, and plant-based antioxidants called “polyphenols”. [2, 3]
Apple cider vinegar is made through a natural fermentation of aged apple juice which initially makes the alcohol-containing hard apple cider. If it is not collected for hard apple cider, the liquid will undergo a second fermentation which breaks the alcohol into acid and creates vinegar. 
Apple Cider Vinegar History
The name vinegar comes from the French “vin aigre” which means “sour wine”. The use of apple cider vinegar goes back as far as 420 BC as a natural and effective wound disinfectant and treatment. In the late 18th century, there are writings from US physicians including the use of apple cider vinegar for treatment of poison ivy, croup, stomach ailments, and more. Today, it has popular use by the health community and people who like natural solutions to everyday health issues. [3, 5]
How is ACV made?
Apple cider vinegar undergoes multiple steps to turn from apples into vinegar. First, the sugar in the apples is fermented by yeasts and produces alcohol-containing “hard” apple cider. The bacteria and microorganisms remaining from the first fermentation use the alcohol in a second process in which the alcohol is oxidized into acetic acid (or vinegar). The bacteria which turns the alcohol into acetic acid is called acetobacter. [3, 6]
What is Apple Cider Vinegar Made of?
The most common types of bacteria in apple cider vinegar are acetic acid bacteria and lactic acid bacteria. Acetic acid bacteria contain mostly Acetobacter and Komagataeibacter, with Komagataeibacter in a larger quantity at the end of the oxidation process. The lactic acid bacteria consist of two generas: Lactobacillus and Oenoncoccus. Oenococcus has the highest concentration of the lactic acid group. A smaller concentration of bacteria found in apple cider vinegar is Gluconobacter. 
Some of the Lactobacillus in apple cider vinegar has been gene sequenced and is known to contain Lactobacillus collinoides, Pediococcus parvulus, O. oeni, and in smaller concentrations L. casei and P. ethanolidurans. 
Organic apple cider vinegar contains a different constituent profile than conventional apple cider vinegar. Conventional apple cider vinegar also contains some yeasts that survive within acetic acid. Organic apple cider vinegar is considered a more heterogenous mixture of bacteria because conventional ACV only contains two species of bacteria versus organic ACV’s four species of bacteria.
- Organic apple cider contains:
Acetobacter pasteurianus: 71.90%
Acetobacter ghanensis: 12.50%
Komagataeibacter oboediens: 9.35%
Komagataeibacter saccharivorans: 6.25%
- Conventional apple cider vinegar contains:
Acetobacter pasteurianus: 66.70%
Komagataeibacter oboediens: 33.70%
Saccharomycodes ludwigii 
The raw, organic, unpasteurized form of apple cider vinegar has been the focus of health communities because it does contain a better variety of bacteria. The major difference between conventional ACV and raw ACV is the lump at the bottom of the raw bottle known as “the mother”.
The “mother of vinegar” comes from a substance made of cellulose and acetic acid bacteria which develops on fermenting liquids containing alcohols. The “mother of vinegar” is formed by the bacteria Acetobacter aceti and was also known as Mycoderma aceti when first discovered. 
The “mother’s” acetobacter uses the oxygen in the air and the alcohol produced by fermentation to oxidize the alcohol into acetic acid, or vinegar. It is often added to liquids that are already alcoholic to further produce vinegars. It may also form in conventional vinegar if any non-fermented sugar or alcohol is present. 
The “mother of vinegar” is safe to consume and many raw ACV enthusiasts recommend shaking the bottle vigorously, so the sediment formed by the “mother” is mixed into the vinegar and you consume some of it with each use. It can also be removed with a strainer or just left at the bottom of the bottle. 
Some people believe that all apple cider vinegar is a probiotic. Since only the “mother” is still present in raw ACV that has not been pasteurized, it is the only form of ACV that can be considered a probiotic. It retains beneficial bacteria and pectin from the apples, which is a prebiotic. Pectin is a starch found in fruits, vegetables, and their skins. Pectin is often included in the capsules of probiotics to enrich the effectiveness of the probiotics. To be classified as a prebiotic, it has to meet several criteria, and studies have demonstrated that pectin increases the growth of several beneficial strains of bacteria, such as Bifidobacteria and Lactobacillus, which are both present in the gastrointestinal tract. 
What are the benefits of Apple Cider Vinegar?
Apple Cider Vinegar Can Protect Against Oxidative Stress
Apple cider vinegar is a large source of antioxidants. These antioxidants help to protect your cells and tissue against oxidative stress. Oxidative stress is when there is an imbalance between the antioxidant levels and free radical levels in your body. The free radicals can cause cell damage that causes you to age and have problems with your various systems. 
It's shown to be very effective at protecting against oxidative injuries to the kidneys and liver. Additionally, it lowered the serum lipid levels in tests on mice. Other studies showed that adding apple cider vinegar to your diet can reduce any damage and improve the capacity of the antioxidants present in your body. [15, 17]
Apple Cider Vinegar Can Lower High Cholesterol Levels
Apple cider vinegar contains an antioxidant that is called chlorogenic acid. This antioxidant works to safely and effectively prevent particles of LDL from oxidizing, which lowers your overall levels. A second study with rats showed that it also reduces the levels of triglycerides while increasing the levels of “good” cholesterol, which can improve your heart health. [11, 12, 13]
Apple Cider Vinegar Can Aid in Losing Weight
One double-blind study took Japanese participants and fed them apple cider vinegar as part of their diet. They found that it effectively reduced their body fat mass and their body weight. An animal study showed that it's effective at preventing weight gain because it increases how quickly you feel full each time you eat. It can also regulate the genes that are directly involved in fat oxidation. [21, 22, 23]
Apple Cider Vinegar Reduces Allergies
Anecdotal evidence suggests that apple cider vinegar has natural antihistamine properties that help your body quickly break up any excess mucus. It's also believed to have anti-inflammatory properties associated with it. These properties can help soothe any irritation or inflammation you may have in your respiratory tract.
Apple Cider Vinegar Has Antimicrobial Properties
Apple cider vinegar inhibits the growth of Pseudomonas aeruginosa and Staphylococcus aureus. 
Apple Cider Vinegar May Help Control Diabetes
Two separate studies showed that adding apple cider vinegar to your diet can help to control any blood sugar spikes. It does this by regulating how much starch your body absorbs when you eat. Additionally, it also helps improve your cell's sensitivity to glucose, and this can help them absorb it more effectively. [25, 26]
Apple Cider Vinegar May Promote Heart Health
A study showed that eating vinegar salad dressing in general five times a week drastically lower the risk of a heart attack. 
Apple Cider Vinegar Might Aid in Digestion
Anecdotal reports state that apple cider vinegar may help with heartburn. Unfortunately, the information about clinical studies is limited. We did find one trial which suggested that ACV does help relieve heartburn for some individuals. 
Apple Cider Vinegar Might Prevent Kidney Stones
Consuming fermented vinegar like apple cider vinegar may reduce the formation of kidney stones by alkalizing the acid content in your urine. 
Apple Cider Vinegar Can Help Detox
The acid content in apple cider vinegar can play a key role when it comes to detoxing your organs and systems. One animal study showed that apple cider vinegar can be useful for flushing toxins out the liver and preventing forms of liver disease. 
Apple Cider Vinegar Might Help with Improve Hair Health
Apple cider vinegar balances the pH of the scalp and works as a detangler, clarifier, and conditioner.
Apple Cider Vinegar Can Help with Acne
Anecdotal evidence suggests that apple cider vinegar can work as an all-natural astringent toner.
How to Use Apple Cider Vinegar
There are several ways that you can use apple cider vinegar. However, you rarely want to use it without diluting it because it is very strong and concentrated. Ways to use it include:
- As a toner for acne: Mix one part apple cider vinegar with three parts water. Cleanse your face with a mild soap and water. Pat it dry before applying the apple cider vinegar mixture to your acne spots. Let it sit for 15 to 20 minutes and rinse it off—the rinse off is very important. Do this every morning or evening.
Apple Cider Vinegar Drink:
- Apple Cider Vinegar Drink: Add a tablespoon of apple cider vinegar to eight ounces of water. You can drink this before or with your meals to improve your digestion.
Apple Cider Vinegar Detox:
- Apple Cider Vinegar Detox: Mix one cup of water, one tablespoon of apple cider vinegar, one tablespoon of lemon juice, half of a tablespoon of cinnamon, and a pinch of honey together. Drink this every morning to help flush your system.
- Disinfectant: Mix a half of a cup of vinegar with a cup of water and spray it on your counters and hard surfaces for natural germ-killing action.
- Hair Care: Add a tablespoon or two to eight ounces of water. Wash your hair and rinse it with the apple cider vinegar mixture. Let it sit in your hair for a few minutes and rinse it out. Repeat twice a week.
How to Incorporate Apple Cider Vinegar Safely into Your Diet:
Never drink apple cider vinegar without diluting it first because it is very strong. It’s also a good idea to start introducing ACV into your diet gradually and observing how your body reacts to it.
Since it is so acidic, you need to rinse your mouth after you take it to avoid damaging the enamel on your teeth, and wait at least 30 minutes after you rinse your mouth to brush your teeth.
Apple Cider Vinegar Side Effects
For the most part, side effects of apple cider vinegar are rare and mild.
Apple cider vinegar can potentially have negative interactions with diuretics and insulin. This can lead to dangerously low potassium levels or blood sugar levels if you mix them. Some of the medications you want to avoid mixing with apple cider vinegar include:
- Tolbutamide and others 
Delayed Stomach Emptying
Apple cider vinegar slows down the rate that food leaves your stomach and digestive tract. In turn, this slows down how fast it absorbs into the bloodstream. For people that have gastroparesis, this can cause it to worsen or flare. Side effects may include bloating or abdominal pain. 
Tooth Enamel Erosion
Drinking apple cider vinegar undiluted can damage the enamel on your teeth. One study showed that teeth that are immersed in apple cider vinegar for four hours can experience between 1 and 20-percent enamel loss. This can lead to tooth decay and cavities if you don't dilute it and remove any residue. [33, 34]
Burning of Throat Tissue
Undiluted apple cider vinegar has the potential to cause tissue burns in your throat. This is especially true for children, and one study even suggested that apple cider vinegar be kept in a childproof container. Another study showed a woman who experienced burns after an apple cider vinegar tablet got stuck in her throat. [35, 36]
As apple cider vinegar is very acidic, a few reports have demonstrated that putting even a few drops of pure apple cider vinegar on your skin to clear up acne or to help clean open wounds can cause irritation or slight burns on your skin. 
Who Should Avoid Taking Apple Cider Vinegar
Children under the age of three should avoid contact with apple cider vinegar. If you apply it topically, you need to ensure that it's very diluted. Women who are pregnant or nursing should also avoid taking it because it can cause a drop in blood sugar. Those who are taking potassium supplements should consult with their healthcare practitioner before beginning apple cider vinegar supplementation.
When used correctly, apple cider vinegar can be a useful and natural tool to help with a variety of health issues.
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