What to Eat When You Have a Hiatal Hernia

Dietary Recommendations for Better Management

In This Article

A hiatal hernia is a condition that involves the upper part of the stomach abnormally protruding though the hiatus (an opening in the diaphragm between the stomach and the chest). The esophagus (the tube that carries the food from the mouth to the stomach) normally goes 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 gastric fluid flows upward into the esophagus. This may result in a condition called gastroesophageal reflux (GERD), which has symptoms of pain and discomfort (heartburn) in the chest area. GERD may worsen after ingesting certain foods or beverages. According to Columbia University, “Most small hiatal hernias do not cause symptoms. The most common symptom of hiatal hernia is gastroesophageal reflux (GERD).”

The overall goal of the hiatal hernia diet is to eliminate foods that increase stomach acid, thus, lessening the symptoms of acid reflux. In addition, there are other several other lifestyle goals thought to improve symptoms of hiatal hernia.

Benefits

Diet is thought to play a significant role in the severity of symptoms, as well as 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 certain foods lend themselves to the cause of hiatal hernia, and if so, it’s not well understood exactly how this may occur.

Most of the clinical research on hiatal hernia and diet involves the link between eating certain foods and gastroesophageal reflux disease (GERD).

In an online report by the Canadian Society of Intestinal Research, dietary recommendations include avoiding foods that delay the time it takes for the stomach to empty. The report explains that the more time it takes for foods to be digested and moved through the stomach, the more prolonged the exposure of stomach acid in the esophagus, increasing the likeliness of gastric reflux in those with GERD. Foods said to prolong gastric (stomach) emptying time include high fat foods, cream, ice cream, high fat cheese, sausages, bacon, potato chips, and more.

The report also suggests that those with GERD symptoms should be sure to eat plenty of high protein foods, explaining that early studies show that protein helps relieve LES pressure in the stomach, thereby promoting closure of the opening of the gastric sphincter (the ring of muscles that function to open and close to allow food into the stomach from the esophagus).

Not all studies support the theory that high protein foods can help close the LES sphincter, but according to the Canadian Society of Intestinal Research, “Even though more recent studies do not support this belief, maintaining a diet with an adequate low-fat protein intake can still help in the healing of irritated mucous [the lining of the stomach] or ulcers.”

The esophagus has two openings (called sphincters) which are bundles of muscles that open and close. The upper esophageal opening keeps food from going into the windpipe when 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. Gastroesophageal reflux occurs when LES pressure is lower than (inside the stomach) pressure.

Chocolate and coffee contain compounds thought to relax the LES sphincter in the stomach, and coffee is said to stimulate (and raise) stomach acid, which promotes gastric reflux and irritates the lining of the esophagus in some people. The tolerance of coffee (either regular or decaffeinated) should be evaluated on an individual basis.

Alcohol, mint, citrus fruit, tomatoes and carbonated beverages may cause irritation and further damage to the lining of the esophagus in those with GERD, but these foods have not been proven to cause reflux.

How It Works

Generally, the hiatal hernia diet involves a process in which individuals eliminate foods from their diet that cause an increase in symptoms. Some foods, such as carbonated beverages, citrus fruits, and more, 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.

Duration

The duration of the hernia diet depends on several factors such as if symptoms improve or worsen, if the hernia worsens, and if surgery is necessary. It’s important to consult with your health care provider to formulate a long-term plan regarding diet and lifestyle.

What to Eat

People diagnosed with a hiatal hernia should avoid foods that are highly acidic, those that are fatty, oily, rich, as well as processed foods with preservatives.

Compliant Foods

  • Chicken and other lean protein sources

  • Whole grains

  • Aloe juice

  • Carrot juice

  • Yogurt

  • Almonds and almond milk (as well as other plant-based milk, such as oat milk​

  • Artichokes

  • Carrots and peas

  • Sweet potatoes

  • Green beans

  • Green leafy vegetables (such as spinach and kale​)

  • Fermented foods (such as sauerkraut)

  • High fiber foods (such as oatmeal, whole grains, beans and legumes, as well as whole fruits and vegetables​)

  • Fruits and juices that are not considered citrus fruits such as apples, pears, various melons, and berries

  • Green tea (and herbal teas)

Non-Compliant Foods

  • Onions

  • Garlic

  • Some citrus foods (such as oranges and limes​ )

  • Salty foods

  • Fried foods

  • Tomatoes and tomato-based foods (such as salsa, tomato sauce, and more​)

  • Chocolate, cocoa

  • Mint (including peppermint and other types of mint​)

  • Coffee

  • Alcoholic beverages

  • Carbonated beverages

  • Doughnuts

  • Condiments (such as ketchup, mustard​)

  • Fatty/oily foods

  • Prepackaged, highly processed foods​

In a 2017 Korean study, 126 participants (51 of which had GERD and 75 of which had possible GERD) were observed. The study found that in 37.3% of the GERD cases and in 22.7% of the possible GERD cases, GERD symptoms were induced by specific foods. The specific foods identified in the study that increased symptoms of GERD were:

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

Consider drinking cucumber water. A 2017 study conducted by Complementary Therapies in Medicine reported that “All test samples except lemon showed significantly higher (p<0.05 for cucumber) acid neutralizing effect than water.” The study found that the “Highest antacid activity was demonstrated by cold milk and broccoli, which was comparable with ENO and sodium bicarbonate.”

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 diary/food log of triggers that lead to binge eating or eating foods that should be eliminated from the hiatal hernia diet and the weight loss diet (for those who are overweight).
  • Chew your food thoroughly and eat slowly and drink lots of water during meals to promote proper digestion.
  • Do not eat right before exercising or bending over.
  • Eat foods high in probiotics (such as fermented foods) and consider taking probiotic supplements to promote healthy digestion.
  • Avoid excessive hunger (which increases the stomach acid level) or being too full.

Recommended Timing

The timing of meals is just as important as what is eaten or withheld from the diet. 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 even longer).
  • Avoid eating before exercise or before bending over.
  • Spread meals out throughout the day and eat frequent small meals avoiding large meals.

Cooking Tips

The way a person prepares food can make a difference for those with GERD symptoms. For example, frying foods to trigger gastric reflux for most people, as well as eating large portions. Cooking tips for people on the hiatal hernia diet include:

  • Use healthy oil to sauté foods (such as olive oil, grapeseed oil and avocado oil).
  • Avoid deep-frying.
  • When cooking with high heat, be aware that some oils (such as olive oil) breaks down. Healthy oils that can maintain their non-saturated fat content when cooking with high heat include coconut oil, avocado oil, and more.
  • Avoid pre-packed 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 in the preparation of foods such as sauerkraut, pickles, yogurt, and kefir.

Modifications

Those who are in search of a diet to maintain a healthy weight and/or a heart healthy diet for people diagnosed with may be interested in learning about one study, published in 2017, that discovered the Mediterranean diet was effective in decreasing the risk of GERD symptoms in 817 study participants.

The Mediterranean diet is the most studied diet, compared to most other eating plans. It consists of a high intake of vegetables, beans and 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.

Considerations

A 2017 report, published by the journal Current Options in Gastroenterology, suggests that acidic foods (such as citrus fruits and tomatoes) may trigger reflux symptoms, simply because of the physiological mechanism utilized to ingest these foods. For example, acidic drinks (like citrus fruit juice) were found to take longer to drink, requiring a higher number of swallows as compared to other liquids (such as water). Frequent swallowing can cause an influx of air, which can exacerbate (worsen) GERD symptoms in some people. 

Often, those with GERD symptoms of a hiatal hernia, self-modify their diet, decreasing the foods that seem to worsen reflux symptoms. Those in the study with GERD symptoms were found to adjust the foods (such as acidic citrus and foods) that were perceived to worsen symptoms, but they did not eliminate all foods traditionally linked with exacerbating reflux.

It’s important to keep in mind that some foods (such as high fat foods) do not immediately seem to cause an increase in symptoms, but rather, create problems long after they are ingested.

Those who are on a vegetarian diet may be pleased to know that foods containing animal fats are found to lend themselves to worsening symptoms of hiatal hernia, compared to vegetarian protein options such as high fiber beans and legumes.

Overall, the hiatal hernia diet restricts many foods that are not healthy, in favor of whole, natural foods and low-fat foods that are more health promoting. The downside of the diet may be cost, Many healthy foods can be more costly, but not always. Most bakery foods and other junk foods (high in saturated fats and sugar) can also be costly. Consider that when only healthy snacks and meals are purchased and kept in the home, many people find they are less likely to overeat, saving money in the long run.

Dietary Restrictions

For those with hiatal hernia combined with other gastrointestinal disorders, such as Crohn’s disease, restricting fiber may be an issue. While a high fiber diet is thought to lower the symptoms of GERD, those with inflammatory diseases of the bowel may need a low residue/fiber diet of no more than 15 grams of fiber per day (ideally, 25 to 38 grams of fiber is recommended daily for a typical adult diet). It’s best to consult with a health care professional regarding the intake of fiber and foods such as dairy products, certain types of carbohydrates (to lower the incidence of abdominal cramps and diarrhea) and fiber for those who have more than one condition of the gastrointestinal system.

A Word From Verywell

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

Keep in mind that if gastric reflux (GERD) symptoms are left can cause serious complications such as inflammation of the esophagus (esophagitis), esophageal ulcers, bleeding, or scarring. Surgery may be required to correct a hiatal hernia in those who have chronic (long-term) unrelieved symptoms of esophageal reflux that do not improve with diet or medication. It’s vital to seek ongoing medical attention and keep the provider updated about your response to the hernia diet.

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Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Harvard Health Publishing. Hiatal Hernia, What is It? Updated May, 2017.

  2. GI Society. Canadian Society of Intestinal Research What is the Treatment of GERD? Updated in 2019.

  3. Panda V, Shinde P, Deora J, Gupta P. A comparative study of the antacid effect of some commonly consumed foods for in an artificial stomach model. Complement Ther 2017;34:111-115. doi:10.1016/2017.08.002

  4. Sethi, S, Richter, J. Diet and Gastroesophageal Reflux Disease: Role in Pathogenesis and Management. Lippincott Williams & Wilkins. Curr Opin Gastroenterol. 2017;33(2):107-111. doi:10.1097/MOG.0000000000000337

  5. Owczarek D, Rodacki T, Domagała- R, Cibor D, Mach T. Diet and nutritional factors in inflammatory bowel diseases. World J Gastroenterol. 2016;22(3):895-905. doi:10.3748/v22i3895

  6. Cleveland Clinic Health Library. Hiatal Hernia: Management and Treatment. Updated August 17, 2019.

Additional Reading

  • New York Presbyterian Hospital/Columbia University Irving Medical Center, Columbia Surgery, ESOPHAGEAL DISORDERS PROGRAM. Hiatal Hernia. Updated in 2019.