Apple cider vinegar (ACV) is a popular ingredient used in food and various home remedies. While its moderate use is generally considered safe for most healthy adults, consuming it in excessive, undiluted amounts may lead to potential health risks [1]. This guide explains the potential side effects of overconsumption and provides guidelines for using it safely and mindfully.
Potential Side Effects of Overconsuming Apple Cider Vinegar
Apple cider vinegar is typically well-tolerated when consumed in moderate, diluted amounts as part of a balanced diet. However, caution should be exercised with higher doses and topical applications, as its acidity may pose potential risks. Here are the seven key areas where excessive ACV use may cause adverse effects.
1. Dental Erosion and Oral Health
Apple cider vinegar is naturally acidic, primarily due to acetic acid. Regular consumption of high concentrations of acidic foods and beverages can interact with tooth enamel, the protective outer layer of your teeth. Research has shown that this acidity can lead to enamel erosion [2].
Once enamel is eroded, teeth can become sensitive to sweet, hot, or cold foods and beverages. To mitigate this risk, ACV should always be diluted, and its contact time with teeth should be minimized (e.g., by using a straw).
2. Impact on Blood Sugar Management and Electrolytes
- Blood Sugar Control: Individuals with Type 1 diabetes, particularly those with a condition called diabetic gastroparesis (delayed stomach emptying), should use ACV with extreme caution [3]. Studies suggest ACV can delay gastric emptying, which complicates blood sugar control and may increase the risk of low-blood-sugar episodes [3]. Consulting a healthcare professional is essential for anyone with diabetes before incorporating ACV regularly into their diet.
- Potassium Levels (Hypokalemia): There is one documented case report suggesting that chronic, excessive ACV consumption (250 ml diluted in water daily for six years) may contribute to low potassium levels (hypokalemia) and associated symptoms like muscle weakness [4]. This effect is believed to be linked to ACV’s potential to increase acid and mineral excretion. While this is a singular, extreme case, regular users experiencing muscle weakness or fatigue should consult a physician to check electrolyte levels.
3. Digestive Issues, Nausea, and Irritation
ACV is known to slow down the rate at which food leaves the stomach, which can promote a feeling of fullness and potentially aid in appetite suppression [5]. However, this delayed digestion can also lead to unwanted gastrointestinal side effects, such as nausea and indigestion [5].
When consumed in concentrated form or too frequently, the high acidity of ACV can irritate the lining of the stomach and esophagus (the food pipe), potentially leading to symptoms of acid reflux or ulcer-like discomfort [6].
4. Throat, Esophagus, and Skin Irritation
Due to its potent acidity, swallowing undiluted ACV may cause a burning sensation or irritation in the throat and esophagus [7].
Topical application of undiluted ACV is also highly discouraged. Its acidic nature can cause severe skin irritation and chemical burns [8]. There are reports of people sustaining full-thickness skin burns after applying ACV directly to the skin, which required medical attention [8].
5. Possible Interactions with Medications
Apple cider vinegar may interact with certain medications, including:
- Diuretics (Water Pills): Both ACV and diuretics can lower potassium levels in the body. Combining them could increase the risk of severe hypokalemia [4].
- Laxatives: ACV’s impact on digestion could interfere with the effectiveness of some laxatives.
- Insulin and other Diabetes Medications: As ACV affects blood sugar levels, it may require dose adjustments for people on diabetes medication [3].
If you are taking any prescription medications, consulting your healthcare professional before using ACV is crucial to prevent adverse medication interactions.
6. Potential Effects on Bone Health
Long-term, excessive consumption of undiluted ACV may theoretically contribute to bone demineralisation, although evidence is primarily limited to one severe case report [4]. The hypothesis is that the body might deplete alkaline minerals, like calcium, from bones to neutralise chronic, high acid intake [4]. This risk is associated with extreme overuse over a sustained period, not typical moderate use.
7. Kidney Considerations
Individuals with pre-existing or compromised kidney function should exercise caution with ACV intake. The kidneys are responsible for maintaining the body’s acid-base balance. Consuming highly acidic substances in excess may potentially add stress to the kidneys, particularly in those with underlying renal disease [9]. If you have any known kidney issues, consult your doctor before adding ACV to your routine.
Guidelines for Safe Consumption
To enjoy the potential benefits of apple cider vinegar while minimising risks, follow these safe use guidelines:
Dilute Always: Always mix ACV with water, tea, or other liquid before drinking. A common safe starting ratio is 1–2 teaspoons (5-10 ml) mixed into a glass (about 250 ml) of water [1].
Limit Dosage: Limit daily intake to small, diluted amounts. For most healthy adults, 1–2 tablespoons (15–30 ml) of ACV, taken across one or two doses per day, is a generally accepted upper limit [10].
Use a Straw: Consider using a straw to minimise the contact of the acidic liquid with your tooth enamel.
Rinse After: Rinse your mouth with plain water after consuming ACV to help neutralise residual acid on your teeth.
Avoid Undiluted Topical Use: Never apply undiluted ACV directly to the skin or eyes.
Summary
While apple cider vinegar is a popular traditional remedy, its potential benefits are best realised through mindful, safe, and moderated consumption. Excessive or undiluted use carries clear, documented risks, including dental erosion, digestive upset, and potential interactions with medications [1], [3], [5].
It is essential to consume ACV in moderation, strictly adhere to dilution guidelines, and be aware of potential drug interactions. The most critical precaution is to consult a physician before using ACV if you have diabetes, kidney disease, low potassium levels, or are taking prescription medications. Following these steps ensures you can enjoy ACV’s potential without compromising your well-being.
Expert Quote:
“While apple cider vinegar offers several potential health benefits, it must always be consumed cautiously and in moderation. Always use apple cider vinegar in a properly diluted form to prevent adverse effects like tooth enamel erosion and gastrointestinal irritation.”
–Dr. Boban Raju
Frequently Asked Questions (FAQs)
How much apple cider vinegar is recommended for daily consumption?
A daily consumption of 1–2 tablespoons (15–30 ml) of ACV, diluted in a glass of water, is generally considered a safe upper limit for healthy adults seeking potential benefits [10].
Is diluted apple cider vinegar safe to drink daily?
Yes, properly diluted ACV is safe for most healthy adults to drink daily. However, it should be consumed with meals or diluted to minimise dental and digestive risks [1].
Does one of the disadvantages of using apple cider vinegar hamper kidney function?
For healthy individuals, moderate consumption of diluted ACV is unlikely to harm kidney function. However, people with pre-existing kidney disease should consult their doctor, as the acidity could potentially be taxing on compromised kidneys [9].
References
[1] Hlebowicz, J., Darwiche, G., Björgell, O., & Almér, L. O. (2007). Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: A pilot study. BMC Gastroenterology, 7(1), 46. https://doi.org/10.1186/1471-230X-7-46
[2] Willcox, J., Rošin-Grget, K., Eraković, S., & Perković, M. (2016). The effect of two common vinegar types on the microhardness and surface morphology of tooth enamel. Applied Sciences, 6(4), 111. https://doi.org/10.3390/app6040111
[3] Ostman, E., Granfeldt, Y., Persson, L., & Björck, I. (2005). Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. European Journal of Clinical Nutrition, 59(9), 983–988. https://doi.org/10.1038/sj.ejcn.1602142
[4] Lhotta, K., Höfle, G., Gasser, R., & Finkenstedt, G. (1998). Hypokalemia, hyperreninemia and metabolic alkalosis in a patient with an unusual eating disorder. Nephrology Dialysis Transplantation, 13(2), 438–439. https://doi.org/10.1093/ndt/13.2.438
[5] Hasan, F. O., Hamilton, K. P., Angadi, S. S., & Kranz, S. (2022). Effects of vinegar/acetic acid intake on appetite measures and energy consumption: Systematic review. Translational Journal of the American College of Sports Medicine, 7(3), e000205. https://journals.lww.com/acsm-tj/fulltext/2022/07140/Effects_of_Vinegar_Acetic_Acid_Intake_on_Appetite.6.aspx
[6] Górska, M., Kałuża, I., Golemo, J., Serkis, B., Dębińska, J., Celichowska, M., … & Miazga, M. (2024). Apple cider vinegar in the combat against type 2 diabetes and obesity–An overview of recent research. Quality in Sport, 20, 53303-53303. https://apcz.umk.pl/QS/article/view/53303
[7] Hill, L. L., Woodruff, L. H., Foote, J. C., & Barreto-Alcoba, M. (2005). Esophageal injury by apple cider vinegar tablets and subsequent evaluation of products. Journal of the American Dietetic Association, 105(7), 1141–1144. https://doi.org/10.1016/j.jada.2005.04.003
[8] Bunick, C. G., & Ludwick, B. S. (2016). Chemical burn from topical application of apple cider vinegar for a dermatologic lesion. The Journal of Clinical and Aesthetic Dermatology, 9(9), 56–57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075487/
[9] Perumpuli, P. A. B. N., & Dilrukshi, D. M. N. (2022). Vinegar: A functional ingredient for human health. International Food Research Journal, 29(5), 959–974. (Used for general background on ACV acidity and organ system considerations)
[10] Shmerling, R. H. (2018, April 25). Apple cider vinegar diet: Does it really work? Harvard Health Blog. https://www.health.harvard.edu/blog/apple-cider-vinegar-diet-does-it-really-work-2018042513703
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