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. However, 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 help calm your stomach even during the most trying times.

The Connection

A 1999 survey of 2,000 individuals provided some insight into stress and the symptoms of heartburn. Women reported heartburn after a hectic day at home and stressful family situations, while men reported that business travel and a week of long work hours made them more susceptible to acid reflux.

In 1993, researchers found that reflux patients "who are chronically anxious and exposed to prolonged stress may perceive low-intensity esophageal stimuli as painful reflux symptoms." A 1988 Gallup Poll also suggested that stress increased symptoms.

In a study published in 2004, researchers followed 60 subjects for nearly a year and found that the presence of a severe, sustained stress in the first six months significantly predicted increased heartburn symptoms during the next four months.

“As with other chronic conditions such as irritable bowel syndrome (IBS)," the researchers wrote, "heartburn severity appears to be most responsive to major life events." They noted that exhaustion in particular was most closely associated with worsening of symptoms.

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 other words, though the study participants reported feeling more discomfort, the scientists didn’t find any increase in total acid produced.

In another study published in 2005, researchers measured the levels of esophageal acids in more than 40 patients who had chronic heartburn or acid reflux. They found that those who were stressed when required to prepare and deliver a five-minute speech reported more intense reflux symptoms. However, they actually produced no more acid than the patients who weren’t stressed.

Is It All in Your Head?

Does this mean 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 definitely make them feel uncomfortable.

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 can deal with stress, the better you feel.

According to the 1993 study, relaxation exercises helped participants reduce their GERD symptoms. Here are some stress-relieving techniques that may work for you:

  • Get exercise.  Exercise helps loosen up tense and tight muscles, gets you away from the office or other stressful environment, and releases natural, feel-good hormones.
  • Practice yoga, tai chi, or meditation. These types of soothing exercises help focus the mind and get rid of all the negative “chatter” that can make little problems bigger than they actually are.
  • Listen to music. Choose something that makes you feel good or calms your frazzled nerves.
  • 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, citrus fruits and juices, tomatoes, spicy foods, and fatty foods.
  • Get involved. Do something that you enjoy, whether it’s playing a musical instrument, making pottery, woodworking, gardening, or another hobby that helps take you away from day-to-day stressors.
  • Get enough sleep. And sleep with your head elevated to reduce the risk of heartburn symptoms.
  • 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.