Episode 346 - The Insulin Sensitivity Playbook: Vinegar and Glucose with Dr. Carol Johnston

Dr. Carol Johnston—Arizona State University nutrition professor and registered dietitian known online as “The Vinegar Lady”—joins Rob to break down what decades of research actually say about vinegar, blood glucose, and metabolic health. Johnston explains how her work began with an obscure 1988 rat study and led to a landmark 2004 Diabetes Care paper showing vinegar could blunt post-meal blood glucose spikes in people without diabetes, those with pre-diabetes, and those with type 2 diabetes. They dig into why vinegar still gets treated like “fringe” advice despite strong replication across countries—and why the mechanism overlaps with a major target of metformin.

The conversation gets highly practical: why liquid vinegar matters (pills don’t), how timing at the start of a meal changes outcomes, and the two core mechanisms—reduced starch digestion plus increased glucose uptake into muscle via GLUT4, similar to the effect of post-meal walking. Johnston also connects vinegar to the gut microbiome and acetate’s growing role in brain and energy metabolism, sharing her own routine (on vegetables) and emerging findings on cognitive/depression measures supported by metabolomics. You’ll also hear real-world implementations like homemade vinaigrettes (flip the ratio to 2:1 vinegar to oil), mustard as a stealth vinegar vehicle, and even “pickle sickles,” plus safety notes around dilution, enamel, and gastroparesis risk.

Chapters:

00:01 Intro: “The Vinegar Lady” + why vinegar is on the table for diabetes

01:35 Johnston’s background + why she studies simple, sustainable nutrition strategies

03:03 The 1988 rat study discovery → the first human trials with bagels + vinegar

04:32 Publishing in Diabetes Care (2004) + replication across the world

05:53 Why clinicians resist vinegar (“we have drugs for this”) + metformin overlap

10:28 Acetic acid, fermentation, and the gut microbiome connection (why it matters)

14:04 The two key mechanisms: starch digestion interference + faster muscle glucose uptake

22:46 Practical + safety: pills don’t work, dilution, enamel/aspiration risk, timing with meals

25:53 Johnston’s personal protocol + brain/cognition/depression angle + metabolomics support

46:47 Athletic applications: pickle juice, “pickle sickles,” mustard hack + where research goes next

Resources:

Carol Johnston’s Studies

Vinegar Decreses Postprandial Hyperglycemia in Individuals with T1D

Effect of apple cider vinegar on delayed gastric emptying in patients with T1D