Balsamic vinegar: the acid is tested, the bottle is a blend

Across 16 randomised trials in 910 adults, 750 to 3600 mg of acetic acid a day for about 8 weeks lowered triglycerides by 20.51 mg/dL (95% CI 8.04 to 32.98) in overweight and obese adults. In people with type 2 diabetes the same review found triglycerides down 7.37 mg/dL (95% CI 4.59 to 10.15) and fasting glucose down 35.73 mg/dL (95% CI 7.67 to 63.79), with no change in HbA1c, HDL or any body measure. Its authors rate most of those 16 studies at unclear or high risk of bias, five of them never stated the dose, and none measured blood acetate. For scale, a separate 4-week trial further down this page counted 2.95 g of acetic acid a day, near the top of that range, as about four tablespoons of vinegar. That is the strongest finding on this page, and it belongs to the acid. We found no trial of balsamic vinegar itself, so what follows comes from vinegar research and from the EU rule that owns the name. Under that rule, Aceto Balsamico di Modena PGI is a blend. Boiled or concentrated grape must has to be at least 20 percent of the volume sent for processing, and up to 2 percent caramel may be added for colour. The blend also takes in a vinegar aged at least 10 years and at least 10 percent vinegar made by acidifying wine. A bottle sold simply as balsamic vinegar, or as a glaze, sits outside that specification altogether.

The numbers, per 100 g

How much is actually in it

• Under the EU specification for Aceto Balsamico di Modena PGI, boiled or concentrated grape must has to be at least 20 percent of the volume sent for processing, and up to 2 percent caramel may be added for colour. — the protected geographical indication Aceto Balsamico di Modena, EU law Evidence E source
  Minimum 20 percent boiled or concentrated grape must, maximum 2 percent caramel by volume of the end product
• The protected name covers a blend rather than one aged product: grape must, a quantity of vinegar aged at least 10 years, and at least 10 percent vinegar made by acidifying wine. — the protected geographical indication Aceto Balsamico di Modena, EU law Evidence E source
  At least 10 years of ageing for the aged vinegar component and at least 10 percent wine vinegar in the blend

What a real portion looks like

• Two teaspoons of vinegar, about 10 g, taken with a starchy meal lowered post-meal glucose by 20 percent against placebo, and did so most when it came at mealtime rather than 5 h before. — adults with and without type 2 diabetes, 9 to 10 per trial across four randomised crossover trials, bagel and juice or dextrose test meals (n = 38) Evidence B source
  About 20 percent lower postprandial glucose area under the curve against placebo, largest when vinegar was taken at mealtime rather than 5 h before, and no effect with monosaccharides or with sodium acetate

What cooking and storage change

• Rice eaten with vinegar-soaked dried apple cut the two-hour glucose area under the curve by 42.4 percent against plain rice in 15 healthy women. — 15 healthy young women in a randomised crossover trial, five equicarbohydrate rice meals (n = 15) Evidence B source
  42.4 percent lower incremental area under the curve over 120 min, 27.0 percent lower glucose peak and 29.7 percent smaller glycaemic excursion against the rice reference

What it does to your health

• Across 16 randomised trials and 910 adults taking 750 to 3600 mg of acetic acid a day for about 8 weeks, triglycerides fell in overweight adults and in type 2 diabetes, and fasting glucose fell in type 2 diabetes. — 910 adults in 16 randomised controlled trials, overweight or obese otherwise healthy people and people with type 2 diabetes, interventions of at least 1 week and averaging 8 weeks (n = 910) Evidence A source
  Triglycerides -20.51 mg/dL (95% CI -32.98 to -8.04) in overweight and obese adults and -7.37 mg/dL (95% CI -10.15 to -4.59) in type 2 diabetes, fasting glucose -35.73 mg/dL (95% CI -63.79 to -7.67) in type 2 diabetes, no change in HbA1c, HDL or body measures
• Four tablespoons of vinegar a day for 4 weeks lowered PHQ-9 depression scores by 42 percent against 18 percent on a vinegar pill, while the difference on the second depression scale was not significant. — healthy overweight adults taking 2.95 g acetic acid, about 4 tablespoons of vinegar, against 0.025 g acetic acid as one vinegar pill, for 4 weeks Evidence B source
  PHQ-9 down 42 percent against 18 percent, p = 0.036, and CES-D down 26 percent against 5 percent, not significant between groups

Safety, limits and interactions

• In 16 healthy adults vinegar did cut appetite, and it did so alongside significantly higher nausea ratings, with the least palatable drink suppressing appetite most. — 16 healthy young normal weight adults in an acute feeding study, and 14 in a sham feeding study of taste without swallowing (n = 30) Evidence B source
  Lower subjective and measured appetite after swallowing vinegar, together with higher nausea ratings, and no effect at all from taste alone

Who this works differently for

• Among 329 Greek eight-year-olds, a stated preference for lemon or vinegar went with more erosive wear on the permanent teeth (p = 0.041), alongside soft drinks. — 329 children aged 8 and 263 aged 14 in Greece, examined with the Basic Erosive Wear Examination index, risk factors by questionnaire (n = 592) Evidence C source
  Preference for lemon or vinegar significantly affected wear prevalence and BEWE scores in permanent teeth of 8-year-olds, p = 0.041, with soft drinks at p < 0.0001

What is still unknown

• In 16 adults with type 2 diabetes, vinegar added to a high glycaemic index meal cut the glucose area under the curve from 311 to 181 mmol min/l, and added to a low glycaemic index meal it changed nothing. — 16 patients with type 2 diabetes in two groups matched for age, sex and HbA1c, one high GI meal and one low GI meal, each eaten with and without vinegar (n = 16) Evidence B source
  Glucose incremental AUC over 120 min 181 +/- 78 against 311 +/- 124 mmol min/l with the high GI meal, P = 0.04, and 229 +/- 38 against 238 +/- 25 mmol min/l with the low GI meal, P = 0.56
• In 20 people without a stone history, a daily diluted apple cider vinegar drink for a week moved none of the 24-hour urine measures that predict stones, while coconut water raised urinary citrate by 273.8 mg per 24 h. — 20 non-stone formers, median age 31, randomised to two of four beverages for one week each with a two-week washout, 24-hour urine collections (n = 20) Evidence B source
  No significant change in 24-h urinary citrate, pH or volume with apple cider vinegar, against coconut water +273.8 mg/24 h (95% CI 67.9 to 480) and lemon water +167.7 mg/24 h (95% CI 16 to 319)

The bottom line

At the table, vinegar does one thing with some consistency, and it is small and short. Two teaspoons, about 10 g, taken with a starchy meal lowered the post-meal glucose curve by about 20 percent against placebo across four randomised crossover trials with 9 to 10 people each, and the same acetate given as a neutralised salt did nothing. The effect was largest when the vinegar came at mealtime rather than 5 h before, and these are two-hour curves rather than daily glucose control. It also depends on what the meal is. In 16 adults with type 2 diabetes, split into two groups of eight, vinegar with a high glycaemic index meal cut the two-hour glucose area from 311 to 181 mmol min/l (P = 0.04). With a low glycaemic index meal, in that same small trial, it changed nothing, 229 against 238 (P = 0.56). In 15 healthy young women, rice eaten with vinegar-soaked dried apple cut that curve by 42.4 percent against plain rice, though the fruit and the acid cannot be separated there and dried apple alone already cut it by 31.4 percent. Two other findings are worth less than the headlines they make. In healthy overweight adults, four tablespoons of vinegar a day for 4 weeks dropped PHQ-9 depression scores by 42 percent against 18 percent on a single vinegar pill (p = 0.036). On the CES-D scale the fall was 26 percent against 5 percent, and the difference between groups was not significant. Those are self-reported scales in people without a diagnosis, and the comparator was a very low dose rather than an inert placebo. In 20 people with no history of stones, a daily diluted apple cider vinegar drink for a week moved none of the 24-hour urine measures that predict stones, while coconut water raised urinary citrate by 273.8 mg per 24 h (95% CI 67.9 to 480). Six people finished the vinegar arm, nobody was blinded, and that trial used apple cider vinegar. Two cautions come out of the trials themselves. In 16 healthy young adults vinegar did cut appetite, measured and subjective alike, and it did so alongside significantly higher nausea ratings, with the least palatable drink suppressing appetite most. Tasting it without swallowing did nothing at all in the 14 people tested that way, and the authors of that acute study conclude that promoting vinegar as a natural appetite suppressant is not appropriate. The second caution is for teeth. Among 329 Greek eight-year-olds examined with an erosive wear index, a stated preference for lemon or vinegar went with more wear on the permanent teeth (p = 0.041), alongside soft drinks at p < 0.0001. That is a cross-sectional questionnaire, the preference covers lemon as well as vinegar, and it says nothing about how much or how often. What is missing is most of the page you might expect. We found nothing on balsamic vinegar in pregnancy, in children, with medicines, or on what heating and storage do to it, and the USDA holds a single record for the product with no sampling spread behind it. Treat it as flavour. The measured effects belong to the acid, in the amounts and with the meals listed above.

Sources

1. balsv-r2-09 · regulation
   The percentage of boiled and/or concentrated grape must should not be less than 20 % of the volume sent for processing...A maximum of 2 % by volume of end product of caramel may be added for colour stability.
   Commission Regulation (EC) No 583/2009, specification for Aceto Balsamico di Modena PGI · checked 2026-09-24
2. balsv-r2-10 · regulation
   'Aceto Balsamico di Modena' is obtained from grape must that is partially fermented and/or boiled and/or concentrated by adding a quantity of vinegar aged for at least 10 years and with the addition of at least 10 % of vinegar produced from the acidification of wine only.
   Commission Regulation (EC) No 583/2009, specification for Aceto Balsamico di Modena PGI · checked 2026-09-24
3. balsv-r2-03 · RCT, crossover, postprandial
   Two teaspoons of vinegar ( 10 g) effectively reduced PPG, and this effect was most pronounced when vinegar was ingested during mealtime as compared to 5 h before the meal...In these situations, vinegar attenuated PPG by 20% compared to placebo.
   Ann Nutr Metab, 2010 · checked 2026-09-24
4. balsv-r2-08 · RCT, crossover, postprandial
   whereas the VDA + R resulted 42.4%, 27.0%, and 29.7% reductions in the incremental area under the curve0-120, peak, and glycemic excursion, respectively
   Nutr Res, 2020 · checked 2026-09-24
5. balsv-r2-01 · meta-analysis of RCTs
   Sixteen studies were included, involving 910 participants who consumed between 750 and 3600 mg acetic acid daily in interventions lasting an average of 8 weeks...Supplementation with dietary acetic acid is well tolerated, has no adverse side effects, and has clinical potential to reduce plasma TAG and FBG concentrations in individuals with type 2 diabetes, and to reduce TAG levels in people who are overweight or obese.
   J Acad Nutr Diet, 2021 · checked 2026-09-24
6. balsv-r2-05 · RCT, 4 weeks
   At week 4, mean CES-D scores fell 26% and 5% for VIN and CON participants respectively, a non-significant difference between groups, and mean PHQ-9 scores fell 42% and 18% for VIN and CON participants (p = 0.036).
   Nutrients, 2024 · checked 2026-09-24
7. balsv-r2-04 · RCT, crossover, acute feeding
   In Study 1, ingestion of vinegar significantly reduced quantitative and subjective measures of appetite, which were accompanied by significantly higher nausea ratings, with unpalatable treatment having the greatest effect...On this basis the promotion of vinegar as a natural appetite suppressant does not seem appropriate.
   Int J Obes (Lond), 2014 · checked 2026-09-24
8. balsv-r2-07 · cross-sectional study
   In their permanent teeth, soft drink consumption (p < 0.0001) and preference for lemon/vinegar (p = 0.041) significantly affected wear prevalence and BEWE scores
   Caries Res, 2016 · checked 2026-09-24
9. balsv-r2-02 · RCT, postprandial meal test
   In group A, the incremental area under the curve of glucose (GiAUC(120)) was lower after the addition of vinegar (181+/-78 mmol min/l vs 311+/-124 mmol min/l, P=0.04)...In group B, the addition of vinegar did not affect either the GiAUC(120) (229+/-38 mmol min/l vs 238+/-25 mmol min/l, P=0.56)
   Eur J Clin Nutr, 2010 · checked 2026-09-24
10. balsv-r2-06 · RCT, crossover, 2026
    ACV did not significantly change 24-h urinary parameters. Coconut water (+ 273.8 mg/24 h, 95% CI 67.9-480 mg/24 h) and lemon water (+ 167.7 mg/24 h, 95% CI 16-319 mg/24 h) were associated with increased urinary citrate.
    Int Urol Nephrol, 2026 · checked 2026-09-24