7 Potential Side Effects of Apple Cider Vinegar You Should Know

Apple cider vinegar (ACV) has gained tremendous popularity as a natural health remedy, touted for its potential benefits ranging from weight loss to blood sugar management. While this fermented liquid does offer certain health advantages, consuming it improperly or in excessive amounts can lead to serious side effects that many people aren’t aware of.

Understanding both the benefits and risks of apple cider vinegar is crucial for anyone considering adding it to their daily routine. This comprehensive guide explores the potential adverse effects of ACV and provides practical advice on how to use it safely.

Understanding Apple Cider Vinegar

Apple cider vinegar is produced through a two-step fermentation process. First, apples are combined with yeast, which converts the fruit’s natural sugars into alcohol. Then, bacteria are introduced to ferment the alcohol into acetic acid, the primary active compound in vinegar.

The final product contains approximately 5-6% acetic acid, which gives ACV its characteristic sour taste and pungent smell. Despite being classified as a “weak acid,” acetic acid possesses strong acidic properties, especially in concentrated forms.

Beyond acetic acid, apple cider vinegar contains water, trace amounts of other acids, vitamins, minerals, and beneficial compounds known as polyphenols. Research suggests that acetic acid may contribute to various health effects, including improved insulin sensitivity, reduced blood sugar levels, and enhanced fat metabolism.

However, it’s important to note that while some studies show promising results, comprehensive human research on the long-term effects and optimal dosing of apple cider vinegar remains limited.

7 Potential Side Effects of Apple Cider Vinegar

While apple cider vinegar can be part of a healthy lifestyle when used appropriately, excessive consumption or improper use can result in several adverse effects. Here are the seven most significant side effects to be aware of:

1. Delayed Gastric Emptying

One of the most concerning side effects of apple cider vinegar is its impact on digestion, particularly the rate at which food moves from the stomach to the small intestine.

Research indicates that ACV can significantly slow down gastric emptying. While this might help with feelings of fullness and potentially aid in weight management for some individuals, it can be problematic for others, especially those with pre-existing digestive conditions.

This effect is particularly concerning for individuals with gastroparesis, a condition where the stomach’s nerves don’t function properly, causing food to remain in the stomach longer than normal. This condition is common among people with diabetes.

In a controlled study involving patients with type 1 diabetes and gastroparesis, consuming apple cider vinegar with water significantly increased the time food remained in the stomach compared to drinking plain water. This can make it extremely difficult to manage blood sugar levels and time insulin doses appropriately.

Symptoms that may worsen include heartburn, bloating, nausea, and unpredictable blood sugar fluctuations.

2. Digestive Discomfort and Nausea

Apple cider vinegar can trigger various unpleasant digestive symptoms, even in people without pre-existing conditions.

While some research suggests that acetic acid may temporarily reduce appetite, studies have also found that this effect might be due to nausea and indigestion rather than any genuine appetite-suppressing properties.

In research studies, participants who consumed beverages containing higher amounts of apple cider vinegar (around 25 grams) reported not only decreased appetite but also significantly increased feelings of nausea and general discomfort. The unpleasant taste of the drink appeared to compound these negative effects.

Common digestive side effects include:

• Nausea and queasiness
• Indigestion and upset stomach
• Reduced appetite due to discomfort
• Acid reflux or heartburn
• Abdominal cramping

3. Low Potassium Levels and Bone Health Concerns

While controlled studies on this topic are limited, there is documented evidence that excessive apple cider vinegar consumption may lead to dangerously low potassium levels (hypokalemia) and potential bone health issues.

One notable case report involved a 28-year-old woman who consumed approximately 8 ounces of diluted apple cider vinegar daily for six years. She was eventually hospitalized with severely depleted potassium levels and abnormal blood chemistry.

Medical examinations revealed that she had also developed osteoporosis—a condition characterized by weak, brittle bones that is extremely uncommon in young adults. Healthcare professionals who treated her concluded that the chronic consumption of large amounts of ACV likely caused minerals to be leached from her bones in an attempt to neutralize the acid in her bloodstream.

Additionally, high acid levels in the body may interfere with the formation of new bone tissue. Potassium is essential for numerous bodily functions, including:

• Proper muscle function, including the heart
• Nerve signal transmission
• Maintaining healthy blood pressure
• Fluid balance regulation

While this represents an extreme case involving excessive daily consumption over many years, it highlights the importance of moderation.

4. Tooth Enamel Erosion

The acidic nature of apple cider vinegar poses a significant threat to dental health, particularly tooth enamel—the hard, protective outer layer of your teeth.

Acidic foods and beverages are well-documented causes of enamel erosion. While soft drinks and fruit juices have been studied extensively, research confirms that the acetic acid in vinegar can also damage tooth enamel.

Laboratory studies have demonstrated that exposing tooth enamel to various vinegars with pH levels ranging from 2.7 to 3.95 resulted in a 1-20% loss of minerals from the teeth after just four hours of exposure.

While these were laboratory conditions that don’t perfectly replicate real-world scenarios (where saliva helps neutralize acidity), they demonstrate the erosive potential of vinegar.

A case study documented a 15-year-old girl who developed severe dental decay attributed to her daily consumption of one cup of undiluted apple cider vinegar as a weight loss strategy. The undiluted vinegar caused extensive damage to her tooth enamel, leading to cavities and tooth sensitivity.

Signs of enamel erosion include:

• Increased tooth sensitivity to hot, cold, or sweet foods
• Discoloration or yellowing of teeth
• Rounded or transparent-looking tooth edges
• Increased susceptibility to cavities
• Tooth pain or discomfort

5. Esophageal and Throat Burns

The caustic nature of apple cider vinegar can cause burns to the throat and esophagus, particularly when consumed in concentrated form or large quantities.

A comprehensive review of accidental poisonings in children found that acetic acid from vinegar was the most common acid responsible for throat burns. Based on these findings, researchers recommended that vinegar be classified as a “potent caustic substance” and stored in childproof containers to prevent accidental ingestion.

There are documented cases of adults who consumed large volumes of vinegar beverages over extended periods and required medical treatment for throat burns and esophageal damage.

Additionally, apple cider vinegar tablets and capsules have caused throat injuries when they became lodged in the esophagus before fully dissolving. The concentrated acid released from these tablets can cause severe localized burns.

Symptoms of throat burns may include:

• Severe throat pain
• Difficulty or pain when swallowing
• Chest pain or discomfort
• Hoarse voice
• Excessive drooling

If you experience any of these symptoms after consuming apple cider vinegar, seek medical attention immediately.

6. Chemical Skin Burns

When applied topically, the strong acidity of apple cider vinegar can cause chemical burns and skin damage.

Several documented cases illustrate this risk. In one instance, a 14-year-old girl developed significant erosions and scarring on her nose after applying apple cider vinegar directly to her skin in an attempt to remove moles. She had followed instructions she found online without understanding the risks.

Another case involved an 8-year-old boy with multiple health conditions who suffered leg burns after his mother applied apple cider vinegar to treat a suspected infection. The child required medical treatment for the resulting chemical burns.

Numerous anecdotal reports online describe similar incidents where people experienced skin burns, scarring, and irritation from topical ACV application. The skin on the face and areas with thinner, more sensitive skin are particularly vulnerable.

Never apply undiluted apple cider vinegar directly to your skin, and be extremely cautious even with diluted solutions. If you’re considering using ACV topically for any reason, consult with a dermatologist first.

7. Medication Interactions

Apple cider vinegar can interact with certain medications, potentially leading to dangerous complications. If you’re taking any medications, it’s essential to consult with your healthcare provider before regularly consuming ACV.

Diabetes Medications: If you take insulin or medications that stimulate insulin production, consuming apple cider vinegar could cause your blood sugar levels to drop too low (hypoglycemia). This combination may also lead to dangerously low potassium levels.

Heart Medications: Certain heart medications work by affecting potassium levels in your body. When combined with apple cider vinegar (which may also lower potassium), this could result in hypokalemia.

Diuretic Medications: Some diuretics (water pills) cause your body to excrete potassium. Consuming large amounts of apple cider vinegar while taking these medications could lead to potassium depletion.

Always inform your healthcare provider about any supplements or natural remedies you’re using, including apple cider vinegar. They can advise you on potential interactions and help you use these products safely.

How to Use Apple Cider Vinegar Safely

Despite the potential side effects, most people can safely incorporate apple cider vinegar into their diet by following these important guidelines:

Start Small and Dilute Properly

Begin with small amounts—just 1 teaspoon (5 mL) diluted in a large glass of water. Gradually increase to no more than 1-2 tablespoons (15-30 mL) per day, always diluted. Never consume apple cider vinegar undiluted or in concentrated form.

Protect Your Teeth

To minimize contact between the acidic vinegar and your tooth enamel:

• Always dilute ACV in at least 8 ounces of water
• Drink it through a straw to bypass your teeth
• Rinse your mouth thoroughly with plain water after consuming
• Wait at least 30 minutes before brushing your teeth to avoid damaging already-softened enamel
• Consider consuming it with meals rather than on an empty stomach

Choose the Right Form

Liquid apple cider vinegar is generally safer than tablets or capsules, which can become lodged in the throat or esophagus and cause concentrated burns. If you prefer tablets, take them with plenty of water and never before bedtime.

Know When to Avoid It

Certain individuals should avoid apple cider vinegar or use it only under medical supervision:

• People with gastroparesis or delayed gastric emptying
• Individuals with chronic kidney disease
• Those with a history of esophageal problems
• People taking medications that interact with ACV
• Anyone with severe acid reflux or ulcers
• Those with allergies to apples or vinegar (though rare)

Monitor Your Body’s Response

Pay attention to how your body responds to apple cider vinegar. If you experience any adverse effects such as nausea, throat irritation, digestive discomfort, or tooth sensitivity, reduce your intake or discontinue use. Trust your body’s signals.

Consider Alternative Uses

Instead of drinking apple cider vinegar straight, consider incorporating it into your diet through cooking:

• Use it in salad dressings mixed with olive oil
• Add it to marinades for meat or vegetables
• Use it in pickling recipes
• Include it in homemade sauces

These methods allow you to gain potential benefits while minimizing risks and making consumption more palatable.

Frequently Asked Questions About Apple Cider Vinegar Side Effects

Is it safe to drink apple cider vinegar every day?

Drinking apple cider vinegar daily can be safe for most people when consumed in moderation (1-2 tablespoons diluted in water per day). However, daily consumption does carry risks of tooth enamel erosion, digestive issues, and potential nutrient deficiencies if consumed in excess. Always dilute it properly and monitor for any adverse effects.

What are the signs you’re consuming too much apple cider vinegar?

Signs of excessive ACV consumption include persistent nausea, throat irritation, tooth sensitivity, digestive discomfort, low energy levels (which could indicate low potassium), and worsening acid reflux. If you experience any of these symptoms, reduce your intake or stop using it entirely.

Can apple cider vinegar damage your stomach lining?

Yes, consuming undiluted or excessive amounts of apple cider vinegar can potentially irritate and damage the stomach lining, especially in people with pre-existing conditions like gastritis or ulcers. The high acidity can exacerbate these conditions and cause inflammation.

How long does it take for side effects to appear?

Some side effects, like tooth enamel erosion and throat irritation, can occur immediately after consuming undiluted or concentrated ACV. Other effects, such as low potassium levels or bone density issues, typically develop only after prolonged excessive consumption over months or years.

Who should absolutely avoid apple cider vinegar?

You should avoid apple cider vinegar if you have gastroparesis, severe acid reflux, esophageal problems, chronic kidney disease, or if you’re allergic to apples or vinegar. Additionally, if you’re taking medications that may interact with ACV, consult your healthcare provider before using it.

Can apple cider vinegar cause low blood sugar?

Apple cider vinegar may lower blood sugar levels, which can be dangerous for people taking diabetes medications or insulin. This can lead to hypoglycemia (dangerously low blood sugar), causing symptoms like dizziness, shakiness, confusion, and even loss of consciousness. If you have diabetes, consult your doctor before using ACV.

The Bottom Line on Apple Cider Vinegar Side Effects

Apple cider vinegar is a popular natural remedy that may offer certain health benefits when used appropriately. However, it’s not without risks. The acidic nature of ACV can cause tooth enamel erosion, throat burns, skin damage, and digestive issues. It may also interact with certain medications and cause dangerously low potassium levels when consumed excessively.

The key to using apple cider vinegar safely is moderation, proper dilution, and awareness of potential side effects. Always start with small amounts, dilute it thoroughly, protect your teeth, and pay attention to how your body responds.

If you have any pre-existing health conditions or take medications regularly, consult with your healthcare provider before adding apple cider vinegar to your routine. They can help you determine whether it’s appropriate for your situation and advise on safe usage.

Remember that apple cider vinegar is not a miracle cure or substitute for a healthy diet, regular exercise, and proper medical care. While it may complement a healthy lifestyle, it should never replace evidence-based medical treatments or advice from qualified healthcare professionals.

By understanding both the potential benefits and risks of apple cider vinegar, you can make informed decisions about whether and how to incorporate it into your health regimen safely.

Sources:

• National Center for Biotechnology Information – Vinegar: Medicinal Uses and Antiglycemic Effect
• National Institute of Diabetes and Digestive and Kidney Diseases – Gastroparesis
• PubMed – Vinegar and delayed gastric emptying in patients with diabetes
• PMC – Erosive effect of acidic beverages on tooth enamel
• Mayo Clinic – Apple Cider Vinegar