When we’re up all night with reflux, it’s not uncommon to berate ourselves for eating too much chocolate or forgetting to stock the medicine cabinet with antacids. We’re familiar with some of the common triggers of reflux and often point the blame at food.
Don’t get me wrong, certain foods do aggravate reflux, some because they’re acidic, and others because they relax the LES (lower esophageal sphincter) which should ideally stay tight to keep stomach contents from rising up into the esophagus (hold the onions, please!).
But in the hurry to feel better, we often overlook one of the biggest acid reflux culprits: stress. It makes perfect sense once we start connecting our emotions to our physical health. But we can miss it if we’re not aware how stressed we are and how much that stress is affecting us.
What’s more, it’s not uncommon to use reflux trigger foods as a way to calm our nerves when we’re stressed. A glass of wine after a stressful day, a bar of chocolate to soothe a broken heart, which only worsen reflux. We may not always identify stress as being behind our cravings, but when we’re able to pause and step back, we can make the connections and start to address the stress in healthier ways.
Is there really a connection between stress and reflux?
Yes, many, in fact!
For one, stress disrupts digestion. When we perceive a threat (whether it’s real or not) our amygdala, the part of our brain that processes anxiety and fear, lights up like a pinball machine. Our modern lifestyle has many of us in a chronic state of stress, where our amygdala is constantly stimulated, firing off signals to our nervous system to enter “fight or flight” mode. In “fight or flight,” non-essential bodily and cognitive functioning, including digestion, are impaired. That’s why reflux, not to mention indigestion, constipation, and diarrhea worsen when we’re stressed out.
Then there’s stress-induced inflammation. When cortisol rises, it heightens inflammation in the body, and if the esophagus is already inflamed from repeated reflux, we’ll experience the burning sensation more intensely.
Additionally, stress decreases stomach acid production. We need adequate stomach acid for digestive health and to heal from acid reflux. Stomach acid needs to be in regular contact with the LES in order to keep it tight. That’s right, contrary to popular misconception, stomach acid is a good thing, and nine out of ten cases of acid reflux are due to too little stomach acid, not too much.
Finally, stress increases our sensitivity to pain, and acid reflux is painful enough as it is. To understand this, let’s first consider that our brain plays a significant role in how we experience pain in the body.
The brain has many pain receptors. Their job is to interpret pain signals before we experience them as a physical sensation. The brain also has a filter system and may choose to alert us to pain or not, depending on the situation. For example, being in shock—no matter how badly injured, a victim may be too distracted to register the pain.
When pain receptors pick up signals from the environment (e.g., stepping on a nail), the brain interprets and filters based on priority. Sure, the nail in my foot would likely hurt a lot, but if a moment later a lion jumped out of the bushes, somehow, I wouldn’t feel the pain in my foot. Our brain wants us to focus on more important matters: not dying. So the brain does us a favor by decreasing the pain of the less important stimuli.
Just as the brain has the ability to decrease the severity of pain, it also has the ability to amplify it. Our brain wouldn’t amplify pain just for the fun of it, but when stress comes into play, it changes things.
Stress turns up the volume for pain receptors in the brain, and when we’re under chronic stress, our pain receptors can stay stuck on high alert. When our pain receptors are more sensitive, injuries, illnesses, or symptoms that would otherwise not feel as intense can feel unbearable. And that’s when we get desperate for Tums.
Knowing that stress can cause, trigger, and exacerbate reflux, checking in with yourself is always a good place to start. Before jumping for antacids or self-soothing with foods that will only make you feel worse, ask yourself:
“What/how am I feeling right now?”
“What do I need right now?”
“Will this wine/chocolate/bag of chips alleviate my discomfort in the long run?”
“What are some other ways I can attend to what I need right now?”
“How can I support myself with what I need?”
“What are some easy ways to reduce my stress?”
No stress-reducing toolbox would be complete without breathing. Among the many ways to mitigate stress, breathing is especially appealing due to its benefits-only outcomes (no negative side effects) and for its accessibility (anyone can do it anytime, anywhere, for free).
While breathing happens automatically, most of us take shallow, quick breaths, just enough to bring oxygen in and get carbon dioxide out. This type of breathing does not do much to reduce stress.
Conversely, longer, deep breaths have medicinal effects, lowering cortisol and relaxing us. Many techniques are easy to practice and all encourage deep breathing. A few examples are:
Diaphragmatic breathing (deep breathing into the belly, not the chest)
Box breathing (picturing drawing one side of a square with each inhale and exhale)
4-7-8 breathing (breathing in for 4 seconds, holding for 7, breathing out for 8 seconds)
Alternate nostril breathing (inhaling through one nostril and exhaling through the other)
In addition to stress reduction, some breathing techniques strengthen the diaphragm and other muscles around the LES, which allow the LES to tighten. Some forms of breathing can also clear obstruction and pressure in the stomach caused by gas.
There’s a reason why we refer to heavy workloads as having “too much on our plate.” When it comes to reflux, everything we put on our plate matters. Feeling overburdened can cause stress with emotional and physical consequences, just as much as (if not more than) spicy meals.