7-Day Food and Symptom Diary

If you suspect that foods may trigger or worsen your symptoms of gastroesophageal reflux disease (GERD), try keeping a one-week daily diary. Share the information with your doctor during your next visit. It may help to gain a better understanding of your symptoms.

For the next 7 days, keep a record of any and all heartburn and other symptoms you may have, and how often they occur. Record each symptom each time it occurs, even if it occurs several times a day. Make sure your diary is accurate and complete.

Throughout each day record the time of day, description (food and amount), activity, and any symptom that follows (including “none”).

Name the symptoms you experience (refer to this list of common symptoms of GERD). Examples include:

  • Heartburn (burning discomfort that rises into the chest)
  • Sour/acid taste in the mouth
  • Difficult or painful swallowing

sample GERD diary

Need a little help getting started?

Learn more about how to keep track of your symptoms and print out this free 1-week diary template to help you get the most out of your next doctor visit.

Published in Digestive Health Matters, Vol. 23, No. 3.

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IFFGD is a nonprofit education and research organization. Our mission is to inform, assist, and support people affected by gastrointestinal disorders.

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