Can You Eat Pineapple if You Have Acid Reflux?

Experts disagree on whether people with acid reflux should avoid pineapple. The tropical fruit is acidic, but it also contains bromelain, an enzyme said to aid digestion and have anti-inflammatory properties, other nutrients and fiber. The question may ultimately come down to: Does pineapple bother you?

"Pineapple has vitamin C and bromelain, but there's not a lot of [bromelain]," says gastroenterologist and internist Richard I. Rothstein, MD, chair of the Department of Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. And it's "best to eat it in its natural form, not cooked," he says.

Many health claims are made for bromelain, which is also found in pineapple extract or enzyme supplements. As a supplement, people buy it to help digestion, plus treat pain and swelling, sinusitis, osteoarthritis and even cancer. However, not many studies have been done to verify its effectiveness, according to the National Center for Complementary and Integrative Health.

Cooking pineapple cuts the vitamin content and probably eliminates the bromelain, Dr. Rothstein says. Canned pineapple and pineapple juice are both cooked during processing. Commercially made pineapple juice lacks the fiber found in fresh pineapple, but you can make your own juice and not strain out the pulp, he adds. Dr. Rothstein describes the fruit as "mildly acidic," about 3 to 4 on the pH scale, which would put it in the middle of the acidic range, with 1 being most acidic and 7 being neutral.

"Citrus fruit, pineapple, apples — they're all weak acids," Dr. Rothstein says.

The most acidic fruit juice commonly sold is cranberry, which weighs in with a pH of 2 to 2.5, Dr. Rothstein says. Low-acid fruits include bananas, cantaloupe, dates, figs, papaya and watermelon. All have a pH of 4 or higher, according to the U.S. Food & Drug Administration.

Acid or gastric reflux occurs when stomach acid leaks into the esophagus, causing the sensation of heartburn. Many health experts caution people with acid reflux against eating any acidic foods, including pineapple. For example, the U.S. National Library of Medicine recommends people with chronic acid reflux, or GERD, avoid high-acid foods, including pineapple, along with citrus fruits and tomatoes.

However, Dr. Rothstein says pineapple is OK as long as it does not aggravate acid reflux, and that depends upon the individual, portion size and preparation style.

"You could put it in a smoothie, make it more bland," he says. "Add dairy products, ripe banana, greenery like kale, spinach, broccoli and avocado. Raise the pH."

Coconut milk, with a pH approaching a neutral 7, can also be added to recipes to counter pineapple's acidity, Dr. Rothstein says.

Not all foods commonly described as bad for acid reflux cause problems for every patient. For instance, coffee and caffeinated drinks are generally regarded as troublemakers. Yet, Dr. Rothstein says he lets each patient's experience be their guide.

Medications that decrease production of stomach acid may help people with acid reflux enjoy a wider range of foods. Dr. Rothstein says when patients go on an acid blocker, they can enjoy more foods.

These medications, known as proton pump inhibitors (PPIs), limit the amount of hydrochloric acid produced by the parietal cells in the lining of the stomach. PPIs sold over the counter include Prevacid, Nexium and Prilosec. An effect of these drugs is they also block production of a factor the body needs to make vitamin B12, Dr. Rothstein says, but long-term use has not been found to be a problem. Anyone who routinely has heartburn should talk to their doctor, as chronic acid reflux can damage the esophagus.

"Reflux is incredibly common," he says. "If they have episodes three or more times a week, they should be seen."