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All,

 

Dr. Greger has another interesting video out today (embedded below) on the benefits of vinegar (diluted acetic acid). Adding a tablespoon or so of vinegar to meals reduces the post-meal spikes in glucose, insulin and triglycerides. I've included his references (with links to the Pubmed abstracts) at the bottom.

 

The fact that I add a little more than a tablespoon of (cider) vinegar to my salad dressing may explain in part how my glucose remains below 125 mg/dl despite eating so many calories in a single big meal per day. 

 

--Dean

 

 

Dr. Greger Vinegar Video References:

 

J B Kohn. Is vinegar an effective treatment for glycemic control or weight loss? J Acad Nutr Diet. 2015 Jul;115(7):1188.

P Mitrou, E Petsiou, E Papakonstantinou, E Maratou, V Lambadiari, P Dimitriadis, F Spanoudi, S A Raptis, G Dimitriadis. Vinegar Consumption Increases Insulin-Stimulated Glucose Uptake by the Forearm Muscle in Humans with Type 2 Diabetes. J Diabetes Res. 2015;2015:175204.

T Kondo, M Kishi, T Fushimi, S Ugajin, T Kaga. Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects. Biosci Biotechnol Biochem. 2009 Aug;73(8):1837-43.

J H O'Keefe, N M Gheewala, J O O'Keefe. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol. 2008 Jan 22;51(3):249-55.

C S Johnston, A J Buller. Vinegar and peanut products as complementary foods to reduce postprandial glycemia. J Am Diet Assoc. 2005 Dec;105(12):1939-42.

K Ebihara, A Nakajima. Effect of acetic acid and vinegar on blood glucose and insulin responses to orally administered sucrose and starch. May 1988.

C J Panetta, Y C Jonk, A C Shapiro. Prospective randomized clinical trial evaluating the impact of vinegar on lipids in non-diabetics. World J. Cardiovas. Dis. 3, 191-196. 2013.

J L Chiasson, R G Josse, R Gomis, M Hanefeld, A Karasik, M Laakso; STOP-NIDDM Trail Research Group. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet. 2002 Jun 15;359(9323):2072-7.

M Naissides, J C Mamo, A P James, S Pal. The effect of acute red wine polyphenol consumption on postprandial lipaemia in postmenopausal women. Atherosclerosis. 2004 Dec;177(2):401-8.

M Hanefeld, J L Chiasson, C Koehler, E Henkel, F Schaper, T Temelkova-Kurktschiev. Acarbose slows progression of intima-media thickness of the carotid arteries in subjects with impaired glucose tolerance. Stroke. 2004 May;35(5):1073-8. Epub 2004 Apr 8.

J L Chiasson, R G Josse, R Gomis, M Hanefeld, A Karasik, M Laakso; STOP-NIDDM Trial Research Group. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA. 2003 Jul 23;290(4):486-94.

DECODE Study Group, the European Diabetes Epidemiology Group. Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med. 2001 Feb 12;161(3):397-405.

A M Opperman, C S Venter, W Oosthuizen, R L Thompson, H H Vorster. Meta-analysis of the health effects of using the glycaemic index in meal-planning. Br J Nutr. 2004 Sep;92(3):367-81.

"Z Beheshti, Y H Chan, H S Nia, F Hajihosseini, R Nazari, M Shaabani, M T S Omran. Influence of apple cider vinegar on blood lipids. Life Science Journal 2012;9(4).

T C Wascher, I Schmoelzer, A Wiegratz, M Stuehlinger, D Mueller-Wieland, J Kotzka, M Enderle. Reduction of postchallenge hyperglycaemia prevents acute endothelial dysfunction in subjects with impaired glucose tolerance. Eur J Clin Invest. 2005 Sep;35(9):551-7.

G Livesey, R Taylor, H Livesey, S Liu. Is there a dose-response relation of dietary glycemic load to risk of type 2 diabetes? Meta-analysis of prospective cohort studies. Am J Clin Nutr. 2013 Mar;97(3):584-96.

J I Mann, L Te Morenga. Diet and diabetes revisited, yet again. Am J Clin Nutr. 2013 Mar;97(3):453-4.

J Fan, Y Song, Y Wang, R Hui, W Zhang. Dietary glycemic index, glycemic load, and risk of coronary heart disease, stroke, and stroke mortality: a systematic review with meta-analysis. PLoS One. 2012;7(12):e52182.

S H Holt, J C Miller, P Petocz. An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods. Am J Clin Nutr. 1997 Nov;66(5):1264-76.

E A Gale. Lessons from the glitazones: a story of drug development. Lancet. 2001 Jun 9;357(9271):1870-5.

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Thanks Dean. This may be another potential application of meal ordering with vinegar with the salads before the carbs. In the video he also cited a study using almond butter with apparently similar results.

 

Some advocate having an alkaline product before the main meal to reduce inflammation / ROS production in association with the meal ( e.g. - lemon juice which is technically acidic but I understand net promotes an alkaline environment ) though I'm not sure whether there is good science behind it.

 

Other foods may yield a similar benefit - thanks to Dean's encouragement I am going directly to the literature in my quest to get a sense of the pros / cons of substantial EVOO supplementation in meals above and beyond the cooking with it that we have done all along. This research uncovered that EVOO, like vinegar, can reduce post-pyramidal blood sugar spikes although at least part of the the mechanism appears to be via increases insulin release ( as opposed to strictly increased insulin sensitivity), so it may not all be a good thing as elevated insulin has it's own problems / sequela. Here's the link, which regrettably I can't embed in a word since I am posting from my smartphone: http://www.ncbi.nlm.nih.gov/m/pubmed/26192450/?i=14&from=extra%20virgin%20cardiovascular

Edited by Mechanism

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Mechanism,

 

Some advocate having an alkaline product before the main meal to reduce inflammation / ROS production in association with the meal ( e.g. - lemon juice which is technically acidic but I understand net promotes an alkaline environment ) though I'm not sure whether there is good science behind it.

 

Yes - I drink 20oz of water with 1 tablespoon of lemon juice in the two hours before my meal (while riding my stationary bike) for the benefits I've heard for pre-meal lemon juice.

 

Here's the link, which regrettably I can't embed in a word since I am posting from my smartphone: ....

 

When posting from my Android tablet, I "request desktop site" using the instructions here. I confirmed with my iphone-using daughter that you can do the same on an iphone, using instructions described here. That way you can have all the nice editing tools available on the desktop.

 

--Dean

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I enjoy the lemon freshly squeezed ( fresh, preservative free) & if I have the time scrape out and enjoy the pulp too ( at least for oranges the white rind is richer in anti-oxidants, not to mention fiber, etc.).  Getting the pulp out is no easy task (not nice and easy like squeezing out an avocado) due to tight adherence to the peel, but limes are even harder.  

I do avoid the peel though unless it is organic due to the higher pesticide retention there though.

Edited by Mechanism

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I haven't been doing the lemon water thing -- are you using real lemons? (Prob a silly question -- I'm sure you are!) Not yet lemons I use, but I have been adding a tablespoon of ACV (Bragg's) to my water bottles everyday -- can't say I've noticed much from this practice -- and constantly sipping water with diluted ACV all day long probably isn't great for my tooth enamel :-(

Edited by Sthira

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Sthira,

 

I haven't been doing the lemon water thing -- are you using real lemons? (Prob a silly question -- in sure you are!) 

 

You'll be surprised to hear I use bottled lemon juice, he says sheepishly...

 

...constantly sipping water with diluted ACV all day long probably isn't great for my tooth enamel :-( 

 

That's why I drink from a Stainless Steel Travel Tumbler w/ Stainless Steel Straw.

 

--Dean

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I read this thread after posting this separately and thought I should add it to this discussion. Adding vinegar and also considering the carb/ fiber ratio could be a double whammy! See below:

 

 

I have been thinking about the ratio of carbs to fiber and always considered it to be an important element to consider. I am wondering if others on this list consider this when using software to design their diets. After seeing a video on nutrition facts.org recommending a ratio of 5/1 I checked my diet on cron o meter and found that my ratio was slightly better than 5/1 at 4.78.

 

I think it is probably a very important component considering that many of us are eating a lot of carbs and the importance of post meal glucose control

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Dr. Greger has another interesting video out today (embedded below) on the benefits of vinegar (diluted acetic acid). Adding a tablespoon or so of vinegar to meals reduces the post-meal spikes in glucose, insulin and triglycerides.

 

So, I actually sat through this one ;) . I don't know whether to be annoyed or relieved. On the one hand, this is not one of the many cases where Greger completely distorts the evidence on some subject to provide false support for his vegan agenda. But instead, it's a mixture of bait-and-switch (granted that his video title is "Can Vinegar Help with Blood Sugar Control?" and he spends almost none of the video addressing that question) andhis second-most-common bad habit: although there's little suggestion of post hoc justification for a pre-existing dietary dogma, he simply doesn't dig into the literature he's citing, or evaluate contradictory evidence, or in general bring critical thinking into his posts.

 

Either that, or he has an undisclosed financial relationship with the Vinegar Institute — or, truer to type, Bragg Live Foods, Inc. ;)

 

It's true, first off, that there is a significant body of evidence that vinegar consumption does lower postprandial glucose levels in diabetic subjects and/or in the context of high-GI test meals, although the evidence is a lot less consistent even on that front than Greger suggests — as, indeed, is summarized by the first two references in his reference list:

 

Although there is a lack of evidence at this time to recommend vinegar as an adjuvant treatment for diabetes, vinegar is considered to be safe when consumed in reasonable amounts. There have, however, been adverse events reported with apple cider vinegar tablets, and with vinegar ingested daily for several years.4,9 The risks for hypoglycemia or hypokalemia are also concerns with long-term oral use or when used concomitantly with some prescription medications, over-the-counter medications, and herbal supplements.(1)

 

Several studies have demonstrated that vinegar can help reduce hyperglycemia, hyperinsulinemia, hyperlipidemia, and obesity. Other studies, however, have shown no beneficial effect on metabolism. ...  Although some evidence supports the use of vinegar as a complementary treatment in patients with glucose and lipid abnormalities [MR emphasis — vide infra], further large-scale long-term trials with impeccable methodology are warranted before definitive health claims can be made.(2)

As it stood back in the early 2000s, the evidence available at the time led a lot of CR practitioners (including myself) to use and encourage the use of vinegar for this purpose. However, as might be suggested by the bolded passage above, most studies in subsequent years (and well within the period covered by Greger's selected references) have found that it doesn't actually do much for normoglycemic people, and that most of the effect is lost in meals that are low-GI to begin with:

 

http://www.nature.com/ejcn/journal/v64/n7/abs/ejcn201089a.html

http://care.diabetesjournals.org/content/27/1/281.full

http://www.ncbi.nlm.nih.gov/pubmed/16321601

http://www.sciencedirect.com/science/article/pii/S0002822305012228

https://cardinalscholar.bsu.edu/bitstream/handle/123456789/195877/BollingerL_2012-2_BODY.pdf

http://file.scirp.org/Html/2-1910098_30260.htm

 

Starting around 3:46, Greger finally gets around to the evidence that is most central to the question of whether vinegar is useful in lowering PPG. His first study is PMID 16321601 , which he says had the effect of "cutting the blood sugar response in half if you chug down 4 teaspoons." But in fact, as the abstract informs us, "these reductions were significant only for the high-glycemic load meal" — ie, for bagel and juice, glycemic load=81, and not for chicken and rice, glycemic load=48, which Greger would certainly not endorse. Additionally, per (2) (which is on Greger's reference list!), they found that those individuals "showed a reduction in postprandial insulin response without a significant reduction in postprandial glucose response," which would be the exact opposite of what you'd want if you have the curious variant of impaired glucose tolerance present in CR with low/lowish IGF-1 (and T3 and testosterone, tho' IGF-1 appears determinative) (4), if (as some studies suggest) the effect is indeed the result of suppressed beta-cell insulin response to incoming glucose.

 

The title and context of (3), which is one of the citations in (1) below cited by Greger, at first suggested that it might find otherwise. However, (a) even the "complex carbohydrate" in this trial was from bagels, which have a glycemic index of 69, and (b) the result was both internally and externally a lot messier than their abstract suggests:

 

trial 1 demonstrated that 10 g (≈2 teaspoons) of 5% acidity vinegar reduced PPG after 2 h by 23% compared to placebo (p = 0.05). This amount of vinegar is about one half that demonstrated to reduce PPG previously … In trial 1, however, the higher amount of vinegar (20 g vinegar containing 1 g acetic acid), a dosage used successfully to reduce PPG in previously published reports as well as in trials 2 and 4 of this report, reduced PPG by only 6–10%. ... [and] the reductions for meal-induced PPG by vinegar was statistically significant for one trial (p = 0.05) but not the other two trials (p = 0.097 and p = 0.169). …

 ... which obviously all suggests the possibility that the single positive result at 10 g may have been a fluke, especially with the small subject number.

 

Now, to be fair, despite the title of the video, Greger here actually spends very little time propping up the use of vinegar to lower PPG, instead focusing on avoiding high-GI and processed foods: as noted above, he really only gets rolling on vinegar about 2/3 of the way thru' the video. And does at least allude to the fact that the effect is at least more important in overweight people and/or high-GI foods. But if that's his real message, the video should be branded honestly that way, rather than generating advertorial content for Bragg's.

 

I should also add that the fact that the evidence seems to be that vinegar doesn't lower PPG in normoglycemic people or people eating low-GI foods (let alone those who are both normoglycemic and who eat healthy diets), I wouldn't on that basis immediately jump to the conclusion that the effect is irrelevant in CR practitioners: again, the paradoxical finding of a variant of impaired glucose tolerance in CR practitioners with the otherwise very desirable CR endocrine trifecta (4) suggests the possibility that we might benefit (tho' as noted above, if we instead respond to vinegar like normoglycemic individuals instead of more conventionally glucose-intolerant folk, it could even be counterproductive, further suppressing our recalcitrant beta-cells). So the focus here is primarily on Greger being a sloppy zealot, and for the benefit of our many non-CR readers: YMMV on CR proper.

 

How about mustard/salsa as substitutes for vinegar? (both of these also have substantial amounts of vinegar in them)

As noted above, the usual dose found to lower PPG (in diabetics and with high-GI foods) is 20 g, and in some studies it's as high as 40 g; this recipe for homemade mustard uses, along with minor ingredients,

  • 1/4 cup dry mustard powder
  • 1/2 cup sweet pickle juice
  • 1/4 cup water
  • 1/2 cup cider vinegar
  • 1/4 cup mustard seed

... which implies an awful lot of mustard to get 20-40 g of vinegar ...

 

References

1. J B Kohn. Is vinegar an effective treatment for glycemic control or weight loss? J Acad Nutr Diet. 2015 Jul;115(7):1188. (http://www.ncbi.nlm.nih.gov/pubmed/26115563)

 

2: P Mitrou, E Petsiou, E Papakonstantinou, E Maratou, V Lambadiari, P Dimitriadis, F Spanoudi, S A Raptis, G Dimitriadis. Vinegar Consumption Increases Insulin-Stimulated Glucose Uptake by the Forearm Muscle in Humans with Type 2 Diabetes. J Diabetes Res. 2015;2015:175204.

 

3: Johnston CS, Steplewska I, Long CA, Harris LN, Ryals RH. Examination of the antiglycemic properties of vinegar in healthy adults. Ann Nutr Metab. 2010;56(1):74-9. doi: 10.1159/000272133. PubMed PMID: 20068289.

 

4: Luigi Fontana, Samuel Klein, John O. Holloszy. Effects of long-term calorie restriction and endurance exercise on glucose tolerance, insulin action, and adipokine production. Age (Dordr). 2010 Mar;32(1):97-108. Epub 2009 Nov 11.

PMID: 19904628

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