Heartburn is a burning, often painful feeling in the throat or chest. It’s common, affecting more than 60 million people in the United States at least once monthly. When left untreated, heartburn can negatively impact quality of life and lead to complications. Studies show that stress and heartburn are linked.
This article allows healthcare professionals and patients to explore the relationship between stress and heartburn.
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What is Heartburn?
Heartburn is described as a burning sensation in the chest or throat caused by acid reflux, which is stomach acid that leaks back up into the esophagus. Heartburn doesn’t affect the heart, but you might have symptoms near the area where your heart is.
Symptoms of Heartburn
The symptoms of heartburn include:
- Acidic or bitter taste in the mouth
- Burning in the chest or throat
- Burning sensation at night or after eating
- Worsening symptoms when bending over or lying down
- Acidic feeling in the chest
- Burning sensation after eating spicy or acidic foods
- Burping
- Sour taste in the mouth
- Food regurgitation
- Nausea
- Difficulty swallowing
- Feeling of a lump in your throat
You might also experience a chronic cough, worsening asthma, a sore throat, laryngitis, or bloating. Heartburn could last a few minutes to several hours, sometimes longer, often disappearing after the last meal passes through the stomach.
Heartburn Risk Factors
About 20% of people in the United States experience gastroesophageal reflux disease (GERD), which is characterized by heartburn and similar symptoms. Common risk factors for heartburn include:
- Obesity
- Smoke inhalation
- Tight clothing
- Pregnancy
- Hiatal hernia
- Alcohol
- Indigestion
- Lying down after eating
- Some medications, such as blood pressure-lowering medicines and birth control pills
- Certain foods (citrus fruits, coffee, chocolate, tomato sauce, and mint)
- Aging
- Weight gain
Heartburn occurs when stomach juices, including enzymes and acids, backwash into the esophagus and irritate these tissues. It happens because the lower esophageal sphincter, a valve at the bottom of your esophagus, doesn’t close all the way.
The Role of Stress in Heartburn
Stress can negatively affect the human body in numerous ways. In the short-term, stress activates the body’s fight or flight response, protecting it against threatening situations.
A perceived threat can prompt the release of hormones cortisol and adrenaline, making the heart beat faster and blood pressure, blood sugar, and energy increase. This can help the human body escape threats.
However, cortisol alters the body’s immune system response. It suppresses the digestive system, growth processes, reproductive system, and mood. When the body’s fight or flight system is always activated because of chronic stressors, the risk of the following increases:
- Digestive problems
- Headaches
- Depression
- Anxiety
- Muscle pain and tension
- Sleep problems
- Heart attack
- Stroke
- High blood pressure
- Focus and memory problems
- Weight gain
- Heartburn
Therefore, it’s vital to keep chronic stress under control to maximize health and reduce the risk of chronic diseases, bothersome symptoms, and medical complications.
Can Stress Cause Heartburn?
Stress appears to increase the risk of heartburn. Emotional stress can boost acid production within the stomach, particularly in people diagnosed with GERD. The potential mechanisms of action include visceral hypersensitivity, dilated intercellular spaces, increased esophageal permeability, and activated nociceptors.
Stress and anxiety could directly promote reflux by reducing pressure in the lower esophageal sphincter, altering esophageal motility, or boosting gastric acid secretion.
Stress can trigger esophageal spasms, which may cause esophageal sphincter contraction abnormalities and contribute to heartburn.
Can Stress Cause Heartburn and Chest Pain?
Stress not only contributes to heartburn in some people, it boosts the risk of high blood pressure, heart disease, and a heart attack — which can contribute to chest pain. It’s important to differentiate between heartburn-related chest pain and chest pain from other causes, including a heart attack. Chest pain linked to heart conditions may cause:
- Chest pressure, crushing, or squeezing sensations
- Fatigue
- Shortness of breath
- Discomfort in the shoulders, abdomen, back, shoulders, arms, jaw, or neck
- Lightheadedness
- Sweating
- Feeling sick to your stomach
If you’re unsure if chest pain is caused by heartburn or something more serious, seek medical attention right away.
Clinical Evidence and Research
Numerous research studies have shown a link between stress and heartburn.
One study found that reflux esophagitis, a cause of heartburn, is associated with psychosocial stress. The researchers demonstrated that the severity of reflux correlates to the severity of stress.
Another study showed that being exposed to high levels of stress increases the risk of GERD symptoms, and that stress reduction is a vital component of GERD management.
Researchers demonstrated that stress worsens heartburn symptoms in people with GERD, and that stress, anxiety, and depression may lead to gastrointestinal tract disorders.
Harvard Health practitioners confirm that stress can cause heartburn and stress-reducing strategies appear to ease unpleasant symptoms.
Managing Stress-Induced Heartburn
Making simple lifestyle adjustments can lessen stress-related heartburn. Consider the following changes to relieve bothersome symptoms:
Dietary Recommendations
Consider adding the following foods to a meal plan to minimize stress, anxiety, and heartburn:
- Vitamin B-rich foods: chicken, turkey, eggs, whole-grain cereals, and nutritional yeast
- Omega-3 fatty acids: fatty fish (salmon, tuna, anchovies, mackerel, herring, sardines, etc.), flax seeds, chia seeds, and walnuts
- Magnesium-rich foods: bananas, green vegetables, cauliflower, potatoes, whole grains, legumes, soy milk, nuts, and seeds
- Mediterranean diet foods: fruits, vegetables, whole grains, legumes, nuts, seeds, fish, olive oil, and other plant-based fats
- Probiotics-rich foods: kefir, Greek yogurt, kimchi, and sauerkraut
- Watery foods: watermelon, other types of melon, lettuce, cucumber, broth, and tea
- Fennel
- Ginger
Studies show that following the Mediterranean diet appears to counteract the negative effects of stress and lessen the risk of GERD. Choose whole, plant-based foods when possible to reduce inflammation and stress-induced high cortisol.
Foods to Avoid
Foods to steer clear of because they may increase cortisol levels or boost the risk of heartburn include:
- Soda and other sugar-sweetened drinks
- Cakes, pastries, candy bars, and other sweets
- Caffeine
- Alcohol
- Refined grains, such as white bread
- Heartburn-promoting foods (citrus fruits, mint, tomato sauce, coffee, and mint)
- Spicy foods
- Fried foods
- Highly processed snacks
- Cheeses
- Fatty meats
- Carbonated drinks
- Pizza
Avoid skipping meals and stick to a regular eating schedule that involves consuming smaller meals every few hours.
Exercise and Physical Activity
Getting regular exercise not only eases stress and anxiety, it also helps you maintain an ideal body weight – which lowers your risk of heartburn. Aim to complete at least 30 minutes of exercise most days of the week. Combine aerobic (jogging, cycling, swimming, etc.) with strength training and pick exercises you enjoy to further minimize stress.
Relaxation Techniques
Relaxation techniques that lessen stress (and therefore heartburn) include tai chi, yoga, mindfulness meditation, massage, and deep breathing. Studies show that spending time outdoors also reduces anxiety and stress, particularly when being physically active outside.
Medical Treatments and Interventions
In addition to using healthy lifestyle habits to minimize stress, anxiety, and heartburn, medical treatments and interventions are available as needed. If lifestyle habits alone haven’t eliminated heartburn, healthcare professionals may suggest one or more of the following treatments:
- Antacids
- H2 blockers
- Alginates
- Proton pump inhibitors
- Topical steroids
- Low-dose neuromodulators
- Surgical procedures
Patients with GERD who haven't responded to lifestyle changes and medications may be candidates for hernia repair surgery (if heartburn is caused by a hiatal hernia) or medical procedures that tighten the lower esophageal sphincter.
Consult with a healthcare provider if heartburn doesn't go away with lifestyle changes or if it’s severe.
Preventive Measures
Ways to reduce the risk of stress-induced heartburn include:
- Avoid eating very large meals (consume smaller, more frequent meals throughout the day)
- Avoid tight-fitted clothes, particularly around the waist
- Don't eat large meals right before bed
- Sleep on your left side
- Avoid going to bed with a full stomach
- Maintain a healthy body weight
- Avoid foods that trigger heartburn
- Avoid smoking
- Minimize stress using yoga, tai chi, meditation, massage, or other relaxation techniques
- Exercise regularly
- Get enough sleep
- Eat nutritious, plant-based foods
- Consider the Mediterranean diet
It's important to attend regular medical checkups to help manage stress, heartburn, or underlying medical conditions.
FAQs and Patient Education
Common questions regarding stress and heartburn include:
Q: Are stress and heartburn linked?
A: Yes, studies show that stress and heartburn are linked. That's why stress-reduction strategies are encouraged as part of a long-term heartburn management treatment plan.
Q: What else can cause heartburn?
A: Stress isn’t the only potential cause of heartburn. Other risk factors include carrying excess body weight, drinking alcohol, smoking, eating very large meals, lying down right after eating, wearing tight clothing, taking certain medications, and eating acidic, greasy, or spicy foods.
Q: How can I effectively manage stress-induced heartburn symptoms?
A: Manage stress-induced heartburn by eating smaller (more frequent) meals, trying stress-reduction strategies like yoga and tai chi, maintaining an ideal body weight, exercising regularly, and avoiding excessive alcohol and smoking.
Resources for further information regarding stress management and heartburn relief include:
- John Hopkins Medicine
- Mayo Clinic
- Cleveland Clinic
- National Library of Medicine
- Harvard Health
- MedlinePlus
- American Society of Gastrointestinal Endoscopy (ASGE)
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
- American College of Gastroenterology (ACG)
- American Gastroenterological Association (AGA)
- NYU Langone Health
Consider GERD/acid reflux/heartburn or other gastrointestinal disorder support groups, either in person or virtually.
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Key Takeaways
- Heartburn and stress are related based on numerous research study findings.
- It’s vital to address underlying causes of both stress and heartburn to eliminate debilitating GERD symptoms and maximize well-being.
- A nutritious diet, exercise, sleep, relaxation techniques, and healthy weight management can minimize stress and stress- or anxiety-induced heartburn.
- Seek professional help as needed for heartburn intervention if stress management and other healthy lifestyle adjustments haven’t eased bothersome symptoms.
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