Originally appeared in the article, "Should You Avoid Consuming Citrus (OJ and Lemon Water Included) On an Empty Stomach? Gastroenterologists Weigh In," by Jordan Galloway in Well + Good on May 27, 2022.
Whether it’s drinking that go-to morning glass of lemon water, sipping fresh-squeezed orange juice, or eating grapefruit wedges by the spoonful, plenty of people start their day by enjoying some form of citrus. “In general, citrus fruit provides a rich source of vitamins, minerals, and dietary fiber that is essential for overall greater well-being,” Genail McKinley, a holistic nutritionist, previously told Well+Good. And you can't deny that the classic tart-and-tangy zing you get from citrus fruits helps fight off some of the morning blearies.
However, as gastroenterologist Peyton Berookim, MD, explains, citric fruits also contain high amounts of citric acid, which is what lends them their sour flavor. And it’s for this reason that there seems to be some confusion about whether or not it’s okay to consume citrus on an empty stomach. According to Dr. Berookim, folks often come to him with questions like: Is citric acid okay on an empty stomach? Is citrus good in the morning? And can we eat citrus fruit on an empty stomach?
In most cases, the answer to all of these questions is yes, according to Dr. Berookim as well as gastroenterologist Mark Pimentel, MD, an associate professor of medicine and of gastroenterology at Cedars- Sinai. “The stomach is a very acidic place,” Dr. Pimentel says. “So for most people, citrus is not a problem.” For every rule, though, there are exceptions.
Who shouldn’t consume citrus on an empty stomach
Eating citrus when you don’t have any food in your stomach can be an issue if you have a history of significant heartburn (otherwise known as GERD), explains Dr. Pimentel. “In part because you are drinking an acid drink and your food pipe, or esophagus, is already irritated due to your GERD condition,” he says. “Secondly, because adding more acid and more liquid volume, you can have more reflux.”
A great remedy for acid reflux or a “sour stomach” is alkaline water, Dr. Berookim says. “Drinking four to five glasses of alkaline water can significantly improve heartburn symptoms,” he recommends.
Dr. Berookim also cautions that it’s not just citrus fruit or juice that folks dealing with acid reflux need to be mindful about consuming. “Not only is citric acid found in juice drinks [and fruits], but also in carbonated beverages—it’s added to soft drinks for flavor,” he says. “Some flavored carbonated waters also contain citric acid but at much lower amounts.” So keep those beverages in mind if you experience acid reflux or GERD as well.
Diluting citrus juice in water
All fruits contain very different amounts of citric acid, making them more or less tart and sour vs. sweet. That is, of course, why drinking a glass of OJ is enjoyable, while sipping straight lemon or lime juice would cause most mouths to pucker. According to both gastroenterologists, this is good news for those with GERD.
“Many people with acid reflux may be able to tolerate pineapple or apricot juice since the citric acid content is not quite as high in these fruits,” Dr. Berookim says. “In addition, apple and grape juices have lower amounts of citric acid.”
On the other end of the sour spectrum are citrus fruits, particularly lemons and limes, which is why people often add them to water to dilute their tart taste. However, it's important to keep in mind that mixing lemon juice with water won't actually do anything to alter the acid content of the citrus fruit. “The chemistry of acid is that water is not a buffer,” Dr. Pimentel says. “The pH, a measure of acid, is not changed by the volume of water.”
That being said, so long as you don’t have issues with heartburn, drinking diluted citrus juice, like lemon or lime water, won’t be an issue, whether you’ve eaten anything or not, Dr. Pimentel adds. And if it means you’ll drink more water, then Dr. Berookim says by all means, squeeze a little citrus juice into your H2O. “Drinking pure water first thing in the morning is best,” he says, “but that can be difficult for some people who prefer water with some flavor. In this case, it is acceptable to drink water with lemon if that is the way that one can promote adequate hydration.”
Bottom line? If lemon is your main squeeze in the morning—or you can’t imagine starting your day without OJ—doing so with (or without) eating food is totally fine unless your doctor has told you otherwise.