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, 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. 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.
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. What Causes Digestion to Stop With Food Left in the Stomach? Foods You Can Eat When You Have Gastroparesis Gastroparesis and Weight Gain Does Vitamin C Make the Body More Acidic? Gastroparesis as a Cause of Vitamin B-12 Deficiency The 10 Worst Foods for Acid Reflux Signs and Symptoms of Acid Reflux Disease What Is Esterified Vitamin C?
Vitamins for Acid Reflux Sample Diet for Gastroparesis Can Multivitamins Worsen Acid Reflux? How to Avoid Acid Reflux from Fish Oil and Omega-3 Capsules What Are the Benefits of Buffered Vitamin C? 3 Ways to Pick Fruits for an Acid Reflux Diet Foods Containing Vitamin C But No Citric Acid How to Neutralize Acid Reflux Is Green Tea Bad for Acid Reflux? Causes, Risk Factors and Prevention of Acid Reflux Disease Saltines and Butter for Acid Reflux Can You Use Basil to Control Acid Reflux? Answer: You may want to avoid supplements like vitamin B-6 and cocoa, which can irritate the stomach or cause heartburn in some people. Arginine may potentially increase stomach acid levels and worsen esophageal reflux (heartburn). (Be aware that arginine may be sold as a single ingredient supplement, or as an ingredient in a sexual enhancement supplement.) If taken with heartburn medication such as omeprazole (Prilosec), St. John's wort can worsen reflux symptoms.
A number of other supplements can cause nausea or stomach upset. Vitamin C may cause an "acid stomach" in some people, but fortunately, there is a special form of vitamin C which may be helpful. Multivitamins often contain minerals such as iron and zinc which can cause stomach distress. Citrus bioflavanoids, another common ingredient in multis, can cause nausea or vomiting in a small percentage of women, especially those taking oral contraceptives or hormonal replacement therapy. See the "Avoiding Nausea" section of the Multivitamin and Multimineral Review for tips for reducing stomach upset. If you need supplemental iron, consider taking it separately. There are several forms of iron that are more gentle on the stomach; these may be a good option for people who experience stomach upset even when taking iron with food. CoQ10 can cause nausea, however, this can be minimized by dividing your dose and taking over the course of the day — just be sure not to take it too late in the evening.
There are several ways to reduce stomach discomfort and "fish burps" caused by fish oil supplements. (See the CL Answer about this for our tips — as well as tips submitted by CL members). Magnesium can also cause stomach upset or diarrhea, however, taking it with food may help. Certain forms of magnesium may also be less problematic than others. SAMe may cause stomach upset in some people, which can be reduced by taking an enteric-coated formula, smaller, divided doses, or taking with food. Interestingly, although one study found curcumin to improve heartburn symptoms, be aware it can cause nausea and mild stomach distress in some people, especially in high doses or when taken for long periods of time. Similarly, although there is some prelimenary evidence that ginger may be helpful for nausea or heartburn, it may also cause stomach upset or heartburn in some people. When available, you may also want to try alternatives to hard tablet supplements, such as chewables, liquids, or fortified foods, which may help reduce stomach irritation.