Does Citrus or Spicy Foods Cause or Worsen Reflux?

If you have reflux, there are certain foods that every known medium says you should avoid. The news, the internet, and even your doctor give you a list of foods that trigger reflux. Many people have heard that citrus and spicy foods aggravate reflux, but do they and why?

Are there scientific reasons why these foods supposedly trigger reflux or is it bunk?

Do Citrus and Spicy Foods Cause or Worsen Reflux?

Citrus

Many people report reflux symptoms after they ingest citrus fruits or foods that have added citrus flavoring. I remember when I was a kid; the only food that gave me symptoms was drinking orange juice. I did not get heartburn when I ate an orange, but orange juice would cause me heartburn. Looking back on it now, it probably was not the orange in the juice itself, but the added sugar (increasing fermentation potential), in combination with me overeating at breakfast.

So what do the studies say about ingesting citrus fruits and reflux? Well, most of the studies are inconclusive at best. Citrus fruits appear not to weaken the lower esophageal sphincter (LES). Most citrus fruits are lower in fructose, so fermentation potential of citrus fruits is minimal. Therefore, excessive pressure on the LES should be minimum. In addition, citrus fruits have differing amounts of d-limonene, which protects the esophagus and stomach from free radical damage and inflammation. Some people even report that ingesting citrus fruits or juices help relieve their reflux symptoms. So why do so many individuals report that they get acid reflux from ingesting citrus fruits?^{1 2 3}

My hypothesis is that the very low pH of citrus fruits irritates the already compromised esophageal tissue in people that have reflux symptoms from citrus ingestion. Citrus fruits are histamine liberators, which may cause problems for people with histamine intolerance health issues that mimic reflux. Urushiol is an oily plant allergen that is the cause of poison ivy (and other Toxicodendron) allergic reactions, is found in the peel of some citrus fruits including limes, lemons, and bergamots. Urushiol can cause issues with its ingestion, including gastrointestinal upset in people that are sensitive to it. Finally, most individuals with silent reflux (LERD) should avoid citrus fruits because of their lower pH, which would activate pepsin and worsen their symptoms.^{4 5 6}

VERDICT: It is unknown if citrus directly worsens reflux or weakens the lower esophageal sphincter. Some people report that ingestion of citrus fruits improves their reflux. That being said if you have esophageal inflammation, suffer from LERD, are sensitive to urushiol, or suffer from histamine intolerance you may want to avoid citrus fruits until you resolve those issues.

Spicy Food

Another culinary delicacy that people avoid when they have reflux is spicy foods. Spicy foods for a lot of people seem to trigger reflux symptoms. One of the biggest believed triggers of reflux by the medical establishment is spicy foods, and most are told to avoid them if you have reflux. Is there any truth that if you are suffering from reflux, you should avoid spicy food?

Well according to the science, it appears that the caution of ingesting spicy foods is unwarranted when it comes to reflux. Capsaicin, the main chemical found in hot peppers, has many medicinal benefits and can enhance digestion. The studies that we have of capsaicin and reflux shows that it increases LES pressure (helps to keep the LES closed), improves esophageal peristalsis and gastric emptying, desensitizes the vagus nerve, and reduces esophageal pain by activating the vanilloid receptor one sites. Capsaicin also increases dopamine and serotonin, which may help alleviate depression and make you feel happier.^{7 8 9 10}

So why do some people have issues with spicy foods? Again, I believe it is because they are either eating other foods with it that triggers reflux, eating greasy foods, or are overeating. Finally, people with LERD might want to avoid hot sauces with low pH; you might be able to, however, tolerate red pepper flakes to add spice to your meals.

VERDICT: Capsaicin for most people improves both the symptoms and the mechanisms of reflux. Therefore, it alone is probably not a cause of reflux.