Using an acid to fight acid reflux sounds odd, yet apple cider vinegar (ACV) is one of the most searched home remedies for heartburn. Here's the honest answer up front: there's no good clinical evidence that it helps, and for some people it may make things worse. Below we explain what reflux is, why the ACV theory doesn't hold up and what does help.
What's the difference between acid reflux, heartburn and GERD?
Acid reflux
Acid reflux happens when stomach contents flow back up into your esophagus, the tube that carries food from your mouth to your stomach. A ring of muscle called the lower esophageal sphincter normally stops that from happening. When it relaxes at the wrong time or is weak, stomach contents can come back up.
Reflux is more likely after a large or fatty meal, or when you lie down or bend over soon after eating. Symptoms can include a sour or bitter taste, regurgitation, nausea, bloating and trouble swallowing.
Heartburn
Heartburn is the burning feeling in the chest, sometimes rising toward the throat, that reflux can cause. It has nothing to do with your heart, although chest pain should always be checked by a doctor.
GERD
Gastroesophageal reflux disease (GERD) is reflux that is frequent or troublesome, typically heartburn or regurgitation at least once a week. It's common: population studies put it at about 18% to 28% of adults in North America.
What causes reflux and GERD?
According to the NIH, factors that can weaken or relax the lower esophageal sphincter include:
- Overweight or obesity
- Pregnancy
- Smoking or secondhand smoke
- A hiatal hernia
- Some medicines, including NSAIDs such as ibuprofen, certain asthma and blood pressure medicines, sedatives and some antidepressants
Large meals, eating close to bedtime and certain trigger foods can also bring on symptoms.
Does apple cider vinegar help acid reflux?
There's no good evidence that it does. We couldn't find any controlled clinical trials showing that ACV relieves heartburn or GERD, and major guidelines, such as the American College of Gastroenterology's GERD guideline, don't recommend it.
The usual theory is that reflux comes from too little stomach acid, so adding acid helps. That idea hasn't been shown in studies, and the main mechanism behind reflux is the sphincter letting stomach contents back up, not a lack of acid.
There are also reasons for caution. Vinegar is acidic enough to erode tooth enamel in lab tests, and an esophagus that's already irritated by reflux doesn't need more acid. ACV tablets aren't automatically safer: a report on ACV tablets was prompted by an injury to the esophagus linked to a tablet.
What actually helps acid reflux?
Lifestyle changes have the best evidence. A systematic review found that losing weight, quitting smoking, avoiding late evening meals and raising the head of the bed reduce reflux. The NIH suggests raising your head 6 to 8 inches with a wedge or extra pillows under your head and upper back, along with changes to eating habits.
- Eat smaller meals, and avoid eating in the two to three hours before bed.
- Notice your personal trigger foods and drinks, and cut back on them.
- Stay upright after meals; a gentle walk is better than the couch.
- Ask your doctor or pharmacist about over-the-counter antacids for occasional heartburn, and see your doctor if you need them often.
If you're managing your weight or blood sugar, our guide to why blood sugar matters is a helpful place to start.
If you still want to try apple cider vinegar
Talk to your doctor first, especially if you have GERD, an ulcer or take medicine for diabetes. If you do try it, never drink it straight: dilute a small amount in a large glass of water, take it with food, rinse your mouth afterward, and stop if your symptoms get worse. If you prefer tablets, swallow them with a full glass of water and stay upright. Our article on apple cider vinegar pills vs. liquid covers the trade-offs.
When should you see a doctor about heartburn?
See a doctor if you think you have GERD or your symptoms don't improve with over-the-counter medicines and lifestyle changes. Get medical care promptly for chest pain, loss of appetite, persistent vomiting, trouble or pain when swallowing, vomit that contains blood or looks like coffee grounds, black or bloody stools, or unexplained weight loss.
