Marianne

Isabelle J. Mariano 2014-19109

MCB 120

Wonders of Apple Cider Vinegar


Apple cider vinegar has been said to be present as early as 5000 BC and has many
uses. Babylonian used apple cider vinegar as a food flavoring and preserving agent while
others used it as a remedy for ailments such as cough and colds. During the American Civil
war, it was used as an antiseptic for wounds. Vinegar is formed when ethyl alcohol is
converted to acetic acid by Acetobacter, a gram-positive bacterium, in the presence of
oxygen. In the case of apple cider vinegar, apple extract with yeast and sugar to initiate the
fermentation process. Apple cider vinegar contain vitamins such as vitamin B1, B2, and
niacin; it also contains small amounts of minerals like sodium, calcium, iron and magnesium.
Aside from that, ACV is also said to have organic acids, flavonoids and polyphenols. Over the
years, ACV has been getting the interest of many researchers as it has been said to have many
health benefits.
Antibiotics are used to treat bacterial infections that could harm an individual. The
first use of antibiotic dates back to the year 1928 when Alexander Fleming discovered
penicillin. Since then, hundreds of antibiotics has been produced in order to combat and treat
bacterial organisms. There are different types of antibiotics such as tetracyclines that are used
to treat widespread bacterial infections by stopping the growth of the bacteria (Aminov,
2010). Specifically, tetracycline prevents protein synthesis activity of the bacteria by
preventing the attachment of the aminoacyl-tRNA to the ribosomal acceptor site (Chopora
and Roberts, 2001). Another type of antibiotic is the sulfonamides. It inhibits metabolic
processes of bacteria by inhibiting the addition of a specific enzyme, dihydropteroate
synthase. Before, it is used to treat urinary tract infection but is no longer used because of
the potential adverse reactions (Greenwood, 2012). Over the years, there has been an
increase in antibiotic resistance. This happens when bacteria no longer response or when the
antibiotic cannot effectively control or kill bacterial growth. As antibiotics have been used for
a long time, bacteria are exposed to these antibiotics which eventually adapts to it, making
the drugs less effective. Using antibiotics often makes the risk of resistance greater especially
in children and older adults (Cunha, nd). Bacteria become resistant to antibiotics by genetic
mutation or by acquiring resistance from other bacteria. The World Health Organization
released the results of their study about the antibiotic resistance last January 29, 2018 and it
showed that the resistance of bacteria such as Escherichia coli, Staphylococcus aureus and
Salmonella spp. has been continually rising. Urinary tract infections associated with E. coli has
showed about 8 to 65% resistance to ciprofloxacin, that is commonly used to treat UTI (WHO,
2018).
Antibiotic resistance of bacteria is one of the biggest threat in the medical field as
treating common infections become difficult that may lead to greater complication in one’s
health and can eventually lead to death. This also affects the cost of health care system across
the world. Researchers have been studying and making ways in order to find out a different
way or alternative medications to treat these bacteria and lessen the risk of higher antibiotic
resistance.
With this issue, researchers have been conducting studies that aim to find possible
alternative ways in killing bacteria as to lessen the risk of antibiotic resistance. As the apple
cider vinegar continues to get the attention of the public as well as the medical community
because of its said health benefits, the researchers aimed to investigate the antimicrobial
activity of apple cider vinegar on microbes and inflammatory pathways. The study used three
common bacteria that causes infection – Escherichia coli, Staphylococcus aureus and Candida
albicans. This review paper aimed to review other journal articles that provide any findings
regarding health benefits of using apple cider vinegar and its potential to be used as an
alternative medicine in curing various diseases.
In this study conducted by Yagnik et al. (2018), they observed the antimicrobial activity
of different ACV concentrations in the three mentioned microorganisms, its ability to
downregulate cytokines and examine its effect on the microbial protein expression. Results
showed that the microorganisms required different minimum ACV concentration to inhibit
microbial growth. E. coli requires a minimum of 1/25 concentration of ACV to inhibit growth,
S. aureus requires 50% ACV concentration to inhibit microbe growth while pure ACV is needed
to inhibit the growth of Candida albicans. Candida albicans is an opportunistic pathogenic
yeast that can be found in the humans. It can cause oropharyngeal and vulvovaginal
candidiasis. In a study conducted by Manohar and Gopinath (2017), they observed the
antifungal activity of ACV against clinical isolates of Candida species. They collected twenty
non-repetitive isolates from immunocompromised individuals from Thandalam, India. Five
Candida spp were identified and characterized – C. tropicalis, C. kefyr, C. parapsilosis, C. krusei
and C. albicans. Minimum inhibitory concentration was used for this test. Results showed that
the isolates were inhibited from 0.25-0.50% concentration of ACV. It can be compared that in
this study the minimum concentration to inhibit the growth of Candida spp. is 0.25% and that
the study by Yagnik et. al showed that pure apple cider vinegar can inhibit the growth of
Candida albicans. However, it can be noted that in this study, five Candida spp were studied
and thus the results are not exclusive for Candida albicans only. Another study conducted by
Mota et. al last 2014 examined the antifungal activity of ACV on Candida spp involved in
denture stomatitis. The researchers used the same method (MIC) and also the minimum
fungicidal concentration. Results also showed that the apple cider vinegar showed a minimum
inhibitory concentration of 2500 µg/ml in Candida spp. This result coincides with the study of
Manohar and Gopinath as they also used five Candida spp.
Acetic acid is one of the component of apple cider vinegar, though ACV only has 5%
acetic acid. A study was conducted regarding the antibacterial activity of acetic acid against
biofilm forming pathogens of relevance to burns patients by Halstead et al. last 2015. Twenty-
nine isolates of common wound infecting pathogens were sampled. Some of these are
Pseudomonas aeruginosa, Acinobacter baumanii, Escherichia coli and Staphylococcus aureus
although it can be noted that in this study, E. coli and S. aureus were only considered as
comparator organisms that commonly causes hospital acquired infection. It can be noted that
they only tested the antibacterial activity of acetic acid by using only two concentrations –
0.16 and 0.31. The two strains of E coli used in this study had a MIC of 0.31 while there was a
total of four strains of S. aureus that were used, three of the strains had a MIC of 0.31 and
one strain had a MIC of 0.16. This can support and correlate to the findings of the key paper
regarding the inhibition of apple cider vinegar, which contains acetic acid, against the growth
of E. coli at a minimum concentration of 0.25. However, it cannot be said that it correlates
with the data regarding the inhibition of apple cider vinegar against the growth of S. aureus
as the key paper only tested four concentrations – 0.01,0.10,0.5 and pure ACV extract.
Comparison of the antimicrobial activity of apple cider vinegar and different
antibiotics was conducted in Bengaluru, India last 2017 by Asma Saqib. Antibacterial activity
of ACV was tested on S. aureus and E. coli and the zones of inhibition were compared to that
of the Ciprofloxacin, which was the control. Meanwhile, the antifungal activity of ACV was
tested on C. albicans and A. niger having Fluconazol as the control. Zones of inhibition were
then measured after 24 hours for the antibacterial set up and after 48 hours for the antifungal
activity. Results showed that ACV had rendered a larger mean zone of inhibition than the
Ciprofloxacin in the S aureus culture having a 31.60±0.548mm as compared to 21.40±0.894
of the Ciprofloxacin. ACV also had a larger zone of inhibition in E coli with a mean of
26.60±0.548 compared to that of the Ciprofloxacin with only a mean zone of inhibition of
20.40±0.894. As for the antifungal part of the study, ACV also had a higher mean zone of
inhibition for both C. albicans and A. niger against the standard Fluconazol drug. ACV had a
mean zone of inhibition of 20.80±0.447 on C. albicans and 26.60±0.548 on A. niger.
Fluconazol on the other hand, had a mean zone of inhibition of only 21.40±0.894 on C.
albicans and 20.40±0.894 on A. niger. These results show that apple cider vinegar has a
greater ability of inhibiting the grow of these microorganisms as compared to the commonly
used antibiotics.
Proteomic study in Yagnik’s paper showed that after the application of ACV in the
three different microorganisms, a number of key enzymes involved in various metabolic
processes of the organisms were not expressed. Table 1 shows some of the key enzymes that
were not expressed after the application of ACV.

Table 1. Key Enzymes that were not detected after the application of Apple Cider Vinegar.
Escherichia coli Staphylococcus aureus Candida albicans
Citrate synthase Alcohol dehydrogenase Fructose biphosphate
Isocitrate dehydrogenase Catalase aldolase
Deoxyribose-phosphate Serine hydroxymethyl Key enzymes required for
idolase transferase glycolysis
Malate dehydrogenase L-lactate dehydrogenase-2 Pyruvate kinase
Aminoethyltransferase Ornithine aminotransferase Phosphogluconate
Formate acyltransferases dehydrogenase
Succinyl-CoA ligase


The acetic acid of the apple cider vinegar is said to be one of the main components
that affects the microbial growth and expression. Acetic acid is an organic acid and
undissociated acid has been traditionally assumed to have the ability to affect the metabolic
pathways of microorganisms by penetrating the membrane of the bacterial cell and once
inside, it dissociates into anions and protons causing a change in the neutral pH of the
bacteria. Microorganisms must maintain a near neutral pH cytoplasm to be able to function
and sustain the cell. Export of excess protons requires the consumption of ATP resulting in a
low source of cellular energy needed to perform metabolic activities (Ricke, 2003; Saquib,
2017).
Aside from this, apple cider vinegar has also been proven to have an effect on the
transcriptional activities of immune response related genes of Litopenaeus vannamei or the
white shrimp. In this study, diets of the L. vannamei included the different concentrations of
ACV (1%, 2% and 4%) mixed with the shrimp feed, 0.5% Proprionic Acid (PA) was another
experimental set – up while a commercial shrimp feed was used as the control. Results
showed that intake of ACV and PA increased the mRNA expression of Lysozyme after 30 and
60 days as compared to the control group. Lysozyme is considered to be an antibacterial
defense in animals and is also used as a model system in modern molecular biology and even
in protein chemistry. Lysozymes are hydrolytic enzymes that can cleave the bonds in
peptidoglycan, the bacterial cell wall polymer (Callewaert and Michiels, 2010). There was also
a significant difference in the expression of Pen-3a genes of L. vannamei at 1% and 2% ACV
diet. Penaeidin 3a gene is also an antimicrobial gene in found in shrimps. This study showed
that ACV intake can affect the expression of immune related response genes in shrimps,
specifically Litopenaeus vannamei. Studies in
Diabetes is one of the ten global causes of death based on the World Health
Organization report. It is estimated that approximately two million people have died because
of diabetes mellitus (WHO, 2018). Diabetes is when the blood sugar of an individual are too
high. And there are two types of diabetes – 1 and 2. Type 1 diabetes is when the body does
not produce any insulin. Insulin is a hormone secreted by the pancreas that helps the body to
maintain the blood sugar level. Type 2 diabetes is when the body does not use up or make
enough insulin. The potential of apple cider vinegar of treating diabetes has been tested by a
number of researches.
One study showed that ACV affected the production of HbA1-c in diabetic Wistar rats.
HbA1-c or the hemoglobin A1c is a minor component of hemoglobin where glucose usually
binds. HbA1-c levels in an individual can help determine blood glucose concentrations and
therefore is used to diagnose diabetes (Stoppler, nd). In the study, it was found out that
diabetic rats treated with ACV had a decreased level of HbA1-c by 18.8%. In addition to that,
the total concentration of serum triglyceride and cholesterol levels of the rats were measured
after four weeks. Experimental subjects treated with ACV showed lower concentrations of
serum triglyceride after the introduction of ACV to their diet. The mean total serum
triglyceride before treatment was 39±21 and reduced to 28±17 after the treatment.
Meanwhile, total cholesterol before treatment was 72±15 and afterwards, lowered into
63±13 after introduction of ACV. These results showed that diet with ACV can have a
beneficial effect on lipid profiles of rats (Shihehbor et al., 2008).
In 2012, another study was conducted to see the effects of ACV in blood lipids but in
this case, experimental subjects were 19 patients with hyperlipidemia. Hyperlipidemia is a
general term used to refer to high levels of fat proteins in the blood. The subjects were asked
to consume 30ml of 4% ACV twice a day for 8 weeks. Blood samples were then taken for every
end of the week and was taken up for blood analysis. Triglyceride levels for both female and
male subjects decreased all throughout the duration of the study. Meanwhile, cholesterol
levels also decreased at p < 0.001. Results showed that oral intake of ACV can help reduce or
harmful lipids in blood especially for hyperlipidemic individuals (Behesti et al., 2012).
These studies showed that apple cider vinegar can have beneficial effects as it can be
used as an antimicrobial agent against various microorganisms. Also, apple cider vinegar
clearly affects microbial expression not only of bacteria but it also increases the production
of immune related genes and enzymes in certain organisms. It can also be concluded that
addition of apple cider vinegar in an individual’s diet can have a positive effect in maintaining
overall health as number of studies showed that apple cider vinegar can help reduce or lower
production of harmful lipids in blood that could eventually cause harmful illnesses. However,
some of the studies were done in vivo or in other organisms such as rats and fish and only a
number of studies have been conducted in humans. It can be recommended that more
studies should be done in order to fully understand the benefits of apple cider vinegar and its
potential to cure diseases.
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