A hiatal hernia occurs when part of the stomach pushes through the diaphragm and into the chest cavity. While many people with hiatal hernias experience no symptoms, larger hernias can lead to heartburn and other uncomfortable issues. Dietary and lifestyle adjustments are often the first line of defense in managing these symptoms, similar to the recommendations for gastroesophageal reflux disease (GERD). This article provides a comprehensive guide to dietary recommendations for managing a hiatal hernia, based on NHS guidelines and general medical advice.
Understanding Hiatal Hernias and Their Symptoms
A hiatal hernia is a condition where a portion of the stomach protrudes through the esophageal hiatus, an opening in the diaphragm that allows the esophagus to connect to the stomach. It’s not always clear what causes a hiatal hernia, but it is very common, especially in people over 50. While a hiatal hernia may make gastro-oesophageal reflux more likely, these two diagnoses are not the same thing. A hiatus hernia may occur without reflux, and reflux may occur without a hiatus hernia.
The primary symptom of a hiatal hernia is heartburn, which is often related to gastroesophageal reflux disease (GERD). 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).
General Dietary Guidelines for Hiatal Hernia
The best food choices for people with hiatal hernias are non-acidic, minimally processed, and high in fiber. The goal is to reduce inflammation, neutralize stomach acid, and prevent tissue irritation.
Foods to Include in Your Diet
Lean Proteins: Include lean meats like turkey and chicken, as well as other lean protein sources.
Read also: Hiatal Hernia and Diet
Grains: Rice, pasta, and breads are generally safe choices.
Non-Citrus Fruits: Opt for fruits like apples, bananas, pears, melons, berries, and papaya.
Vegetables: Fresh vegetables such as artichokes, carrots, sweet potatoes, asparagus, squash, green beans, leafy greens, and peas can be beneficial.
Nuts and Seeds: Incorporate almonds, chia seeds, and sunflower seeds into your diet.
Low-Fat Yogurt: Choose low-fat yogurt options.
Probiotic Foods: Fermented or cultured foods rich in probiotics may help reduce hiatal hernia and GERD symptoms. Popular fermented foods include unsweetened yogurt, kimchi, kefir, sauerkraut, kombucha, cheese, miso, tofu, and buttermilk. However, reducing sugar intake is crucial, so avoid probiotic ice creams, juices, sweetened protein powders, and gummies.
Plant-Based Milks: Choose low-sugar options like soy milk, oat milk, and almond milk.
Certain Natural Juices: Aloe vera, carrot, and cabbage juice may be helpful.
Foods to Limit or Avoid
Limiting or avoiding certain foods might help reduce and prevent symptoms of indigestion or GERD, including heartburn, bloating, gas, and regurgitation. It is a good idea for people with a hiatal hernia to limit or avoid foods that are acidic, rich, oily, or contain preservatives.
Acidic Foods: Citrus fruits like limes and oranges, as well as tomatoes and tomato-based products (salsa, bruschetta, spaghetti sauce), should be limited.
Read also: Lifestyle Changes for Hiatal Hernia
Fried and Fatty Foods: These can worsen symptoms.
Spicy or Highly Seasoned Foods: Avoid spicy foods.
Certain Vegetables: Garlic, onion, and peppers may trigger symptoms in some individuals.
Processed Foods: Foods high in sodium and preservatives.
Other Foods: Smoked or salted fish, pickles, vinegar, mustard, strongly flavored meats and sausages, strong cheeses, dried nuts and fruit, strong tea or coffee, alcohol, chocolate, and mint should be limited or avoided.
The Importance of Probiotics
Fermented or cultured foods that are rich in probiotics may also help reduce hiatal hernia and GERD symptoms. Popular fermented foods include: unsweetened yogurt, kimchi, kefir, sauerkraut, kombucha, cheese, miso, tofu, and buttermilk.
It is also important to keep in mind that reducing sugar intake may help improve GERD symptoms. This means that probiotic ice creams, juices, yogurts, sweetened protein powders, and gummies are typically not a good source of probiotics.
The Mediterranean Diet
Some research has also shown that following specific diets that are high in the intake of fruits, vegetables, and whole grains, such as the Mediterranean diet, can also help to reduce the symptoms of GERD and hiatal hernias.
Lifestyle Adjustments to Manage Hiatal Hernia
Aside from diet, a person could try making some lifestyle adjustments to help manage hiatal hernia and GERD symptoms.
Maintain a Moderate Weight: Obesity can worsen hiatal hernia symptoms.
Quit or Avoid Smoking: Smoking can irritate the esophagus.
Elevate the Head While Sleeping: This reduces acid reflux.
Eat Smaller and More Frequent Meals: Avoid large meals that can distend the stomach.
Do Not Skip Meals: Regular meals can help regulate stomach acid.
Drink Fluids After a Meal Instead of During It: This can help reduce stomach distension during meals.
Avoid Eating or Drinking Late at Night: Allow several hours between your last meal and bedtime.
Eat Slowly and Chew Food Well: This aids digestion.
Avoid Eating Foods That Are Very Hot or Very Cold: Extreme temperatures can irritate the esophagus.
Avoid Triggering Foods: Identify and avoid foods that worsen your symptoms.
Manage Stress: Practice stress-reducing strategies such as walking, spending time in nature, mindfulness, meditation, or yoga.
Walking After Eating: Walking after eating and avoiding going to bed shortly after a meal.
Sleeping Position: Sleeping on your left side.
Clothing: Skipping tight-fitting clothes, which can make your heartburn worse.
Eating Environment: Eating your meals in a calm and relaxing place.
Other Strategies to Prevent and Manage GERD, Acid Reflux, and Hiatal Hernia Symptoms
Other strategies to prevent and manage GERD, acid reflux, and hiatal hernia symptoms may include: elevating the head of your bed so your chest is slightly higher than the legs, managing your weight so it’s optimal for your age and height, stopping tobacco use if you smoke, skipping tight-fitting clothes, which can make your heartburn worse, asking a healthcare professional about over-the-counter (OTC) medications that may reduce acid in your stomach, taking probiotics and digestive enzymes, eating your meals in a calm and relaxing place, eating slowly and chewing well, and avoiding standing up while eating.
Medical Treatments
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. 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.
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. However, making lifestyle and diet changes is generally the first step.
Sometimes surgery may be necessary. This operation is performed for patients with symptoms which include acid reflux or heartburn which has not completely responded to medical treatment and lifestyle adaptive changes. Patients will often have undergone tests advised by their surgeons to guide the diagnosis and help exclude other conditions, which may not respond to this surgery. The second step involves wrapping the top part of the stomach around the lower part of the oesophagus to strengthen the valve. This might be a full “wrap” (Nissen’) or half wrap (partial fundoplication). This helps reduce reflux of stomach contents from the stomach but can also reduce the ability to belch or to vomit. It may not be possible to complete the operation using keyhole surgery. In less than 1 in 100 cases the surgeon will need to convert to a conventional open operation using a cut in the patient’s abdomen.
Post-Surgery Diet
This information is for patients who have had an operation on the stomach or oesophagus. Surgery can cause swelling and bruising of the stomach or oesophagus. This can temporarily make swallowing difficult. There are three stages to the post-surgery diet. Most patients start on a liquid diet, then move on to a puree diet followed by a soft diet. The amount of time you spend on each stage will depend on what type of operation you have had. If at any point you are struggling with a certain stage, please drop back to the previous stage. Try to move to the next stage again after a few days. This will depend on the type of operation you have had. Some people may be able to take medication as normal. Some people may need to crush their tablets or take them in liquid form. Try to blend each part of a meal separately rather than all in one go. Your surgeon will tell you when you can return to a normal diet. When you start eating a normal diet, cautiously add in firmer foods items like bread and meat.
Following surgery, a specific diet is essential to prevent complications. The post-surgery diet typically involves three stages: liquid, puree, and soft foods.
Liquid Diet: This is the initial stage, involving clear fluids.
Puree Diet: Foods should be blended to a smooth consistency. Try to blend each part of a meal separately rather than all in one go.
Soft Diet: Gradually introduce soft, easily digestible foods.
Foods to Avoid Post-Surgery
It is advisable to avoid bread and fizzy drinks for the first 4 to 6 weeks. You will notice during the first few weeks that food tends to stick, therefore it is important to eat slowly and to chew food thoroughly.
Yes. Very dry foods and lumps can all get stuck in the food pipe. X Lumps of hard cheeseFood with grilled cheese toppingsDairy products containing hard pieces e.g. X Hard fibrous cereals e.g. X Any type of bread or toastDough-based foods e.g. X Green saladRaw uncooked vegetablesVegetables with tough shells e.g. peas and sweetcornStringy vegetables e.g. celery, green beansGas producing vegetables e.g.