Diet 101: Low Calorie Condiments (Salt, Spices, Zero Cal. Sweeteners, Broth, Vinegar, Lemon Juice)

Updated: Jul 3



Hello everyone, Drew here, health & nutrition coach and personal trainer, hanging out in the kitchen, continuing the Diet 101 series. With this series we’re looking at healthy foods and beverages through a macronutrient lens, and today our topic is NO & LOW CALORIE CONDIMENTS. Today we’ll be looking at things like salt, baking soda, spices & herbs, zero calorie sweeteners (like stevia), low calorie soup broths, vinegar and lemon juice. Remember, to make it into this group the items must contain negligible amounts of proteins, fats or carbohydrates, if they contain any at all. Let’s start by looking at salt…


Salt is made up of two essential major minerals- sodium (which is 40% of salt) and chloride (which is 60% of salt). Both sodium and chloride are also electrolytes, and because they can carry an electric charge when present in the blood, they play a central role in the regulation of nerve and muscle functioning.

Salt often gets a bad rap when it comes to health, in part because it can increase blood volume, which can drive up blood pressure. However, this is often more a consequence of under-functioning kidneys, which play a central role in regulating the volume and electrolyte composition of body fluids, combined with deficiencies in other major minerals such as potassium and magnesium. An estimated 37 million Americans (or 15% of adults) have Chronic Kidney Disease, and 9 out of 10 of those with CKD don’t know they have it. Incredibly, 97% of Americans fail to meet the recommended dietary intake for potassium and 48-75% fail to meet the recommended intake for magnesium. [1-5]

Could it be that salt has unjustly been labelled the villain when it comes to hypertension and heart disease, when in reality it’s the widespread prevalence of kidney disease coupled with potassium and magnesium deficiencies that’s really to blame?


While much of the clinical literature is biased against salt, there are a few studies that discuss the numerous health benefits provided by proper amounts of dietary sodium and chloride, such as this 2018 study from the Journal of Experimental Neuroscience that highlights salt’s essential role in various physiological processes, including electrolyte homeostasis, nervous system functioning, muscle contraction and nutrient absorption. [6]


Speaking of nutrient absorption, chloride, salt’s lesser talked about partner to sodium, also plays a central role in the formation of hydro-CHLORIC acid (HCL) in the stomach. HCL functions as both a crucial digestive fluid and as vehicle for killing harmful microbes that are sometimes present in beverages, foods and saliva. [7]

Could it be that vilifying and overly restricting dietary salt has led to lower stomach acid levels, which has been linked to h. pylori infections and conditions like stomach ulcers, acid reflux and GERD?


Salt also has implications for the adrenal glands and plays a significant role in conditions like adrenal insufficiency (commonly called adrenal fatigue).

Over time, insufficient levels of dietary salt will negatively impact several basic metabolic processes, including nerve signaling and nutrient transport. In response, the body will stimulate other pathways to produce the needed energy to function. One of these pathways is hormonal and involves the adrenal glands (which sit on top of the kidneys) and adrenal hormones like cortisol and adrenaline (aka epinephrine). If the adrenal gland is continually over-stimulated, then, over time, adrenal insufficiency will result, and levels of several adrenal hormones, including cortisol, will drop. Combine a low salt diet with a high stress lifestyle and you have a formula for the accelerated development of adrenal insufficiency and low energy levels.



Conversely, the stress hormone cortisol plays a role in regulating sodium, and when cortisol levels are abnormally low (which is often the case with the latter stages of adrenal fatigue), then often the body’s retention of sodium also drops, resulting in lower blood sodium levels. This often leads to low energy levels and increased cravings for salt. In other words, the feedback loop here doesn’t work without an adequate intake of salt.

To make matters even more complicated, nutritional ketosis (of which I’m a big fan of in certain situations) tends to accelerate sodium excretion by the kidneys. Put simply, the risk for dangerously low sodium levels, as well as adrenal insufficiency/fatigue, may be highest for those with chronically low salt intake, high stress levels and who are trying to eat a very low carb or keto diet. [8]


One very large 2014 study from the New England Journal of Medicine really seems to refute the dietary dogma of “less salt is better.” In this study, a group of international scientists collected urine samples from more than 100,000 adults in 17 countries, which included low, middle and high income countries. The scientists then observed the health status of the study participants for 4 years. What they found was that those consuming less than 4g a day of sodium (or 10g of salt per day) significantly increased their overall risk of death, to the point where those consuming around 1.8g of sodium per day (or 4.5g of salt) DOUBLED their risk of death.

While the study found that 4-6g of sodium/day (10-15g of salt) was ideal, even those with very high intakes, up to 12g sodium or 30g of salt per day, still only increased their mortality risk by roughly 40% (compared to 200% for those only consuming 4.5g of salt per day). [9]

The Institute of Medicine recommends that adults consume 1.5-2.3g of sodium per day (equiv. to 3.75-5.75g of salt).

The USDA and the US Dept of Health & Human Services also recommend adults limit their intake to no more than 2.3g of sodium/day (5.75g salt or about 1 tsp).

The WHO suggests consuming 2g of sodium per day (5g salt).

And the American Heart Association advises 1.5g of sodium or 3.75g of salt a day.

Americans average around 3.4g of sodium (or 8.5g of salt) per day.

If we consider the results from the 2014 PURE study we just talked about, the average American’s salt intake increases their risk of all-cause mortality by (drumroll)… about 10%. And that’s because it’s on the LOW end.

If Americans were to follow the advice of the IOM, USDA, WHO and AHA, they’d increase their risk of all-cause mortality by (drumroll)… anywhere from 40-250%! [8, 10]

Based on the clinical data, my advice to most healthy adults is to aim for that 4-6g range for sodium, daily (which equates to 10-15g or around 2 tsp of salt/day). If your kidneys are under-functioning, you’re dealing with hypertension or edema or you suspect you have potassium and/or magnesium deficiencies, I’d encourage you to first spend some time trying to improve your kidney health and potassium/magnesium levels before drastically increasing your sodium and salt intake. For those without major kidney or cardiovascular issues who may be dealing with gastric or adrenal insufficiencies, you may benefit from an even higher intake of sodium and salt, at least temporarily.


Again, contrary to popular opinion, studies have found that hypo-natremia, or low sodium levels in the blood, is actually much more common than hyper-natremia, or high blood serum sodium levels. And even in the majority of hypernatremia cases, the condition is rarely caused by excessive sodium intake. [11]


With salt, I generally recommend a high-quality unrefined salt such as a Himalayan pink salt, Celtic Sea Salt or Redmond’s Real Salt. For a deeper dive into the many health benefits of salt, check out Dr. David Brownstein’s 2006 book Salt Your Way to Health, or James DiNicolantonio’s 2017 book The Salt Fix.


After salt, we turn to baking soda. Also known as sodium bicarbonate, baking soda is another high-sodium no-calorie kitchen staple. While commonly used as a leavening agent in baked goods, sodium bicarb has also been used historically to combat dyspepsia or indigestion. Additionally, several studies have shown that sodium bicarbonate improves kidney health markers and halts the progression of chronic kidney disease (CKD). [12-14]

While baking soda has a multitude of uses, its effects on physical and sports performance is where much of the clinical research lies. For instance, there’s this 2016 review from the journal Current Sports Medicine Reports, which highlighted sodium bicarb’s effectiveness as an ergogenic aid at daily doses up to 5 tsp a day. Other studies have shown performance benefits uses doses of around 2 tsp/day.

For adults interested in oral sodium bicarbonate therapy (as in cases of indigestion, sub-optimal kidney health or as a performance aid), I’d suggest starting at ½ tsp mixed in a little water, just 1 time a day. A dose of 1 tsp taken 3x a day would be the maximum amount I’d feel comfortable recommending.

One of the difficulties with oral consumption of greater amounts of baking soda (i.e. >1 tsp) is that GI distress is a common side effect. Taking multiple, smaller doses is one strategy to combat this, as is not exercising shortly after consuming or using delayed release capsules (if you can find them). [15-22]

As far as specific brands go, I like the baking soda made by Bob’s Red Mill, but both Bob’s Red Mill and Arm & Hammer make high-quality, excipient-free baking soda products. [23]


Next we come to spices and fresh herbs. While serving sizes here are generally small, spices and herbs pack a substantial nutritional punch, in large part due to their incredible antioxidant effects.

Several spices and herbs have clinical data supporting their positive effects on health, including black pepper, turmeric, ginger, garlic, onion, saffron, cardamom, fenugreek, cayenne, mustard, wasabi, mint, rosemary, oregano, thyme, cinnamon & clove. [24-28]


For example, this 2017 study from the scientific journal Antioxidants highlighted the positive effects that many spices and herbs have against several conditions, including heart disease & hypertension, neurodegenerative diseases like Alzheimer’s, diabetes, gastrointestinal diseases, liver diseases, endocrine & hormonal disorders, obesity, bone diseases, immune system dysfunction, kidney diseases, and cellular damage & cancers. [29]


With spices I’d give special preference to turmeric and black pepper (which dramatically improves the bioavailability of turmeric), as well as cayenne, garlic and cinnamon.

I’d also emphasize the unique therapeutic potential of fresh herbs. If you’re an adventurous type and are looking to add an extra nutritional boost to your diet, try adding fresh raw basil leaves to your salad or even your smoothie. [30]


Next we turn to zero calorie sweeteners. This group includes natural sweeteners like stevia and monk fruit, as well as sugar alcohols like erythritol (usually made from corn) and xylitol (which is often derived from birch bark). Also known as non-nutritive sweeteners, there is a growing body of scientific evidence highlighting several benefits that come from regularly consuming these types of sweeteners, especially when compared with high glycemic load sweeteners like cane sugar and high fructose corn syrup. [31-33]

This 2019 study from the journal Advances in Nutrition discussed stevia, erythritol & xylitol. Stevia was found to be non-carcinogenic, and the fructans found in stevia were shown to stimulate the growth of lacto and bifido bacteria, which are important for bowel health. Sugar alcohols like erythritol and xylitol were found to be non-cariogenic, meaning they inhibit the bacteria that cause cavities in the teeth. The last several years I’ve used chewing gum sweetened with xylitol, like this one made by the company Spry. Erythritol and xylitol don’t interfere with blood sugar or insulin levels, making them safe for diabetics. Those with gastrointestinal disorders like IBS or Crohn’s disease should be a little more careful when ingesting larger amounts of sugar alcohols, especially xylitol, as abdominal discomfort, gas and laxative effects can occur. [34]

Other studies from 2007 and 2009 showed that Monk Fruit contains natural compounds that inhibit growth of dangerous oral bacteria and yeast, while also eliciting significant antioxidant effects. [35-36]


While we’re on the topic of non-nutritive sweeteners, there are 6 FDA-approved artificial sweeteners on the American market, including acesulfame potassium, advantame, aspartame (Equal), neotame, saccharin (Sweet 'N Low) and sucralose (Splenda). With the exception of saccharin, all were approved from 1981 to 2014.


While this is another area with lots of controversy and conflicting data, an increasing amount of research is highlighting some of the negative effects linked with consumption of artificial sweeteners, including this 2018 review from the journal Molecules, which found that “Consumption of artificial sweeteners has been linked with adverse effects such as cancer, weight gain, metabolic disorders, type-2 diabetes and alteration of gut microbiota activity.” [37-39]

I’d stay away from these artificial sweeteners, in favor of those like stevia, monk fruit and erythritol.

Like salt, spices and the 4 zero-calorie, healthy sweeteners I previously mentioned, soup broth is another item that can be classed into the no & low calorie camp (although some store-bought soup broths will have notable amounts of protein). And while there are a relatively small number of published studies on the health benefits of chicken soup, there are even fewer on the health effects of low calorie broth.

I did find this 1978 study in the scientific journal CHEST (a periodical that covers heart & lung-related issues), which found that sipping hot chicken soup broth increased mucus flow and the clearing of nasal passageways significantly better than sipping either cold or hot water. And then there’s a 2018 animal study that found that drinking chicken broth liquid helped reduce inflammation in cases of temporomandibular disorder. [40-41]

As we wind down the conversation on no and low calorie items, we come to vinegar, which includes apple cider vinegar and vinegar-based condiments like mustard & hot sauce. If we look at the scientific literature, there are quite a few studies that discuss the health benefits of vinegar and acetic acid, which is one of the main organic acids found in vinegar.

For example, there’s this 2009 study from the journal Bioscience, Biotechnology & Biochemistry that found consuming 1 tbsp of vinegar 2 times a day significantly reduced weight, body fat and triglyceride levels in obese adults. Other studies have shown that consuming 2-6 tbsp of vinegar a day elicits significantly beneficial effects on blood sugar levels and glycemic profile. [42-43]


Still other studies have shown that regular consumption of vinegar and acetic acid elicits antioxidant, antitumor, antimicrobial, antihypertensive and cholesterol-lowering effects on the body, in addition to reducing the risk of kidney stones. [44-45]

I should mention that, with vinegar, you’ll want to limit the amount of time it comes into contact with your teeth. This is true of any food or beverage with a pH under 5, and with a pH of 2-3 apple cider vinegar definitely falls into this camp.

And lastly we come to lemon juice.


There are a few studies on lemon juice and citric acid out there (citric acid is an organic acid found in high amounts in lemon and lime juices). A 2014 study found that consuming 4 oz of lemon juice a day was shown to significantly improve kidney health markers, and this 2008 study in the journal Urological Research found that lemon juice can be an alternative treatment for calcium-based kidney stones. Note that lemon juice has a pH of around 2, and like vinegar, can erode tooth enamel if prolonged or repeated contact is allowed. [46-47]

Before wrapping up I should mention that certain preservatives (such as MSG, sodium benzoate and some sulfites) as well as thickeners (like carrageenan) and artificial colors and flavors also technically fall into the no & low calorie camp. As you might guess I recommend avoiding these kinds of preservatives, thickeners & artificial additives whenever possible, as studies like this one, from a 2014 edition of Current Obesity Reports, has linked items like these to obesity and other common health conditions. One easy way to avoid these items is to practice a habit of reading ingredient labels. [48]

SUMMARY

Well that finally wraps the discussion for these no & low calorie items! Let’s sum up what we’ve learned…

With salt, I generally recommend a higher salt diet (10-15g/day total), especially for those dealing with stomach or adrenal issues. That said, if a person is dealing with kidney disease, hypertension or any edema or swelling, I’d first suggest a kidney support protocol, possibly coupled with potassium and magnesium supplementation before significantly increasing dietary salt intake.

In addition to its use as a leavening agent, baking soda (i.e. sodium bicarbonate) can also be used to combat mild dyspepsia, and several studies have highlighted its benefits in improving kidney health and physical performance. I advise that most start with ½ tsp/day (in 1 dose) and titrate up to as high as 3 tsp/day, in divided doses, as gastric response allows.

Spices and fresh herbs are antioxidant powerhouses. Use liberally! Personally, I’m partial to the health benefits associated with black pepper, turmeric, cayenne, garlic, cinnamon and fresh basil leaves.

With natural zero calorie sweeteners, we reviewed their positive effects on blood sugar & insulin markers, making them safe for diabetics. We also looked at their positive effects on intestinal, oral and dental health. Personally, I’m partial to stevia and monk fruit, although I think erythritol is fine in moderate amounts. I would caution against consuming significant amounts of xylitol.

While there’s a paucity of clinical data on the health effects of low calorie soup broth, we did find 2 studies showing positive effects on both respiratory health and inflammation.

With vinegar, consuming 1-2 tbsp 1-3 times a day has been clinically shown to positively influence several metabolic markers; just limit how long it comes into contact with your teeth.

With lemon juice, we saw that consuming 2-4 tbsp (or 1-2 oz) up to 3 times a day can have positive effects on kidney health, including kidney stones.

And we briefly touched on the problems associated with certain zero calorie preservatives, thickeners and artificial additives.

Since this wraps a relatively long discussion of no & low calorie items (which includes the low calorie beverages and non-starchy veggies I discussed in previous articles & videos), I should mention that practicing healthy habits with these items tends to work best when paired with a smart, comprehensive, personalized nutritional approach.


While there are many tools in the nutritional toolbox, these 6 are the ones I find give people the best results: staying hydrated, taking therapeutic doses of supplements for your specific needs, reducing allergenic & inflammatory items (ex. Paleo diet), balancing macronutrient intake (which for many may involve significant carb restriction or keto), practicing healthy meal frequency & timing (which may include intermittent fasting) and practicing healthy portion control (which may include a habit of eating until no more than 80% full).

I also regularly suggest people take advantage of nutritional tracking apps, such as MyFitnessPal. As the old saying goes “It’s hard to manage what you don’t measure,” and tracking apps like these help increase dietary awareness and provide detailed feedback on important factors such as macronutrient intake.

Well that’s it for today’s topic. I hope you learned something helpful! If you liked this video, please hit the like & subscribe buttons & be sure to turn on the notification bell so you’ll know when the next video drops. Next in this series we’ll be looking at HIGH PROTEIN ITEMS, which includes things like collagen, whey and vegan protein powders as well as eggs, fish, poultry and red meat, in addition to organ meats, pork, shellfish and soy protein products. It’s gonna be a good one so keep your eyes peeled for that.

If you’re interested in holistic health & nutrition coaching or holistic personal training, reach out to me. I’d love to help! Until next time…

SOURCES

1 www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html (37 million Americans with Chronic Kidney Disease)

2 www.ncbi.nlm.nih.gov/pmc/articles/PMC3650509/ (2013 review on potassium & health; only 3% of Americans meet recommended intake)

3 https://jaoa.org/article.aspx?articleid=2673882 (2018; citing 2005-06 data found that up to 48% of US population deficient in magnesium)

4 www.thorne.com/take-5-daily/article/who-is-at-risk-for-magnesium-deficiency (2018; 55% below RDA and 20% well below RDA for magnesium)

5 www.aafp.org/afp/2009/0715/p157.html#afp20090715p157-b2 (2009 article citing early 1990s data showing 75% of Americans don’t meet daily intake for magnesium)

6 www.ncbi.nlm.nih.gov/pmc/articles/PMC6249657/ (2018; “Salt (NaCl) is an essential nutrient required for various physiological processes, including electrolyte homeostasis, neuronal activity, nutrient absorption, and muscle contraction.”)

7 https://humannaturellc.com/blogs/news/when-salt-restriction-backfires (salt’s role in HCL production)

8 www.virtahealth.com/blog/sodium-nutritional-ketosis-keto-flu-adrenal-function (2017; health benefits of salt, including analysis of the 2014 PURE study findings)

9 www.nejm.org/doi/full/10.1056/nejmoa1311889 (2014 salt & mortality study of >100,000 participants from 17 countries)

10 www.healthline.com/nutrition/sodium-per-day (2018; information on salt/sodium guidelines from several health organizations)

11 https://lpi.oregonstate.edu/mic/minerals/sodium (review of clinical data on sodium)

12 www.ncbi.nlm.nih.gov/pubmed/30220653 (2018; in both clinical & experimental studies sodium bicarb has been shown to improve GFR and halt the progression toward end stage renal disease)

13 https://academic.oup.com/ndt/article/27/8/3056/1817928 (2012; use of baking soda in patients w/ early to advanced CKD has proved to be reno-protective)

14 www.ncbi.nlm.nih.gov/pmc/articles/PMC3580168/ (2012; systematic review of short and long-term effects of sodium bicarb therapy on chronic kidney disease [CKD] found sodium bicarb therapy associated w/ an improvement in kidney function, which may slow the progression of CKD)

15 www.ncbi.nlm.nih.gov/pubmed/30680463 (2019; sodium bicarb is well-established ergogenic aid but GI distress is common side effect; delayed-release capsules can mitigate GI symptoms that come with aqueous solution)

16 www.ncbi.nlm.nih.gov/pmc/articles/PMC5957406/ (2018; small study of 21 CrossFit participants over 10 days found 150mg per kg sodium bicarb [roughly 2 tsp/day for 150lbs person or 2.75 tsp/day for 200lbs person] improved fitness performance)

17 www.ncbi.nlm.nih.gov/pubmed/27399820 (2016; sodium bicarb as an effective ergogenic aid; suggested therapeutic dose is 300mg per kg [or roughly 4 tsp/day for 150lbs person or 5.5 tsp/day for 200lbs person])

18 www.ncbi.nlm.nih.gov/pmc/articles/PMC4475610/ (2015; small study of 13 men in their early 20s found sodium bicarb improved high-intensity intermittent training [HIIT] performance, and lowered rate of perceived exertion)

19 www.ncbi.nlm.nih.gov/pmc/articles/PMC3641618/ (2013; sodium bicarb supplementation results in increase in serum bicarb and improves lower body strength after short-term intervention in CKD patients w/ mild acidosis)

20 www.ncbi.nlm.nih.gov/pubmed/23323673 (2013; sodium bicarb ingestions improves cycling performance, in part due to attenuation of ratings of perceived exertion)

21 www.ncbi.nlm.nih.gov/pubmed/21964428 (2012; small study of 8 men found that ingesting sodium bicarb 3 hrs before physical exertion reduced likelihood of GI distress when compared to ingesting 1 hr or 2 hrs before exertion, without sacrificing ergogenic benefits)

22 www.ncbi.nlm.nih.gov/pubmed/2849539 (1988; pre exercise administration of sodium bicarb improves performance in interval swimming)

23 www.thepinkelephantspeaks.com/post/is-all-baking-soda-the-same (comparison of different types of baking soda)

24 www.ncbi.nlm.nih.gov/pmc/articles/PMC6334595/ (2019; review of herbs and their impact on diabetes, Alzheimer’s and aging)

25 https://pubmed.ncbi.nlm.nih.gov/29181579/ (2018 study showing consumption of fresh herbs linked to reduced risk of alopecia (hair loss) in males)

26 www.ncbi.nlm.nih.gov/pmc/articles/PMC6266658/ (2018; “In this review, we focused on the potential protective effects of specific nutrients from spices, such as pepper, ginger, garlic, onion, cinnamon and chili, in atherosclerosis and atherosclerotic cardiovascular disease.)

27 www.ncbi.nlm.nih.gov/pmc/articles/PMC4997408/ (2016 anti-cancer effects of several spices)

28 www.ncbi.nlm.nih.gov/pmc/articles/PMC2771684/ (2008; anti-microbial, antioxidant, and anti-tumorigenic properties of herbs and spices… and likely anticancer contributions.)

29 www.ncbi.nlm.nih.gov/pmc/articles/PMC5618098/ (2017; “Based on the reviewed literature, we know that spices…can also protect people from acute and chronic diseases, due to their high antioxidant activity.”)

30 www.medicalnewstoday.com/articles/266425 (2019; evidence-based benefits of basil)

31 www.ncbi.nlm.nih.gov/pmc/articles/PMC5011233/ (2016; erythritol superior to xylitol in preventing dental cavities)

32 www.ncbi.nlm.nih.gov/pmc/articles/PMC4229159/ (2014; review of health effects of stevia, erythritol and xylitol)

33 www.ncbi.nlm.nih.gov/pmc/articles/PMC3296175/ (2012; review of health effects of stevia, erythritol and xylitol)

34 www.ncbi.nlm.nih.gov/pmc/articles/PMC6363527/ (2019; review of health effects of stevia and erythritol)

35 https://pubmed.ncbi.nlm.nih.gov/20183321/ (2009 study on Monk Fruit)

36 https://pubmed.ncbi.nlm.nih.gov/17852496/ (2007 study on Monk Fruit)

37 www.ncbi.nlm.nih.gov/pmc/articles/PMC6222326/ (2018; “Consumption of artificial sweeteners has been linked with adverse effects such as cancer, weight gain, metabolic disorders, type-2 diabetes and alteration of gut microbiota activity.”)

38 www.ncbi.nlm.nih.gov/pmc/articles/PMC4899993/ (2016; “There is a lack of properly designed randomized controlled studies to assess their efficacy in different populations, whereas observational studies often remain confounded due to reverse causality and often yield opposite findings... The overall use of NNS remains controversial, and consumers should be amply informed about the potential risks of using them, based on current evidence-based dietary guidelines.)

39 www.ncbi.nlm.nih.gov/pmc/articles/PMC4661066/ (2015; “data from several epidemiological studies have found that consumption of NNS, mainly in diet sodas, is associated with increased risk to develop obesity, metabolic syndrome, and type 2 diabetes”)

40 www.ncbi.nlm.nih.gov/pubmed/359266 (1978 study of 15 people found that sipping hot chicken soup increased mucus flow (thus clearing nasal passageways) significantly better than sipping either cold or hot water)

41 www.ncbi.nlm.nih.gov/pmc/articles/PMC7001769/ (2018 rat study found chicken broth liquid helped reduce inflammation in TMD/TMJ cases)

42 www.jstage.jst.go.jp/article/bbb/73/8/73_90231/_pdf (2009; study of 175 obese Japanese found vinegar [~1 tbsp 2x a day] reduces body weight, body fat and triglyceride levels)

43 www.sciencedirect.com/science/article/abs/pii/S2405457719303055 (2019; apple cider vinegar intake has beneficial effect on glycemic profile; consumption of 2-6 tbsp of vinegar appears to be adequate to acutely alter glycemic profile)

44 www.ncbi.nlm.nih.gov/pmc/articles/PMC6642359/ (2019; daily intake of vinegar reduced stone recurrence, increased citrate & reduced calcium in urinary excretion in CaOx stone formers without adverse side effects)

45 https://onlinelibrary.wiley.com/doi/full/10.1111/1750-3841.12434 (2014; therapeutic effect of vinegar arise from compounds like acetic acid, gallic acid and others; these compounds have antioxidative, antidiabetic, antimicrobial, antitumor, antiobesity, antihypertensive and cholesterol-lowering effects)

46 www.ncbi.nlm.nih.gov/pmc/articles/PMC4265710/ (2014; “Patients with low urinary citrate should be encouraged to increase their consumption of foods high in citric acid, such as lemon and lime juice. Consuming just 4 oz of lemon juice/day has been shown to significantly increase urine citrate levels without increasing oxalate levels”)

47 www.ncbi.nlm.nih.gov/pubmed/18946667 (2008; “lemon juice can be an alternative in the treatment of urinary calcium stones in patients with hypocitraturia”)

48 www.ncbi.nlm.nih.gov/pmc/articles/PMC4101898/ (2014 review that highlighted the role several dietary additives play in obesity & other common conditions)

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