Diet for Hiatal Hernia

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Under normal circumstances, the hiatus is a small opening in the muscular diaphragm at the juncture where the esophagus meets the stomach. A hiatal hernia develops when the opening widens and allows the upper part of the stomach to protrude upward through the hiatus. Some hiatal hernias are present at birth.

Most of them, however, develop during life as the opening of the hiatus becomes stretched, often as a result of pregnancy or excessive weight gain, both of which place upward pressure on the stomach.

Severe coughing, vomiting, straining when moving the bowels, or sudden physical exertion may also stretch the hiatus.

Although hiatal hernias are quite common, occurring in about 40 percent of Canadians, most people are unaware of the condition because they don’t experience symptoms or associated problems.

A hiatal hernia is usually diagnosed after recurring bouts of indigestion and heartburn, typically as a result of acid reflux into the esophagus and throat. Even when symptoms develop, the condition is usually not considered serious.

There are, however, exceptions in which frequent exposure to stomach acids causes severe esophageal damage, including ulceration, bleeding, narrowing, and even obstruction or rupture.

In such cases, surgical treatment is necessary. More often, however, self-care measures are all that’s needed. These may entail losing excess weight to alleviate pressure on the stomach and not wearing constrictive clothing, tight belts or girdles.

Dietary Approaches

Avoid large meals that overly distend the stomach; instead, eat four or five small meals spread over the course of a day. In addition, try to avoid drinking carbonated beverages, which may increase discomfort.

After eating, do not lie down, stoop, or bend over for at least an hour, because this may promote reflux. Do not try to eat or drink anything for at least 2 hours before going to bed at night, when attacks are most likely to occur.

Avoid substances that relax the diaphragmatic muscle. Alcohol, including wine, is one such muscle relaxant; in particular, abstain from any alcoholic beverage in the evening.

Eliminate foods that tend to irritate your stomach or provoke a bout of indigestion. The culprits vary from one individual to another, but common offenders include spices, citrus fruits, tomato juice, pickles, and vinegar. Coffee in any form increases stomach acidity, as does tobacco.

Chocolate and peppermint tend to relax the hiatal sphincter; fatty foods stay in the stomach longer than other foods and can also provoke indigestion. Small sips of water or a warm herbal tea may be useful when you feel a bout of regurgitation coming on, but avoid antacids that contain peppermint.

Constipation Can worsen a hiatal hernia because straining distends the abdomen. Eat plenty of high-fiber foods, such as whole-grain cereals and breads, as well as fresh vegetables and fruits. Daily exercise and an adequate fluid intake are also important.

People who experience frequent nighttime symptoms of a hiatal hernia can try raising the head of their bed 3 to 6 inches.

This elevates the upper body and uses the force of gravity to keep the stomach in place and prevent a reflux of stomach acids.

If self-care measures fail to provide adequate relief, a doctor may recommend an antacid to neutralize stomach acid; a histamine blocker, such as cimetidine, to reduce stomach acid output; or an acid pump inhibitor, such as omeprazole.

If lifestyle modification and conservative medical treatment do not alleviate symptoms, surgery may be recommended to reposition the stomach below the diaphragm and to narrow the hiatal opening.

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