Citric acid intolerance (and acetic acid): a metabolism disorder

I may have identified the root cause and discovered the remedy to a medically unidentified disease known on the web as Citric Acid Intolerance. Here’s the story and the remedy. I hope it helps you.

Discussed in this post:

My initial symptoms and diagnosis

In my mid-twenties I began suffering terrible, painful abdominal problems that I soon attributed to acid foods. That theory mostly held but not always. I could only live my life, get out the door, and not constantly worry about finding the nearest bathroom by keeping a strict diet of completely plain foods.

Plain, as in, baked or grilled or steamed; no seasoning but salt; no complicated ingredients;  water or seltzer to wash it down. That could mean a burger with lettuce, no sauces, no tomatoes and no onions. It meant a salad of lettuce, carrots, and cucumbers with oil but no vinegar. It’s harder than it sounds and eating was difficult. Eating at a restaurant was nerveracking. I ate like this for years but at least I got some of my life back.

All the while I disagreed with doctors who diagnosed me with IBS (irritable bowel syndrome) and were lobbing random medicines to see what worked, including prescription medications with side-effects and even antacids. One doctor told me IBS was “a wastebasket diagnosis,” meaning if they did not know what the digestive problem was, it was IBS. I was not content with this hopeless life sentence. Since I had some control over the symptoms through diet, I had reason to believe there was a pattern that hadn’t been identified.

Isolating Citric Acid and Acetic Acid

I was Buddha-like in my dietary vigilance and therefore was able to test methodically. Since my plain diet left me symptomless, I was able to use this to determine what specifically was affecting me by adding on occasion a questionable ingredient to my food and assessing the outcome. A few key things became clear:

  • Upon ingestion of problem foods and ingredients, symptoms did not manifest for at least a day, usually two. This happened consistently suggesting that my problem was not a digestive problem. If it was, the pains would have come within hours not days.
  • There were ingredients and foods that were affecting me that at the time I did not consider acidic included sushi (not sashimi), mayonnaise, and canned foods like artichokes hearts and beans (but not all brands, surprisingly).
  • There were ingredients and foods that I thought would affect me but didn’t such as coffee, apples, grapes, black pepper, and soy sauce (without naturally occurring alcohol).
  • Foods and ingredients previously suspected were confirmed to be problems, such as tomatoes (especially cooked or canned), onions, mustard, sodas, and salad dressings.

Since initially this did not entirely make sense, I kept track of every ingredient in every can or jar of whatever I was eating. I also researched fruits and vegetables to determine what exactly was inside them. Eventually this led me to my first discovery: there were only three things affecting me: citric acid, acetic acid (vinegar), and alcohol.

At first I thought citric acid was specifically the issue, so I began my internet search to figure out if anything had been written about such a problem, what could be done, and who else is suffering from it. There was not a lot out there but what I found was:

  • The citric acid cycle is a critical metabolic process for energy production in organisms and occurs at the cellular level. Says Wikipedia’s Citric Acid Cycle page, “This series of chemical reactions is central to nearly all metabolic reactions, and is the source of two-thirds of the food-derived energy in higher organisms.”
  • There is a lot of talk about citric acid allergies, which is not the same thing. Allergic reactions are an immune response that usually manifest immediately, not a day later.
  • Eventually I discovered Vicky Clarke’s page on what she calls Citric Acid Intolerance, a brave woman from England – the one person that corroborated my suspicions and documented her very similar (albeit more severe) plight in great detail. To find someone else who had been on this journey made me realize I was not imagining things – I was right! I wish I knew how to reach out to her to say thank you.

The Citric Acid Cycle, the metabolic connection

Note the Acetyl and Citrate, resulting from Acetic Acid and Citric Acid, respectively, and their relation to Coenzyme A (CoA). Credit Wikipedia, authored by Narayanese, WikiUserPedia, YassineMrabet, TotoBaggins
Note the Acetyl and Citrate, from Acetic Acid and Citric Acid, respectively, and their relation to Coenzyme A (CoA).
Credit Wikipedia, authored by Narayanese, WikiUserPedia, YassineMrabet, TotoBaggins

Eventually I deduced that the problem was dysfunctional metabolization related to the Citric Acid Cycle. Continued research showed that alcohol broke down into acetic acid, and both citric acid and acetic acid are integral to the Citric Acid Cycle (Krebs Cycle), specifically with relation to interactions with Coenzyme-A, a critical component of the the cycle. I surmised that this process was malfunctioning within me.

Of course, I was not entirely sure and this line of thinking was probably a stretch considering my limited medical knowledge. However, it is a hypothesis that I feel I have since adequately proven.

(Furthermore, I believe the outcome of this Citric Acid Cycle malfunction is the production of an irritant that was causing the pain. I later found a research paper linking elevated levels of pyruvate from the citric acid cycle in stool samples from patients with IBD (inflammatory bowel disorder), so this part of the hypothesis is not without reason but not proven.)

With the confidence that the Citric Acid Cycle was the issue I turned to another part of the puzzle I had discovered, that vitamin B5 had beneficial effects that eased my symptoms. Regular intake offered some flexibility in my food consumption but not much.

Vitamin B5 and Coenzyme A

At around the same time I was discovering the benefits of vitamin B5, Vicky Clarke updated her page to include mention of the same. More vindication; I was on the right path!

Research into vitamin B5 revealed something that gave me further confidence in this direction. Vitamin B5, known as pantothenic acid, is also a critical component of Coenzyme A synthesization. One more thing pointing to the Citric Acid Cycle.

Coenzyme A is not like the lactose enzyme; you can’t just ingest coenzyme A, your body has to make it. So I needed to determine what supplements were necessary to help my body create more coenzyme A. I was fortunate to find that there was one lab that creates an over-the-counter supplement engineered for this, called Pure Coenzyme A. Although marketed as an energy boosting aid (and obviously not containing pure coenzyme A), it had the combination of supplements needed including pantothenic acid, pyruvate, and amino acids. I had nothing to lose by trying.

Testing the theoretical remedy

I took one pill daily for three months before I experimented with eating citric acid- and acetic acid-rich foods. I still remember the terror of eating that first pizza slice. At that point I had not eaten pizza in years and so savored it, all the while dreading what may happen in a day or two. But the pain never came. It never came!

As an extension of my food testing, for the next few weeks I experimented with one problem ingredient or food every few days. Eventually I hit a limit of how much I could eat but even then the pain wasn’t so bad. So I started taking two pills a day. And then even that limit broke.

After a while two pills a day was too much and I moved back to one a day. There are days now that I skip the supplement intake entirely. I still need to take it but I have no dietary restrictions anymore. I eat everything without concern. There is no more pain.

Success!

I repeat: I have no dietary restrictions at all. None at all!

Ten years after I first experienced symptoms, I got my life back. I’m a few years in from that point and still doing great.

And I want you to have your life back too. So here are my suggestions if you think you’re suffering from the same thing.

Disclaimer: I am not a medical professional. While none of what I discuss involves prescription medications or medical procedures, please don’t take my assumptions as doctrine and do contact a doctor if you have concerns. While doctors have never heard of this problem, they can at least tell you if the supplements I’m suggesting are okay for you to take. Also, if there are errors in my thinking, I would appreciate clarification to refine the theory. While I did confer with a biologist who agreed with some of my assumptions, I’ve only tested this on me.

How to determine that Citric Acid Intolerance is your problem

Testing and identifying whether you have problems with the Citric Acid Cycle is the first step. It might also be the hardest. As mentioned, problem ingredients are found in many, many foods so isolating requires significant determination but it is possible to do.

Know the foods and ingredients with citric acid and acetic acid

  • Many canned foods use citric acid as a preservative and it’s usually, but not always, listed in the ingredients. Example: artichoke hearts or canned beans.
  • Vinegar is mostly acetic acid. Anything containing vinegar is going to be a problem, including sushi which contains rice wine vinegar in the rice.
  • Alcohol breaks down into acetic acid, as mentioned previously.
  • Many vegetables, especially when cooked, have high concentrations of citric acid, such as tomatoes and onions.
  • Citric fruits such as oranges, lemons, and pineapples have high concentrations of citric acid.
  • Most condiments have any one or more of the following: citric acid, vinegar, tomato, onion (or onion powder), or citric fruit juices.
  • Powders derived from onions, celery, or the any substances derived from ingredients that are a problems in another form.
  • Honorable mention: Phosphoric acid. This is an artificial acid and I have not researched why it is problematic but testing has shown it is.

Know what foods do not have citric acid or acetic acid

  • Fruits such as apples and grapes are fine in moderation because they have tartaric acid not citric acid. Bananas are also fine.
  • Sodas that use tartaric acid (from grapes) instead of citric acid, like Blue Sky organic cola, for example.
  • Proteins, plain or mildly seasoned with foods not ordinarily a problem (e.g. herbs).
  • Nuts too are fine.
  • Soy sauce is one of the few saucy condiments that does not have problematic ingredients. Just be aware of those with naturally occurring alcohol mentioned on the label.
  • Dairy. If lactose intolerance is a problem, it is a separate issue and can be managed with over-the-counter supplements.
  • Sugary items, such as cookies and cakes without problematic ingredients are fine.

Fortunately there are several sites that offer Citric Acid free recipes but I highly recommend sticking to plain foods to better isolate ingredients. Here are a few.

Testing to determine if you suffer from Citric Acid Intolerance

  • Test yourself by STRICTLY limiting your diet to plain foods with very few ingredients. If you were unable to stabilize your digestive problems then either Citric Acid Intolerance is not your problem or you have not been as strict with your diet as you need to be.
  • Stick to plain foods and water until digestive issues have stabilized.
  • Keep a diary.
  • Introduce one food with either citric acid or acetic acid. Eat once, don’t eat anything else with citric or acetic acid, and wait a few days. Document the reaction.
  • Over time there should be a pattern showing you that citric acid and acetic acid are without question the cause of your problems.
  • Now stop testing and return to a plain diet.
  • Start taking the over-the-counter supplement, if it’s okay for you to do so. Pure Coenzyme A is not commonly found everywhere but you can certainly order it from Amazon. Also, most of the components of Pure Coenzmye A can be bought separately more easily if preferred.
  • Take for a month or more before you start the food testing again.
  • After a month or more, introduce one known problem food or ingredient. As before, eat once, then stick to plain foods, and document the reaction over the next few days.
  • If there is a difference in your reaction – notably, if you have no reaction – things are working.

I hope this works for you. Please let me know if this information has helped you in any way. Wishing you the best of luck and good health.

26 thoughts on “Citric acid intolerance (and acetic acid): a metabolism disorder

  1. Hi Milind, my name is Brandy. Three months I’ve been going to the Er because of citric acid. All my allgeric relations are different eating jelly really upset my stomach and I vomit . One night eat curry and had wild cherry Pepsi had hives one face arms and legs. Pineapple and oranges lime and lemons and peaches I go into analysis shock . I don’t know what to do . I’m also really highly allergic to perfumes as well

    1. Hi Brandy,

      Sounds like you might be having an allergic reaction and not necessarily the metabolic issue that I’m going through. There are several sites that have lists of foods and ingredients that are problems. They’ll help you stay away from problem foods if citric acid is the thing causing your reactions.

      - CitricAcidAllergies.wordpress.com is one such site.
      - Vicky Clarke’s site also has some suggestions
      - There is also a Facebook group for our lot that might be very supportive of what you are going through.

      I hope this helps.

  2. Hi Milind,

    thanks for the post. I am intolerant to citric acid but am ok with acetic acid and alcohol. Sometimes I crave acetic acid and like to use vinegar in my food. I didn’t quite understand what you said under “Testing the theoretical remedy”. Do you mean that on 1 pill a day you started to increase your intake of problem foods until the problems came back, then you increased dose to two pills and again increased your intake until you hit problems? Later you say that there are now no problems – is that because you are making sure you don’t go above you limit with problem foods?

    Thanks,

    Chris

    1. Hi Chris,

      Thanks for asking.

      That’s partly what I meant. I was being very conservative/meticulous with testing. I definitely didn’t want to return to the way things were. So at first I started taking one pill daily without trying citric acid foods. Then three months later started eating more and more foods until symptoms returned. That gave me a baseline to work with.

      At that point I moved on to two pills to see what kind of limit I would hit with that. I never actually found a limit and that might be because I had enough of the supplement in me to satisfy daily consumption. Eventually I went back down to one.

      At this point, as long as I take the supplements regularly (nearly daily but not necessarily every day) I feel comfortable enough not to have to keep track of my intake.

      I hope that clarifies. If you decide to try the suggested supplements, or are trying some other remedy, please let me know how you fare.

      Milind

    2. Ah, after rereading your comment and my answer, I realize there is a point I haven’t been clear enough about. I say that I started taking one pill, then two, and went back down to one. I also discuss limits in what I could eat and then getting to a point where I don’t have a limit. I think this is breakdown in my logic and explanation so let me try to clarify here and I’ll update the post.

      I assumed when I was testing that the number of supplements I take would have a direct correlation to the amount of citric acid I could consume. However, I eventually realize that there wasn’t a one-to-one correlation. I probably lack enough of the necessary substances necessary for proper metabolization. As long as enough supplements are taken to maintain adequate levels within me, I’m able to metabolize just fine.

      The initial limits I faced with just the one pill were probably due to the fact that my body still didn’t have enough of the supplement to properly metabolize. Moving to two most likely rectified that. I had to reduce when I felt like I was probably taking too much. My body is probably at a comfortable level now as long as I take the supplements regularly.

      I hope that better explains and thanks for pointing out this confusing point.

      1. Thanks for the clarification. If you are interested there is a Citric Acid intolerance group on Facebook. But this is the first time I have heard of CA, Acetic acid and alcohol intolerance. It seems that everyone in the CA group on facebook has a slightly different set of foods which upset them. Food intolerance is a complex thing!

        1. They truly are. Again, this is just my thinking on the topic based mostly on my experiences. But I hope what I have discovered about myself can help others.

          I never thought to look on Facebook. Thanks for letting me know. I’ll check it out.

  3. Hi All

    Was wondering if you could provide updates on how you are feeling? If you still have symptoms from citric acid? And if your symptoms to citric acid decreased, what are you taking to make this happen?

    Thanks,

    A citric acid allergy sufferer,

    Adam

    1. Hi Adam,

      Thanks for asking! I’m feeling very well as long as I take the supplements I mentioned in the post on a regular basis. I don’t have to take them daily though but it took a while for me to get to that point. I go into more detail about it in this part of the article.

      Also I don’t think what I have is an allergy. We might not have the same problem but certainly researching always helps. Please let me know if you have any questions.

  4. I wanted to update you Milind, Ido think something is helping. The symptoms we are seeing improvement in are warmer hands, more energy, needing less sleep, better digestion, less exercise fatigue I think too. I have made it a little more difficult to figure out exactly which things are helping as I started taking AOR’s Advanced B Complex just before we started taking the Coenzyme A supplement. My youngest son who is 14 is only taking the B Complex and is also getting improvements. Both supplements contain the Pentathine so maybe that is the key? The other ingredients are different. We are trying to sort it out and then in a few months will see if we are less intolerant to the CA. The B Complex also contains P5P and B12(methy). I am wondering if those are perhaps helpful as well? Any thoughts?

    1. I do think Pantethine or Pantothenic Acid (i.e. Vitamin B5) are the key. My decision to use the mentioned coenzyme-A supplement was guided by my thinking that it was addressing the exact issue. However, I’m sure other supplements or combinations of supplements can help, with vitamin B5 being one of the most important parts. I also think that Pantethine is the more effective version of vitamin B5 but I have no clear data on that.

      It’s great to hear things are looking up. For me it did take several months before I was confident in expanding my diet but I remember seeing some immediate effects earlier on, like less fatigue and lower sugar craving.

  5. Thank you for posting your findings. A few members of our family have a similar intolerance to the preservatives Citric acid, ascorbic acid and sodium citrate, lemons and limes. No issues with acetic acid or natural CA. We are going to give this a try.

    1. Very interesting set of intolerances. I’m not sure if my remedy will help you but please do let me know either way. I wish you the best of luck.

      Also, how do you distinguish natural citric acid from artificial? I didn’t know there was a distinction and never investigated it.

      1. I guess the easiest way to distinguish the two for us is that ripe tomatoes (high CA food) does’t bother us but canned tomatoes with added citric acid as a preservative makes us very ill. B5 seems to help with moderating our reactions so we are somewhat optimistic. I was wondering if you are feeling well now? I sincerely hope you have found a solution to your issues and all is well. Thank you again for posting! Even if this doesn’t work for us it is always good to have more information.

        1. I should have looked up natural CA values before posting! A better example would have been oranges. We can eat them if they are naturally ripe but can’t eat anything with added CA as a preservative.

        2. I had never considered making the distinction before, always thinking the citric acid molecule was the molecule. I know that processed foods have higher concentrations of citric acid, which may mean that you can handle some but not a lot. This is how it was for me in the beginning. However, now that you have mentioned it, I will look a little more closely into any distinction between naturally occurring and artificially added citric acid. Thank you for sharing this idea with me.

          Since I discovered and started taking the remedy, I have been eating normally. I continue to take the Coenzyme A supplement regularly, although not daily. I have sometimes stopped taking the supplement for extended periods and my symptoms have returned, so I do need to continue. But overall, I do not suffer. I wish you the same!

          1. It is easy to spot if you read the ingredients on everything. My Mother has had these issues for over 40 years so it was easier for her to notice as preservatives like citric acid and sodium citrate were added to products she could no longer eat them without getting sick. It is so much now it would be hard to figure out. My son has almost the same intolerances as my Mother but even between them there are little differences so it does vary. Mine are much milder. I am glad to hear that you continue to have good health!

          2. I had tried it for a little while and did feel a bit better. However I took it at a time when my methodology wasn’t refined enough. I also felt like I was getting different results with different brands. I don’t think I tested just pantethine enough or properly and so my findings are inconclusive.

            The Coenzyme A supplement I take does include pantethine as one of the ingredients.

          3. Thanks, I was also wondering if you take any other supplements? Zinc, other B vitamins or anything like that. We are taking just the Pantethine right now as we are waiting for the coenzyme A supplement to arrive. It is too early for us to tell anything yet but I will update you when we know if we are benefiting from these.

          4. I do occasionally take a multi-vitamin for general health support. I also take a supplement for lactose intolerance. I don’t take anything additional for the citric acid problem.

          5. Thanks Milind Shah. Sorry to ask you additional questions, we have been trying you suggestions and are noticing some improvement. We will update you after a few months and let you know if it worked for us.

          6. Please do feel free to ask me anything. I’ve been unable to respond promptly recently but I welcome your questions. I’d like to offer you as much support as I can.

            I hope this remedy works for you! Looking forward to hearing from you.

  6. I have a 13 year old daughter who had eczema as a baby and after lots of research I cut all citric acid out of her diet. Her eczema cleared up after a couple of years trial and error as citric acid is in toiletries, detergents, creams etc.

    To cut a long story short, my daughter became ill when she was 10 and 2 years later a tumour was found on one of her adrenal glands. The tumour was very rare and called pheochromocytoma. I have since found out that these tumours can be part of genetic diseases some of which are connected to the citric acid cycle or Krebs cycle.

    My daughter has tested negative to all of these.

    Not saying for one minute that this is what’s wrong with you but this has never been mentioned as a probable cause of the tumour except when I mentioned it to a doctor who didn’t think it important enough to note.

    My daughter also abnormally craves vinegar.

    I’m no expert, just a mum wanting to keep her child safe, but what you wrote has made me confident enough to push this information forward to see if this has any connection to the tumour.

    My daughter is now fine and will be monitored for the rest of her life.

Care to share your thoughts?