Hiatal Hernia: What to Eat?

A hiatal hernia occurs when part of the stomach (the cardia) imoves into the chest through the opening in the diaphragm (oesophageal hiatus), which is intended for the passage of the oesophagus. This condition can be intermittent or become permanent. The condition is rare in children, but its prevalence increases with age, primarily affecting people over the age of 50. It usually does not lead to complications, and severe cases are rarely treated with surgery.

The Different Types of Hiatal Hernia

Sliding Hiatal Hernia: Type I

This is the most common type, accounting for up to 95% of cases. In this type, the oesophagogastric junction and the upper part of the stomach move up into the chest, above the diaphragm.

Rolling or Paraoesophageal Hiatal Hernia: Type II

The upper part of the stomach passes through the diaphragmatic hiatus and is positioned next to the oesophagus within the chest cavity. Unlike a sliding hiatal hernia, the oesophagogastric junction remains in place, while the rest of the stomach remains below the diaphragm.

Mixed Hernias: Types III and IV

These types of hernias are less common and combine features of Type I and Type II hernias. In Type III, the stomach moves up into the chest cavity both by sliding, as in Type I, and by rolling, as in Type II. In Type IV, in addition to the stomach, one or more organs of the digestive system, such as the colon, small intestine, or spleen, also pass through the oesophageal hiatus of the diaphragm.

Diaphragmatic Hernia, a Congenital Malformation That Should Be Distinguished from a Hiatal Hernia

A diaphragmatic hernia is not a hiatal hernia. It results from a congenital malformation of the diaphragm, leaving a larger opening through which several abdominal organs, such as the intestines, stomach, or liver, can move into the chest cavity. The lungs do not develop normally, which can lead to serious respiratory problems at birth. Affected babies may have difficulty breathing and require immediate medical care, sometimes including surgery to reposition the organs and repair the diaphragm. However, prenatal ultrasounds usually allow the malformation to be diagnosed and enable the medical team to prepare for its management.

The cause of a hiatal hernia is generally unknown, but it is thought to be linked to a distension of the fibroelastic membranes (fascia) surrounding the structures at the oesophageal hiatus. Several factors can contribute to the development of this condition.

Genetic Factors

Family history may play a role in the development of hiatal hernias. A 2024 article published in The American Journal of Surgery highlights the potential role of genetic factors in the development of different types of hernias, including hiatal hernias. Researchers have identified several genetic regions associated with an increased risk of hernias, suggesting that genetics may contribute to differences in the strength and structure of connective tissues.

Ageing

In older adults, a weakening of the diaphragm muscles with age can contribute to the development of a hiatal hernia.

Obesity

Excess weight is a significant independent risk factor for hiatal hernia. It is significantly associated with oesophagitis.

Pregnancy

During pregnancy, the pressure exerted by the uterus on the abdomen can cause part of the stomach to rise through the oesophageal hiatus. In addition, hormonal changes, particularly increased progesterone levels, tend to relax the muscles, including those of the diaphragm, which can exacerbate the problem.

Chronic Cough

A persistent and intense cough (caused by chronic bronchitis, asthma, or smoking, for example) can increase intra-abdominal pressure and gradually weaken the muscles of the diaphragm. This excessive pressure can contribute to the herniation of part of the stomach into the chest cavity.

Constipation

Repeated straining during bowel movements in cases of chronic constipation increases abdominal pressure, which can contribute to the development of a hiatal hernia. A high-fibre diet and staying well-hydrated can help prevent this problem.

Among the most common symptoms of a hiatal hernia are:

• acid reflux and heartburn

• food regurgitation into the mouth

• chest pain

• swallowing difficulties (trouble swallowing)

• feeling full quickly after eating

• feeling bloated

• belching (burping).

Other, rarer symptoms may occur, such as a bitter taste in the mouth, bad breath, or a cough, etc.

Diet can help manage symptoms of heartburn and gastro-oesophageal reflux.

Good to Know: To avoid indigestion, it is also advisable to eat slowly and in a calm environment. Smoking is harmful because it promotes acid reflux.

Hiatal Hernia: What to Eat in the Evening?

For dinner, it’s best to eat a light, easily digestible meal to prevent nighttime reflux. You should therefore avoid high-fat dishes, spicy sauces, and acidic foods like tomatoes and citrus fruits. Ideal options include: steamed vegetables, small portions of wholegrain carbohydrates, a lean protein source such as fish or tofu, and applesauce. The best tips for reducing nighttime acid reflux are to eat dinner at least two to three hours before bedtime and to raise the head of the bed slightly.

Various lifestyle and dietary measures can help alleviate the symptoms of a hiatal hernia by reducing acid reflux into the oesophagus.

1. Avoid Irritating Foods in Favour of an Easily Digestible Diet: Limiting fatty and spicy foods, citrus fruits, chocolate, coffee, and alcohol may help relieve symptoms. Scientific evidence linking these foods to gastro-oesophageal reflux remains limited, but they are often reported as reflux triggers

2. Eat Smaller, More Frequent Meals: Rather than eating large, heavy meals, it is recommended to eat smaller portions several times a day. This may help prevent the stomach from becoming overly distended and reduce the risk of acid reflux

3. Avoid Lying Down Too Soon After Meals and Raise the Head of the Bed: It is strongly recommended to wait at least two to three hours before going to bed. Raising the head of the bed may also help alleviate reflux symptoms, particularly when the oesophageal anti-reflux barrier is weakened, as can occur with a hiatal hernia. Sleeping on your left side may also help reduce nighttime acid reflux and improve digestive comfort, whereas sleeping on your back or right side may worsen reflux

4. Avoid Staying in a Forward-Leaning Position for Too Long: Instead, squat down when necessary, especially when gardening

5. Lose Weight or Maintain a Healthy Weight: Excess abdominal fat puts pressure on the abdomen and increases the risk of gastric reflux. Weight loss, even moderate, may help reduce this pressure and improve symptoms. A study published in 2023 in Best Practice & Research Clinical Gastroenterology highlighted the importance of incorporating diet and weight management into the management of gastro-oesophageal reflux disease (GERD). It concluded that these elements should be part of management plans for GERD, particularly in people with a hiatal hernia

6. Avoid Tight-Fitting Clothing Around the Waist and Abdomen: Tight-fitting clothing can increase abdominal pressure

A hiatal hernia can cause gastro-oesophageal reflux and may also lead to chest pain or breathing difficulties. If symptoms are persistent or severe, it is essential to consult a healthcare professional.

You can keep a food diary to identify which foods trigger your symptoms. This can help you adjust your diet accordingly. Understanding what to eat if you have a hiatal hernia can then become easier.

An agricultural engineer specialising in nutrition and a Doctor of Food Science, Lila is a journalist and science writer. She contributes to B2B trade magazines and works with innovative companies in the health and wellbeing sector. Passionate about sharing knowledge, she is committed to making complex scientific information accessible to everyone. Convinced of the essential role played by micronutrients, plants and the microbiome, she explores the links between science and nature to better understand the foundations of our well-being.