When you search the internet for a keto diet, apple cider vinegar comes up every time. Why is this?
I’ve been researching and using a low-carb keto diet for medical reasons in a clinical setting as a lifestyle treatment for reversing diabetes, for obesity, and for high blood pressure. I learned from other doctors to use this in the late 1990’s and our group at Duke University studied programs that were being used clinically and were formalized with science around them. Now, other groups around the world have shown that a low-carb keto diet, properly formulated with real food, is safe and effective to treat these medical issues. I think low-carb keto diets are healthy for everyone, if you eat real food.
Enter in apple cider vinegar. We never used it in our studies. It’s something very new, a phenomenon of the “internet keto” that you see out there. I can’t find a study in real people over a period of time in weight loss or diabetes reversal where they’ve used apple cider vinegar. It’s this unstudied phenomenon that apparently cuts your hunger out. What happens is I’ll be treating people, teaching them how to just eat meat, chicken, eggs, shellfish, and some (not many) veggies and they’ll come in and say, “I’m just not eating.” I tell them that’s okay, as long as they’re eating once a day – the good protein foods. They’ll tell me, “No, I’m not eating.” This one fellow pulled out apple cider vinegar from his backpack and said, “I’m just drinking this, and I’m not hungry. You said, ‘Don’t eat if you’re not hungry,’ and so I’m only drinking this.” He was losing weight too fast on a low-carb keto diet for what I consider to be safe. I want to make sure it’s as safe as possible.
It’s one of these things that just wasn’t part of the research studies that we’ve done. I don’t really know its role in a well-formulated, real food-based program that you’re going to do for the long term. I can’t imagine drinking that once a week and liking it. That was the other thing with this gentleman. I asked him if he liked it and he said, “No, it tastes terrible!” What kind of program is that?!
We just don’t know how to use apple cider vinegar in the context of a program that’s been tested over time. I like things to be evidence-based and well tested, like a prescription drug. As a doctor, I want to know that it’s safe and that it really works. People value my opinion on things, so honestly, I don’t know the role of apple cider vinegar and I don’t recommend it. I don’t sell products like that and say you must have these products, like some people on the internet apparently do. It’s this “internet keto” that sometimes can be really crazy. For some people I’ll say that if it says ‘Great for keto!’ on the product, stay away from those things because they’re not really tested in a program that’s trying to help you lose weight or reverse diabetes in the healthiest way possible.
I came across some studies showing some success in humans with apple cider vinegar, but this was typically with people on a high-carb diet. Have you heard about this at all?
When my patients tell me they’re using apple cider vinegar, there’s no question that it lowers hunger. You don’t need a study to show that. If everyone is doing it, I don’t need a research study to say something that’s obvious. If 100 people use something and it has that effect every time, there’s no question that it reduces hunger. The real question is, in the context of a weight loss program including food—whether it’s high carb or low-carb, that doesn’t matter to me—the real question is: in the context of a program like that, does it add value beyond the program itself?
When people come back to me on a keto diet, they’re not hungry anyway and they’re not using apple cider vinegar. Occasionally people have some hunger – it might be from some medication they’re on or from cravings or habit, but we work with that.
A common thing that you’ll see is that a product has been studied for a brief period of time or among people who eat carbohydrates and then we’re always left with the question, “What if you studied it for a longer period of time?” And then, “What if you studied it in a low-carb or keto context? Would it have the same effect?” I think hunger suppression will be the same. I’ve had people use it and then not like it and ask if they have to have it and I say no. Some people will come to me for the first time, doing internet keto, and that’s one of the things that they’re having. They might also be having medium chain triglycerides (MCT), putting butter on steak and things like that. We teach them not to do that and then things start to work for them. That’s the difference between our work and “internet keto,” and I think apple cider vinegar is part of that.
I’ve never tried apple cider vinegar personally. I bet it probably would reduce hunger; I think there’s a long history of folklore that it’s healthy on its own. Maybe some cultures have used that, but that’s not sufficient for me to sign off on it in terms of a weight loss program or long-term health.
Is this something you would like to do a study on or don’t you have much of an interest in it at all?
I think we need more tools, definitely. If it was an adjunct or an add-on to something, I might be interested. I really feel that a nutritional change should be based on real foods, not these things. We have products that we sell, but we don’t push them as something you must use. They’re an occasional treat for every now and then. I think it would be good to study things like apple cider vinegar, MCTs, or exogenous ketones, which have never been studied in a weight loss trial. I don’t know whether they have a benefit or not, so I don’t recommend those sorts of things. I’m like the anti-marketer in terms of these products. Just eat real food.
I have to explain that there are things we still don’t know about food and vitamins. The more you get away from real foods, the more the environment and the food quality changes, the more likely we might be deficient in things. I’m always surprised to learn that we’re discovering new vitamins, for example. You might think you take a multivitamin and everything’s in there, well, no. There are still things that science has yet to discover. We don’t understand all of the components of great nutrition. We know a lot about it, but not everything.
What is your opinion on these three statements:
- Apple cider vinegar will help with insulin resistance.
I don’t know.
- Apple cider vinegar will help with blood sugar control.
I don’t know.
- Apple cider vinegar helps with weight loss.
I don’t know! I do know that it can suppress hunger, and if you suppress hunger, then you eat less, and all of those things will get better, definitely. There’s this assumption that if you’re not going to be doing anything else other than apple cider vinegar, all those things will get better, but that’s not good enough for me. I want to know how it works all day long, all week long, all month long, all year long before I’ll say anything definitive about it.
When I ask questions and the answer is, “I don’t know,” I certainly appreciate that, because it’s a much better answer than pretending you know the answer. So, sometimes the best answer is, “I don’t know,” or “I don’t know yet.”
I’m still learning and you have to understand, I’m in a clinic where people come back to me and tell me whether it works or not, so I’m not off the hook by just saying “Do this; buy my product.” What I do in my clinic has to work. That’s why I really focus on things that are tested over and over, not only clinical trials, but in a clinical setting as well. I am open to new things if they help, they’re safe, and they don’t take away from good nutrition. Those are the questions I still have about apple cider vinegar.
A lot of people watching this episode may get very excited about the fact that you have mentioned that it definitely helps with hunger. I did a bit of research and found some negative side effects of consuming too much apple cider vinegar. These include digestive issues, dental issues, bone loss, drug interactions, and throat burns. Have you heard of any of these things before?
No, and I don’t know how common those are. My understanding is basically from people telling me they’ve tried it. Most people don’t like the taste, although there are some that have worked out the flavors or some people will tolerate the old “if it tastes bad, it must be good for you” thing. I have to imagine those other studies saying how bad it is are probably not solidly based on hundreds or thousands of people. If something is that potent to suppress hunger it may have other potent side effects that you don’t want to have, those unintended ones. GI issues are something that people have told me about. That quickly goes away when you stop having it.
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