Vinegar from the Point of View of Traditional Medicine

Farzollah Gholizadeh and Fariba Bayrami

The temperament of vinegar, its types, raw materials, useful components, how and when to use it, and answers to common questions.

Introduction

Vinegar is one of the oldest fermented products in human history. Many traditional schools of medicine (Persian-Greek medicine, Ayurveda, East Asian medicine and others) have valued it as a flavouring, a digestive aid and a substance that balances temperament. Modern science explains vinegar as the result of a two-stage fermentation: first, yeast turns sugars into alcohol; then, with oxygen, acetic acid bacteria turn the alcohol into acetic acid.

So anything that contains sugar, or starch that can be turned into sugar, can be made into vinegar. But the raw material and the quality of the fermentation affect both the taste and the biologically active compounds of the vinegar.

The temperament of vinegar in traditional medicine

Traditional medicine usually considers vinegar cold and dry. That is why it has been recommended to “calm heat”, to reduce thirst caused by heat, and to help digest heavy foods. This is part of a temperament-based system, where the most important principles are moderation and suiting the person’s temperament. Among the classical sources, Ibn Sina’s Al-Qanun fi al-Tibb is a key reference on temperament.

Historical texts do sometimes disagree about the temperament of certain substances, so in practice what matters most is how your body responds and how much you take.

Practical conclusions from traditional medicine:

• People with a hot temperament usually tolerate vinegar better.
• People with a cold temperament should take less, and take it in balancing mixtures such as sekanjabin (vinegar and honey syrup) or vinegar with grape molasses.

What is vinegar made from?

The rule is simple: the raw material must contain sugar, or starch that can be turned into sugar, and then go through the two-stage fermentation.

• Fruit: apple, grape, pomegranate, date, fig, mulberry, cornelian cherry, sour cherry, cherry, peach, nectarine, apricot, plum, banana, pineapple, citrus, mango, papaya, kiwi, coconut and others. Natural, less refined kinds usually contain more plant compounds (such as polyphenols).
• Grains and starchy sources: rice, barley/malt, wheat, maize, rye, potato and others (the starch is first turned into sugar, then fermented).
• Sugary substances and syrups: honey, sugar cane, molasses, grape/date/mulberry molasses, maple syrup, palm or coconut syrup, coconut water, and kombucha fermented fully into vinegar.
• Alcoholic fermented drinks: wine, beer and others become vinegar when turned into acetic acid in a controlled way.
• Vegetables: onion, garlic, carrot, beetroot, squash, celery, bell pepper and others. These usually need an extra source of sugar to ferment well.
• Flowers (edible ones only): rose, hibiscus, jasmine, orange blossom, apple blossom and others.
• Leaves and aromatic herbs: vine, fig, mulberry and apple leaves, mint, basil, thyme, rosemary, sage, lavender and others. These are usually used to flavour vinegar rather than as the main raw material.

What cannot be made into vinegar: oils and fats, sugar-free products, meat and dairy, and poisonous or unknown plants.

The useful components of vinegar

Vinegar is not just a “sour” liquid; it is a water-based solution of several organic compounds:

• Acetic acid: gives the main taste and the metabolic effect; usually 4–8%.
• Other organic acids: depend on the raw material (for example citric, tartaric or lactic acid).
• Polyphenols and antioxidants: found especially in natural fruit vinegars.
• Aromatic compounds: give each vinegar its own smell (as in balsamic vinegar).

General benefits for the body (supported by human studies)

Regulating blood sugar after meals. Studies show that vinegar taken with carbohydrate-rich meals can reduce the rise in blood sugar and insulin after eating.

Helping with appetite and weight control (a supporting effect). This is linked to slower stomach emptying and a greater feeling of fullness. The effect is limited, and it does not replace diet and physical activity.

Antimicrobial effect in food. Its acidity can limit the growth of some microorganisms. But there is no strong evidence that drinking vinegar treats infections.

Harms and limits

Vinegar is acidic, and too much can be harmful:

• with heavy use, damage to tooth enamel and irritation of the throat and oesophagus
• worse reflux or heartburn in sensitive people
• with long-term overuse, a risk of low potassium (especially together with certain medicines)

Types of vinegar and their uses

• Apple vinegar: lighter; used in small amounts in everyday cooking.
• Grape vinegar: more astringent; natural kinds partly keep the grape’s polyphenols.
• Pomegranate vinegar: in its natural form, a good antioxidant choice in the diet (not a treatment).
• Date vinegar: a softer taste; traditionally considered more balanced for some cold temperaments.
• Rice vinegar: milder acidity; may suit a sensitive stomach better.
• Balsamic or aged vinegar: a more complex aroma and a less sharp taste.
• Industrial white vinegar: mostly acetic acid and water, with few plant compounds; nutritionally not as good as natural fruit vinegars.

Which vinegars count as “hot” or “cold”?

By the traditional classification:

• Colder and drier: grape, apple, pomegranate and citrus vinegars
• More balanced or slightly warm: date vinegar, honey vinegar, and some herbal vinegars (such as garlic or thyme)

This classification follows the temperament of the raw material and how sour the vinegar is; in practice, your body’s response decides.

Vinegar and the joints, skin and sleep

Joints. Vinegar does not treat arthritis directly. Any effect is probably indirect, through less general inflammation and easier digestion.

Skin. Apple vinegar in particular is used in some home remedies to adjust the skin’s pH, but strong or undiluted use can cause irritation and chemical burns. Use it only well diluted and with care.

Sleep. Vinegar is not a sleep remedy. But taken with dinner, by steadying the blood sugar response, it may indirectly help some people sleep more comfortably.

Vinegars not suitable for daily use

• fully refined white vinegar
• very strong or harshly acidic vinegars (especially cleaning vinegars)

Fresh or aged?

Traditional sources usually consider aged vinegar more mature and gentler. From a food chemistry point of view, too, matured vinegars generally have a more complex aroma.

Does vinegar expire?

Because of its high acidity, vinegar keeps for a long time. Cloudiness or sediment in natural vinegar does not always mean it has spoiled; but if there is mould or a bad smell, do not use it.

How and when to use it

The golden rule: take vinegar with or after meals, in small amounts.

• Best time: with a salad or a meal, or after a meal.
• On an empty stomach: not recommended, especially for people with a cold temperament or a sensitive stomach.
• Amount: a little, regularly, is better than a lot, now and then.
• Protect your teeth: do not drink it undiluted, and rinse your mouth with water afterwards.

Conclusion

Traditional medicine usually considers vinegar cold and dry, and sees it as cooling and helpful for digestion. Modern science also shows that natural vinegar in particular can reduce the blood sugar response after meals and add a little to the feeling of fullness. But wrong use (undiluted, on an empty stomach, too much, for too long) can harm the stomach, oesophagus and teeth. The best way to benefit from vinegar is to use it with meals and in moderation.

Sources

1. Shishehbor F, Mansoori A, Shirani F. Vinegar consumption can attenuate postprandial glucose and insulin responses: a systematic review and meta-analysis of clinical trials. Diabetes Res Clin Pract. 2017;127:1–9.
2. Johnston CS, Gaas CA. Vinegar: medicinal uses and antiglycemic effect. MedGenMed. 2006;8(2):61.
3. Harvard T.H. Chan School of Public Health. The Nutrition Source: Vinegar.
4. Harvard Health Publishing. Does apple cider vinegar have any proven health benefits?
5. McGee H. On Food and Cooking: The Science and Lore of the Kitchen. New York: Scribner; 2004.
6. Avicenna (Ibn Sina). Al-Qanun fi al-Tibb (The Canon of Medicine). Chicago: Kazi Publications; 1999.
7. Najmabadi M. History of Persian Medicine. Tehran: Tehran University Press; 2012.
8. Gholizadeh F. Holistic Health and Natural Lifestyle. Tehran: Dr Kalan Publications; 2021.

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