Vinegar Is Good for You

Vinegar has evidently been used as a weight-loss aid for nearly 200 years. Like hot sauce, it can be a nearly calorie-free way to flavor foods, and all sorts of delicious exotic vinegars—like fig, peach, and pomegranate—are available to choose from. The question, though, is whether there is something special about vinegar that helps with weight loss, which is the topic of my video Does Apple Cider Vinegar Help 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 that 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 activation,” which would be potentially beneficial for long-term weight loss. There’s no need to develop such a compound, though, if you can buy it in any grocery store.

We know vinegar can activate AMPK in human cells, but is the dose one might get when sprinkling it on a salad enough? If you take endothelial cells (the cells lining our blood vessels) 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 determined in a petri dish. What do clinical studies show us?

A double-blind trial was conducted investigating the effects of vinegar intake on the reduction of body fat in overweight men and women. The researchers call them obese, but they were actually slimmer than the average American. In Japan, they call anything over a BMI of 25 obese, whereas the BMI of the average American adult is about 28.6. Nevertheless, they took about 150 overweight individuals and randomly split them into one of three groups: a high-dose vinegar group drinking a beverage containing two tablespoons of apple cider vinegar a day, a low-dose group drinking a beverage containing only one tablespoon of apple cider vinegar a day, and a placebo control group drinking 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.

There were no other changes in their diet or exercise. In fact, the researchers monitored their diets and gave them all pedometers so they could make sure the only significant difference amongst the three groups was the amount of vinegar they were getting every day. Within just one month, there were statistically significant drops in weight in both vinegar groups compared with placebo, with the high-dose group doing better than the low-dose group, and the weight loss just got 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. Was the weight loss actually significant or just statistically significant? Compared with the placebo group, the two-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.

They also got slimmer, losing up to nearly an inch off their waist, suggesting they were losing abdominal fat. The researchers went the extra mile and put it to the test. They put the research subjects through abdominal CT scans to actually measure directly the amount of fat in their bodies before and after. 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. Visceral fat, on the other hand, is the killer. It’s the fat that builds up around your internal organs that bulges out the belly—and the kind of fat the placebo group was putting on when they were gaining weight. Both the low-dose and high-dose vinegar groups, however, were able to remove about a square inch of visceral fat off that CT scan slice.

Like any weight loss strategy, it only works if you do it. A month after they stopped the vinegar, the weight crept right back, but that’s just additional evidence that the vinegar was working. But how was it working?

A group of researchers in the United Kingdom suggested an explanation: Vinegar beverages are gross. They created vinegar beverages that were so unpleasant the study subjects actually felt nauseated after drinking them and ate less of the meal the researchers provided. So, there you go: Maybe vinegar helps with both appetite control and food intake, though these effects are largely due to the fruity vinegar concoctions invoking feelings of nausea. Is that what was going on in the original study? Were the vinegar groups just eating less? No, the vinegar groups were eating about the same compared with 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 we otherwise wouldn’t have these amazing data, but is also bad because it always leaves you wondering whether the funding source somehow manipulated the results. The nice thing about companies funding studies about healthy foods, though, whether it’s some kiwifruit company or the National Watermelon Promotion Board (check out watermelon.org), is, really, what’s the worst that can happen? Here, for example, even if the findings turned out to be bogus and worst comes to worst, your salad would just be tastier.


I’m so excited to finally be getting to this topic. Type “vinegar” into PubMed, the search engine biomedical literature, and 40,000 studies pop up. It took me a while to take it all in, but I’m so glad I did, as it’s something that has caused a shift in my own diet. I now try to add various vinegars every day.

This is the first of a five-part video series. See the other installments:

For more holistic approaches to weight loss, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Hope for Alzheimer’s Patients

In 1901, Auguste was taken to an insane asylum in Frankfurt, Germany, by her husband. She was described as a delusional, forgetful, disoriented woman who “could not carry out her homemaking duties.” She was seen by a Dr. Alzheimer and was to become the case that made his a household name.

On autopsy, he described the plaques and tangles in her brain that would go on to characterize the disease, but in the excitement of discovering a new entity, a clue may have been overlooked. He described arteriosclerotic changes—hardening of the arteries—within her brain.

We typically think of atherosclerosis in the heart, but atherosclerosis involves virtually the entire human organism—our entire vascular tree. One of the most poignant examples of this systemic nature is the link between coronary artery disease, degenerative brain disease, and dementia.

Back in the 1970s, the concept of “cardiogenic dementia” was proposed—dementia generated from the cardiovascular system. Since the aging brain is highly sensitive to lack of oxygen and since heart problems are so common, it was easy to imagine that’s how dementia could result. Now we have a substantial body of evidence that strongly associates atherosclerotic vascular disease with the number one cause of dementia, Alzheimer’s disease. Autopsy studies, for example, have shown that individuals with Alzheimer’s have significantly more atherosclerotic narrowing of the arteries within their brain.

In my Alzheimer’s and Atherosclerosis of the Brain video, you can see what cerebral arteries should look like—open and clean, allowing blood to flow—versus what atherosclerosis in our brain arteries looks like—clogged with fat and cholesterol, closing off the arteries, and restricting blood flow to our brain. It’s really a remarkable compelling comparison—I encourage you to check it out.

What kind of brain arteries do you want in your head?

The normal amount of blood circulating within our brains is about a quart a minute, but we lose about a half-percent a year; by age 65 we may be down 15-20%. This doesn’t necessarily affect brain function since we have a built-in buffer. However, this age-related decline in cerebral blood flow can become critical to brain cell survival if an additional burden further lowers flow. This reduction of blood flow can starve the brain of oxygen, cause silent little mini-strokes and brain atrophy, the cumulative effects of which appear to play a pivotal role in accelerating and augmenting the development and evolution of Alzheimer’s disease.

As shown in Alzheimer’s and Atherosclerosis of the Brain, you can see the vast difference in the amount of atherosclerosis in the arteries that specifically supply blood to critical memory and learning centers of the brain of healthy, non-demented controls compared to those with Alzheimer’s disease. In light of such findings, some have even suggested the disease be reclassified as vascular disorder.

This is good news, though, because atherosclerosis is potentially reversible. These findings were confirmed in two larger studies of more than 1,000 autopsies each, which found the same thing. Atherosclerosis in the brain is significantly more frequent and severe in those with Alzheimer’s disease.

This suggests that strategies proven to delay the progression of artery disease like plant-based diets may be useful for preventing or treating Alzheimer’s disease. Of course, autopsy studies are a little late for that, so to assess the impact of intracranial arterial narrowing on the progression from mild cognitive impairment to Alzheimer’s disease, researchers followed 400 people with cognitive impairment for four years using CT angiography—special CAT scans that evaluate the amount of brain artery blockage. The cognition of those with the least atherosclerosis in their heads remained pretty stable over the years, but those with more cholesterol buildup got worse and those with the most blockage rapidly declined. The ability to carry on the activities of daily living was also affected, and the progression to Alzheimer’s disease was doubled. An inefficient blood supply to the brain has very grave consequences on brain function.

But does treatment of vascular risk factors like high blood pressure and high cholesterol actually make a difference? We didn’t know, until a recent study of 300 patients with Alzheimer’s. Those with all their vascular risk factors treated showed significantly less decline and slowed progression of their disease, compared with those who went untreated.

It’s been said that the “goal of medicine is to provide patients with hope and when there is no hope, to offer understanding.” Well, for the first time in the history of this disorder, we have the chance to provide Alzheimer’s patients with hope.


If this information sounds familiar, it’s because I featured it in my 2014 year-in-review presentation From Table to Able: Combating Disabling Diseases with Food.

For more on this disease, check out Alzheimer’s May Start Decades Before Diagnosis, Cholesterol & Alzheimer’s Disease, and The Alzheimer’s Gene: Controlling ApoE.

Lifestyle medicine is critical for our body and mind. See:

In fact, NutritionFacts.org started because I saw how lifestyle medicine extended my grandmother’s life far beyond what her doctors expected. See the story in my Introductory Videos.

Blood flow is also important for other critical organs, as I discuss in my videos Cholesterol and Female Sexual Dysfunction and Survival of the Firmest: Erectile Dysfunction and Death.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Brown Fat: Losing Weight Through Thermogenesis

During World War I, it was discovered that many of the chemicals for new explosives had toxic or even lethal effects on the workers in the munitions factories. Chemicals such as di-nitro-phenol (DNP) can boost metabolism so much that workers were too often found wandering along the road after work, covered in sweat with temperatures of 106 to 109 degrees Fahrenheit before they died. Even after death, their temperatures kept going up, as if they were having a total body meltdown. At subacute doses, however, workers claimed to have grown thin to a notable extent after several months working with the chemical.

That got some Stanford pharmacologists excited about the “promising metabolic applications” of DNP. Our resting metabolic rate jumps up 30% after one dose of DNP, and therefore, it becomes an actual fat-burning drug. People started losing weight, as you can see in my video Brown Fat: Losing Weight Through Thermogenesis, with no apparent side effects. They felt great… and then thousands of people started going blind and users started dropping dead from hyperpyrexia, fatal fever due to the heat created by the burning fat. Of course, it continued to be sold. Ad copy read:

“Here, at last, is a [weight] reducing remedy that will bring you a figure men admire and women envy, without danger to your health or change in your regular mode of living….No diet, no exercise!”

It did work, but the therapeutic index—the difference between the effective dose and the deadly dose—was razor thin. It was not until thousands suffered irreversible harm that it got pulled from the market and remained unavailable. Unavailable, that is, until it was brought back by the internet for those dying to be thin.

There is, however, a way our body naturally burns fat to create heat. When we’re born, we go from a nice tropical 98.6 in our mother’s womb straight to room temperature, just when we’re still all wet and slimy. As an adaptive mechanism to maintain warmth, the appearance of a unique organ around 150 million years ago allowed mammals to maintain our high body temperatures.

That unique organ is called brown adipose tissue, or BAT, and its role is to consume fat calories by generating heat in response to cold exposure. The white fat in our bellies stores fat, but the brown fat, located up between our shoulder blades, burns fat. BAT is essential for thermogenesis, the creation of heat in newborns, but has been considered unnecessary in adults who have higher metabolic rates and increased muscle mass for shivering to warm us up when we get chilled. We used to think brown tissue just shrank away when we grew up, but, if it was there, then it could potentially make a big difference for how many calories we burn every day.

When PET scans were invented to detect metabolically active tissues like cancer, oncologists kept finding hot spots in the neck and shoulder regions that on CT scans turned out not to be cancer, just fat. Then, some observant radiologists noticed they appeared in patients mostly during the cold winter months. When they looked closer at tissue samples taken from people who had undergone neck surgery, they found it: brown fat in adults.

The common message from a number of studies is that BAT is present and active in adults, and the more we have and the more active it is, the thinner we are. And we can rapidly activate our fat-burning brown fat by exposure to cold temperatures. For example, if you hang out in a cold room for two hours in your undies and put your legs on a block of ice for four minutes every five minutes, you can elicit a marked increase in energy expenditure, thanks to brown fat activation. So, the studies point to a potential “natural” intervention to stimulate energy expenditure: Turn down the heat to burn calories (and reduce the carbon footprint in the process).

Thankfully, for those of us who would rather not lay our bare legs on blocks of ice, our brown fat can also be activated by some food ingredients such as those that are covered in my Boosting Brown Fat Through Diet video.


I briefly touch on the role cold temperatures can play in weight loss in The Ice Diet and talk more about calories in (Nutrient-Dense Approach to Weight Management) and calories out (How Much Exercise to Sustain Weight Loss).

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: