Lemons and other citrus fruits have long been considered trigger foods with the potential to cause or worsen acid reflux. Although the 2013 clinical practice guidelines from the American College of Gastroenterology encourage people with acid reflux and its more severe form, gastroesophageal reflux disease, to monitor their symptoms to determine their own problem foods, lemons have properties that could potentially affect acid reflux. Understanding how lemons and other citrus fruits may affect symptoms can help acid reflux sufferers plan their diets to manage this condition.
Lemon and Pepsin
Acid reflux occurs when acidic stomach contents travel up into the esophagus, causing discomfort and heartburn -- a burning pain in the chest area. According to Dr. Jonathan Aviv, author of "Killing Me Softly From the Inside," one way acidic foods such as lemons can fire up heartburn is by activating pepsin, the stomach enzyme that breaks down proteins. While lemon may not alter pepsin's action in the stomach, reflux of the stomach's digestive juices may leave inactive pepsin molecules inside the throat and esophagus. According to Dr. Aviv, on the way to the stomach, acidic foods may come in contact with this inactive pepsin, activating it and causing damage by breaking down the protein in these tissues.
Lemon and Throatburn
In some cases, acid reflux can reach into the throat and voice box. Dr. Aviv refers to this as "throatburn" or laryngopharyngeal reflux, which causes hoarseness, sore throat, chronic cough and other symptoms. Lemons and other citrus fruits may aggravate this condition by irritating any damaged tissue in the throat or esophagus. If lemon or lemon products worsen any of these symptoms, it’s best to avoid them. However, according to a review article published in the April 2009 issue of "World Journal of Gastroenterology," no definitive data is available to conclude that avoiding citrus helps acid reflux, so any food restrictions need to be based on individual tolerance.
Many acid reflux trigger foods are assumed to aggravate symptoms by relaxing the muscle that connects the esophagus and stomach, allowing acidic stomach contents to travel into the esophagus. However, citrus foods have not been shown to affect this muscle, thus they are not proven to cause acid reflux, according to a research summary published in the September 2009 "Gastroenterology & Hepatology." Interestingly, lemon is actually touted as a natural remedy to help heartburn by neutralizing acidity in the body. Dr. Aviv discourages acid reflux sufferers from trying so-called cures for acid reflux, including drinking various kinds of vinegar and other acidic liquids. Also, according to the American College of Gastroenterology, research doesn't support including or restricting specific foods to manage acid reflux.
Warnings and Next Steps
Acid reflux is treated with a combination of acid-blocking medications and lifestyle changes, including weight loss and sleeping at an incline to prevent nighttime reflux. Follow up with your doctor if acid reflux symptoms are frequent or severe. Although lemon and citrus fruits are commonly mentioned as acid reflux triggers, there is little research establishing a connection. If large amounts of lemon or citrus cause pain or aggravate symptoms, using small amounts of lemon, lemon juice and lemon zest typically will not cause problems.
Medical advisor: Jonathan E. Aviv, M.D., FACS