SUPPORT AFTER CORTICOSTEROIDS

Ian Spohn, ND, is a staff naturopathic doctor for Energique who enjoys challenging the dogmas of both conventional and alternative medicine. He is a passionate supporter of the paleo diet and classical homeopathy.

It is difficult to argue against the use of corticosteroids in certain situations, for instance temporal arteritis, which can result in permanent blindness if left untreated. On the other hand, the sheer utility and fast action of these anti-inflammatory agents lend them to being overprescribed, often as a convenient crutch at the expense of determining and addressing the root causes of illness. To make matters worse, they almost invariably produce side effects. These range from benign nuisances like unwanted weight gain due to water retention, to serious issues like increasing the risk of osteoporosis with long-term use. Even a short course of corticosteroids disrupts the endocrine system sufficiently to warrant the drugs to be tapered, and it is not unheard of for patients to report side effects continuing for months, or even years. Because these medications are so commonly prescribed, and because their side effects can be so persistent, it is especially important to have strategies to support patients who have taken these drugs in the past.

                Although corticosteroid withdrawal is a verified phenomenon, and has been reported in some cases to persist as long as 6-12 months[i], patients are not supposed to be experiencing side effects years after discontinuing their medication. Yet, sometimes patients report stubborn weight gain, beginning while taking a course of corticosteroids, which never went away and seems to resist all efforts to reverse. The short-term weight gain experienced while taking prednisone is often due to water retention, due to the drug’s activating effect on the mineralocorticoid system, but weight that remains for months or years is more likely to represent an actual increase in body fat. Steroid-induced diabetes is a recognized phenomenon, but even if blood sugar remains within normal ranges, it’s possible that this stubborn weight gain represents a sort of steroid-induced metabolic syndrome, which may be frustratingly resistant to conventional recommendations involving diet and exercise.

At the base of this mystery might be a little-known and underappreciated side effect of taking corticosteroids, namely urinary chromium loss. Chromium is a trace mineral that is essential to healthy blood sugar control, and research has shown that even a short course of corticosteroids can dramatically increase the amount of chromium lost through the urine[ii]. With long-term use, this could possibly result in chromium deficiency. There are also case reports of steroid-induced diabetes resolving with chromium supplementation[iii], suggesting that chromium deficiency may in fact be to blame. Therefore, chromium supplementation is an important consideration to support healthy blood sugar levels in any patient using oral corticosteroids and may be especially useful to support healthy insulin levels in patients who struggle to lose weight after taking prednisone.

                While chromium deficiency may explain some of the long-term metabolic effects of corticosteroids, most of the withdrawal symptoms result of under-functioning adrenal glands. Taking large doses of synthetic cortisol for any length of time will result in suppression of hypothalamic-pituitary-adrenal (HPA) axis, resulting in decreased natural cortisol levels. Tapering off of the drugs can help mitigate this to an extent, but sometimes symptoms of fatigue, brain fog, water retention, joint pain, and mood changes seem to last much longer than expected, resulting in a sort of never-well-since-prednisone syndrome. In this case, administering homeopathic cortisol may be an effective way to help re-sensitize the body to its own natural cortisol, stimulating the vital force to help reestablish a natural rhythm of secretion. Adaptogen herbs may also be useful in this regard, due to their overall normalizing effect on adrenal function.

There are numerous adaptogens to support the adrenal glands, but another herb to consider when supporting patients after corticosteroid use is Astragalus, due to its immune support benefits. Immune suppression is not just a side-effect, but in many ways the main effect of corticosteroid medication. While these drugs are remarkable for their ability to control inflammation, they do so by depressing the immune system generally, which can include reducing T-lymphocyte populations[iv]. Astragalus is so potent that it is actually considered contraindicated in patients currently taking corticosteroids[v], as it may reduce their intended effect, so what better way to support the immune system after their discontinuation? In these times when a healthy immune system is so critical, supporting its natural recovery as soon as possible after ceasing the medication should be made a priority. In addition to its blood-building and immune support properties, Astragalus may also support healthy blood sugar control[vi], making it even more worthy of consideration to support patients as they come off of corticosteroids.

 

[i] Younes AK, Younes NK. Recovery of steroid induced adrenal insufficiency. Transl Pediatr. 2017;6(4):269-273. doi:10.21037/tp.2017.10.01

[ii] Ravina A, Slezak L, Mirsky N, Bryden NA, Anderson RA. Reversal of corticosteroid-induced diabetes mellitus with supplemental chromium. Diabet Med. 1999 Feb;16(2):164-7. doi: 10.1046/j.1464-5491.1999.00004.x. PMID: 10229312.

[iii] Ibid.

[iv] Schuyler MR, Gerblich A, Urda G. Prednisone and T-cell subpopulations. Arch Intern Med. 1984 May;144(5):973-5. PMID: 6231898.

[v] Natural Medicines Comprehensive Database, Eight Edition. (2016). Astragalus [monograph].

[vi] Agyemang K, Han L, Liu E, Zhang Y, Wang T, Gao X. Recent Advances in Astragalus membranaceus Anti-Diabetic Research: Pharmacological Effects of Its Phytochemical Constituents. Evid Based Complement Alternat Med. 2013;2013:654643. doi:10.1155/2013/654643

 

 

Any homeopathic claims are based on traditional homeopathic practice, not accepted medical evidence. Not FDA evaluated.

These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.