Prednisone is a corticosteroid medication prescribed to treat a wide range of conditions, including asthma, lupus, kidney conditions, rashes, and certain types of arthritis. While it effectively reduces inflammation and suppresses the immune system, it's crucial to be aware of its potential side effects, particularly weight gain. This article explores the relationship between prednisone and weight gain, offering insights into why it occurs and providing strategies for managing this common side effect.
How Prednisone Affects Weight
Weight gain is a commonly dreaded side effect of steroid use, incurred to some degree by nearly all patients who take them. The amount of weight gain varies from individual to individual. Prednisone influences weight in several ways:
- Increased Appetite: Prednisone stimulates appetite, leading to increased calorie intake. This can be difficult to control, making it essential to manage dietary habits consciously.
- Fluid Retention: Prednisone can cause the body to retain fluids and sodium, leading to swelling in the arms, legs, and face. This fluid retention contributes to weight gain and can also elevate blood pressure.
- Redistribution of Body Fat: Prednisone leads to a redistribution of body fat to places that are undesirable, particularly the face, back of the neck, and abdomen. Some patients also develop supraclavical fat pads, which are collections of fat at the base of the neck, just above the collarbones.
- Metabolic Changes: Prednisone can negatively affect metabolism, potentially slowing it down. This can make it harder to burn fat and contribute to weight gain over time.
- Muscle Atrophy: Many patients undergo loss of muscle strength (muscle atrophy) while taking steroids.
Managing Weight Gain While on Prednisone
While weight gain is a common side effect, there are several strategies to manage it effectively:
Dietary Adjustments
- Low-Sodium Diet: Reduce sodium intake to no more than 2,000 mg a day to combat fluid retention. Avoid canned foods, pickles, potato chips, crackers, and bacon, which are high in sodium.
- High-Potassium Diet: Increase potassium intake to help minimize fluid retention. Foods high in potassium include bananas, apricots, prunes, oranges, tomatoes, raisins, potatoes, artichokes, spinach, and squash.
- High-Protein, Low-Carbohydrate Diet: Follow a high-protein, low-carbohydrate diet. This type of diet can be effective for weight loss and helps manage blood sugar levels.
- Choose Complex Carbohydrates: Eat carbohydrates in the form of fresh fruits and vegetables. Avoid "simple" carbohydrates and concentrated sweets like cakes, pies, cookies, jams, honey, chips, breads, and candy.
- Limit Saturated Fat and Cholesterol: Choose lean meats, poultry, and fish. Reduce intake of foods with added fat, such as margarine, butter, and some sauces and gravies. If consuming dairy, opt for products with a lower fat content (2% fat or less).
- Eat Foods Rich in Calcium: Prednisone may alter your body's ability to use calcium. Try to get four servings of calcium-rich foods per day to help prevent osteoporosis. Good sources include corn, sardines, almonds, broccoli, milk, yogurt, cheese, tofu, cooked soybeans, boiled white beans, and salmon.
Regular Exercise
- Aerobic Exercises: Engage in aerobic exercises to burn calories and improve cardiovascular fitness. A simple walking program can be a good start.
- Moderate Weight Training: Incorporate moderate weight training to strengthen muscles and slow bone loss.
- Consistency is Key: Aim for a program of regular exercise, even if you're too fatigued some days.
Monitoring and Medical Consultation
- Regular Check-ups: It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and to decide if you should continue to receive it. Blood or urine tests may be needed to check for unwanted effects.
- Blood Sugar Monitoring: Prednisone can increase blood sugar levels, so regular monitoring is essential, especially for individuals with diabetes.
- Cholesterol Monitoring: Prednisone may cause a spike in cholesterol levels, requiring regular monitoring.
- Bone Density Tests: Undergo bone density measurements using DEXA scans, especially if on prednisone for prolonged periods, to monitor for osteoporosis.
- Consult a Doctor: Discuss any concerns or side effects with your doctor, who may adjust the prednisone dose or recommend additional treatments.
Other Important Considerations While Taking Prednisone
Besides managing weight gain, consider these additional factors while on prednisone:
- Infections: This medicine may cause you to get more infections than usual. Avoid people who are sick or have infections and wash your hands often. If you are exposed to chickenpox or measles, tell your doctor right away. If you start to have a fever, chills, sore throat, or any other sign of an infection, call your doctor right away.
- Vision Changes: Check with your doctor right away if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment.
- Vaccinations: While you are being treated with prednisone, do not have any immunizations (vaccines) without your doctor's approval.
- Mood Changes: This medicine may cause changes in mood or behavior for some patients. Tell your doctor right away if you have depression, mood swings, a false or unusual sense of well-being, trouble with sleeping, or personality changes while taking this medicine.
- Bone Health: This medicine might cause thinning of the bones (osteoporosis) or slow growth in children if used for a long time. Tell your doctor if you have any bone pain or if you have an increased risk for osteoporosis. If your child is using this medicine, tell the doctor if you think your child is not growing properly.
- Cancer Risk: This medicine may increase your risk for cancer, including Kaposi's sarcoma. Tell your doctor right away if you have flat, painless spots that are red or purple on white skin and bluish, brownish, or black on dark skin.
- Adrenal Gland Problems: Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems. Talk to your doctor right away if you have blurred vision, dizziness or fainting, a fast, irregular, or pounding heartbeat, increased thirst or urination, irritability, or unusual tiredness or weakness.
- Stress Management: If you are using this medicine for a long time, tell your doctor about any extra stress or anxiety in your life, including other health concerns and emotional stress. Your dose of this medicine might need to be changed for a short time while you have extra stress.
- Pregnancy: Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away.
- Medication Interactions: Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
- Inform Other Healthcare Providers: Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain skin tests.
Prednisone Tapering and Long-Term Use
Prednisone is often used at high doses initially to control conditions like vasculitis and then gradually reduced ("tapered") while another immunosuppressive drug is started for long-term treatment. Over time, the "steroid-sparing" immunosuppressive drug is used to control the condition, and prednisone is eventually stopped.
Read also: Managing Prednisone with Diet
Side Effects of Long-Term Use
Corticosteroids cause a long list of side effects, making it dangerous to use these drugs at significant doses for long-term treatment. The side effects of prednisone are related to the amount of steroid a patient takes in his/her daily dose, and the length of time the patient remains on the medication.
With long-term use, corticosteroids can result in many side effects, including a need for increased doses to manage physical stress, steroid withdrawal syndrome, insomnia, mood changes, elevated blood pressure or blood sugar levels, infections, gastrointestinal symptoms, increased appetite and subsequent weight gain, osteoporosis, cataracts or glaucoma in the eyes, hardening of the arteries or avascular necrosis.
Minimizing Side Effects
The side effects of prednisone can be minimized by following dietary guidelines, exercising regularly, and staying in close communication with your healthcare provider.
Weekly Prednisone Dosing
Recent studies in mice suggest that intermittent, once-weekly prednisone dosing may have different outcomes compared to daily dosing. The once-weekly prednisone promoted nutrient uptake into the muscles and prevented obesity. However, these studies are preliminary, and further research is needed to determine the effectiveness and safety of weekly prednisone dosing in humans.
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