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Hiatal Hernia: An Overlooked Cause of Disease

By Dr Cliff Fruithandler DC

Hiatal Hernia has been one of my favourite conditions to treat. One of my first patients 1n 1980, while working as a student Intern came in with Chronic constant belching and epigastric pain. Using my newly acquired knowledge in AK
I found a classic weakness of the diaphragm and psoas muscles. Using Applied Kinesiology Chapman's and neurolymphatic reflexes along with Chiropractic and simple exercises her symptoms of many years duration, fully resolved with in a few weeks.

Hiatal Hernia is a great mimicker of Heart Attacks (MI) and other issues in the abdominal, chest and thoracic spine regions. Essentially there is a weakness in the diaphragm's opening (hiatus) for the esophagus to go through. Pressure on or in the abdomen pushes the stomach up through the hiatus creating weakening of the Cardiac sphincter which then released hydrochloric acid from the stomach into the esophagus (acid reflux). Its all to common. Treated medically with antacids gives temporary relief, but long term the antacids reduce the digestive tracts abiilitiy to breakdown proteins resulting in new digestive issues. We use AK reflexes to diagnose and treat the cause, usually a weakenes of the diaphragm and psoas muscles. Finishing with home treatments of the reflexes and exercises the symptoms usually resolve till next Thanksgiving when a huge meal may recreate the weakness. Good news, the home treatment usually puts HH back into check. If not a few office visits with AK and Chiropractic will re-clear the flare up.

Below are some excellent articles that go along and fairly well explain my treatment program along with some home self help.

Dr Cliff

Hiatal Herniareflexes

Hiatal Hernia: An Overlooked Cause of Disease
Steven H. Horne 1997-2001

About three years ago Jack Ritchason, a naturopathic physician, corrected a health problem I must have carried since childhood--a hiatal hernia. The impact this simple maneuver has had on my health has amazed me. I immediately noticed a difference in my lung capacity and my digestion and in the months that followed I began to put some muscle on my skin and bones frame and gain newfound strength and stamina.

Dr. Ritchason tells me that this is a common health problem and my own observations as well as those of others confirm this fact. But this is more than a personal observation as the American Digestive Disease Society has estimated that nearly half of all adults--some 60 million people--have a hiatal hernia.

It occurs more often in women than in men. It affects people of all ages, but is most prevalent in people over 50 and highly likely in people over 65.

The Great Mimic
Hiatal Hernia has been called the "great mimic" because it mimics many disorders. A person with this problem can get such severe pains in their chest that they think they are having a heart attack. They may think they have an over acid stomach because they will regurgitate stomach acid after they eat, or their stomach may hurt so badly they will think they have an ulcer. This is just a sampling of the symptoms that may occur from this disorder.

What is a Hiatal Hernia?
When you swallow, your food passes down a long tube known as the esophagus into the stomach. This tube must pass through a muscle known as the diaphragm, which is located near the bottom of your rib cage. This opening in the diaphragm, which permits the esophagus to pass through, is regulated by a sphincter muscle (or "valve") which relaxes and opens when we swallow to permit the food to pass through the diaphragm and into the stomach. This sphincter then closes to prevent stomach acid from coming back up into the throat. A hiatal hernia occurs when the top of the stomach rolls or slides up into this opening and becomes stuck there.

Naturally, when part of the stomach is forced into this opening, the sphincter cannot close properly. Thus, stomach acid may travel back up into the esophagus causing burning sensations (heartburn), esophageal spasms, inflammations and ulcers.

The cramped position of the stomach can also stress the vagus nerve, which stimulates the release of hydrochloric acid. This can cause both over and under secretion of hydrochloric acid and stomach enzymes. It may also affect the sphincter or valve at the bottom of the stomach so that digestive secretions "leak" out of the stomach and are lost before they have completed their job.

The hiatal hernia will also interfere with the movement of the diaphragm muscle. This muscle normally pulls downward to expand the chest capacity and inflate the lungs. Since the hiatal hernia interferes with this movement, the person may be restricted to shallow breathing, or will resort to using the chest and shoulders to expand the lung capacity and take a deep breath.

The esophagus may also "kink" in the throat, which will irritate the thyroid gland and may cause some difficulty in swallowing. Often persons with hiatal hernias will have difficulty in swallowing capsules or tablets as they get the sensation that they are "sticking" in their throat.

The irritation on the vagus nerve can cause reflex irritations throughout the body. The vagus nerve comes from the medulla and goes to the heart, esophagus, lungs, stomach, small intestines, liver, gall bladder, pancreas and colon. It also has links to the kidney, bladder, and external genitalia. Thus, a hiatal hernia may start imbalances in the system such as decreased stomach acid and pH imbalance in the intestines and elsewhere.

If a person develops poor stomach digestion due to a lack of hydrochloric acid, they will have difficulty digesting and assimilating protein and most minerals. It will also contribute to food putrefaction in the intestines, causing greater toxicity in the body. This lack of nutrition and toxic condition may contribute towards food allergies, constipation, anemia and immune and glandular system weaknesses.

Two other problems that a hiatal hernia may contribute to are asthma and heart disease. Since the hernia reduces the lung capacity by interfering with natural breathing, it could be a factor in asthma. The hernia may also put pressure on the heart. Gas in the intestines may put pressure on the hernia and push it against the bottom of the heart, which may be one way in which a heart attack can be triggered. None of this spells immediate fatality, but it does point to a major contributing factor in degenerative illness.

The causes of a hiatal hernia are speculative and unique to each individual. However, there are a number causes. First of all there may be a mechanical cause. Improper lifting, hard coughing bouts heavy lifting, sharp blows to the abdomen (the kind that "knock the wind out of you"), tight clothing and poor posture may contribute to the development of this problem. Improper lifting may be the biggest mechanical cause of this disorder. If the air is not expelled out of a person's lungs while lifting, it will force the stomach into the esophagus.

Secondly, there are dietary causes. Hiatal hernia just about always accompanies a swollen ileocecal valve. The ileocecal valve is the valve between the small and large intestines which permits material to enter the colon from the large intestine, but prevents material in the colon from moving back into the small intestine. When this valve becomes swollen and irritated it cannot close properly. This allows material from the colon to leak back into the small intestine. This is analogous your sewer backing up into your kitchen. This creates gas and indigestion, which puts pressure on the stomach and presses it tighter against the diaphragm.

The relationship between the ileocecal valve and the hiatal hernia is a chicken/egg situation ... it is hard to know which comes first. However, it is clear that the ileocecal problem aggravates the hernia. Hence, the things which irritate that valve may be causal factors. These are the basic causes of digestive problems: poor food combining, overeating, drinking with meals, overeating and eating when upset.

Lastly, there are emotional causes. According to one applied kinesiologist text a hiatal hernia comes from repressed anger. A person "swallows their anger" and "can't stomach it." When you get angry, you suck your breath upward. If you fail to release this anger, your stomach stays up. I have observed that most of the people with severe hiatal hernias have a great deal of emotional stress and hold a lot of it inside.

The easiest way to tell if you or someone you know has a hiatal hernia is to place your fingers on the solar Plexus, just below the breastbone. Then take a deep breath. You should feel the solar plexus expand and move outward. If there is no movement at the solar plexus and you have to lift your chest and shoulders to take a deep breath, then you probably have a hiatal hernia. You should be able to take a deep abdominal breath without lifting your shoulders.

There are other, more complicated, methods of determining if you have a hiatal hernia, such as muscle testing, but this is a fairly simple and reliable method.

Since a hiatal hernia is primarily a mechanical problem, the easiest and best way to correct it is mechanically. Medical doctors have attempted surgery to correct this disorder, but the results tend to be poor. Cutting into this area can further weaken it so that the hernia will return in short order. A better method is to manipulate the stomach and bring down the hernia by hand. Unfortunately, you can't do this to yourself. You will need to find a good chiropractor, applied kinesiologist or massage therapist who understands this problems and knows how to correct it.

If you want to learn how to do this adjustment to others, you will have to find someone who does it and have them show you how since it is impossible to adequately describe the technique(s) in writing. They have to be learned through demonstration and practice. ..

There are some self-help adjustment techniques. They aren't as effective as having someone else perform the adjustment, but they may help. The best one I've tried is to drink a pint of warm water first thing in the morning, then stand on your toes and drop suddenly to your heels several times. The warm water helps to relax the stomach and diaphragm and puts some weight in the stomach. By dropping down suddenly, the weight of the water helps to pull the stomach down. In a mild case, this might be enough to bring the hernia down. In a more severe case it may loosen the stomach and make it easier for someone else to bring it down. It will also help you to keep the stomach down once mechanical corrections have been made.

Nutrititional Aids
Until the problem is corrected mechanically, there are some nutritional therapies which may be of help. Immediate, but temporary, relief of pain and discomfort can often be achieved by the use of a mucilaginous herb like slippery elm or comfrey. These herbs absorb the digestive secretions and help to prevent their traveling back up the esophagus and burning it. They also help to prevent irritation of the ileocecal valve. Comfrey can also speed the healing of this problem once mechanical adjustments have been made. Okra pepsin is a good combination for this problem as well.

Marshmallow is also helpful in soothing the mucous membranes for hiatal hernias and other ulcerations in the gastrointestinal system.

A digestive aid will help the person obtain the nutrients they need when the hernia is interfering with digestion.

This may take the form of a hydrochloric acid supplement or a food enzyme tablet, or perhaps an herbal digestive aid such as papaya and peppermint, chamomile tea, safflowers, ginger root and so forth.

Other food or herb products that have been used to help people with hiatal hernias include: raw cabbage juice (where ulcerations have occurred), balm, barley water, brown rice, celery, coriander, gentian, hops, licorice, marshmallow and passion flower.

Dietary modifications may be necessary to relieve the problem and to keep it from reoccurring once it has been corrected. Since the pressure of abdominal gas can push the stomach upward, it would be advisable to avoid gas forming foods like beans. It would also be wise to watch food combinations carefully and to avoid overeating. Dr. Jack Ritchason recommends that people with hiatal hernias avoid eating any heavy meals after 3 pm.

Symptoms of a Hiatal Hernia

What is a Hiatal Hernia?

A hiatal hernia occurs when the top of the stomach rolls or slides up into the opening in the diaphragm which the esophagus passes through and becomes stuck there.

This condition may create difficulty with digestion (and hence general nutrition and well-being) as well as breathing difficulties, nervous problems, circulatory problems and glandular imbalances. All of the following symptoms have been connected with a hiatal hernia. If you have some of these symptoms especially those marked with an asterisk (*) you may wish to consider being checked for this condition.

*Belching, *Bloating, *Heartburn, *Difficulty digesting meat/high protein foods, Tension or pressure at the solar plexus, Sensitivity at the waist, Intestinal gas, Regurgitation, Hiccups, Lack or limitation of appetite, Nausea, Vomiting, Diarrhea, Constipation, Colic in children, Difficulty in gaining weight or overweight, Ulcers.

*Difficulty with deep abdominal breathing, *Difficulty in swallowing capsules, *Asthma, *Inability to take a deep breath from diaphragm, Overall fatigue, Tendency to swallow air, Allergies, Dry tickling cough, Full feeling at base of throat, Pain or burning in upper chest, Pressure in the chest, Pain in the left side of chest, Pressure below breastbone, Lung pain, Rapid heartbeat, Rapid rise in blood pressure, Pain in left shoulder, arm or side of neck.

TMJ (Temporo-Mandibular Joint Pain), Bruxism (Grinding teeth in sleep), Joint pain, Localized or overall spinal pain, Headaches.

*Suppression of anger or other emotions, *Living with or having lived with a quick-tempered person, Dizziness, Shakiness, Mental Confusion, Anxiety attacks, Insomnia, Hyperactivity in children.

*Open ileocecal valve, *General weakness, *Difficulty in getting and/or staying healthy, Overactive thyroid, Cravings for sugar or alcohol, Candida Albicans, Menstrual or prostate problems, Urinary difficulties, Hoarseness.


Nature's Field, Vol.17 No.3, May/June 2001
Steps for Manual Manipulation of a Hiatal Hernia
Laura McCready, N.D.

This procedure can be performed on yourselfafter being shown the technique by your natural health practitioner.

Perform this procedure every morning for at least one month, two months for large or long-term hernias. Steps one and two are optional but should be done for tense individuals or stubborn hernias. This procedure can be performed anytime the stomach seems to be displaced but best results are achieved if this is done with an empty stomach.

  1. Five minutes before the procedure, take a dropperful (15-20 drops) each of Lobelia Essence (stock # 1765-8) and Stress-J Liquid (stock # 3163-3) in 2 ounces of warm water to relax the diaphragm and vagus nerve.
    Magnesium Complex (stock # 1859-8) can also be taken daily to promote muscle relaxation.
  2. Massage Tei Fu Oil (stock # 1618-7), Lavender Essential Oil or Chamomile Essential Oil into the stomach area before the procedure.
  3. Lie on your back on a hard flat surface or the floor. Take a deep breath and remember what it feels like. (You should be able to breathe deeper and easier when the procedure is over.)
  4. Place both hands just beneath the breastbone. Palms are against the body and fingers are touching so that the thumbs meet just below (1"-2") where the ribs come together.
  5. Take a deep breath and as you slowly and forcefully exhale, push thumbs inward and downward about two inches with a steady, heavy pressure. Do not lift your hands or release the pressure on your abdomen at the end of the breath.
  6. Maintaining constant pressure with the thumbs, take another breath and repeat the procedure until you reach the waistline. This will take a total of about 3-5 breaths.
  7. Hold your left thumb in place and move your right thumb over to shut the ileocecal valve. Using your right thumb this valve is found by locating the front, upper point of the right hip bone and moving the thumb toward the center of the body two inches and then down two inches. (This valve must be closed in order for the gastroesophageal valve to remain closed.)
  8. As your right thumb applies pressure to the ileocecal valve in an inward and upward direction (toward the stomach) move the left thumb over to assist with the pressure. Hold this pressure for 30 seconds. Release with a slight wiggling, massaging motion.
  9. Repeat the entire procedure (steps 4-8) three times.
    Take a deep breath and see how much better you feel.
  10. To Avoid pressure on the stomach, DO NOT rise as if you were doing a sit-up. Roll onto your side and push yourself to a sitting position using your arms rather than lifting yourself using your abdominal muscles.


Health Parameters Research site.
Abdominal Massage
Pat Block, N.D., 2000.

Ileocecal Valve Massage

The ileocecal valve is a sphincter (circular muscle) which is found where the small intestine connects to the large intestine. It is located above the appendix in the lower right side of the abdomen. When this valve does not function properly a host of gastrointestinal problems and other problems including heart symptoms and blood pressure problems and even migraines can result. Massaging the valve will encourage proper function.

To locate the valve area (its placement can vary slightly for each person) place your left thumb on your navel, your right thumb on your right hip (the high part of your pelvic bone). Imagine a line connecting those two points and find the middle of that line. Place all your fingers 3 inches below the middle of that line and you should be close to the ileocecal valve. On men's trousers there is usually a belt loop right over the area. With all your fingers, press in FIRMLY and find the tender spot. Believe me this area will be tender in 90% of Americans.

It will be like finding a golf ball under a pillow - but some of us have more pillow than others so keep palpating to locate the spot. (Palpate means to press in slowly but deeply to feel for hardened or tender areas.) Sometimes it is easier to locate the tender spot while lying down. Using some emollient cream may also enable you to find it more easily. Once you've found it, massage it in a circular fashion as you would any cramped muscle. After all, the whole digestive tract from the throat to the rectum is a muscular tube - and any section can cramp, get 'Charlie horses', become too weak to function, etc.

Ideally, this massage should be done 3X/day before meals. At the least do it in bed before going to sleep and in the morning before you get out of bed. Some people experience gurgling, flatulence, burping - or other sounds during or after this massage and sometimes a bowel movement will follow. All of these are evidence that this valve needs help. You'll find that the tenderness will subside after about a week or two of diligent application of this technique and you'll feel much better and be healthier for it.

And then what?
The same massage should then be applied to the rest of the colon by massaging from the ileocecal valve upward toward the ribs where the ascending colon lies. Then, traverse across the belly above the navel to the opposite rib, then down the left side to wind up on the opposite side of the abdomen from the ileocecal valve. This firm, deep massage encourages proper bowel function. Learn where your tender or hardened areas are and continue this massage daily until these resolve. This whole massage can be done through the clothing but take time to locate the all tender spots. You'll be healthier for it.

Correcting the Displaced Stomach (Hiatal Hernia)

Why does it happen? The hiatal hernia results from the upward displacement of the stomach and the resultant kinking of the esophagus. This often results in heartburn, acid reflux or the newly coined GERD (Gastro Esophageal Reflux Disease). 50% of the American population over 50 have this condition in varying degrees. Resulting symptoms include belching, hiccups, nausea, bloating, shortness of breath, difficulty swallowing capsules or foods, chest pains, irregular or rapid heart beat - all made worse or precipitated by bending over or lying down.

So one must ask: Why does the stomach decide to climb through the diaphragm and move toward the throat? The answer is: it doesn't go willingly - it is pushed up there by a digestive tract full of gas caused by fermenting and putrefying toxins. (See website Library info on Digestive Path Hygiene or ask at my office) These gases fill up the intestines like a balloon pushing the stomach up into, and sometimes through the diaphragm (which is a muscle that divides the digestion organs from the heart and lungs). This in turn causes the esophageal tube to bend or kink making swallowing difficult and putting pressure on organs above the diaphragm like the thyroid, heart and lungs.

If the lack of nutrients in the body allows for weak connective and muscular tissue, the diaphragm opening will weaken permitting more of the stomach through the opening. The diaphragm will create a pinching force on the muscles of the stomach causing a lower blood flow and consequent cramping of the upper stomach muscle - just like any muscle cramp in your leg or arm, etc. This displacement also puts pressure on the main artery and vein to the lower part of the body creating poor circulation, increased blood pressure and stress on the heart. This produces pain and all the symptoms listed above. So that is the 'why' - now how does one fix it.

The fix.
In addition to the herbs recommended for this condition, (see Herbal Solutions on my website or ask at my office) the following mechanical fix will bring great relief. First it may be advisable to take the herbs and do the ileocecal valve massage described above for about a week prior to pulling down the stomach. Also it will be more effective if there is no problem with constipation - which obviously will continually act to inhibit the exit of gas producing material. If constipation is a problem, go to Herbal Solutions or ask at my office so you can get that resolved before beginning.

Do it!
This technique should be done on an empty stomach
- first thing in the morning is best, but doing this before each meal will bring quicker results. After massaging the ileocecal valve and colon area first (see above), palpate the stomach area below the sternum or breastbone to find the hardened and/or tender areas. Now gently try to relax them using a gentle circular massage. Again it is sometimes like feeling for a golf ball through a pillow. Now take a deep breath and exhale slowly.

While exhaling and relaxing the abdomen apply a firm inward and downward (toward the feet) pressure with overlapped thumbs from the base of the sternum down toward the navel. You should move about 2 inches down as you exhale. Hold for thirty seconds. Repeat this 3 times. The whole technique should be repeated daily for at least one month doing it before each meal. This can be done through the clothing. You'll begin to notice a positive difference not only in the amount of tenderness in the abdomen area but in the over all quality of your life and health.

Those who experience a stiff neck will find their neck has greater freedom of movement without pain. Often it is easier to get someone to do this massage for you. They will be using the pads of their fingers to do the pulling - they also may need to cut and file their fingernails. If you are uncertain that either you or your helper is doing the technique correctly, you can just do the massage part. That is, find and massage any tender spots in the abdominal area. I'll be happy to show you how to do the technique at our next appointment - just let me know ahead of time so we don't use up our time on other topics.

Lower Abdominal Pressure

(for Frequent Urination esp. at Night)
The same bloating forces that dislocate the stomach upward can also press on the organs in the lower pelvic cavity - the bladder, uterus, lower bowel and rectum. To reposition these organs, the tips of the fingers are placed at the top of the pubic bone. With short quick strokes the hand is moved inward (toward the spine) and upward (toward the head). The hand travels in short steps from the pubic bone to the navel and is best done lying down before sleeping. (This exercise is called 'scooping up the guts' - a term which helps visualize what is happening.) Doing this repositioning exercise will also increase bladder volume for those who find themselves waking often at night to urinate. Herbs to rebuild the connective tissue will be useful to support the proper organ position - which helps with proper function! .

Hiatal Hernia by Dr Cliff Fruithandler DC An Overlooked Cause of Disease the great mimicker and some natural treatments to help resolve symptoms located in Margate coconut creek parkland coral springs florida in broward county 33067 33066 33065 33066 33068 33071