Coping with Steroid medications
Those who have had to take oral Steroid medication such as Prednisone (sometimes also known as Wysolone, Deltasone, Liquid Pred, Meticorten or Orasone) for an inflammatory or autoimmune condition know just what a heavy toll it can take on our bodies and minds for the benefits it offers. In this article I will explore four areas that it impacts and some things we can do to cope better with them.
Rapid weight gain
When you are on a heavy dosage of prednisone there is a tendency to be much hungrier than before. You could eat a whole meal and feel like it was just the appetiser. This hunger can feel urgent and desperate. It can also lead to feeling ‘hangry’ when you don’t have much to eat. In addition to this on the physical level, there often is also an emotional emptiness which makes you want to keep munching something. The more sugary, creamy or heavy in carbs the food is, the more satisfied the inner hunger-monster feels. Then, it expects more the next time. So goes the downward spiral. The tendency to eat like this leads to pretty rapid weight gain. Sometimes a kilogram or two pounds per week or more. The weight gain is linked to imbalances in blood pressure and blood sugar regulation but even when those things don’t happen it is just so much harder to do things. Energy levels are low. Exercises you once found easy, are nearly impossible because it feels like you suddenly are carrying a very heavy backpack. The bones and muscles in your body have not caught up to carrying around all this extra weight.
So what can you do about this?
- Load up on fibre — Initially, it is not easy to reduce the quantity you want to eat so instead we are going to change what you eat. Soak legumes and slow cook them. They feel creamy and are extremely filling but are full of protein and fibre goodness. You can also load up on a whole bunch of vegetables, especially greens. The more fibrous the better! Not only will this help you feel full, it will recharge you with good nutrients.
- Cut sugar and grains out — All refined sugar and processed food must go. Once you do longer depend on grains to feel full and you have found our new friends in fibre, you can cut out wheat, and cut back on rice and other grain consumption. While a small portion of whole grains may still be ok, try to have this only in the morning meals so you have the whole day to digest it. Some experts on autoimmunity would recommend avoiding grains altogether unless you are ready to soak, sprout, ferment, cook and then consume them.
- Explore and enjoy herbal teas — You want to feel full and keep your mouth busy in consuming something. Herbal teas are the answer. They hydrate you, taste good, introduce some antioxidants, reduce stress, detoxify some organs and keep you feeling full all for the cost of no calories. I recommend dandelion, chamomile, ginger-turmeric, reishi mushroom, licorice root, and if you feel immunosuppressed and like a cold might be coming on, you can also have elderberry, echinacea and tulsi. It might be a good idea to consult a herbalist to identify which teas may be most beneficial for you. I see herbal teas as your reward for cutting out the sugars and grains. They can make you feel soothed and cared for.
- Consume more healthy fats — consuming avocado, nuts, chia seeds, flax and certain kinds of fatty cold water fish can go a long way in nourishing the body. Unsaturated fats can help you feel full and reduce your overall need for food.
Following these suggestions, you are likely to experience weight loss and increase in energy. Don’t be surprised if as you lose more weight, your inflammation levels also come down.
Lower Bone Density
Prolonged prednisone exposure can lead to lowered bone density. This is often monitored by doctors if they know you have been on it for more than two years. Please request it if no one has suggested this for you yet. (Actually, it would be good to get a baseline beforehand so that you can keep track of your bones through the prednisone treatment.)
As with any of these consequences, you want to catch any weakening early and take mitigating steps. Though many doctors will talk to you about calcium supplementation and taking Vitamin D3, not many will strongly suggest you do weight bearing exercises. Exercises such at Qigong or Yoga which emphasise alignment of the body and joints and bearing weight in alignment helps build back bone strength. There is a book called ‘Yoga for Osteoporosis’ by Dr Loren Fishman and associated Youtube videos which have variations of the postures for those with very weak bones (osteoporosis), mildly weakened bones (osteopenia) and for those with regular strength for those looking to maintain strong bones. Apart from these exercises, you may also want to take walks. As you get stronger you can add some exercises using your own body weight, light dumbells or the weight machines in gyms at the lower settings. Slowly working your way up from where you are, perhaps with the help of a Yoga or Qigong teacher, or a personal trainer who understands your condition can help retain bone density and even strengthen your bones. Taking calcium and Vitamin D3 supplements is known to be better absorbed and therefore more effective when combined with appropriate exercise.
Dental Maintenance
Just as bone health is impacted by Prednisone, your teeth also take a toll. Part of this is because of the calcium absorption we talked about in the previous section but the other aspect is that the mouth produces less saliva than it needs. This leads to varying degrees of dry mouth. You may realise you have this when you wake up with a dry mouth and perhaps a different morning breath, when it takes you longer to chew the same food, or when you find you need to keep drinking water to feel normal in the mouth. It is possible your dentist will tell you about the gumline degradation of enamel and the possibility that you may need partial crowns, full crowns or even root canals to deal with the level of decay in your teeth.
Impeccable oral hygiene habits will help you keep what you have.
- Since you are off sugar and grains you have already done half of what it takes to keep your teeth.
- The fibre you eat also helps to clean away anything sticky.
- Avoiding acidic foods, or rinsing well with water right after eating them can help. Keep in mind to leave a significant gap between eating the acidic food and brushing your teeth as the enamel is weakened by acid.
- There are various chewing gums and mouthwashes which help neutralise the pH and keep your mouth moist. Your dentist may recommend these products.
- Regular brushing and flossing helps reduce the time your precious enamel is in contact with acidic and sticky foods.
Mood Changes
Many people experience depression, mood swings and terrible temper with the use of prednisone. The doctor who prescribes this is aware this can happen but often is not equipped to help. At best they are sympathetic and say it will get better as the dosage comes down. At worst they dismiss you saying ‘it is a known side effect’, as though feeling constant pain, snapping at loved ones and feeling like your life is not worth living is ‘just a side effect’. What can you do about it though?
Some people turn to meditation to develop more control, peace and awareness to catch spiralling thoughts. Some turn to a psychologist for short term antidepressants use. Some find the use of Flower essence remedies highly effective. There are various Yoga and Qigong breathing practices which also help in emotion regulation. Exploring these options with the experts in each field can result in a great alleviation of the internal suffering Prednisone can cause.
Are there other ideas you have tried that have been effective for any of the four side effects listed here? Are there other side effects that you would like to be seen addressed by another article. Please leave your comments and questions. I hope this post has been helpful. Take care everyone.
Janani Dhinakaran PhD helps those with chronic illnesses improve their quality of life using positive lifestyle changes. She specialises in Autoimmunity but has a wide range of experience with prediabetes, anxiety, acidity, weight loss etc. https://riselife.org/testimonials/ She can be reached at janani@riselife.org