The sour truth about apple cider vinegar - evaluation of therapeutic use

Apple cider vinegar is an old folk remedy claimed to be beneficial in treating a long list of ailments. Proponents say that it can cure arthritis, guard against osteoporosis, lower blood pressure and cholesterol, prevent cancer, destroy infection, assist in digestion and weight control, maintain memory, and protect the mind from aging.

Vinegar is said to have been used for medical ailments for at least 10,000 years. The Babylonians first converted wine into vinegar in 5000 BCE using date palms, grapes, and figs, and believed vinegar had exceptional healing properties. Hippocrates is said to have used vinegar as an antibiotic. Samurai warriors supposedly used a vinegar tonic for strength and power. During the U.S. Civil War, soldiers used vinegar to prevent gastric upset and as a treatment for various ailments including pneumonia and scurvy. It was used to treat wounds during World War I.

The name vinegar comes from a French word meaning "sour wine." It is produced by the action of yeast and bacteria on grains or fruit juices. Vinegars take their name from the material used to make the vinegar, i.e., apple cider vinegar comes from apples, wine vinegar comes from grapes.

Apple cider vinegar is made by crushing apples and squeezing out the liquid. Sugar and yeast are added to the liquid to start the fermentation process, which turns the sugars into alcohol. In a second fermentation process, the alcohol is converted by acetic acid-forming bacteria into vinegar. Acetic acid gives vinegar its sour taste.

"Mother of vinegar" is a term used to refer to the mass of scum that forms on top of cider when alcohol turns into vinegar, or to the cloudy substance that sometimes develops in stored vinegar. It is actually bacteria and yeast cells that have died.

Folk Claims

In 1958 Dr. D. C. Jarvis, a "noted Vermont country doctor," wrote a book entitled Folk Medicine in which he extolled the virtues of vinegar. He claimed that Vermonters knew how to cure migraine headaches, diabetes, chronic fatigue, arthritis, and a variety of other ailments. They used apple cider vinegar.

Among Dr. Jarvis's many tenets about apple cider vinegar was his advice to pregnant women to drink an apple cider vinegar tonic daily to assure that the infant is born with "an excellent chemical pattern with which to meet its new environment." He recommended the same tonic for those suffering from arthritis. Believing that apple cider vinegar would destroy bacteria in the digestive tract, he advised those with GI problems to consume a tonic with each meal. He also declared that the regular consumption of an apple cider vinegar tonic would make body fat disappear because the vinegar would cause the fat to be burned instead of stored.

His book quickly sold 500,000 copies and is still in print. Apple cider vinegar is still promoted as one of the chief "natural" remedies for arthritis.

Those who believe that apple cider vinegar has miraculous properties attribute its powers to an abundance of nutrients in the liquid. One company's sales pitch states, "Each golden drop is a natural storehouse of vitamins and minerals." Marketers point to the trace minerals, bacteria,. and enzymes present in their product as the ingredients that give apple cider vinegar its curative characteristics. Another company suggests that their apple cider vinegar is superior because it contains pectin, beta-carotene, and potassium in addition to enzymes and amino acids. Apple cider vinegar is also said to contain an abundance of complex carbohydrates and dietary fiber. Dr. Jarvis believed that the healing properties of apple cider vinegar were due in large part to its rich potassium content.

Some New Twists

Apple cider vinegar is sold today by "health food" companies and others who claim it has remedial properties. The claims are similar to those in the past, but some have taken on a modem twist based on more recent medical research.

Marketers contend that the beta-carotene in apple cider vinegar destroys free radicals in the body which are involved in the aging and mutation of tissues and in destroying the immune system. Apple cider vinegar's beta-carotene is said to be in a "natural, easy to digest form."

Its use as a remedy for arthritis is based on the notion that acid crystals harden in the joints and tissues which cause the joints to become stiff and the tissues to harden. These acid crystals also cause the body to age prematurely, so the ads state. Apple cider vinegar is supposed is put these acid crystals in solution so they can be flushed from the body.

Producers also claim that apple cider vinegar can lower cholesterol and blood pressure. These assertions are based on the assumption that people naturally crave acids when eating animal proteins in order to lessen the thickening influence of "heavy proteins and fat." Apple cider vinegar supposedly thins the blood so it can circulate. more freely. Thick blood, they say, puts a strain on the heart and up goes the blood pressure. Another source states that the pectin present in apple cider vinegar works its way through the digestive system, binding to cholesterol and removing it from the body.

Apple cider vinegar is also available in tablet form. One brand is merchandised as a "digestive aid for vegetarians." The manufacturer of this product alleges that the tablets help acidify the stomach and help digest protein. Another tablet, which contains apple cider vinegar as one of its components, is sold as a fiber supplement and supposedly assists in weight loss. Still other companies add herbs to their apple cider vinegar "so people see relief from even more ailments."

The rubbery mass of goo called the mother of vinegar" is reputed to have magical healing properties as well. Nibbling on a bit of this moldy slime every day is purported to prevent most infectious diseases and keep germs and parasites from invading the body.

One company's advertisement for organic, raw, unfiltered, unheated, unpasteurized apple cider vinegar is particularly alarming. This company's ad maintains that "there is nothing in this wonderful natural apple cider vinegar that can in any way harm your body!" Apparently, they have never heard of the danger of E. coli 0157:H7 in unpasteurized fruit juices. Normally vinegar is too acidic to support bacteria. However, should the acidity weaken (pH reaching 4.6 or higher), then pathogens will survive and grow.

Jogging in a Jug

In 1985, Jack McWilliams, an Alabama farmer, concocted a potion he called "Jogging in a Jug." It consisted of apple cider vinegar combined with a variety of fruit juices to give it a more appealing taste.

Acetic acid, claimed McWilliams, was lacking in the modem diet, and this deficiency was the root cause of many health problems. He claimed that the potion had cured his arthritis and heart disease, and it could reduce the risk of cancer in the internal organs. McWilliams marketed his product through the media, receiving extensive coverage in small community newspapers and broadcast outlets. He reportedly sold $9 million worth of his potion in one year.

The FDA, however, did not look kindly on Mr. McWilliams's vinegar product and its advertised claims. The federal government seized the product in 1994 due to the unproven health claims.

In 1995, thousands of bottles of the potion were ordered destroyed because the product was considered an unapproved new drug due to the claims made by the producer. Subsequently, Mr. McWilliams's company, Third Option Laboratories, Inc., paid the Federal Trade Commission a $480,000 fine to settle charges of false advertising. "Jogging in a Jug" is still on the market today with a new label that meets FDA guidelines.

The Real Story

There is no scientific evidence that apple cider vinegar has any medicinal properties. While the folksy anecdotes from those who claim to have benefited from apple cider vinegar tonics may be amusing to read, they are simply that -- anecdotes.

Apple cider vinegar is anything but a storehouse of nutrients. A nutritional analysis of one tablespoon (more than the one or two teaspoons suggested to make a tonic) reveals that the golden liquid contains less than a ram of carbohydrate: minuscule amounts of calcium, iron, magnesium, sodium. copper, manganese, and phosphorus; and a mere 15 mg of potassium. The fiber, vitamin, and amino acid content is zero.

10 questions your gynecologist wants you to ask: don't be shy; speaking up could save your life

The less time your annual gynecology checkup takes, the better - breast exam, pelvic, Pap smear and you're gone.

Wait - not so fast! Maybe you should take a few minutes longer with the gynecologist. You may think all doctors are in a rush to get to the next patient, but most want to give their patients the best care.

However, doctors can't address what you don't tell them. "The 20s and 30s are basically a healthy time of life, and young women tend to come in to the gynecologist's either to get a form filled out or to get a new prescription for contraception and then leave," says Ann Davis, M.D., assistant professor of obstetrics and gynecology at Harvard University and Beth Israel Deaconess Medical Center in Boston. What gets lost in the quick shuffle are potentially crucial health (and happiness) issues, from HIV testing to sexual satisfaction.

Here are 10 top questions that your gynecologist would love to discuss with you - if only you'd ask.

1. Should I be tested for sexually transmitted diseases?

"I wish patients would ask and be completely frank about risk-taking sexual activity, which really begins with anything other than abstinence or a long-term, monogamous relationship," says Jill Maura Rabin, M.D., chief of ambulatory care and head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y. "We want to be able to educate them about how to keep themselves alive and safe."

Besides being on the lookout for symptoms of chlamydia, gonorrhea, syphilis, pelvic infection and more, that might also mean: increasing the frequency of Pap smears if so-called high-risk human, papillomavirus (HPV, the virus that causes genital warts) is detected, since it predisposes you to cervical cancer; annual HIV tests (condoms are not fail-proof AIDS prevention, Rabin points out, because 13 percent of them will break or leak); and hepatitis C tests in case you've been exposed through your own or a partner's drug use, or had a blood transfusion or C-section prior to 1992, when donated blood was not routinely screened for the disease.

2. What about a different contraceptive?

Just because a contraceptive's worked for you in the past doesn't mean it's still the best choice, Rabin notes. If you've used condoms only, for instance, you can ask about going on the pill or another hormonal method for contraceptive backup. Or, if the pill causes symptoms you're unhappy with, look into a different formulation and balance of hormones. If you're terrible about remembering to take the pill on schedule, ask about the new, virtually goof-proof contraceptive patch.

3. Should I have a prescription for the "morning-after pill"?

"Having either an undated prescription or the actual medication on hand for emergency contraception is an excellent idea," Davis suggests. Note, however, that this is a lousy choice as a regular contraceptive method, cautions Gerald F. Joseph Jr., M.D., medical director for women's services at St. John's Regional Health Center in Springfield, Mo. But for unanticipated encounters it can be one huge headache-saver. And in cases of rape (date, spousal or other), while the ideal is for a woman to go to an emergency room for help and to call the police, not every woman in fact does, and either way, knowing you have the means to prevent a resultant pregnancy can eliminate at least one worry, Joseph notes.

4. What can I do about incontinence?

"One thing we know young women are not bringing up is incontinence," Davis reports. Up to 20 percent of women experience urinary incontinence at some point in their teens, 20s and 30s, according to Rabin. But only about half of women of any age with the problem raise the issue with their doctors.

Childbirth, and the weakening of the urethra's sphincter muscles that can result, accounts for some stress incontinence, where external pressure on the bladder (such as with a sneeze or cough) causes a little leakage. But more common among young women is urge incontinence, where one feels the need to urinate even though the bladder isn't full. The problem can stem from a complex process in which artificial sweeteners, stress, caffeine, iced drinks, hot peppers or other triggers cause nerves governing the bladder to set off a spasm, making it contract. Treatment -- avoiding triggers, "retraining" your bladder, Kegel exercises, medication and other approaches -- works 80 percent of the time, so it's definitely worth putting shyness aside to ask.

5. Why are my periods irregular?

It's perfectly normal for a woman's cycle to fluctuate occasionally: Stress -- even small changes in routine, diet and exercise -- can throw a minor monkey wrench into the works. "Menstrual irregularity is something young women tend not to pay much attention to beyond making sure they're not pregnant," Joseph says. "But even with a negative pregnancy test, a missed period or spotting could indicate a dangerous ectopic pregnancy."

Irregular bleeding -- what you might mistake for an out-of-sync or especially light period -- also can signal infections or cancer of the cervix or uterus, or a panoply of other problems including thyroid disease, endometriosis, fibroids and hormonal disorders. "Furthermore," Joseph notes, "if you're going along hardly ever ovulating or having periods, we're concerned not only because this could be a symptom of anorexia or polycystic ovary syndrome, but also because the lack of estrogen could be impairing your ability to store up the bone mass that will be crucial later in life, or you could even be losing bone already." Don't panic -- most of these symptoms usually mean nothing -- but do ask.

6. What can I do about sexual problems?

Hard to imagine a bigger squirm factor, for patients and some physicians, than with this question. But it's precisely because your gynecologist is a good bet to have some answers that it's worth asking. "A lot of women are reticent to bring up sexual difficulties, which I certainly can understand, but most problems can be answered or at least addressed by an OB/GYN," Joseph says.

The culprits easiest to identify for low libido among young women are medications -- for instance, many of the most widely used anti-depression and anti-anxiety drugs can chill sexual response, and some women report decreased libido from oral contraceptives. Discomfort or pain during intercourse can lead to sexual problems, and the underlying cause can range from serious medical issues such as endometriosis or pelvic inflammatory disease to something as simple as a yeast infection, sensitivity to spermicide or cyclic fluctuations in vaginal lubrication. And if he or she can't find a physical cause, your gynecologist is a smart choice to initiate a referral to a sex therapist.

7. Can I talk to the nurse?

Your gynecologist is not the only one in the office of whom it's worth asking questions. "One of the best resources, and one that patients don't utilize well, is the office nurse," Davis observes. "Office nurses are usually very experienced, and a lot can be handled directly through them."

The best case is when your doctor has his or her own nurse or two, with whom you develop a good relationship and who knows that if you say it's a urinary-tract infection that cannot wait, it's a urinary-tract infection that cannot wait. With a less simpatico nurse, or a more anonymous one from a larger practice, you can still get valuable advice about how concerned to be about a certain symptom, how to treat run-of-the-mill ills (menstrual cramps, morning sickness), what the standard instructions are for medications and to which specialists your doctor usually refers patients. Nurses often can take care of pregnancy tests or UTI screens without your spending the time or money for a doctor's visit. And if you have a long laundry list of concerns, the preliminary chat with the nurse is an ideal time to go over them and winnow them down to the most important to bring into the examining room.

8. I was abused or assaulted (sexually or otherwise) in the past -- what effect does that have on my health?

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health conditions that cause weight gain

If the needle on your bathroom scale starts creeping upward, or refuses to head downward, you'll probably suspect the cause is too many doughnuts, not diseases or drugs. But while the usual culprits -- too much food, too little exercise -- do account for most excess poundage, there are some surprisingly common medical conditions and widely used prescriptions that can add anywhere from a little to a lot -- a whole lot -- of excess weight. Here is a checklist of what to watch for if you inexplicably find fat either packing on or unwilling to pack up and go.

1. Hormonal havoc

You'd think 40 or more extra pounds would be a clue that something's amiss. Yet many of the 7-10 percent of pre-menopausal women with polycystic ovary syndrome (PCOS) often go for years unaware that their weight gain is in part due to this underdiagnosed condition, in which the ovaries and sometimes the adrenal glands, for unknown reasons, pump out too much male hormone, according to Andrea Dunaif, M.D., chief of endocrinology at Northwestern Memorial Hospital and professor of metabolism and molecular medicine at Northwestern university Medical School. Because the pounds typically pile on gradually beginning around puberty, or sometimes don't surface until post-pregnancy weight refuses to budge, it's frequently not obvious to PCOS sufferers, or their doctors, that there's a medical trigger. Possible tip-offs: thinning hair, excess facial hair, severe acne, irregular periods, impaired fertility -- all hallmarks of excess male hormone.

It's not the extra male hormone that triggers the weight gain, though. So what does? Short answer: Nobody knows, Dunaif says. While there seems to be a genetic component to PCOS -- it runs in families -- and a genetic component to the associated weight gain, there's little to explain why some of those diagnosed develop weight problems while others do not. It is clear that cultural and environmental factors play a part because Europeans, and Americans on the coasts, who may feel more social pressure to be skinny, gain much less weight on average than do their (sometimes literal) sisters in middle America. The encouraging side of this is that while many women with PCOS feel like their weight is an immovable number (and treatment for PCOS does not help with weight loss), studies show that almost any woman with PCOS, treated or not, can, if put on a supervised diet and exercise program, lose 10 percent or more of body weight, Dunaif notes. Dropping such a moderate amount of weight often will, in turn, push male hormone levels down, leading to a resumption of regular periods and improved chances of conception.

2. Thicker from thyroid?

For the most part, blaming a sluggish thyroid for excess weight falls in the "you wish" category. "A lot of overweight people sort of hope they have hypothyroidism because it's treatable," comments Howard Eisensen, M.D., director of Duke University's Diet and Fitness Center. "But it's rare to find someone who's significantly overweight because of an underactive thyroid. Even if there is decreased thyroid function, correcting it doesn't do much to correct overweight because it doesn't cause much gain to begin with." If weight creep is on a small scale -- in the 5- to 10-pound ballpark -- it's possible that hypothyroidism is behind it, though. If you have other telltale symptoms, such as brittle hair and nails, dry skin and a tendency to feel cold, definitely get checked out. If your thyroid is to blame, treatment should shrink you a bit, but not because of much fat loss.

Another name for hypothyroidism is "myxedema," which describes a kind of swelling from thick fluidlike tissue that is a hallmark of chronic low thyroid, explains George Bray, M.D., Boyd Professor at Louisiana State University. Most of thyroid-prompted weight gain, therefore, is actually due to excess fluid, not fat; correcting the thyroid problem banishes soggy tissue, along with its poundage, pretty effectively.

3. The weight of water

As Bray points out, extra pounds don't always equal fat, but are sometimes due to fluid retention -- familiar to most women from premenstrual symptoms. If puffiness isn't related to the menstrual cycle, though, it shouldn't be ignored. "If someone's retaining a lot of water -- enough to add more than a couple of pounds -- they'd better get to their physician very quickly to make sure they don't have heart or kidney failure, both of which can cause edema, or swelling," cautions Robert Berkowitz, M.D., medical director of the university of Pennsylvania Weight and Eating Disorders Program, though he adds that such problems are much more likely to afflict older women. "If you push a fingertip into your skin and it leaves a real indentation rather than springing back, that's a tip-off that it's fluid, not fat." Other symptoms include shortness of breath (congestive heart disease), decreased urine output and loss of appetite (kidney failure), and fatigue and increased abdominal girth even without weight gain, for b oth. Liver disease and certain cancers can cause abnormal fluid accumulation in the abdomen as well, so any big boost in your waist size, with or without weight gain, warrants a look by your doctor, Eisensen advises.

4. A knot in your stomach

Unlikely, but worth mentioning: "If women have rapid, unexplained weight gain, it's possible, though rare, that they have a tumor," Eisensen reports. One example: ovarian tumors, some of which are benign, such as a dermoid tumor, a weird conglomeration of various body tissues (sometimes including teeth) that grow in the abdomen. "We've had patients gain over 100 pounds because of a huge ovarian tumor in their belly," he adds. Again, don't ignore any disproportionate expansion of your middle -- check it with a physician.

5. Rx that rounds you up

Do you take any medicines on a regular basis? Then there's a chance that one of them may be nudging your figure toward the fuller side. "It may be medications, more than diseases, that tend to contribute to weight problems," Eisensen says, "and it's helpful for people to know that there may be alternatives." Some medicines that commonly cause weight gain:

* Anti-depressants are probably the most common weight-gain agents. Of the widely prescribed SSRls (selective serotonin reuptake inhibitors) and SNRIs (selective serotonin and norepinephrine reuptake inhibitors), many researchers and clinicians believe that paroxetine tends to produce the most weight gain, though typically not more than several pounds. Other antidepressants, like fluoxetine, sertraline and venlafaxine also may lead to weight gain, especially if used long term. "Short-term use of most SSRls and SNRls is not associated with weight gain," Eisensen says, "but if people are on them a year or longer, they can gain a few pounds or more."

One of the most popular mood stabilizers is bupropion, which if anything, often helps patients drop a few pounds (but side effects may not make it a good choice for all overweight people with depression, Eisensen says). The point is that within each class of anti-depressants are some that tend to produce more weight gain, and some that tend to produce less, Bray explains.

* Anti-diabetes drugs Ironically, medications for Type II diabetes -- the kind caused primarily by obesity -- are often responsible for further weight gain, creating a vicious cycle. Although it's not suitable for everyone, one effective anti-diabetes drug called Glucophage does not increase weight, says Berkowitz. And, he says, even some patients on other anti-diabetes drugs may be able to lose weight, under their doctor's supervision, by scaling back on their dosage or adding a weight-loss drug such as orlistat, which partially blocks fat absorption.

* Oral contraceptives may plump you up a bit, Dunaif says. But the low-dose pills commonly prescribed now won't add more than a few extra pounds, according to Berkowitz.

* Steroids are among the literal heaviest hitters. The most commonly prescribed are adrenocorticoids, used to control severe autoimmune problems, including asthma, arthritis, lupus and inflammatory bowel disease. Long-term use can increase appetite and hike weight by 20 pounds or more, Berkowitz says, but because the symptoms these steroids alleviate are potentially life-threatening, you don't have much choice but to be on them when you need to be. However, doctors should be vigilant about cycling patients off medication when they don't need it, which can help them lose some of the weight they have accumulated, he says.