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