Hiatal Hernia: The Great Imitator

June 11, 2019
Ann Louise Gittleman, PhD, CNS

Ann Louise Gittleman, PhD, CNS

Award-winning nutritionist and New York Times bestselling author.

Mistaken for everything from asthma to a heart attack, this common muscle weakness mimics many different health issues and can be difficult to diagnose.

Mary was 55 years old when the fatigue and body aches set in. She had always considered herself fairly healthy, even with the extra 20 pounds she gained after menopause, so she brushed it off as being a little out of shape and resolved to get more exercise. Once she started going for a brisk walk every day, she noticed she was easily out of breath, which she took as another sign of her lack of conditioning. It wasn’t until she woke up in the middle of the night with a burning pain in her chest that she realized something more was going on with her health.

Once her doctor ruled out a heart issue, she was wisely checked for a hiatal hernia, which she did indeed have. Hiatal hernia is most common in overweight women over age 50, thought it’s estimated that up to 50 percent of the adult population could have one. A hiatal hernia can be completely asymptomatic for several years, or have symptoms so severe you feel you are having a heart attack or asthma attack.

Regardless of what alerts you to this stealthy diagnosis, once you know what you are dealing with, there’s much more you can do to resolve it than simply taking acid reducing medications. These medicines may make you feel better in the short term, but in the long term can lead to nutrient deficiencies because of their inhibitory effect on your digestion.

What Is A Hiatal Hernia?

A hernia happens when an organ pushes through an opening that a muscle is holding in place. In the case of a hiatal hernia, the muscle involved is the diaphragm. Normally, the esophagus and stomach join together right at the hiatus, which is an opening in the diaphragm that allows these digestive organs and the vagus nerve to pass through. When the diaphragm muscle becomes weak, a portion of the stomach protrudes up through the hiatus, resulting in a hiatal hernia.

Where the stomach and esophagus join together, there’s a sphincter that closes so the stomach acid doesn’t wash up into the esophagus. When you have a hiatal hernia, that sphincter is mechanically forced open, allowing acid to wash up into the esophagus, causing acid reflux symptoms. At the same time, this displacement irritates the vagus nerve, which can cause troubling symptoms that imitate other illnesses.

Signs You May Have a Hiatal Hernia

Mary was fortunate to be diagnosed so quickly with her hiatal hernia. Because it can mimic so many other conditions, it’s often not discovered until it’s advanced far enough to cause worrisome symptoms. In Mary’s case, her hiatal hernia symptoms were fatigue, body aches, shortness of breath, and burning chest pain.

The vagus nerve travels from the brain to the heart, lungs, esophagus, stomach, small intestine, liver, gallbladder, pancreas, colon, kidneys, bladder, and external genitals. Once a hiatal hernia irritates the vagus nerve, effects can be seen downstream in any of these organs and their functions. Symptoms can include, but aren’t limited to:

  • Heartburn
  • Acid reflux or GERD (Gastroesophageal Reflux Disease)
  • Bloating after meals and during symptoms
  • Dry mouth and gum irritation
  • Bitter taste in your mouth, and even sour liquid or regurgitated acidic foods
  • Difficulty swallowing pills
  • Nausea and even vomiting
  • Waking up gasping for air, choking or coughing in the middle of the night
  • Excessive belching and gas
  • Frequent hiccups
  • Intermittent hoarseness, worse in the morning
  • Chronic cough or sore throat
  • TMJ Disorder
  • Weight loss
  • Erosions and ulcers in esophagus
  • Esophageal spasm
  • Abdominal pain that’s worse when slouching or bending over
  • Shallow breathing and difficulty taking a deep breath
  • Asthma
  • Thyroid gland irritation
  • Decreased stomach acid
  • pH imbalance
  • Nutrient deficiencies from digestive disturbances
  • Food allergies
  • Constipation
  • Anemia
  • Chest pain
  • Fatigue
  • Body Aches

To get an idea of whether you may have this condition, place the fingers of one hand on the solar plexus, which is just below the breastbone. Take a deep abdominal breath in. What you should feel is the solar plexus expanding and moving your fingers outward. If you have to lift your chest and shoulders to get a deep breath in, then you may have a hiatal hernia. If you see minimal movement of your fingers or no movement at all, then your breathing is shallow and may be a sign of a hiatal hernia.

What Causes a Hiatal Hernia?

The most common cause of a hiatal hernia is increased pressure in the abdomen, often for an extended period of time. This pressure can come from:

  • Being overweight or obese
  • Pregnancy
  • Slouching and poor posture
  • Persistent coughing
  • Vomiting
  • Repeated straining during bowel movements
  • Inflammation
  • Poor diet causing indigestion and nutrient deficiencies
  • Heavy lifting
  • General muscle weakness and debility
  • Physical trauma

The diaphragm is the muscle that separates your abdomen from your chest cavity. When it becomes weak from the pressure, the hiatus opens more, allowing a portion of the stomach to pass through. The acid from the stomach begins splashing up into the esophagus, causing weakness and strain in the swallowing muscles and esophageal tissues. This is why hiatal hernia is often confused with GERD, because the symptoms at this point can be so similar.

When the primary cause of hiatal hernia is dietary, there is often accompanying inflammation of the ileocecal valve, which separates the small intestine from the colon. This valve can become swollen and not close properly, which then allows the contents of the colon to leak back into the small intestine, much like a sewer backup. This creates excessive gas, which puts pressure on the diaphragm and can cause a hiatal hernia.

One final cause is emotional concerns. Do you swallow your anger or have situations in your life you just can’t stomach? These phrases exist for a reason – your emotional health affects your physical health. When you are angry, you breath more shallow and suck your breath upward, leading to pressure that pulls your stomach upward.

Many people with hiatal hernias hold their emotional stress inside, and it affects their digestive and immune health most profoundly. Traditional Chinese Medicine (TCM) refers to the source of anger as “liver fire,” which can come from vagus nerve irritation and liver congestion, both of which have a relationship to hiatal hernia.

What You Can Do For a Hiatal Hernia

I was first introduced to the insidious issues this malady causes in the 1980s, through the work of Dr. Theodore Baroody. During that time, hiatal hernia was often dismissed as GERD and treated only for the stomach acid issues. His book opened my eyes to both the mechanical nature of this common problem, and the options available beyond antacid medications and surgical intervention.

When a muscle like the diaphragm becomes weak and out of shape, it’s essential to do exercises to condition it and restore its strength. Dr. Baroody has a set of exercises in his classic book, Hiatal Hernia Syndrome; The Mother of All Illness?, and since its publication, chiropractors have also developed a set of exercises for hiatal hernia. While chiropractic adjustment can be helpful, it’s also temporary, and you need to do exercises at home to reinforce the effectiveness.

One common exercise is to drink warm water, which relaxes the stomach and weighs it down, then drop from your tiptoes down to your heels multiple times to bring the stomach down through the hiatus. Another common exercise is to blow up a balloon daily, to both increase lung capacity and to create pressure from the chest cavity that keeps the stomach down and in place. In the beginning, many people can barely blow up one balloon, but over time will notice they can blow up several of them per day.

Abdominal massage by a qualified practitioner will target the ileocecal valve and the diaphragm, and follow the path of your digestion to relieve physical stress and induce relaxation. This can also help relieve some of the emotional stress associated with hiatal hernia. Lifestyle changes that help with hiatal hernia include eating small meals, wearing loose clothing, using good posture, practicing deep breathing, sitting up after eating, avoiding alcohol and caffeine, limiting fatty foods, and losing excess abdominal weight.

Because I believe good health starts with the gut, focusing on digestive health is a key component of resolving hiatal hernia issues for good. Whether it’s constipation, low stomach acid, food allergies, or liver and gallbladder sludge, you have to address any and all digestive issues – both above and below the hernia site. Only then do you stand a chance of it actually healing for the long term.

Eat an anti-inflammatory diet. My Radical Metabolism plan was designed not only for people with difficulty losing weight, but for those with inflammation as a root cause to their diseases. People who haven’t had success with autoimmune Paleo or GAPS-style diets are feeling better and having more energy once they get Radical. In addition to the eating plan, there is also a customizable supplement plan included to help you with the digestive issues that accompany a hiatal hernia.

Balance your stomach acid. Even though you feel the pain of the acid from your stomach washing up into your esophagus, it doesn’t mean you have excess acid. In fact, it’s often the opposite problem that’s to blame. When acid is reduced too low, even though you feel less discomfort in the short term, your food is essentially rotting and fermenting downstream, resulting in gas, bloating, and other digestive issues that backup and put pressure on the diaphragm. When you have optimal stomach acid, you will break down protein more quickly, and absorb iron, calcium, vitamin B12, and other nutrients more efficiently, without bloating or fatigue. I like UNI KEY Health’s HCL+2 when stomach acid support is needed.

Build better bile. When there’s sludge and congestion in the liver and gallbladder, or the gallbladder has been surgically removed for these issues, you often need ongoing cleansing and bile support for optimal fat digestion. I like to start with Liver-Lovin Formula from UNI KEY Health, for gentle liver cleansing and support. If your gallbladder is sludgy or has been surgically removed, I like to use UNI KEY Health’s Bile Builder as a sort of gallbladder replacement therapy to keep bile thin and free-flowing, and keep fat digestion running optimally.

And for a daily dose of tips and strategies for maintaining healthy weight, conquering insomnia, and much more… check out my Radical Health Tips


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Ann Louise Gittleman, PhD, CNS, is an award-winning New York Times bestselling author of more than thirty books including The Fat Flush Plan series and her latest book, Radical Metabolism. She’s been rewriting the rules of nutrition for more than 40 years and is internationally recognized as a pioneer in the field of diet, detox and women’s health issues. 

For a FREE daily dose of tips and strategies for maintaining healthy weight, conquering insomnia, and much more…check out my Radical Health Tips.

I’d like to meet and greet you on my Facebook groups, so won’t you check us out at the Radical Metabolism RevolutionFat Flush Nation, or my Inner Circle!


  1. Suzanna Baer

    So interesting about needing more HCL. I will look for that book you mentioned. I would love to treat myself naturally.

  2. Samantha

    Amazing that there is a natural way to heal this condition. Thank you so much!



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