Is Apple Cider Vinegar Good for You?

     My brother started drinking apple cider vinegar every morning.  He'd heard it was a good tonic--good for everything, and natural--unlike the medicines his doctor prescribed.
     Two months ago he started taking two ounces mixed in water, gulped down quickly--followed by a handful of Tums to quell the burning.  He quit taking his prescription medicines at the same time.
     The members of my family don't hide the fact that they hate doctors.  At times, their vitriole has no limits, and it doesn't seem to matter that I'm a doctor.  They gripe to me that doctors don't know anything, order too many tests, don't explain things, "force" medicines on people, and want to make a quick buck off them.
     "But I'm a doctor," I remind them.
     "Well, if the shoe fits, put it on!" is the reply.
     Until they want my advice, which is several times a month.
     "Should I be drinking apple cider vinegar?" my brother asked me last week.
     "I thought you hated doctors!" I gibed.
     "Yeah, well, I do," he insisted.  "But this is different."
     "Why are you drinking it?"  I asked.
     "Well, I figured it was good for me," he said.  "So...is it?"
     "That depends on what you're trying to accomplish."
     "Whaddya mean?"
     "I mean, are you hoping it will make you live longer?"
     "That would be good," he said.
     "Or do you think it will give you energy?"
     "That would be good, too."
     "Or do you think it will lower your blood pressure?"
     "Well, will it?" he demanded.
     "Or, do you have head lice?"
     "No, nothing like that!"
     "Well, are you trying to bring your cholesterol down?"
     "Yeah, maybe," he admitted.  The guessing game was over.
     "So, you think that I, a detestable doctor, can tell you that?"
     "Just gimme a straight answer, will you?" he said.
     Of all the supplement questions patients ask, the one about apple cider vinegar is the most tenacious.  Other fads have their day and disappear:  noni juice, pomegranate pulp, kiwis, red yeast rice, panax ginseng, cinnamon, ginger, odorless garlic, the Atkins and paleo diets, protein powders, creatine, turmeric, spirulina, green tea, and one or another miracle cure for obesity, fatigue, or sexual function.
     Sometimes patients think I'll fall into the same propaganda trap they're in, and promote their pyramid-scheme product to me, hoping I'll help make them rich.
     "It really, really works!" they insist, without being able to give specifics.
     That's the effect of glowing testimonials--absent scientific backing--on the colorful pamphlets in the mail.
     "Go ahead and keep taking it," I say. "It's probably not doing harm."  Most of these panaceas have no active ingredients.
     If I raise the subject a few months later, their enthusiasm has fizzled out.  The products cost too much.
     Apple cider vinegar is good for cleaning your coffee pot, so it sort of makes sense that it might dissolve the calcified plaque in your arteries, too.  The problem is that you can't infuse your arteries with vinegar as though it were Drano--and when you drink it, it doesn't get past the duodenum without nullifying biochemical alterations.
     Whatever its flaws, the beauty of western medicine is that it uses the scientific method to separate truth from falsehood when it comes to miracle cures.  Without the scientific method, people rely on emotional cues to decide whether something is good for them or not.
     Given the slick, psychological marketing employed by industry today, it's a good thing we have the scientific method.  It may be big and bunglesome, like an elephant stamping out termites on a football field, but it's the best we have right now.
     There are no reliable scientific studies showing that apple cider vinegar lives up to any folk medicine claims.  It doesn't grow hair, or lower blood pressure, or lead to weight loss, or correct cholesterol, or kill lice.  It hasn't been proven to increase life expectancy, either--but it might give you a case of heartburn.
     Although the stomach's parietal cells secrete up to two quarts of hydrochloric acid a day, and the mucosa of the GI tract can resist the burn of this production, adding vinegar in one fell swoop throws the stomach out of kilter, and may cause acid indigestion.  Taking an antacid may counteract the pain, leading to belching and a sense of relief, but what kind of relief is it, when you caused the problem in the first place?
     Not counting water, the main ingredient in apple cider vinegar is acetic acid.  It also contains micronutrients, a carryover from the apples that were used to ferment the product in the first place.  These include potassium, sodium, amino acids, and traces of vitamins.  Certain blood pressure medicines like lisinopril can accentuate the effect of apple cider vinegar to cause dangerously high levels of potassium.
     Vinegar may "alkalinize" the system like citric acid, which is prescribed to prevent gout, kidney stones and gallstones.
     I prescribe citric acid pills (as Urocit-K) to patients who are prone to these conditions--but not without a litany of dietary instructions (no meat, mushrooms, alcohol, coffee, tea or processed foods; more fruits and vegetables), which are much more important than pills.  Real foods (like citrus) are a better source of citric acid than pills.
     Apple cider vinegar makes good salad dressing, combined with sour cream, herbs, salt, and oil, and in salads that include avocado, apples, pears or oranges.  Why take vinegar in any other way?
     Salads have long been served before a main course to enhance digestion.  Vinegar perks up the taste buds for more savory dishes, and may contribute to a sense of fullness by the meal's end.  The micronutrients in vinegar probably have health benefits that can't be measured by science--the human body has developed in parallel with its food sources over millions of years.  Fermented and vinegary products, when used the way our ancestors used them, must be good for us.
     "Why don't you skip the morning tonic," I suggested to my brother, "and make salad dressing or pickles with your vinegar?"
     "Would that be better for my health?"
     "Probably.  There's no science to support the idea of drinking it like medicine."
     "Great!" he said.  "I can quit drinking it.  I'm sick of taking that stuff every morning--it makes my coffee taste bad."
     "I'm glad the doctor could be of some help," I said.