 I know you work hard to make the best lifestyle choices, so you can improve your health, destiny, and longevity. And there's lots of information out there on how to do just that. So where do you start? Well, we start with the facts. Welcome to the Nutrition Facts Podcast. I'm your host, Dr. Michael Greger. My job is to bring you the latest peer-reviewed nutrition and health research, and share it with you here. I know what you're thinking. Vinegar, that stuff you hide in the back of your kitchen cabinet? In our first story, we look at how daily vinegar consumption can lead to a significant loss of abdominal fat. Vinegar has evidently been used as a weight loss aid for nearly 200 years. But does it work? Well, like hot sauce, it can be a nearly calorie-free way to flavor foods, and there's all sorts of tasty, exotic vinegars out there, now like fig, peach, and pomegranate to choose from. But the question is, is there something special about vinegar that helps with weight loss? Vinegar is defined simply as a dilute solution of acetic acid, which takes energy for our body to metabolize, activating an enzyme called AMPK, which is like our body's fuel gauge. If it senses that we're low, it amps up energy production, tells the body to stop storing fat and start burning fat. And so, given our obesity epidemic, it's crucial that oral compounds with high bioavailability are developed to safely induce chronic AMPK enzyme activation, which would potentially be beneficial for long-term weight loss. No need to develop such a compound, though, if you can buy it at any grocery store. We know vinegar can activate AMPK in human cells, but as the dose one might get, sprinkling it on a salad, enough. If you take endothelial cells, blood vessel lining cells from umbilical cords after babies are born, and expose them to various levels of acetate, which is what the acetic acid and vinegar turns into in our stomach, it appears to take a concentration of at least 100 to get a really significant boost in AMPK. So how much acetate do you get in your bloodstream sprinkling about a tablespoon of vinegar on your salad? You do it 100, but only for about 15 minutes. And even at that concentration, 10 or 20 minutes exposure doesn't seem to do much. Now, granted, this is an apetite dish, but we didn't have any clinical studies until we did. A double-blind trial investigating the effects of vinegar intake on the reduction of body fat in overweight men and women. Now, they call them obese, but they were actually slimmer than your average American. In Japan, they call anything over a BMI of 25 obese, who is the average American adult, is about 28.6. But anyway, they took about 150 overweight individuals and randomly split them into one of three groups, a high-dose vinegar group, where they drank a beverage containing two tablespoons of apple cider vinegar a day, a low-dose group, where they drank a beverage containing only one tablespoon of apple cider vinegar a day, and a placebo-control group, where they had them drink an acidic beverage they developed to taste the same as the vinegar drink, but using a different kind of acid, so there was no acetic acid. No other changes in their diet are exercised. In fact, they monitored their diets and gave them all pedometers, so it makes sure that the only significant difference between the three groups was the amount of vinegar they were getting every day. And within just one month, statistically significant drops in weight in both vinegar groups compared to placebo, with higher dose doing better than the low dose, we just got better and better month after month. In fact, by month 3, the Do Nothing placebo group actually gained weight, as overweight people tend to do, whereas the vinegar group significantly dropped their weight. Now, was the weight loss actually significant or just kind of statistically significant? Well, that's for you to decide. This is in kilograms, so compared to placebo, the two tablespoons of vinegar a day group dropped 5 pounds by the end of 12 weeks. That may not sound like a lot, but they got that for just pennies a day without removing anything from their diet. And they got slimmer up to nearly an inch off their waist, suggesting they were losing abdominal fat, but the researchers went the extra mile and put it to the test. They put the research subjects through abdominal CT scans to actually directly measure the amount of fat before and after in their bodies. They measured the amount of superficial fat, visceral fat, and total body fat. Superficial fat is the fat under your skin that makes for flabby arms and contributes to cellulite, but visceral fat is the killer. That's the fat building up around your internal organs that bulges out the belly. And that's the kind of fact the placebo group was putting on when they were gaining weight, not good. But both the low dose and high dose vinegar groups were able to remove about a square inch of visceral fat off that CT scan slice. Now like any weight loss strategy, it only works if you do it a month after they stopped the vinegar, the weight crept back up, but that's just additional evidence that the vinegar was working. But how? A group of researchers in the UK suggested an explanation. Vinegar beverages are gross. They made a so-called palatable beverage by mixing a fruity syrup in vinegar and water, then went out of the way to make a really nasty, unpalatable vinegar beverage, both with white wine vinegar, which were so unpleasant the study subjects actually felt nauseous after drinking them, so ate less of the meal they gave it with. So there you go. Vinegar helps with both appetite control and food intake, though these effects were largely due to the fruity vinegar concoctions invoking feelings of nausea. So is that what was going on here? Were the vinegar groups just eating less? No. The vinegar groups were eating about the same compared to placebo. Same diet, more weight loss, thanks perhaps, to the acetic acid's impact on AMPK. Now the CT scans make this a very expensive study, so I was not surprised it was funded by a company that sells vinegars, which is good, since otherwise we wouldn't have these amazing data, but it's also bad, because it always leaves you wondering if the funding source somehow manipulated the results. But the nice thing about company's funding study is about healthy foods, whether it's some kiwifruit company or the National Watermelon Promotion Board at watermelon.org, check it out. Is that what's the worst that can happen? If the findings turned out to be bogus, worse comes the worst. Your salad would just be tastier. Next up we look at how sprinkling vinegar on greens may augment their ability to improve artery function. There was a famous study from Harvard published back in 1999 that found that women who used oil and vinegar salad dressing about every day went on to have fewer than half the fatal heart attacks compared to women who hardly ever used it, less than half the risk of the number one killer of women. They figured it was the omega-3s in the oil that explained the benefit, but I know what you're thinking. Those who use salad dressing every day probably also eat salad every day. But no, they were able to adjust for vegetable intake, so it didn't appear to be the salad. But why does the oil get the credit and not the vinegar? If only there was a way we could test that. Well, what about creamy salad dressing? They were also made from omega-3 rich oils like canola, in fact even more so than oil and vinegar dressing. So if the oil and not the vinegar, then creamy dressing would be protective, too. But it's not. No significant decrease in fatal heart attack rates were. Non-fatal heart attack rates, for that matter. Now it could be the eggs or butter fat counteracting the benefits of the omega-3s, but maybe the vinegar is actually playing a role. But how? Well, if you're paying close attention in the vinegar weight loss video, the title of that paper was vinegar intake enhances flow-mediated vasodilation via up-regulation of endothelial nitric oxide synthase activity. In other words, vinegar enhances arterial function by allowing our arteries to better dilate naturally by boosting the activity, the enzyme in our body that synthesizes nitric oxide, the open sesame signal to our arteries that improves blood flow. If you remember, acetate is cleared out of your blood within a half an hour after consuming a salad with a tablespoon of vinegar in it. Apparently not enough time to boost the AMPK enzyme, but within just 10 minutes those kind of acetate levels can boost the activity of the nitric oxide synthesizing enzyme within human umbilical cord blood vessel cells in a petri dish. But what about in people? They measured the dilation of arteries in the arms of women after they had a tablespoon of rice vinegar, a tablespoon of brown rice vinegar, or a tablespoon of forbidden rice vinegar. In other words, vinegar made from black or purple rice. All the vinegars appeared to help, but it was the black rice one that most clearly pulled away from the pack. Black rice contains the same kind of anthocyanin pigments that make some fruits and vegetables blue and purple and may have independent benefits. For example, if you give someone a big blueberry smoothie containing the amount of anthocyanins in a cup and a half a while blueberries, you get a nice spike in arterial function that lasts a couple hours. Thus the maximum forearm blood flow in the forbidden rice vinegar intake group might be attributed to an additional or synergistic effect of anthocyanin with the acetate. But it could also just be the antioxidant power of anthocyanins, in which case balsamic vinegar, which is made from red wine, may have a similar effect, as it was shown to have remarkably higher free radical scavenging activity than rice vinegar. Enough to counter the artery constricting effects of a high-fat meal? Well, we've known for nearly 20 years that a single high-fat meal, sausage and egg McMuffins with deep-fried hash browns, can cripple our artery function, using the ability of our arteries to dilate normally in half within hours of going into our mouths, compared to frosted flakes. Even with that massive unhealthy sugar load, no effect on the arteries, because there was no fat, and not just animal fat, we're talking about a quarter cup of safflower oil had a similar effect. In fact, the very first study to show how bad fat was for our arteries basically dripped highly refined soybean oil into people's veins. But extra virgin olive oil isn't refined. We know some whole food sources of plant-fat such as nuts actually improve artery function, whereas oils, including olive oil, worsen function, but they didn't specify extra virgin here. I mean, you can see smell, taste, the phytonutrient still left in extra virgin olive oil. Are they enough to maintain arterial function? No. A significant drop in artery function within three hours of eating whole grain bread dipped in extra virgin olive oil, and the more fat in their blood, the worse their arteries did. Ah, but what if you ate the same meal, but added balsamic vinegar on a salad? That seemed to protect the arteries from the effects of the fat. And now balsamic vinegar is a product of red wine. Would you get the same benefits just drinking a glass of red wine? No. No improvement in arterial function after red wine, huh? Why does balsamic vinegar work but red wine not? Maybe it's because the red wine lacks the benefits of the acetic acid in vinegar, or maybe it's because the vinegar lacks the negative effects of the alcohol. And a third option might be it was the salad ingredients had nothing to do with the vinegar. To figure out this puzzle, all we'd have to do is test non-alcoholic wine, non-alcoholic red wine worked. So maybe it was the grapes in balsamic vinegar, not the acetic acid. And indeed, if you eat a cup and a quarter of seeded and seedless red, green, and blue-black grapes with your sausage and egg McMuffin, you can blunt the crippling of your arteries. So plants and their products may provide protection against the direct impairment in endothelial function, unless those products are oil or alcohol. Finally today, we look at how vinegar can help control blood sugar. A double-blind placebo-controlled randomized study found that body weight and belly fat were significantly reduced, adding just a single tablespoon of vinegar to one's daily diet. But is there any benefit to vinegar consumption if you're not overweight? Well, their triglycerides normalized, and on the two tablespoons a day dose, there was a dip in blood pressure. But those effects may have just been because of the weight loss. Other than taste, is there any benefit to normal weight individual sprinkling vinegar on their salad? What about vinegar for blood sugar control? If you feed people a massive amount of sugar, half cup of table sugar, as their blood sugar spike, their artery function can become impaired. And the higher the blood sugars go, the more the arteries take a hit. There's a drug, though, that can block sugar absorption, and by blunting the blood sugar spike with the drug, you can prevent the arterial dysfunction. Demonstrating that's probably good for your heart, if you don't have big blood sugar spikes after meals. And indeed, how high your blood sugar spike after a meal is a predictor for cardiovascular mortality. So do people who eat lots of high glycemic foods, like sugary foods and refined grains, tend to have more heart attacks and strokes? Yes. And they appear more likely to get diabetes, but maybe people who eat lots of frosted flakes and wonderbread also have other bad dietary habits. The diets that have been put to the test in randomized controlled trials and proven to prevent diabetes are the ones focusing on cutting down on saturated fat and ramping up the consumption of fiber-rich whole-plant foods, such as fruits, vegetables, and whole grains, without specific regard to lower or higher glycemic loads. The drug has been put to the test, though, and blunting one's mealtime blood sugar spikes does seem to reduce the risk of developing diabetes, as well as reduce the risk of heart attacks and high blood pressure. So is there any way to prevent these blood sugar spikes without having to take drugs? Well, one way would be to not sit down to a half a cup of sugar. Yes, the drug can slow the progression of your atherosclerosis, but wouldn't it be better to eat a diet that actually reverses heart disease or reverses diabetes? The healthiest diet to prevent the meal-related blood sugar and fat spikes, the oxidation, and inflammation is a diet centered around whole-plant foods. But what if you really want to bagel? Instead of spreading drugs on it, spreading on some almond butter may help blunt the blood sugar spike from refined carbs. And another option is to dip your baguette in some balsamic vinegar. The consumption of vinegar with meals was evidently used as a home remedy for diabetes before drugs came along, but wasn't put to the test until 1988. After all, how much money can be made from vinegar? Well, according to the Vinegar Institute, millions of dollars, but a single diabetes drug like Resulin can pull in billions before it was pulled from the market for killing too many people by shutting down their livers. The drug company still made off like a bandit having to pay out less than a billion to the grieving families for covering up the danger. No liver failure from a peanut butter-smeared bagel, though, cutting the blood sugar response in half, and the same with vinegar. If you chug down four teaspoons of apple cider vinegar diluted in water, you get that same blunting of the spike, and you get the additional advantage over the nuts of lowering insulin levels in the blood, something peanut butter apparently can't do. But presumably better than a bagel with locks, fish causes triple the insulin response, or red wine, which also increases insulin levels, though not as much as the fish, and also shoots up triglycerides, though de-alcoholized red wine, non-alcoholic wine, doesn't have the same problem. Okay, but what about vinegar? Not only. May a tablespoon a day tend to improve cholesterol and triglycerides over time vinegar can drop triglycerides within an hour of a meal, along with decreased blood sugars and the insulin spike, potentially offering the best of all worlds. We would love it if you could share with us your stories about reinventing your health through evidence-based nutrition. Go to nutritionfacts.org slash testimonials. We may share it on our social media to help inspire others. To see any graphs, charts, graphics, images, or studies mentioned here, please go to the Nutrition Facts podcast landing page. There you'll find all the detailed information you need, plus links to all the sources we cite for each of these topics. For a vital, timely text on the pathogens that cause pandemics, you can order the e-book, audiobook, or the hard copy of my last book, How to Survive a Pandemic. For recipes, check out my new How Not to Diet Cookbook. It's beautifully designed with more than 100 recipes for delicious and nutritious meals. And all proceeds I've received from the sales of all my books goes to charity. NutritionFacts.org itself is a non-profit, science-based public service where you can sign up for free daily updates on the latest in nutrition research via bite-sized videos and articles. Everything on the website is free. There's no ads, no corporate sponsorship. It's strictly non-commercial. I'm not selling anything. I just put it up as a public service, as a labor of love, as a tribute to my grandmother, whose own life was saved with evidence-based nutrition.