One of the worst aspects of being extremely overweight and/or diabetic is the hidden problems that may be affecting your health in ways that are often not apparent or visible until considerable damage has already been done.

GERD (gastroesophageal reflux disease), caused by acid reflux, is one example. Gerd is more than just frequent heartburn, although heartburn is usually a symptom of the problem. It's even possible to have GERD and not experience heartburn that frequently, since the amount of heartburn can depend on what kind of foods you eat, degree of overweight and other factors.

What is GERD?
GERD happens when stomach acid flows back into your esophagus--the "tube" through which food enters your stomach. This happens more often when you bend over, or when you're lying down at night. Worst of all, it can continue during the night, bathing your esophagus in stomach acid over several hours and hastening the damage. Over time, this can result in acid burns to your esophagus and even your vocal chords, resulting in scar tissue that narrows your esophagus, causing difficulty swallowing and even trouble breathing. Asthma-like wheezing, chronic laryngitis, and--infrequently--cancer of the esophagus can also result if left uncorrected. Since the cause of these problems is not immediately apparent--especially if you're not experiencing frequent bouts of heartburn--they often go undetected until substantial damage has been done.

What causes GERD?

Overweight
When you swallow, a band of muscle around the lower part of your esophagus (called the esophageal sphincter) relaxes long enough for the food or liquid to pass through the esophagus to your stomach, then tightens again to keep stomach acid where it belongs--in your stomach. If you are extremely overweight, the excess weights crowds your stomach and diaphragm (the big band of muscle between your stomach and chest that helps you breathe), pushing your diaphragm against the bottom of your esophagus. The added pressure forces the esophogeal sphincter open, allowing stomach acid to flow backward into your esophagus.

Diabetes
One of the lesser-known side effects of diabetes is gastroparesis which simply means your stomach takes longer than normal to empty. Food that stays in your stomach too long can sour and regurgitate, sending the acid-drenched contents into your esophagus and causing heartburn.

Unhealthy Habits:
Eating the wrong foods (see "Ways to Prevent GERD" below) can make heartburn/GERD worse. Drinking alcohol, smoking, eating very large meals and lying down too soon after eating are other GURD "triggers".

How Can I Repair the Damage from GERD?
Over-the-counter antacids (Maalox ®, Tums ® or Rolaids ®, for example), may control your heartburn by neutralizing stomach acid. Weaker versions of prescription drugs that reduce the amount of acid in your stomach, rather than neutralizing it--like Pepcid ® or Zantac ®--may be more effective than simple antacids against GERD. But if your esophagus is already damaged, you may need a full prescription-strength medicine to prevent acid reflux and help heal the damage. Prilosec ® is one such drug, though its full-strength version is now sold over the counter. To be effective, Prilosec ® and similar drugs need to be taken at least half an hour before eating.

Are there ways to prevent GERD?
Apart from medications, there are other things you can do to prevent the acid reflux that causes GERD:

• Lose weight

• Eat smaller meals

• Elevate the head of your bed 6-9 inches by inserting a foam wedge under your pillow or putting cement blocks under the front legs of the bedframe.

• Quit smoking and avoid alcohol

• Eliminate "triggers" from your diet--fried or fatty foods, onions, garlic, chocolate and coffee are frequent culprits.

• Avoid bending over

• Don't lie down right after eating. Wait 3-4 hours after eating before going to bed.