Corticosteroids (often just called “steroids” or heard as cortisone) are synthetic and are used in the form of oral pills, nasal sprays and creams to treat inflammatory conditions such as:

• asthma
• intestinal problems (Crohn’s disease ,ulcerative colitis)
• anaemia
• rashes
• arthritis, including osteoarthritis and rheumatoid arthritis
• allergic conditions, seasonal allergies
• skin conditions, such as severe psoriasis and lupus etc

However, on September 2^nd 2020, WHO published guidelines for health care professionals on the use of corticosteroids in patients with COVID-19. I will not provide brand names, or dosing in this article, but as a Licensed clinical dietician I will provide some tips on how to prevent weight gain as a side effect of using Cortisone.

I’ve counselled several patients with a history of cortisone oral pill treatment, and the common complaint was weight gain which is 70% of the case! So, what happens exactly?

• increased appetite
• increase in blood sugar levels
• fluid and salt retention
• Fat redistribution in the abdomen, face, and neck.

This is why your dietician and/ or physician warns you to avoid sugar and salt in your diet! Even if you control weight gain, you’ll still look heavier while on these drugs because of this fat redistribution.

How much and whether you gain weight depends on the dosage and the duration of intake.

the higher the dose and the longer you’re on it, the more likely you will face weight gain. The good news is, once your physician takes you off the steroids and your body readjusts, the weight gradually comes off within 6 months to a year.

Tips to curb weight gain:

• Choose filling low-calorie foods like fresh fruits and veggies.
• Eat six small meals a day versus three large ones.
• Choose fiber-rich and slower-to-digest complex carbohydrates versus refined ones (for example, whole wheat pasta instead of regular pasta, and brown rice instead of white).
• Include a source of protein with each meal (meat, fish. chicken, eggs, cheese, legumes, etc.). Research published in the American Journal of Clinical Nutrition found that meals that contain 25-30g protein are most effective at curbing appetite and controlling weight.
• Drink water.
• Eat potassium rich foods to balance the water .
• Watch out for extra hidden salt, like most packaged foods.
• Stay active. This is sometimes hard when you feel weak but it can help a lot!

Sodium is essential for the human body, but you should also reduce it by 75% if you are on cortisone medication – ask your doctor first before making any changes to your food

To sum up!
Steroids are tremendously effective at treating some inflammatory conditions. But the drugs are potent and can produce some serious and unwanted side effects, and weight gain. Do not take or stop medication without a doctor’s approval.

Stay safe and healthy everyone.

General Note: Corticosteroids are different from anabolic steroids that help build muscle.

References:
Allergy Asthma and clinical immunology journal 2013
https://www.who.int/news-room/feature-stories/detail/who-updates-clinical-care-guidance-with-corticosteroid-recommendations

Nathalie Jabrayan
Clinical Licensed Sports Dietician and Personal Trainer