What are the health benefits and risks of consuming lemon juice?

Health Value of Lemon Juice

Lemon juice can be a beneficial addition to the diet as a source of vitamin C, potassium, and citrate, but whole fruits are nutritionally superior and should be prioritized over juice consumption. 1

Nutritional Benefits

Micronutrient Content

• 100% fruit juices, including lemon juice, provide meaningful amounts of vitamin C and potassium, which are often inadequate in typical diets—modeling studies show that without fruit juice, diets would be substantially lower in these nutrients. 1
• Lemon and citrus juices contain phytonutrients including flavonoids and phenolic acids that may have long-term health benefits such as decreased risk of cancer and heart disease. 1
• The bioactive compounds in lemon extracts demonstrate antioxidant, anti-inflammatory, and hepatoprotective properties in experimental studies. 2

Specific Medical Applications

• Lemon juice supplementation (60 mL twice daily) may reduce recurrent kidney stone formation in patients with calcium oxalate nephrolithiasis, with exploratory analyses showing a hazard ratio of 0.43 at one year, though adherence declined significantly over time. 3
• Diet lemonade (2 L daily) significantly increases urinary citrate levels and urine volume while decreasing calcium oxalate supersaturation in patients with hypocitraturic nephrolithiasis. 4
• Long-term lemonade therapy increases urinary citrate by a mean of 383 mg per day and reduces stone formation rate from 1.00 to 0.13 stones per patient per year in hypocitraturic patients. 5

Health Risks and Limitations

Dental Health Concerns

• Prolonged exposure to the sugars and acids in juice is a major contributing factor to dental caries, particularly when juice is sipped throughout the day or consumed from bottles. 1
• The acidic nature of citrus juice can cause perioral chemical irritation in some infants. 1

Weight and Metabolic Considerations

• Regular lemonade provides 805 additional calories and 225 g of sugar per day compared to diet versions, which can contribute to energy imbalance. 4
• Every daily serving of 100% fruit juice (240 mL) is associated with 0.22 kg weight gain over 4 years in adults, though no significant associations were found with diabetes, cardiovascular disease, or blood pressure. 1
• In children aged 1-6 years, consuming ≥1 serving per day of 100% juice is associated with small amounts of weight gain (BMI z score change of 0.09 units over 1 year). 1

Nutritional Inferiority to Whole Fruit

• Juices contain less fiber, lower levels of some beneficial nutrients, and more naturally occurring sugar than whole fruits, making them a less optimal way to obtain nutrients from plant-based foods. 1
• The Dietary Guidelines for Americans recommend that at least half of fruit intake come from whole fruits rather than juice. 1

Age-Specific Recommendations

Infants (Under 12 Months)

• Juice should not be introduced before 12 months of age unless clinically indicated, as there is no nutritional indication for juice in infants younger than 6 months. 1
• Offering juice before solid foods could risk malnutrition and short stature due to reduced intakes of protein, fat, and essential minerals. 1

Toddlers and Young Children (1-6 Years)

• If juice is introduced after 12 months, limit consumption to 4-6 oz (118-177 mL) daily. 1
• Juice should be offered in a cup, not a bottle, and as part of meals or snacks rather than sipped throughout the day. 1
• Whole fruit should be encouraged instead of juice to promote healthy eating behaviors. 1

Children and Adolescents (7-18 Years)

• No association was found between 100% fruit juice consumption and BMI z score increase in this age group. 1
• Choose low-sodium juice options when juice is consumed. 1

Clinical Pitfalls to Avoid

• Do not use juice for rehydration during acute gastroenteritis—the high carbohydrate content (11-16 g%) compared to oral electrolyte solutions (2.5-3 g%) can exceed intestinal absorption capacity and worsen osmotic diarrhea. 1
• Juice is low in electrolytes (sodium 1-3 mEq/L) and may predispose infants to hyponatremia when used as fluid replacement. 1
• Unpasteurized lemon juice may contain pathogens (E. coli, Salmonella, Cryptosporidium) and should be avoided, particularly in children. 1
• Juice "cleanses" or "detoxification" diets have no scientific evidence supporting cancer risk reduction or toxin removal and may be inadequate in important nutrients. 1

Drug Interactions

• Citrus juices contain flavonoids that can decrease the activity of intestinal cytochrome P450 3A4 (CYP3A4) and affect drug bioavailability, though this should not automatically contraindicate treatment. 1
• The amount and type of juice, specific interaction characteristics, and drug bioavailability should all be considered when evaluating potential juice-drug interactions. 1