Apple cider vinegar and fatty liver disease
When it comes to fatty liver disease, diet and lifestyle changes are the main treatment methods. Over time, though, natural remedies were researched to potentially help fatty liver and associated conditions. Apple cider vinegar particularly receives a lot of attention, so we ask: is apple cider vinegar good for fatty liver disease and another way to improve your health?
To find this out, it is necessary to learn what apple cider vinegar is, its possible advantages, safety, and side effects. From there, you can determine the level of benefit (or lack of) to your health.
Types of fatty liver disease
Fatty liver disease consists of two categories:
Nonalcoholic fatty liver disease (NAFLD) is when fat builds up in the liver. Ruling out alcohol consumption, autoimmune disorders, and other issues helps make the diagnosis. Causes include:
- being overweight or obese
- having insulin resistance, prediabetes, or type 2 diabetes
- elevated LDL cholesterol and/or triglycerides
- low HDL cholesterol
- high blood pressure
- metabolic syndrome
- other causes such as certain medications or malnutrition
Alcoholic fatty liver disease is the other kind. With excessive alcohol intake, liver cells change and become damaged. If someone continues consuming alcohol with a fatty liver, further inflammation and fibrosis could result, possibly leading to cirrhosis.
Diagnosing fatty liver
There are different tests doctors use to diagnose fatty liver disease. Blood tests show changes in liver enzymes. Imaging helps identify if fat buildup is present. Another diagnostic tool called a biopsy verifies a diagnosis and shows how advanced the condition is (1,2).
What is apple cider vinegar?
Apple cider vinegar is created through a double fermentation process (alcoholic and acetic) using natural yeasts and bacteria (3). It is utilized in multiple ways with cooking, such as in sauces, flavorful marinades, and salad dressings, to name a few. People have also used it as a food preservative and for non-food purposes like skin and hair treatments!
Several production methods exist. The type of apple used (known as “cultivar”), and the processing technique can influence the end product, altering its potential effectiveness (3). Unfortunately, it is unlikely that this information is available per the regular store packaging on the product (4).
Apple cider vinegar is a natural approach that can potentially treat several health conditions related to nonalcoholic fatty liver disease. These include obesity, type 2 diabetes, and hyperlipidemia (high cholesterol) (3).
Apple cider vinegar has several components that may be health-promoting. One, in particular, is polyphenols. Other sources of polyphenols in the diet are also generally plant-derived; they include vegetables, whole grains, and nuts…even red wine, dark chocolate, tea, and coffee count (5)!
Polyphenols are a source of antioxidants and have anti-inflammatory effects, which may help protect your body from health issues, including insulin resistance and cardiometabolic problems (5).
Is apple cider vinegar good for fatty liver and related conditions?
Determining if apple cider vinegar improves fatty liver disease is not easy. Studies linking this product and fatty liver disease were conducted on animals, whereas other conditions were researched in humans. With this, figuring out if it is beneficial or not depends on its effectiveness for related health issues.
A study conducted in Japan demonstrated weight loss among participants treated with apple cider vinegar. The decrease was only a few pounds on average, though. There is insufficient data showing that apple cider vinegar is an effective way to achieve weight loss (6).
When thinking of losing weight, it is important to remember the most significant changes are due to a healthy diet pattern and regular exercise. Can apple cider vinegar affect the amount of weight you lose? Maybe. Will it make a big difference? Not likely, according to the most up-to-date research.
Losing as little as 5-10% of your weight can improve nonalcoholic fatty liver disease, but how you do so matters. A balanced diet plus exercise will help keep weight off long-term.
Multiple studies investigated how apple cider vinegar affects cholesterol and triglyceride levels. Elevated LDL (low-density lipoprotein) cholesterol, total cholesterol, and triglycerides are unhealthy and can cause further problems for your cardiac health. On the opposite end, low HDL (high-density lipoprotein) cholesterol can be problematic.
Research found apple cider vinegar helped lower total cholesterol and improve triglyceride levels, particularly in patients with type 2 diabetes. However, no significant changes were observed with LDL and HDL cholesterol levels in the same group (7).
Type 2 Diabetes
In addition to weight loss and cholesterol studies, there has been a lot of work on the effect of apple cider vinegar in patients with type 2 diabetes. A significant decrease in fasting plasma glucose (the level taken in the morning before you eat) resulted from use of the product. Interestingly enough, this occurred in people without diabetes (7).
So, the uncertainty remains if whether or not apple cider vinegar helps lower blood sugar in patients with type 2 diabetes.
Safety of apple cider vinegar
Apple cider vinegar usually does not cause problems when consumed in food or small amounts over a short timeframe (8). Still, you should not ignore that there are adverse side effects and medication interactions that exist.
The Natural Medicines Comprehensive Database provides information on safety, evidence, and medication interactions for supplements. According to this database, apple cider vinegar is likely safe in amounts found in food. Additionally, it is possibly safe if used in a medicinal role, but still for the short-term (9).
Apple cider vinegar can be possibly unsafe when used over a long period and in large dosages, leading to a low potassium level in the body (9). Low potassium can potentially lead to serious cardiac issues.
Because of the acidity of the product, apple cider vinegar can damage your tooth enamel and the lining of your esophagus (10). It is essential to dilute it to reduce the acidity. For example, if you are using one tablespoon (15 milliliters or “ml”) of apple cider vinegar, mix it with a mug-sized serving of warm water (10).
Even though apple cider vinegar is a food product, it can still interact with several medications and other supplements. These include insulin, drugs for treatment of type 2 diabetes, diuretics (you may know this as a “water pill”), and a cardiac medication called Digoxin (9).
The Natural Medicines Comprehensive Database shows herbs and supplements might interact with apple cider vinegar. These include ones intended to lower blood sugar or that contain what is known as cardiac glycosides. Using these supplements with apple cider vinegar could cause blood sugar to drop too low, or low levels of potassium may result from the ones with cardiac glycosides (9).
How much apple cider vinegar is enough?
Just one tablespoon (15 ml) is likely needed in efforts of cholesterol and weight management (6,7). Several diabetes studies utilized amounts from one tablespoon (15 ml) to slightly more with 20 ml (7).
If apple cider vinegar is something you want to try, it is a good idea to incorporate it as part of foods and according to the amounts usually found in them. Due to lack of evidence on a specific dosage, this could be the best and safest way to do so.
Duration of use
The duration of use is not clear for apple cider vinegar, and studies have just looked at short-term periods from 1-3 months (7).
There is not adequate information to determine if long-term use is appropriate or safe yet. Due to this, apple cider vinegar should only be used on a short-term basis.
Other treatments for nonalcoholic fatty liver disease
A healthy diet contributes to long-term improvements in your health. On the other hand, apple cider vinegar was only studied for short periods and is currently not recommended for long-term use. Therefore, consuming a balanced diet while limiting certain foods (such as added sugars and saturated fats) will have a greater impact over time.
Exercise is another important part of managing nonalcoholic fatty liver disease, along with your cardiovascular health and overall well-being. Aiming for at least 150 minutes weekly of moderate-intensity exercise would be a good goal to keep in mind. If you are just beginning, go slow and increase over time to avoid injury.
Other possible remedies – coffee and green tea
Other natural remedies that may benefit someone with nonalcoholic fatty liver disease include coffee and green tea.
The antioxidant and anti-inflammatory effects found in green tea were specifically researched. Two different studies using a dose of 500 milligrams (mg) of green tea extract showed improvement of liver enzymes, insulin resistance, and overall condition of fatty liver (11).
If you are a coffee drinker, getting your daily fix is a good thing! Polyphenols and caffeine found in coffee may reduce problems such as steatohepatitis and insulin resistance. Furthermore, there is a connection between getting your cup of Joe regularly and reduced fibrosis risk (11).
Coffee and green tea do not result in toxic effects, according to research thus far (11). Nonetheless, it is still important to stay aware of other aspects related to their use, including any interactions with medications you take.
Are apple cider vinegar supplements good for fatty liver?
If you ever strolled down the vitamin aisle at the grocery store, odds are you saw apple cider vinegar supplements. It exists in various forms, but what is inside them exactly? Honestly, it is hard to know for sure.
The Food and Drug Administration does not regulate supplements, so there is no guarantee of what they contain or the proportion of ingredients. And, there have not been any conclusive studies backing up apple cider vinegar supplements as an effective product (12).
At this time, there is not enough evidence supporting the use of apple cider vinegar for treatment of nonalcoholic fatty liver disease, type 2 diabetes, high cholesterol, or weight loss. This product requires further research, especially with human studies. We hope there will be more specific guidance in the future.
In the meantime, focusing on lifestyle changes will make the greatest impact on your health.
It is important to use caution with any treatment, natural or otherwise. Discussing it with your doctor or registered dietitian first is crucial before beginning any new regimen. This step will allow you to gain knowledge to make the best decision for your health moving forward.