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

Question

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
The practitioner gives M.L. a checklist of lifestyle changes that can help minimize GERD symptoms. Based on the diet recall above, M.L. would benefit from education about each of these tips except:

a. Consume only small meals and drink liquids between meals so that the stomach does not become overly distended, which can exert pressure on the lower esophageal sphincter.
b. Limit foods that weaken lower esophageal sphincter pressure or increase gastric acid secretion, such as fried and fatty foods.
c. During periods of esophagitis, avoid foods and beverages that may irritate the esophagus, such as citrus fruits and juices, tomato products, garlic, onions, pepper, spicy foods, carbonated beverages, and very hot or very cold foods.
d. Avoid eating bedtime snacks or lying down after meals. Meals should be consumed at least three hours before bedtime.

Answer 1

c