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Lifestyle modifications should be the first-line approach and include: Eating smaller, more frequent meals rather than large portions that overwhelm the already-slowed digestive system Avoiding eating within 2-3 hours of bedtime to allow adequate time for gastric emptying before lying down Elevating the head of the bed by 6-8 inches using blocks or a wedge pillow to reduce nocturnal reflux Identifying and avoiding trigger foods such as caffeine, alcohol, chocolate, spicy foods, citrus, and high-fat meals Maintaining an upright posture for at least 2-3 hours after meals Wearing loose-fitting clothing that doesn't compress the abdomen Pharmacological management may be appropriate for patients with persistent symptoms despite lifestyle modifications

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25(OH)VD, insulin, glucose, GSH, protein carbonyl, and Malondialdehyde (MDA) assays Plasma levels of 25(OH)vitamin D were determined using an ELISA kit (Calbiotech, Spring Valley, CA), levels of insulin were determined using ELISA kits from ALPCO Diagnostics (Salem, NH)