Apple Cider Vinegar for Gout: Does It Really Work?

By Ashley Braun, MPH, RD
Updated on August 02, 2023
Medically reviewed by Stella Bard, MD

The use of apple cider vinegar (ACV) as a natural remedy has seen a significant resurgence in recent years, with widespread claims suggesting its efficacy in managing various health conditions. Proponents often highlight its potential to assist in lowering blood sugar and blood pressure, supporting weight management, and reducing inflammation. While apple cider vinegar has indeed been a popular alternative therapy for decades, it is crucial to approach these claims with a discerning eye. Current scientific research provides minimal direct evidence to support many of these health benefits, particularly concerning its specific effects on gout. However, a few studies do offer some insight into its broader impact on certain physiological processes.

This article delves into the composition and claimed benefits of apple cider vinegar, examines the nature of gout, and critically assesses the scientific evidence—or lack thereof—regarding ACV's role in managing this painful condition. As healthcare professionals, our aim is to provide clear, evidence-based information to help you make informed decisions about your health, while always emphasizing the importance of consulting with your medical provider for any significant health concerns or before incorporating new remedies into your routine. Understanding the nuances of these claims is essential for anyone considering ACV for health purposes.

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What Is Apple Cider Vinegar?

Apple cider vinegar is produced through a fascinating two-step fermentation process that transforms the natural sugars found in apples into a potent therapeutic agent. Initially, yeast converts the sugars in crushed apples or apple cider into alcohol, creating apple cider. Following this, acetic acid bacteria take over, converting the alcohol into acetic acid. This acetic acid is the primary active compound responsible for many of ACV’s purported health benefits, and it is present in other vinegars as well, such as white vinegar. The unique flavor and aroma of apple cider vinegar, however, come from other compounds formed during its specific fermentation.

From a nutritional standpoint, apple cider vinegar is remarkably simple. It contains virtually zero calories, as it lacks carbohydrates, fats, or proteins. Its composition typically ranges from 5% to 6% acetic acid, depending on its dilution and production. The only mineral found in any significant amount is a small quantity of potassium. When apple cider vinegar is unfiltered, you might notice a cloudy sediment at the bottom of the bottle, often referred to as "the mother." This substance is composed of the acetic acid bacteria and enzymes that facilitate the fermentation process. With a pH level typically ranging from 2 to 3, apple cider vinegar is notably acidic, which is a key factor in both its potential benefits and its associated risks.

What Is Gout?

Gout stands as a distinct and particularly debilitating form of arthritis characterized by its sudden, intense flare-ups of pain, often accompanied by significant swelling, redness, and a profound soreness in the affected joints. While it can manifest in various joints throughout the body, it most commonly targets the joint at the base of the big toe, an area often referred to as podagra. Other frequently affected joints include the ankles, knees, elbows, wrists, and fingers, turning simple movements into agonizing tasks during a flare. The unpredictable nature of these attacks, combined with their severe pain, makes gout a challenging condition to manage.

The underlying cause of gout flares is an accumulation of excessively high levels of uric acid within the body, a condition known as hyperuricemia. Uric acid is a natural byproduct formed when the body metabolizes purines—compounds that are both produced internally and found in various foods. Normally, the kidneys efficiently filter uric acid from the blood, excreting it through urine. However, when uric acid levels become too elevated, or if the kidneys are unable to process it effectively, uric acid can crystallize in the joints, triggering a severe inflammatory response and the characteristic intense pain of a gout attack. Dietary factors play a significant role, as foods rich in purines, such as red meat, poultry, certain seafood like shellfish, and alcoholic beverages, especially beer, have been strongly linked to increased uric acid levels and a higher risk of gout flares.

Apple Cider Vinegar and Gout

Despite the widespread anecdotal claims suggesting apple cider vinegar possesses anti-inflammatory properties that could directly alleviate gout symptoms or prevent flares, it is crucial to recognize the current absence of robust scientific research supporting these specific effects in humans. While ACV is often lauded as a natural anti-inflammatory agent in general wellness circles, there is no direct evidence from clinical studies demonstrating its effectiveness in reducing the inflammation associated with gout or in preventing the painful attacks. For individuals seeking relief from gout, relying solely on ACV without professional medical guidance could delay access to proven treatments.

One area of research that has explored the connection between diet and uric acid levels involves the concept of an alkaline diet. A study examining dietary approaches to control uric acid found that following an alkaline diet—rich in fruits and vegetables and typically lower in protein—increased the pH of urine, which was associated with enhanced excretion of uric acid. Interestingly, vinegar was included in the components of the alkaline diet in this study. However, it was not specifically apple cider vinegar, and the study did not isolate vinegar as the sole contributing factor to the observed effects. Therefore, while diet plays a critical role in gout management, the direct contribution of apple cider vinegar to uric acid excretion remains largely unproven.

While direct evidence for apple cider vinegar's role in gout treatment is limited, some of its broader health claims, supported by research, could indirectly offer benefits that might be relevant to individuals managing gout. It is important to note that many of these studies did not specifically use apple cider vinegar but rather a general type of vinegar. Understanding these potential indirect benefits can help contextualize ACV’s place in a comprehensive health strategy. Always remember that these are not direct treatments for gout itself, but rather potential adjuncts to overall well-being.

Diabetes and Blood Sugar Control

Among the various health claims attributed to vinegar, its effects on blood sugar control are perhaps the most extensively supported by scientific evidence. Multiple studies have consistently demonstrated that vinegar can play a role in lowering blood glucose levels. The proposed mechanism involves vinegar's ability to reduce the glycemic index of foods, thereby lessening their impact on blood sugar spikes after a meal. This effect is particularly relevant for individuals managing their blood sugar, whether for diabetes or general metabolic health.

For instance, one study highlighted that incorporating vinegar as a salad dressing significantly reduced the blood sugar response to a meal containing 50 grams of carbohydrates by over 30%. In a similar vein, another study observed that a meal including pickled cucumbers, as opposed to fresh cucumbers, resulted in a more than 30% reduction in the glycemic response. These findings suggest that the acetic acid in vinegar can temper the body's reaction to carbohydrates. However, for those with diabetes who are already on medication to manage their blood sugar levels, it is critically important to consult with a healthcare provider before attempting to use vinegar as a complementary strategy, as it could lead to dangerously low blood sugar levels (hypoglycemia).

Weight Management

Maintaining a healthy weight is a cornerstone of overall well-being and can indirectly impact conditions like gout, given the link between obesity and increased gout risk. A double-blind research study conducted in 2017 provided promising insights into vinegar's potential role in weight management. The study found that participants who consumed either 15 milliliters or 30 milliliters of vinegar daily experienced reductions in body weight, waist circumference, and serum triglyceride levels, especially when compared to a placebo group. These outcomes suggest that regular vinegar intake might contribute to healthier metabolic profiles.

It's important to note that the vinegar used in this particular study was not specified as apple cider vinegar, implying that the observed effects could be attributed to acetic acid, the primary active component common to many types of vinegar. While these results are encouraging, it is vital to understand that vinegar is not a miracle weight-loss solution. Instead, its potential benefits are likely best realized as part of a broader lifestyle approach that includes a balanced diet and regular physical activity. For sustained weight management, focusing on comprehensive changes in diet and exercise remains the most effective strategy.

Reduce Inflammation

The quest for natural anti-inflammatory remedies is ongoing, and apple cider vinegar often features in discussions about reducing inflammation. A study conducted in mice offered some intriguing preliminary findings, suggesting that apple cider vinegar might help in controlling chronic pain and inflammation. The researchers posited that the beneficial effects observed in the mice could be linked to the presence of B-vitamins within apple cider vinegar, which are known to play various roles in cellular function and metabolism, including aspects related to inflammation.

However, it is crucial to draw a clear distinction between findings in animal studies and their direct applicability to humans. While the results in mice are scientifically interesting, there is currently no robust evidence from human clinical trials to demonstrate that apple cider vinegar effectively reduces inflammation in people, particularly the inflammatory processes characteristic of gout. Therefore, while the idea is appealing, medical professionals continue to emphasize that more comprehensive human research is needed before any definitive claims can be made regarding ACV's anti-inflammatory effects in humans.

Blood Pressure

The management of blood pressure is a critical component of cardiovascular health, and certain natural remedies are often explored for their potential to contribute to healthy levels. One study conducted in rats investigated the effects of apple cider vinegar on blood pressure. The findings indicated that daily consumption of apple cider vinegar for six weeks led to lower systolic blood pressure in the animal subjects. This animal model research suggests a potential physiological mechanism through which ACV might influence vascular health.

However, it is imperative to note that, as of now, there have been no human studies that consistently support this blood-pressure-lowering effect of apple cider vinegar. While anecdotal reports might suggest otherwise, current medical consensus emphasizes the lack of human clinical evidence. Moreover, it is well-established that there is a strong and direct relationship between body weight and blood pressure. Significant weight loss, even as modest as 10% of body weight, can lead to substantial reductions in blood pressure. Therefore, while ACV is still being explored, prioritizing proven lifestyle interventions such as maintaining a healthy weight, adopting a balanced diet, and engaging in regular physical activity remains the most effective strategy for blood pressure management.

Cholesterol Levels

Managing cholesterol levels is vital for preventing cardiovascular disease, and various dietary interventions are often explored. A randomized control trial conducted in 2018 investigated the effects of apple cider vinegar on lipid profiles. The study found that apple cider vinegar helped to reduce both triglyceride levels and total cholesterol levels more effectively than a calorie-restricted diet alone. This outcome offers preliminary, yet promising, information regarding apple cider vinegar's potential influence on cholesterol markers, suggesting it could play a supportive role in lipid management.

However, it is important to contextualize these findings. The study was relatively small, involving only 39 participants, which limits the generalizability of its results. While encouraging, further large-scale, well-designed research studies are needed to conclusively demonstrate apple cider vinegar's consistent effect on cholesterol levels in a broader population. Until more robust evidence emerges, apple cider vinegar should be considered a potential complementary strategy rather than a primary intervention for managing cholesterol, and it should always be discussed with a healthcare provider, especially if you are already on cholesterol-lowering medication.

Dosage and Preparation

For those considering incorporating apple cider vinegar into their health regimen, it is important to understand that there is no universally standardized dosage or form recommended by medical professionals, primarily due to the limited comprehensive research in humans. Apple cider vinegar is readily available in both liquid and tablet forms. When considering its use, always adhere to the directions provided on the product packaging, and, most importantly, consult with your healthcare provider to discuss potential interactions or suitability for your specific health condition. This professional guidance is paramount before beginning any new supplement.

Based on existing research exploring vinegar's general health effects, studies often utilized approximately 15–30 milliliters, which is equivalent to about 1 to 2 tablespoons, consumed daily. When using liquid apple cider vinegar, proper dilution is critical to prevent adverse effects; a common suggestion is a 1:10 vinegar-to-water ratio. It is also worth noting that the acetic acid content can vary significantly between different brands of apple cider vinegar, unlike white vinegar, which typically has a standardized 5% acetic acid concentration. Most of the beneficial research on vinegar's effects on blood sugar and weight involved its integration into meals—for instance, as a salad dressing, a topping for vegetables, or within pickled foods. There is less evidence supporting its efficacy when taken as a tablet or as a standalone liquid outside of meal times. Practical ways to incorporate apple cider vinegar include making homemade salad dressings, adding a splash to marinades for meats or vegetables, or even using it as a tangy component in dips.

Risk and Side Effects

Despite its popularity and perceived natural benefits, it is crucial to recognize that apple cider vinegar, due to its highly acidic nature, can be quite harmful if not used correctly. Proper dilution is not merely a suggestion but a critical safety measure. If applied directly to the skin without adequate dilution, its acidity can lead to severe chemical burns. Internally, the risks are equally significant, and improper consumption can cause considerable damage to various body tissues. Understanding these potential hazards is essential for anyone considering its use.

When consumed improperly, apple cider vinegar can provoke a range of adverse internal effects. Its potent acidity can erode and damage the delicate tissues of the esophagus, leading to esophagitis, which manifests as throat pain and difficulty swallowing. It can also significantly damage tooth enamel, increasing susceptibility to cavities and long-term dental issues. Furthermore, prolonged or undiluted consumption can irritate and potentially damage the stomach lining, leading to discomfort or more serious gastrointestinal problems. A particularly critical risk is the potential for hypoglycemia, or dangerously low blood sugar levels, especially for individuals who are already taking medications designed to lower blood sugar. This interaction underscores the absolute necessity of consulting a healthcare provider before incorporating apple cider vinegar into any regimen, especially if you have pre-existing health conditions or are on medication.

A Word From Verywell

Apple cider vinegar has enjoyed a reputation as a versatile home remedy for centuries, with a myriad of health benefits attributed to it. While its historical use is undeniable, contemporary scientific scrutiny provides a more nuanced picture. There is some encouraging, albeit often preliminary, evidence suggesting that incorporating vinegar as part of a balanced diet could offer modest support for aspects such as weight management and blood sugar control. These findings align with general health principles that emphasize mindful eating and metabolic balance.

However, it is crucial to reiterate that despite popular belief, current research does not directly support apple cider vinegar as an effective treatment or preventative measure specifically for gout. The complexities of gout management require a comprehensive approach that includes medical supervision, specific medications, and dietary adjustments proven to lower uric acid levels. Therefore, before considering any alternative therapies like apple cider vinegar to help manage gout or any other health condition, it is paramount to consult with your healthcare provider. A medical professional can offer personalized advice, discuss potential interactions with other medications, and ensure that any new additions to your routine are safe and appropriate for your individual health needs.

Frequently Asked Questions

While the article addresses these throughout, for quick reference:

• Does apple cider vinegar reduce inflammation? Perhaps, but the research is limited and not strong. A study in mice found that apple cider vinegar reduced inflammation as measured by blood markers.4 However, there is no research in humans that replicates these results.
• Does apple cider vinegar make gout worse? Probably not. Apple cider vinegar is often recommended as a home remedy for gout. While there is no evidence to support apple cider vinegar is effective in treating gout, there is also no evidence showing it is harmful to people with gout.
• What is apple cider vinegar good for? Apple cider vinegar has long been used as a home remedy for many ailments, though there isn't a lot of research to support these claims. Areas where science shows apple cider vinegar may be beneficial include blood sugar management, weight loss, and cholesterol levels.

Read more:

• Health A-Z
• Arthritis
• Gout

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Johnston CS, Gaas CA. Vinegar: medicinal uses and antiglycemic effect. MedGenMed. 2006;8(2):61.
2. Kanbara A, Hakoda M, Seyama I. Urine alkalization facilitates uric acid excretion. Nutr J. 2010;9:45. doi:10.1186/1475-2891-9-45
3. Kondo T, Kishi M, Fushimi T, Ugajin S, Kaga T. Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese japanese subjects. Bioscience, Biotechnology, and Biochemistry. 2009;73(8):1837-1843. doi:10.1271/bbb.90231
4. Moallem S, Barahoyee A. Evaluation of acute and chronic anti-nociceptive and anti-Inflammatory effects of apple cider vinegar. IJPR. 2004;Volume 3(Supplement 2). doi:10.22037/IJPR.2010.466
5. Khezri SS, Saidpour A, Hosseinzadeh N, Amiri Z. Beneficial effects of Apple Cider Vinegar on weight management, Visceral Adiposity Index and lipid profile in overweight or obese subjects receiving restricted calorie diet: A randomized clinical trial. Journal of Functional Foods. 2018;43:95-102. doi:10.1016/j.jff.2018.02.003

By Ashley Braun, MPH, RD Ashley Braun, MPH, RD, is a registered dietitian and public health professional with over 5 years of experience educating people on health-related topics using evidence-based information. Her experience includes educating on a wide range of conditions, including diabetes, heart disease, HIV, neurological conditions, and more.
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