Apple cider vinegar has long been used as a folk remedy for a number of health conditions — including infections, for “detoxification,” and more recently, for its supposed weight loss effects. So it’s not surprising that some people with inflammatory bowel disease (IBD) — Crohn’s disease and ulcerative colitis (UC) — are curious about whether it might help their condition.
What’s in Apple Cider Vinegar, and What It Does
Apple cider vinegar is created in a process of fermentation, in which yeast turns sugars in apples into alcohol, and then bacteria turn this alcohol into acetic acid — the key ingredient that makes it vinegar. It’s about the same color as apple juice, and it contains vitamins and plant-based antioxidants (called polyphenols) at about the same levels as apple juice.
Unfiltered apple cider vinegar has a cloudy substance that settles in it, called the “mother.” This sludge contains yeast, bacteria, and acids from the fermentation process. While there’s a lot of hype about the supposedly beneficial effects of the mother, the long history of therapeutic uses for apple cider vinegar is “most likely just due to the acetic acid,” says Olivia Vaughn, RDN, a dietitian in the division of gastroenterology, hepatology, and nutrition at the Ohio State University Wexner Medical Center, in Columbus.
Acetic acid — which is found in all types of vinegar — “has some health-promoting properties,” says Vaughn. “It’s an antimicrobial agent. It’s antifungal.” And outside the realm of IBD, there’s compelling evidence that it may help certain people with diabetes lower their blood sugar levels.
The antimicrobial properties of acetic acid are the theoretical basis for how it might help certain people with Crohn’s. “It may alter our microbiomes, all those organisms within the GI tract that do very much affect our health,” Vaughn explains. “The microbiome directly impacts the health of our GI tract.”But exactly how our microbiomes — consisting of bacteria, fungi, and other small organisms — affect our digestive and overall health is an area of science that’s quite new. There are only a few clues about how apple cider vinegar affects our microbiomes, and what this may mean for IBD.
Apple Cider Vinegar and Crohn’s: What the Science Says
There have been no scientific studies to date looking at the effects of consuming apple cider vinegar on Crohn’s disease. In fact, one piece of evidence that vinegar may have any impact on IBD is a single study involving mice.
Published in January 2016 in the Journal of Agricultural and Food Chemistry, the study was designed to investigate whether vinegar could help prevent ulcerative colitis in mice — which the researchers induced by giving the mice a chemical. Some of the mice were given vinegar for 28 days as part of their drinking water before any other chemicals were given. The researchers found that these mice had higher levels of certain potentially beneficial bacteria in their feces, and lower levels of E. coli, a potentially harmful type of bacteria.
Once the researchers gave the mice a chemical to cause UC, they found that the vinegar-fed mice had significantly lower disease activity and lost less body weight than the other mice. Further analysis showed specific biological mechanisms through which vinegar reduced inflammation in this group of mice. While this study is certainly intriguing, it doesn’t show that taking vinegar has any benefit in humans who already have UC or Crohn’s. But Vaughn notes that the alteration of the mice’s microbiome is important, because “[the microbiome] may play a role in the development of inflammatory bowel disease” in humans.
Should You Take Apple Cider Vinegar if You Have Crohn’s?
There’s certainly no overall recommendation that people with Crohn’s should take apple cider vinegar. In fact, Vaughn says, she rarely gets questions about it from her IBD patients.
Since vinegar is sold as a food in the United States, it’s not something many doctors or even dietitians will mention when discussing drugs and supplements with patients. But that doesn’t mean you can consume it without risk, or that you should start adding it to your diet without first discussing it with a health professional.
The lack of studies on vinegar and IBD means that its safety profile as a food ingredient just isn’t known. “We have evidence-based practice,” says Vaughn. “I don’t want to just say, ‘It’s safe because it’s food, so go use it as much as you’d like,’ if I don’t truly know.”
When it comes to potential effects on your digestive tract, vinegar “could absolutely be an irritant,” contributing to digestive upset and possibly exacerbating Crohn’s symptoms. But this is likely to vary from person to person. And it’s worth remembering, Vaughn says, that “you do have your stomach to help neutralize it a little bit. It’s not like you’re pouring it directly on an area of inflammation.”
Still, it’s best to follow some precautions if you’re interested in taking apple cider vinegar, including:
Discuss it with your doctor first. Apple cider vinegar may interact with certain drugs or supplements. It’s especially important to have this discussion if you take insulin for diabetes or a diuretic drug. If you have chronic kidney disease, your kidneys may have trouble removing the extra acetic acid from your body.
Dilute it. You should never take apple cider vinegar without first diluting it in water since the concentrated acid can damage your tooth enamel and irritate your throat. You may also want to drink plain water immediately after taking it, to rinse it out of your mouth and throat.
Look out for both positive and negative effects. While it’s a good idea to be patient when evaluating the potential benefit from any drug or dietary change, you should also lookout for any worsening of your Crohn’s symptoms if you start taking apple cider vinegar. And if you aren’t seeing any noticeable improvement in your Crohn’s symptoms after a while, you’ll need to reevaluate whether taking apple cider vinegar makes sense for you.
Ultimately, the only way to know if apple cider vinegar will have any beneficial effect is to try it. “I’m not one to totally discredit the health-promoting properties it may have for some people,” says Vaughn. “I just don’t think we know enough.
Get Your Gut Back On Track!
An estimated 110,000 people consume antibiotics daily in Ireland, between December/March. (Source: Health Protection Surveillance Centre).
We asked Nutritional Therapist Rosanna Davison for her Top Tips to get your gut back on track after an illness.
1. Take time out
Don’t push yourself too quickly. Remember your body needs time to rebuild its reserves and regain strength.
Take more rest than usual. If you need to sleep longer, go to bed earlier.
Cut back on non-essential activities; they can wait until you are feeling 100%.
- Embrace fibre-rich foods full of protective nutrients
Fresh vegetables and fruits are rich in dietary fibre, vitamins and antioxidants. Try eating seven to nine portions over the course of each day. Choose different colours so that you nourish your body with a variety of phytonutrients.
Eat a portion of complete protein at each meal, such as poultry, fish, eggs, beans, pulses or tofu.
Consume essential omega-3 fatty acids daily. Avocados, seeds (flax, chia) and oily fish (mackerel, wild and organic salmon), are naturally rich in anti-inflammatory fats.
- Go ‘fermented’
Fermented foods are rich in ‘friendly’ bacteria. Sauerkraut is simple to make at home or buy kefir or kimchi in your local health store.
- Reduce or eliminate sugary foods
Processed foods often contain refined sugars to enhance taste. Excess refined sugar and processed foods may encourage the growth of ‘unfriendly’ bacteria, so aim to buy and eat fresh food.
If you have a sweet tooth, try eating berries (strawberries, blackberries, blueberries, raspberries). They are rich in antioxidants and naturally low in sugar.
If you need a sweetener, try Stevia which is extracted from plant leaves and doesn’t impact blood sugar levels.
Do vegans need to take supplements?
A varied, wholesome vegan diet provides almost all essential nutrients in sufficient quantities. I hear you shouting ‘Noooo! It provides absolutely everything we need!’ and you may be right, but only if you regularly eat certain fortified foods. The sad truth is that modern food production systems and lifestyles make it more difficult for everyone – vegans or not – to get all they need from diet alone. It doesn’t mean a vegan diet is unnatural or unhealthy, in fact the opposite is true. It means that how we grow, produce and consume food has changed and, with an ever-growing population, the demands on the systems that produce our food are so high that certain nutrients become harder to obtain.
I get a lot of questions about supplements and understand why people are confused. Over the years, I’ve worked on many vegan research projects and as science and population studies reveal ever more data, the guidelines and recommendations change and evolve. Hence, what we were told 10 years ago may no longer be up-to-date and that’s why different opinions arise, depending on where and when we got our information. It’s my job to keep up-to-date, so hopefully I can bring some clarity to the supplement discussion!
So what’s needed? The trio of nutrients to keep a close eye on are vitamin B12, vitamin D and iodine. You may not need to supplement with all these, all year long, but it depends on several factors. Read on…
Vitamin B12 naturally comes from bacteria in the soil and both people and animals would traditionally have got it from eating unwashed plants. However, we not only wash vegetables before we eat them (and for good reasons), but food production is now so sanitised that most vegetables are washed in chlorine, or other sterilising solutions, so there’s not a trace of B12 left.
People are not generally aware that most farmed animals are given B12 supplements and this is how the vitamin eventually ends up in their flesh. So, the argument that meat is a natural source of B12 doesn’t really stack up as meat-eaters essentially consume B12 supplements recycled by the animals that were given them!
It is absolutely necessary that we have a reliable source of vitamin B12 for our bodies. We need it to make red blood cells, for a healthy heart and circulation, and it’s essential for the nervous system. It takes years to develop a B12 deficiency, so on one hand, you don’t need to worry about not having taken B12 for a while. On the other hand, you do need to pay attention, as when symptoms develop, it’s usually serious.
To ensure adequate intake, you should have at least 5µg (micrograms) daily from supplements or fortified foods. The B12 used in both foods and supplements is produced commercially by growing bacterial cultures in large vats – and it’s always suitable for vegans.
There are two forms of B12 in supplements – cyanocobalamin (cheap) and methylcobalamin (expensive). Cyanocobalamin is the stable ‘inactive,’ form of B12 and is used in supplements and to fortify foods and drinks. Once ingested, it’s activated by your body so it can be used. Methylcobalamin is the ‘active’ form of vitamin B12 as it does not require any metabolic reactions to be activated. It costs more and is not so stable.
So which one to choose? Unless you’re a heavy smoker, have kidney failure or any other serious condition affecting your metabolism, cyanocobalamin – the cheap form of B12 – is perfectly fine. Intakes up to 2,000µg a day are safe and you can take either a lower dose daily or a higher dose a couple of times a week.
We need vitamin D for healthy bones, teeth and muscles and it also performs other essential functions in our metabolism. It is produced in the skin when exposed to sunlight and this is the main source of vitamin D for most people. However, if you always use sun-block, cover most of your skin or live in a country, like the UK, where we don’t get enough sunlight over the winter, you need a supplement, whether you’re vegan or not.
The UK Government now recommends that we all take a supplement from October to April and, if you protect your skin ferociously over the sunnier spring and summer months, you should take a supplement all year long. Otherwise, just 20 minutes of sunlight on the face and arms is all that is required by the body to manufacture sufficient vitamin D.
Fortified breakfast cereals, bread, plant milks and vegan margarines can be useful sources if exposure to sunlight is not practicable, but may not be enough. When it comes to supplements, there are two types and your body can use both, but it’s advisable to check the source – vitamin D2 is always vegan, but vitamin D3 can be of animal origin. Many vegan foods are fortified with vitamin D2 and labelled so, but if not specified, especially on cereal products, vitamin D tends to be of animal origin. If you choose to supplement your diet, there’s a range of quality and affordable vegan supplements with vitamin D2. There are also those made from algae or mushrooms that contain D3 and these are recommended if you need a higher dose. When deciding on your dosage, 10µg per day is enough and you shouldn’t go above 25µg.
Iodine has been a hot topic lately, especially with plenty of tabloid ‘experts’ warning that vegans are missing out. This mineral is necessary for thyroid function and helps to regulate how energy is produced and used in the body.
The amount of iodine in plants depends upon the iodine content of the soil in/on which they are grown. The closer to the sea, the more iodine and therefore vegans can get enough from plant foods, but there’s no guarantee. Seaweed, which of course grows in seawater, is always a good source and includes nori, laver, dulse and the kelp family (kombu, arame, wakame). But be warned – kelp absorbs far more than other seaweeds and you can get too much iodine from it. So, while seaweed consumption is encouraged, kelp should be used only sparingly.
It’s best to use a kelp supplement so you know exactly how much iodine you’re taking – it’s cheap, reliable and you don’t have to worry about taking too much. The recommended daily intake is 140µg and intakes up to 500µg are considered safe. In many countries, iodised salt is commonly used to ensure iodine intake, but it’s not the norm in the UK.
The dairy industry has been boasting about the iodine content of cow’s milk. What they don’t tell you is that it’s not a natural component of milk, but comes from iodinated cattle feed, supplements, iodophor medication, iodine-containing sterilisers of milking equipment, teat dips and udder washes. Cow’s milk is neither a natural nor the best source of iodine, so we can happily leave all that dairy out of our diet.
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