Diet and Hiatal Hernia

Diet and Hiatal Hernia

September 13, 2019 30 By Ewald Bahringer


“Diet and Hiatal Hernia” In terms of preventing
acid reflux heartburn, I’ve talked about how high fat meals
cause dramatically more acid exposure in the esophagus in
the hours after a meal, but why does high fiber
intake decrease the risk? One typically thinks of fiber helping
out much lower in the digestive tract. A systematic review and meta-analysis 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. It could be the
anti-inflammatory effects. Fiber could be removing carcinogens. But those are all generic anti-cancer
effects of whole plant foods. Specific to this type of acid
irritation induced esophageal cancer, fiber may decrease the
risk of reflux in the first place. But how? 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
up into the esophagus and throat. It affects more than
1 in 5 American adults. In contrast, in rural
African communities that were eating their
traditional plant-based diets, it wasn’t 1 in 5; it was closer to
1 in a 1,000 — almost unheard of. It’s 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 help illustrate the mechanism producing
upward herniation of the stomach through the hole in the diaphragm
that separates the abdomen from the chest called the
esophageal hiatus; that’s the opening. If a ball with a hole in it is filled
with water and then squeezed, the water is pushed
out through the hole. The abdominal cavity
may be likened to a ball, the hole in the ball corresponding to that esophageal hiatus
in the diaphragm. So abdominal straining during
efforts to evacuate firm feces corresponds to squeezing the ball and may result in gradual expulsion
of the upper end of the stomach from the abdominal cavity
up into the chest. It’s like when you squeeze
one of those stress balls. Straining at stool raises pressures
inside our abdominal cavity more than almost any other factor. When we bear down and strain at
stool, it’s like squeezing 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 sub-diaphragmatic,
whereas it usually straddles the diaphragm in Westerners
and is above the diaphragm in the presence of hiatus hernia. And the same abdominal
pressure from straining that may cause hiatal hernias may
cause a number of other problems. The straining can cause herniations in the wall of the colon itself,
known as diverticulosis. And that same pressure
can also backup blood flow into the veins around
the anus, causing hemorrhoids, and push blood flow back into the legs,
resulting in varicose veins as well.