What is a Hiatal Hernia and How Can Dietary Changes Help?

More than half of middle aged people have a hiatal hernia (sometimes referred to as a “hiatus hernia“), but most people are only diagnosed when their symptoms become a problem or when having medical tests for something else.

A hiatal hernia is where part of the stomach bulges up through the space (called a “hiatus”, meaning a “gap”) in the diaphragm/ abdominal wall where the esophagus normally passes. 

Illustration of a hiatal hernia (“hiatus hernia”)

There are two types of hiatal hernias; the sliding type and the fixed type.

The sliding type of hiatal hernia is the more common type and occurs intermittently (i.e. from time to time), when the pressure in the abdomen increases.  This increased pressure pushes part of the stomach up through the gap in the diaphragm where only the esophagus is supposed to pass, and the little bulge is caused the hiatal hernia.

The fixed type of hiatal hernia is also called a paraesophageal hiatal hernia and occurs when the opening for the esophagus in the abdominal wall is bigger than usual. The stomach, and sometimes other organs including the small intestine or colon (large intestine) may also bulge into the chest cavity through this paraesophageal hernia. Paraesophageal hernias often get worse over time, in which case surgery is required to treat the problem. 

A strangulated hernia is not a type of hernia, but rather a complication in any one of a number of different types of hernias that can occur in different parts of the body — such as an inguinal hernia which can occur near the pubic bone, an umbilical hernia which occurs near the umbilicus (or “belly button”), or in a hiatal hernia in the upper part of the abdominal wall. A strangulated hernia is a serious condition where the blood supply to the stomach, intestines or other organ is being cut off because of that part of the body being forced into the small hole of the hernia, and requires immediate medical attention.

What Causes Hiatal Hernia?

A common contributing factor to development of a hiatal hernia is obesityespecially when people are carrying their weight around their middles.  The presence of increased fat around their internal organs (called visceral fat), as well as the excess fat under their skin (called sub-cutaneous fat — meaning “under the skin”) contributes to increased abdominal pressure especially when they are sitting, frequently bending, or lifting heavy objects.

Other contributing factors are frequent coughing (sometimes secondary to smoking), straining due to constipation, or it may simply be hereditary.

Symptoms of a Hiatal Hernia

Hiatal hernias are usually diagnosed when people go to their doctors complaining of symptoms such as frequent heartburn, or are having a test such as a barium swallow or endoscopy, for some other reason.

Many people with hiatal hernias have no symptoms — and because of that, they don’t even know they have one! People without symptoms usually don’t require treatment — although they may be advised to lose weight — especially if they are carrying excess weight around their abdomen. If their waist-to- height ratio is greater than 0.50, this means they are carrying more weight around their middle then optimal, so reducing this is a great place to start to prevent symptoms from occurring. Reducing fat around the abdomen may reduce abdominal pressure caused by the excess fat in the belly pushing the stomach up through the hernia.

Symptoms may include heartburn, chest pain or pressure, coughing, or frequent burping and since these symptoms may be caused by other conditions, it is important that people first see their doctor to find out the cause.  In addition, many people with hiatal hernia have also been diagnosed with  GERD (gastroesophageal reflux disease) and by teaching people how to make simple dietary and lifestyle changes often greatly reduces and even eliminates the symptoms of both.

Final Thoughts…

Losing weight, especially around the belly, and simple dietary and lifestyle changes can significantly improve the symptoms that result from hiatal hernia, as well as GERD which often accompany it.

More Info?

I provide nutrition education for reducing the symptoms of hiatal hernia which can be taken as a one-hour stand alone session, or at reduced cost as an add-on option for those taking the Complete Assessment Package. You can read more about that here.

To your good health!


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Ashwell M, Mayhew L, Richardson J, Rickayzen B (2014) Waist-to-Height Ratio Is More Predictive of Years of Life Lost than Body Mass Index. PLoS ONE 9(9)

HealthlinkBC, Hiatal Hernia, https://www.healthlinkbc.ca/health-topics/hw239946

Simic, P. John, Hiatal Hernia, emedicinehealth, March 3, 2020, https://www.emedicinehealth.com/hiatal_hernia/article_em.htm


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