Apple cider: unfiltered apple juice, and the risk when it is raw

American apple cider is unfiltered apple juice, often unpasteurised. It is not vinegar and not the alcoholic drink. No trial has tested cider by that name, so the closest evidence comes from cloudy apple juice. In a randomized crossover in 23 healthy adults, 17 fl oz (500 ml) a day of clear apple juice for 4 weeks raised LDL cholesterol by 6.9% compared with whole apples and pomace. Cloudy juice only trended 2.2% lower, which is a trend, short of a proven drop. A 248 g cup of cider carries about 114 calories and 23.9 g of sugars in the US survey database, with 2.2 mg of vitamin C and 250 mg of potassium, and that database files cider under apple juice with no separate analysis. The sharpest risk is raw cider. Three US outbreaks traced E. coli O157:H7 and Cryptosporidium to fresh pressed cider, and washing the apples did not stop it.

As people eat it, per 3.5 oz (100 g)

How much is actually in it

• In 20 young adults drinking 17 fl oz (500 ml) a day for 4 weeks, a cloudy apple juice rich in polyphenols but low in vitamin C raised insulin and HOMA, while a vitamin C-rich one raised plasma antioxidant activity. — 20 healthy adults aged 21-29 years, 2 x 250 mL/day of two cloudy apple juices, 4-week crossover periods (n = 20) Evidence B source
  Vitamin C-rich juice (60 mg/L, 510 mg catechin eq/L): FRAP up, P = 0.031; polyphenol-rich juice (22 mg/L vitamin C, 993 mg/L): plasma insulin and HOMA up, glutathione down, P < 0.05

What a real portion looks like

• A 248 g cup of apple cider carries about 114 calories and 23.9 g of sugars but only 2.2 mg of vitamin C in the US survey database. — USDA FNDDS Apple cider, food code 64101010 (fdc 2709319) (n = 4 measures) Evidence E source
  Per 100 g: 46 calories, total sugars 9.62 g, vitamin C 0.9 mg, potassium 101 mg; 248 g: 114.1 calories, 23.9 g sugars, 2.2 mg vitamin C, 250.5 mg potassium; 1 fl oz 31 g: 3.0 g sugars

What your body absorbs

• After 1.1 quarts (1 L) of apple juice, the rise in blood antioxidant activity in 12 healthy adults tracked uric acid from fructose, while plasma phenolics did not change, whether the juice was cloudy or stripped of polyphenols. — 12 healthy non-smoking adults, 1.1 quarts (1 L) clear, polyphenol-free clear or cloudy apple juice, or water, 4 hours of sampling (n = 12) Evidence B source
  FRAP and DPPH peaked at 1 hour after all juices, paralleled by serum uric acid; no significant change in plasma total phenolics or quercetin

What cooking and storage change

• In a 5 x 4 week crossover in 23 healthy adults, 17 fl oz (500 ml) a day of clear apple juice raised LDL cholesterol by 6.9% compared with whole apples and pomace, while cloudy juice trended 2.2% lower. — 23 healthy volunteers, whole apples 550 g, pomace 22 g, clear or cloudy juice 17 fl oz (500 ml) a day, or nothing, 4 weeks each (n = 23) Evidence B source
  LDL +6.9% clear juice vs whole apples and pomace; trends to lower LDL: whole apple 6.7%, pomace 7.9%, cloudy juice 2.2%; no effect on HDL, TAG, weight, blood pressure
• In a 1991 Massachusetts outbreak, E. coli O157:H7 illness was tied to one mill's unwashed, unpasteurized cider, and the bacteria survived 20 days in refrigerated cider. — 18 patients and 49 controls, southeastern Massachusetts, plus laboratory survival test (n = 67) Evidence C source
  Cider drinking OR 8.3 (95% CI 1.8 to 39.7); survival 20 days refrigerated, under 7 days with 0.1% sodium benzoate
• In a 1996 Connecticut E. coli O157:H7 outbreak of 14 patients from one brand of unpasteurized cider, washing and brushing the apples did not prevent contamination. — Connecticut residents, enhanced surveillance and case-control study, October 1996 (n = 14) Evidence C source
  14 outbreak-associated patients; matched OR undefined (95% CI 3.5 to infinity)

What it does to your health

• In 68 men with overweight (BMI 27 or more), 25 fl oz (750 ml) a day of cloudy apple juice for 4 weeks cut body fat by 1.0 point against 0.2 with a matched drink, with the effect seen only in one IL-6 genotype. — 68 non-smoking, non-diabetic men with BMI 27 or more, 750 mL/day cloudy apple juice (802.5 mg polyphenols) or isocaloric control, 4 weeks (n = 68) Evidence B source
  Percent body fat change -1.0 +/- 1.3 vs -0.2 +/- 0.9, p < 0.05; no effect on plasma lipids, BMI, waist; reduction only in IL-6 -174 C/C carriers

Safety, limits and interactions

• At a 1993 Maine school fair, drinking hand-pressed apple cider raised the risk of cryptosporidiosis 26-fold, with 54% of drinkers falling ill. — 611 fair attendees surveyed, students and staff, central Maine (n = 611) Evidence C source
  154 of 284 exposed (54%) vs 6 of 292 unexposed (2%); RR 26 (95% CI 12 to 59); secondary household transmission 15%

What people believe that the data does not support

• The EU rejected the claim that apple cider vinegar helps control body weight, a vinegar claim often attached to sweet apple cider by mistake. — EU Register on nutrition and health claims, substance Apple cider vinegar Evidence E source
  Status Non-authorized; all 4 apple cider vinegar claims in the register non-authorized, none for sweet cider

Who this works differently for

• US law requires packaged unpasteurized juice such as fresh cider to warn that it may cause serious illness in children, the elderly and people with weakened immunity, but cider sold by the glass at orchards needs no label. — packaged juice not processed to a 5-log pathogen reduction, US Evidence E source
  Mandatory boxed WARNING statement; exemption for 5-log processed juice and bulk juice; no label required for juice sold by the glass
• FDA says children, older adults, pregnant women and people with weakened immune systems risk serious illness or even death from drinking untreated juice. Packaged untreated juice or cider must carry a warning label, but cider sold by the glass at orchards, farmers markets and roadside stands does not need one. — children, older adults, pregnant women and people with weakened immune systems Evidence E source
  Untreated juice can cause serious illness or death in these groups; packaged untreated juice must carry a warning label, juice sold by the glass need not

The bottom line

The rest of the juice trials are small and short. In 68 non-diabetic men with a BMI of 27 or more, 25 fl oz (750 ml) a day of cloudy apple juice for 4 weeks cut body fat by 1.0 percentage point against 0.2 with a drink of equal calories. BMI, waist and blood lipids did not change, and the drop appeared only in men with one IL-6 genotype. In 20 adults aged 21 to 29 drinking 17 fl oz (500 ml) a day for 4 weeks, a cloudy juice rich in polyphenols but low in vitamin C raised plasma insulin and the HOMA insulin resistance score. A juice richer in vitamin C raised a marker of blood antioxidant activity instead. Juices on the shelf vary that much too. That antioxidant marker is weaker than it sounds. After 1.1 quarts (1 liter) of apple juice, 12 healthy adults showed a rise in blood antioxidant activity that tracked uric acid, and plasma phenolics did not change, even when the juice had its polyphenols stripped out. The EU rejected the claim that apple cider vinegar helps control body weight, and all four vinegar claims in its register are non-authorized. None of them concern sweet cider, which is a different product. Who should be careful. The warnings here come from outbreak studies of raw cider, and those outbreaks made ordinary adults and schoolchildren ill. In Massachusetts in 1991, 13 of 18 patients and 16 of 49 controls had drunk cider (odds ratio 8.3, 95% CI 1.8 to 39.7), all traced to one mill using unwashed apples, and the bacteria survived 20 days in refrigerated cider. At a Maine school fair in 1993, 154 of 284 people who drank hand pressed cider got cryptosporidiosis against 6 of 292 who did not (relative risk 26, 95% CI 12 to 59). In Connecticut in 1996 one brand of unpasteurised cider made 14 people ill, and washing and brushing the apples had not prevented it. US law makes packaged unpasteurised juice carry a warning that it can cause serious illness in children, the elderly and people with weakened immune systems. Cider sold by the glass at an orchard needs no such label. Juice treated to cut pathogens 100,000-fold, as pasteurized cider is, does not need the warning, so for children, older people and anyone with a weakened immune system the version these warnings point to is pasteurized cider. In these outbreaks washing the apples did not make raw cider safe, and the bacteria survived refrigeration. We have no card on raw cider in pregnancy, so pregnancy missing from the warning above does not mean raw cider is safe then. We found no study of cider in kidney disease or with medicines.

Sources

1. apcd-daily-r7-05 · RCT
   During the VCR period, plasma antioxidant activity (FRAP) increased (P = 0.031), while ICAM-1 and total cholesterol showed a trend to decrease (P = 0.060 and P = 0.094, respectively). During the PR period, plasma insulin and HOMA increased, and total glutathione decreased (P < 0.05).
   Eur J Nutr, 2014 · checked 2026-09-29
2. apcd-daily-r7-01 · reference dataset
   Apple cider, fdc 2709319: Energy 46 KCAL | Total Sugars 9.62 G | Vitamin C, total ascorbic acid 0.9 MG | Potassium, K 101 MG per 100 g | Quantity not specified 248 g | 1 fl oz (no ice) 31 g
   USDA FNDDS, Apple cider code 64101010 · checked 2026-09-29
3. apcd-daily-r7-04 · RCT
   This was paralleled by the rise of serum uric acid, but no significant changes in plasma total phenolics and quercetin levels were observed after all dietary interventions.
   J Am Coll Nutr, 2010 · checked 2026-09-29
4. apcd-daily-r7-02 · RCT
   Trends towards a lower serum LDL-concentration were observed after whole apple (6.7%), pomace (7.9%) and cloudy juice (2.2%) intake. On the other hand, LDL-cholesterol concentrations increased by 6.9% with clear juice compared to whole apples and pomace.
   Eur J Nutr, 2013 · checked 2026-09-29
5. apcd-daily-r7-06 · case-control
   Thirteen (72%) of 18 patients but only 16 (33%) of 49 controls reported drinking apple cider in the week before illness began (odds ratio [OR], 8.3; 95% confidence interval [CI], 1.8 to 39.7). ... In the laboratory, E coli O157:H7 organisms survived for 20 days in unpreserved refrigerated apple cider.
   JAMA, 1993 · checked 2026-09-29
6. apcd-daily-r7-08 · case-control
   This outbreak was associated with drinking one brand of unpasteurized apple cider. ... Washing and brushing apples did not prevent cider contamination.
   Epidemiol Infect, 2000 · checked 2026-09-29
7. apcd-daily-r7-03 · RCT
   However, CloA consumption significantly reduced percent body fat compared to CB (∆ % body fat: CloA: -1.0 ± 1.3 vs. CB: -0.2 ± 0.9, p < 0.05).
   Eur J Nutr, 2012 · checked 2026-09-29
8. apcd-daily-r7-07 · cohort
   Persons drinking apple cider that was hand pressed in the afternoon were at increased risk for cryptosporidiosis (154 [54%] of 284 exposed vs six [2%] of 292 unexposed; relative risk, 26; 95% confidence interval, 12 to 59).
   JAMA, 1994 · checked 2026-09-29
9. apcd-daily-r7-10 · regulatory decision
   POL-HC-6626 Apple cider vinegar Helps control and normalize body weight. Non-authorised
   EU Register on nutrition and health claims, claim POL-HC-6626, snapshot 2026-09-21 · checked 2026-09-29
10. apcd-daily-r7-09 · regulation
    WARNING: This product has not been pasteurized and, therefore, may contain harmful bacteria that can cause serious illness in children, the elderly, and persons with weakened immune systems.
    21 CFR 101.17(g), FDA juice warning statement · checked 2026-09-29
11. sf-juice-r6-2 · agency advice
    While most people’s immune systems can usually fight off the effects of foodborne illness, children, older adults, pregnant women, and people with weakened immune systems (such as transplant patients and individuals with HIV/AIDS, cancer, or diabetes) risk serious illnesses or even death from drinking untreated juices. ... These untreated products should be kept under refrigeration and are required to carry the following warning on the label: WARNING: This product has not been pasteurized and therefore may contain harmful bacteria that can cause serious illness in children, the elderly, and persons with weakened immune systems. However, FDA does not require warning labels for juice or cider that is sold by the glass – for example, at apple orchards, farmers’ markets, roadside stands, juice bars, and some restaurants.
    U.S. FDA, What You Need to Know About Juice Safety, content current as of 03/05/2024 · checked 2026-10-08