What to Eat When You Have a Hiatal Hernia

A hiatal hernia is a condition that involves the upper part of the stomach abnormally pushing up through the hiatus. The hiatus is an opening in the diaphragm between the abdomen and the chest.

The esophagus (the tube that carries the food from the mouth to the stomach) normally passes through the hiatus. But, in a hiatal hernia, part of the stomach slips through the hiatus into the chest. 

Commonly, symptoms of a hiatal hernia include acid reflux, a condition in which stomach juices flow back upward into the esophagus. This may result in a condition called gastroesophageal reflux disease (GERD).

GERD's main symptoms are pain and discomfort (heartburn) in the chest area. Certain foods or drinks can worsen GERD. 

Small hiatal hernias usually don't cause symptoms. When there are symptoms, GERD is the most common one.

The overall goal of the hiatal hernia diet is to lessen acid reflux by reducing or eliminating foods that increase stomach acid. In addition, several other lifestyle changes are thought to improve symptoms of hiatal hernia.

This article discusses how foods can affect your hiatal hernia symptoms and what dietary changes you can make to reduce them.

Effects of Diet

Diet is thought to play a significant role in how severe your symptoms are. It may also be a possible underlying cause of hiatal hernia. 

Researchers know that some foods can cause irritation to the lining of the stomach and digestive tract and may cause inflammation. But scientists are not certain if specific foods can cause a hiatal hernia. If they can, it’s not well understood exactly how this may occur.

Most of the research on hiatal hernia and diet involves the link between eating certain foods and GERD.

High-Fat Foods

The Canadian Society of Intestinal Research (CSIR) recommends avoiding high-fat foods if you have GERD. That's because these foods increase the time it takes for the stomach to empty. 

The longer it takes for foods to move through the stomach, the longer the exposure of the esophagus to stomach acid. This increases the likelihood of acid reflux in those with GERD. 

Foods said to prolong gastric (stomach) emptying time include high-fat foods such as:

• Bacon
• Cream
• Deep-fried foods
• Full-fat cheese
• Ice cream
• Potato chips
• Sausages

If you have GERD symptoms, you may consider eating plenty of high-protein foods. Not all studies support the theory that high-protein foods can help GERD symptoms. But according to the CSIR, low-fat protein can still help heal the irritated lining of the stomach.

Caffeine

Foods and drinks with caffeine can cause acid reflux as well. This happens because they weaken the muscles that keep food in the stomach.

The esophagus has two openings called sphincters, which are bundles of muscles that open and close. The upper esophageal sphincter keeps food from going into the windpipe during swallowing. 

The lower esophageal sphincter (LES) is a bundle of muscles at the lower end of the esophagus where food enters the stomach. When the LES closes, it keeps stomach contents and acid from traveling upward back into the esophagus.

Chocolate and coffee contain compounds thought to relax the LES in the stomach. Coffee stimulates stomach acid, which promotes gastric reflux and irritates the lining of the esophagus in some people. A person's tolerance to coffee (either regular or decaffeinated) should be evaluated on an individual basis.

Other Foods

Alcohol, mint, citrus fruit, tomatoes, and carbonated beverages may irritate the lining of the esophagus in those with GERD. Like caffeinated drinks, they also relax the LES and cause reflux.

A 2017 report published by the journal Current Options in Gastroenterology suggests that some acidic drinks may also trigger reflux because of the time it takes to drink them.

For example, citrus fruit juices required a higher number of swallows as compared to other liquids (such as water). Frequent swallowing can cause you to take in more air, which can worsen GERD symptoms in some people. 

Dietary Changes

Generally, the hiatal hernia diet involves eliminating foods that increase symptoms. Which foods are problematic can vary from person to person.

Some foods, such as carbonated beverages and citrus fruits, may increase symptoms in some people diagnosed with a hiatal hernia. Other foods, like fatty fried foods, are problematic to most people who experience symptoms of GERD.

Foods to Avoid

If you're diagnosed with a hiatal hernia, you should avoid high-acid foods. Also avoid foods that are fatty, oily, and rich, as well as processed foods with preservatives.

In a 2017 Korean study, 126 participants (51 of whom had GERD and 75 of whom had possible GERD) were asked to list foods that triggered their symptoms. The study found that symptoms were caused by specific foods in 37.3% of the GERD cases and 22.7% of the possible GERD cases.

The specific foods identified in the study that increased symptoms of GERD were:

• Asian dishes with pork fried in lard
• Breads
• Coffee
• Doughnuts
• Fried foods
• Hot dogs
• Hot spicy stews
• Pizza
• Ramen noodles
• Rice cakes (and spicy rice cakes)

Other Lifestyle/Diet Changes

Being overweight has been associated with an increase in the incidence of GERD and hiatal hernia. 

Those who are overweight should combine the hiatal hernia diet with a weight loss diet. Other diet tips known to lower the symptoms of hiatal hernia include:

• Eat frequent meals and snacks in small portions.
• Drink plenty of fluids (particularly water) each day.
• Keep a food diary to identify your triggers.
• Chew your food thoroughly, eat slowly, and drink lots of water during meals to promote proper digestion.
• Do not eat before exercising.
• Eat foods high in probiotics, such as fermented foods, and consider taking probiotic supplements to promote healthy digestion.
• Avoid excessive hunger, which increases stomach acid.
• Avoid eating large meals.

Recommended Timing

The timing of meals is just as important as what is eaten or avoided. Tips for the recommended timing of the hiatal hernia diet include:

• Do not eat late at night.
• Finish the last meal/snack of the day at least three to four hours before lying down. For some people, that may need to be even longer.
• Spread meals out throughout the day and eat frequent small meals.

Cooking Tips

The way food is prepared can make a difference for those with GERD symptoms. For example, fried foods can trigger gastric reflux for most people. 

Cooking tips for people on the hiatal hernia diet include:

• Use healthy oil to sauté foods. Try olive, grapeseed, or avocado oil.
• Avoid deep-frying.
• When cooking with high heat, be aware that some oils, such as olive oil, break down. Avocado oil is a healthy oil that can maintain its unsaturated fat content when cooking with high heat.
• Avoid pre-packaged processed foods and ingredients. Use whole, fresh foods whenever possible. These foods contain more fiber, which is thought to help reduce symptoms of GERD.
• Include fermented foods such as sauerkraut, pickles, yogurt, and kefir.

Mediterranean Diet

Those who are in search of a heart-healthy diet may be interested in learning about one study, published in 2017. It found that the Mediterranean diet was effective in decreasing the risk of GERD symptoms in 817 study participants.

The Mediterranean diet has been studies more closely than most other eating plans. It consists of a high intake of vegetables, beans, legumes, fresh fruits, whole grains, fish, and olive oil, along with limited amounts of red wine and dairy products. 

Note: Those with GERD may opt to forgo the red wine. Alcohol has been found to irritate the lining of the esophagus.

Duration

How long you should do the hernia diet depends on several factors. These include whether your symptoms improve or get worse, if the hernia worsens, and if surgery is necessary. Talk with your healthcare provider about a long-term plan for your diet and lifestyle.

Other Restrictions

For those who have a hiatal hernia along with other gastrointestinal disorders, such as Crohn’s disease, restricting fiber may be an issue. 

A high-fiber diet is thought to lower the symptoms of GERD. However, those with inflammatory diseases of the bowel may need to follow a low-fiber diet of no more than 15 grams of fiber per day. Usually, 25 to 38 grams of fiber is recommended daily for a typical adult diet. 

Talk with your doctor about how much fiber you should get, particularly if you have more than one gastrointestinal condition. Your doctor can also talk to you about any other dietary recommendations for your condition, such as dairy and carbohydrates.

Summary

Acid reflux is a common symptom of a hiatal hernia. By making dietary changes, you can help to ease symptoms of heartburn and discomfort.

Try avoiding acidic, caffeinated, and high-fat foods that stimulate stomach acid. Focus on eating whole, natural foods, including vegetables, fruits, grains, and low-fat protein. Also try eating small meals, cooking with healthy oils, and avoiding eating right before bed.

As with any type of new diet, if you are diagnosed with a hiatal hernia you should consult with your healthcare provider before implementing new dietary restrictions or changing your eating pattern. 

Keep in mind that gastric reflux (GERD) symptoms can cause serious complications such as inflammation of the esophagus (esophagitis), esophageal ulcers, bleeding, or scarring. 

You may need surgery for a hiatal hernia if you have chronic (long-term) symptoms that don't improve with diet or medication. It’s important to get ongoing medical care and keep your provider updated about your response to the hernia diet.