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My doctor has recently diagnosed me as having a hiatus hernia. Are there any foods I should avoid?
Norman Wanstall, Burford, Worcestershire.
Many people - around 20 per cent of the population - have a hiatus hernia. Often they don’t realise until it starts giving them pain.
Some experience it as the horrid acid reflux we commonly call heartburn - others find food actually regurgitates on them. The symptoms are extremely unpleasant, and if they occur at night, can disrupt your sleep.
A hiatus hernia is caused when the top part of the stomach is pushed upwards through the muscular diaphragm into the chest cavity - often due to weakened diaphragm muscles.
As a result the stomach doesn’t close properly, which can lead to its acids spilling into your oesophagus (the tube connecting your mouth and stomach).
The oesophagus can become inflamed and eventually damaged or ulcerated if the acid continues to spill over - altogether bad news.
A hiatus hernia can be treated with drugs to reduce the amount of acid you produce in your stomach.
It can also be corrected surgically. This is most commonly done using an endoscope, a tube which is put down your throat while you’re sedated.
However, this is usually a last resort and dietary and lifestyle changes can be incredibly effective. If you smoke, try to stop because smoking is a common cause of an inflamed oesophagus.
First, look at the way you eat - eating too quickly means you’re likely to swallow
larger pieces of food; these sit uncomfortably in your stomach as it struggles to break them down.
You might also swallow a lot of air, which means when you burp, if you have a hernia or a tendency towards reflux, the forcing of air can bring acid up with it. So slow down and chew thoroughly.
Watch the temperature of your food, too - extremes, too hot or too cold, can mean you take in more air.
Research suggests that carrying too much weight around the middle can press on the stomach and aggravate hiatus hernia. This is especially so for women, particularly if they also take HRT (it seems the oestrogen affects the muscles that control the stomach valves, so HRT might not be advisable for women who have hiatus hernia).
Losing excess weight can help. But this must be gradual and not involve long periods without food, because this leaves the acids with nothing more to do than cause havoc with your gut - so the usual rule of healthy, regular meals applies here.
As to the types of foods you eat, spicy and fatty foods tend to irritate, so no creamy sauces, buttery pastries, and not too much olive oil on foods such as pasta - keep your diet light on the fats and gentle on the seasonings.
This doesn’t mean food has to be bland, but dishes such as curry or fish and chips would be too much to cope with.
Less acidic fruits such as apples, pears and bananas may suit you better than citrus fruits, especially if they’re cooked, which makes them easier to digest.
Ideally you should cut out caffeine (including chocolate - it contains theobromine, a milder form of caffeine), because it can weaken the muscles at the top of the stomach and cause food to repeat.
Similarly, if you haven’t eaten anything but then drink caffeine, this increases acid secretion.
Avoiding this can make an enormous difference, as can cutting right down on alcohol - especially drinking on an empty stomach.
More surprisingly, although mint tea and mint-flavoured remedies are traditionally used to soothe the stomach. If you’re overly liberal with the quantity or the strength, the polyphenols (a type of oil) in them can actually irritate rather than soothe.
Try not to drink too much liquid, including water, at mealtimes, and avoid fizzy drinks, even fizzy water - the fluid can make your stomach swish acid up into the oesophagus and the bubbles can make you burp.
Last but by no means least, sitting for a while to digest your food is preferable to lying down on the sofa.
Try to sleep with your head well elevated - big pillows will help keep the acidic juices in your stomach. But if despite eating and living well your symptoms still remain, medication might be the only solution.
I have seen patients so against medication that their diet becomes nutritionally unbalanced, as they find they can eat only a small group of foods. In the long run this is obviously not the best solution.
Manuka honey's anti-bacterial properties make it an effective antiseptic I usually buy Manuka honey because of its anti-bacterial properties. But a friend says it's only beneficial if you live in New Zealand. Please could you advise.
Babar Coughlan, Middlesex.
As it happens I am a great fan of Manuka honey - it helps me get over coughs and colds more easily.
I usually take one teaspoon neat, morning and evening, if I'm ill or when someone around me is streaming with a cold, and I want to avoid it. But the actual evidence for its efficacy is mixed.
Its anti-bacterial and anti-viral properties make it an effective antiseptic, killing the common forms of bacteria that infect wounds. And it's been shown to help with wounds such as bad grazes or burns, or for elderly people with pressure sores and ulcers.
But when it comes to the honey's other main purported benefit, to inhibit the growth of bugs such as Helicobacter pylori (the bug linked to stomach ulcers), scientists have struggled to show it works - even though many people I see in my practice do find that it helps.
I'm not aware that there is any difference whether or not you're sitting in New Zealand eating this delicious honey, although again the locals may well swear that there is.
Still, I think it's worth sticking with, if you'll forgive the pun.
ASK JANE
Do you have a nutritional question? Jane will answer a selection of readers’ queries every week. Write to Jane Clarke, Good Health, Daily Mail, 2 Derry Street, London W8 5TT, or e-mail jane.clarke@dailymail.co.uk. Jane cannot enter into personal correspondence. Please include contact details. Her replies cannot apply to individual cases and should be taken in a general context. Contact your GP with any health problems.
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