Vinegar ingestion at mealtime reduced fasting …

1 Short communicationsVinegar ingestion at mealtime reduced fastingblood glucose concentrations in healthy adultsat risk for type 2 diabetesCarol S. Johnston*, Samantha Quagliano1, Serena WhiteNutrition Program, School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Phoenix, AZ 85004, United StatesARTICLE INFOA rticle history:Received 5 July 2013 Received in revised form23 July 2013 Accepted 4 August 2013 Available online xxxxKeywords:VinegarAcetic acidFasting glucoseBreath hydrogenABSTRACTThis 12-week pilot study examined effects of Vinegar on markers of type 2 diabetes in at-risk adults.

2 Participants (n= 14) ingested 750 mg acetic acid as a Vinegar drink or a controlpill (40 mg acetic acid) twice daily at mealtime . Blood glucose ( fasting and 2-h postprandial)was recorded daily. fasting blood collected at weeks 0 and 12 was analyzed for insulin andglycated hemoglobin. Average change in fasting glucose was reduced in the Vinegar groupversus control group ( versus mmol/l) (p= ). Average change in2-h postprandial glucose, insulin and glycated hemoglobin did not vary between breath hydrogen at week 12 was elevated 19% in the Vinegar group versus controlgroup suggesting an increase in colonic fermentation in the Vinegar group.

3 These data indi-cate that Vinegar , a simple addition to meals, has antiglycaemic effects in adults at-risk fortype 2 diabetes, possibly related to carbohydrate maldigestion. 2013 Elsevier Ltd. All rights prevalence of type 2 diabetes in the US and worldwideapproaches 10% and is predicted to rise in the coming disconcerting, the risk of developing type 2 diabetes is esti-mated to be as high as 50% for US adults >65 y (Danaei et al., 2011;Tab a k, Herder, Rathmann, Brunner, & Kivima ki, 2012). TheAmerican Diabetes Association assesses risk for type 2 diabetesbased on impaired fasting glucose ( fasting concentrations> mmol/L) or impaired glucose tolerance (2 h post-load con-centrations > mmol/L).

4 Strategies to reduce risk and slowprogression to type 2 diabetes are urgently needed. Weight man-agement using prudent diet approaches and physical activity areeffective at delaying progression to type 2 diabetes in high-riskindividuals (Taba k et al., 2012; Knowler et al., 2002). However,much of the research has focused on drug therapies to reducedisease incidence, particularly antidiabetic agents such as al-pha-glucosidase inhibitors, thiazolidinediones and agents reduced progression to type 2 diabetes by 40 60%in high-risk adults (Tab a ketal.,2012). However, the cost, accessand toxicities associated with pharmaceutical medications limittheir $ - see front matter 2013 Elsevier Ltd.

5 All rights *Corresponding : Nutrition Program, 500 N. 3rd Street, Phoenix, AZ 85004, United States. Tel.: +1 602 827 2265;fax: +1 602 827 Johnston).1 Current address: Cancer Treatment Centers of America at Western Regional Medical Center, 14200 Celebrate Life Way, Goodyear, AZ85338, United : BMI, body mass index; A1c, glycated hemoglobinJOURNAL OF FUNCTIONAL FOODSxxx (2013) xxx xxxAvailable homepage: cite this article in press as: Johnston, et al., Vinegar ingestion at mealtime reduced fasting blood glucose concentrations in healthyadults at risk for type 2 diabetes,Journal of Functional Foods(2013), antiquity, Vinegar has been used medicinally; more-over, it is inexpensive, shelf-stable and a common ingredientin many cuisines.

6 Numerous investigations have verified theantiglycaemic effects of Vinegar at mealtime in both healthyadults and adults with type 2 diabetes (Johnston & Gaas,2006). Although the mechanisms of Vinegar action are un-clear, acetic acid, the defining ingredient of all vinegars,may interfere with carbohydrate digestion, promote glucoseuptake by muscle, and/or increaseb-cell insulin secretion(Ogawa et al., 2000; Fushimi et al., 2001; Seok et al., 2012). Inadults with type 2 diabetes, daily ingestion of Vinegar loweredfasting glucose concentrations and glycated hemoglobin (A1c)(White & Johnston, 2007; Johnston, White, & Kent, 2009).

7 Todate there has not been a long-term trial examining theefficacy of daily Vinegar ingestion for lowering markers ofdiabetes in at risk ParticipantsHealthy adults at risk for type 2 diabetes (diagnosed prediabe-tes or a fasting blood glucose measure > mmol/l at studyentry) were screened for diabetic medications, but otherstable medication use (>3 months) was permitted. Data arereported for individuals who completed the 12-week study(14 of 19 participants; 13 F and 1 M). All participants providedwritten informed consent, and the study was approved by theArizona State University Institutional Review Study designParticipants were paired by gender, age, body mass index(BMI) and prediabetes diagnosis and randomly assigned tothe Vinegar (drink) or control (pill) group.

8 Participants main-tained customary diet and activity patterns during the studyand measured blood glucose concentrations twice daily (uponwaking in a fasted state and 2-h after the evening meal) usinga calibrated glucometer with memory (ACCU-CHEK, Aviameter system, Indianapolis, IN). Glucometer data were down-loaded by study investigators at study weeks 6 and 12. Atstudy weeks 0 and 12, fasting venous blood samples were col-lected for insulin and A1c analyses, and at week 12, fastingbreath hydrogen and methane samples were study treatments ( Vinegar : 8 oz Vinegar drink; control:1 Vinegar pill) were ingested twice daily with meals.

9 Thecommercially available Vinegar drink (Bragg Organic Apple Ci-der Vinegar Drink Sweet Stevia, Bragg Live Food Products, San-ta Barbara, CA) contained 1 tablespoon Vinegar (750 mg aceticacid) per 8 oz. The commercially available Vinegar pills (AppleCider Vinegar tablets, General Nutrition Corporation, Pitts-burgh, PA) contained trace amounts of acetic acid (40 mg/tablet). Blood and breath samplesVenous blood samples were immediately analyzed for A1cusing the DCA Vantage Analyzer (Siemens Healthcare Diag-nostics, Tarrytown, NY) and plasma was extracted for laterinsulin analysis (Human Insulin-Specific RIA, MilliporeCorporation, Billerica, MA).

10 Three consecutive breath sampleswere attained in the fasting state using a mouthpiece and col-lection bag (QuinTron AlveoSampler bags model#QT00842-P,QuinTron Instrument Company, Milwaukee, WI). Sampleswere transferred to the BreathTracker SC from QuinTronand analyzed for hydrogen and methane. Values from thethree breath samples were averaged after correction usingcarbon dioxide measurement. Breath hydrogen and breathhydrogen + methane 2 values are Statistical analysisResults are expressed as the mean SE. The Mann WhitneyUtest was used to test differences between means at analyses were used to identify significant differ-ences in the outcome variables controlling for potential covar-iates and Pearson s correlation was used to examinerelationships between variables (Predictive Analytics Soft-Ware Statistics package , IBM, 2009).