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The Low FODMAP Diet and Hiatal Hernia

Hiatal hernias are fairly common in the West, especially in females. If you’re approaching old age, your chances of developing the condition are high. Around 70% of people older than 70 years suffer from a hiatal hernia.
Let’s take a look at what a hiatal hernia is and whether a low-FODMAP diet can help treat it.


What is a hiatal hernia?


A hiatal hernia is when part of the stomach gets displaced above the diaphragm.
Your chest and abdomen are separated by a sheet of muscle called the diaphragm. Within the diaphragm is an opening (called a hiatus) that allows the esophagus to pass through it and join the stomach. The esophagus is a long tube that transports food from your mouth to your stomach.
In the most common type of hiatal hernia (type I), the opening in the diaphragm becomes lax and allows part of the stomach to push through into the chest cavity. This allows the stomach acid to easily reflux into your esophagus, leading to the most common symptom of the condition, heartburn.
Most patients with a hiatal hernia experience no symptoms, but those who do, develop the symptoms of gastroesophageal reflux disease (GERD) as stomach acid gains easy entry into the esophagus. These include:

● Heartburn — a burning sensation in the chest, especially after meals
● Increased salivation
● Difficulty in swallowing food
● Pain in swallowing
● Bloating
● Bad breath
● Nausea

The risk of developing this type of hiatal hernia is increased with factors like:

● Increased age
● Smoking
● Obesity
● Genetic factors
● Pregnancy
● Chronic cough
● Long-term constipation

All of these factors either make the hiatus in the diaphragm loose or increase the pressure in your abdomen, which pushes the stomach upwards.
Other, less common types of hiatal hernia also exist and they can lead to abdominal pain, retching, and a feeling of fullness after eating just a bit. These hernia types are rare, so going onwards, we’ll be discussing the type that causes GERD (type I).


Is a low-FODMAP diet good for hiatal hernia?


A low-FODMAP diet has not been demonstrated conclusively to improve the symptoms of a hiatal hernia alone. However, if you have other GI conditions like the irritable bowel syndrome (IBS), a low-FODMAP diet may reduce the GI distress the two conditions together cause.
FODMAP is the abbreviation for fermentable oligo-, di-, mono-saccharides and polyols. These are sugars found in foods like wheat. FODMAPs can be fermented by bacteria in the gut, which leads to the release of gas and causes bloating, nausea, cramping, and abdominal pain.
Since the bacteria that feed on FODMAPs are found mainly in the large intestine, a low-FODMAP diet is useful for disease processes that affect this part of the gut. Examples include ulcerative colitis and IBS. A hiatal hernia involves the beginning of the stomach, which is very far from the large intestine. Therefore, a low-FODMAP diet is unlikely to cause a direct effect on a hiatal hernia.
However, in some cases, a low-FODMAP diet may help. Some foods either increase the production of stomach acid or reduce the functioning of the lower esophageal sphincter (LES). The LES is a ring of muscle that sits between the esophagus and stomach and prevents the reflux of acid. When it doesn’t function properly, you experience heartburn.
If some high-FODMAP foods make your heartburn worse (via the above mechanisms), eliminating them from your diet will help.
Once again, no studies conclusively prove the effectiveness of a low-FODMAP diet in treating hernia-induced heartburn. However according to a study, fructose and fructans (both are FODMAP sugars) lead to the relaxation of LES, leading to acid reflux and heartburn. But the evidence is preliminary, and more studies are needed.


Should I follow a low-FODMAP diet for hiatal hernia?


If you suffer from a hiatal hernia alone, a low-FODMAP diet is unlikely to help. However, if you also suffer from IBS, you may want to talk to your doctor about the diet.
A low-FODMAP diet is administered under expert supervision, which ensures you receive adequate nutrients throughout the plan. Tinkering with your diet unsupervised is a bad idea, so before you decide to follow a low-FODMAP diet, make sure to involve your doctor.


What irritates a hiatal hernia?


Fatty and acid foods, and some activities like smoking can irritate a hiatal hernia and worsen the symptoms of GERD.
Some foods irritate the stomach lining, worsening the inflammation. Other foods (especially fatty items) slow gastric emptying, which can also worsen your heartburn.
To reduce heartburn from a hiatal hernia, avoid the following foods:

● Spicy foods
● Deep-fried items
● Chocolate
● Fizzy drinks
● Foods and sauces based on tomatoes
● Butter
● Citrus foods like oranges, lemons, and cranberry juice
● Bacon
● Cream
● Ice cream
● Sausages
● Full-fat cheese
● Coffee

Note that not all people get a worsening of their heartburn from coffee. So if you love coffee, you may not have to let it go.
Additionally, eating large portions, eating before going to bed, smoking, consuming alcohol, being too obese, and some medications (like blood pressure drugs) can all worsen heartburn from a hiatal hernia.
This is why doctors recommend eating smaller meals, and taking your last meal at least 3 hours before going to bed. Weight-loss exercises are also helpful.
Finally, consider elevating the head of the bed while sleeping as it can reduce the amount of acid that refluxes and prevent nighttime symptoms.


What foods neutralize stomach acid?


Although these foods don’t exactly neutralize stomach acid, they don’t cause a significant rise in its production, which is why it’s a good idea to include them in your diet:

● Water
● Lean meat
● Apples
● Bananas
● Low-fat sweets
● Bread
● Rice
● Pasta
● Low-fat dairy products like skim milk


Takeaway


Although a low-FODMAP diet hasn’t been shown to improve the symptoms of hiatal hernia alone, it may play a role if you suffer from an additional condition like IBS.
While the evidence for a low-FODMAP diet is scarce, other dietary recommendations — like reducing fatty and spicy foods — and lifestyle changes do play a significant role in improving heartburn from a hiatal hernia.

Medically Reviewed by Onikepe Adegbola, MD PhD


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