A nurse is teaching a client about strategies to manage gastroesophageal reflux disease (GERD). Which of the following statements should the nurse include?

Avoiding eating two to three hours before bedtime is a well-established dietary strategy for managing GERD. When the stomach is empty before lying down, there is less gastric content available to reflux into the esophagus, and the lower esophageal sphincter has less pressure from a distended stomach. This intervention directly reduces nocturnal reflux, which is a major source of esophageal injury and symptom burden in GERD patients. Elevating the head of the bed is indeed recommended for GERD, but the standard recommendation is six to eight inches, not 18 inches. Eighteen inches would be uncomfortably steep and is not evidence-based for this condition. Limiting high-fiber foods is not appropriate advice; dietary fiber is generally beneficial and does not exacerbate GERD. Foods that should actually be limited include fatty foods, caffeine, alcohol, chocolate, peppermint, and acidic foods. Avoiding snacking between meals is not a standard GERD recommendation; in fact, smaller, more frequent meals are sometimes suggested to reduce gastric distension and lower esophageal sphincter pressure compared to large infrequent meals. Nurses should reinforce avoiding late meals, elevating the head of the bed appropriately, maintaining a healthy weight, and identifying individual dietary triggers as core GERD self-management strategies.