Vinegar for Weight Loss

I get a lot of questions about natural ingredients for weight loss. One thing that I will do with this blog is review as many of them as I can with a particular focus on reviewing the available research. Apparently, there was a recent piece that appeared on WebMD about cider vinegar for weight loss. I have had several questions on this since the article appeared. (To read the original piece, click here.)

Apple cider vinegar has been touted as a cure-all for everything from digestive ailments to rheumatism. Hippocrates, the “Father of Medicine” reportedly gave it to patients as a healing tonic in 400 BC. To the best estimates of modern-day herbalists, apple cider vinegar first appeared in weight loss remedies in the 1970s – although modern proponents claim that this was the secret weight loss cure of Ancient Egypt. The secret recipe that started the modern-day trend was a blend of Apple Cider Vinegar, kelp (seaweed), lecithin, and vitamin B6. The story was that the lecithin emulsified fat, iodine in the kelp increased thyroid function (speeding up metabolism), B6 somehow metabolized the freed fat, and the vinegar would then breakdown or dissolve the fat and accelerate metabolism. Other theories have tied weight loss benefits of Apple Cider Vinegar to increased detoxification or improved pH.

Is there any actual evidence that Apple Cider Vinegar can help you lose weight? Not much. I did find a study done in Egypt in 2001 that showed that mice given a high dose of Apple Cider Vinegar for 4 weeks had significant weight loss compared to those on a controlled diet. However, the vinegar-eating mice also had pretty significant damage to their livers, stomachs, and small intestines – including erosion of the lining of the stomach and intestines (ie, ulcers) and changes in the cells of the liver. Not good for the mice. The study that was discussed in the WebMD article was also done in mice fed a diet high in vinegar for 6 weeks. They did not lose weight, but researchers reported that the vinegar "inhibited the accumulation of body fat." So what we really have to date is some less than spectacular data in mice.

Somehow, people always want to take these kinds of animal studies and transform them into the next great miracle cure for obesity. So what about studies in humans? A small study conducted in 2005 on 12 adults found that subjects who consumed 2 tablespoons of vinegar with a meal of bread reported less hunger after their meal. The same researcher later conducted a study in 13 adults and found when subjects used an oil and vinegar dressing with a meal of potatoes, they had lower post-meal blood sugars and a healthier insulin response. Finally, one study from 2004 gave a dose of 2 tablespoons of vinegar to 15 adults before lunch and dinner for 4 weeks. Compared to placebo, the vinegar group lost an average of 2 pounds over 4 weeks.

While these small trials are interesting, they do not look at big enough numbers to be significant and they do not address other issues of health. I have found one case report of a woman who suffered an acid burn in her esophagus from taking Apple Cider Vinegar tablets - she apparently did not lose weight. As part of the follow up to that case, investigators tested many products and found that some of them were so acidic (containing acetic acid levels over 20%) that they were in the range that the Consumer Product Safety Commission considers poisonous to humans.

Overall, Apple Cider Vinegar has some very good and valid uses. You can use it in salad dressing, it makes a great addition to marinades or to tenderize meat, you can clean gold jewelry with it, and you can use it as a natural weed killer in your garden. But as a weight loss agent, it has not yet been shown to be effective, and it could be harmful. Future more rigorous studies in humans might show doses that have both good safety and health benefits. For now, proceed with caution.

References:

Mohamed el-OA, Mohamed SM, Mohamed KA. The effect of cider vinegar on some nutritional and physiological parameters in mice. J Egypt Public Health Assoc. 2001;76(1-2):17-36.

Hill L. L., Woodruff L. H., Foote J. C., Barreto-Alcoba M. Esophageal Injury by Apple Cider Vinegar Tablets and Subsequent Evaluation of Products. JADA; 105(7): 1141-1144 (July 2005).

Ostman E, Granfeldt Y, Persson L, et al. Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. European Journal of Clinical Nutrition, 2005;59;983-988.

Leeman M, Ostman E, Bjorck I. Vinegar dressing and cold storage of potatoes lowers postprandial glycaemic andinsulinaemic responses in healthy subjects. European Journal of Clinical Nutrition, 2005

Johnston CS, Kim CM, Buller AJ. Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care, 2004;27:281-282.

Cholesterol Confusion

I believe that sometimes there can be too much of a good thing. People have been given so much nutrition information in the past 20 years that they no longer know what is good or bad. Are carbohydrates important for energy or will they make you obese and diabetic? Are fats bad for your heart or good for your brain? Should I eat fish because it's good for me, or will the mercury kill me? Part of the problem is that these questions are not simple yes or no issues, but the other part is that everyone now has a lot of information about food and diet, much of it conflicting, and for the average consumer the unending and rather confusing stream of messages can make every day diet decisions a serious challenge. I recently read a great book about decision making, that discusses the role of information overload in hampering our ability to chose. The book is called How We Decide, by Jonah Lehrer. It's a great read and I hope some of you choose to pick it up.

So I have received several questions along the lines of "what is really true about this food?" I can't answer them all in one post, so I am going to take this one:

Egg yolks- I am very confused. You hear that they raise cholesterol, but I also know much of the nutrition in the egg is in the yolk.

A lot of people are confused about eggs and cholesterol. I am going to try to keep this answer as simple as possible. For most healthy people, the amount of cholesterol they get in diet doesn't really have much to do with the cholesterol in your blood. Most of the cholesterol your doctor finds and measures on your blood test is manufactured by your liver from fats that you eat. A diet high in saturated fat or trans fats will do much more to elevate cholesterol in your blood than the amount of cholesterol you consume. Genetics, and conditions like insulin resistance also contribute. So, generally speaking if you are pretty healthy and have never had high cholesterol on a blood test, you should not get terribly concerned about consuming high cholesterol foods like egg yolks.

The story is a bit different if you have high cholesterol. If you have had high cholesterol on a blood test, studies have shown some benefit in keeping your dietary intake of cholesterol below 300 mg per day. Since a large egg with the yolk has about 200 mg of cholesterol, that still means that people with high cholesterol can enjoy eggs - but they should probably limit themselves to one per day, and try not to consume other high cholesterol foods like shrimp on the same day. If you have high cholesterol and you want to consume a big fluffy omelette, use one whole egg and one or two egg whites. This way you get all the great nutrition in the yolk. Just so you know I am not making this up, the data from the largest US population study of heart disease ever done (the Framingham Heart Study) has shown no correlation between egg eating, serum cholesterol and heart disease (click here to read).

As the questioner notes, while the white of the egg has the protein, the real nutrition is in the yolk. Egg yolk contains all the fat-soluble vitamins (A, D, E and K), lecithin, B1, B2, B5, folic acid, calcium, iron and zinc - I mean WOW!

Now I know once I post this there will be other questions, so here are a few of the answers:

1. Be careful of egg substitutes. If you are vegan and you have baking needs, there are some good products from companies like Ener-G, but if you are considering commercial liquid egg replacers, be careful. They are mostly egg white anyway, so just separating your eggs and using the whites is less expensive and healthier.
2. You can buy eggs now that are fortified with omega-3 fatty acids. I think this is great.
3. Buy organic. I am in general a fan of organic foods. But I think some foods are more important that others and eggs are one. Commercial non-organic eggs are produced with a lot of antibiotics and hormones. If you are going to enjoy the goodness of eggs, no need to spoil it with hormone and antibiotic residue. And truly - try for yourself if you need to - organic eggs taste a lot better than commercial eggs.

So I hope that clears up someone's confusion today! I will eventually try to tackle similar questions about sweeteners, fats, and more, so stay tuned.

In Health,

Dr. Jacques