What Is the Hiatal Hernia Diet? (2024)

Diet modification is one of the cornerstones of hiatal hernia treatment. By knowing which foods to eat and which to avoid, you can help minimize many of the gastrointestinal (GI) symptoms of a hiatal hernia, including acid reflux and heartburn.

While there is no "hiatal hernia diet" per se, there are guidelines that help direct not only what you eat but how you eat. These dietary and lifestyle changes may be enough to minimize one of the more common complications of a hiatal hernia, known as gastroesophageal reflux disease (GERD).

Foods to Eat

Gastroesophageal reflux disease (GERD) is one of the most common consequences of a hiatal hernia and often the condition that leads a person to seek medical treatment in the first place.

GERD is a chronic upperGI diseasein which the contents of the stomach frequently backflow into the esophagus (feeding tube). This leads to symptoms such as acid reflux, heartburn, regurgitation, chronic cough, dysphagia (trouble swallowing), and chest pain.

The dietary recommendations for hiatal hernia tend to mirror those for GERD. These include eating foods that help reduce or dilute stomach acids.

Alkaline Foods

Alkaline foods are those with a pH of over 7.0. These foods help counter and neutralize stomach acids which have a pH under 7.0.

These include alkaline foods like:

• Bananas
• Melons
• Cauliflower
• Fennel
• Nuts

Foods With High Water Content

Watery foods help manage GERD by diluting stomach acids. Foods with water content between 90% and 99% of the most useful, including:

• Nonfat milk
• Cantaloupe
• Strawberries
• Watermelon
• Lettuce
• Cabbage
• Celery
• Spinach
• Squash

High-Fiber Foods

High-fiber foods increase satiety (a feeling of fullness). Early satiety helps prevent overeating and the overproduction of stomach acids needed to digest the food.

These include high-fiber foods such as:

• Whole grains, including oatmeal, brown rice, and couscous
• Root vegetables, like carrots, sweet potatoes, and beets
• Legumes, like lentils, peas, and lima beans
• Green vegetables, like asparagus, broccoli, and green beans

Probiotic Foods

Some studies suggest that probiotic foods may be beneficial to people with GERD. Probiotic foods are fermented foods that contain live bacteria and yeasts beneficial to the GI tract.

Among the most beneficial is a probiotic bacteria called Lactobacillus johnsonii which tempers stomach acid production and Bifidobacterium bifidum which protects the stomach and esophagus by increasing mucus production.

Probiotic foods rich in Lactobacillus johnsonii and Bifidobacterium bifidum include:

• Low-fat yogurt
• Kefir
• Kimchi (mild)
• Kombucha
• Sauerkraut
• Tempeh

Foods to Avoid

Knowing which foods to avoid if you have a hiatal hernia is as important as knowing which foods to eat. These include many of the "unhealthy" foods your provider would want you to avoid anyway (like fried foods and processed foods) but also some foods that are otherwise healthy and nutritious.

High-Fat Foods

The Canadian Society of Intestinal Research (CSIR) recommends avoiding high-fat foods if you have GERD. These foods slow the time it takes to empty the stomach after meals, thereby increasing the amount of acid the stomach produces.

These include high-fat foods such as:

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

Caffeinated Foods

Caffeine can cause acid reflux by relaxing the ring-shaped muscle called the lower esophageal sphincter (LES) which prevents the backflow of stomach acid into the esophagus.

These include highly caffeinated beverages and foods such as:

• Coffee
• Black tea
• Green tea
• Cocoa
• Chocolate
• Colas
• Energy drinks

Other Foods

Other foods are commonly linked to GERD, some of which irritate the stomach and others of which have the same relaxing effect on the LES as caffeine.

According to a 2019 study in Current Medicinal Chemistry, these include food like:

• Alcohol, including wine
• Citrus fruits and juices
• Tomatoes, including sauces and juices
• Carbonated beverages (which add gas to the stomach)
  

A 2017 study in Neurogastroenterolgy and Motility created a similar "hit list" of foods most commonly associated with GERD in people with hiatal hernia. According to the research, up to 37% experienced GERD after eating:

• White bread
• Doughnuts
• Fried foods
• Hot dogs
• Spicy stews
• Pizza

Recommended Lifestyle Changes

How you eat is as important as what you eat when you have a hiatal hernia. This includes the timing of meals and your mealtime habits.

Timing of Meals

Good eating habits are key to controlling symptoms of GERD. Some adjustments may also be needed to prevent overeating.

Consider these useful tips:

• Eat frequent, smaller meals spread throughout the day instead of three big ones.
• Eat healthy snacks to avoid getting overly hungry between meals.
  
• Avoid eating before strenuous exercise.
• Avoid snacking out of a bag or box which can lead to overeating.
• Avoid snacking in bed which places the esophagus in a compressed position.
• Finish your last meal or snack at least three hours before bedtime.

Cooking Tips

The way food is prepared can make a big difference if you are struggling with GERD symptoms:

• Use healthy oils like olive, grapeseed, or avocado oil. Avoid butter, lard, ghee, and coconut oil.
• Avoid deep-frying. Instead, try broiling, steaming, or baking meats, fish, and vegetables.
• Focus on whole foods. Pre-packaged and processed foods almost invariably contain ingredients on the "do not eat" list.

Other Restrictions and Recommendations

Here are a few additional tips to keep in mind if you have a hiatal hernia and experience frequent bouts of acid reflux:

• Eat sitting in a straight-backed chair. Slouching or eating lying down promotes acid reflux.
• Eat slowly to avoid gulping air. You should also avoid sipping from a straw.
• Drink plenty of water during meals, and keep well hydrated throughout the day.
• Do not lay down or bend over right after meals. Give your food time to digest.
  
• Elevate your head and shoulders slightly while sleeping if you experience nighttime reflux.
• Lose weight if you are overweight or obese as both promote acid reflux.
• Quit cigarettes. Tobacco smoke weakens the LES and makes GERD symptoms worse.

When to See a Healthcare Provider

People with hiatal hernias can often manage their symptoms with diet, lifestyle changes, and medications. However, it's important to speak with your healthcare provider if your GERD symptoms are severe, you find it increasingly difficult to swallow, or are experiencing persistent chest pain with coughing.

In severe cases, a hiatal hernia can become "pinched" in the diaphragm, cutting off blood flow to the stomach (strangulation). This is a medical emergency.

Call 911 or seek immediate emergency care if you have signs of hernial strangulation, including:

• Sudden, excruciating upper abdominal pain
• Nausea or vomiting
• Upper abdominal swelling, redness, and heat
• Rapid heartbeats
• Chest pain that feels like a heart attack
• Inability to pass gas or have a bowel movement
• Bloody stools
  

Summary

GERD is common with a hiatal hernia. By making dietary changes, you can help ease symptoms of heartburn and acid reflux. This includes the avoidance of acidic, caffeinated, and high-fat foods that stimulate stomach acid. Focus on eating whole foods, including vegetables, fruits, grains, and low-fat protein.

Also, try eating small meals, cooking with healthy oils, and avoiding eating right before bed.