Can Apple Cider Vinegar Damage the Stomach or Esophagus?

Apple cider vinegar benefits your waistline as well as your blood sugar levels — or at least that's what its proponents say. These claims are not entirely unfounded. The downside is that apple cider vinegar may damage your teeth, stomach and esophagus, in the long run.

Most people are familiar with the potential health benefits of apple cider vinegar (ACV). This beverage has emerged as a natural remedy for acid reflux, kidney stones, diabetes, dandruff, obesity and even cancer.

According to the University of Chicago Medicine, ACV can indeed improve glycemic control and contribute to weight loss, even though its effects on body weight are negligible. However, it's unlikely to cure diabetes, reduce blood pressure or kill cancer cells.

​Read more: ​The Powers of Apple Cider Vinegar Have Been Vastly Overestimated

What you may not know is that apple cider vinegar can affect digestive health and erode your teeth. This fermented drink contains acetic acid, reports Harvard Health Publishing. In some studies, acetic acid has been shown to reduce blood sugar levels and reduce starch absorption in the body. Unfortunately, it may also damage the tooth enamel and hurt your stomach.

The December 2012 issue of the journal ​Nederlands Tijdschrift Voor Tandheelkunde​, for example, describes the case of a 15-year-old girl who experienced tooth erosion caused by daily consumption of one glass of ACV.

Both Harvard Health Publishing and the University of Chicago Medicine warn about this side effect and recommend drinking plenty of water after ingesting ACV to dilute the acid. Furthermore, anecdotal evidence suggests that acidic foods and beverages, such as apple cider vinegar, may worsen acid reflux.

According to the Canadian Digestive Health Foundation, some people may experience relief from bloating and acid reflux thanks to this beverage. Clinical research doesn't support these claims, though. Drinking too much apple cider vinegar may actually upset your stomach and irritate your throat. It's even riskier for those with gastric ulcers, as it may worsen their symptoms.

All types of vinegar, including ACV, are high in acetic acid. This natural compound occurs during fermentation by lactic acid bacteria, such as Lactobacillus and Oenococcus species, reports a July 2017 review featured in the journal ​Microorganisms​. Although it may have some health benefits, its side effects shouldn't be ignored.

In August 2019, ​Clinical Endoscopy​ published a case report that highlights the erosive action of vinegar on the esophagus. A 15-year-old boy ended up at the ER after vomiting blood. He also experienced severe pain in the upper abdomen. Clinical tests revealed esophageal injuries. Medical professionals attributed these symptoms to the daily ingestion of undiluted vinegar.

​Read more:​ What Are the Dangers of Drinking Vinegar?

As the researchers point out, vinegar is a corrosive agent and may cause acidic burns. Over time, it may damage the lining of the upper digestive tract. Apple cider vinegar is more acidic than commercial vinegar beverages and hence poses greater risks, according to the above review. In fact, there have been several cases of esophageal injury following ACV ingestion.

Apple cider vinegar isn't a medication or dietary supplement, but a food ingredient. Additionally, its potential benefits are questionable. Therefore, there are no set guidelines regarding the optimum dosage.

As Harvard Health Publishing notes, a common dose is 1 to 2 teaspoons of ACV before or during meals. Dilute it with water or use it as an ingredient in dips and dressings to reduce its acidity.

Beware that ACV may cause or worsen hypokalemia, a condition characterized by low potassium levels. In severe cases, hypokalemia may lead to kidney problems, paralysis, muscle cramps and irregular heartbeat.

Apple cider vinegar dosage recommendations may also vary based on your tolerance. If you've never used ACV for weight loss, glycemic control or other therapeutic purposes, start with a small dose.

Mix it with water and drink it with your meals, advises the Canadian Digestive Health Foundation. Do not exceed 2 teaspoons per day. Make your own apple cider vinegar weight loss drink rather than buying one from shady sellers, as they may add potentially harmful ingredients. Consult your doctor beforehand if you have low blood sugar, hypokalemia, kidney disease or digestive disorders, such as heartburn or peptic ulcers.