We asked 8 SIBO experts their opinion on apple cider vinegar (the answers will surprise you!)

Depending on who you ask, apple cider vinegar is either a miracle cure-all or just another condiment in the back of the cupboard.

Some people swear by it like it is mother’s milk. And other people are like, “Yeah, you know that apple cider vinegar? It’s not as good as you think it is. Whatever you do, don’t do that.”

If you have Small Intestine Bacterial Overgrowth, you might be even more uncertain what to use apple cider vinegar for, and if it can help SIBO or make your symptoms worse!

Some practitioners advise using apple cider vinegar to boost acidity in the stomach, improve digestion, and treat heartburn symptoms – usually by drinking it diluted in water – but is that a good idea?

I asked 8 SIBO experts, with different backgrounds and training, their opinions – and I know the answers will surprise you.

Dr. Allison Siebecker, ND

“Acid reflux can be from either having too little acid in your stomach, or too much acid in your stomach. You need a test to figure out. The symptom is the exact same for too little or too much acid. It’s so funny because MDs across the board tend to think there’s too much acid and NDs across the board tend to think there’s too little, when in fact it could be either, it doesn’t matter what your degree or training is, it could be either.

The best test you can do for this is the Heidelberg test, with the Heidelberg machine. You need to find an office with a Heidelberg machine and make sure that they do the test in a functional way.

I had a colleague who ran it here in Portland and he had done years, and year, and years of this, seen so many patients. By the time he finally left that practice he said it was about a 60/40, 60% in total of the people that he saw had too little acid, and 40% had too much.

If you can’t get tested you could always do a trial of one of the things that help increase acid and just start slow and increase up, and see how it does for you.

Whether that’s bitters, apple cider vinegar, or hydrochloric acid pills, just start very slow and gently. If you do have too little acid usually you start slow, you increase, and what you find is you can keep increasing up to a set max.

I recommend about 1 tablespoon mixed with a glass of water with meals.”

Kristy Regan, SIBO Nutritionist

“I think apple cider vinegar is great  if you have low stomach acid. Basically, if you try apple cider vinegar and it gives you a sour stomach or pain in your stomach, then you know you probably already have enough acid, and you shouldn’t be adding to it. But definitely, for most people, this can be helpful.

So, adding a little bit of bitters in water, drinking that before meal, or one teaspoon of apple cider vinegar in one cup of water before meals.”

Dr. Mona Morstein, ND

“If you have gastroparesis and you’re having food sit in your stomach, and you’re just adding more and more acid (from apple cider vinegar or HCL), you’ve got a real risk of burning out your mucus, and potentially causing not just a stomach ulcer, but also gastroparesis patients do have GERD quite a bit because it’s sitting there too long, and just too much pressure for too long against the lower esophageal sphincter can cause a problem, and there can be some considerable GERD and esophagitis.

So, it’s not necessarily the best thing for a gastroparesis patient overall. Of course, finding the reason why they have gastroparesis might be helpful too.

For apple cider vinegar in particular, considering it’s mixed with oil and a salad dressing with 6- out of 8-billion people a day, I’m not really sure we’re seeing headlines about disease from apple cider vinegar, which is just used all the time, or any vinegar.

I’m not really sure what people are thinking is bad about vinegar. We do know that vinegar may support production of digestive enzymes in the stomach. It also can decrease carbohydrate absorption in people with pre-diabetes and diabetes, so they have less high blood sugar numbers.

If we get a fermented apple cider vinegar from Bragg’s, we get fermented food, which is the best food ever, to put in the gastrointestinal tract, apple cider vinegar breaks down into an alkaline aspect to the body. So it’s anti-acidic to the cells.

Now, I would say there are—when we have patients who have candida, there is the idea that we remove vinegar during the specific treatment of the diet in people with candida, for a month or so while we’re eradicating candida.

But nobody develops candida because they have olive oil and vinegar on their leafy greens at supper. Candida is an antibiotic sugar mix thing. So they can add it back in once the candida is taken care of. But I’m not afraid of vinegar myself.”

Dr. Mark Pimentel, MD

“I don’t have a problem with the concept of supplement hydrochloric acid if you don’t have enough. I don’t think we have enough data to say one way or another that’s a bad thing.

What I can tell you though is, if you’re constipated or you have methane, methane uses hydrogen to produce methane, and that source could be hydrogen gas from the bacteria there, or it can be protons which are acid. So acid, the H+, can be used by methanogens to make methane.

The more you take the hydrochloric acid or the apple cider vinegar if you’re a methane person, you’re going to have more methane.

How do I know that? Because if you looked at a study that we published a number of years ago, people on PPI who had methane, their methane was lower as a result of the PPI—no acid in the stomach, less methane production on the breath test.

Be careful is what I’m saying because you can actually make things worse by taking these if you’re a methane producer.”

Dr. Partha Nandi, MD

“It’s fermented, right, the apple cider vinegar. So you’ve got some people that will actually get benefit from it. If you have damage to your esophagus, I wouldn’t take more acid and acidic stuff. You’re adding more acid where acid is the problem. So if you have esophagitis or damage to the esophagus, then I would not take apple cider vinegar.

And conversely, if you just had heartburn symptoms, and it happens occasionally, or we’ve done an endoscopy—endoscopy is a little scope that’s about half the size of my little finger.

And it goes into your mouth while you’re asleep. It goes into your esophagus and your stomach. And if there’s no damage, then it’s okay to take apple cider vinegar.

It’s not going to help everybody. Like everything else, nothing is going to help everybody. But if it does help you, then go ahead and start taking it.”

Dr. David Jockers, DNM, DC

“Apple cider vinegar is actually really good for vagal nerve activity – bitter herbs in general. We say bitter is good for the liver. Bitters are also good for the migrating motor complex.”

Dr. Melanie Keller, ND

“No. Just no apple cider vinegar with the mother. But I also have family in dentistry and they cringe at the use of apple cider vinegar, especially being in a beverage that people can sip throughout the day.  

If you do use it, we’re really specific. It’s best to use a straw. It’s best to rinse with baking soda and water.

And I actually have my patients end brushing their teeth leaving a little bit of baking soda on their toothbrush, not fully spitting everything out and that’s helping balance pH in the mouth because digestion begins in the mouth.”

Dr. Jay Davidson, DC

“There are so many people preaching betaine HCl, apple cider vinegar, all these to increase stomach acid, which I’m fine with that. But ask the next question. What’s the source of that lack of stomach acid? It’s usually from bile not moving right.

And here’s how it all connects.

Your bile is needed to neutralize stomach acid. Your bile is also needed to emulsify fat when you eat food. So let’s just theoretically say your bile is not moving well. It’s clogged. There’s not enough bile to neutralize the stomach acid that the stomach is dumping in the small intestine.

The body’s going to say, “Hey! Wait a minute. Red flag, red flag! Too much stomach acid. Decrease it.” The body decreases stomach acid.

If the bile is not moving right, the body decreases stomach acid. Food is not getting digested properly. And now, all of a sudden, there’s more stress in the digestive tract . You throw that on somebody that’s already got SIBO going on or potentially at risk of developing it, you’re looking at just massive digestive issues.”

Experts Don’t Always Agree…

As you’ve probably realized, experts don’t always agree on even seemingly simple things like apple cider vinegar!

What does that tell us?

Small Intestine Bacterial Overgrowth is super complex – and no two cases are the same. There’s no one protocol that works for everyone: healing SIBO is a different path for each of us.

How do we find the right path?

I believe the answer lies in getting as much information from the experts as we can.

Then, we can lean into our own innate wisdom to find what works for us and what doesn’t. I created the SIBO SOS™ to help bring you ALL the latest information on SIBO – right to your home.

Ready to take the next step on your customized path to healing? 

↪️ Join our community and our SIBO Recovery Roadmap® Course!

The Roadmap was designed by SIBO expert Dr. Allison Siebecker, ND and can help you understand where you are on your SIBO journey and what your next steps might be.

Do you use apple cider vinegar? I’d love to hear what works for you – please leave us a comment!



33 thoughts on “We asked 8 SIBO experts their opinion on apple cider vinegar (the answers will surprise you!)”

  1. When you think of apple cider, you probably think of fall. A warm sweet glass full of apples and spice that warms the body on a cool fall day and this delicious drink is where this miracle tonic gets its start. It begins life as apples that are pulverized to make cider. This cider is then combined with yeast which turns the sugars in the cider into alcohol.

  2. I recently posted that I was testing for my sibo I’m not going to till February 26 but I’m treating candida staying on sibo protocal along with candida protocal I was also using braggs apple cider vinegar as part of protocol 1 teaspoon in 8 once of water with each meal.keep in mind my sibo is methane.i did use this apple cider vinger for one week I had to stop its was exabrating my methane sibo cause me high hystamine and my stomach was burning bad .the braggs apple cider vinegar is fermented and you cant do fermented treating methane .he is right it made sibo symptoms return.big no no.im still taking other things to kill off candida but not that apple cider vinegar no no no.

    1. ….burning in the stomach, no fun, I’m sure. It’s a no for you then!

      But you’re absolutely right, there are so many other things we can do. Always, always listen to what your body tells you!

      Good luck with the Candida.

      PS… stay tuned to our emails! We have something special coming up this January 2020… including getting free access to a Candida masterclass with Dr. Satish Rao!

  3. I am finishing up sibo treatment and then starting my candida treatment as part of one the protocal is 1tsp of braggs apple cider vinegar to my cup of water with digestive enzymes per meal basically 3 times a day amongst all the other things to treat it.i take my sibo methane breath test in a week I’m pretty sure it’s gone

    1. Hey! Where can I find your sibo and candada treatment protocol? Does it have to be in that order? I thought they where the same treatment and separate ones.

  4. I was diagnosed with celiac 6/18 and went gf. At the time, my symptoms were extreme bloating, belching and constipation, however, the latter has been an issue most of my adult life. I am also a severe migraineur. I improved on a gf diet, lost 30 lbs before the diagnosis. I have continued to lose weight because of intermittent nausea. A year later I have lost 20 more lbs (none of this deliberate, but I was heavy to start) and continue to lose weight because eating causes such distress. Even when my diet is gf. I have had bouts of severe bloating and gas every time I eat. About 6 wks ago my doc suspected diverticulitis and put me on cipro and flagyll. It worked amazingly. The symptoms however returned worse and I got to the point I could not eat and was so uncomfortable from eating I could not even sleep. I did research on SIBO because my doc had mentioned it as a possibility and found the possible use of apple cider vinegar before meals to be a possible help. I have started using 1 tbsp in 8 oz water (w honey) before I eat ANYTHING. It has been miraculous even to the point where after about 6 or 7 days, I can eat small things w/o it. I still want a SIBO test and am thinking of going to Johns Hopkins as them seem to be the most thorough on the East Coast. I live in Rhode Island.

    1. Hi Heidi, sounds like you’ve been on quite a journey thus far in dealing with your gut issues. Since you’ve mentioned you’re suspecting SIBO, just wanted to pitch in that many of the experts we feature here at SIBOSOS.com seem to be at a consensus that the breath test is the gold standard for SIBO testing. I thought this might be relevant to you: Everything You Need To Know About SIBO Testing

  5. Anyone who finds their symptoms getting worse from ACV might benefit from looking up histamine intolerance. There’s a good overview of this as yet little-known condition on Medical News Today and another on the Dr Jockers site. If you have histamine intolerance, any fermented food – including vinegar – is going to make your symptoms much, much worse.

  6. I know this is a SIBO post, but I use apple cider vinegar for a hair rinse. I cannot recommend this enough. It leaves you hair like when you were a child. So soft, so clean.

  7. I have never used ACV for digestion issues. But I have taken it internally in salad dressings, guacamole, etc. The result for me is that the inside of my mouth gets swollen sores, usually on the inside of my cheeks. Have never been able to figure out why this is, and I do use Bragg’s.

  8. I tried taking ACV several times and every time my symptoms would worsen. I would develop burning and irritated esophagus and cough. My stomach acid is virtually non-existent but ACV and HCL makes me way worse.

  9. I had an endoscopy in November of 2018, was diagnosed with gastritis and the worst case of bile reflux my doctor had ever seen in her years of practice. I started Carafate and it has made a big difference in my gut pain, I would be bloated and excruciating pain daily. I did try the Braggs acv and it felt like I was drinking battery acid, couldn’t even tolerate it. Then in July of 2019 I was diagnosed with SIBO methane dominance, now after reading this I will most definitely stay away from acv, and not listen to all of the people who say it cures all, not for me.
    I have been doing so much research lately and the learning has helped me help my doctor move me in the right direction. Every little bit of knowledge is always a plus. Thank you!

  10. I had rectal colon cancer in 1998, radiation and chemo. Have suffered with chronic diarrhea for years. Was diagnosed with SIBO in 2018, I have taken Xifazan, two different prokenics they both caused severe heart burn. Now I’m using Fast Track diet. This has helped with the diarrhea, trying to overcome the constipation. I lost 50lbs down to 115 at 5’4”. Want to gain weight so when I get sick I’ll have some weight to lose.

  11. Some conditions and medications cause excess stomach acid. I had normal pressure hydrocephalus, in which your brain tells your body to generate excess stomach acid. First thing I was given was proton pump inhibitors, which rebounded and made the acid worse. Apple cider vinegar w/ the mother did not help cs I already had excess acid. I was finally able to wean off PPIs using zinc carnosine per the bottle instructions and deglycerinated licorice. Now, to address acid from an NSAID and the angiotensin 2 blocker, Micardis (generic telimisartan), I use zinc carnosine at night, plus Gas-X extra strength (125 mg simethicone), recommended by my internist MD, to prevent further acid damage to my airway. My gastroenterologist is also on board w/ the zinc carnosine, which I found by reading GERD books, and then pt comments at the online seller site i-herb. Since getting a shunt for my hydro, me acid is only from my meds. People should be aware that as my gastro says, “There are many neuro reasons for extreme constipation.” In my experience, both brain and spine conditions can contribute to decreased motility.

  12. Thank-you, THank-you for this article 🙂 Now for the first time in ages… I know I am not crazy or unique .. because, even the tiniest amount of ASV gives me pain in the stomach, burns ALL the way down, makes me nauseous right away,like I just swallowed a rock, . My stomach will actually clench. … I run for a spoon full of baking soda in a little water and drink it down .. ahhhh … finally relief. So, I’m pretty sure I’m in the too much stomach acid group. *lol* It’s nice to know I’m not alone, in that the acid of any vinegar or acidic salad dressing hurts, really hurts. It’s NOT my friend 🙂

  13. I’ve been taking apple cider for a while – it helped with a lot of health problems, including gas, and constipation – but now I am bloated a lot go from constipation to diarrhea – have poor digestion, didn’t have that until about 6 months to 9 months ago, have gas and wind all the time, breath not good – again this has been a recent problem. I watched your SIBO talks, all very interesting.
    As a result I stopped taking probotics with garlic, I am now waiting for a delivery of Allicin (sorry if I’ve spelt that wrong). I think I will stop taking apple cider vinegar for a while and see what transpires. Thanks for all your help. Lidia

  14. I had low stomach acid for years I burped and belched all day and night. Didn’t know why?
    I took the low stomach acid challenge and I was up to 6 pills of gastric acid at each meal. That got pricey. I had at this point trying to eradicate my Sibo for almost a year. I them switched to ACV and it worked I did this for about two months then I didn’t need it and I stopped the belching!! Hooray!!
    Still working on my Sibo at 1 plus years on herbal tincture and now BioBotanical protocol. Feeling much better.
    Tisha Brizzee

  15. A few years ago my ND prescribed bitters or HCL to manage my GERD symptoms and it was like a miracle cure. So I stopped taking them for a year or so and everything was fine. I thought I was cured. Woohoo! Then the GERD came back with a vengeance last year but unlike the first time, the bitters and HCL only made it worse. That was promptly followed up with a relapse of SIBO last fall. So even though something may work for some of us some of the time, it may not always work all of the time. We need to stay tuned to our changing bodies. Very complex indeed. Thanks for the great question and the very interesting answers.

  16. I use acv every day in the morning. I feel it helps. I had sibo and used the low fodmap diet for around a year. Then I went on a strict Whole30 protocol. It helped. I immediately got relief on the sibo diet. Doing the whole 30 after helped get ride of the bloat.

  17. Check out what AnthonybWilliam (Medical Medium) says about apple cider vinegar in his book, Liver Rescue. I find his work very interesting. There’s also a chapter on SIBO!

  18. There was a period of a year that I used ACV before every meal and it helped my digestion and to relieve digestive disturbances GREATLY. I’m an advocate for using it. It’s very useful for nausea and heartburns, too.
    It is however important to rinse your mouth after to avoid erosion to the teeth so a user needs to be careful if they are using it 3x or more a day.

  19. Thank you for that information.
    I was tested through a lab using spit and
    Practitioner said I had very low stomach acid. My stools at the time had a lot of undigested food. She started me off with
    ACV and it helped , then I started on HCI three at meals and stools show digested food. I also don’t get the oesophagitis
    that I had previously suffered with.
    Not sure how it affects the SIBO for me but I will now be mindful of what Dr Pimental is saying about methane.

  20. I have been gluten free (grain free) and dairy free since last August. It has helped me tremendously in ways that I never imagined it would help. However, I was still getting acid reflux at 10 p.m. nightly. My chiropractor suggested I take 1 T Bragg’s apple cider vinegar followed by a “chaser” of water. It has solved that problem but now I have developed much more gas and loose bowels. I am backing off of the vinegar.

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