The Citric Acid Lowdown with Acid Reflux and GERD

When Life Gives You Lemons, You Get Citric Acid.

Citric acid is an organic compound, which means it is naturally occurring and originally derived from lemons. Though it can also be found in other citrus fruits such as grapefruit, oranges, limes, tangerines, pomelo, and kumquat. When not coming directly from the fruit, citric acid is used as a preserving agent and flavoring for candies and soft drinks. Believe it or not, citric acid is also used to preserve or stabilize medications and can also be used as a disinfectant.

What you may ask yourself is, since citric acid is a naturally occurring compound, can I or should I eat it? 

For those who do not suffer from acid reflux or GERD (Gastroesophageal Reflux Disease), you absolutely can. But for those who do suffer from acid reflux or GERD, it may not be a great idea. 

While the stomach is intended to be able to handle high levels of acid, your esophagus is not. 

When you consume highly acidic foods this can cause your stomach to produce more stomach acid. If you already suffer from GERD then your stomach may not be able to produce a high pressure environment in order to contain all of that acid, resulting in a fuller stomach and increased chance of reflux. A systematic review looking at dietary and lifestyle factors related to GERD revealed a positive correlation between consuming citrus fruits with meals and GERD, with acidic foods inducing reflux-related symptoms (Ther Clin Risk Manag, 2021).

There are other foods that contain smaller amounts of citric acid and may be included into your diet. These foods will have to be introduced in small doses, but may quell any craving for something tart or acidic. You can try pineapple, strawberries, raspberries, cranberries, or cherries. 

While citric acid is naturally occurring, it is expensive to produce directly from citrus fruits. When used as an additive, it is the manufactured version that you find listed as an ingredient in a food product and is GRAS- Generally Recognized As Safe in the US (Chemistry Central Journal, 2017). Most products that use the manufactured version of citric acid are sodas, juices, powdered beverages, candies, frozen foods, and some dairy products. It is also used in some canned fruits and vegetables to protect against botulism. 

Tomatoes, on the other hand, contain citric acid, as well as malic acid, which is a double dose of acid to your stomach. 

This makes tomatoes and tomato-based foods products that you want to avoid. Malic acid is another naturally occurring organic compound found in fruits and vegetables. For acid reflux and GERD sufferers you will want to take note of these food sources and begin to limit them from your daily dietary intake. 

Keep in mind the pH of malic acid is higher than citric acid (making it less acidic), but when these foods are combined with other acids- that’s when you are fueling the fire. In nature, malic acid is found in prunes, currants, bananas, apples, mangos, strawberries, and nectarines (Gurtler & Mai, 2014). Vegetables that contain malic acid are broccoli, carrots, peas, and potatoes. 

Having a GERD flare up is never something anyone wants to have happen, but it can become difficult to recognize foods that may be triggering. The best thing you can do as a GERD sufferer is increase your knowledge as to what foods would be best to add and avoid and to be mindful of combining acidic foods for flare-up prevention.

Ciriminna, R., Meneguzzo, F., Delisi, R. et al. Citric acid: emerging applications of key biotechnology industrial product. Chemistry Central Journal 11, 22 (2017). https://doi.org/10.1186/s13065-017-0251-y

J.B. Gurtler, T.L. Mai, PRESERVATIVES | Traditional Preservatives – Organic Acids, Editor(s): Carl A. Batt, Mary Lou Tortorello, Encyclopedia of Food Microbiology (Second Edition), Academic Press, 2014, Pages 119-130, ISBN 9780123847331, https://doi.org/10.1016/B978-0-12-384730-0.00260-3.

Zhang M, Hou ZK, Huang ZB, Chen XL, Liu FB. Dietary and Lifestyle Factors Related to Gastroesophageal Reflux Disease: A Systematic Review. Ther Clin Risk Manag. 2021;17:305-323, https://doi.org/10.2147/TCRM.S296680

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