Category: diet

Water

As infants our bodies are composed about 75% of water.  The percentage of water present decreases as we age.  By middle age we are about 60% water and by old age we are composed of about 55% water.  This water is found both within our cells (intracellular water), and outside of our cells (extracellular water).  Extracellular water can further be divided into the water found in our blood stream (plasma) and the water found in the spaces between our cells (interstitial).   More muscular individuals contain more total body water because muscle cells contain glycogen (sugar stored for energy use) and glycogen binds water.  In contrast, fat cells contain very little water, so individual with more fat tissue will have less total body water.

Water is integral to our health and well-being.  Humans can survive for up to 3 weeks without food, but without any water, death with ensue within days.  The location of the water within our bodies can be an indication of health status. For example, swelling in the legs and feet can be an indication of blood clots, cardiac disease, lymphatic disease, kidney disease or even infection.  In general, our water homeostasis (balance) is tightly controlled.   Some of the many  factors that affect the distribution of total body water include:

  • Kidney Function
  • Nutritional Status – (protein content in the blood)
  • Cardiac Function
  • Water loss (such as through sweating and breathing)
  • Specialized Receptor Function (can detect over-hydration or dehydration)
  • Hormone level

 

Recently, a significant amount of attention has been devoted to different types of water and the various health benefits.

There are several different types of commercially available water.

These include:

Tap Water:  water from the faucets that has been treated, purified and disinfected.  Can contain fluoride and chlorine

Bottled Water:  can be either bottled tap water, or water that is from a spring that has been purified

Purified water:  physically treated to remove impurities

Distilled water: water that is boiled and evaporated to remove dissolved minerals and then re-condensed without any minerals

Reverse Osmosis: usually acidic, water forced through membranes to remove large particles, pollutants and minerals

Alkaline water:  water that has been separated and contains electric charges such as those found in magnesium and calcium ions

Deionized or demineralized water:  minerals ions and impurities have been removed, but may still contain germs and bacteria

Soft water:  water that only contains sodium

Hard water:  any water with dissolved minerals

Alkaline water has been popping up on grocery shelves everywhere.  Pure water has a pH of 7.0.  Alkaline water has a pH of greater then 7.0, and acidic water has a pH less then 7.0.

 

What is pH and why is pH important?

pH is a measurement of the relative amount of free hydrogen ad hydroxyl ions in water.  When water has more free hydroxyl ions it is basic and when it has more fee hydrogen ions it is acidic. The pH of water is important because it determines the amount of a substance that can be dissolved in water, the amount of dissolved substances that are biologically available, and the the toxicity of heavy metals found in the water.  In general, heavy metals are more toxic at lower pH’s because of they are increasingly solubility (higher concentration of heavy metals can be dissolved in the water).

Our blood pH is tightly regulated between 7.35 and 7.45.  When our blood pH gets too high (alkaline) or too low (acidic) it can be very dangerous and even fatal.

Just like our bodies tightly control our water homeostasis, our bodies have numerous intricate mechanisms to maintain our blood pH in the very narrow optimal range.  When our blood pH is abnormal it is usually due to an underlying cause which needs to be further evaluated and treated appropriately.  We cannot change our blood pH dramatically just by controlling our intake of acidic and basic foods/waters (unless your body’s control mechanisms are severely malfunctioning).

The theory behind the use of alkaline water is that it is ionized and can serve as an antioxidant to counteract the acidity of your blood.   The theory is that this “acidity” can lead to conditions such as cancer, arthritis and other inflammatory issues.   This has not been definitively borne out in the literature to date.   At this time, it does not appear that alkaline water has enough support to promote it efficacy in cancer prevention.   Drinking it occasionally should not have any significant effect on your health and well-being.

What is most important is to make sure that you are drinking adequate amounts of water.  This recommendation varies some depending on your physical activity, kidney function, amount of water loss, medications, etc.  The current general recommendation is about 2.7 liters per day for women and 3.7 liters per day per men.  That being said, look at your urine, if you have no known kidney issues, and your urine is very dark that is an indication that you may need to increase your water intake.    If your water intake is not adequate you are at risk for dehydration.

Some side effects of dehydration include:

  • Decreased physical performance (can occur with just 2% dehydration)
  • Reduced endurance
  • Increased fatigue
  • Decreased motivation
  • Mood disruption
  • Impaired cognitive function
  • Decreased alertness, increased delirium
  • Decreased short term memory
  • Constipation
  • Impaired kidney function
  • Decreased blood pressure (can cause fainting, light-headness)
  • Headache
  • Poor skin complexion

The take home message at this time seems to be to drink filtered, purified water if possible with naturally occurring minerals but without contaminants (such as heavy metals, hormones, plastics, and antibiotics) and artificial sweeteners.  In addition, it is important not to store water in plastic bottles which when heated (left out in the sun) can release BPA and other potentially toxic compounds into our water.     Currently, it appears that spring water, mineral water or purchasing a filter for your tap water are the best choices.

 

 

 

Can You Calculate Nutritional Needs Based on Exercise Level?

The short answer to this questions is NO.  You cannot directly calculate your increased calorie allowance based on increased exercise levels.

This is because the equation Calories In = Calories Out is not entirely accurate.

While it is true that if you eat significantly more Calories then your body burns per day, then you will store these Calories as fat and likely gain weight.  This is because of the Law of Thermodynamics, which states that energy is neither created nor destroyed.    In addition, if you eat significantly less Calories then you burn per day, in theory you should lose weight.

However, the problem is that not all Calories are created equally.

Foods are processed via different biological pathways, and have different effects on complex hormones in the body.

For example, 100 Calories of protein consumed are not processed by your body the same way that 100 Calories of carbohydrates consumed are processed.

When you eat 100 Calories of protein, your body uses between 20-30% of those Calories just to chew, swallow and digest the proteins.  Therefore you are left with a net of 70-80 Calories for your body to burn or store.  In addition, eating protein provides your body with amino acids, which form the building blocks to make more muscle.  This muscle in turn is then able to burn more fat and boost the metabolic rate.    The protein also stimulates your satiety center, so you will feel full and satisfied.

In contrast, when you eat 100 Calories of carbohydrates (we will use fructose in this example) it only takes about 5-10% of those calories  to digest the fructose.  Therefore you are left with a net of 90-95 Calories for your body to utilize.  If your liver has room, it will store the fructose ultimately as glycogen.  However, if your stores are glycogen are full in the liver, then the body will convert the carbohydrates to fat and store them.   In addition, fructose raises insulin levels, a hormone which ultimately promotes fat storage,  and has no effect on decreasing hunger hormone ghrelin.  Therefore, you will likely still be hungry.   Furthermore, fructose can lead to insulin resistance, and increase your cholesterol and triglyceride levels and increase abdominal obesity.

With regard to fat metabolism, it takes only 0-3% of total Calories consumed to process fat.   Therefore, 100 Calories of fat results in a net of 97-100 Calories to be burned or stored by the body.  It is important to understand however that not all fats are bad, and they body needs fat for survival and brain function.   Trans fats lead to inflammation and insulin resistance.  However, good fats, can decrease inflammation and promote cardiovascular health.

When you diet, and begin to cut Calories, your body thinks you are starving, and will therefore decrease your metabolic rate to conserve energy.   A recent study done by Pontzer and colleagues and published on Jan 28 in Current Biology, found that for “less active people, energy expenditure increased alongside increases in physical activity.  But at higher levels of activity, calorie burn plateaued. “The body has a metabolic set point, which it works very hard to maintain.

The take home message from this study is in order to lose weight, it is more effective to focus on calorie intake, rather then increase activity above a certain point.

Not only is it important to limit calorie intake, but it is also important to eat the right types of Calories, at the right times, in the right portions.  This is because a proper diet is can optimize your nutrition obtained from high quality foods.  This in turn, positively impacts your body and targets weight loss hormones rather then promoting hormones which signal the body to store weight.

The Danger of Sugar in Our Diets

In the 1980’s and 1990’s we were all told to eat low fat because the fat in our foods was leading to obesity. It turns out that this may have been one of the greatest public health mistakes in the modern error.   Food companies jumped on the low fat bandwagon with fervor and quickly churned out tons of low fat products. Unfortunately, the fat in these products were replaced with sugars, artificial sweeteners and simple carbohydrates. When fat is removed from food, the food tastes bland. Therefore, companies add in “natural and artificial flavors” as well as sugars to improve the taste profile   The inclusion of artificial flavors, natural flavors, sugars, and sugar substitutes into our foods can be harmful to our health and well being.

Research has shown that it is not the fat consumption in our diets that leads to obesity, metabolic syndrome, impaired cholesterol levels, diabetes and heart disease, but the simple SUGARs.   It turns out that when we consume too much sugar, it is converted into fat and stored by the body. In addition, sugar consumption drives hunger and further sugar consumption. This is a negative cycle that is very difficult to break. This is because sugar consumption actually stimulates the centers in the brain that are activated in drug addiction and drug seeking behaviors.

We are all brainwashed into thinking we should be eating low fat, but current research shows this is absolutely incorrect. It is still prudent to keep the amount of fat we are eating to a reasonable amount, but more important then the amount of fat, is the type of fat we are eating.

Just the other day, I overheard a conversation on regarding which candies were the best choices if you were going to “cheat” during Halloween.   I heard, “eat a ‘Milky Way ®’ or a ‘Peppermint Patty ®’ because they have very little or no fat.”   While it is true that these candies are relatively low in fat, they are both very high in sugar. By eating simple sugar without fat, all you are doing is driving your hunger cravings.     Most of us remember the quote, “Snickers really satisfies you ®”.   In some sense, this is a true statement. That is because Snickers contain actual peanuts.   To be clear, I am not promoting eating Snickers, but just stating that the peanuts in the Snickers bar will provide protein and fat and offset some of the rapid blood sugar rise seen with other candy bars.

It appears that the fruit in sugars is not actually that good for us either. Fruits contain fructose, and excess fructose is turned into fat by our livers. In addition, too much fructose in our diets appears to be the driving force for metabolic syndrome (abdominal obesity, insulin resistance, impaired lipids, cardiac disease, etc).   So, does that mean we should avoid fruit in our diet? NO.   When eaten whole, rather then juiced, fruit provides us with many important nutrients, fibers and even fats (think avocado). Fruit consumed whole is digested by our bodies as a “whole package”. We are able to extract out important nutrients and utilize them appropriately.   On the other hand, fruit juice, is processed by our body the much same way as simple sugars found in candy.   If you are making smoothies or juice drinks it is important to use the whole fruit instead of just the liquid.

Complex carbohydrates are handled differently by our bodies because it takes more time for these molecules to be broken down.   Therefore, the sugar rise after eating a complex carbohydrate is slower and more consistent.

Getting back to the idea of low fat, it appears currently the best thing you can do for yourself is to allow yourself to eat good fats. In addition, to help with satiety (the feeling of fullness), fat is required for numerous functions in our bodies.

Why do we need to eat fat?

  • Fat serves an important energy source
  • Certain ‘essential fatty acids” cannot be made by our bodies and need to be consumed as part of our diets
  • Nerve cells are coated by fat as an insulation for proper electrical signaling in the brain and nervous system
  • All of our cell membranes have fatty acids in them – the type of fatty acids in the cell membrane determine the flexibility of our cell walls
  • Fat is required for proper immune function

As was mentioned in a previous article, fat can be broken down into several categories; Monounsaturated fatty acids (MUFA), Polyunsaturated (PUFA) and Saturated fatty acids (SFA).   We actually need a combination of all three types of fat in our diets.   It appears that monounsaturated fats such as those found in olive oil, nuts, seeds, and dark chocolate help our heart health and protect against chronic disease and inflammation.     Certain polyunsaturated fatty acids are also beneficial, particularly, those foods that contain Omega-3 Fatty acids.   This type of fat is found in salmon, chia seeds, walnut, flaxseeds, enriched egg yokes, natto (fermented soy) and cod liver oil.

The jury is still out with regard to saturated fatty acids. It remains true that trans-fats, such as those found in margarines, vegetable shortening and partially hydrogenated vegetable oils, are still associated with significant health problems. However, certain saturated fatty acids, such as those obtained from grass fed meats, grass fed butters appear beneficial. In a review article published in the Annals of Internal Medicine in March 2014 by Rajiv Chowdhury et al,, no link was identified between saturated fat and heart disease.

So, based on the most current research, it seems most prudent to significantly restrict your simple sugar intake, (including fructose and artificial sweeteners) and stick to whole, non-processed full fat foods.

What’s the Deal with Aspartame and Diet Soda?

I suffered from chronic daily headaches for about 8 years. The headaches were never terrible nor debilitating, but always present. It was as if I was in a constant state of fogginess. During medical school, I drank about 1 liter of diet soda every day while I studied. In residency, I switched to Crystal Light Iced Tea because I decided I needed to cut down on my soda intake. During one particularly busy week in residency, I ran out of my iced tea and was unable to make it to the grocery store. I didn’t realize it at first, but over the course of the week my ever-present headaches disappeared. By the end of the week, I was noticeably better and my fogginess had lifted completed. I wasn’t sure the reason, but I was certainly thrilled. Fast-forward to the next week when I was able to get to the grocery store, and all of a sudden my headaches returned.

It took me a while to make the association, but I ultimately figured out that 8 years of suffering, in my case, was due to aspartame consumption. I now avoid it like the plague and have had a negligible number of headaches over the last 12 years. That’s not to say that I don’t get headaches here or there but many of them I can trace back to eating foods, sweets or drinks which I didn’t realize at the time, contained aspartame.

Aspartame is one of the artificial sweeteners found in many diet sodas but is also being utilized as a sweetener in many foods such as:

  • Powdered drinks
  • Flavoring syrups for coffee
  • Sweetened iced teas
  • Fruit and vegetable juices
  • Flavored waters
  • Gums
  • Candies
  • Yogurt
  • Certain condiments and desserts
  • Meal replacement bars

Why is this an issue?

Aspartame is broken down by enzymes in our body into phenylalanine, aspartic acid, diketopiperzine, and methanol. These breakdown products can have significant effects of on our bodily functions and metabolism.

According to a review article published in the European Journal of Clinical Nutrition in 2009, aspartame can:

  • Disturb amino acid metabolism
  • Disturb protein structure and metabolism
  • Impair neuron functioning
  • Cause endocrine imbalances
  • Change the concentration of neurotransmitters in the brain
  • Cause excessive nerve firing in the brain
  • Compromise the function of the blood brain barrier
  • Affect fertility

In certain individuals, a byproduct of aspartame breakdown, methanol, can cause a toxicity that mimics fibromyalgia. Symptoms can include spasms, shooting pains, numbness in legs, cramps, vertigo, dizziness, headaches, tinnitus, joint pain, depression, anxiety, slurred speech, blurry vision and memory loss.

It is very important to prevent toxic substances from entering into our brain where they can cause inflammation and damage neurons. This is the role of the blood brain barrier. This barrier has transporters that allow important amino acids to cross into our brains to be used to make needed substances called neurotransmitters. These neurotransmitters are chemicals that allow communication between brain cells to control everything from our moods, and emotions to our sleep-wake cycles.

Essentially, what happens is that when we eat and drink foods with aspartame our bodies digest the aspartame into its components. The high levels of these breakdown products (particularly phenylalanine) can flood or overload the transporters in the brain and allow too much phenylalanine to get into the brain and prevent other needed amino acids from entering. This can lead to too much of certain neurotransmitters being produced while inhibiting the formation of others. These imbalances may influence or worsen diseases such as Parkinson’s, Multiple Sclerosis, and Epilepsy.

In addition to the neurological effects described above, multiple studies have shown that daily consumption of diet soda results in an increased risk of metabolic syndrome (a group of symptoms such as abdominal obesity, elevated blood pressure, elevated fasting blood sugar levels which raise your risk for heart disease) as well as type II diabetes. Specifically, a study done collectively by Columbia University and the University of Miami, published in the Journal of General Internal Medicine in Sept 2012, followed diet soft drink consumption over 10 yearsand found that daily diet soft drink consumption led to an increase of vascular events such as stroke, heart attack or vascular disease. There was however, no increased risk seen with regular soda consumption or infrequent diet soda consumption.

Therefore, the take home message is that very infrequent diet soda and artificial sweetener consumption is probably okay unless you are like me and can’t tolerate even small amounts. If you suffer from chronic daily headaches, seizures, chronic fatigue, chronic pain, infertility, neurological diseases, or even autoimmune diseases, consumption of artificial sweeteners may be exacerbating your conditions. A trial of elimination of all artificial sweeteners may help to alleviate or even in some cases eliminate some of your symptoms.

How To Choose Your Foods?

The definition of organic is “relating to or derived from living matter”. With regard to the food industry, the definition of organic is somewhat vague. Organic foods are “produced by methods that comply with standards of organic farming”. The issue with this definition is that these standards are not in fact standardized and vary widely throughout the world. Generally speaking, organic farming is meant to protect the environment and allow for renewable resources, encourage the balance in ecological systems and conserve biodiversity. In addition, organic foods are supposed to be produced without solvents, synthetic food additives and irradiation, these standards still allow for some pesticides and fertilizers to be used.

By now, you have probably heard of the “Dirty Dozen Plus” and the “Clean 15″. The “Dirty Dozen Plus” are foods that are recommended to be organic, while the “Clean 15″ can be consumed despite production via conventional farming. These foods were found to have the highest pesticide load by Dr. Andrew Weil in conjunction with the Environmental Working Group (EWG).

The “Dirty Dozen Plus” – these should be organic when eaten

  • Apples
  • Peaches
  • Nectarines
  • Strawberries
  • Grapes
  • Celery
  • Spinach
  • Sweet Bell Peppers
  • Cucumbers
  • Cherry Tomatoes
  • Snap Peas (Imported)
  • Potatoes
  • Hot Peppers
  • Kale
  • Collard Greens

In contrast, the “Clean 15” foods were found to have acceptable levels of pesticides and at this time are felt to be o.k. to be consumed when farmed conventionally with regard to level of pesticides. These include:

  • Avocados
  • Sweet corn
  • Pineapples
  • Cabbage
  • Sweet Peas (frozen)
  • Onions
  • Asparagus
  • Mangoes
  • Papayas
  • Kiwi
  • Eggplant
  • Grapefruit
  • Cantaloupe (domestic)
  • Cauliflower
  • Sweet potatoes

The effects of pesticides are mixed according to the medical literature, and there is not definitive evidence on either side of the argument. One of the reasons for such disagreement is that we are all genetically different and pesticides and toxins affect us differently.

For example, there is genetic variation in a gene called the MTHFR gene. This gene (in combination with others) helps our body with detoxification. If you contain a specific combination of gene mutations, then you may have more difficulty with detoxifying then someone sitting right next to you. In this case, you may be very sensitive to pesticides, while your neighbor is not. Therefore, it would be important for you to eat mainly organic foods, but you neighbor may be able to tolerate a much higher pesticide load in his or her diet.

Some other factors to consider when purchasing foods:

Is the animal grass fed vs grain fed?
Grass fed animals tend to have a better fat profile, meaning more Omega-3 fatty acids (which are anti-inflammatory) vs Omega-6 fatty acids (which are inflammatory). Therefore, grass fed animal fats are healthier for us while grain fed animals skew the diet to be more inflammatory. This is especially important to consider in an individual with a chronic auto-immune disease such as arthritis, lupus, or even those who suffer from asthma.

Is the fish farmed or wild caught?
Not all farmed fish is equivalent. The major concern in the past with farm-raised fish is that they tend to be higher in contaminants such as mercury, PCB’s and antibiotics and lower in omega-3 fatty acids. Wild caught fish are found in their natural environment and are free to eat algae and other natural food sources. Another important concern is the type of fish you are eating. Larger, predatory fish such as salmon, swordfish, king mackerel, marlin, orange roughy, shark, tilefish, and ahi tuna all contain higher levels of mercury then do smaller fish. Therefore, it is important to limit your weekly consumption of such fish.

Recently, companies such as Whole Foods and Wegmans have raised the bar on their fish farming practices. The farmed fish are fed healthier diets enriched with algae, a raised in water that is more closely monitored for contaminants and do not allow the use of antibiotics in the water. In general, wild caught is currently still the best although wild caught fish has a greater carbon foot print.

The take home message is to know where the fish you are buying is coming from and the methods used to raise them. U.S. farmed fish are significantly safer then internationally farmed fish.

Does the food contain added hormones or antibiotics?
Often times antibiotics are used liberally to control the outbreak of diseases on farms and with livestock. The antibiotics can change the bacteria found in our GI tracts and may lead to a condition called gut “dysbiosis”. This alteration of bacteria in our gut has been theorized to contribute to multiple auto-immune conditions as well as anxiety, depression and schizophrenia. In addition, the overuse of antibiotics leads to bacterial resistance and the formation of “super bugs”. Avoiding food and water sources with antibiotics can lessen your exposure and prevent resistance.

Hormones are added to certain animals to make them gain weight faster and increase milk supply. The effects of exposure to chronic low levels of hormones is unknown however, several countries have banned the use of rBGH due to lack of certainty.

The best bet is to eat non-processed, locally sourced food with as few contaminants as possible. Cage free, grass fed, organic food without added hormones and antibiotics is definitely more expensive and will significantly impact your grocery bill. Therefore, it is important to make informed decisions about your food sources and vary your exposure to a multitude of environmental toxins. As far as genetics are concerned, there are blood tests available to look for genetic variations. Though these tests are not recommended for everyone, if you suffer from chronic diseases, fibromyalgia, it is possible they might be of benefit.

Should You Incorporate Apple Cider Vinegar Into Your Diet?

 

Recently apple cider vinegar has been garnering a fair amount of attention due to its possible health benefits. In order to provide you with the most up-to-date information, I decided to review the literature to find out if there is any scientific evidence to support these health claims. It appears that indeed there are some benefits to incorporating a small amount (1-2 Tablespoons) of apple cider vinegar into your diet, but adding more than that may be harmful.

Apple cider vinegar is made by crushing apples and collecting the liquid or cider. Bacteria and yeast are then added to this cider which causes the fruit sugars to ferment first into alcohol and ultimately, with the help of bacteria called acetobacter, into vinegar. Apple cider vinegar is more palatable then pure vinegar due to fact that is is made from apples. Regular vinegar is much more sour and made from the fermentation of grain alcohol. The benefits of apple cider vinegar are due to the acetic acid (vinegar) therefore in theory regular vinegar should be beneficial as well. The main issue is that regular vinegar is sour and harsh tasting.

Some of the benefits of apple cider vinegar consumption:

  • Increased satiety or feeling of fullness
  • Beneficial effect of fat levels in the blood
  • Decreased blood levels of triglycerides
  • Increased beneficial HDL cholesterol levels in the blood
  • Decreased LDL cholesterol levels in blood
  • Seems to prevent/lower risk for vascular disease/ plaque formation in the arteries
  • May help with oxidative stress (functions as a beneficial antioxidant)
  • Promotes glycogen synthesis (sugar storage, thus reducing blood sugar levels)

In a study done by Kondo T, et al, published in August 2009, it was found that Vinegar intake decreased body weight, body fat mass and serum triglyceride levels in obese Japanese individuals. These effects were fairly modest and on average individuals lost a few more pounds then the control subjects over a three-month time. It appears though, that this benefit only helped when the apple cider vinegar was consumed.

According to a study published by the American Diabetes Association in Diabetes Care, 2 Tablespoons of apple cider vinegar at bedtime taken with 1 ounce of cheese favorably impacted or decreased the waking blood sugar levels in patients with diabetes. These patients were given cheese because it was felt that a small amount of food was beneficial when taking the vinegar to prevent stomach upset. The fasting glucose levels improved by 4-8% as compared to controls.

It it theorized that vinegar slows down digestion in the stomach and causes delayed gastric emptying, which is usually beneficial. This is because by slowing gastric emptying, you are slowing down the rate of sugar being released into your blood stream. However, if you have a condition called Diabetic Gastroparesis (a problem with the nerves in the stomach leading to slowed or delayed digestion), it is not recommended to take apple cider vinegar because this can worsen your digestion.

Recommendations for consumption:

  • 1-2 Tablespoons at most per day (can be used as a salad dressing or mixed with other foods/liquids)
  • Drink either after meals or dilute with 8 ounces of water
  • Don’t consume on an empty stomach or you may get nausea, bloating or gas
  • Do not use the vinegar pills – there is a case report of a women with esophageal erosion (throat burns) due to the pill being stuck in her throat for several months

Potential side effects or complications:

  • May interact with certain medications, specifically:
    • Diabetic medications
    • Digoxin
    • Anti-hypertensive medications (blood pressure medications) such as diuretics
    • Any other medications which effect potassium levels
  • In a case study of a women who took 8 ounces per day for 6 years, she developed low potassium and osteoporosis (bone loss)
    • It is thought that too much vinegar consumption will take minerals from the bones to buffer the acidity and result in osteoporosis
  • May cause damage to tooth enamel due to acidity
  • May interfere with stomach emptying (called gastroparesis) and result in heartburn, bloating and nausea

In conclusion, there is scientific evidence that a modest intake of no more that 1-2 tablespoons of apple cider vinegar per day improves your blood sugar levels, helps you to feel fuller and thus consume less calories and improves the fat profile of your blood to decrease your risk for stroke and heart disease. As always if you are taking medications or have diabetes check with your physician to make sure this is safe addition to your diet.