long - term hyperglycemia causes health problems including heart disease , eye , kidney , and nerve damage .
it is estimated that the number of people with diabetes will alter from 171 million to 336 million in the period 20002030 .
studies have shown that blood lipids are related to several factors such as lifestyle , diet , and smoking , body mass index ( bmi ) , waist circumference , physical activity , sex and age .
dyslipidemia consists of different abnormalities in lipid profile and is one of the main risk factors of several diseases such as cardiovascular disease ( cvd ) , diabetes mellitus , hypertension , stroke , or acute pancreatitis .
increasing its prevalence is related to unhealthy diet and lifestyle changes in the most developed and developing countries .
healthy diet and natural food are so important to prevention and sometime treatment of diseases . finding the beneficial natural ingredients
have been noted for prevention or treatment of metabolic disorders due to the expensive medications and the side effects of drugs .
recently , findings showed vinegar and acetic acid ( the main ingredient of vinegar ) affect postprandial glucose , lipid profiles , blood pressure and weight loss .
studies showed that consuming acetic acid and apple cider vinegar reduced postprandial glucose and insulin responses in healthy subjects , type 2 diabetes and insulin resistant . in spite of the evidences that demonstrate the hypoglycemic effect of vinegar , lack of antihyperglycemic action of vinegar in humans
honey is a natural food and a complex mixture of sugars , in which fructose and glucose are the main constituents .
fructose is a monosaccharide , which is absorbed more slowly from the gastrointestinal tract compared to glucose , so after fructose consumption blood glucose increases slightly .
in addition , natural honey contains various antioxidants and according to previous findings , antioxidant intake was associated with weight loss in obese individuals and beneficial effects on risk factors of cvd .
studies showed that honey intake considerably decreased postprandial glycemic response or had less adverse effect on plasma glucose than other sugars or sweeteners in diabetic patients .
however , another study reported that , 8-week consumption of natural honey led to a significant elevation in glycosylated hemoglobin ( hba1c ) level , with no significant change in fasting blood sugar ( fbs ) concentration in diabetic patients . this negative effect on hba1c
can be due to the high dose or high glucose : fructose constituent of honey administered .
studies showed vinegar and honey had some beneficial effects on blood glucose or lipid profiles separately .
honey vinegar syrup ( hvs ) , a mixture of these two ingredients is traditional syrup .
sekanjabin is one of the oldest iranian drinks , which is made by sugar and vinegar .
sucrose can cause lots of disorders . in the present study using natural honey as beneficial ingredient instead of sugar for preparation of hvs ,
the aim of this study was to investigate the effect of hvs consumption on cvd risk factors in healthy individuals .
the study included 72 healthy male and female volunteers ( 32 male and 40 female ) aged 2040 years and bmi between 18.5 and 30 kg / m .
inclusion criteria were lack of medications affecting blood glucose , lipid or appetite , no acute or chronic diseases , no smoking , no pregnancy or lactation .
the exclusion criteria were having special diet , honey or vinegar consumption during the last 3 months prior the study , pregnancy during the trial , diagnosis of disease ( such as bacterial or viral infections , seasonal allergies or acute illnesses ) and start drug therapy during the trial , volunteers with known / suspected drug or alcohol abuse , and allergies to hvs .
all subjects signed an informed consent and withdrawal from the study was permitted at any time .
eligible subjects were randomly assigned to either control ( normal diet , n = 36 ) or intervention group ( normal diet plus 21.66 g honey vinegar , n = 36 ) for 4-week .
the main composition of honey vinegar is shown in table 1 . for the preparation of hvs ,
1 kg of natural honey was mixed with six units of water ( 1500 ml ) and was heated for a few minutes .
some branches of mint were added to the mixture and let the syrup to be condensed . then
300 g of vinegar was added to the syrup , after fewer pimples were removed from the heat it is allowed to be cooled , and the syrup poured into the bottles and was delivered to the participants .
participants should mix two tablespoons of hvs ( 21.66 g ) with 250 cc water and drank it in mid - morning or early evening snack daily for 4-week .
composition of honey included 17.1% water , 38.38% fructose , 31% glucose , 7.2% maltose , 1.5% sucrose , 4% oligosaccharides , 0.5% vitamins , minerals and enzymes , etc .
, total phenolic content was 79.63  0.11 mg gallic acid equivalents/100 g honey , total flavonoids content was 7.94  0.54 mg catechin equivalents/100 g , hydroxymethylfurfural level was 3.80  0.14 mg/100 g and diastase activity ( -amylase ) values was 17.4  2.8 schade units .
dietary recommendations were based on healthy food pyramid . in both groups , we recommended 2530% energy from lipid , 15% from protein , and 5560% from carbohydrate .
intervention group received extra calories ( about 75 kcal ) via hvs consumption . during the study , we called or used text messages twice a week to remind participants to drink hvs regularly .
dietary assessments were performed using 3 days food records ( 2 days mid - week and a weekend day ) 3 times during the study period : baseline , week 2 and week 4 .
we used nutrition 4 software ( first databank , san bruno , ca ) for nutrient analysis .
nutrient composition of the hvs blood samples were obtained from fasting subjects between 7:00 and 8:00 a.m. after at least 12 h fasting at week 0 and week 4 .
fasting blood glucose ( fbs ) and serum insulin was measured by colorimetry and enzyme - linked immunosorbent assay respectively .
total cholesterol ( tc ) , high - density lipoprotein cholesterol ( hdl - c ) and triglycerides ( tg ) were measured by enzymatic methods using autoanalyzer elan 2000 .
low - density lipoprotein cholesterol ( ldl - c ) concentration in serum samples with tg  400 mg / dl was calculated by friedewald et al .
we calculated the homeostasis model assessment of insulin resistance ( homa - ir ) , with the following formula , homa - ir = ( fasting insulin [ miu / l ]  fasting glucose [ mmol / l])/22.5 .
values in the text are mean  standard deviation ( quantitative variables ) or percent ( qualitative variables )
analysis of covariance was used to compare changes of variables included fbs , insulin , homa - ir , tc , tg , hdl - c , ldl - c and ldl - c / hdl - c between two groups of control and intervention .
the study included 72 healthy male and female volunteers ( 32 male and 40 female ) aged 2040 years and bmi between 18.5 and 30 kg / m .
inclusion criteria were lack of medications affecting blood glucose , lipid or appetite , no acute or chronic diseases , no smoking , no pregnancy or lactation .
the exclusion criteria were having special diet , honey or vinegar consumption during the last 3 months prior the study , pregnancy during the trial , diagnosis of disease ( such as bacterial or viral infections , seasonal allergies or acute illnesses ) and start drug therapy during the trial , volunteers with known / suspected drug or alcohol abuse , and allergies to hvs .
all subjects signed an informed consent and withdrawal from the study was permitted at any time .
eligible subjects were randomly assigned to either control ( normal diet , n = 36 ) or intervention group ( normal diet plus 21.66 g honey vinegar , n = 36 ) for 4-week .
for the preparation of hvs , 1 kg of natural honey was mixed with six units of water ( 1500 ml ) and was heated for a few minutes .
some branches of mint were added to the mixture and let the syrup to be condensed . then 300 g of vinegar was added to the syrup , after fewer pimples were removed from the heat it is allowed to be cooled , and the syrup poured into the bottles and was delivered to the participants .
participants should mix two tablespoons of hvs ( 21.66 g ) with 250 cc water and drank it in mid - morning or early evening snack daily for 4-week .
composition of honey included 17.1% water , 38.38% fructose , 31% glucose , 7.2% maltose , 1.5% sucrose , 4% oligosaccharides , 0.5% vitamins , minerals and enzymes , etc .
, total phenolic content was 79.63  0.11 mg gallic acid equivalents/100 g honey , total flavonoids content was 7.94  0.54 mg catechin equivalents/100 g , hydroxymethylfurfural level was 3.80  0.14 mg/100 g and diastase activity ( -amylase ) values was 17.4  2.8 schade units .
dietary recommendations were based on healthy food pyramid . in both groups , we recommended 2530% energy from lipid , 15% from protein , and 5560% from carbohydrate .
intervention group received extra calories ( about 75 kcal ) via hvs consumption . during the study , we called or used text messages twice a week to remind participants to drink hvs regularly .
dietary assessments were performed using 3 days food records ( 2 days mid - week and a weekend day ) 3 times during the study period : baseline , week 2 and week 4 .
we used nutrition 4 software ( first databank , san bruno , ca ) for nutrient analysis .
blood samples were obtained from fasting subjects between 7:00 and 8:00 a.m. after at least 12 h fasting at week 0 and week 4 .
fasting blood glucose ( fbs ) and serum insulin was measured by colorimetry and enzyme - linked immunosorbent assay respectively .
total cholesterol ( tc ) , high - density lipoprotein cholesterol ( hdl - c ) and triglycerides ( tg ) were measured by enzymatic methods using autoanalyzer elan 2000 .
low - density lipoprotein cholesterol ( ldl - c ) concentration in serum samples with tg  400 mg / dl was calculated by friedewald et al .
we calculated the homeostasis model assessment of insulin resistance ( homa - ir ) , with the following formula , homa - ir = ( fasting insulin [ miu / l ]  fasting glucose [ mmol / l])/22.5 .
values in the text are mean  standard deviation ( quantitative variables ) or percent ( qualitative variables ) . paired t - test was used to compare changes of variables within groups .
analysis of covariance was used to compare changes of variables included fbs , insulin , homa - ir , tc , tg , hdl - c , ldl - c and ldl - c / hdl - c between two groups of control and intervention .
eleven participants discontinued the study ( overall attrition rate = 15.3% ) for some reasons .
five participants ( three in the intervention group and two in the control group ) withdrew during the study period for personal reasons .
four participants ( two in the intervention group and two in the control group ) were excluded because of viral infection and drug therapy .
one subject in the control group was excluded because of seasonal allergies and drug therapy and one participant from the intervention group withdrew because of adverse effects ( nausea , stomach ache and headache ) .
thus , the main analyses were conducted with 61 participants ( intervention group , n = 30 ; control group , n = 31 ) [ figure 1 ] .
summary of subject flow diagram the baseline demographic characteristics of the 72 study subjects are summarized in table 2 .
there were no differences between the groups for sex , educational status , job , age and daily caloric intake at baseline .
no between - group differences were found in bmi and blood examination findings at baseline .
baseline characteristics of the study population dietary intake data from 16 subjects ( 22.22% ) were not analyzed because they had incomplete food records ( the attrition rate at the first , second and the third , three - dimensional food records was = 4.16 , 8.69 and 11.11% , respectively ) .
a total of 56 subjects ( 77.77% ) were included in the analysis of dietary data ( n = 27 and 29 from intervention and control groups , respectively ) .
sugar , fructose and glucose intake were higher among the intervention group [ table 3 ] .
dietary intakes of study participants throughout the study insulin level increased ( p = 0.01 ) and hdl - c concentration ( p < 0.001 ) and tc ( p = 0.05 ) decreased in intervention group significantly .
the changes in hdl - c in two groups of intervention and control were different significantly .
no significant changes were observed in fbs , tg and ldl - c [ table 4 ] . the effect of hvs on glucose metabolism and lipid profiles * no serious adverse events were reported .
subjects who withdrew from the study did not report any serious adverse events as a reason for withdrawal . only one participant reported nausea , stomach ache and headache after 15 days of hvs consumption .
eleven participants discontinued the study ( overall attrition rate = 15.3% ) for some reasons .
five participants ( three in the intervention group and two in the control group ) withdrew during the study period for personal reasons .
four participants ( two in the intervention group and two in the control group ) were excluded because of viral infection and drug therapy .
one subject in the control group was excluded because of seasonal allergies and drug therapy and one participant from the intervention group withdrew because of adverse effects ( nausea , stomach ache and headache ) .
thus , the main analyses were conducted with 61 participants ( intervention group , n = 30 ; control group , n = 31 ) [ figure 1 ] .
there were no differences between the groups for sex , educational status , job , age and daily caloric intake at baseline .
no between - group differences were found in bmi and blood examination findings at baseline .
dietary intake data from 16 subjects ( 22.22% ) were not analyzed because they had incomplete food records ( the attrition rate at the first , second and the third , three - dimensional food records was = 4.16 , 8.69 and 11.11% , respectively ) .
a total of 56 subjects ( 77.77% ) were included in the analysis of dietary data ( n = 27 and 29 from intervention and control groups , respectively ) .
sugar , fructose and glucose intake were higher among the intervention group [ table 3 ] .
insulin level increased ( p = 0.01 ) and hdl - c concentration ( p < 0.001 ) and tc ( p = 0.05 ) decreased in intervention group significantly .
the changes in hdl - c in two groups of intervention and control were different significantly .
no significant changes were observed in fbs , tg and ldl - c [ table 4 ] .
no serious adverse events were reported . subjects who withdrew from the study did not report any serious adverse events as a reason for withdrawal . only one participant reported nausea , stomach ache and headache after 15 days of hvs consumption .
this present pilot hypothesis - testing study investigated the potential effect of hvs on blood sugar and lipid profiles .
in contrast , we did not observe amelioration in hdl - c level . according to the previous findings
our findings are in accordance with the previous human or experimental studies , which reported a negative significant effect of fructose on hdl - c level .
study on patients with nonalcoholic fatty liver disease showed fructose consumer group had lower fasting serum glucoses , tg and hdl - c .
the short - term effect of oral fructose on patients with chronic kidney disease showed tc , ldl - c , and hdl - c significantly decreased and serum tg markedly increased .
animal studies reported high - fructose feeding ( 60 g/100 g diet ) to normal rats led to a significant increase in the concentrations of cholesterol , tg , very low - density lipoprotein cholesterol and ldl - c , but hdl - c reduced significantly .
high fructose diet in metabolic syndrome rats were accompanied by high significant increase in serum tg , tc and ldl - c while hdl - c level was significantly decreased as compared to control groups .
honey lowered serum concentrations of tg compared with diets of equal energy densities in rats .
findings showed honey consumption decreased tc , ldl - c and increased hdl - c level in healthy subjects and patients with hyperlipidemia .
similarly , a recent study found that 8-week honey intake significantly reduced tg , tc , ldl - c , ldl / hdl ratio and increased hdl - c compared with baseline in type 2 diabetic patients .
another study indicated that the intake of vinegar along with high - fat meal increased tg levels significantly without any notable effect on other lipid variables .
these results showed vinegar could ameliorate unfavorable effects of high - fat diet on lipid profiles .
according to findings , acetate in vinegar inhibits lipogenesis and stimulates fatty acid oxidation and may lead to beneficial effects on lipid profiles .
the precise mechanism of action in not clearly understood , but it can be explained by the role of fructose in reducing the lipoprotein lipase ( lpl ) and lecithin cholesterol acyl transferase ( lcat ) activities in plasma .
lcat , the enzyme that catalyzes esterification of cholesterol with ffas , along with lpl is responsible for hdl - c synthesis .
reduction in the lpl activity , an insulin - sensitive enzyme , in hvs consumers can be ascribed to the insulin resistance induced by fructose .
fructose can lead to a decrease in the ability of insulin to stimulate the activity of lpl .
bahrami et al . showed , honey consumption for 8-week augmented hba1c levels in patients with type 2 diabetes .
the major copound of hvs is honey ( approximately 70% honey vs. 30% grape vinegar ) ; therefore , its effects on variables can be explained mostly via the honey 's ingredients .
the underlying mechanisms of the effect of hvs can be explained via two different ways : ( 1 ) honey reduces prostaglandin levels and elevates nitric oxide .
it was demonstrated that pge2 is one of the major physiological inhibitors of insulin and glucose - induced insulin secretion , ( 2 ) polyphenol compounds of grape vinegar improve insulin sensitivity or insulin release via the pi3 kinase - akt pathway and activate sirtuin-1 and adenine monophosphate kinase . in the present study
the interaction between nutrients in honey and grape vinegar may lead to different effect in comparison with consumption of honey and vinegar separately .
zinc and copper are two trace elements in honey that are important for insulin and glucose metabolism ; however , in the present study after hvs consumption we observed no favorable changes in these variables . the strengths of this study are its randomized , controlled design ; this study is the first trial that investigated the effect of honey and vinegar together .
we observed no significant effect of hvs on blood sugar and lipid profile between groups except for hdl - c .
however , tc level decreased , and fasting insulin increased significantly in the intervention group .
 background : the impact of honey or vinegar on several metabolic abnormalities has been studied separately , a mixture of these two ingredients known as honey vinegar syrup ( hvs ) has not been investigated previously so far . 
 the aim of this study was to assess the impact of hvs consumption ( iranian 's traditional syrup ) on glycemic parameters and lipid profiles in healthy individuals.methods:we conducted a 4-week , randomized , controlled , parallel study consisting of two groups of nonobese healthy volunteers . 
 all subjects were asked to stay on their normal diet . 
 intervention group ( n = 36 ) received a cup of hvs daily in the evening snack for 4-week ( 250 cc syrup contains 21.66 g honey vinegar ) . 
 assessments of fasting blood sugar ( fbs ) , insulin , homeostasis model assessment of insulin resistance ( homa - ir ) , total cholesterol ( tc ) , triglyceride ( tg ) , high - density lipoprotein cholesterol ( hdl - c ) and low - density lipoprotein cholesterol ( ldl - c ) were conducted at the baseline and after 4-week of study.results:we observed no significant effect of hvs on fbs , homa - ir , ldl - c and tg . 
 a significant effect of hvs was found on increasing fasting insulin and homa - ir and reduction in tc level only in intervention group (  = 3.39 p = 0.01 ,  = 1.65 p = 0.03 ,  = 9.43 p = 0.005 , respectively ) . 
 changes of fbs , tg and ldl - c were 1.83 mg / dl , 1.53 mg / dl and  3.99 mg / dl respectively in the intervention group . 
 these changes were not significant . 
 an unfavorable and significant reduction in hdl - c level was also observed between two groups (  = 4.82 p < 0.001 in the intervention group).conclusions : honey vinegar syrup increased fasting insulin level and decreased tc level in the intervention group . 
 hvs had an unfavorable effect on hdl - c level . 
 further prospective investigations are warranted to confirm these findings . 