What Should I Eat If I Have a Hiatal Hernia?

In short

• Smaller meals, a three-hour gap before lying down and fewer fried foods ease reflux for most people with a hiatal hernia.
• Diet changes how much acid flows back up. It does not shrink the hernia or close the gap in the diaphragm.
• Common triggers are fried snacks, spicy or sour food, strong tea, coffee, chocolate and alcohol. Your own list may be shorter.

A hiatal hernia means part of the stomach has slid up through the gap in the diaphragm. That makes it easier for acid to flow back into the food pipe. The result is heartburn, a sour taste or a burning chest after meals.

What you eat, how much and when can change these symptoms a great deal. This page is about everyday eating. It does not cover surgery in detail.

What diet can and cannot do

Food choices change how much acid comes back up. They do not move the stomach back down, and they do not close the gap. A hernia seen on a scan will look the same after a year of careful eating.

That is fine. Most people with a small hiatal hernia never need an operation. For them, good habits and sometimes a tablet are the whole treatment.

Meal size matters more than any single food

A large meal fills the stomach and pushes up against the weak spot. The same food in a smaller amount causes less trouble.

1. Eat three modest meals and one or two small snacks, not one heavy meal.
2. Stop when you are comfortable, not when you are full.
3. Eat slowly. A meal that takes twenty minutes sits better than one eaten in five.

Timing: the three-hour rule

Lying down soon after eating is the most common reason for night-time heartburn. Try to finish dinner at least three hours before bed.

Late dinners are common in many homes. If you cannot eat early, make the late meal the light one. Have your main meal at lunch and stay upright for a hour after it.

Raising the head end of the bed by about six inches also helps. Put blocks or bricks under the legs at the head end. Extra pillows are less useful, because they bend you at the waist.

Everyday swaps that ease reflux

Everyday swaps that ease reflux

Heartburn every night in spite of changing what you eat? Bring your endoscopy report and your list of medicines.

Foods that most often cause trouble

Triggers differ from person to person. These are the ones people report most:

• Fried and oily food, such as pakoda, samosa and farsan.
• Very spicy or sour food, including pickles and tomato-heavy gravies.
• Strong tea and coffee, especially on an empty stomach.
• Chocolate, mint and fizzy drinks.
• Alcohol, and smoking, which weakens the valve at the top of the stomach.

You do not need to give all of these up. Keep a simple note for two weeks of what you ate and when the heartburn came. Then cut back the two or three that matter for you.

Weight, waist and posture

Extra weight around the belly squeezes the stomach upward. Losing even a few kilos often makes reflux easier. Tight belts and waistbands do the same thing on a smaller scale.

Bending forward after a meal, for example to sweep the floor or tie laces, can bring food back up. Leave those jobs for later in the day.

Signs that need a doctor, not a diet change

Signs that need a doctor, not a diet change

• Food sticks in the chest or comes back up undigested.
• You lose weight without trying.
• You vomit blood or pass black stools.
• Heartburn wakes you most nights in spite of these changes.
• Chest pain that comes with effort, sweating or breathlessness. Get the heart checked first.

When surgery comes into the picture

Surgery is considered when symptoms continue in spite of diet and medicines, when the hernia is large, or when it causes problems such as bleeding or food sticking. The operation brings the stomach back below the diaphragm and narrows the gap.

Even after a repair, the eating habits on this page remain useful. They protect the repair and keep reflux low.

Related pages

The main page on this site is robotic hernia surgery in Ahmedabad. These cover the neighbouring questions.

Where to find us

Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Shah's Gastro, Cancer & Robotic Surgery Centre
Apollo Hospital, Bhat, Gandhinagar
Gota OPD, Ahmedabad
Bring your reports. Second opinions are welcome.