Prior to starting anti-secretory therapy, consider discussing lifestyle modifications and natural remedies with your patients. Decreasing GERD symptoms through these steps requires an empirical approach as the literature gives little guidance regarding non-drug approaches. Smoking cessation, alcohol avoidance, and targeted food avoidances have been shown through anecdotal evidence to make a minimal difference in symptoms in some patients, although studies are of poor quality.
If patients find that making certain lifestyle changes improve symptoms, they should be encouraged to continue with these modifications:
Avoiding acidic foods (citrus and tomato-based products), alcohol, caffeinated beverages, chocolate, onions, garlic, salt, and peppermint
Avoiding large meals
Avoiding medications that may potentiate GERD symptoms: calcium channel blockers, β-agonists, α-adrenergic agonists, theophylline, nitrates, phosphodiesterase type 5 inhibitors, sedatives
Avoiding recumbency three to four hours postprandially
Avoiding tight clothing around the waist
Decreasing dietary fat intake
Dietary fibers and physical exercise may be protective
Elevating the head of bed four to eight inches
Losing weight
Minimize stress and anxiety (see mind-body unit)
Smoking cessation