Who Cannot Use Apple Cider Vinegar? A Guide to Precautions

January 5, 2026 •

4 min read

According to research published in the journal Diabetes Care, consuming vinegar can help moderate blood sugar levels. However, despite its potential health benefits, apple cider vinegar is not safe for everyone, and it's essential to understand the precautions and risks before incorporating it into your routine.

Quick Summary

An acidic home remedy, apple cider vinegar is unsafe for some individuals, particularly those with diabetes, digestive disorders like gastroparesis, and low potassium levels. The substance can also interact dangerously with medications and damage tooth enamel and the esophagus if not properly diluted.

Key Points

Diabetes Risk: ACV can cause dangerously low blood sugar (hypoglycemia) in individuals with diabetes, especially when combined with insulin or other medications.
Drug Interactions: ACV interacts with various medications, including diuretics, laxatives, and the heart medication digoxin, potentially causing dangerously low potassium levels.
Digestive Conditions: People with gastritis, ulcers, acid reflux (GERD), or gastroparesis should avoid ACV, as its high acidity can worsen symptoms and cause irritation.
Low Potassium: Individuals with low potassium (hypokalemia) should not consume ACV, as large doses can further decrease potassium levels, leading to serious muscle and heart issues.
Tooth Enamel Erosion: The high acidity of ACV can permanently damage tooth enamel, leading to sensitivity and decay, especially when consumed undiluted.
Throat Damage: Drinking undiluted ACV can cause irritation and even burns to the delicate lining of the esophagus and throat.
Pregnancy/Breastfeeding: Due to insufficient safety research, it is recommended that pregnant and breastfeeding women avoid medicinal doses of ACV.

Health Conditions That Prohibit Apple Cider Vinegar Use

While often touted as a natural remedy, apple cider vinegar (ACV) can be harmful to individuals with specific pre-existing health issues. The acetic acid that gives ACV its potential benefits also poses significant risks to those with certain chronic conditions.

Diabetes and Gastroparesis

One of the most important considerations is for individuals with diabetes, especially those with gastroparesis, a nerve disorder that affects stomach emptying. ACV can further slow down gastric emptying, causing food to sit in the stomach longer, which complicates blood sugar management. This delayed digestion can be particularly problematic for those with type 1 diabetes who rely on precise insulin timing relative to their meals. For any person with diabetes, combining ACV with insulin or other blood sugar-lowering medications like metformin or semaglutide could cause blood sugar levels to drop dangerously low, a condition known as hypoglycemia.

Low Potassium Levels (Hypokalemia)

Large, long-term doses of ACV have been linked to low potassium levels, or hypokalemia. This can cause symptoms ranging from muscle weakness and cramps to heart palpitations and irregular heart rhythms. Individuals already experiencing low potassium or those taking medications that affect potassium, such as diuretics, should not use ACV unless medically supervised.

Gastrointestinal Issues

Because of its high acidity, ACV can exacerbate existing digestive problems. People with a history of acid reflux, GERD, ulcers, or gastritis may find that ACV worsens their symptoms. Drinking undiluted ACV is particularly irritating and can cause burns to the esophagus and throat lining.

Pregnant or Breastfeeding Women

Medical professionals recommend that pregnant or breastfeeding women avoid taking ACV in medicinal or supplemental doses. While small amounts used in cooking are generally considered safe, there is a lack of reliable research on the effects of larger doses during these critical periods. It is best to err on the side of caution.

Comparison of Risks by Health Condition


Health Condition	Primary Risk from ACV	Why ACV Is Unsafe	How to Use Safely (If Possible)
Diabetes/Gastroparesis	Hypoglycemia and poor blood sugar control	Exacerbates delayed stomach emptying and interacts with diabetes medications.	Only under strict medical supervision and dose monitoring.
Low Potassium (Hypokalemia)	Worsened low potassium levels	Can lower potassium levels further, leading to muscle and heart problems.	Avoid altogether.
Digestive Disorders (GERD, Ulcers)	Irritation and inflammation of the GI tract	High acidity can trigger or worsen acid reflux and damage the esophagus.	Use sparingly and diluted, or avoid completely if symptoms worsen.
Heart Conditions	Digitalis toxicity from low potassium	Lowering potassium levels can interfere with heart medications like digoxin.	Must be monitored by a healthcare professional.
Pregnant/Breastfeeding	Insufficient safety research	Lack of data on effects on pregnancy or infants makes it a risk.	Stick to food amounts only, avoiding supplements.

Drug Interactions to Avoid with ACV

Beyond pre-existing conditions, ACV can interact with several common medications. Consulting a doctor or pharmacist is crucial if you are on any prescription drugs.

Diuretics ("water pills"): Medications like furosemide and hydrochlorothiazide are used to treat high blood pressure and heart failure but can cause a loss of potassium. Combining these with ACV can dangerously increase the risk of hypokalemia.
Laxatives: Certain stimulant laxatives, including bisacodyl, can also lead to potassium loss. Mixing them with ACV further increases the risk of low potassium.
Diabetes Medications: As mentioned, ACV can amplify the blood sugar-lowering effects of insulin, metformin, and other antidiabetic drugs, potentially leading to hypoglycemia.
Digoxin (Lanoxin): This heart medication has an increased risk of side effects if potassium levels are low. Since ACV can lower potassium, it can increase the risk of digitalis toxicity.

Protecting Your Body from ACV's Acidity

For those who can safely use ACV, proper consumption is key to avoiding issues like tooth enamel erosion and throat irritation. The highly acidic nature of vinegar poses a direct threat to dental health and the lining of the esophagus.

To minimize these risks, follow these guidelines:

Always dilute: Never drink undiluted apple cider vinegar. Mix a small amount, typically 1–2 tablespoons, in a large glass (at least 8 ounces) of water.
Use a straw: Drinking the diluted mixture through a straw can minimize contact with your teeth, protecting the enamel from the acid.
Rinse afterwards: After consuming, rinse your mouth with plain water to wash away any remaining acid.
Wait to brush: It is best to wait at least 30 minutes after drinking ACV before brushing your teeth. Brushing immediately after exposure to acid can cause further erosion.

Conclusion: Prioritize Safety Over Trends

While apple cider vinegar is a popular health fad with some research-backed benefits, its potent acidity and physiological effects mean it's not a safe choice for everyone. Individuals with diabetes, gastrointestinal issues, low potassium, heart conditions, or those who are pregnant or breastfeeding should exercise extreme caution or avoid it entirely. It is equally important to be aware of the numerous drug interactions that can occur with common medications. Before starting any new supplement, including ACV, it is best to consult a healthcare professional to ensure it is appropriate for your individual health needs and to avoid any adverse effects. Always prioritize your health and well-being over unverified health trends. For more information on health and wellness, visit reputable sources like the Cleveland Clinic.

Frequently Asked Questions

People with diabetes should consult their doctor before using apple cider vinegar, especially for weight loss. While some studies suggest it can lower blood sugar, it can also dangerously reduce blood sugar levels when combined with diabetes medications like insulin.

Individuals with heart conditions, particularly those on medications like digoxin, should avoid ACV unless supervised by a healthcare provider. ACV can lower potassium levels, which can increase the risk of digitalis toxicity associated with digoxin.

Yes, apple cider vinegar's high acidity can worsen symptoms of acid reflux, GERD, and other digestive issues like ulcers or gastritis. It is best for individuals with these conditions to avoid it or use it with extreme caution and in diluted form.

ACV can interact with diuretics (water pills), laxatives, diabetes medications (including insulin), and the heart medication digoxin. It is crucial to speak with a healthcare provider before combining ACV with any prescription drugs.

To prevent tooth enamel damage, always dilute ACV in a large glass of water, drink it through a straw to minimize tooth contact, and rinse your mouth with plain water afterward. Avoid brushing your teeth for at least 30 minutes after consumption.

For pregnant and breastfeeding women, experts recommend limiting apple cider vinegar to normal food amounts, such as in salad dressings. There is not enough research to confirm the safety of medicinal or supplement doses during these periods.

Yes, long-term consumption of large amounts of apple cider vinegar has been linked to low potassium levels (hypokalemia). This can lead to muscle weakness, fatigue, and heart problems.