Symptoms and Diagnosis

How can I tell if I’m reacting to Citric Acid?
What kinds of symptoms can Citric Acid cause?
Talking to your doctor

How can I tell if I’m reacting to Citric Acid?

There are a lot of different foods and preservatives that one can react to. Citric acid is especially difficult to pinpoint as a problem, because unlike nuts or dairy, it is in pretty much everything to some degree.

The best way to figure out what you’re reacting to is to keep a food diary. Each day, keep track of:

  • What you ate, and what time you ate it
  • What symptoms you experience
  • What time those symptoms flare up, as well as symptom duration

You may start to notice some patterns: for example, you may have a headache on days you have orange juice for breakfast. It’s important to keep track of ALL of your symptoms, even if they don’t pop up within a couple of hours of mealtimes.  Some symptoms, especially those that are neurological or systemic (e.g. fatigue or diffuse pain), can take more than 24 hours to present themselves. Use this list to get an idea of which foods have high, moderate, or low levels of citric acid, or if you’d like to look up a specific food’s citric acid content.

Sometimes patterns are difficult to decipher, and you can’t tell when things are making you worse. If this is the case, eliminate citric acid from your diet for two weeks.  Why two weeks, you ask?  If you eat something that your body doesn’t like, you will have what my allergist refers to as an “allergy sprain.”  When you sprain your ankle, little things that typically go unnoticed, like catching your toe on a step, or even just walking too far, can really freaking hurt! These silly things may even manage to worsen your injury, and greatly increase your overall recovery time.  The same thing is true of your allergies and sensitivities: when they have suffered an insult and are thus “sprained,” little things that normally fly under the radar can cause reactions.  If you are in the process of identifying your food friends and foes, it’s likely that you’ve worked your way into a chronic allergy sprain.  You need to let your body rest and heal before you can figure out what is bothering you; everyone takes a different amount of time to recover from reactions, but most people will have returned to their “normal” body state after two weeks.  You may choose only to eliminate high citric acid foods, or you might go full ninja and eliminate all sources of citric acid. If you feel better, try reintroducing citric acid and see if your symptoms come back.

Of course, you may not be reacting to citric acid at all!  Be sure to keep an eye out for patterns with other potential offenders. Don’t get frustrated if you can’t figure something out right away; it can take a couple of months or longer of keeping a detailed diary to figure out what you’re reacting to.  Common offenders include dairy, eggs, tree nuts, peanuts and other legumes, wheat, gluten, fish, and shellfish.  Many people also do poorly on foods that are genetically modified, or treated with antibiotics and hormones.  You may need to start reading the labels of everything you eat and looking for reactive patterns that concern minor ingredients, additives, or preservatives.

If you believe there may be more than one food causing your problems, it’s a good idea to go on a strict elimination diet for two weeks.  Stick to simple, bland foods like chicken and rice.  Make sure the chicken is plain: none of that processed stuff with spices and mystery flavors!  Also be sure to wash the chicken thoroughly, because even raw, organic packages of chicken breasts are often washed with citric acid.  That waxy paper in the bottom of the tray also typically contains citric acid.  If you live in the US, this information will NOT be on the label!

Stay away from fruits, vegetables, legumes (including soy), corn, garlic, and onion to avoid most major sources of citric acid; other commonly allergenic foods you may want to stay away from include dairy, eggs, nuts and peanuts, wheat, and shellfish.  I know two weeks of chicken and rice sounds like torture, but it can be very helpful in determining what you can and can’t eat!  Once the two weeks is up, pick one of the foods you eliminated and reintroduce it into your diet.  Keep a detailed food diary during this time, and hopefully you’ll start having some “light bulb” moments.  If you do start having reactions, but want to test more foods, go back to the elimination diet and try the next thing no sooner than three full days after all symptoms have subsided.

If you’re still stuck, bring your food diary to your doctor!

What kinds of symptoms can Citric Acid cause?

A reaction to citric acid can cause a wide variety of symptoms.  The following list of symptoms was compiled from a survey of your fellow ninjas-in-training; keep in mind that these symptoms can be indicative of something other than a reaction to citric acid, and many of them require medical attention.

General/Systemic:

  • Anaphylaxis
  • Anaphylactoid reaction
  • Extreme fatigue
  • Excessive pain
  • Dizziness
  • Fainting spells
  • Headache
  • Migraine
  • Sweating
  • Bloating, swelling
  • Swollen lymph nodes
  • Weight gain

Auditory:

  • Itching in ear canal
  • Build-up of earwax
  • Hypersensitivity to noise

Cardiac:

  • Low blood pressure
  • Tachycardia
  • Palpitations

Dermal:

  • Hives
  • Itching
  • Rash
  • Eczema
  • Flushing, “hot” feeling in skin
  • Dry or scaly skin
  • Hypersensitivity to touch

Female-specific:

  • Delay of menstrual cycle
  • Skipped menstrual cycle
  • Vaginal irritation (burning, itching)

Gastrointestinal:

  • Nausea
  • Vomiting
  • Acid reflux
  • Indigestion
  • Gastroparesis
  • Stomach/intestinal cramping
  • Gas
  • Constipation
  • Diarrhea
  • Irritation/burning of the anus

Neurological:

  • Inability to concentrate; short attention span
  • Short-term memory difficulties
  • Cognitive dysfunction (difficulty with comprehension or communication)
  • Clumsiness
  • Reduced fine motor skills
  • Seizures

Ocular:

  • Swollen eyes
  • Eye irritation/itching
  • Light sensitivity
  • Double vision

Oral:

  • Swollen mouth (lips, tongue, gums, or palate)
  • Itchy mouth
  • Blisters, canker sores, or sores in mouth
  • Hives in mouth
  • Swollen taste buds
  • Scalloping of the tongue
  • Buildup of yeast on tongue (white, looks like plaque but doesn’t come off)
  • Sore throat
  • Itchy throat
  • Thick, “furry” sensation in throat
  • Inflamed tonsils
  • Tonsiliths

Psychological:
(Note: although constantly checking over your shoulder for evil lemons can definitely cause stress, the lemons themselves can cause all kinds of changes in your body; some of these chemical changes can affect your mood and mental state.)

  • Anxiety
  • Panic attacks
  • Irritability
  • Mood swings
  • Sudden/severe loathing of lemons
    • (Okay maybe that one’s not chemical)
    • (Or maybe it is)
    • (Destroy ALL the lemons!)

Respiratory:

  • Restricted breathing due to:
    • Swollen throat
    • Paradoxical vocal fold dysfunction
    • Asthma
  • Hypoxia
  • Depressed breathing rate
  • Shallow breathing
  • Feeling that you can’t get enough air
  • Pressure in lungs
  • Hyperventilation
  • Coughing
  • Wheezing

Talking to your doctor

Talking to your doctor is a very important step in managing any food problem.  I understand that some doctors can be incredibly frustrating–some do not believe you can react to citric acid–but there are many excellent doctors out there who can help you diagnose and treat your citric acid sensitivity.  (Wait– sensitivity?  Doctors tend to prefer the most technically accurate terms; see here for why I refer to it as an “allergy.”)

There are blood tests available for true IgE-mediated allergies like dairy protein, egg protein, and peanut protein.  Since reactions to citric acid are not IgE-mediated, there is currently no blood test for citric acid.  Some doctors may do an oral challenge, where they give you a small dose of citric acid and see how you react; some doctors may do scratch tests.  Other doctors will ask you to keep a food diary; as there is no definitive test for citric acid, a food diary is key to diagnosis!

Once you have a diagnosis, your doctor will be able to prescribe any necessary medications such as epinephrine, which can stave off a life-threatening reaction until you can seek emergency medical care.  They may also be able to help you find out hidden ingredients in products.