Features September 2012 Issue

Arthritis, Steroids, and Your Diet

The benefits of corticosteroids for people with arthritis come with some undesireable, but manageable diet-related side effects.

Steroids—not the performance-enhancing anabolic drugs that some athletes are known to use—are strong, effective anti-inflammatory drugs prescribed for a variety of serious medical conditions, including some of the more than 100 types of arthritis. However, if you’re a patient who has been prescribed steroids, you may have to manage one or more nutrition-related side effects.

To help curb steroid-induced weight gain, and your appetite, drink a glass of water before each meal.

“Oral corticosteroids (also called glucosteroids, glucocorticoids, and simply steroids) affect your entire body instead of just a particular area,” says Cleveland Clinic’s Andrea Dunn, an Advanced Practice Registered Dietitian. “Side effects depend on the dose of medication and how long you have been taking the drug. Within days or weeks of starting oral therapy, you may have a risk of increased blood pressure, fluid retention, and weight gain.”

Long-term use can lead to cataracts, higher risk of infections, loss of calcium from bones, menstrual irregularities, thin skin, easy bruising, and slower-healing wounds.

What can you do to minimize side effects? “You may need to reduce the number of calories you consume or increase your physical activity to prevent weight gain,” says Dunn. “Calcium and vitamin D supplements and prescription bisphosphonates can minimize bone thinning due to corticosteroids.”

“If you have a ravenous appetite,” adds Dunn, “include low-calorie, high-fiber foods—such as fruits and vegetables—throughout the day. Stay hydrated on calorie-free fluids. Try drinking a glass of water before each meal to help make you feel full. Make a list of activities you can do that don’t involve food, and then stay out of the kitchen in between meals and snacks. Keep a food journal. Be aware of what you eat and when you eat it. Avoid skipping meals. It may only make you overeat when you do eat.”

What if you have diabetes? “Most people with diabetes get about 45 percent of their calories from carbohydrates,” says Dunn. “The amount eaten at one time has an impact on the rise in blood sugar. Adhering to a carbohydrate budget—through carb counting or portion control—can help you achieve desirable blood-sugar levels.”

What is the role of exercise? “Regular exercise not only burns calories, but it can reduce the pain of arthritis. Since steroids can cause insulin resistance, exercise and weight management can also assist in keeping blood sugar levels within a target range. Strive for at least 150 minutes of moderate exercise each week with at least two resistance-training sessions—using dumbbells or a resistance band, for example—per week.” 

What can a person do about sodium retention, water retention, and hypertension?  “A lower sodium style of eating can help,” says Dunn. “Think ‘no added salt’ at the table and using fewer processed foods. The DASH diet (visit the U.S. Department of Health website www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf) is a healthy style of eating that has been proven to help manage blood pressure.”

What about dosage? “Work with your doctors in order to take the lowest dose of corticosteroids needed for the shortest period of time,” advises Dunn. “Make sure there is communication among the physicians who treat you for diabetes (or pre-diabetes), heart disease, and arthritis. Factors such as glucose levels, insulin dosage, heart medications, and arthritis drugs may need to be monitored more closely or altered.”