Jeffrey Salazar
Glucocorticoids are powerful medications that combat inflammation and work with the immune system to treat a wide range of health problems. They are synthetic versions of naturally occurring steroids. While short-term use is generally safe, long-term use can cause health issues such as osteoporosis, Cushing's syndrome, muscle loss, and increased risk of infection. As such, patients on long-term glucocorticoid therapy may require nutritional recommendations to ameliorate these adverse effects. These recommendations include optimizing calcium, vitamin D, sodium, and protein intake, increasing consumption of unprocessed foods, and reducing ultra-processed food consumption. However, studies show that patients often struggle to understand and implement these dietary changes.
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What You'll Learn
Consume more calcium, vitamin D, sodium and protein
Calcium, vitamin D, sodium, and protein are all important components of a patient's diet on long-term glucocorticoid use. Glucocorticoids are commonly used to treat rheumatic and autoimmune diseases due to their anti-inflammatory and immunosuppressive effects. They can also be used to alleviate side effects from chemotherapy or radiotherapy, and to inhibit the progression of certain cancers.
Calcium
Glucocorticoid therapy can lead to bone loss and an increased risk of osteoporosis. Calcium is essential for bone health, and patients on long-term glucocorticoid treatment may need to increase their calcium intake to prevent bone density loss.
Vitamin D
Vitamin D is also crucial for bone health, and studies have shown that vitamin D deficiency is associated with an increased risk of inflammatory and autoimmune diseases. Vitamin D supplementation is often recommended for patients on glucocorticoid therapy to support bone health and potentially reduce the risk of certain diseases.
Sodium
Glucocorticoids can affect sodium retention and excretion in the body. Prolonged glucocorticoid use can lead to increased sodium retention, which can impact blood pressure and cardiovascular health. However, in some cases, glucocorticoids can also increase sodium excretion, leading to electrolyte imbalances.
Protein
Glucocorticoids can impact protein metabolism, stimulating protein oxidation after acute administration. This can lead to muscle atrophy and a decrease in circulating muscle proteins. Patients on long-term glucocorticoid therapy may need to increase their protein intake to prevent muscle breakdown and support muscle health.
In summary, patients on long-term glucocorticoid use may benefit from consuming more calcium, vitamin D, sodium, and protein to counteract the potential negative effects of glucocorticoids on bone health, electrolyte balance, and muscle mass.
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Reduce ultra-processed foods
Glucocorticoid (GC) therapy is a common treatment for rheumatic and autoimmune diseases due to its anti-inflammatory and immunosuppressive effects. However, it can also cause adverse effects such as muscle and bone loss, hypertension, metabolic dysregulation, and increased visceral adiposity.
One way to counteract these challenges is by optimising calcium, vitamin D, sodium, and protein intake. Another way is by reducing the consumption of ultra-processed foods. Diets rich in ultra-processed foods tend to lead to increased energy intake and weight gain. Ultra-processed foods are often higher in calories and produce a high glycemic response, leading to increased energy intake and weight gain. They are also associated with an increased risk of cancer.
To reduce the consumption of ultra-processed foods, consider the following:
- Substitute fresh fruits and vegetables for ultra-processed snacks or side dishes.
- Drink more water instead of sugary beverages.
- Choose whole grains over processed grains.
- Make homemade versions of processed foods like bread, kale chips, granola, or salad dressings.
- Make oatmeal with fruit instead of an ultra-processed cereal.
It is important to note that broader societal changes are also necessary to reduce ultra-processed food consumption. For example, advocating for policy changes and incentive programs can help improve access to healthy foods for underrepresented and low-income communities.
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Increase unprocessed and minimally processed foods
Patients undergoing long-term glucocorticoid therapy can benefit from a diet rich in unprocessed and minimally processed foods. Glucocorticoid therapy can induce adverse effects such as muscle and bone loss, hypertension, metabolic dysregulation, and increased visceral adiposity.
To counteract these challenges, patients are advised to increase their consumption of unprocessed and minimally processed foods. This approach aligns with dietary patterns such as plant-based diets or the Mediterranean diet, which are associated with improved cardiovascular health. The NOVA classification system categorises foods into four types based on processing levels: unprocessed or minimally processed foods, culinary ingredients, processed foods, and ultra-processed foods.
Minimally processed foods are natural, whole foods that have undergone minimal changes before consumption. This includes foods like fresh fruits and vegetables, whole grains, lean proteins, and healthy fats. These foods retain their nutritional integrity and provide essential vitamins, minerals, fibre, and antioxidants.
By increasing the consumption of unprocessed and minimally processed foods, patients can benefit from improved nutrient intake, better weight management, and potentially reduced risk of chronic diseases. It is important to note that this recommendation is based on current research, and further studies are needed to specifically understand its impact on patients undergoing glucocorticoid therapy.
Additionally, patients undergoing glucocorticoid therapy should aim to optimise their calcium, vitamin D, sodium, and protein intake. Adequate protein intake is crucial to prevent muscle loss, while calcium and vitamin D are essential for bone health. Sodium intake should be managed in accordance with recommendations to maintain healthy blood pressure levels.
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Manage hypertension with reduced sodium
While glucocorticoid therapy is a common treatment for rheumatic and autoimmune diseases, it can also induce adverse effects such as hypertension. To manage hypertension, one of the recommendations is to reduce sodium intake. Here are some ways to manage hypertension with reduced sodium:
Reduce Salt Intake
Sodium encourages the body to retain fluid, which can increase blood volume and raise blood pressure. Reducing salt intake is a priority for patients with hypertension. The American Heart Association recommends a sodium intake of less than 1500 mg per day for managing hypertension. This can be achieved by removing the salt shaker from the table and choosing low-sodium or sodium-free alternatives when cooking.
Choose Low-Sodium Foods
Processed and packaged foods often contain high levels of sodium. Read nutrition labels and choose low-sodium versions of your favourite foods. Look for terms like "'low salt' or 'low sodium'" on packaging. Avoid foods with visible salt crystals, such as salted nuts, chips, and pretzels. Also, be mindful of high-sodium dairy products and cured or canned meats.
Increase Potassium Intake
Potassium helps cancel out sodium's effect on blood pressure. Eating more fruits and vegetables high in potassium can be beneficial. Some examples include potatoes, tomatoes, spinach, bananas, and oranges. However, check with your doctor or dietitian before significantly increasing your potassium intake, especially if you are on certain medications.
Adopt a Healthy Diet and Lifestyle
The DASH (Dietary Approaches to Stop Hypertension) diet is a popular and effective approach to managing hypertension. It emphasizes whole foods, fresh fruits and vegetables, lean protein, and whole grains. Additionally, reducing sugar intake and limiting alcohol consumption can help lower blood pressure. Staying physically active is also an important part of managing hypertension.
Be Mindful of Medications
Some over-the-counter and prescription medications contain sodium. Talk to your pharmacist about the medications you are taking and how they may impact your sodium intake. It is important to be aware of the sodium content in your medications and make adjustments to your diet or medication regimen if needed.
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Exercise regularly
Exercise plays a pivotal role in counteracting the adverse effects of long-term glucocorticoid use. Glucocorticoids are a common treatment for rheumatic and autoimmune diseases due to their anti-inflammatory and immunosuppressive effects. However, they can induce muscle loss and bone loss, hypertension, metabolic dysregulation, and increased visceral adiposity.
Regular exercise is recommended for patients on long-term glucocorticoid therapy to mitigate these adverse effects. Specifically, weight-bearing exercises and resistance training have been shown to improve bone health and prevent glucocorticoid-induced osteoporosis. For example, resistance exercise training has been found to restore bone mineral density in heart transplant recipients and prevent vertebral osteoporosis in lung transplant recipients.
Exercise can also help resolve steroid-induced myopathy, a reversible condition resulting from muscle breakdown due to high-dose, long-term glucocorticoid use. Withdrawal of glucocorticoids combined with exercise usually leads to the resolution of myopathy. Additionally, exercise can improve functional outcomes and quality of life for individuals experiencing bone loss or fractures related to glucocorticoid use.
It is important to note that the specific type, intensity, and duration of exercise may vary depending on the patient's condition and overall health. Therefore, it is always advisable to consult with a healthcare professional before starting an exercise regimen while undergoing long-term glucocorticoid therapy.
In summary, regular exercise is a crucial component of managing the side effects associated with long-term glucocorticoid use. By incorporating weight-bearing exercises and resistance training, individuals can improve bone health, prevent osteoporosis, and enhance their overall well-being.
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Frequently asked questions
Glucocorticoid (GC) therapy is a common treatment used in rheumatic and autoimmune diseases, owing to its anti-inflammatory and immunosuppressive effects.
Long-term use of glucocorticoids can cause health problems, including osteoporosis, muscle loss, Cushing's syndrome, and increased risk of neuropsychiatric disorders, lipodystrophic features, and cutaneous disorders.
Optimizing calcium, vitamin D, sodium, and protein intake is essential for patients on long-term glucocorticoid therapy. Increasing consumption of unprocessed and minimally processed foods while decreasing ultra-processed foods may also help counteract specific challenges associated with this treatment.
Studies have shown that patients often have difficulty comprehending the information provided and implementing the recommended dietary and physical activity advice. Providing accessible written information, educational brochures, or web pages can help improve patient understanding and adherence to the treatment and diet.
Monitoring of patients on long-term glucocorticoid therapy should include measurements of weight, blood pressure, lipids, glucose levels, and potassium levels. Additionally, eye monitoring and vaccinations against the flu and pneumococcus are important considerations.
