Chances are you’re no stranger to the stresses of daily life. Because of it, many of us may be accustomed to that burning sensation in our chests that we may have come to associate with stress. But is heartburn really caused by stress? Antacids are seemingly a quick and easy fix for the discomfort but could they actually be bad for you? Recent studies are shedding new light not only on how we understand heartburn, but also how we treat it.
What Exactly is Heartburn?
First, let’s take a look at what heartburn is: scientifically speaking, what we identify as heartburn is most commonly a symptom of acid reflux. Acid reflux, formally known as Gastroesophageal Reflux, occurs when stomach acid is regurgitated into the esophagus. This causes a burning sensation which might feel like it’s coming from one’s heart. What is actually happening is your food pipe and stomach are almost working backwards. Rather than just accepting food sent down, the stomach is sending stomach acid back up. Because of the close association, many people like to use the terms heartburn and acid reflux interchangeably. In reality, the former is really a symptom of the latter.
Causes of Acid Reflux & Heartburn
But what causes acid reflux? For many, acid reflux is only occasional and is usually the result of some kind of food or drink which doesn’t really sit well with their stomachs. The lower esophageal sphincter, which is supposed to close completely once food passes from the esophagus to the stomach, doesn’t close all the way or opens too frequently. A potential physical trigger for this can be laying down or bending over at the waist too soon after eating, which can cause stomach acid to rise up as the body is still digesting. Acid reflux is more likely to occur after a large meal, especially one high in fat, spice, or contains any of the following ingredients: chocolate, garlic, mint, tomato, onions, or citrus. Acid reflux can also potentially be triggered by the consumption of caffeinated or alcoholic beverages.
Regular Heartburn Might Mean More Serious Problems
However, for those of us who have more than the occasional bout of heartburn, the cause may go beyond dietary habits. Recurrent acid reflux is classified as Gastroesophageal Reflux Disease or GERD. According to the National Institute of Diabetes and Digestive and Kidney Diseases or NIDDK, GERD is a “more serious and long-lasting form of GER.” The NIDDK also states that “GER that occurs more than twice a week for a few weeks could be GERD. GERD can lead to more serious health problems over time.” It is worth noting that people of all ages can have GERD, some for unknown reasons, but the risk is higher if you’re overweight or obese, pregnant, taking certain medications which may contribute to frequent acid reflux, or are regularly exposed to secondhand smoke. Another potential cause is a hiatal hernia which can cause the upper part of the stomach to push up through the diaphragm into the chest cavity which can potentially lead to GERD.
How Stress and Acid Reflux Are Connected
But the question remains: can stress cause acid reflux or GERD? The answer is most likely not. Studies have shown that many people who report feelings of heartburn while stressed aren’t experiencing any increase in stomach acid production or reflux. So what is this feeling? While not producing excess amounts of stomach acid, people under stress may in fact be more sensitive to small amounts of acid in the esophagus. This is because stress tends to make people more sensitive and receptive to physical discomfort in general. So when you’re stressed you’re more likely to notice slight changes in acid production you wouldn’t notice otherwise. Further, stress can cause a depletion in the production of prostaglandins which are supposed to protect the stomach from the effects of its own acid. This can contribute to increased sensitivity to stomach acid which produces feelings similar to what we call heartburn.
Treating Heartburn and Acid Reflux
So how can we treat heartburn? For most of us, the solution is a trusty antacid. But recent studies reveal that antacids may be more of a problem than a solution. These findings show that adults using certain antacids known as proton pump inhibitors, or PPIs, are 16-21% more likely to have a heart attack than those not using the antacid. Medical News Today reports that “In 2009, they were the third most taken type of drug in the US, and the Food and Drug Administration (FDA) estimates 1 in 14 Americans have used them. Over time, however, experts have begun to question the safety of the drug.” Initially, it was believed that PPIs were only risky to those with existing coronary artery disease, since the use of the antiplatelet drug Clopidogrel was likely to interact poorly with a PPI. However, the risk is now believed to extend further to all usage of PPIs. Tests conducted to determine the risk of PPIs on patients with no prior history of heart disease have revealed that they may very well be put at an increased risk.
It is worth noting that antacids containing the suffix “prazole”, like Omeprazole and Lansoprazole are part of this class of PPIs under investigation. While currently their future is unclear, Dr. Nicholas Leeper, a vascular medicine specialist at Stanford explains that “Our report raises concerns that these drugs – which are available over the counter and are among the most commonly prescribed drugs in the world – may not be as safe as we previously assumed.” According to Nigam H. Shah, professor of biomedical informatics at Stanford, “By looking at data from people who were given PPI drugs primarily for acid reflux and had no prior history of heart disease, our data-mining pipeline signals an association with a higher rate of heart attacks” However, Shah reports no such increased risk identifiable in patients treated with H2 blockers, another type of antacid. More studies are needed to confirm whether or not PPIs are in fact dangerous to the larger population, but these initial results encourage caution. The question is thus raised across the medical community of whether PPIs will continue to be a safe method of addressing various conditions including GERD.