What is Hiatal hernia and its causes?

A hiatal hernia occurs when the upper part of the stomach passes from the abdomen to lodge in the chest. This type of hernia affects approximately 20% of the population. However, knowing how many people suffer from it is difficult because some do not present symptoms, but those who do present them tend to suffer from heartburn, discomfort in the abdomen, swallowing problems, bad breath or dry cough. These symptoms make you eat less and less because eating becomes, in many cases, an ordeal. 

Why does this displacement of the stomach cause discomfort?

Hiatal hernia when we eat, food passes from the mouth to the oesophagus, which is in the chest cavity, and from there, it goes to the stomach, located in our abdomen. The chest and abdomen are separated by a muscle called the diaphragm, and the oesophagus communicates with the stomach through a hole in the diaphragm called the hiatus.

The problem occurs when part of the stomach passes through the hiatus into the chest cavity, which facilitates gastroesophageal reflux (GER). That is the contents of the stomach return to the oesophagus. When it happens, the oesophagus, which is not protected like the stomach to withstand the acids of digestion, becomes irritated. That is when we begin to suffer the symptoms mentioned above.

Causes of hiatal hernia

The hiatus hernia that occurs in children is congenital; they are born with them. For its part, in adults, the cause is usually not so clear. Still, it is related to obesity, smoking, violent coughing or repeated vomiting over a long period or the weakening of the diaphragm muscle, which usually occurs with the passage of the years. For this reason, hiatus hernias are generally more common in people over 50.

Hiatus hernia is not the same as gastroesophageal reflux

No, hiatus hernia can favour GER, and in a large number of cases, it is related, but it can occur even if there is no hernia. For example, if the diaphragmatic muscle relaxes but does not let the stomach pass or if certain situations arise that favour pressure on the stomach, such as pregnancy or obesity, GER can occur even if there is no hiatal hernia.

The symptoms of this situation will also be heartburn, dry cough and abdominal discomfort. Therefore, people suffering from GER, despite not having a hiatal hernia, can follow the nutritional advice we will give later to improve this situation.

Complications of hiatal hernia and GER

If hiatal hernia or GER is not treated, it can get worse, causing inflammation or irritation of the oesophagus (esophagitis) or even gastritis or stomach ulcers. These irritations of the oesophagus can generate scars that cause the passage through it to become narrower, making it increasingly difficult for us to swallow. On the other hand, if these injuries to the oesophagus persist, they can degenerate and favour cancer in this area. Therefore, it is essential to know how diet can reduce reflux to minimise its symptoms and feel better and avoid the complications it can cause.

General recommendations and treatment of hiatal hernia and GER

When we are diagnosed with hiatus hernia or GER, the objective of medical treatment will be to facilitate digestion or reduce the production of stomach acid. Therefore, antacids are commonly prescribed. On the other hand, other recommendations can also be given, such as:

  • Do not sleep or lie down before 3 hours have passed since the last meal, as the horizontal position during digestion will favour reflux.
  • Sleep slightly raised, for example leaning on two pillows. This will make it difficult for gastric contents to return to the stomach.
  • Quit smoking since tobacco stimulates the secretion of gastric acid and, in addition, can favour the worsening of injuries that can occur in the oesophagus or stomach.
  • Wear loose clothing to avoid pressure on the abdomen.
  • When bending down to pick something up off the ground, you should bend at the knees and not at the waist.
  • Try to reduce stress or the moments that cause us stress with relaxing therapies (yoga, meditation, relaxing plants). Pressure generates gastric acid even if we have not eaten anything, which can cause more discomfort and damage to the stomach and oesophagus.
  • Do not perform the intense physical exercise as it can favour gastric acid production. In any case, moderate physical activity for a minimum of 30 minutes a day, if not just after eating, is recommended and, in addition, it will help us lose weight if necessary.

Dietary recommendations for hiatal hernia and GER

Diet for Hiatal hernia general recommendations are helpful, but, in some cases, they are usually not enough, and additional medication or surgery is necessary. Therefore, if we want to improve the symptoms of these conditions, we must follow a diet that includes the recommendations we will give below, within which certain foods are not recommended.

In any case, the Hernia diet should be based on tolerances and personal tastes and in line with our lifestyle while balancing our energy expenditure. This is why it is crucial to have the help of a dietician-nutritionist. Once this is remembered, let’s see what recommendations you should follow:

General dietary guidelines.

  • Reduce weight whenever necessary. This is one of the most important measures as it will relieve the pressure in the abdomen and facilitate an improvement in symptoms.
  • Avoid copious meals. Excesses will make digestion difficult, make the food stay longer in the stomach, and facilitate reflux. Therefore, the solution will be to eat light meals about five times a day, eat slowly and chew food well.
  • Do not eat anything, even liquid, before going to bed. As said before, you should try to eat dinner 2 to 3 hours before bed.
  • Cook gently (boiled, papillote, steam, oven) and avoid fried or battered. Watch out for grilled foods! If these are burned, they can irritate the stomach when we eat them.
  • Avoid foods with extreme temperatures, or very hot or very cold, as this can promote irritation.

 Foods not recommended

  • High fatty, spicy, pickled, or highly salted foods should be reduced or eliminated. Therefore, avoid or take moderately and in small amounts cream or oil-based sauces, pickled or salted fish, cured or full-fat dairy cheeses, fatty meats, sausages, organ meats, and pastry products or chocolate.
  • We must also eliminate or minimise certain drinks that stimulate gastric secretion, such as alcohol, carbonated drinks, tea or coffee.
  • Acidic foods should be limited, especially at dinner time. Thus, many people who suffer from hiatus hernia or GER will feel discomfort if they consume tomato, vinegar, citrus, unripe fruit or, in some cases, although less frequent, even yoghurt.
  • Certain foods or condiments such as garlic, onion or pepper (incredibly raw) also favour discomfort in people with hiatal hernia or GER. Therefore, if you notice pain after eating dishes with these foods, try to reduce or avoid their consumption.

And so, what should I eat for a hiatal hernia?

Faced with this barrage of information, many of you will think, then what do I eat? First, you have to believe that the diet for hiatus hernia or GER must take into account the personal tolerances of each one. But, if you do not tolerate the foods mentioned above, here are some ideas that can help you:

  • To replace the whole dairy, consume skimmed dairy (skimmed milk or yoghurt, 0% cheese, etc.). With this, we will also be making a lower contribution of saturated fat to our diet so that, at the same time, it helps us to avoid symptoms, lose weight and improve our health.
  • If what happens to us is that yoghurt causes us discomfort, but we do not want to reduce our dairy intake, we can have low-fat fresh cheese for dessert.
  • It is also preferable to choose low-fat meats such as turkey or chicken and white fish, although we can eat oily fish in moderation and see your tolerance.
  • On the other hand, to hydrate ourselves, we can drink water, soft infusions such as rosemary or sage (mint infusions can sometimes cause discomfort), broth or non-acidic juices.
  • As for the fruits, it is preferable to take ripe fruits, baked or in compote, since in these cases their acidity decreases.
  • Vegetables and cereals do not usually cause discomfort, but you should be careful with certain flatulent vegetables such as cauliflower, artichokes or Brussels sprouts. In addition, you have to check the chocolate breakfast cereals or mueslis that can be heavy.
  • Finally, although fat and sauces are discouraged, you can take light mayonnaise or margarine in moderation, although olive oil is the most suitable for cooking.

Personalised advice to improve your situation

All the advice can serve as a guideline for a diet for hiatal hernia or GER and improve your situation. In addition, a dietician-nutritionist can help you organise your diet to best suit your tastes and schedules. If you suffer from these conditions and are pregnant, they can help you improve your situation by covering all your nutritional needs. 

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