Prednisone, a corticosteroid medication, is commonly prescribed to treat a variety of conditions affecting the lungs, skin, eyes, kidneys, blood, thyroid, stomach, or intestines. While prednisone is effective in reducing inflammation and suppressing the immune system, it can also cause a range of side effects, especially with long-term use or at higher doses. Nutritional adjustments can play a significant role in managing these side effects and improving overall well-being. This article provides a detailed guide on dietary strategies to mitigate the adverse effects of prednisone.
Understanding Prednisone and Its Effects
Prednisone belongs to a class of drugs known as corticosteroids, which also includes prednisolone, hydrocortisone, and methylprednisolone. These drugs work by reducing the activity of the immune system, decreasing its response to diseases or injuries. Prednisone can be administered in various forms, including pills, injections, and inhalers.
Common conditions treated with prednisone include:
- Kidney conditions
- Lupus
- Asthma
- Rashes
- Certain types of arthritis
While prednisone is effective, it's crucial to be aware of its potential side effects. Some common side effects include:
- Extreme mood swings
- Headaches
- Acne
- Weakness and fatigue
- Dizziness
- Weight gain
- Swelling in the arms, legs, and face
- Slower healing of wounds and cuts
- Irregular appetite
- Unusual collection of fat in certain parts of the body
- Irregular or absent menstruation
- Difficulty getting sleep or staying asleep
Long-term use of prednisone can lead to more severe side effects, such as:
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- Thinner bones (osteoporosis)
- Poorly controlled diabetes
- Eyesight problems
- High blood pressure (hypertension)
In children and teenagers, long-term use of prednisone at higher doses can slow down normal growth. Doctors typically monitor the height and weight of children on this medication to detect any growth delays and adjust treatment accordingly.
General Dietary Guidelines While Taking Prednisone
The side effects of prednisone can be minimized by following specific dietary guidelines. Because Prednisone is a steroid, it tends to interfere with how certain nutrients are absorbed into and utilized by your system. Some of these nutrients, such as calcium, sodium, proteins, and vitamin C and D, are essential for the regular functioning of your body. On the other hand, steroids can cause irritation when you take them on an empty stomach, which is why this should be avoided.
Timing of Meals
Take prednisolone with food to reduce the chances of stomach problems. It's generally advised to avoid taking prednisone on an empty stomach to prevent irritation.
Overall Diet Composition
If you’re taking prednisone to manage a chronic condition, you should consider eating low-calorie foods to prevent sudden weight gain. Your doctor may ask you to follow a low-salt, high-potassium, or high-calcium diet. They may also recommend taking calcium, vitamin D, or potassium supplements.
Specific Dietary Recommendations to Counter Prednisone Side Effects
Managing Fluid Retention and High Blood Pressure
Prednisone can cause the body to retain fluids and sodium, leading to increased blood pressure and swelling. To mitigate these effects:
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- Limit Sodium Intake: Avoid adding too much salt to dishes and reduce the intake of foods high in sodium, such as canned foods, pickles, potato chips, crackers, and bacon. Read nutrition labels and choose foods with less than 140 mg of sodium per serving or 600 mg or less per entree.
- Increase Potassium Intake: Consume foods high in potassium to help minimize fluid retention. Good sources include baked potatoes, grapefruit, lima beans, cantaloupes, bananas, apricots, dried fruits (dates, prunes, raisins), spinach, potatoes, artichokes, and squash.
Supporting Bone Health
Prednisone inhibits the absorption of calcium, increasing the risk of osteoporosis. To support bone health:
- Increase Vitamin D Intake: Getting more vitamin D in your diet can help your body absorb more calcium. Check with your doctor to see if you should take vitamin D supplements.
- Consume Calcium-Rich Foods: Increase your intake of low-fat foods that have high calcium levels, such as corn, sardines, almonds, broccoli, milk, yogurt, cheese, tofu, cooked soybeans, boiled white beans, and salmon. Dairy products are excellent sources of calcium. Consume low-fat milk, cheese and yogurt regularly. If you are lactose intolerant, choose Lactaid milk or calcium fortified soy milk.
Meeting Protein Needs
Prednisone can increase protein breakdown in the body. If you're taking prednisone, this means you’ll need to eat more protein than normal to meet your body’s daily protein needs. Conditions such as Crohn’s disease and ulcerative colitis lead to considerable loss of body protein on top of the effects of prednisone. If you have one of these conditions, you'll have to account for this dual effect on protein breakdown in your diet. Foods high in protein are: fish, eggs, meat, milk, cheese, baked-beans, and soy products. Remember, though, you don’t want to raise your cholesterol so low-fat meats, milk and cheese are recommended. Fish is not only a great source of protein, but also a great source of Omega-3 fatty acids.
Managing Cholesterol Levels
In some cases, prednisone may cause a spike in cholesterol levels. If you're taking prednisone, you'll need to monitor your cholesterol regularly. If your tests indicate that your cholesterol levels are higher than normal, you’ll have to reduce your intake of fatty and oily foods. One way to do this is to eat fewer foods with added fat, such as margarine, butter, and some sauces and gravies. If you eat dairy regularly, choose products that have a lower fat content - 2% fat or less is ideal.
Controlling Blood Sugar Levels
Prednisone is also known to increase blood sugar levels. Limiting your sugar intake is essential to lower the impact of prednisone on your blood sugar, especially if you have a condition like diabetes. Check with your doctor if you need to manage your blood sugar to learn the best ways to do it. It is important to avoid "simple" carbohydrates and concentrated sweets, such as cakes, pies, cookies, jams, honey, chips, breads, candy and other highly processed foods. Choose whole grains instead of refined carbohydrates and carefully monitor portion sizes of foods that contain carbohydrates. Ask a dietitian to help with meal planning if you have already diabetes and are experiencing blood sugar changes.
Managing Weight Gain and Increased Appetite
Weight gain is a common side effect of prednisone. Prednisone can also cause a redistribution of fat to the face, back of the neck and the abdomen, although these changes vary from person to person. Weight gain while taking prednisone is typically due to fluid retention and increased calorie intake because of increased appetite.
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- Control Fluid Retention: Fluid retention can be controlled by eating a diet low in sodium - no more than 2,000 mg a day - and higher in potassium.
- Manage Increased Appetite: Prednisone increases appetite, resulting in increased calorie intake. This increased appetite can be difficult to control. Eat a high-protein, low-carbohydrate diet. There is evidence that a low-carbohydrate, high-protein diet is at least as effective for losing weight as a traditional low-calorie diet that's low in fat and portion-controlled. Eat carbohydrates in the form of fresh fruits and vegetables. Limit saturated fat and cholesterol. Choose lean meats, poultry and fish.
- Frequent, Small Meals: Try eating several smaller, balanced meals throughout the day to prevent overeating, and make sure they all contain some protein and fiber, says Stacy Kennedy, MPH, RD, a registered dietitian in Wellesley, Massachusetts, who is board-certified in oncology nutrition."Eating a variety of fruit and vegetables, you get your potassium and fiber," she says. The protein and fiber help satisfy hunger pangs, and the fruits and vegetables contain nutrients that help fight inflammation and boost the immune system.
Foods to Favor and Avoid
Some of the foods that may be recommended to you when you’re prescribed prednisone are:
- Baked potatoes
- Grapefruit
- Lima beans
- Milk
- Cantaloupes
- Bananas
- Apricots
- Dried fruit, like dates, prunes, and raisins
- Spinach
These foods are high in potassium, which can help minimize your fluid retention.
On the other hand, some of the foods to avoid when you’re taking prednisone are those that contain saturated fat and cholesterol. Instead of higher-fat meats, choose lean meats, poultry, and fish.
Addressing Potential Ulcers and Gastric Problems
Ulcers and gastric problems can accompany the use of steroids. The stomach produces a protective mucous layer that helps it defend itself against the acid it produces. Corticosteroids suppress the growth of gastric mucin, cells that produce mucous. This suppression interferes with production of the mucous layer. In addition, corticosteroids inhibit the production of mucous in the cells that remain. Eventually, this leads to a thinning of the protective layer and a greater risk of ulcer. There are many good medicines used today both over-the-counter and with prescription that have virtually no side effects and can help reduce the problems.
Some good suggestions to relieve symptoms of ulcers or gastritis:
- Eat smaller meals.
- Milk may give some initial relief.
- Add protein to your diet.
- If possible, avoid cafeinated coffee, large amounts of chocolate, citrus and tomato products.
- Try not to snack at bedtime as this can cause gastric acid secretions during the night.
- Ginger tea (even ginger candies) is a wonderful way to reduce stomach discomfort.
- Some people find Peppermint helps.
Other Nutritional Considerations
Vitamins and Supplements
- Calcium and Vitamin D: Consume enough calcium and vitamin D through food and/or supplements. Dairy products are excellent sources of calcium. Consume low-fat milk, cheese and yogurt regularly. If you are lactose intolerant, choose Lactaid milk or calcium fortified soy milk.
- Creatine: Our bodies make creatine from the amino acids in protein. Good food sources are herring, cod, beef, pork, salmon, and milk. Vegetarians tend to have lower stores of creatine. The jury is still out on the benefits of creatine supplements to build muscle, and it is generally believed to be harmless. There are several studies going on to evaluate creatine in various types of myositis. However, one side effect of creatine supplements can be decreased kidney function. So be sure to discuss creatine with your doctor before taking it.
- Coenzyme Q10 (CoQ10): CoQ10 is produced by the human body and is necessary for the basic functioning of cells and acts as an antioxidant. CoQ10 levels are decreased in some people with muscle disease and therefore supplements are sometimes used to increase the body’s level. CoQ10 may interact with other medications so talk to your doctor before taking it.
- Fish Oil (omega-3 fatty acids): Fish Oil (omega-3 fatty acids) from fatty fish such as salmon, sardines and mackerel have been found to decrease inflammation and cytokine production, although there is significant debate about whether the doses patients generally take have a significant effect. They are usually well tolerated but may interact with other medications such as blood-thinners. High doses may cause stomach discomfort.
- Anti-inflammatory spices: ginger and tumeric: these have antioxidant properties, and some limited data have suggested that they may have anti-inflammatory and pain-relieving properties. These spices can be safely added to foods when cooking.
Balancing Food and Vitamin/Mineral Supplements
Your best source of vitamins and minerals is through food. However, supplements should be used whenever you need to fill a nutrition "gap" between what you need and what you eat. Make sure you know the recommended doses of supplements before you shop for them; avoid overdosing. Your calcium needs vary by age, although people with myositis who are on steroids need at least 1200 mg per day - or 1500 mg if you are a woman who has reached the menopause or a man 65 or over. If you are lactose intolerant, Lactaid® or soy milk are good calcium sources, as are yogurt and cheese. However, yogurt is not fortified with vitamin D and studies have shown that the amount of vitamin D in “fortified” milk is variable, so almost everyone is advised to take supplemental Vitamin D. This is especially important if you are taking anti-inflammatory steroid therapy, such as prednisone or methylprednisolone (Medrol®).
If your calcium intake is primarily through supplements, be sure to take them in divided doses - with breakfast and dinner - because your body cannot absorb too much calcium at once. For example, if you are taking 1200 mg of calcium a day through supplements, it is best for optimal absorption to take 600 mg in the morning and the remaining 600 mg in the evening. You can consider a pill that combines calcium and vitamin D.
If you take a daily multivitamin, it is best to take it separately from your calcium supplement - by two to four hours - because the calcium supplement will interfere with your body's absorption of iron in the multivitamin.
Diet and Myositis
Healthy eating is an important part of self-care for everyone, but particularly for those who have a chronic disease such as myositis. Good nutrition is especially important in view of some of the medications prescribed to treat myositis. Eating the right foods can help you feel better and reduce some unwanted side effects of these medications.
Considerations for Pemphigus and Pemphigoid Patients
There are some indications that foods in the Alium group of vegetables (onions, garlic and leeks) might have an effect on triggering pemphigus for some individuals. The researchers add in many other foods that might also be thought of as trigger foods. We suggest that you be aware of these possible trigger foods when picking foods for your diet.
Additional Lifestyle Recommendations
Exercise Regularly
Having a lung disease makes physical activity more difficult. Your exercise program should include aerobic exercises, which burn calories and improve cardiovascular fitness, and moderate weight training, which strengthens muscles and slows bone loss. Start with a simple walking program. If you're ever too fatigued to exercise, try harder tomorrow. The key is to have a program of regular exercise.
Monitor and Manage Other Side Effects
Prednisolone can affect your mood in different ways. Try wearing loose clothing and use a strong anti-perspirant.
Long-Term Monitoring
If you have been taking prednisolone for more than a few weeks, check with your doctor before stopping it suddenly to reduce your chances of withdrawal side effects.
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