Benutzerspezifische Werkzeuge

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Veröffentlichungen • Vinegar drink to improve iron-status during pregnancy

U. Heins, C. Koebnick, C. Leitzmann
Poster for the 10th International Symposium on Trace Elements in Man and Animal, Evian, France 1999



Iron-deficiency anemia is common among young women. Many pregnancies start with diminished iron stores. If the increased need cannot be met by the usual diet, iron supplementation is given to prevent anemia (1). For women refusing iron supplements because of its side effects, some midwives recommend a vinegar drink to improve iron status during pregnancy.


To investigate the influence of vinegar on iron status of iron deficient pregnant and non-pregnant women.



27 pregnant (24th week of pregnancy 5) and 6 non-pregnant women with low iron status took a vinegar drink three times a day with their meals over 4 weeks instead of iron supplements. The drink consists of water, vinegar and honey (optional). Vinegar, honey and standardized spoons of 9 ml capacity were put to the disposal of our participants. Drinking vinegar drink over the time of 4 weeks, means to take 756 ml vinegar. The use of honey was optional. Participants were asked to measure water and vinegar carefully. Compliance was assessed by asking how much vinegar was left in the bottle at the end of the intervention period. The dietary iron intake was calculated on the base of two 4-day-estimated food records, which were completed from Sunday to Wednesday. Blood was taken before and after the intervention. Besides the usual parameters like hemoglobin, MCV, serum iron, ferritin and transferrin, zinc protoporphyrin (ZPP) was analysed, furthermore albumin to exclude protein deficiency. Additionally plasma was stored to analyse folate in case of macrocytic anemia. Because the concentration of hemoglobin, iron, ferritin and transferrin are influenced by physiological hemodilution during pregnancy these data are corrected on the assumption that hematokrit did not change. Data are shown as median and percentiles 25/75. The comparisons of two related variables were computed by Wilcoxons Signed Rank test. Correlations were estimated using Spearman´s Rho correlation coefficient.

Results and Discussion

ZPP is a minor metabolic by-product of heme synthesis. In iron deficiency it is produced instead of heme. Its concentration is measured in erythrocytes and is therefore independent of plasma dilution due to pregnancy (2). ZPP decreases significantly in all participants (pregnant p<0.001, non-pregnant p=0.046). Changes of the other parameters also give hints for an improvement of iron status even though they do not reach statistical significance (Table 1). The change of hemoglobin concentration shows no significance for pregnant women (p=0.081), probably because of the small number of participants; for pregnant and non-pregnant together, it does (p=0.025). The concentration of transferrin rises also during pregnancy. This is known to be physiological. The dietary iron intake does not correlate with the changes in iron status.According to these data a positive effect of the above-mentioned vinegar drink on iron status in pregnant as well as in non-pregnant women could be shown. This might be due to the reducing potency of the acid which improves the absorption of iron. This assumption is supported by a negative correlation between iron-status at the beginning and the change of ferritin and ZPP during intervention (3). The larger the iron stores at the beginning, the slower decreases ferritin during intervention (r=-0.829, p<0.0001). The higher the ZPP concentration at the beginning, the steeper the decrease of ZPP (r=-0.492, p=0.009) and the slower the decrease of ferritin during intervention (r=0.560, p=0.002). The change of ferritin concentration is also dependent on compliance. The less vinegar was left in the bottle, the less decreases ferritin for pregnant women (r=-0.643, p=0.005). The use of honey has no influence on iron parameters.


The positive effect of vinegar drink is more obvious for non-pregnant than for pregnant women. If pregnant women are already iron deficient, the vinegar drink alone is not sufficient to improve iron status. An intake before or at an earlier stage of pregnancy might prevent iron deficiency.



The authors gratefully acknowledge the support of

  • EDEN GmbH, Celle, Germany (provision of honey and vinegar)
  • Company Gossweiler, Ockenheim
    (provision of the Hematoflourometer, AVIV Biomedical Inc., to analyse ZPP)
  • all Gynaecologists (recruitment of participants)
  • and particular the pregnant and non-pregnant participants




pregnant (n=27)

. . . .

non-pregnant (n=6)

. beginning .

4 weeks later

. . . .



4 weeks later

Hemoglobin (g/L) 114 (110/119) . 115 (110/121) . . . . 121 (115/137) . 126 (114/140)
MCV (fl) 89 (86/94) . 91 (87/94) . . . . 89 (80/91) . 89 (81/92)
Iron (µg/dL) 84 (71/102) . 90 (64/109) . . . . 75 (50/90) . 79 (59/102)
Ferritin (ng/mL*) 7 (4/21) . 6 (4/12) . . . . 9 (4/25) . 12 (4/40)
Transferrin (g/L*) 3,9 (3,0/4,3) . 3,7 (3,1/4,6) . . . . 3,2 (3,0/3,7) . 3,0 (2,6/3,5)
ZPP (µmol/mol heme)** 31 (27/40) . 28 (24/35) . . . . 38 (26/90) . 32 (23/78)
* corrected by hematokrit
** p<0,0001 and 0,046














  1. Allen LH: Pregnancy and iron deficiency: Unresolved issues. Nutr Rev 55: 91-101.
  2. Hastka J, Lasserre JJ, Schwarzbeck A, Strauch M, Hehlmann R: Washing erythrocytes to remove interferents in measurements of zinc protoporphyrin by front-face hematoflourometry. Clin Chem 38: 2184-2189, 1992.
  3. Hallberg L, Hultén L, Gramatkowski E : Iron absorption from the whole diet in men: How effective is the regulation of iron absorption? Am J Clin Nutr 66: 347-356, 1997.

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