Do you find your symptoms of acid reflux or gastroesophageal reflux disease (GERD) acting up at the worst times — like during a job interview or right before your daughter's wedding? Most people who suffer from heartburn might stay away from Uncle Ned's spicy chili and pass up orange juice with breakfast. But they may be less aware of how meeting the parents for the first time or giving a presentation may affect their symptoms.

According to some studies and surveys, stress may very well be another trigger for heartburn. That's bad news if you have lots of stress in your life, but with some effective coping techniques, you can calm your stomach even during the most trying times.

The Connection

Lifestyle factors can play a role in how a disease affects an individual. A study in 2010 looked at health surveys of over 40,000 Norwegians and found that people who reported work-related stress were significantly more at risk for GERD symptoms. People who said they had low job satisfaction were twice as likely to have GERD compared to those who reported high job satisfaction. A more recent study, published in Internal Medicine, interviewed 12,653 people with GERD and found that nearly half reported stress as the biggest factor that worsened symptoms, even when on medication.

Does Stress Really Make It Worse?

It’s still debatable whether or not stress actually increases the production of stomach acid or physically creates a worsening in acid. Currently, many scientists believe that when you’re stressed, you become more sensitive to smaller amounts of acid in the esophagus. In 1993, researchers published in the American Journal of Gastroenterology that reflux patients who were anxious and stressed reported having more painful symptoms related to acid reflux, but none of the patients showed an increase in gastric acid. In other words, though people consistently reported feeling more discomfort, the scientists didn’t find any increase in total acid produced. Another study from 2008 added further support to this idea. When researchers exposed people with GERD to a stressful noise, they also found that it increased their symptoms by making them more sensitive to acid exposure.

Is It All in Your Head?

Does this mean that the symptoms are all in your head? Not likely. Researchers theorize that stress may cause changes in the brain that turn up pain receptors, making you physically more sensitive to slight rises in acid levels. Stress can also deplete the production of substances called "prostaglandins," which normally protect the stomach from the effects of acid. This could increase the perception of discomfort.

Stress, coupled with exhaustion, may present even more body changes that lead to increased acid reflux. Regardless of what exactly happens in the brain and the body, those who suffer from acid reflux know that stress can make them feel uncomfortable, and treating lifestyle factors is important.

What Can You Do?

Adopting coping techniques for managing stress in your life can help reduce your risk of conditions such as heart disease, stroke, obesity, IBS, and depression. The better you deal with stress, the better you feel.

  • Get exercise. Exercise helps loosen up tight muscles, gets you away from the office or other stressful environment, and releases natural, feel-good hormones. Exercise can also help you lose weight, which can help reduce the pressure on your abdomen.
  • Watch your diet. This is particularly important if you're under stress, as you're likely to be more sensitive to heartburn-triggering foods like chocolate, caffeine, citrus fruits and juices, tomatoes, spicy foods, and fatty foods.
  • Get enough sleep. Stress and sleep form a cycle. Sleep is a natural stress reducer and less stress can lead to better sleep. To help avoid heartburn symptoms while you snooze, keep your head elevated.
  • Practice relaxation techniques. Try out guided imagery, yoga, tai chi, or using music to relax.
  • Learn to say “no.” Prioritize people and activities. It’s OK to turn down those that don't rate high on your priority list.
  • Laugh. Watch a funny movie, go see a comedian, or get together with friends. Laughter is one of the best natural stress relievers.
  • Spend time with your pet. If you don't have a pet, consider getting one. Pets can help calm and rejuvenate you.
  • Enjoy a massage. Physically relaxing your muscles can encourage your mind to follow.