Statistics show that acid reflux disease is becoming increasingly common around the world [1, 2].
In the United States alone, it is estimated that 20% of the entire population suffers from chronic acid reflux, also known as GERD [3, 4].
According to medical professionals; one of the most effective ways to manage GERD is to eliminate or reduce the intake of foods that trigger acid reflux symptoms [5, 6, 7].
Tomatoes are one of these foods known to induce heartburn in many people with acid reflux. This may come as a surprise to some people; after all, tomatoes are highly nutritious and consumed throughout the world.
In fact, no studies have been specifically conducted to show the effects of tomato consumption in people with acid reflux disease.
However, a large number of patient self-reports reveal that tomatoes and tomato products are one of the most common heartburn triggers [8, 9, 10].
The high acid content of tomatoes — particularly malic and citric acid — mostly explains why a lot of people with acid reflux usually experience heartburn after consuming tomatoes or tomato products such as tomato paste, juice, sauce and ketchup.
The American College of Gastroenterology says: Acidic foods, such as citrus fruits and tomatoes may irritate the damaged lining of the esophagus (food pipe).
In the rest of the article, we’ll talk about the relationship between tomatoes and acid reflux in more detail. Firstly, let’s explain GERD briefly.
What Is Chronic Acid Reflux / GERD?
Acid reflux occurs when stomach acid moves back up into the food pipe (esophagus).
Normally, the Lower Esophageal Sphincter (LES) — a group of muscles located between the esophagus and stomach — prevents stomach acid from moving upward.
However, sometimes LES relaxes when it shouldn’t, thus allowing stomach acid to back up into the food pipe. This can cause some symptoms, most commonly heartburn.
Everyone can have heartburn from time to time. Yet, some people experience it frequently.
Having heartburn more than twice a week for several weeks is called Gastroesophageal reflux disease (GERD), or chronic acid reflux [11, 12].
Are Tomatoes Heartburn Trigger In You?
Patients’ self-reports reveal that tomatoes are a heartburn trigger for many acid reflux sufferers.
However, this doesn’t necessarily mean that you are bound to get heartburn after eating tomatoes and tomato-based products even if you have acid reflux disease. This is because each person tends to react differently to foods [13].
Dr Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital, says “The foods that trigger heartburn are different for everyone,” [14].
If you are not sure whether or not ingesting tomatoes causes heartburn in you, keeping a food diary can help you come to a conclusion on this issue.
On the other hand, if you are certain that eating tomatoes and tomato products induce acid reflux symptoms in you, consider reading the rest of the article carefully as we will talk about the main reasons why tomatoes increase the risk of having heartburn and possible ways to consume tomatoes without having heartburn.
Why Do Tomatoes Cause Heartburn?
As mentioned at the beginning, the natural acids that exist in tomatoes make these nutritious fruits a potential heartburn trigger for many acid reflux patients.
Tomatoes contain more than 10 types of organic acids. Citric acid, malic acid and ascorbic acid (vitamin C) are respectively the most abundant acids present in tomatoes [15, 16, 17].
In fact, the organic acids in tomatoes aren’t harmful to the human body. On the contrary, they offer some health benefits; such as helping prevent kidney stones (malic acid), aiding the absorption of nutrients (citric acid) and repairing body tissue (ascorbic acid) [18, 19, 20].
However, if you are prone to acid reflux, these acids in tomatoes can give you heartburn, especially when you eat them in high quantities or ingest them on an empty stomach.
Here are the details…
Malic and Citric Acids High in Tomatoes
Tomatoes are especially rich in citric and malic acids and both of these organic acids can either trigger or aggravate acid reflux symptoms.
When these acids are ingested in high quantities or on an empty stomach, the stomach can produce too much gastric acid. That can increase the stomach’s acid level high enough to force it towards the throat, leading to heartburn.
The same applies to citrus fruit. Since citrus fruits, such as lemon and grapefruit, are high in citric acid they are usually not recommended to those who suffer from GERD.
Bear in mind, tomatoes have not only one but various acids that can contribute to heartburn.
Ascorbic Acid in Tomatoes May Trigger Heartburn
Another organic acid that is found in tomatoes is ascorbic acid, commonly known as vitamin C.
Even though many don’t know; tomatoes are an excellent source of vitamin C.
Studies suggest that ascorbic acid may increase the risk of experiencing heartburn, especially when consumed on an empty stomach [21, 22].
Possible Ways to Eat Tomatoes Without Having Heartburn
If tomatoes and tomato products cause severe heartburn in you, eliminating them or limiting their intake in your diet is a sensible idea to lower the risk of acid reflux complications.
However, for any reason, you may want to continue eating tomatoes and tomato-based products.
If this is the case, the below-given methods might help you consume tomatoes without having heartburn.
Avoid Eating Tomatoes On an Empty Stomach
Eating tomatoes on an empty stomach may cause a rapid secretion of gastric juice — which contains hydrochloric acid — into your stomach due to tomatoes’ high acidic content. So, try to avoid eating tomatoes and tomato products on an empty stomach.
Choose the Ripest Tomatoes
The pH level of fresh tomatoes ranges from 4.3 to 4.9, making them acidic foods [23].
However, how acidic is a tomato depends on its degree of ripeness. The more ripe a tomato is, the less acidic it will be [24].
So, if you want to eat tomatoes with the lowest acidity level possible, then consider eating the ripest fresh tomatoes that are not processed and sun-dried. This “may” reduce the risk of having heartburn.
Canned Tomatoes Tend to Be More Acidic
Canned tomatoes, in general, are more acidic than fresh tomatoes. The acidity level of canned tomatoes can be as lower as 3.5. The difference in acidity levels between fresh and canned tomatoes stems from the canning process [17].
If fresh tomatoes trigger heartburn in you, possibly canned tomatoes affect your acid reflux symptoms more severely.
Remove the Seeds
Tomato seeds contain the majority of acid content. As such, removing the seeds with a spoon or teaspoon can be a great way to reduce the acidity levels of tomatoes [25, 26]. That, in turn, would decrease your chances of having acid reflux.
Conclusion
We now know that due to their high acidity, tomatoes can trigger heartburn in those who are prone to it.
One study, however, suggests that the acids present in tomatoes may not be the only reason why tomatoes trigger heartburn. Some other components in tomato-based products may also contribute to acid reflux disease [10],[27].
As mentioned above, a diet that omits personal heartburn-triggering foods is one of the most effective ways to manage heartburn. This is especially true if acid reflux is not caused by an underlying condition such as hiatal hernia or helicobacter pylori.
If you realise that you continually get heartburn after consuming tomatoes, then you may want to consider tomatoes as a potential heartburn trigger in you.
Remember that removing triggering foods from your diet may not be enough to solve the problem completely.
If you suffer from heartburn for a long time, you may have developed GERD. If this is the case, we heavily recommend you work with your doctor.
Moreover, you can ask your doctor or dietitian whether it is okay for you to consume tomatoes and tomato products such as tomato sauce, ketchup or juice.
