For someone with acid reflux, commonly referred to as heartburn, certain foods may worsen symptoms. Acidic foods such as tomatoes and citrus fruits -- which are also rich in vitamin C -- are often considered trigger foods, and this intolerance may make it seemingly difficult to enjoy foods high in vitamin C. According to the American College of Gastroenterology, an estimated 60 million Americans experience heartburn symptoms at least once per month, and as many as 15 million experience daily symptoms. Acid reflux is treated with lifestyle modifications and, if needed, antacids and prescribed medication. Even those who experience severe or frequent acid reflux -- also known as gastroesophageal reflux disease -- can include foods rich in vitamin C as part of a healthy eating plan.
Acid reflux occurs when stomach contents back up into the esophagus. A muscle called the lower esophageal sphincter, or LES, normally closes after food passes from the esophagus into the stomach. When this sphincter is relaxed, food contents can travel back up into the esophagus, causing a burning sensation. Foods that relax the LES, such as fat and chocolate, and foods that may irritate the stomach or esophagus, such as acidic or spicy fare, are identified as common triggers to acid reflux. According to the American College of Gastroenterology's 2013 clinical guidelines, the lifestyle changes that most consistently improve acid reflux symptoms include weight loss, avoiding meals 2 to 3 hours before bedtime and elevating the head of the bed while sleeping. The effectiveness of specific diet restrictions is less supported by research, and these guidelines support only eliminating foods that cause symptoms. While certain vitamin C-rich foods may aggravate acid reflux symptoms, many more vitamin C sources may be well tolerated.
Vitamin C in Foods
Vitamin C, also known as ascorbic acid, is an essential nutrient, which means that it is not made in the body and must be obtained from food. It is a common misconception that foods containing natural or added ascorbic acid worsen acid reflux -- or that acid reflux sufferers need to avoid fruits and vegetables solely because they contain vitamin C. If a person clearly links acidic foods to her heartburn symptoms, it's possible only the most acidic fruits and vegetables -- such as oranges, lemons, limes, grapefruits and tomatoes -- are problematic. In this case, there are many choices that may be better tolerated. Fruits and vegetables that are lower in acidic content, but also contain vitamin C, include watermelon, cantaloupe, papaya, honeydew, mango, banana, avocado, bell pepper, broccoli, kale, cauliflower and Swiss chard.
Vitamin C Supplements
There is a wide range of vitamin C supplements on the market. Because doses above 2,000 mg have been reported to cause abdominal discomfort, large amounts of vitamin C could potentially aggravate acid reflux. In comparison, the recommended dietary allowance of vitamin C is 75 mg for women and 90 mg for men. A buffered, or esterified, form is available, and this combination of vitamin C and minerals is thought to be less acidic. However, according to the Linus Pauling Institute, there is not enough research to support the claim that buffered vitamin C is easier on the stomach.
Next Steps and Precautions
The American College of Gastroenterology recommends those with acid reflux only avoid foods that cause or worsen symptoms. If acidic foods aggravate symptoms, there are many lower-acid vitamin C containing foods that may be well tolerated. Anyone with frequent or severe acid reflux should discuss symptoms and management with a doctor. In addition, those suffering from acid reflux should discuss supplement use, including vitamin C supplements, with their doctor. Finally, speaking with a registered dietitian may also be helpful to review current diet and food tolerances and to provide recommendations on how to obtain nutritionally adequate diet.
Is This an Emergency?
- American College of Gastroenterology Patient and Resource Center: Acid Reflux
- American College of Gastroenterology: Diagnosis and Management of Gastroesophageal Reflux Disease
- Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids; Food and Nutrition Board, Institute of Medicine
- Linus Pauling Institute: Micronutrient Information Center: Supplemental Forms of Vitamin C