The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials

Synergistic Amelioration of Letrozole-induced Polycystic Ovary Syndrome in Rats: A Therapeutic Approach with Apple Cider Vinegar and Metformin Combination

The present study was conducted to evaluate the combination effect of apple cider vinegar (ACV) and metformin against letrozole-induced polycystic ovary syndrome (PCOS). Female Wistar rats were administered letrozole (1 mg/kg/day, p.o) for 21 days, except for the control group of animals. On the 22nd day, PCOS-induced animals were segregated into 4 groups and administered with CMC, ACV, metformin, and a combination of ACV and metformin, respectively. The treatments were continued for 15 days, and on the 36th day, all the animals were sacrificed for biochemical (blood glucose, lipid profile), hormonal (sex hormones and adiponectin), and pro-inflammatory mediator estimations in blood samples. The ovarian tissue samples were used for oxidative stress parameters and histological alterations. The PCOS control animals showed a significant alteration in the estrous cycle. The administration of letrozole resulted in the alteration of hormonal balance and elevation of body weights, glycemic state, lipid profile, pro-inflammatory mediators in serum, and oxidative stress in ovarian samples. Individual treatment groups and combination treatment groups reversed the letrozole-induced alterations in PCOS animals, and more promising results were observed with combination therapy than with individual treatment groups. Further, the therapeutic potential of the combination treatment group was also confirmed by the histological observations in the ovarian samples. The study showed that the combination of ACV and metformin significantly alleviated letrozole-induced PCOS complications in rats. This might have been achieved by mitigating the hormonal imbalance, pro-inflammatory, hyperglycemic, and hyperlipidemic states in serum, and oxidative stress in the ovary samples.

The Chemical Profiles and Antioxidant Properties of Live Fruit or Vegetable Vinegars Available on the Polish Food Market

Live vinegar is a product formed through a two-step fermentation process of a sugar substrate that has not been subjected to filtration or pasteurization. This is considered to preserve all nutrients and biologically active microorganisms, making it a product with a valuable composition and beneficial properties. Therefore, the purpose of this study was to analyze the chemical composition and antioxidant properties of the selected vinegars available on the Polish food market. The material in the study consisted of four live (naturally turbid, unfiltered, unpasteurized) fruit or vegetable vinegars: apple, pear, rhubarb, and lemon. Spectrophotometric, HPLC, and GC methods were used. Among the vinegars tested, lemon vinegar had the highest vitamin C content-15.95 mg/100 mL. Apple vinegar proved to be the best source of polyphenols and flavonoids (TPC-191.97 mg GAE/L, TFC-70.22 mg RE/L). All of the vinegars contained dihydroxybenzoic acid, 4-hydroxybenzoic acid, caffeic acid, 2-hydroxycinnamic acid, and myricetin. The acetic acid content of the tested vinegars ranged from 29.180 to 38.125 mM/L. The pH values ranged from 3.14 to 3.41. In conclusion, the most promising nutraceutical with potentially beneficial health-promoting properties seems to be apple vinegar.

Butyrate and Propionate are Negatively Correlated with Obesity and Glucose Levels in Patients with Type 2 Diabetes and Obesity

Background

Growing evidence has demonstrated the important roles of gut microbiota and short chain fatty acids, especially acetate, propionate and butyrate, in the development of obesity and metabolic diseases. To date, the effects of acetate, propionate and butyrate on human adiposity and glucose metabolism remain controversial. This study aimed to explore the associations of systemically acetate, propionate and butyrate with obesity and glucose homeostasis in patients with type 2 diabetes (T2D) and obesity.

Methods

A total of 12 patients with T2D and obesity and 8 age- and sex-matched healthy individuals with BMI <24 kg/m2 were enrolled in this study. Height, weight, body composition, blood pressure, biochemical indices, a 75-g oral glucose tolerance test, and plasma acetate, propionate and butyrate were measured at baseline. Then, participants in T2D group were given a weight control therapy, in addition to conventional medication, and all the measurements were repeated 12 months from baseline. The direct segmental multi-frequency bioelectrical impedance analysis was used to assess body composition. Acetate, propionate and butyrate levels were determined by liquid chromatography coupled to tandem mass spectrometry.

Results

Butyrate concentration significantly increased from baseline after obvious weight loss (P<0.05). Correlation analysis showed that propionate was negatively correlated with percent of body fat (PBF) and 2-h plasma glucose (2-h PG) (P<0.05), and butyrate was negatively associated with body mass index, visceral fat area, PBF and 2-h PG (P<0.05). No association was found between acetate and obesity.

Conclusion

Butyrate and propionate are negatively correlated with obesity and glucose levels in patients with T2D and obesity.

Apple cider vinegar for weight management in Lebanese adolescents and young adults with overweight and obesity: a randomised, double-blind, placebo-controlled study

Background and aims

Obesity and overweight have become significant health concerns worldwide, leading to an increased interest in finding natural remedies for weight reduction. One such remedy that has gained popularity is apple cider vinegar (ACV).

Objective

To investigate the effects of ACV consumption on weight, blood glucose, triglyceride and cholesterol levels in a sample of the Lebanese population.

Materials and methods

120 overweight and obese individuals were recruited. Participants were randomly assigned to either an intervention group receiving 5, 10 or 15 mL of ACV or a control group receiving a placebo (group 4) over a 12-week period. Measurements of anthropometric parameters, fasting blood glucose, triglyceride and cholesterol levels were taken at weeks 0, 4, 8 and 12.

Results

Our findings showed that daily consumption of the three doses of ACV for a duration of between 4 and 12 weeks is associated with significant reductions in anthropometric variables (weight, body mass index, waist/hip circumferences and body fat ratio), blood glucose, triglyceride and cholesterol levels. No significant risk factors were observed during the 12 weeks of ACV intake.

Conclusion

Consumption of ACV in people with overweight and obesity led to an improvement in the anthropometric and metabolic parameters. ACV could be a promising antiobesity supplement that does not produce any side effects.

The improvement effect of apple cider vinegar as a functional food on anthropometric indices, blood glucose and lipid profile in diabetic patients: a randomized controlled clinical trial

Background

Numerous medical costs are spent each year on treating and preventing the progression of diabetes. The positive effect of apple cider vinegar (ACV) has been shown on post-prandial hyperglycemia. This study aimed to evaluate the effects of prolonged consumption of ACV on blood glucose indices and lipid profile in patients with type 2 diabetes.

Methods

This study was a randomized clinical trial and the participants were adults with type 2 diabetes. Participants were divided into two groups: ACV and control. The ACV group was treated with 30 ml of ACV per day. Both the intervention and control groups received the same recommendation for a healthy diet. Before and after eight weeks, fasting blood glucose, insulin, hemoglobin A1C, insulin resistance, total cholesterol (Chol), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride were measured.

Results

Fasting blood glucose decreased after intervention in both groups, which was only significant in the ACV group (p = 0.01). There was a significant difference in hemoglobin A1C levels between the two groups (p < 0.001) after eight weeks. LDL was decreased in the ACV group (p < 0.001). Total Chol, LDL/HDL and Chol/HDL ratio decreased after the intervention period in the ACV group compared to the control group (p = 0.003, p = 0.001 and p = 0.001, respectively).

Conclusion

Daily consumption of ACV may have beneficial effects in controlling blood glucose indices and lipid profile in patients with type 2 diabetes.

Clinical trial registration

http://www.irct.ir, identifier IRCT20140107016123N13.

Comparative effectiveness of six herbs in the management of glycemic status of type 2 diabetes mellitus patients: A systematic review and network meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

There are several herbal formulations for type 2 diabetes (T2D), but many of them have never been directly compared to establish the most effective methods. Therefore, the present systematic review and network meta-analysis aimed to compare and rank the effects of herbal formulations by combining direct and indirect evidence on the management of type 2 diabetes.

METHODS

From five electronic databases, relevant studies on the effectiveness of herbal formulations for glycemic status for people with type 2 diabetes were retrieved. Only randomized controlled trials that were published in English and looked at how herbal formulations affected adults' (>18-year-old) glycemic levels were included. A systematic review and network meta-analysis design with the random-effects model was used.

RESULTS

A total of 44 trials included 3130 participants on six herbs were included in the final analysis. Apple cider vinegar (ACV) (standardized mean difference (SMD) = -28.99), cinnamon (-9.73), curcumin (-13.15), and fenugreek (-19.64) significantly reduced fasting blood glucose (FBG) compared with placebo (all p < 0.05). Notably, only ACV (SMD = -2.10) and fenugreek seeds (0.84) were found significantly effective in reducing HbA1C. ACV was most effective herb to reduce FBG comparison with other herbs.

CONCLUSIONS

Several herbs could be considered as a valuable adjuvant therapy regarding glycemic control of type 2 diabetes patients. Health professionals should be encouraged to incorporate these herbs for the management of type 2 diabetes as part of their standard care.

Therapeutic Potentials of Reducing Liver Fat in Non-Alcoholic Fatty Liver Disease: Close Association with Type 2 Diabetes

Nonalcoholic fatty liver disease (NAFLD), the most widespread chronic liver disease worldwide, confers a significant burden on health systems and leads to increased mortality and morbidity through several extrahepatic complications. NAFLD comprises a broad spectrum of liver-related disorders, including steatosis, cirrhosis, and hepatocellular carcinoma. It affects almost 30% of adults in the general population and up to 70% of people with type 2 diabetes (T2DM), sharing common pathogenetic pathways with the latter. In addition, NAFLD is closely related to obesity, which acts in synergy with other predisposing conditions, including alcohol consumption, provoking progressive and insidious liver damage. Among the most potent risk factors for accelerating the progression of NAFLD to fibrosis or cirrhosis, diabetes stands out. Despite the rapid rise in NAFLD rates, identifying the optimal treatment remains a challenge. Interestingly, NAFLD amelioration or remission appears to be associated with a lower risk of T2DM, indicating that liver-centric therapies could reduce the risk of developing T2DM and vice versa. Consequently, assessing NAFLD requires a multidisciplinary approach to identify and manage this multisystemic clinical entity early. With the continuously emerging new evidence, innovative therapeutic strategies are being developed for the treatment of NAFLD, prioritizing a combination of lifestyle changes and glucose-lowering medications. Based on recent evidence, this review scrutinizes all practical and sustainable interventions to achieve a resolution of NAFLD through a multimodal approach.

Metabolic status indicators and influencing factors in non-obese, non-centrally obese nonalcoholic fatty liver disease

Non-obese nonalcoholic fatty liver disease (NAFLD) is characterized by metabolic disorders and related complications. This study aimed to provide an integrated description of clinical, metabolic, and influencing factors for a specific category of patients with non-obese NAFLD. A total of 36 participants with body mass index (BMI) < 28 kg/m2 and visceral adipose tissue < 100 cm2 were classified into 2 groups: the non-obese, non-centrally obese control group (n = 17) and non-obese, non-centrally obese NAFLD group (n = 19). Hypertriglyceridemia, impaired fasting glucose, low high-density lipoprotein cholesterol levels, and hypertension were used to determine whether participants were metabolically abnormal. Based on a logistic regression model, odds ratios for the factors influencing NAFLD with 95% confidence intervals were calculated. Insulin resistance (IR) and fasting plasma glucose (FPG) levels were higher in the NAFLD group than in the control group (P < .05). The NAFLD group had a higher metabolic abnormality rate than the healthy control group (36.84% vs 5.88%, P = .044). Correlation analysis showed that IR was positively correlated with FPG and triglyceride (P < .05). BMI was the main influencing factor of NAFLD (regression coefficient β = 0.631; odds ratio = 1.879; 95% confidence interval, 1.233-2.863). NAFLD patients with a BMI < 28 kg/m2 and visceral adipose tissue < 100 cm2 had more apparent IR, higher FPG, and a higher metabolic abnormality rate. IR may be affected by FPG and triglyceride. Even in non-obese and non-centrally obese individuals, BMI should be controlled to avoid NAFLD.

Glycemic index and insulin index after a standard carbohydrate meal consumed with live kombucha: A randomised, placebo-controlled, crossover trial

Introduction

Kombucha is a complex probiotic beverage made from fermented tea, yet despite extensive historical, anecdotal, and in-vivo evidence for its health benefits, no controlled trials have been published on its effect on humans.

Methods

We conducted a randomised placebo-controlled, cross-over study that examined the Glycemic Index (GI) and Insulin Index (II) responses after a standardised high-GI meal consumed with three different test beverages (soda water, diet lemonade soft drink and an unpasteurised kombucha) in 11 healthy adults. The study was prospectively registered with the Australian New Zealand Clinical Trials Registry (anzctr.org.au: 12620000460909). Soda water was used as the control beverage. GI or II values were calculated by expressing the 2-h blood glucose or insulin response as a percentage of the response produced by 50 g of glucose dissolved in water.

Results

There was no statistically significant difference in GI or II between the standard meal consumed with soda water (GI: 86 and II: 85) or diet soft drink (GI: 84 and II: 81, (p = 0.929 for GI and p = 0.374 for II). In contrast, when kombucha was consumed there was a clinically significant reduction in GI and II (GI: 68, p = 0.041 and II: 70, p = 0.041) compared to the meal consumed with soda water.

Discussion

These results suggest live kombucha can produce reductions in acute postprandial hyperglycemia. Further studies examining the mechanisms and potential therapeutic benefits of kombucha are warranted.

Short-Chain Fatty Acids as Bacterial Enterocytes and Therapeutic Target in Diabetes Mellitus Type 2

Diabetes mellitus is a disease with multiple gastrointestinal symptoms (diarrhea or constipation, abdominal pain, bloating) whose pathogenesis is multifactorial. The most important of these factors is the enteric nervous system, also known as the "second brain"; a part of the peripheral nervous system capable of functioning independently of the central nervous system. Modulation of the enteric nervous system can be done by short-chain fatty acids, which are bacterial metabolites of the intestinal microbiota. In addition, these acids provide multiple benefits in diabetes, particularly by stimulating glucagon-like peptide 1 and insulin secretion. However, it is not clear what type of nutraceuticals (probiotics, prebiotics, and alimentary supplements) can be used to increase the amount of short-chain fatty acids and achieve the beneficial effects in diabetes. Thus, even if several studies demonstrate that the gut microbiota modulates the activity of the ENS, and thus, may have a positive effect in diabetes, further studies are needed to underline this effect. This review outlines the most recent data regarding the involvement of SCFAs as a disease modifying agent in diabetes mellitus type 2. For an in-depth understanding of the modulation of gut dysbiosis with SCFAs in diabetes, we provide an overview of the interplay between gut microbiota and ENS.

Mangosteen vinegar from Garcinia mangostana: quality improvement and antioxidant properties

Mangosteen (Garcinia mangostana Linn.) fruit is rich in phenolic compounds which function as antioxidants and play a role in anti-inflammation, anti-hyperlipidemia, and anti-diabetic nephropathy. To investigate mangosteen vinegar (MV) by steaming under high pressure, explore the effects of fermentation, antioxidant activity, and sensory evaluation acceptable using the 9 -point Hedonic scale. Steamed mangosteen was processed to produce 3 types of mangosteen vinegar: mangosteen rind vinegar (MRV), mangosteen flesh vinegar (MFV), and mangosteen rind plus flesh vinegar (MRFV). All 3 kinds of mangosteen vinegar were obtaining >4% acetic acid and significantly higher total phenolic content (TPC), total flavonoid content (TFC), and free radical scavenging ABTS+ and DPPH- antioxidant activity than apple cider vinegar (ACV) (p < 0. 05). The phenolic compounds analysis of mangosteen vinegar using HPLC were found Gallic acid, Catechin, Epicatechin, Vanillic acid, Trans-ferulic acid, Rutin, Gamma-mongostin, and Alpha-mangostin which showed almost higher than that found in ACV. Therefore, MVs produced from streamed mangosteen have higher antioxidants and were more acceptable using the 9-point Hedonic scale, a significantly higher statistical analysis of sensory evaluation than ACV, especially MFV. Taken together, steamed MVs should be further studied to prove the health benefits as a dietary supplement.

Dose-dependent effect of vinegar on blood pressure: A GRADE-assessed systematic review and meta-analysis of randomized controlled trials

BACKGROUND

There are controversial findings regarding the effect of vinegar on blood pressure based on the evidence accumulated so far.

METHODS

A systematic search was conducted through PubMed, Scopus, and ISI Web of Science up to April 2022. We estimated the change in blood pressure for each 30 ml/d increments in vinegar consumption in each trial and then, calculated the mean difference (MD) and 95 %CI using a fixed-effects model. A dose-response meta-analysis of differences in means provided us with the estimation of the dose-dependent effect. The certainty of evidence was rated by the GRADE tool.

RESULTS

Each 30 ml/d increment in vinegar consumption reduced SBP by - 3.25 mmHg (95 %CI: - 5.54, - 0.96; I² = 67.5 %, GRADE = low). Levels of SBP decreased linearly and slightly (P_nonlinearity = 0.69, P_{dose-response} = 0.02) up to vinegar consumption of 30 ml/d (MD30 ml/d: - 3.36, 95 %CI: - 5.77, - 0.94). Each 30 ml/d increment in vinegar consumption reduced DBP by - 3.33 mmHg (95 %CI: - 4.16, - 2.49; I² = 57.1 %, GRADE = low). Levels of DBP decreased linearly and slightly (P_nonlinearity = 0.47, P_{dose-response} = 0.004) up to vinegar consumption of 30 ml/d (MD30 ml/d: - 2.61, 95 %CI: - 4.15, - 1.06) CONCLUSIONS: According to the findings, vinegar significantly reduces systolic and diastolic blood pressure and may be considered an adjunct to hypertension treatment. Thus, clinicians could incorporate vinegar consumption as part of their dietary advice for patients.

Novel Coconut Vinegar Attenuates Hepatic and Vascular Oxidative Stress in Rats Fed a High-Cholesterol Diet

Background

Hypercholesterolemia is an independent modifiable risk factor that accelerates the development of both non-alcoholic fatty liver and atherosclerosis. Coconut water contains a variety of phytochemicals that make it appealing for producing vinegar. Coconut vinegar is rapidly gaining popularity for health benefits in Southeast Asia. The purpose of this study is to evaluate the effect of daily supplementation of coconut vinegar on hepatic and vascular oxidative stress in rats fed a high-cholesterol diet (HCD).

Methods

Mature coconut water was fermented with coconut sap sugar using Saccharomyces cerevisiae and Acetobacter aceti vat Europeans, respectively. Bioactive compounds and antioxidant capacity of coconut vinegar were examined in vitro. Adult male Sprague-Dawley rats were randomly divided into four groups; the control group fed a standard diet (S), a group that received HCD (SC), a group that received HCD supplemented with coconut vinegar at a dose of 1 mL/kg/day (SCV), and a group that received HCD with atorvastatin at a dose of 30 mg/kg/day (SCA). After 8 weeks, serum metabolic profiles, fatty liver, hepatic, and vascular oxidative stress were determined.

Results

In in vitro studies, coconut vinegar was rich in phenolic compounds and organic acids. The antioxidant capacity of 30 μL of coconut vinegar was 181.55 ± 8.15 μM Trolox equivalent antioxidant capacity (TEAC). In the HCD fed rats, daily supplementation of coconut vinegar reduced weight gain, serum triglycerides, and fasting blood sugar levels without renal or liver toxicity. In the liver, coconut vinegar reduced the accumulation of both hepatic cholesterol and hepatic triglyceride, and it also reduced hepatic 4-hydroxynonenal (4-HNE) lipid peroxidation. In the aortic tissues, coconut vinegar increased nitric oxide bioavailability and reduced aortic 4-HNE lipid peroxidation.

Conclusion

Novel coconut vinegar is the source of antioxidants, and daily supplementation of coconut vinegar was found to attenuate dyslipidemia-induced hepatic and vascular oxidative stress by protective against cellular lipid peroxidation.

Effect of a Combination of Rosa canina Fruits and Apple Cider Vinegar against Hydrogen Peroxide-Induced Toxicity in Experimental Animal Models

Oxidative stress is the trigger of several diseases. It is an imbalance between the production of free radicals and antioxidants. This study aims to evaluate the antioxidant capacity and the protective property of Rosa canina fruits and apple cider vinegar combined or not against hydrogen peroxide (H2O2)-induced toxicity in Wistar rats. The experiment included five groups: group 1 received distilled water (10 mL/kg b.wt), group 2 received H2O2 10% (10 mL/kg b.wt), group 3 received H2O2 10% (10 mL/kg b.wt) and apple vinegar (2 mL/kg b.wt); group 4 received H2O2 10% (10 mL/kg b.wt) and apple vinegar supplemented with Rosa canina fruits extract (300 mg/kg b.wt); group 5 received H2O2 10% (10 mL/kg b.wt) and extract of Rosa canina fruits (300 mg/kg b.wt). The doses were given once daily via a gavage. The antioxidant capacity of apple vinegar and Rosa canina extract was analyzed, and AST, ALT, PAL, urea, and creatinine were determined on day 22 of the experiment. In addition, the kidney and the liver tissues were analyzed. The results showed that H2O2 caused a significant elevation of blood urea, blood creatinine, and transaminases. The histopathology examination revealed that H2O2 caused congestion, hemorrhage, and Bowman’s space enlarged. On the other hand, the results clearly showed that apple vinegar and Rosa canina fruits counterbalance the biochemical and histological changes induced by H2O2. In conclusion, the two natural products studied in this work are effective against the harmful effect of oxidative stress, which explains their use in traditional medicine.