Doctor's Note

This can be considered a companion video to Diet and GERD Acid Reflux Heartburn.

Hiatal hernia is not the only condition that high fiber diets may protect against. See:

I’ve got a load of other bowel movement videos dropping soon. Stay tuned for:

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  • Nicole

    So if you have a hiatal hernia, can it be reversed? My mom just had surgery to correct hers, I’m wondering if changing her diet could have helped her avoid the surgery…

    • questions

      I second this question, I would like to know this and another question for dr greger and staff, what is the safest, best insect repellent according to the science, the internet is filled with stories, but I want to know the facts.

    • Joevegan

      There are U tube videos showing how to manually manipulate the stomach back into the abdominal cavity. I am curious if this method is safe and if it works? As I have a friend that has a hiatal hernia and often must swallow several tums just to get through her meal.

      • David Johnson

        Eating too many Tums can be risky – can get too much calcium. I assume she’s seeing a specialist.

      • apprin

        My own opinion and experience. Antacid treatments are one of the downfalls of the western diet. Acid reflux or indigestion is often simply a result of poorly digested food gassing up as methane type gas from the stomach. This happens when the stomach acid is too weak or diluted to fully digest the food. Meat, animal fat and high protein is particularly difficult to digest and dilutes our digestive acids. Antacid treatments treat a condition that is largely a myth … Too much acid? In the stomach? A healthy stomach has acids that can digest an anvil. The trouble starts when digestive acids are weakened by animal fats and meats. The best treatment that I’ve found for indigestion, believe it or not, is a little vinegar water (many use apple cider vinegar). It restores the normally high acid strength so that food can completely digest and not push acids up the esophagus with half digested food-gas. Personally, I experienced this condition for years until I stopped eating animal products. Since that time, I have NEVER had one case (honestly) of indigestion – not one.

        • Joseph Gonzales R.D.

          Great points! We have many videos on antacids, if interested.

        • Rebecca

          I tried using vinegar as well, but quickly developed a series of canker sores. A search revealed this can be caused by the acidic vinegar. Using Betaine Hydrochloride works better for me. If vinegar works, more power to you! But if you get a lot of canker sores, try another source of stomach acid.

    • Joseph Gonzales R.D.

      Hi Nicole. I would doubt reversing a hiatal hernia with diet can be achieved since it’s a structural issue. Diet can surely help prevent another from occurring so that should be reason alone to assure proper fiber intake.

    • baggman744

      I was diagnosed with a hiatal hernia after an endoscopy. The GI said I was likely born with it. Not sure about that though. My mom also had one. I read it can be caused by child birth, excessive frequent straining, such as lifting, etc. Although its unlikely diet can reverse the structural damage, it can prevent the symptoms (GERD), and strengthen the function of the LES. Preventing GERD is very important, not just for the obvious reasons, but because it can prevent a condition called Barrett’s esophagus, which can lead to esophageal cancer.

  • Plantstrongdoc M.D.

    Man – a diet so poor that you have to use so much force in the lavatory, that you actually move your organs around! Crazy shit…. :-)

    • Wade Patton

      Even when eating close to SAD, I went to the outhouse per normal early one morning at camp. Came back to the cabin and one guy laughed and inquired,
      “What did you forget?”
      “Nothing, I’m done.” was my reply.
      He couldn’t believe that I had simply walked to the toilet, done my business in a minute or so and everything was fine. He said he takes half an hour!
      People think that is normal! That you read newspapers and magazine and sit on the throne for half a day. I suppose it is normal, but good grief it’s NOT healthy. Now that I know so much about flax and fiber, I can be more helpful if that situation arises again.

      • Plantstrongdoc M.D.

        You know Mrs. Torrance, you got to keep regular, if you want to be happy! – Dick Halloran (The Shining)

      • elsie blanche

        What about cyanide in flax seed, when eaten everyday raises concern for me. It is not like humans spent most of their time on earth eating cyanide containing seeds everyday. I am in the camp that the cyanide 300+ days a years might create long term issues. I’ve asked in past, but wanted to keep this topic relevant as I think some folks might not be able to detox properly all the cyanide.

        • We detoxify small amounts of hydrogen cyanide by an enzyme rhodanese. yielding non toxic thiocyanide.

          http://www.whfoods.com/genpage.php?pfriendly=1&tname=foodspice&dbid=81

          “”Cyanide” is a term that we typically associate with the potentially deadly poison, hydrogen cyanide. However, there are very small amounts of cyanide constantly present and undergoing metabolism in human tissue. These small amounts of cyanide are found in relatively non-toxic forms like thiocyanates. Of course, these same thiocyanates are also found to occur naturally in foods (for example, in cruciferous vegetables). Linamarin and lotaustralin are two of the primary cyanogenic glycosides in flaxseeds, and like the thiocyanates in cruciferous vegetables, both of these compounds can contribute to cyanide metabolism in humans. However, as long as our metabolic processes are not overloaded and we are in reasonably good health, about two tablespoons of flaxseeds per day are likely to provide too little linamarin and lotaustralin to cause an adverse reaction. We’ve seen research on flaxseed meal, for example, which shows about 5-6 milligrams of cyanogenic glycosides (CGs) in one tablespoon. (And to give you a comparison, oral doses of sodium cyanide and potassium cyanide that cause acute and dangerous toxicity in humans fall into the range of 1000’s of milligrams.)

          The issue of cooking and CGs in flaxseeds is somewhat ambiguous. We’ve see one study in which the baking of flax-flour containing muffins at 230F for 15-18 minutes showed no CGs in the final product. That result would point to a helpful impact of cooking on cyanide-related risk. We’ve also seen a study in which the overnight soaking of cassava, fermentation of cassava, as well as boiling, steaming, and dry heating of cassava all resulted in decreased CG content, with decreases falling into a very wide range of 32-99% range. While cassava is a food which can have the exact same amount of CGs as flaxseed, and in some cases, much higher amounts, it is also a food that is less compact and more porous than flaxseeds, and it would be expected to respond differently to cooking. In one study on commercial processing of flax, 20-30 minutes of heating at 150-221F did not appear to alter the CG content of the seeds or the processed flaxseed flakes or flaxseed cakes. From all of these studies, our overall conclusion is as follows: you may well benefit from the cooking of flaxseeds as a way of decreasing your cyanide-related risks, but you also may have no compelling reason to do so, since (1) the amount of CGs contained in 1-2 tablespoons is relatively small; (2) not all CGs will get broken down by enzymes and converted into hydrogen cyanide; and (3) if hydrogen cyanide does get created, most healthy persons will be able to detoxify it when it is present in such relatively small amounts. ”

          The issue of cooking and CGs in flaxseeds is somewhat ambiguous. We’ve see one study in which the baking of flax-flour containing muffins at 230F for 15-18 minutes showed no CGs in the final product. That result would point to a helpful impact of cooking on cyanide-related risk. We’ve also seen a study in which the overnight soaking of cassava, fermentation of cassava, as well as boiling, steaming, and dry heating of cassava all resulted in decreased CG content, with decreases falling into a very wide range of 32-99% range. While cassava is a food which can have the exact same amount of CGs as flaxseed, and in some cases, much higher amounts, it is also a food that is less compact and more porous than flaxseeds, and it would be expected to respond differently to cooking. In one study on commercial processing of flax, 20-30 minutes of heating at 150-221F did not appear to alter the CG content of the seeds or the processed flaxseed flakes or flaxseed cakes. From all of these studies, our overall conclusion is as follows: you may well benefit from the cooking of flaxseeds as a way of decreasing your cyanide-related risks, but you also may have no compelling reason to do so, since (1) the amount of CGs contained in 1-2 tablespoons is relatively small; (2) not all CGs will get broken down by enzymes and converted into hydrogen cyanide; and (3) if hydrogen cyanide does get created, most healthy persons will be able to detoxify it when it is present in such relatively small amounts. “

    • Anthony

      Hiatal hernia can also be healed naturally by herbal medicines from Grocare India – Hernica and acidim. see here for more details – https://www.grocare.com/diagnose/hiatal-hernia

  • Charzie

    My husband was never diagnosed with hiatal hernia, but I always guessed he had it…he used to eat antacids like candy, and would wake up in the middle of the night choking on acid reflux and scared me half to death. I don’t know if he still does, but sending him this video because he never believes me and he has a lot of these issues! Thanks!

    • SeedyCharacter

      Charzie, You might want to go to Ask Dr. Dawn http://www.askdrdawn.com/audioarchives.php# and scroll through the audio archives. Dr. Dawn is a brilliant functional medicine practitioner who has a weekly call-in radio program. Each show is archived with topics detailed so one can just download or stream the desired topic. Dr. Dawn commonly addresses reflux, use of antacids, etc. On her 5/16 show, she’s got a 2 minute segment on reflux. She recommends an elimination diet to see what food/s the person may be reacting to. In her experience, once the food triggers are identified, the problem is often resolved. (e.g. alcohol is apparently a common trigger).

  • Kitsy Hahn

    Maybe Dr. Oz should do something with this information. He loves to do “poop” shows. Not long ago he asked one of his guests what her poop looked like and she happily drew an “s” in the air. The good doctor then beamed his approval.

  • guest

    Africans poop squatting and the Westerners sitting on a chair with a hole. could this be a factor?

    • Wade Patton

      Leaning forward on the “chair” makes the position more “squattish”, if you need to. But when your diet is dominated by fiber-containing foods and you add flaxseed daily, position is _completely_ irrelevant.

    • ears2theground

      After living in a village in subsaharan Africa for a couple of years and having the opportunity to use a “chimbutzi” (hole in the ground), I can verify that the position aids a more complete passing. I missed the “chim” when I returned to the US because of this.

    • Danilo

      I think that’s the difference.

      “…The study demonstrated that when squatting, individuals took only 51 seconds to move their bowels, compared to the 130 seconds when sitting on a higher toilet. Additionally, when individuals were squatting they were more likely to rate their experience effortless…”
      http://www.medicaldaily.com/sitting-vs-squatting-how-bathroom-posture-affects-way-you-poop-242243

    • Doug Overman

      I bought this stool called a “squatty potty” it fits in the front of the conventional toilet so you can elevate your feet and puts you into a squat. Highly recommended.

      • ears2theground

        Thanks for the tip @dougoverman:disqus! I just checked out the squatty potty website and they really know how to market their product. It was entertaining and I might get one. LOL!

      • Gatherer

        In case someone reads this at a later date, Dr Greger reports that the “squatty potty” doesn’t put the body in the optimal position to aid bowel movement. See the video below for a simple and free solution that does work, albeit not as well as true squatting.
        http://nutritionfacts.org/video/should-you-sit-squat-or-lean-during-a-bowel-movement/

  • Gina Mai Denn

    Glad to see this video. I was diagnosed with GERD about 10 years ago (after being vegan for 10 years), and an endoscopy found a hiatal hernia. I don’t remember straining to go to the bathroom, though. When I finally adopted a PBWF diet my symptoms cleared up, but over the years I’ve slipped and it’s gotten worse. Trying to stick with it, but I end up tempted at restaurants and parties with oily food and alcohol. I’m just hoping that really sticking to it will cure the hiatal hernia.

    • Wade Patton

      I was using PPI’s to control my GERD for a few years. Changing to WFPB fixed me. I do eat “off the plan” sometimes-like last night and my system doesn’t like that-anymore. If I keep animal products portions strictly controlled, then no problem. But I got too much last night and spent hours feeling bloated and not good. I do consume alcohol regularly, with no GERD repercussions-it took several weeks. I tell more under the GERD video. Best of luck.

      • Gina Mai Denn

        Yes, I didn’t get into all the details above, but at first I was on PPI, constantly for 3 years. I started developing psoriasis, and when it showed up on my eyelid I decided I had to quit the PPI and started WFPB (Eat to Live) with full force. I stuck with it about half a year, lost weight and GERD and almost all the psoriasis went away. It’s hard for me, but I think I have to give up all oils and alcohol if I’m ever going to get the GERD under control. My main, persistent symptom is a raw throat. Bad news.

        • Wade Patton

          Best of luck with it. Food is the right answer, hope you get the combination worked out.

          • Gina Mai Denn

            Thank you.

        • b00mer

          Hi Gina, years ago I was dealing with a hiatal hernia, gastritis, esophagitis, and ulcers and was on PPIs as well. Wasn’t vegan yet at the time, but was still eating a heavily plant based and fairly high fiber diet. My issues were a result of NSAID overuse (ie use as prescribed by doctor).

          Anyway, through all the prescribed medications – prilosec, nexium, something like a prescription grade pepto, etc – the only thing I felt really helped me was slippery elm bark. I’d get it in powdered form and mix with hot water to form a slurry. It isn’t delicious but it isn’t horrible, and it gave me more relief in situations of acute discomfort more so than anything else I tried. I think the powder/slurry is the most potent form, but you can also get strips of the bark to make a tea which still has some mucilaginous character. It may help to soothe your chronically sore throat. Best of luck. Hopefully everything will resolve in time.

          • Gina Mai Denn

            Thanks!

    • You can have a Hiatal hernia and not have GERD or you can have GERD without a Hiatal hernia or both. Regardless we can all benefit from not having acid reflux up from our stomach into our esophagus. The WFPB diet often helps or relieves symptoms. Initially this is due to the lowered fat and animal protein in the diet. They tend to delay the emptying of the stomach. There are some plant foods that can make this situation worse. Some patients seem to be more sensitive than others. You might want to read Dr. McDougall’s article, “My Stomach’s on Fire and I Can’t Put it Out”, in his February 2002 newsletter available free on line on his website for helpful information. Good luck.

      • Gina Mai Denn

        Just to clarify, I’ve been vegan the entire time, since I was 21 and I’m now 46. I may have had the hiatal hernia my whole life. My mother speculated that I had one when as a child, as I would burp uncontrollably when I went to bed. I broke myself of the burping habit after I had the endoscopy around age 36. I will go look for the newsletter, thank you.

  • PamyCST

    Another possible cause of this problem is the restriction of the Ligament of Treitz – which surrounds the cardiac sphincter and continues down to wrap around the Duodenal/jejunum juncture. Easily relieved with gentle Visceral Manipulation. I have met many such ligaments and helped them relax!

    • HereHere

      I saw an osteopath for work on the cardiac sphincter (my own MD denied that there is even something called the cardiac sphincter). Unfortunately, the visceral manipulation didn’t work for me, despite the series of treatments and self-treatment. A chiropractor suggest jumping with food in your stomach may help, but it did not resolve. I think that would be a jump down a single stair, not up. However, I also read JP Barral’s book where he notes in the autopsy’s he’s done, those who had pneumothoraxes/atelectisis (collapsed lungs) all had hiatal hernias from the movement of the organs due to pressure changes in the thorax. Since I had one of these, I believe this to be the cause of my ‘small’ haital hernia. I’ve been vegan for 6 years and this reflux has been persistent, although it has been better in the past year for some reason. Perhaps related to the extra strawberry consumption, I’m not sure.

  • Cory

    Fascinating news. I was wondering if the fibre and adenocarcinoma study differentiated between soluble and insoluble fibre? While I would always recommend to my client to eat a plant-based diet, could the same risk be reduced with fibre supplements? This would be great to know when traveling or doing multi-day expeditions. Would hiatal hernia also be more prevalent with a high-protein diet (with most of that protein from animal sources)?

    • Joseph Gonzales R.D.

      Hey Cory. Great question. You can view all of the studies by clicking on “sources cited” to see what type of fiber was consumed per study. Researchers typically look at insoluble and soluble fiber together. We actually have a video comparing food with fiber supplements. Since high-protein diets tend to be higher in fat I would expect an increased hiatal hernia risk.

  • Drew Corrigan

    In addition to a WFPB diet one thing I have found that has helped me to eliminate effortlessly is using a “Squatty Potty” (https://www.squattypotty.com) type device which helps recreate a natural squatting configuration. When you squat the puborectalis muscle relaxes making elimination much easier. You can use things like yoga blocks to place beneath your feet instead and assume a squatting posture (as I did for a time), but I find the dedicated device is easier to keep clean and use. People in non-Western cultures include squatting many times throughout their day (not just for elimination) so dropping down into a squat to eliminate is easy for them. Many Westerners however find squatting is difficult due to lack of strength and range of motion in the hips, and lack of extensibility in the calves, a side effect of sitting in chairs for lengthy periods of the day and wearing heeled shoes. A squatty potty makes squatting possible for the “squat challenged”. :)

    • HereHere

      I’m thinking someone could just use a pair of inverted bowls or even yoga blocks or books to elevate the feet, but it’s a neat idea!

    • Anthony

      Hiatal hernia can also be helped naturally by herbal medicines from Grocare India – Hernica and acidim. see here for more details – https://www.grocare.com/diagnose/hiatal-hernia

  • UCBAlum

    I’ve been vegan for about 5 years – vegetarian for many years prior to that.

    I recently had an ultrasound where the tech said “bear down like you’re straining on the toilet”. I had to think about how to do that, the process was very deliberate, and it took a few seconds to get right.

    • SeedyCharacter

      Funny story! I eat so much fiber and drink so much water that I can have the opposite challenge. I recently broke my leg and had a lot of pain, so resorted to tylenol with codeine for a couple of days. The codeine caused me to strain to poop and it was miserable. I thought, good, god, is this how most people struggle most of the time? I could feel how quickly a person could develop hemorrhoids . . . I feel sad that these “strainers” don’t realize that a WFPB diet could help them so much.

  • carrot

    I’m glad that, as Dr Greger said in another video, vegans are regular people. :D

    That said, I wonder if the research reported in the video took into account differences in posture during “stooling”? Is a squat style toilet process less straining than as toilet seat process?

    • Joseph Gonzales R.D.

      Many people are bringing “squat posture” into question. I suggest checking out the “sources cited” section to see if posture was involved. If you need help finding the right study or reading in full please let me know.

  • Wade Patton

    different subject: Positive vs. Negative, Dr. Popper speaks to the positive approach of sharing our nutritional bent with the rest of the world. She also blasts the “binge-eating disorder” drug now being pushed (to those who view TV programming apparently). As always, I post the start time of the topical discussion on her Tuesday editions (in my comment), where she does local announcements for a minute or two. I do this as a service to those who like her messages but don’t need to know anything about the local goings on. It is 2:17 this day. Clip should be pre-loaded there:

    https://youtu.be/nzreUpv7jFo?t=2m17s

  • Jada Clarke

    Wow, good to know.

  • Sylwester Grega

    Wow, this is very interesting.

  • Naturenotes

    Here is a tip on treating hiatal hernia…I have had VERY GOOD results with this…!!

    After eating a meal or drinking, follow this procedure:

    1) Walk over to a solid surface.
    2) Raise your arms from your sides.
    3) Lift yourself up on our tip-toes.
    4) Take a deep breath.
    5) ABRUPTLY drop down on your heels while exhaling and RELAXING your abdominal muscles.
    6) You can do this several times in a row to be sure you were successful.
    7) When finished, take several rapid breaths and lower your arms. (This will tighten-up the diaphragm slightly.)

    The object of the exercise is to force the stomach to drop down below the diaphragm. If you do it correctly, you may even feel a very slight pain in your diaphragm as the stomach slides down (by the way, another name for haital hernia is ‘sliding hernia’). Initially, you may need to do this several times a day, until the diaphragm begins to tighten-up. The point of this is to keep the stomach down long enough for the diaphragm to restore itself to its former shape (to whatever degree that it can), and to avoid making the hernia WORSE. Using this method, I have been able to resolve my hernia so that I no longer have any pain, that is, until I do something stupid, like lift excessively or improperly.

    I probably first got my hiatal hernia from straining during bowel movements after
    years of low fiber eating, although it was not symptomatic until I
    lifted a heavy log a couple of years ago, and the stomach tore through
    the diaphragm causing intense pain. I have been a vegan for about
    6-years, and have insured that my fiber intake is high, so I don’t strain
    anymore. However, lifting heavy objects (especially while bending
    over!) can re-activate the hernia. Despite the haital hernia, I never had any GERD, and I attribute
    this to a vegan diet.

    Good luck!
    Dan

  • Jim Felder

    I have a question, does anybody have any information on any food or other substances that will tighten up or, even better, improve the muscle tone of the lower esophageal sphincter? GERD happens in part because the LES fails to keep stomach contents from refluxing. I have heard that fat, caffeine and chocolate among other foods causes the LES to relax. Stands to reason that other foods, or components of foods might cause it to contract. A related example from a recent video on turmeric cautions those with gall stones from taking turmeric since it causes the muscles of the gallbladder to contract causing sever pain in those with stones. So if something we eat can cause one muscle to contract, then perhaps something else could do the same for another muscle.

    A search of net turns up discussions of things like dissolved calcium citrate causing the LES to contract as the calcium washes over it. But I am very cautious about folk remedies that haven’t been put to the test as Dr. Greger would say. So if there could be references to some level of objective testing, that would be the best.

    Thanks!

    • Pam

      I read that melatonin works to tighten the LES – which makes sense, as our bodies produce it at night when we will be horizontal for a while – so I am now taking it most nights (search the studies online). It has helped my GERD but not stopped it. I find getting 8 hrs or more a night, and eating smaller, lower-fat meals, to be the most helpful, besides the melatonin. Also, peppermint actually relaxes the LES, so avoid it. I’ve been vegan 13 years or so, and developed what my doctor believes is hiatal hernia in the last couple of years. At first I only had an irritated throat, no classic heartburn symptoms, but it gradually got to the point where I was having intense pressure/pain in my chest, back, throat, shoulders, and even sinus headaches and some earaches. I now use a wedge pillow at night (helps my throat) and have had to begin taking H2 blockers at 75mg 2x/day, even though I don’t take any other kind of medication. This keeps it somewhat in control but still have some pressure/pain most days. (I dread having to take PPIs and will do whatever I can to avoid them.)

      I think another thing to remember is to drink lots of water between meals, even if your fiber intake is high, to avoid straining.

      Have yet to try it but some people have luck with D-limonene for reflux – not sure if it works on the LES specifially – and Shatavari has I think in at least one study shown to be helpful.

      Just curious, has anyone had any luck (or not) with either massage or chiropractic for hiatal hernia? I tried self massage and the “water and jumping” cure with no luck. I suspect the water – jump approach might work if there was no inflammation or scarring causing a bulge below the LES. Also interested in any reviews of meadowsweet tea, which is proving hard to find but is commonly used in Europe for reflux.

  • Nidia Urizar

    Dear Dr. Greger;

    I don’t have acid reflux but after eating, specially at night I can’t get to relax on a chair cause I feel a pressure on my chest and I have to go for a walk and when I wake up my mouth has a bitter taste, so do you think is the same problem?

    • Dan & Donna Barski

      If you have hiatal hernia, DO NOT EAT LATE or before going to bed! (In fact, this may be sound advice even if you don’t have a hiatal hernia.) Your symptoms sure do sound like acid reflux to me!

  • Aundrea

    How can you prevent all acid reflex

  • Following is a list of foods that you can eat:

    Fruits and vegetables: Fruits that are rich in antioxidants, such as blueberries, cherries, and apricots, can help reduce symptoms of indigestion. Antioxidant-rich vegetables, such as carrots, red bell peppers, and broccoli are excellent choices as well.

    Lean meats and fish: Turkey, salmon, ground beef, skinless chicken breast, and certain types of fish (i.e. cod and mackerel) are the go-to choices for protein in the hiatal hernia diet. Make sure the fish and meat products are baked and not fried.

    Beverages: Water is the ideal beverage to incorporate into the hiatal hernia diet. It’s important to drink it slightly warm as ingesting food or beverages that are too hot or too cold can interfere with the natural action of the stomach acids.

    Oils and grains: Healthy fats, such as extra virgin olive oil and safflower oil, are better alternatives to trans fats. Fiber is a necessary part of the hiatal hernia diet, so be sure to include plenty of whole grains in your meals. Brown rice, whole-grain pasta, rye bread, and quinoa are all excellent options. If you prefer, substitute these options with gluten-free alternatives.

    http://www.doctorshealthpress.com/general-health-articles/hiatal-hernia-diet-can-combat-gerd

  • Deborah Stevens

    I have been diagnosed with a hiatal hernia. Am trying to eliminate foods that are irritating my stomache. Are sunflower seeds allowed to eat, even when crushed, or they a no – no ?

  • Cibeles Guerrero

    So what would you recommend for practitioners as a strategy when several pathology invades one person body?
    I would Think the best option is always to go back to natural foods and take the strategies of WFPB but in this case, when you have a person telling you that many fruits and vegetables cause them insigestion, how would you increase the amount of fiber without the process being painfull for the patient??
    Sorry if any grammar or spelling mistakes were made! Best regards from Argentina!