A hiatal hernia occurs when part of the stomach pushes up through an opening in the diaphragm, known as the hiatus. While many people with a hiatal hernia experience no symptoms, others may suffer from heartburn and acid reflux, which can significantly impact their quality of life. Fortunately, dietary and lifestyle adjustments can often effectively manage these symptoms. These changes are usually the first line of management for acid reflux, GERD, and hiatal hernias.
Understanding Hiatal Hernias
A hiatal hernia involves a portion of the stomach extending or pushing through a small opening (hiatus) in your diaphragm. The diaphragm is a parachute-shaped muscle that extends along the rib cage, under the lungs, and helps you breathe in and out. Your food pipe passes through the muscle to connect to the stomach. When this occurs, stomach acid can flow back into the esophagus, leading to discomfort.
Common Symptoms
The main symptom of a hiatal hernia is acid reflux, which is when acid and other stomach contents flow back up the food pipe. You may experience heartburn (burning sensation in the chest), sore throat, belching, and epigastric pain, among others. Chronic acid reflux may also lead to gastroesophageal reflux disease (GERD).
A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or pain in the chest or upper abdomen. X-ray of your upper digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. A procedure to look at the esophagus and stomach, called an endoscopy. Endoscopy is a procedure to examine your digestive system with a long, thin tube with a tiny camera, called an endoscope. A test to measure muscle contractions of the esophagus, called an esophageal manometry. This test measures the rhythmic muscle contractions in your esophagus when you swallow.
The Role of Diet in Managing Symptoms
Your diet may significantly impact acid reflux and other symptoms associated with a hiatal hernia. The first step is usually identifying triggers (foods that cause symptoms to worsen) and then avoiding these foods. Diet modification is one of the cornerstones of hiatal hernia treatment. While there is no "hiatal hernia diet" per se, there are guidelines that help direct not only what you eat but how you eat. GERD is a chronic upper GI disease in which the contents of the stomach frequently backflow into the esophagus (feeding tube). The dietary recommendations for hiatal hernia tend to mirror those for GERD.
Read also: Hiatal Hernia and Diet
Foods to Limit or Avoid
Knowing which foods to avoid if you have a hiatal hernia is as important as knowing which foods to eat. Limiting or avoiding certain foods might help reduce and prevent symptoms of indigestion or GERD, including heartburn, bloating, gas, and regurgitation. Certain foods are known to trigger or worsen symptoms. These include:
- Citrus Fruits: Limes, oranges, and other citrus fruits can increase stomach acidity, leading to heartburn.
- Tomatoes and Tomato-Based Foods: Salsa, bruschetta, spaghetti sauce, pizza sauces, and other tomato-based products are highly acidic.
- Spicy Foods: These can irritate the esophagus and exacerbate heartburn.
- Fried and Fatty Foods: These foods can slow down digestion and increase the risk of acid reflux.
- Sugary Foods: High sugar intake can contribute to inflammation and worsen GERD symptoms.
- Chocolate: Chocolate can relax the lower esophageal sphincter, making it easier for stomach acid to back up.
- Peppermint and Mint: These can also relax the lower esophageal sphincter.
- Alcohol: Wine, beer, and spirits can irritate the esophagus and increase stomach acid production.
- Coffee and Caffeinated Teas: Caffeine can worsen acid reflux symptoms.
- Carbonated Drinks: Seltzer water, soda, and other carbonated beverages can increase stomach pressure.
- Whole Milk: High-fat dairy products can contribute to acid reflux.
- Onions and Garlic: These can trigger heartburn in some individuals.
- Foods high in sodium
The Canadian Society of Intestinal Research (CSIR) recommends avoiding high-fat foods if you have GERD. A 2017 study in Neurogastroenterolgy and Motility created a similar "hit list" of foods most commonly associated with GERD in people with hiatal hernia.
Foods to Include in Your Diet
In general, you want to add foods that reduce inflammation, neutralize stomach acid, and prevent tissue irritation. Eating high-protein, high-fiber foods that are not acidic can help control hiatal hernia symptoms. You should also look for foods that are low in fat and mild (no spicy salsa!).
- Non-Citrus Fruits: Apples, pears, melons, berries, and papaya are gentle on the stomach.
- Fresh Vegetables: Artichokes, carrots, sweet potatoes, asparagus, squash, green beans, leafy greens, and peas are all beneficial. Fiber-rich vegetables - Vegetables like spinach, green peas, carrots, sweet potatoes and cucumber are a great source of fiber and packed with vitamins and minerals.
- Whole Grains: These are a good source of fiber, which can help with digestion.
- Nuts and Seeds: Almonds, chia seeds, and sunflower seeds are healthy options.
- Lean Proteins: Choose lean meats like turkey and chicken. Lean protein - Lean meats such as skinless chicken, turkey, or fish, and beans and peanut butter are all packed with protein-an essential nutrient for repairing and rebuilding body tissue. Lean beef cuts include round, chuck, sirloin, or loin. Lean pork cuts include tenderloin or loin chop.
- Low-Fat Yogurt: This can help soothe the digestive system. Low-fat dairy - Skim milk, low-fat yogurt, fat-free cheeses, cream cheese, and fat-free sour cream are also a good source of protein.
- Probiotic Foods: Sauerkraut, kombucha, and kimchi can promote gut health.
- Plant-Based Milks: Soy milk, oat milk, and almond milk are good alternatives to whole milk.
- Certain Natural Juices: Aloe vera, carrot, and cabbage juice may help soothe symptoms.
- Alkaline foods Alkaline foods are those with a pH of over 7.0.
Try to choose fresh and whole foods over processed ones whenever possible.
Eating Habits and Cooking Tips
How you eat is as important as what you eat when you have a hiatal hernia. Good eating habits are key to controlling symptoms of GERD. The way you cook and eat your food can make a difference.
Read also: Understanding Hiatal Hernia Before Weight Loss
- Cook with Healthy Fats: Use avocado, coconut, and olive oils. Use healthy oils like olive, grapeseed, or avocado oil. Avoid butter, lard, ghee, and coconut oil. Healthy oils and fats - Opt for healthier-oils such as nut and seed oils (avocado, sunflower, grapeseed, olive oil) and healthy fatty foods such as salmon and avocado. Saturated or trans fat food items such as fatty cuts of red meat, processed food, high-fat dairy products, and hydrogenated vegetable oil can lead to inflammation and increased weight.
- Eat Whole Foods: The fiber content of fresh foods should help with your acid reflux. Focus on whole foods.
- Eat Small, Frequent Meals: Eating too much food at one time or too fast may also make your hiatal hernia and acid reflux symptoms worse. Eat small meals every few hours instead of three large meals during the day. Do not overeat. Instead, eat small, frequent meals. And take your time. Eating fast can make heartburn symptoms worse. Eat sitting in a straight-backed chair. Eat slowly to avoid gulping air.
- Add Probiotic Foods: Cultured vegetables, like pickles, are a tasty option. Yogurt, kefir, and kombucha are other good choices. Taking a probiotic supplement is also an option. Some studies suggest that probiotic foods may be beneficial to people with GERD.
- Drink Plain Water: Drinking 8 glasses of water per day may help. Try adding lemon to your water for additional acid-lowering power. Lemon is a fruit that, although acidic outside the body, is metabolized to have alkaline byproducts. High-water-content foods: Fruits and vegetables with a high water content can dilute stomach acid and reduce reflux. So can drinking lots of water. Watery foods help manage GERD by diluting stomach acids. Essential for a smooth digestive function, water helps your body function regularly.
- Avoid Deep-Frying: Instead, try broiling, steaming, or baking meats, fish, and vegetables. Bake or broil foods instead of frying.
- Skim off fat from meat during cooking.
- Go easy on seasoning. Most seasonings are OK as long as they are not spicy but should be used in moderation.
- Substitute low-fat dairy foods, such as low-fat yogurt, for ice cream.
- Steam your vegetables with water only.
- Limit butter, oils, and cream sauces. Use cooking spray instead of cooking oil when sautéing.
- Choose low-fat or nonfat ingredients over full-fat products.
- Get creative. There are all kinds of ways to modify recipes. Don't be afraid to try new things.
Additional Lifestyle Changes
Other strategies to prevent and manage GERD, acid reflux, and hiatal hernia symptoms may include:
- Walking After Eating: Walking after eating and avoiding going to bed shortly after a meal.
- Elevating the Head of Your Bed: Elevating the head of your bed so your chest is slightly higher than the legs. Raise the head of your bed 6 to 8 inches with wood blocks or some other sturdy objects. Propping your head up with pillows probably won't give you the relief you need.
- Sleeping on Your Left Side:
- Managing Your Weight: Maintaining your weight so it’s optimal for your age and height. Get to a healthy weight.
- Stopping Tobacco Use: Quitting cigarettes.
- Skipping Tight-Fitting Clothes: Avoiding tight-fitting clothes, which can make your heartburn worse.
- Asking a Healthcare Professional About Medications: Seeking advice from a healthcare professional about over-the-counter (OTC) medications that may reduce acid in your stomach.
- Taking Probiotics and Digestive Enzymes:
- Eating Meals in a Calm Place: Eating your meals in a calm and relaxing place.
- Eating Slowly and Chewing Well:
- Do not lay down or bend over right after meals. Do not bend over right after eating. Avoid lying down immediately after eating.
- Quit cigarettes.
- Don’t slouch, as it can put extra stress on your stomach.
- Incorporate exercises like walking, running, swimming, and biking into your fitness routine.
- Experiment with different cooking methods. If you’re used to frying foods, try grilling, baking, and steaming.
- Do not skip meals
- drink fluids after a meal instead of during it
- avoiding eating or drinking late at night
- avoid triggering foods
- Managing stress and practicing stress-reducing strategies, such as walking, being in nature, mindfulness, meditation, or yoga, may also help manage symptoms.
Medical Treatments
Most people with a hiatal hernia don't experience any symptoms and won't need treatment. However, if symptoms persist, medical interventions are available.
Medications
- Antacids: Antacids that neutralize stomach acid. Antacids may provide quick relief. A person can also take over-the-counter antacids, though long-term use does carry risks. Individuals should discuss the use of antacids with their healthcare professional.
- H-2-Receptor Blockers: Medicines to reduce acid production. These medicines are known as H-2-receptor blockers. They include cimetidine (Tagamet HB), famotidine (Pepcid AC) and nizatidine (Axid AR).
- Proton Pump Inhibitors (PPIs): Medicines that block acid production and heal the esophagus. These medicines are known as proton pump inhibitors. They are stronger acid blockers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Proton pump inhibitors available without a prescription include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec, Zegerid).
- A healthcare professional can prescribe medications designed to treat indigestion that can reduce discomfort and improve the overall quality of life for people with hiatal hernias.
Surgery
Sometimes a hiatal hernia requires surgery. In severe cases, a hiatal hernia can become "pinched" in the diaphragm, cutting off blood flow to the stomach (strangulation). Surgery may help people who aren't helped by medicines to relieve heartburn and acid reflux. Surgery to repair a hiatal hernia may involve pulling the stomach down into the abdomen and making the opening in the diaphragm smaller. Surgery also may involve reshaping the muscles of the lower esophagus. This helps keep the contents of the stomach from coming back up. Surgery may be performed using a single incision in the chest wall, called a thoracotomy. Surgery also may be performed using a technique called laparoscopy. In laparoscopic surgery, a surgeon inserts a tiny camera and special tools through several small incisions in the abdomen.
Creating a Personalized Plan
Not everyone has the same trigger foods, so it may be worth paying close attention to the relationship between what you eat and your symptoms. You may find that some of the foods listed under "foods to avoid" may not bother you, while others on the "foods to enjoy" list may cause discomfort. Everyone tolerates food differently. To determine the best diet for you, keep a food diary for a few weeks. And then avoid anything that causes you to have symptoms.
Another way to determine the best diet for you, keep a food journal and note if/when something causes symptoms to know what to avoid in the future. Each person is different and tolerates food differently. The guidance provided in this article follows general rules that should be discussed with your doctor. This article is for informational and educational purposes only. It does not substitute for medical advice.
Read also: The Hoxsey Diet
When to Seek Medical Attention
A person should seek medical attention if symptoms do not go away within 3 weeks or if their symptoms are severe or worsen over time.A healthcare professional may assess heartburn, abdominal pain, bloating, gas, or regurgitation that does not improve with the use of antacids, dietary changes, and lifestyle adjustments.