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Can Stress Cause Heartburn?
The answer is YES. Let us check the relation between stress and heartburn.
Heartburn is generally related to anxiety. Stress and anxiety are not the usual risk factors that cause acid reflux. However, research suggests that there is a connection between heartburn and stress.
GERD or Acid Reflux:
GERD is gastroesophageal reflux disease (also known as acid reflux) which occurs when the stomach acid refluxes into the oesophagus. This action of acid reflux causes swallowing trouble, heartburn, burning taste, etc. Occasional heartburn does not pose a big threat, but on a regular basis it can be an indicator of GERD. GERD can be cured by drugs, lifestyle modifications, and over-the-counter medications. But when left undiagnosed and untreated, it can result in situations including but not limited to erosive esophagitis, chronic cough, and oesophagal cancer.
Causes of GERD:
The cause of the symptoms of heartburn and acid reflux originates where the stomach meets the oesophagus. The muscular tube which connects the stomach and mouth is the oesophagus. The stomach gets closed from oesophagus when not eating by the lower oesophagus sphincter (LES). During eating, the LES opens to allow food through the oesophagus to the stomach. When LES does not function properly, the acid from the stomach refluxes into the oesophagus. This acid irritates and eats the inner lining of the oesophagus, and produces the burning sensation of heartburn. Typically, GERD is caused by an increase in abdominal pressure like pregnancy, obesity, medication cycles, smoking, and hernia. It can also be due to the consumption of alcohol, oily foods, spicy foods, eating when bedtime is near, overreacting, etc.
From surveys, most people have identified stress as a common factor of acid reflux. It has also been observed that people with stress and GERD have very frequent and acute symptoms of heartburn. Many experts theorize that cholecystokinin (CCK), a brain chemical which has correlations with gastrointestinal disorders and panic, might have a role to play in the presence of GERD in people with stress and anxiety disorders. Theories also suggest that stress and anxiety result in reduced digestion, increasing the acid content in the stomach or inducing muscle tension which pressurizes the stomach to create acid reflux.
Another major contributing factor is lifestyle. Most sufferers tend to indulge in activities like smoking, consumption of alcohol, and consuming fatty foods, spicy foods or fried foods. These coping habits promote the acid reflux in the stomach to the oesophagus region. This worsens and triggers the symptoms of heartburn resulting in discomfort and pain. The reverse effect is also one of the major concerns. Chest pain or trouble swallowing can cause worry and increase stress and anxiety levels, triggering a panic attack. The explanation for stress creating acid reflux is explained as hypervigilance. In simple terms, hypervigilance is the awareness of and sensitivity to physical symptoms. This, in turn, creates stress, which may cause the very same symptoms.
In a 2005 study in the Journal of Psychosomatic Research, researchers measured the acid levels of the oesophagus in more than forty patients. These patients had a history of chronic heartburn and acid reflux. During the experiment, stress was induced in half of their patients by the researchers. The stress was induced by asking them to prepare a speech for five minutes and deliver it in front of the crowd. The acid levels were found to increase identically for the entire group, but the heartburn was reported more by the stressed group to be more acute in reflex symptoms showing their heightened senses when stressed.
Stress excites cells in the brain which makes the receptors of pain more active in the region of the oesophagus. Stressed people have the same physical response and acid buildup as non-stressed people, but the stressed person will feel more pain for the acid reflux due to the excitation of these pain receptors. Stressed people are also observed to have a drop in the levels of hormones like prostaglandins, which help in protecting the stomach lining from the acid.
Remedies for Heartburn:
There are a number of activities which may reduce heartburn. During the treatment of GERD, it is important to make some changes in the lifestyle to avoid acid reflux and heartburns.
1. Do not over eat:
Large meals and overeating results in expansion of stomach muscles. This increases the upward pressure on the LES. Due to this pressure, acid reflux can occur which in turn result in heartburns. Splitting larger meals into small breakdowns a day will avoid the stomach being too full and reduce acid production.
2. Do not eat too quickly:
Consumption of food on a rapid pace results in a large amount of food for the stomach to break down in a shorter span of time. This results in the production of acid which causes acid reflux, which increases the probability of heartburn. Following certain practices like giving ample time between every bite, chewing the food thoroughly, and taking small bites.
3. Avoiding foods that trigger heartburn:
- Food like the below could be avoided to reduce heartburns.
- Oily food
- Food with high-fat content
- Creamy food
- Dairy products with wholesome milk
- Caffeinated beverages
- Carbonated beverages
- Spicy food
- Tomato-based food items
- Citricfood (grape, lemon, oranges, etc.)
4. Eating out prepared:
When going out, it is better to be prepared to know what to order for food which does not stimulate the acid reflux and prevent heartburn.
- Lean meat cuts
- White meat
- Grilled food items
- Vegetables which are steamed
- Soups which are broth based
- Turkey,chicken, or roast beef sandwiches with whole grain bread
- Potatoes baked and topped with a salad of low-fat servings
- Angel food cakes or light desserts
5. Avoid going to bed soon after eating:
After eating, the stomach is filled with food. Lying down immediately after eating causes the food inside the stomach to press hard against the lower oesophagal sphincter. This increases the acid refluxes in the stomach.Following small tips like waiting for three hours after eating will help the stomach. Avoiding snacking late at night. It is always good to have larger meals at breakfast or lunch. This gives ample duration for the stomach to break down the contents, reducing the risk of heartburn.
6. Avoid smoking:
Smoking is the primary contributor for many health issues and heartburn is one among them. This is due to:
- Reduction in the production of saliva. Saliva, being alkaline, neutralizes the acid. Smoking inhibits saliva production.
- Oesophagus gets damaged directly due to smoking. This makes smokers even more susceptible to heartburn.
- The lower oesophagal sphincter gets damaged due to smoking. Smoking weakens and relaxes functionality. The relaxation can happen inappropriately, or the function gets impaired as smoking affects oesophagus directly.
7. Avoid stress:
Stress has been linked to heartburn triggers. Stress results in triggering of brain cells to stimulate the pain cells in the oesophagus which increases the sensitivity of acid levels. This creates heartburn. It is advised to alleviate stress through meditations, exercise, medications, etc. This helps in bringing down the chances of heartburns.