Does apple cider vinegar help with weight loss?

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Social media platforms are awash with videos extolling the virtues of apple cider vinegar (ACV).

Part of the appeal is ACV’s range of purported health benefits, including reduced cholesterol levels, antibacterial activity, blood glucose regulation, and improvements in skin and heart health. In an era of increasing overweight and obesity, its potential role in weight loss has attracted particular attention.

Before considering the weight loss claims, it is useful to clarify what ACV is and how robust the evidence is for its use.

Vinegar as medicine

Vinegar is made from fermentable carbohydrate. The process starts with yeast fermentation of natural sugars into alcohol, followed by conversion of the alcohol to acetic acid by Acetobacter. Its health effects probably arise from the acetic acid, which has antibacterial activity.

ACV also contains flavonoids such as gallic acid, catechin and ferulic acid. Animal studies have reported antioxidant, anti-inflammatory, antidiabetic, antihypertensive and antihyperlipidaemic properties.

From a cardiovascular perspective, ACV may have potential benefits. A 2021 meta-analysis of nine studies showed significant reductions in total cholesterol, fasting plasma glucose and HbA1c, although the authors advised caution because of limitations in several included studies.

Although acetic acid is responsible for many of ACV’s potential effects, the mechanism remains unclear. Proposed actions include delayed gastric emptying and inhibition of digestive enzymes.

ACV and weight loss

In a 2020 systematic review of ACV for weight loss, researchers concluded that poor-quality studies meant it was not possible to determine with certainty whether ACV had health benefits. In 2025, the BMJ group retracted a paper on ACV and weight loss because the analyses could not be replicated and multiple errors were identified.

If ACV does have weight loss benefits, one group likely to be interested is patients with type 2 diabetes (T2D), which was the focus of a more recent analysis. This meta-analysis of RCTs examined whether ACV consumption had an anti-obesity effect.

Overall, 10 studies involving 861 patients were included, with ACV administered at doses of 5–30ml daily for 4–12 weeks. The analysis found a mean difference in weight loss of 7.45kg between the ACV and placebo groups. Reductions were also reported in body mass index (2kg/m² lower with ACV) and waist circumference (2.95cm).

To assess the validity of their findings, the researchers conducted sensitivity analyses that varied assumptions, methods and data inclusion criteria, including removal of high-risk-of-bias studies. The findings remained significant, except for changes in waist circumference.

Implications for practice?

The meta-analysis appears to support a claim that ACV consumption may contribute to weight loss. The authors reported a small-to-moderate effect.

Some included trials also used a low-calorie diet, so ACV may be best viewed as a potential adjunct rather than a standalone intervention. Dose appears important, with evidence suggesting at least 30ml daily for a minimum of 12 weeks.

On average, patients may lose up to 7.4kg, which, depending on baseline weight, could lead to clinically meaningful improvements in cardiometabolic risk factors.

When patients ask about non-medical approaches to weight loss, pharmacy teams can explain that there is some evidence to support a role for ACV. They should also make clear that the evidence is still developing and that ACV should not replace established advice. Potential additional benefits include improvements in glucose, cholesterol and other cardiometabolic markers. Recent data also suggests that vinegar may have beneficial effects on the gut microbiome.

Although ACV may offer potential weight loss benefits, it remains unclear whether supplementation is preferable to simply eating a daily apple, which provides antioxidants and fibre that supports the gut microbiome. Alternatively, ACV can be incorporated into the diet through salad dressings or marinades. In the final analysis, whether ACV is superior to other weight loss supplements remains unclear given the lack of comparative studies. So watch this space.

Sources

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