This change in practice is witnessed by the high daily dose of morphine and 54% prior intervention rate in the recent negative trial of combination micronutrient therapy (Table 2) (145), compared to none on either count in the 1990 report (159)

Dietary and lifestyle interventions include: Consuming smaller, more frequent meals rather than large portions that increase gastric distension Avoiding late evening meals and maintaining at least a 3-hour interval between dinner and bedtime Limiting foods that relax the lower esophageal sphincter (chocolate, peppermint, high-fat foods, caffeine, alcohol) Reducing acidic and spicy foods that may irritate the esophageal mucosa Elevating the head of the bed by 6-8 inches using blocks or a wedge pillow Maintaining upright posture for at least 2-3 hours after eating Avoiding tight-fitting clothing around the abdomen Smoking cessation (if applicable) Continuing weight loss efforts, as weight reduction is an evidence-based therapy for GERD [16] [21] Pharmacologic management may be necessary for persistent symptoms
Not consuming enough nutrients and water also leaves the body without sufficient fuel for training and recovery
Protein first
In: Parrillo JE, Dellinger RP, eds
(A) Heatmap showing relative gene expression changes between vehicle and melatonin treated ILC2s