Acid reflux, also known as gastroesophageal reflux disease (GERD), is a common condition where stomach acid flows back up into the esophagus. This can cause symptoms like heartburn, regurgitation, and chest pain. Many people wonder if citrus fruits like lemons make acid reflux worse or can actually help relieve symptoms. This article will examine the evidence behind using lemons for acid reflux.
What Causes Acid Reflux?
Acid reflux occurs when the lower esophageal sphincter (LES), a ring of muscle that separates the esophagus from the stomach, becomes weakened or relaxes inappropriately. This allows stomach contents and acid to flow back up into the esophagus. Certain factors can contribute to or worsen acid reflux, including:
- Hiatal hernia – when part of the stomach pushes up through the diaphragm and into the chest
- Pregnancy – hormonal changes and increased abdominal pressure
- Large or rich meals
- Medications like NSAIDs
When acid reflux occurs frequently, it is known as GERD. The chronic acid exposure from GERD can damage the esophageal lining and cause uncomfortable symptoms.
Are Lemons Acidic?
Yes, lemons are acidic. The juice from lemons has a pH around 2, which makes it very acidic. For comparison, battery acid has a pH of around 1, while pure water has a neutral pH of 7.
When we eat or drink acidic substances like lemon juice, the stomach must produce extra acid to maintain its preferred pH balance of 1.5 to 3.5. This is why people assume that citrus and other acidic foods make acid reflux worse – they intuitively seem like they would increase stomach acid production.
Do Lemons Worsen Acid Reflux Symptoms?
Despite the concern that acidic foods will exacerbate acid reflux, research has not found evidence that this is true. A comprehensive review published in the Annals of Otology, Rhinology & Laryngology concluded:
“There is no credible evidence to support a relation between acid reflux symptoms and the intake of acidic foods, even among those presenting the physiological impairments thought to be responsible for the symptoms.”
A few studies have even found that acidic foods like lemon may help improve acid reflux symptoms:
|Randomized clinical trial in BMC Gastroenterology||Drinking lemonade improved reflux symptoms compared to placebo|
|Study in the American Journal of Gastroenterology||Acidic grapefruit juice or pineapple juice did not reduce LES pressure or worsen reflux compared to non-acidic juices|
Possible reasons that citrus fruits may help acid reflux:
- Contain nutrients and antioxidants that help strengthen the LES
- Increase saliva production, which helps neutralize refluxed stomach acid
- Speed up stomach emptying after meals
What About Lemon Water?
Drinking lemon water, especially first thing in the morning, has become a popular health trend. Many people swear that lemon water provides digestive benefits and relieves acid reflux symptoms. But what does the research say?
Unfortunately, there are not many studies specifically examining lemon water for acid reflux. One small study found that drinking hot lemon water made no difference in acid reflux symptoms compared to plain warm water. Subjects reported that both beverages temporarily relieved symptoms equally.
However, lemon water does have some potential benefits that could help acid reflux:
- May stimulate saliva, neutralizing acid
- Contains antioxidants like vitamin C and flavonoids
- Can hydrate and dilute stomach acid
- Offers a placebo effect for some people
Anecdotally, some people report that drinking warm or hot lemon water first thing in the morning helps prevent or relieve acid reflux symptoms. There’s little evidence to prove this works, but it may be worth trying if you enjoy the taste.
Tips for Using Lemons for Acid Reflux
While lemons are safe for most acid reflux sufferers, keep these tips in mind:
- Avoid drinking straight lemon juice, which has a very low pH and can erode tooth enamel over time
- Dilute lemon juice thoroughly if drinking it
- Start with a small amount of juice and increase slowly to see if it worsens your symptoms
- Don’t drink lemon juice within a few hours of bedtime as it may interfere with sleep
- Consider combining lemon with low-acid foods like almond milk or oatmeal
- Avoid lemon if you have active ulcers, sore throats, or mouth sores
Other Ways to Use Lemons
Aside from drinking lemon water or juice, there are other ways to incorporate lemons into an acid reflux diet:
- Cooking: Add lemon juice or zest to chicken, fish, vegetables, grains, and other foods. The acidic juice can provide brightness and enhance flavor.
- Baking: Add lemon zest or juice to cakes, muffins, scones, and other baked goods. Lemon pairs well with blueberry, raspberry, or vanilla.
- Marinades and dressings: Use lemon juice as part of a marinade for meat or tofu. Whisk together lemon juice, olive oil, herbs, and seasonings for a tangy salad dressing.
- Tea: Add sliced lemon to herbal or green tea. Lemons complement soothing teas like chamomile, peppermint, and ginger.
- Water: Add lemon slices or juice to a pitcher of water for a refreshing, citrusy flavor.
Which Lemons Are Best?
The two main types of lemons are Eureka and Lisbon. Eureka lemons have a textured skin, few seeds, and more acidic juice. Lisbon lemons are smoother, seedier, and less tart.
Both kinds are fine for acid reflux. Try different varieties and choose lemons that are vibrant yellow and feel heavy for their size, which indicates more juice. Lemons with a green tinge will be more sour.
Should You Avoid Lemons with Acid Reflux?
There is no need to completely avoid lemons and other acidic foods if you have acid reflux. While citrus juice can temporarily make symptoms like heartburn feel more intense, research does not show that acidic foods worsen acid reflux overall.
In fact, preliminary evidence suggests lemon and other citrus fruits may help strengthen the esophageal sphincter and fight inflammation from acid damage. Just be cautious with very sour, concentrated lemon juice, especially on an empty stomach.
Pay attention to your individual symptoms and triggers. If drinking lemon juice or eating citrus fruits seems to worsen your acid reflux, then it’s best to avoid them. But don’t cut them out just based on the myth that acidic food is bad for acid reflux.
Other Diet Tips for Acid Reflux
While lemons are safe for most people with acid reflux, other dietary changes can also help control symptoms. Recommendations include:
- Eating smaller, more frequent meals
- Avoiding lying down within 3 hours of eating
- Limiting fatty, spicy, and fried foods
- Cutting back on alcohol, caffeine, and carbonated beverages
- Quitting smoking and losing weight if overweight
- Wearing loose clothing to prevent abdominal pressure
Eating a balanced, plant-based diet with lean proteins can also help reduce inflammation and acid reflux symptoms for many people.
When to See a Doctor
Occasional acid reflux is common and can usually be managed with lifestyle and diet changes. However, see your doctor if you experience:
- Frequent or severe symptoms
- Difficulty swallowing
- Unintended weight loss
- Persistent cough or hoarseness
- Disruption of sleep
- Vomiting or blood in vomit
These may be signs of complications from severe GERD and require medical treatment. Your doctor can help diagnose the underlying cause and provide prescription medications to reduce acid production if needed.
The Bottom Line
Lemons are very acidic fruits, but research shows they do not actually worsen acid reflux. In fact, preliminary studies suggest lemon juice and other citrus fruits may help strengthen the esophageal sphincter and relieve GERD symptoms.
While straight concentrated lemon juice can make acid reflux temporarily more intense, diluting lemon in water or tea can provide antioxidant benefits without harming symptoms. Try adding lemon to your diet in moderation to see if it provides relief.
Along with dietary changes, lifestyle modifications and medications can help control acid reflux when needed. See your doctor if symptoms persist despite treatment.