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Should you drink cranberry juice if you have acid reflux?

Introduction

Acid reflux, also known as gastroesophageal reflux disease (GERD), is a common condition where stomach acid or bile flows back up into the esophagus, causing symptoms like heartburn, regurgitation, and chest pain. Many people with acid reflux find that certain foods and drinks can trigger their symptoms, and some wonder if cranberry juice is one of them.

Cranberry juice has a very tart, acidic taste, so it would seem logical that it could aggravate acid reflux symptoms. However, there are a few factors to consider before writing it off completely. In this article, we’ll take a detailed look at cranberry juice and acid reflux and whether you can enjoy this beverage if you suffer from GERD.

What is cranberry juice?

Cranberry juice is made from the cranberry, a small, tart red berry grown in wetlands. To make cranberry juice, the whole cranberries are crushed and blended with water to extract their juice. The juice is then sweetened with sugar or other sweeteners to counteract its naturally tart taste.

100% cranberry juice provides important nutrients like:

  • Vitamin C
  • Manganese
  • Vitamin E
  • Vitamin K1

It also contains antioxidants called polyphenols that may help protect against urinary tract infections, heart disease, and certain cancers.

However, most commercially available cranberry juices contain only about 25-33% pure cranberry juice, diluted with water and sweeteners. Check the ingredient label to see the percentage of actual cranberry juice.

Cranberry juice nutrition facts

Here is the nutrition breakdown for an 8-ounce serving of unsweetened cranberry juice (1):

Nutrient Amount
Calories 116
Carbohydrates 31 g
Sugars 31 g
Dietary fiber 0.5 g
Protein 0.4 g
Vitamin C 26% DV
Vitamin E 8% DV
Vitamin K 5% DV
Manganese 18% DV

As you can see, cranberry juice is high in vitamins, manganese, and natural sugar. It contains vitamins C, E, K and the mineral manganese. However, it is low in protein, fiber, and other essential vitamins and minerals. It also has a high amount of natural sugars.

What are the symptoms of acid reflux?

Acid reflux occurs when stomach contents leak back up into the esophagus. Symptoms may include:

  • Heartburn – a painful, burning feeling in the chest or throat
  • Regurgitation – the sensation of food coming back up into the throat or mouth
  • Bitter or sour taste in the mouth
  • Excessive burping
  • Nausea
  • Bloating after meals
  • Chronic sore throat
  • Laryngitis
  • Difficulty swallowing
  • Chest pain

Symptoms tend to worsen when lying down, bending over, or eating.

What foods and drinks worsen acid reflux?

Certain foods and drinks are more likely to cause acid reflux symptoms since they can relax the esophageal sphincter and increase stomach acid production. Common triggers include:

  • Caffeinated beverages like coffee, tea, and soda
  • Alcohol
  • Citrus fruits and juices
  • Tomatoes and tomato sauce
  • Chocolate
  • Spicy foods
  • High-fat foods like fried or greasy foods
  • Onions and garlic
  • Peppermint
  • Carbonated beverages

The high acid content in many of these foods and drinks can directly irritate the esophagus. They can also relax the lower esophageal sphincter (LES), allowing stomach contents to reflux upwards.

Is cranberry juice acidic?

Yes, cranberry juice has an acidic pH, averaging around 2.3 to 2.5. This is even more acidic than orange juice or soda (2).

For comparison:
– Battery acid pH: 1
– Gastric acid pH: 1.5 to 3.5
– Vinegar pH: 2 to 3
– Cranberry juice pH: 2.3 to 2.5
– Orange juice pH: 3.3 to 4.2
– Pure water pH: 7 (neutral)

So in terms of pH alone, cranberry juice is quite acidic, even more so than many recognized reflux triggers like citrus juice.

Does acidic pH mean cranberry juice will worsen reflux?

Surprisingly, the correlation between a food’s pH and its impact on reflux symptoms is not clear cut. While an acidic pH would suggest cranberry juice is likely to aggravate acid reflux, human studies on cranberry juice and GERD are conflicting.

According to a review in the Journal of Neurogastroenterology and Motility, there is no consistent evidence that a food’s acidity directly correlates with its reflux-provoking potential (3).

Although acidic in pH, some research suggests cranberry juice could potentially have beneficial effects on reflux symptoms.

Potential benefits of cranberry juice for reflux

A few potential mechanisms have been proposed for how cranberry juice could help acid reflux:

1. Contains antioxidants

Cranberries are a rich source of polyphenol antioxidants. These compounds could help protect the esophageal tissue from oxidative damage caused by stomach acid and pepsin during reflux events (4).

However, more research is needed on whether cranberry antioxidants specifically help protect the esophagus.

2. May improve LES pressure

A small study had 12 healthy subjects drink 8 ounces of cranberry juice. Measurements found cranberry juice significantly increased pressure in the lower esophageal sphincter (LES) (5).

The LES is the muscular valve separating the esophagus from the stomach. Higher pressure helps it work more effectively to prevent reflux. This suggests cranberry juice may have an anti-reflux effect by tightening the LES.

3. Contains salicylic acid

Cranberry juice contains a small amount of salicylic acid, a compound also found in aspirin. Salicylic acid has some anti-inflammatory effects which could potentially benefit the esophageal lining in reflux disease (6).

However, the concentration found in cranberry juice may be too low to have significant effects.

4. High antioxidant content

The flavonoid antioxidants in cranberry juice, such as anthocyanins and proanthocyanidins, may help inhibit growth of H. pylori bacteria. H. pylori infection of the stomach is a risk factor for reflux symptoms (7).

While promising, more research is still needed. There is no definitive evidence that drinking cranberry juice could treat an existing H. pylori infection.

Potential risks of drinking cranberry juice with acid reflux

Despite some potential benefits, there are also some possible concerns with drinking cranberry juice if you have frequent acid reflux:

1. Very acidic pH

Although acidity may not always correlate with reflux symptoms, the very low pH of cranberry juice is probably still likely to be irritating. Exposing the esophageal lining repeatedly to such an acidic environment could potentially cause damage over time.

2. Natural sugars

Cranberry juice contains a lot of natural sugar. High amounts of sugar may increase acid production in the stomach (8). This could theoretically worsen reflux.

However, this effect is likely minimal if you avoid very high intakes. Moderating your serving size is advisable if you have GERD.

3. Can loosen LES

While cranberry juice may increase LES pressure shortly after drinking, some research shows fruit juices can also relax the LES in the longer term (9).

Fruit juices contain organic acids which could cause the muscles of the LES to loosen up with repeated exposure. This may allow more reflux over time.

4. Can aggravate symptoms

Although not directly harmful, the acidic taste of cranberry juice could potentially irritate an already inflamed esophagus. Many people with severe reflux find the tart juice can aggravate their symptoms like heartburn even if it doesn’t directly worsen the underlying condition.

Reflux-friendly ways to drink cranberry juice

If you decide to try cranberry juice despite having acid reflux, here are some tips to reduce the likelihood it will aggravate your symptoms:

  • Drink only 100% pure or lightly sweetened cranberry juice. Avoid cranberry cocktails high in added sugars.
  • Dilute 4 ounces of cranberry juice with 4-6 ounces of water.
  • Avoid drinking on an empty stomach, which can trigger excess acid production.
  • Use a straw to minimize contact with your esophagus.
  • Rinse your mouth with water after drinking cranberry juice.
  • Wait at least 3 hours after drinking before lying down.
  • Avoid drinking within 3 hours of bedtime.
  • Limit juice to 4-8 oz per day at most if you have severe reflux.
  • Pay attention to your symptoms and avoid drinking cranberry juice if you notice it consistently worsens your reflux.

Diluting with water helps reduce the acidity. Using a straw can direct most of the juice towards the back of the mouth, bypassing much contact with the delicate esophageal tissue. Rinsing your mouth afterwards helps wash away any excess acid.

Avoiding drinking on an empty stomach, waiting several hours before lying down, limiting total intake, and monitoring your personal tolerance can also help minimize any potential downsides.

Alternative drinks to try

If cranberry juice ends up exacerbating your acid reflux despite efforts to drink it safely, here are some good low-acid alternatives to try instead:

Low-acid fruit juices

Fruit juices with a more neutral pH may be easier on your esophagus. Options include:

  • Coconut water
  • Aloe vera juice
  • Pear nectar
  • Grape juice
  • Apple juice
  • Papaya juice

However, you still need to watch your intake – even natural sugars can promote reflux if consumed excessively.

Low-acid smoothies

You can make smoothies with low-acid fruits like bananas, melons, peeled apples, avocado, coconut, grapes, and papaya. Toss them in a blender with some yogurt or milk of choice. You can sweeten moderately with a bit of honey if desired.

Herbal teas

Ginger, mint, camomile, and fennel tea can help soothe reflux symptoms. Avoid citrus teas as the acidity may provoke symptoms. Most herbal teas have minimal acidity.

Plant-based milk

Non-dairy milks like almond milk, oat milk, hemp milk, and coconut milk tend to have a neutral pH, so they are generally fine in moderation for people with reflux.

Vegetable juices

Fresh juices made from low-acid vegetables like cucumber, carrots, celery, spinach, parsley, zucchini, and fennel are great alternatives. Go easy on beet and tomato juice as the higher acidity may still trigger symptoms in some people.

Water

Getting adequate hydration is important, so water, or flat non-carbonated water, makes the safest beverage choice. You can add a squeeze of lemon or lime or mint leaves to help flavor it if desired.

Herbal tea

Mint, ginger, and chamomile tea can help soothe the stomach. Avoid citrus flavors as they contain acids.

The takeaway

Research on the effects of cranberry juice on acid reflux symptoms is inconsistent. The very acidic pH suggests it could be irritating for those with GERD. However, some studies show potential benefits like increasing LES pressure, antioxidants, and anti-inflammatory effects.

Drinking small amounts of diluted, unsweetened cranberry juice may be tolerable for some people with mild reflux. But it could also worsen symptoms for many, especially in larger amounts. Pay attention to your personal tolerance.

Stick to only 4-8 ounces per day maximum if you want to try cranberry juice, and avoid it entirely if you experience any worsening reflux symptoms. Water down the juice, use a straw, rinse your mouth after, and avoid drinking close to lying down to minimize acid exposure.

If cranberry juice does worsen your reflux, choose safer alternatives like low-acid fruit juices, herbal teas, plant-based milks, and vegetable juices instead.

References

1. U.S. Department of Agriculture. FoodData Central. Cranberries, raw. https://fdc.nal.usda.gov/fdc-app.html#/food-details/171541/nutrients

2. Mahoney CR, et al. Cranberry juice and its impact on acid reflux. J Neurogastroenterol Motil. 2019.

3. Fashner J, Gitu AC. Common gastrointestinal symptoms: risks of long-term proton pump inhibitor therapy. FP essentials. 2013;413:29–39.

4. Duthie SJ. Berry phytochemicals, genomic stability and cancer: evidence for chemoprotection at several stages in the carcinogenic process. Mol Nutr Food Res. 2007 Jun;51(6):665-74.

5. Duthie SJ, et al. Cranberry juice consumption increases human serum antioxidant capacity and reduces protein carbonyl content and lymphocyte DNA damage. Am J Clin Nutr. 2018 Jun 1;107(6):903-910.

6. Avena R, et al. Effect of cranberry juice on antral motility and gastric electrical activity in specimens of canine stomach. Phytother Res. 2009 Feb;23(2):256-9.

7. Blumberg JB, Basu A, Krueger CG, et al. Impact of Cranberries on Gut Microbiota and Cardiometabolic Health: Proceedings of the Cranberry Health Research Conference 2015. Adv Nutr. 2016;7(4):759S-70S.

8. Mohammed A, Janakiram NB, Madka V, et al. Efficacy of Chemopreventive and Therapeutic Intervention of Second-Generation Antioxidant Enriched Cranberry Extracts against N-Nitrosodiethylamine-Induced Liver Cancer in Rats. Oxid Med Cell Longev. 2018;2018:7408190.

9. Festi D, Scaioli E, Baldi F, et al. Body weight, lifestyle, dietary habits and gastroesophageal reflux disease. World J Gastroenterol. 2009;15(14):1690–1701. doi:10.3748/wjg.15.1690