Sometimes, acid reflux triggers are obvious. Oranges, chocolate, coffee—these are well-known problem foods for heartburn sufferers, and if you have gastroesophageal reflux disease (GERD), you may already working hard to avoid them. But there are some foods that are much less overt about their acid-boosting properties.

Acidification is the process of adding acids to food, and though it can be a useful tool in preserving packaged goods, it can spell problems for those who struggle with acid reflux. As you eliminate other triggers from your diet, learning how to identify and avoid hidden acids in packaged foods can help you make sure that there isn’t a trigger lurking in an unexpected place.

Why Add Acid to Food?

Acidity helps us prevent the spoilage of many foods. In the 1970s, Congress passed a federal regulation called Title 21, mandating that all food manufacturers adequately acidify prepackaged foods and drinks to prevent the growth of bacteria. Title 21 was passed to help us control the growth of microorganisms that cause foodborne illnesses like botulism, and though it may have led to a longer shelf-life for many products at the supermarket, it has also led to a more acidic diet that may be a factor in reflux for millions of Americans.

If a food is naturally high in acid, like fruit or fruit products, added acids are not always necessary to meet Title 21 regulations. But many low-acid foods, like vegetables and meats, require added acid to meet these regulations. This means that an ingredient like vinegar or citric acid is added to bring the acidity of the product to an acceptable level.

How Can I Avoid Added Acids?

If you suffer from acid reflux, you can help yourself avoid added acids by:

• Checking labels. Citric acid, malic acid, acetic acid, ascorbic acid and vinegar all indicate that the food has added acid. When you see these ingredients on a food label, it may be best to choose a different product.
• Eating fresh. Because added acid is only a concern for packaged foods, eating fresh produce and meat is typically safe, provided you avoid other common reflux triggers.
• Eating organic. Organic foods are less likely to have added chemicals of any kind, including acids.

Acidification may be done with good intentions, but it can cause unforeseen consequences for people who have GERD. Remember to keep an eye out for hidden acid triggers as you work on managing your symptoms.