Diet and Hiatal Hernia

Image Credit: Sally Plank

Treating the Root Cause of Acid Reflux

In terms of preventing acid reflux heartburn, high-fat meals cause dramatically more acid exposure in the esophagus in the hours after a meal. I talked about this in Diet and GERD Acid Reflux Heartburn. High fiber intake decreases the risk, but why? One typically thinks of fiber as helping out much lower in the digestive tract.

A systematic review and meta-analysis published in 2013 found a highly significant protective association between esophageal adenocarcinoma and dietary fiber intake, suggesting that individuals with the highest fiber intakes have an approximately 30% lower risk of cancer. This could be because of the phytates in high-fiber foods slowing cancer growth, fiber’s anti-inflammatory effects, or even fiber-facilitated carcinogen removal. But those are all generic anti-cancer effects of whole plant foods. Specific to this type of acid irritation-induced esophageal cancer, fiber may reduce the risk of reflux in the first place. But how?

As you can see in my video, Diet and Hiatal Hernia, hiatus hernia occurs when part of the stomach is pushed up through the diaphragm into the chest cavity, which makes it easy for acid to reflux into the esophagus and throat. Hiatus hernia affects more than 1 in 5 American adults. In contrast, in rural African communities eating their traditional plant-based diets, the risk wasn’t 1 in 5; it was closer to 1 in 1,000—almost unheard of. Hiatus hernia is almost peculiar to those who consume western-type diets. Why are plant-based populations protected? Perhaps because they pass such large, soft stools, three or four times the volume as Westerners.

What does the size and consistency of one’s bowel movement have to do with hiatal hernia? A simple model may be helpful in illustrating the mechanism that produces upward herniation of the stomach through the hole (called the esophageal hiatus) in the diaphragm, which separates the abdomen from the chest. If a ball with a hole in its wall is filled with water and then squeezed, the water is pushed out through the hole. If we liken the abdominal cavity to the ball, the esophageal hiatus in the diaphragm corresponds with the hole in the ball. Abdominal straining during movement of firm feces corresponds to squeezing the ball and may result in the gradual expulsion of the upper end of the stomach from the abdominal cavity up into the chest. It’s like when we squeeze a stress ball. Straining at stool raises pressures inside our abdominal cavity more than almost any other factor.

In effect, straining at stool puts the squeeze on our abdomen and may herniate part of our stomach up. “Consistent with this concept is the observation that in Africans the lower esophageal sphincter is entirely subdiaphragmatic, whereas it usually straddles the diaphragm in Westerners and is above the diaphragm in the presence of hiatus hernia.”

This same abdominal pressure from straining may cause a number of other problems, too. Straining can cause herniations in the wall of the colon itself, known as diverticulosis. That same pressure can backup blood flow in the veins around the anus, causing hemorrhoids, and also push blood flow back into the legs, resulting in varicose veins.

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

I also have a load of other bowel movement videos:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


43 responses to “Treating the Root Cause of Acid Reflux

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    1. Not without surgery, which you should aviod. However, you don’t have to have symptoms. The GI said I was probably born with it. It may also have occurred from weight training; who knows. I was on a PPI (Nexium) for almost 14 years. I did some research, and with a little trial and error, was successful in weaning myself completely off more than 2 years ago. PPIs are a miracle drug for acute symptoms, but were never intended for long term use.




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      1. I have a small hiatal hernia and had pretty bad acid reflux a few years ago These days I have no problem whatsoever. The difference? Switching from an oily ovo-lacto-pisco-vegetarian diet (which I had been on for almost 50 years) to a 100% whole food plant diet. Solved other health issues too e.g. no gout attacks, normal blood work, BMI and I’m on no medications, increasngly rare for my age (70).




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    2. If you type in “Natural cures for hiatal hernia” there are a lot of options that pop up. I had a friend who went to a naturopath doctor with a hiatal hernia. The doctor did some sort of “maneuver” on her that involved some pushing on her stomach (I’m getting this second hand) which appeared to fix the problem. I don’t know if this is for all hiatal hernias or just new ones. Anyways, it might be worth looking into.




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  1. With gastroparesis, all the literature says to consume a low fiber diet. I find it hard to believe that this is the best way to handle for this condition. I would love comments on gastroparesis and diet.




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    1. Thanks for your comment.

      I have found a 2011 publication that can help as it describes this condition in great detail and it confirms your suggestion about reducing fiber intake. In the summary section it states & I quote:

      “Summary of Oral Diet Recommendations for Patients with Gastroparesis:

      • Decrease volume of meals / eat smaller, more frequent meals throughout the day
      • Use more liquid calories
      – May need to switch to liquid calories over the course of
      the day as fullness worsens
      – If solids are not tolerated, consider a trial of a pureed/
      liquid diet
      • Chew foods well
      • Sit up for 1–2 hours after a meal
      • For patients with diabetes, control blood glucose levels
      • Decrease fiber in the diet (see Table 5)
      – May delay gastric emptying
      – May lead to bezoar formation
      • Evaluate fat intake
      – Fat in liquid form is often tolerated
      – Fat is a good source of calories and should only be limited
      after other measures have been exhausted or if intake of solid fat is excessive”

      Here is a guide on how to follow a low fiber diet, just make sure you eat plant based foods.

      Hope this answer helps.




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      1. ​Part of my problem is not being able to eat beans and whole grains. I do not eat meat, nor tofu! I was hoping that there would be some evidence that beans and legumes were okay for those with gastroparesis as they are said to be the healthiest of foods and I love them. Oh well! Thank you for your response. I appreciate the article; I had not read this one.




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  2. Now I know what happens with those wrinkly garden hoses that kind of retract themselves. They develop a weak spot inside and have a hernia! Then the hernia bursts and you need a new hose!!!




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  3. This is great news for those who want to avoid GERD but what about those of us who unknowingly acquired it over the years due to not having had this information available to us. What can we GERD sufferers do NOW to heal ourselves and/or prevent further complications such as Barrett’s or esophageal cancer?




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      1. darchiterd, I thank you for sending this link. I did watch it and hope it may not be too late for me to take control and hopefully avoid the serious complications of GERD. I wish there were studies that involved subjects with long-term GERD who were successful in reversing the path toward those complications and knowing how long it may have taken to see results. I have been cleaning up my act, so to speak, for awhile now and will continue to do so as best I can. My gastroenterologist is determined for me to use PPI long-term and wants me to have an endoscopy to see what the damage may be. I wish I could say it doesn’t frighten me to find out. I should mention too that I must be on aspirin therapy due to having had a TIA and wish there was some information from Dr. Greger on how to use aspirin therapy while avoiding GERD. Again, thanks for taking the time to respond.




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        1. hi Lee, I replied to your question the other day, but if I may, I’d like to add a couple of points. in hindsight, I would have to say that the two things that kept my severe GERD happening was, the wrong diet, and the ppi meds. I really regret the 10 years I took them . The wfpb diet is very healing to the esophagus and stomach once you are off the meds (took me 7 weeks to wean off them). BUT, it was very important for me to avoid several things. 1. Oil and fats, including avocado, dressings, prepared foods, vegan ice cream, cheese etc. 2. High acid foods like citrus, tomato, condiments with vinegar, most vinegars, many herbal teas, some coffees, salsa, hot sauces and cayenne etc etc. 3. Mints, mouthwashes, cough candies
          I could only eat less than 2 cups of food at a time at first. Dont over-eat.. it aggrivates GERD.

          I did have the scope done, 2 times. The stomach heals very quickly in response to good whole foods I take a time release daily aspirin (for 10 years now) with my morning oatmeal and I have never had any problem with it. Best of luck Lee!




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          1. Hi, Susan
            So good of you to share although I am shocked at how many things you have had to eliminate. If it is not too personal, did your endoscopy show any damage to your esophagus considering how many years you had GERD? If so, was it healed over time with your new approach to diet? And, finally, was it difficult to convince your doctor that you no longer wanted to be on PPI’s? My gastroenterologist is quite formidable and strikes fear in me that I will wind up with Barrettes or worse if I don’t take the PPI’s.




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            1. hi again Lee, thanks for the questions .. I should have thought to include that info. First, the elimination list was for when I went off the ppi’s starting at around week 3 and I continued to avoid them until my stomach was ‘healed’. According to Dr Klaper (anothet plant based doc) the stomach can heal quickly in about 30 days or less, even for leaky gut. His website offers more info and videos. I felt a ‘lump’ in my throat when I had GERD.. this resolved quickly. I have found that fat in or on food is what prompts acid reflux in me. Acid foods irritate the already inflamed esophagus even more. Once healed,(and it did heal, confirmed) I could add some things back in to my diet like, a bit of lemon, an orange once in a while, a tomato for a mild curry, or a cup of mint/camomile tea. Note the moderation. Also, I had to adopt the Drs Ornish / Esselstyn style diet and maintain No oil rule, with no avocado or strong vinegars. I do enjoy ethnic cooking using lots of herbs and spices, but not hot chilies.

              I had seen an Ear Nose and Throat specialist as well as the Gastroenterologist. I simply did not go back after the second scope where I had biopsies taken. I changed my diet and went off the meds with my family doctor’s blessing. I healed up quickly with no returning symptoms of GERD, and currently, all inflammation markers are very low.

              I understand the anxiety that doctors can evoke in a person. Maybe share your situation with your family physician.. ask for a second opinion. Try the diet. Use tumeric and other anti inflammatory spices. Eat a serving of berries daily, and some broccoli, and a yam.. a variety of whole plant foods will help to bring down inflammation and heal irritated tissues. Dr Klaper also does consults over the phone or skype if that is something that interests you. http://doctorklaper.com/

              I hope that I have offered some encouragement. I dont know what the future will bring, but I am sure glad to be off medications that can have bad side effects, and I think I am eating the best diet possible to prevent disease and promote health. Check out the videos at NutritionFacts.org on inflammation, on aspirin, and on tumeric maybe. I wish you well Lee!




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              1. Susan, I am in total awe of you.  I admire the way that you have taken control and modified your lifestyle to achieve better health and resolve your GERD issues.  You have been a great help to me and I thank you for it.  Quite often I find the forum posts to be so esoteric and scholarly in their dissection of Dr. Greger’s findings that they are of little help to me.  Thanks for your straightforward explanation.  Best to you in health as well!




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    1. I was diagnosed with hiatus hernia and Barrett’s some years ago. Two years ago I was diagnosed as high risk after a coronary arter scan. I have been on a WFPB diet for eighteen months and now only rarely have reflux. I have virtually stopped my PPI medication.




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  4. I also would love to know what can be done to mitigate the symptoms of hiatal hernia and GERD once the damage has been done, or better yet, to cure either condition (without surgery), and to avoid esophageal damage and cancers. I have been on a plant-based diet for 16 years but still have reflux at times.




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    1. Thanks for your question Nicole.

      I think every case should be treated individually with medical guidance. Having that said, I am happy to hear that you’re on a plant based diet. & as far as my knowledge goes, it appears that high fat foods could also worsen GERD. Therefore, it would be a good idea to see what foods you are consuming. On the other hand, I truly believe that a plant based diet can only help people but it can’t always eliminate a problem completely. Having a good diet can perhaps relieve the symptoms, if someone was to eat meat, it is expected that they would be suffering much more.

      Hope this answer helps.




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    2. Hi Nicole A. Strawberries can reverse progressions to esophageal cancer https://nutritionfacts.org/video/strawberries-versus-esophageal-cancer/ and high antioxidant low fat plant foods can help with GERD. https://nutritionfacts.org/video/diet-and-gerd-acid-reflux-heartburn/

      Also a number of published studies have shown that a gluten-free diet can efficiently control esophageal symptoms and help prevent recurrence. http://www.everydayhealth.com/gerd/gerd-gluten-free-diet.aspx A friend of mine only gets acid reflux after eating foods that contain gluten, so might be worth a try.




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      1. Afterthought: are freeze dried strawberries rehydrated before eating? Dr. Greger didn’t specify in the video how these were consumed.




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        1. Hi Lida. I would think regular fresh or frozen strawberries would work just as well. It’s the healthy components of the strawberries that do the trick, not the form it comes in. Of course organic would be best, but conventional berries are much better than none.




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      2. I took a look on the NLM site and couldn’t find any mention of these studies unless they were tied to celiac disease…

        Rick Weissinger, MS, RD, LDN Author, *What the Experts Say About Food and Cancer* Co-author, *Nutrition Guide for Clinicians*, editions 1 and 2 Phone: (912) 226-6191 (Home) (301) 525-9078 (Mobile)




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      3. I watched the video to which you referred but found no mention of how the freeze-dried strawberries were consumed.  Were they eaten as is or rehydrated?  Also, were they eaten on their own or combined with other foods such as oatmeal?  I didn’t find the study details to be very specific.




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        1. hi Lida, under the Sources tab of the strawberry video is the study link https://www.ncbi.nlm.nih.gov/pubmed/22135048 which describes the freeze dried strawberries, ground to a powder and stirred into a glass of water making a drink. Two doses were tested .. 30 gm per day and 60 gm per day, which Dr Greger says is equivalent to a pound of fresh strawberries per day. https://nutritionfacts.org/video/strawberries-versus-esophageal-cancer/ They use the freeze dried strawberries I imagine because of the difficulty in obtaining a fragile seasonal fruit.




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        2. I looked up the study when I was diagnosed with Barrett’s 2 months ago and they were freeze dried and powdered and mixed with water than drank over a span of I think 5 minutes. I just have been eating fresh ones daily




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          1. Julie, thanks.  I think eating fresh or frozen organic strawberries is the only feasible way to go.  I am sorry that you are dealing with Barrett’s and  it may be that I will be as well.  Do you mind sharing what treatment you are following for it?  Besides dietary changes are you also on meds?  Wishing you the best outcome.
            Lee




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            1. Hi Lida, I was diagnosed with a 1cm hiatal hernia and short segment Barrett’s with no displasia(thank god). What scares me is I’m only 34 and have 4 kids. I was told to take a ppi i’m guessing for the rest of my life but only really have symptoms if I slip up and eat something I shouldn’t. So I only take an H2 or tums if I feel I need something. Ive also been drinking carrot juice daily, I’ve read that can help. My bed is raised 6 inches at the head. I switched my exercise routine as well. I now walk before I eat anything in the day, I used to walk after dinner. For me I think the hernia causes most of my issues. I’ve been plant based for 7 years but drank beer until a year ago and ate oily foods until February when I was diagnosed with IC which diet has completely fixed.




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              1. Jaime, thanks for sharing your story.  I learn so much from people like you whose experiences coincide with mine.  So I gather you chose not to be on PPI?  I am at a terrible crossroad.  My gastroenterologist insists I take one but I read all of these negative comments about PPI’s and the dangers of taking them.  I don’t know who to listen to.  The gastroenterologist claims that all of these studies are flawed and that my situation requires that I take them.  He has prescribed a generic of protonix.   I wonder if anyone else would care to share their experience especially if they are also on a PPI and doing well on it.

                Thanks for your input.
                Lee




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  5. Diet is frequently but not always the answer to a problem. In spite of eating a plant-based diet, my GERD persisted for years, and I was not able to stop my use of H2 blockers until I started practicing meditation. In my work with patients, I also see a high degree of concordance between GERD and psychological distress. See Relationship between Depression and Laryngopharyngeal Reflux at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5355023/ as well as Anxiety and depression in patients with gastroesophageal reflux disease and their effect on quality of life at: https://www.ncbi.nlm.nih.gov/pubmed/25892882




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  6. Is there any research into the effect of straining during strength training and the manifestation of hiatal hernia? I was diagnosed with hiatal hernia a few years ago, which coincidentally after I had been barbell training for a few years following the Starting Strength methodology, which involves doing heavy sets of 5 reps of squats and deadlifts. The proper way to squat and deadlift involves utilizing the valsalva maneuver, which increases inter-abdominal pressure in order to protect the spine from injury during the lifts. Even if barbell training may have caused my hiatal hernia, it made me far stronger than Nautilus ever did. By comparison, I enjoy pooping 2 or 3 times a day because I do indeed eat plenty of fiber.




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    1. A gallbladder stores bile used for digestion of fat. Without a gallbladder, there will be less bile available after a meal, so less fat should be consumed. Recommendations also include eating smaller meals. I am not an expert. This is common information on the Internet.




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    2. Darla,

      Indeed, per Ken, the gall bladder has the ability to store and regulate the discharge of bile, typically 2nd to signals from fat in a meal.

      Without this storage method you might find it helpful to use a digestive enzyme with a meal that contains a fair amount of fat, regardless of the source. One of the easiest ways to address the question is to try some meals containing fat…. such as avocados or salad dressings and note gas, belching or other GI distress, diarrhea or greasy stools, etc. This will give you an idea of your ability to digest an amount of fat. Obviously decrease the amount or take an enzyme to replace the lost ability.

      When choosing the enzyme look for the lipase level often represented in LU’s (Lipase activity level). You can use the supplement prior to the meal or with the meal. My suggestion is to dose according to the amount of fat in the meal however there is a very low potential of any side effects even with high levels, typically.

      Also keep in mind that without the gall bladder you have also altered the microbiome (gut bacteria/environment) so further consideration with some pre and pro biotics might be in order.http://link.springer.com/article/10.1007/BF01076595 If you want additional information you might also see many published articles using the term, post cholecystectomy syndrome.

      Dr. Alan Kadish moderator for Dr. Greger




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      1. drkadish, I wonder if you could help me?  Are there any circumstances for which Dr. Greger would approve of using baby aspirin therapy and, if so, does he indicate how, when, or with what to take it in order to avoid the obvious side effects to the digestive system?  Do you know of any such information?I would be so grateful for your help.
        Lee




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    3. Hi Darla,

      I am a volunteer for Dr. Greger. Thanks for your question.

      The gallbladder stores bile, which is important for digesting fat. Bile will still be released for aiding in digestion, but will not be regulated as tightly as it would with a gallbladder.

      Many people without gallbladders will experience diarrhea. To minimize this, decrease fat consumption (especially eating large amounts of fat at one time), increase fiber intake, and eat smaller, more frequent meals. In particular, dairy products and foods with added sugar may also want to be avoided. Also be sure to keep tabs on fat soluble vitamin absorption. Vitamins A and E, especially, may not be as well absorbed without proper fat digestion.

      I hope you find this information helpful.




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