M.L. is a 34-year-old male computer programmer with a BMI of 26 who is seeking dietary counseling. His dose of Prilosec was recently increased, and although he now suffers less often from heartburn symptoms, he is also leery of medical side effects and would like any and all suggestions to manage his GERD "naturally." Having had GERD for the past eight years and been on some form of antacid or
antisecretory medication continuously during that time, M.L. knows what foods or factors cause symptoms, and is able to generally avoid them; hence, he has not had reflux esophagitis in over a year. A 24-hour diet history reveals M.L. ate these foods yesterday:
Breakfast: Skipped
Snack: Fresh pear; instant oatmeal made with water, eaten with brown sugar and two non-dairy creamers; skim milk
Lunch: Lean turkey lunch meat on whole-grain bread with lettuce, tomato, and mustard; 100% grape juice diluted with water; snack pack of carrots, no dressing
Snack: Sugar cookies; skim milk
Dinner: Tempura (deep-fried, breaded) salmon; buttered rice; salad with lettuce and tomato; vinegar and oil dressing; water
Snack, at bedtime: Ginger ale and ginger snap cookies
M.L. should be made aware that absorption of some nutrients can be adversely affected by antacid and antisecretory medication use. These include:
a. iron.
b. vitamin B12.
c. folate.
d. calcium.
e. all of the above
e
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