Ask anyone who has taken steroids for an extended period of time about their experience and they will likely bemoan the dreaded moon face, insomnia and mood swings with gusto. Something they may not mention (or possibly even know about) are the nutritional side effects they had.
This past fall I had some issues that landed me in the hospital for a month and during this time I was put on the highest dose of steroids possible. Now the physical side effects were apparent from the get-go, and my mom promptly dubbed the medication “makes-Carly-crazy-dron.” I was having hot flashes and crying for no apparent reason, and then my face swelled which made me cry even more. Not fun. So being a registered dietitian, I focused on what I could control and immediately dug into the research about what these medications were doing to my nutritional status.
What I found is that a lot of the ph
ysical symptoms that cause us the most angst, are actually due to changes in how we process our food. Pretty neat!
Side note: It’s important to mention that the steroids I’m discussing are glucocorticoids, the kind used to decrease inflammation, NOT anabolic steroids, the kind used by people looking to gain muscle.
Let’s take a look at weight gain. Many of us who have taken large doses of steroids notice an increase in appetite. Not a small increase, but more like an I’m-so-hungry-I-could-eat-a-whole-pizza-every-two-hours kind of increase. So what causes this? Well, a lot of things, but a major part is that steroids change the way your body uses the glucose, or sugar, you eat. Steroids stimulate the liver to give up the glucose that it stores in the case of starvation, but because you aren’t starving, this causes your blood sugar to go up in a similar way it does in people with diabetes.
At the same time, the body has a harder time transporting all that extra glucose into cells where it can be broken down for energy and if you can’t get that energy, you’re going to be hungry! You might notice that you are also more thirsty and may need to urinate more often if this happens because your body is constantly excreting all that extra sugar. It’s a vicious cycle. Luckily, once you stop the steroids your body gets back to working the way its supposed to! If you are on long-term steroids and experience high blood sugar, this can easily be managed with your doctor and/or dietitian by keeping track of your blood sugar readings and adjusting how much carbohydrate you have at each meal.
Not only do steroids affect how you use glucose, but they also change how you metabolize fat. The hormonal changes that occur redistribute fat to the face and upper body leading to the most noticeable side effect: moon face. Unfortunately, this change utilizes the fat already stored in your body and changing your diet or intake of fat will not help prevent this side effect.
Another side effect that isn’t so noticeable is bone loss. Steroids affect the way the body utilizes calcium and vitamin D which is a major threat to those who are at risk for low bone density (including people with IBD), take high doses of steroids or require long term use. Bone loss can occur soon after the medication is started as it slows bone building cells called osteoblasts and increases the breakdown of bone for calcium. In fact, it is estimated that one can suffer a 10-20% reduction in bone mass during the first six months of steroid therapy!
Most people will likely not notice any changes until it is too late and they have suffered a fracture or are diagnosed with osteoporosis. However, bone loss may be prevented by including high calcium foods in the diet including dairy, leafy greens, beans and fortified foods. Because vitamin D is essential to the absorption and use of calcium by the body you should also make sure that you are getting enough vitamin D via sunlight or supplements. Exercise that requires weight bearing such as walking, lifting, or yoga may also help reduce bone loss.
Steroids affect not only calcium, but several other nutrients including sodium. You may have heard that sodium can affect your blood pressure; as you the amount of sodium in your blood increases, your body retains more water to keep it balanced which puts more pressure on those tiny vessels that carry blood throughout the body. Some types of steroids, including prednisone, decrease how much sodium is excreted causing fluid retention, called edema, and possibly an increase in blood pressure. Although this is will be treated by your doctor, you can help by choosing foods lower in sodium.
To Recap:
- Track your blood sugar and work with your doctor to adjust carbohydrates
- Stay hydrated
- Eat an especially high calcium diet
- Get enough Vitamin D through supplements or sunlight
- Avoid too much sodium in your diet
These medications can (literally) be a lifesaver, which I can vouch for. Many of us may gripe about the side effects, but we are lucky we have these big guns to bring in when nothing else is working. By understanding how steroids affect the body and what we can do to help reduce some of the side effects, we can make the most of a crappy (wink) situation.
Sources:
Fields TA. Steroid Side Effects: How to Reduce Corticosteroid Side Effects. Hospital for Special Surgery. 9 Sept. 2002. Web. http://www.hss.edu/conditions_steroid-side-effects-how-to-reduce-corticosteroid-side-effects.asp#.VO4gsfnF-So
McKay LI, Cidlowski JA. Physiologic and Pharmacologic Effects of Corticosteroids. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003. Available from: http://www.ncbi.nlm.nih.gov/books/NBK13780/
The post Steroids: A (Manageable) Nutrition Nightmare appeared first on thegreatbowelmovement.org.
