Apple Cider Vinegar For Gout Relief: Science Required

There have been interesting discussions about the science of (ACV)  apple cider vinegar for gout relief.I have summarized my understanding of apple cider vinegar, but I feel some of the discussions we have had leave questions unanswered. I have closed the existing discussions, and moved relevant comments here. You can add to the debate below, but please restrict comments to science-based knowledge, not random personal experience. If you have views or questions about apple cider vinegar, please add them in the comments box below.

Apple Cider Vinegar For Gout Relief: Existing Comments

These are the relevant contributions from existing debates:May 19, 2009 George Glasser

Saw your statement about apple cider vinegar. I tried it and it worked very fast. personally, I didn’t think it would from my initial research, but from the preponderance of positive, anecdotal evidence, I gave it a shot.Being an ex investigative, environmental journalist, I wanted to find out why, and like you, couldn’t find any reason at first. However, as I investigated further, it contains malic acid, which apparently neutralizes uric acid.I also found it curious that absolutely not scientific research has been done with ACV and gout, but interestingly, apples are one of the fruits that have been researched the most for curative properties, and have the highest malic acid content. Apples are also a reccommended food for people suffering with gout.Consequently, it’s reasonable to to state that, ACV would also have high levels of malic acid which may well be more bioavailable than simply eating and digesting a whole apple.I’ve seen data which states that the malic acid level in fermented apple cider can easily reach 1.5%.I determined that I have a potassium deficiency, and while the ACV gave me a kick start, I have increased my uptake of potassium.I think that it is possible that many problems with gout may well be related to potassium deficiency.Best Regards,GC Glasser

May 19, 2009 zip2play

Just to be chemically precise, there is no way to neutralize an acid with another acid. To neutralize an acid one needs to use a base, an ALKALINE substance.Yes, the kidney's  alility to retain or release uric acid is closely related to it's handling of poassium both are influenced by handling of sodium. It's a delicate dance and helps explain why people can precipitate a gout attack by using thiazide diuretics which cause elimination of soidium and for balance an elimination of potassium and to balance BOTH, a retention of urate ion. But this electrolyte dance is not a simple matter. Perhaps increase of potassium is wise since historically we get less and less of it while we get more and more sodium.I find that any discussion of cider vinegar to cause MEGO (my eyes glaze over) because I have read over the years about its ability to cure amost  EVERYTHING. My experience is that any such miracle usually cures NOTHING, except perhaps poor apple sales. The cider vinegar people have a GOOD ad-campaign going for them.The answer to any of these "cures" is a simple study with half a large population taking the miracle stuff and half not. The ABSENCE of these studies should breed a healthy skepticism.

June 22, 2009 George Glasser

Actually, it isn't any magical properties in ACV, it's the plain old acetic acid that does the trick. Acetic acid is absorbed through the stomach as ionic acetate – not as an acid per-se – and  oxidizes to a bicarbonate which raises the blood pH.Potassium acetate is used for gout treatment. When it passes through the stomach lining into the blood, it converts to potassium carbonate, raises the blood pH  and the alkaline salts excreted by the kidney render the urine less acid. "It is a marked diuretic, increasing the amount of urine and the solids of the urine without irritation of the kidney," American Medical Association – "A Handbook of Usefu Drugs."Sodium acetate can also be used, but it causes stomach upset in some people – it would convert to bicarbonate of soda.Potassium citrate is also effective in facilitating the excretion of uric acid.There is quite a bit of scientific evidence that strongly suggests that acetic acid should help in the with uric acid elimination by raising the blood pH and increasing the solubility of uric acid. Acetate is also a vascular dilator which improves blood flow and dissolution of sodium urate crystals.

June 23, 2009 zip2play

Salts like potassium acetate, sodium acetate, and potassium carbonate  are salts formed from a weak acid and a strong base, I forget the name for these salts but when they are hydrolyzed the acidic part picks up and holds an H+ ion, taking it out of solution leaving an abundance of OH- to make the solution basic.This CAN NOT be extended to the acid itself. Vinegar is ACID and thus it dissociates  very differently from potassium acetate. It is actually Hydrogen acetate, or acetic acid and to the extent that it hydrolyzes it contributes substantial H+ ions into the solution (whereas the acetate SALTS contribute -OH (base) becasue of their K+ions.  These are two VERY different situations.One cannot assume the salt will have anything like the properties of the forming acids and bases. Thus while NaCl is delicious on food, it is quite a different effect from sprinkling the food with either lye (NaOh) or hydrochloric acid (HCl) which when mixed in a beaker make salt.I've never measured the effect but I am sure that  large amounts of acetic acid (vinegar) will acidify the urine but sodium or potassium acetate will alkalyze it.

Overlapping that forum discussion was another discussion about apple cider vinegar and gout.George Glasser May 25, 2009

An addendum to my last post about the impact ACV had on my gout.I was curious about the “WHY” vinegar seemed to be so effective in relieving my gout.At first look, I found the out of hand dismissal of ACV for gout relief by health professionals as suppositional as the fantastic claims made on natural health sites because of the paucity of solid research. The only evidence for ACV’s effect on gout was strictly anecdotal, but overwhelming in favour, which speaks volumes in and of itself.Looking for answers, the first thing I did was investigate the enzymatic acids in apples that might play a role in relieving gout symptoms. The only thing I discovered in any quantity was malic acid. Next, I investigated the fermentation products of apples and their potential content in ACV. The only product contained in any significant quantity to impact gout was acetic acid, which is the primary fermentation product found in all vinegars.Many times, the problem with researching something like ACV is that the answers are never straightforward and lie in synonyms and esoteric scientific jargon. Subsequently, if you enter ACV into a search engine, and all you will come up with are sites selling it as a ‘miracle’ cure-all, and most often, the claims made are based on notion, ‘word of mouth,’ and association rather than science. While, many of the claims may have foundation, the mechanisms suggested are not scientifically accurate.On scientific/medical databases, such as Pubmed, I found more information by simply entering “vinegar” as a primary search word.The last aspect of my research was acetic acid of which ACV is between 4.0% – 5.0% by volume.After running into quite a few brick walls, I finally came across a group of search terms involving synonyms for acetic acid that began to pay off – acetate.On face value, acetic acid shouldn’t do anything; however, upon further research, one begins to see that there is a solid scientific and associative foundation to suggest, that in fact, the acetic content in ACV may well play a role in gout relief and prevention.For instance, research on animals shows that sodium acetate (basically the product of acetic acid and baking soda) raises the alkalinity level of blood. Raising the blood alkalinity would affect the metabolism of uric acid and dissolve the uric acid crystals.Acetyl based medications such as Acetyl-resveratrol are used to treat gout.Other studies suggest that it has an effect on blood cholesterol and possibly, can help people with Type 2 Diabetes (which is also associated with gout) and indirectly aid process serum protein.Acidic acid (synonyms – acetyl, acetate, etc.) is part and parcel of many non-steroidal, anti-inflammatory drugs.It’s also a component of many energy enhancing sports supplements.Acetic acid, in reality, is a key component to life as we know it. Our body synthesizes it, and it plays an essential role in the Krebs (Citric Acid) Cycle. “The Krebs Cycle is a metabolic pathway involving oxidative metabolism of acetyl [acetic acid – acetate] compounds which forms part of the breakdown of carbohydrates, fats and proteins into carbon dioxide and water in order to generate energy.”From Wikipedia, the free encyclopaediaAcetyl-CoA is an important molecule in metabolism, used in many biochemical reactions. Its main use is to convey the carbon atoms within the acetyl group to the citric acid cycle to be oxidized for energy production. In chemical structure, acetyl-CoA is the thioester between coenzyme A (a thiol) and acetic acid (an acyl group carrier). Acetyl-CoA is produced during the second step of aerobic cellular respiration, pyruvate decarboxylation, which occurs in the matrix of the mitochondria. Acetyl-CoA then enters the citric acid cycle.)Acetyl-CoA is also responsible for the production of acetylcholine, which is a neurotransmitter in the peripheral nervous system (PNS) and central nervous system (CNS) in many organisms including humans.If the Krebs Cycle isn’t functioning properly, it can throw all the metabolic function off balance. While the Krebs cycle might not directly relate to the production of uric acid, more then likely, it may be a root, causal effect.Interference with Krebs Cycle function can occur from exposure environmental pollutants (such as lead, fluorides, endocrine disrupters, etc.), poor diet, medications, and even illness.While the Krebs Cycle is dependent on the availability of the acetyl (acetic acid) molecule to function, all of the research I read doesn’t say how it gets into the body; or in some cases, the researchers say it is produced in the Krebs Cycle. However, there is a simple possibility for the bioavailability of acetic acid – acetobacteria and lactobacillus species populating the intestines.Acetobacter species are the critters responsible for creating acetic acid. They are all around us and also play an integral role in the digestion of food of which the main product is acetic acid (acetate) which is absorbed into the blood.Acetobacter are also responsible for the second fermentation process which create vinegar from sugary fruits.Carbohydrate fermentation in the human colon and its relation to acetate concentrations in venous blood.Journal of Clinical Investigation, 1985E W Pomare, W J Branch, and J H CummingsAbstract [truncated]…However, areas under the blood acetate curves were closely related (r = 0.97; n = 5), whatever the source of acetate. These studies show that the large intestine makes an important contribution to blood acetate levels in man and that fermentation may influence metabolic processes well beyond the wall of this organ.Plasma Acetate Turnover and OxidationJ Clin Invest, 1979C. L. SKUTCHES, C. P. HOLROYDE, R. N. MYERS, P. PAUL, and G. A. REICHARD,Department of Research, Lantkenau Hospital, Philadelphia, Petinsylvania 19151….Acetate is a major source of energy in ruminant animals formed primarily from the microbial fermentation of cellulose and hemicellulose in the rumin (1). The acetate so produced is absorbed rapidly resulting in arterial plasma concentrations of 1.0-2.0 mM…..The decline in plasma acetate turnover with age is yet another metabolic change that occurs during aging in mammals.All in all, there has been very little research into the overall impact acetic acid (acetate) has on the metabolic activities in humans. Essentially, all they know is that it is essential to life and the function of the Krebs Cycle. However, from a logical standpoint, it would appear because the body produces it in the intestines and it is absorbed into the system, Acetate has to play an important role in the biofunctions of all animals.From the material I reviewed, it appears that hyperuricemia, may be the result of insufficient acetate produced in the intestinal tract to drive the Krebs (Citric Acid) Cycle and other metabolic functions efficiently.For many gout sufferers, it could be as simple as getting hold of vinegar made from any fruit, or even using the acetobacter culture which is obtainable in capsule form to top off the bacteria in the gut. Acetobacteria are tough critters and impervious to stomach acid.As far as fast relief goes, any old type of acetic acid or food grade acetate will probably do.For most gout suffers that acetic acid works, it often alleviates acute symptoms within hours.While AVC, acetic acid or other acetate compounds appears to help many people suffering with gout, it might not help others. However, from personal experience, I would say that if you’re suffering from chronic gout give it a try. The worst that can happen is that it won’t help.It’s important to note that the over use of acetic acid or acetate can also cause health problems, but in the amount (two tablespoon two or three time a day) shouldn’t have any adverse effects other than a minor loss of potassium. Remedying the potassium loss is simple, just eat high potassium content foods or take supplements (Potassium also helps reduce uric acid in the blood).From personal experience, I would say that if you’re suffering from chronic gout give it a try. The worst that can happen is that it won’t help.

Rich September 16, 2009

Great job George, you over delivered on content. The extra links added in were a nice touch. I just wanted to add that too much potassium (form of supplements) can be harmful in older gout sufferers and those with kidney disorders as this affects the bodies fluids. I,m definitely going to look into this ACV a little closer.
George Glasser September 16, 2009Too much of anything in the line of minerals that has negative effects. However, it’s pretty difficult to overdose on potassium because you don’t retain it in your body – it takes ingesting about two or three grams a day to just keep your body functioning. I read some studies that suggest that most people might actually be potassium deficient and the deficiency is attributable to some gout cases.I haven’t had a problem with gout or low urine pH since I started doing vinegar.I also read several studies that said that about 90% of gout cases are not attributed to the overproduction of uric acid, but the decreased elimination caused by kidney problems. Raising the serum pH made the uric acid to become more soluble and eliminated more easily.Another interesting caveat that no one has looked into in any depth is subclinical lead poisoning. If you look at toxicological history and studies into lead, you will find that down through written history, gout is synonymous with lead toxicity.Most people over forty years, probably have some degree of lead poisoning, because of airborne lead pollution from the use of leaded petrol/gasoline. Lead Pollution from leaded petrol was the single greatest contributor to airborne air pollution during the 20th century, and the type of lead could be easily absorbed through the skin. 95% of the lead to which is stored in the bone. When a person hits middle age, a process call bone remodelling begins to accelerate, and the bone lead is reabsorbed back into the system. Many people have build up toxic levels in their bone from lifetime exposure – the lead starts to damage the kidneys causing decreased function and inhibition of uric acid excretion, thus a build up of uric acid and rise of serum pH in the system – and bingo, we have a case of gout in the works.In the US, they did studied following the decrease in blood lead levels as leaded petrol was being phased out. From the late 1970s – 1990 the blood lead levels in US citizens dropped 78% coinciding exactly with the phase out.About the only thing that will help with lead poisoning except for expensive and uncomfortable chelation therapy is taking vitamin C and keeping your serum pH on the alkaline side.The most interesting part, is that other problems like poor circulation in my feet and chronic pain associated the gout, have all but gone.[Made a mistake in the above, build-up of uric acid causes a lowering of serum pH - it’s going acidic.]

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