Peek inside nearly any household’s medicine cabinet, and you’re likely to spot them: small pills or capsules consumed daily for years. The common culprits? Omeprazole and Lansoprazole.
These medications, known as proton pump inhibitors (PPIs), are frequently prescribed to combat the discomfort of acid reflux, a burning sensation that plagues many. Today, they rank among the most widely dispensed drugs nationwide.
Countless individuals rely on these medications. As a physician, it constantly surprises me how seldom people question the necessity of PPIs. Acid reflux is undeniably unpleasant—I can attest to this from personal experience, having battled it intermittently over the years.
The searing, sour sensation climbing from the stomach, the persistent nighttime cough, and the perpetually raw throat are all too familiar. But the crucial question we should be asking is why these symptoms occur in the first place. Frequently, the root cause is not directly linked to the stomach.
In my professional opinion, acid reflux is one of the most overlooked manifestations of stress and anxiety in contemporary medicine. This connection is neither speculative nor vague; it is firmly grounded in biological science.
The gut and the brain are connected by a remarkable cable called the vagus nerve. It runs from the brainstem down through the chest and abdomen, weaving through every major digestive organ. But the vagus nerve doesn’t just relay information about the gut to the brain – the connection is two-way.
When you are anxious, frightened or chronically stressed, the brain sends signals that change how the gut behaves. The lower oesophageal sphincter, the muscular ring meant to keep stomach contents where they belong, becomes lazy. Acid production rises. Digestion slows. The nervous system itself becomes hypersensitive to ordinary sensations.
Put simply, your worried mind reaches down and meddles with your plumbing. And once it starts, the symptoms make you more anxious, which makes the symptoms worse. A self-fuelling fire.
In my view, acid reflux is one of the most under-recognised symptoms of stress and anxiety in modern medicine, writes Dr Max Pemberton
What I find most fascinating, and what I think is too often missed in a rushed GP appointment, is that some people don’t experience anxiety the way you might expect. They don’t feel panicky or visibly worried. Instead, they feel it in their bodies. The stomach burns. The chest tightens. The throat constricts. They go to their GP, get handed a packet of PPIs and are sent on their way. The actual diagnosis, the anxiety, is never made.
I’ve lost count of the patients I’ve seen who came to my clinic for something seemingly unrelated, mentioned almost in passing that they’d been on omeprazole for years, and turned out to be living with chronic, untreated anxiety. When the underlying mood was finally addressed, the reflux often quietly disappeared.
Of course, persistent reflux is not always benign and must never be brushed aside as ‘just stress’. New or worsening symptoms in anyone over 50 including difficulty swallowing, unexplained weight loss, vomiting blood or persistent hoarseness all warrant a prompt visit to your GP. Long-standing reflux can damage the oesophagus and, in some cases, raise the risk of cancer.
If your symptoms are not settling, do not assume breathing exercises will fix it. Get checked.
But for the many whose reflux is being driven, or substantially worsened, by stress and lifestyle, there is a great deal that does not come in a packet.
The best evidence-based technique I know is diaphragmatic breathing, and it is wonderfully simple. Sit or lie comfortably with one hand on your chest and the other on your stomach. Breathe in slowly through your nose for four counts, letting your stomach rise while your chest stays still. Then breathe out slowly through pursed lips for six counts, feeling your stomach fall again. The longer out-breath is the bit that quietens the nervous system.
Studies have shown this kind of training can reduce reflux episodes and even cut PPI use in some patients. It works partly by strengthening the diaphragm, which acts as a natural support for the sphincter, and partly by calming the body’s stress response. Aim for ten minutes a day, ideally after meals. There are plenty of free demonstrations on YouTube from respiratory physiotherapists, and the NHS website has clear written guides for anyone who wants to learn more.
Other things are important too. Eat sitting down, slowly, away from a screen. Stop eating at least three hours before bed. Cut back on alcohol, which both relaxes the sphincter and wrecks your sleep. Look honestly at how much caffeine you are drinking. And take the underlying stress seriously, not as a vague modern complaint but as something literally eating away at you.
For some, cognitive behavioural therapy can be transformative for these kinds of physical symptoms. We have become very good at silencing our bodies and very poor at listening to them. A pill can quieten the message. But it cannot answer it.
And until we start asking what our symptoms are actually trying to tell us, we will keep reaching for the medicine cabinet to solve problems that were never really medical in the first place.
Cameron’s long-term mission
Cameron Diaz, 53, last week announced the arrival of a third child with husband Benji Madden. She spoke of her drive to ‘age well’ so she can be around for their children.
‘The only pressure now is I have to live to be, like, 107,’ she joked. There is something admirable about this instinct. But I want to gently push back on the 107 line. Parents who came to it later in life, and parents in general, can carry an enormous, unspoken anxiety about not being there.
Paradoxically, that can rob children of the very presence they need. Children do not need parents who will live to 107. They need parents who are emotionally available now: calm, curious, attentive.
So yes, Cameron, look after yourself, but not because you have to make it to 107. The years you have, however many they are, are richer when you stop counting them.
With hantavirus in the news, here is what I tell my patients: Take the threat seriously, but keep things in perspective.
This is not a new disease. It is well understood. Outbreaks are rare and geographically specific, and the numbers involved tiny.
Limit your scrolling. Read one credible source rather than ten.
Public health teams are equipped to manage outbreaks. Your job is to manage your nervous system.
The most useful thing most of us can do is close the social media app and go for a walk.
Dr Max prescribes… Open When by Julie Smith
This follow-up to the clinical psychologist’s bestseller Why Has Nobody Told Me This Before? is a beautifully practical book of short, evidence-based exercises for specific moments: anxiety, grief, loss of confidence, anger, overwhelm. You don’t read it cover to cover – you open it when you need it.
