Weight Management Benefits of Apple Cider Vinegar for Overweight Patients

Solaleh Sadat Khezri, MS

Apple cider vinegar (ACV) has long been a used as a natural treatment for any number of ailments, but often those claims of effectiveness are unsubstantiated by medical research. A new study from The Journal of Foods led by Solaleh Sadat Khezri, MS, a faculty member with the Nutrition and Food Technology department of Shahid Beheshti University of Medical Sciences in Tehran, has determined that there may be some evidence of ACV’s benefits to heart health.

The randomized, controlled clinical trial indicates that the consumption of 30ml/day of ACV may help overweight or obese patients on a restricted calorie diet (RCD) lose more weight, while also reducing plasma triglycerides (TG), total cholesterol (TC) levels, and raising high density lipoprotein cholesterol (HDL-C).

Khezri writes that the study measured ACV impact on "the anthropometric measurements, body composition, VAI [visceral adiposity index], plasma lipids, NPY [neuropeptide-Y], and appetite in overweight or obese individuals." The 12-week study included 44 metabolically healthy subjects with a body mass index (BMI) greater than 27kg/m² (range 27-40) randomly assigned to either the ACV (n=22) or control (n= 22) group.

Khezri and colleagues reported that all study participants followed a diet for 12 weeks which limited calorie intake to 250 kcal/day lower than the individual's energy requirements and that diet make up was "approximately 55% carbohydrate, 30% fat, and 15% protein." Subjects in the ACV group were required to consume 30mL of commercial, store-bought ACV per day (acetic acid concentration 486mg/100mL).

Patient measurements including weight, BMI, waist and hip circumference (WC), waist to hip ratio (WHR), and body composition were taken at baseline, 6, and 12 weeks. Results from physical activity assessments to determine metabolic equivalent (MET) using a Modifiable Activity Questionnaire, and appetite assessment using the Simplified Nutritional Appetite Questionnaire (SNAQ) were recorded baseline, 6, and 12 weeks. Blood and biochemical assessment were performed at baseline and 12 weeks and included analysis of TG, TC, HDL-C, low density lipoprotein (LDL-C), and plasma concentration of NPY.

Khezri and colleagues reported that despite there being no significant baseline differences between the ACV and control groups, there were several significant differences at 6- and 12- week assessments. The restricted diet reduced BMI, body fat, body weight, and WHR in both groups, however data showed that body weight (-4 ± 2.5kg ACV vs. -2.3 ± 1.6 control), BMI (-1.52kg/m² ± 0.9 ACV vs -0.89 ± 0.6 control), hip girth (-5.9cm ± 3.71 ACV vs -3.37 ± 2.49 control) and VAI for male (-3.6 ± 2.37 ACV vs 1.98 ± 3.37) and female (-3.6 ± 4.58 ACV vs 1.4 ±3.82) subjects "were significantly reduced in the ACV group in comparison to the control group."

Subjects in the ACV group also saw significantly stronger beneficial effects on plasma and lipids in comparison to the control group from baseline to 12 weeks. Khezri reports that plasma TG concentrations were reduced in the ACV group (-58.1mg/dL ± 16) in comparison to the control group (45mg/dL ± 19.8) whose TG concentrations rose, that HDL-C was significantly increased in ACV subjects (2.95mg/dL ± 4) in comparison to control (0.68mg/dL ± 3), and that TC was significantly decreased in ACV subjects (-5.1mg/dL ± 7.6) in comparison to control (-3.05 mg/dL ±6.6). Data showed that changes in LDL-C and NPY were not statistically significant.

ACV's effects on appetite suppression were determined to be significant with a reduction in appetite as determined by the SNAQ dropping from a mean of 14.40 to 12.90, while the control group reduced from 14.80 to 14.55.

Khezri wrote that previous studies have noted ACV's effects on hunger reduction and that the reduction had been theorized to be an effect of the acetic acid on NPY concentration through an "appetite-stimulating neuropeptide," but given that there was no statistical difference between NPY concentration in ACV and control groups "it seems that appetite control by ACV is not related to plasma NPY."

Khezri and colleagues theorized that the reduction of TG in the control group may be associated with a hypotryglyceridemic effect of vinegar on triglycerides in the liver, but that other studies looking at consumption of pomegranate vinegar showed no reduction in TG, suggesting that some quality of ACV is specific to TG reduction.

“ACV could be used as an adjunctive therapy in concomitant with RCD or other standard way of weight management therapy through appetite controlling or increasing thermic effect of food component,” said Khezri, adding that further study is needed to determine the exact effect ACV has on weight-loss, appetite, and lipid management.

The study, "Beneficial effects of Apple Cider Vinegar on weight management, visceral Adiposity Index and lipid profile in overweight or obese subjects receiving restricted calorie diet: A randomized clinical trial," was published in April 2018.