Apple cider vinegar: I've read taking ACV helps... - Thyroid UK

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Apple cider vinegar

Satva
Satva

I've read taking ACV helps in absorbing levo, due to increasing acidity in the stomach. Is this true? Thanks.

34 Replies
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helvella
helvellaAdministrator

I am not aware of any proof of that.

The only substance I am aware of that helps at all is ascorbic acid.

It is important to realise that levothyroxine is very poorly soluble in acidic or neutral solutions. It is more soluble in alkaline solutions.

Hence, it isn't the acid in your stomach that enables its absorption, but the alkaline bicarbonate in the duodenum, jejunum and ileum.

ACV can help with other issues, I believe.

Smorzando
Smorzando in reply to helvella

Interesting. My endocrinologist suggested that vitamin c increased absorption of liothyronine and said I could take it with a glass of orange juice. I was sceptical, as I had never read anything similar on this forum.

helvella
helvellaAdministrator in reply to Smorzando

I don't remember any discussion about ascorbic acid (vitamin C) and any impact on absorption of liothyronine. Perfectly possible but I'd like to find something to back that up!

In general, liothyronine is fairly well absorbed anyway - so the effect of anything would be expected to be modest. Whereas levothyroxine has numerous absorption issues.

Clinical Trial

J Clin Endocrinol Metab. 2014 Jun;99(6):E1031-4.

doi: 10.1210/jc.2013-4360. Epub 2014 Mar 6.

Effect of vitamin C on the absorption of levothyroxine in patients with hypothyroidism and gastritis

William Jubiz, Marcela Ramirez

• PMID: 24601693

• DOI: 10.1210/jc.2013-4360

Abstract

Background: Malabsorption of l-T4 is a major clinical problem. Changes in gastric pH caused by several medical illnesses are associated with difficulties in the control of patients with hypothyroidism receiving the hormone. Means to correct these alterations would be of clinical value.

Objectives: Our objective was to study the effect of vitamin C on the absorption of l-T4 in patients with hypothyroidism and gastritis.

Design: Thirty-one patients with hypothyroidism, 28 females age 47.5 ± 13.5 (mean ± SD) years and 3 males age 55.7 ± 11.2 years ingested the dose of l-T4 in 120 mL water containing or not containing 500 mg vitamin C in a solution of pH 2.9 ± 0.1 (mean ± SD). Serum concentrations of free T4 and TSH were measured at the end of 3 periods of 2 months each, 2 controls and 1 vitamin C. Serum total T3 was measured in 16 of the patients, before and at the end of the vitamin C period. Serum TSH and free T4 and T3 were measured by a solid-phase, enzyme-labeled chemiluminescent competitive immunoassay All patients had gastrointestinal pathology and were not in good control when taking l-T4 before the study, and 23 had autoimmune thyroiditis or idiopathic hypothyroidism. The median l-T4 dose was 100 μg with an interquartile range of 50 μg. The protocol was reviewed and approved by our institution's ethics committee. Patients were asked to sign a written consent to participate in the study.

Results: Serum concentrations of TSH, free T4, and T3 improved while on vitamin C. Serum TSH decreased in all patients (control, 11.1 [10.5] μIU/mL, median [interquartile range]), vitamin C 4.2 (3.7) μIU/mL, P = .0001), and it was normalized in 17 patients (54.8%). The average decrease was 69.2%. Serum T4 was higher with vitamin C in 30 of the 31 patients (control, 1.1 [0.3] ng/dL; vitamin C, 1.3 [0.3] ng/dL; P < .0001), and serum T3 increased as well in all 16 patients in whom it was measured (control, 60.5 [16.5] ng/dL; vitamin C, 70 [21] ng/dL; P < .005).

Conclusions: In patients with hypothyroidism and gastrointestinal pathology, vitamin C improves the abnormalities in serum free T4, T3, and TSH concentrations. This approach is helpful in the management of these patients.

pubmed.ncbi.nlm.nih.gov/246...

Smorzando
Smorzando in reply to helvella

That's interesting, thank you. This endocrinologist also said caffeine would affect absorption (of liothyronine) but that decaf tea would be fine taken alongside. I'm erring on the side of caution, though, and taking it on an empty stomach.

helvella
helvellaAdministrator in reply to Smorzando

I'd like to know where your endocrinologist is getting this from! :-)

I just searched PubMed for:

caffeine liothyronine absorption

Nothing found. :-(

Caffeine does affect the speed of absorption of other medicines - such as paracetamol. Though it appears questionable whether the total amount absorbed is affected.

Smorzando
Smorzando in reply to helvella

Yes, me too! From the "inside of her mind", perhaps (in common with a lot of doctors I suspect 😬)Maybe next time I see her I'll remember to ask 😊

Scrumbler
Scrumbler in reply to helvella

I think we had a discussion before on this subject helvella and concluded that Levo was dissolved in the acidic environment of the stomach and absorbed in the alkaline environment of the the intestine - as you’ve reiterated above.

Much to my chagrin, I am still having to take a PPI for gastric issues so have been doing some research on the effect of these on other drugs.

Ive been taking Duloxetine (Cymbalta) for 10 weeks and checked out how a PPI impacted upon this drug.

Reputable sources tell me that it is better not to take a PPI with this as it is designed to remain intact in the acid environment of the stomach. Apparently, the coating will only dissolve in an alkaline environment of pH 5.5 after which it is absorbed. If the stomach is too alkaline because of PPI use, it will dissolve / be absorbed in the wrong place. The articles I read claimed that when this happens the drug is metabolised too quickly. They didn’t mention gastritis but as one who suffers with this, I would imagine that this is how Duloxetine has earned its reputation for causing gastritis and oesophagitis.

I should add that drugs.com and other sources lists this as only a minor interaction. I suppose one has to accept that upsetting the pH balance of the gut in any way will have some effect but that it’s incalculable and shouldn’t dominate our doubts about various drugs and their interactions.

We’ve also had many posts about Thyroid S and the fact that some people think it’s slow release because of the coating which is described as enteric. Whilst doing my ‘perusing’ I came across mention of enteric coatings (which are normally used for stomach protection) and it seems that they too will only dissolve and be absorbed in the alkaline environment of the lower gut. It makes sense then that Enteric coating and PPIs aren’t good news when taken together. That said, I always chew them up and have never had a gastric upset from them.

Sometimes you have to take a chance and just use common sense. I take a fibre supplement but well away from meds.

Oh the complications of a malfunctioning body 🤨

I would be wary of taking it because I read recently of someone who died while using it as dietary supplement.

The coroner said acidosis could have caused her death and apple cider vinegar could have caused it.

Apple cider vinegar is a food supplement. There is not much information on the effect it could have. Obviously the vinegar is acidic and we don't know how many she was taking at once.

The only serious effects in the past have been when people have had a lot of vinegar.

en.wikipedia.org/wiki/Acidosis

Well that’s terrifying

Mostew
Mostew in reply to Amethyst91

Please don’t feel it’s another danger . We have enough !! Someone obviously overdid it .....

Scrumbler
Scrumbler in reply to Mostew

Metabolic acidosis is rare but deadly

Mostew
Mostew in reply to Lora7again

1 in how to how many million !!!

. It’s very good for us if we are sensible .

A spoonful in warm water is no harm to any one surely . X

Lora7again
Lora7again in reply to Mostew

That is your choice but I wouldn't want to risk it myself.

Mostew
Mostew in reply to Lora7again

Best do what feels right xx

Amethyst91
Amethyst91 in reply to Mostew

I’ll admit I usually use the cap that the bottle comes with and fill it up and drop it in my tea daily for metabolism but that’s about it.

Mostew
Mostew in reply to Amethyst91

Sounds sensible . You live to tell the tale .!!!

Lora7again
Lora7again in reply to Mostew

I just read this about it.

healthline.com/nutrition/ap...

I’ll be honest I don’t use it very often and when I do use it I don’t notice any amazing positive side effects so I’m using it less and less. I don’t think it does anything wonderful for the body and is more of a fad. If you don’t use it already I don’t see a reason to start. I’ve read things about it over the year that have turned me off from it and I’ll probably not buy another bottle. I just haven’t seen anything in my time of use that makes any difference.

I tried all kinds of supplements to try to get my hair back and none of them worked. The only thing that made my hair stop from falling out was when my thyroid levels were ok.

Mostew
Mostew in reply to Lora7again

Thanks. Interesting article

It shows how important it is to look carefully at what we take

and be well informed, both academic knowledge and instinctive are needed

helvella
helvellaAdministrator in reply to Lora7again

This is a newspaper report. The circumstances appear to combine long-term use of liquid acid cider vinegar, a tablespoonful three times a day, followed by a change to ACV tablets, and very restrictive dieting - possibly 1200 calories a day - and 5:2 dieting. The intent seeming to have been appetite suppression rather than helping with digestion.

theargus.co.uk/news/1799892...

I suggest that taking ACV without food might well be a bad idea. Using a modest amount (say, a teaspoonful of liquid ACV), with food and sufficient liquid, to help with digestion has been widely practised. The lack of information available at the inquest suggests that, even if ACV is implicated in this case, the incidence of severe issues is very low.

I don't think I'd take ACV tablets. But I find the flavour and mouth effect of liquid dilute ACV acceptable though I know others do not. (I do not take ACV as I don't feel the need but have tried some in the past for experience.)

Lora7again
Lora7again in reply to helvella

That is your view and I have mine. I personally wouldn't want to upset my stomach and I am sensitive to anything like that because I have suffered with esophagitis in the past and took I Ranitidine for about a year.

helvella
helvellaAdministrator in reply to Lora7again

I suspect you'd also avoid pickles generally - onions, red cabbage, gherkins, etc. - which might very well be appropriate for you.

I'd also strongly discourage anyone from taking any acetic acid based foods or supplements if they get negative side effects. Certainly not something to push through pain in the vain hope of some gain.

Lora7again
Lora7again in reply to helvella

I do have the occasional pickled onion at Christmas but I don't put vinegar on my chips yuk!

😜

helvella
helvellaAdministrator in reply to Lora7again

Nor do I put vinegar on chips.

I prefer some salt and freshly ground pepper. Maybe lemon juice - for example, if there is a bit of lemon with the fish.

Lora7again
Lora7again in reply to helvella

I have chips about once a week and usually have a bit of tomato ketchup with mine.

😋

Scrumbler
Scrumbler in reply to helvella

I can’t tolerate any form of pickles, vinegar etc.

I would be wary of taking it because I read recently of someone who died while using it as dietary supplement.

The coroner said acidosis could have caused her death and apple cider vinegar could have caused it.

Just wanted to point out that acidosis and acidifying the stomach are two very different things. Acidosis is where the pH of the blood decreases due to various reasons. I’d be interested to know the source of this story.

The stomach has a normal pH of around 2-3 to produce gastric acid. This is very acidic and normal. It helps digest proteins and absorb minerals. This pH can rise due to say H. pylori infection,stress, hypothyroidism, certain drugs, PPIs, taking antacids and certain health problems which is detrimental to digestion. Later on as our food leaves the stomach and enters the small intestine the body produces alkalinising fluids to increase the pH. So that initial acidity has gone. For example from the pancreas. In normal scenarios a stomach which isn’t very acidic causes a huge number of health issues as the body cannot absorb amino acids nor minerals such as calcium, magnesium, iron etc.

Acid reflux is actually because the pH of the stomach isn’t low enough which causes the valve in the stomach to not close properly and thus causes the contents of the stomach to rise up towards the throat. It’s not due to too much acid.

Apple Cider Vinegar is not for everyone. So yes caution is advised because it can burn the throat and break down the enamel of your teeth. It’s certainly not for people such as those with inflammation of the stomach lining like gastritis. It is suggested to take this in small amounts just before meals to increase gastric secretions and make it easier to digest protein based meals. I take 2 teaspoons in warm with water with a metal straw before a protein heavy meal and I find I digest that meal a lot better. I don’t take it randomly throughout the day.

As for thyroid medication, it should only be taken on an empty stomach with water and nothing else.

helvella
helvellaAdministrator in reply to Serendipitious

I did post a link on this thread to a newspaper report about a case which appears could have been the one referred to.

Must have escaped me. I will take a look. Thanks.

There’s a medical journal which discusses ketoacidosis and where the subject was taking Apple Cider Vinegar along with Metformin.

ncbi.nlm.nih.gov/pmc/articl...

I think this shows that if you have a combination of medical complaints such as diabetes, hypertension, iron deficiency anemia, gastroesophageal reflux disease etc combined with a strict low carb or ketogenic diet this can cause a problem but only under certain circumstances. Ketosis can be acid producing. The journal even states that under normal circumstances the ingestion of apple cider vinegar can be helpful and that the body normally alkalinises it.

“Normally, acetic acid is metabolized to bicarbonate in the liver and should not alter acid base balance; however, there may be a delay between the actual ingestion and buffering which could create a temporary acid base disturbance.”

I understand the alarm, fear and people’s concern especially when taking too much ACV. Caution is definitely needed when using this.

You shouldn’t assume that if you are hypothyroid you have low stomach acid. Conversely, indigestion is not necessarily caused by low stomach acid even in hypothyroidism.

If you have gastric problems, the only way you can be sure is by having a gastroscopy to get a definitive diagnosis. My last one showed two haemorrhagic ulcers, oesophagitis and a 3 cm sliding hiatus hernia.

Thanks for all the comments and advice. ACV is good in home made French dressing! Ideally organic with the 'mother' in it. My Swiss step-family use vinegar with herbs to make their delicious dressings, which they eat every day and are all in their mid/late '80s! I think moderation may be the key!! 🌝

Apple cider vinegar is, compared with stomach acid, so weak in acidity as to make no difference to the acidity overall. Indeed different products are differently acid in strength. T4 isn't taken up much by the stomach, but by the small intestine in a much less acid environment . If cider vinegar has any effects, it's not the acid itself that has any effect. People with weak stomach acid might be more responsive but I still don't think it will affect even them to any large extent

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