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 as simply 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,
and tells the body to stop storing fat and start burning fat.
And so given our obesity epidemic, it is 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 is 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 in vinegar turns into in our stomach,
it appears to take a concentration of at least 100 to really get a 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 hit 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 in a Petri 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,
whereas the average American adult is about 28.6.
But anyway, they took about 150 overweight individuals,
and randomly split them up into one of three groups: a high dose vinegar group,
where they drank a beverage containing 2 tablespoons of apple cider vinegar a day;
a low dose group, where they drank a beverage containing only 1 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 or exercise.
In fact, they monitored their diets and gave them all pedometers
so they could make sure that the only significant difference
between the three groups was the amount of vinegar
they were getting every day. This is where they started out.
And within just one month, statistically significant drops in weight
in both vinegar groups compared to placebo,
with higher dose doing better than low dose,
which just got better and better, month after month.
In fact, by month three, the do-nothing placebo group actually gained weight,
as overweight people tend to do,
whereas the vinegar groups 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 2 tablespoons of vinegar
a day group dropped five pounds by the end of the 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, shown here in white, building up around your internal organs
that bulges out the belly. And that's the kind of fat 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 CAT 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 and vinegar in water,
and then went out of their 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 is also bad because it always leaves you wondering
if the funding source somehow manipulated the results.
But the nice thing about companies funding studies about healthy foods,
whether it's some kiwifruit company, or the National Watermelon Promotion
Board — watermelon.org check it out —
is that what's the worst that can happen?
If the findings turned out to be bogus, worse comes to worse,
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 ’99 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 #1 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’re also made from omega-3 rich oils like canola—
in fact even more so than oil and vinegar dressing.
So if it’s 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
or nonfatal heart attack rates for that matter.
Now it could be the eggs or butterfat
counteracting the benefits of the omega 3s,
but maybe the vinegar is actually playing a role. But how?
Well, if you were paying close attention
in the vinegar weight loss video,
the title of that paper was
“Vinegar Intake Enhances Flow-mediated Vasodilatation Via Upregulation
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 of 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 ten 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 mostly 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 of wild blueberries,
you get a nice spike in arterial function
that lasts a couple hours,
Thus the highest 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 balsalmic 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?
We’ve known for nearly 20 years
that a single high fat meal -
Sausage and egg Mcmuffins with deepfried hashbrowns
can cripple our artery function,
cutting the ability of our arteries
to dilate normally in half,
within hours of it 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.
You can see, smell, and taste
the phytonutrients 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.
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. Hmmm.
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,
and had nothing to do with the vinegar.
To figure out this puzzle all we’d have to do is…
test non-alcoholic wine.
And nonalcoholic 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 individuals
sprinkling vinegar on their salads?
What about vinegar for blood sugar control?
If you feed people massive amount of sugar
a half a cup of table sugar,
as their blood sugars 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 it’s probably good for your heart
if you don’t have big blood sugar spikes after meals
and indeed how high your blood sugars 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 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 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? 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 a bagel?
Instead of spreading drugs on it,
spreading on some almond butter may help blunt
the blood sugar spike from refined carbs.
Another option, is to dip your baguette in some balsamic vinegar.
The consumption of vinegar with meals
is evidently used as a home remedy for diabetes
before drugs came along,
but it wasn’t put to the test until 1988.
After all, how much money can you make from vinegar?
According to the vinegar institute,
millions of dollars, but a single diabetes drug,
like Rezulin, 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 schmeared 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 lox,
as fish causes triple the insulin response,
or red wine, which also increases insulin level,
but not as much as fish,
and also shoots up triglycerides,
though dealcoholized red wine,
non-alcoholic wine doesn’t have the same problem.
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 decreasing blood sugars and the insulin spike,
potentially offering the best of all worlds.
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