Citrus intolerance usually shows up as heartburn, a sore or stinging mouth, or an upset stomach after eating oranges, lemons or grapefruit, or drinking their juice. In most people the acidity, the natural sugar in juice, or naturally occurring compounds such as salicylates are behind it, rather than an allergy.
The good news is that citrus is easy to cut back on without missing out, because plenty of other fruit and vegetables provide vitamin C. The trick is knowing where citrus hides.
What are the symptoms of citrus intolerance?
- Heartburn or acid reflux, especially after juice on an empty stomach
- A sore, stinging or tingly mouth or lips
- Stomach ache, wind or loose stools
- Red, itchy or sore skin where juice or peel has touched, such as your hands or around your mouth
- Headaches in some people
Symptoms usually come on within a few hours and tend to be worse with larger amounts, such as a big glass of juice.
Citrus allergy is uncommon, but it does happen. Swelling of the lips, mouth or throat, hives or difficulty breathing after citrus need urgent medical help (call 999 if breathing or swallowing is affected). Intolerance testing is not a substitute for allergy testing.
Why can citrus cause symptoms?
Acidity
Citrus fruits and juices are acidic. That acid can sting a sore mouth or cracked lips, and many people with reflux find that citrus, especially juice, makes heartburn worse. Our guide to reflux after meals covers other common food triggers and simple changes that help.
Natural sugar in juice
A glass of juice contains the sugar of several pieces of fruit without most of the fibre, and you drink it quickly. If you are sensitive to fructose, juice is far more likely to cause wind or loose stools than a single whole orange. Our guide to fructose intolerance explains why.
Salicylates and histamine
Citrus fruits contain natural salicylates, and they often appear on lists of foods that may encourage the body to release histamine. If you notice reactions to a wide range of fruits, spices or aged foods as well as citrus, our guides to salicylate sensitivity and high-histamine foods are worth a read.
Peel oils and the skin
Citrus peel contains aromatic oils that can irritate the skin, which is why people who peel, zest or squeeze a lot of citrus sometimes get red, sore hands. Lime or lemon juice left on the skin in strong sunlight can also cause a burn-like rash. Our guide to skin reactions and food covers other skin signs to look for.
Where does citrus hide?
Whole fruit is the obvious source. These are the ones people tend to miss:
- Juice drinks and smoothies, including blends that are mostly apple or another fruit
- Squash, cordials, lemonade and citrus-flavoured fizzy drinks
- Marmalade, lemon curd and citrus jams
- Salad dressings, marinades, fish dishes and hummus, which often contain lemon juice
- Cakes, biscuits and puddings made with zest or candied peel
- Earl Grey tea, which is flavoured with bergamot, a citrus fruit
- Orange-flavoured sweets, chewable vitamins and fizzy vitamin C tablets
You will also see citric acid (E330) on many labels. Despite the name, it is usually produced by fermentation rather than squeezed from fruit, so it is not the same as eating citrus, although it adds acidity.
Does grapefruit affect medicines?
Yes, grapefruit and grapefruit juice can interact with some medicines and change how much of the medicine reaches your bloodstream. If you take regular medication, check the patient leaflet or ask a pharmacist before eating grapefruit regularly.
What can you eat instead of citrus?
Citrus is a handy source of vitamin C, but far from the only one. The NHS lists peppers, strawberries, blackcurrants, broccoli, Brussels sprouts and potatoes as good sources too.
| Instead of | Try |
|---|---|
| Orange juice at breakfast | Whole berries or kiwi, and water to drink |
| Lemon juice in dressings | A splash of vinegar, or fresh herbs with olive oil |
| Lemon with fish | Dill, parsley or a little mustard |
| Lemon water | Water with mint or cucumber |
| Marmalade | A berry or plum jam |
| Zest in baking | Vanilla, cinnamon or ginger |
If acidity is your main problem, bear in mind that vinegar is acidic too, so herbs and oil may suit you better.
How do you find out whether citrus is your trigger?
- Keep a diary for two weeks. Note every citrus food and drink, including hidden sources, and any symptoms with timings.
- Cut citrus out for two to four weeks. Remove whole fruit, juice and the hidden sources listed above.
- Bring it back one at a time. Start with a whole orange, then try juice a few days later, then lemon. Leave two to three days between each.
- Look at the pattern. If only juice causes trouble, sugar or acidity is the likely factor. If small amounts of any citrus cause symptoms, the fruit itself may be the issue.
Citrus is one of many foods that can be involved; our guide to the most common food intolerances in the UK puts it in context.
Where hair sample testing fits
If citrus is one suspect among several, testing can give you a starting point and help you decide what to try removing first. The Core Intolerance Test tests 500 food items, including oranges, orange juice, lemons, lemonade, grapefruit and Earl Grey tea. Limes are not a separate item on our list.
If you would also like nutritional items tested, the Ultimate Intolerance Test adds items such as citrus bio-flavonoids and vitamin C, as well as non-food items and E-numbers.
Your report groups items into high, medium and low response and includes a 6–8 week elimination plan and a printable food diary. It arrives by email within 3–5 working days of your sample arriving, or 48 working hours with priority.
Frequently asked questions
Why does orange juice give me heartburn?
Orange juice is acidic and is often drunk on an empty stomach, which can trigger heartburn in people prone to reflux. Try a whole piece of fruit with a meal instead, or a non-citrus alternative, and see whether it makes a difference.
Can I be intolerant to oranges but not lemons?
Yes. People often eat oranges and juice in much larger amounts than lemon, and the sugar content differs. Reintroducing each fruit separately, a few days apart, is the clearest way to find out which ones you tolerate.
Is citric acid the same as citrus?
Not quite. Citric acid (E330) is usually made by fermentation rather than from citrus fruit, so it is not the same as eating oranges or lemons. It is acidic, though, so it may bother people who react mainly to acidity.
How do I get enough vitamin C without citrus?
Peppers, strawberries, blackcurrants, kiwi, broccoli, Brussels sprouts and potatoes all provide vitamin C. Eating a variety of fruit and vegetables each day will usually cover your needs without any citrus.
This guide is general wellness information, not medical advice. Our test uses bioresonance, a complementary (CAM) method; it does not diagnose allergies, coeliac disease or any medical condition. Speak to a GP if you have severe or ongoing symptoms.
