1. Weight gain Usually the most dreaded of prednisone's side-effects, increased appetite and weight gain are seen to some degree by nearly all patients. The amount of weight gain varies from individual to individual. In addition to causing weight gain, prednisone also tends to redistribute body fat to places that are undesirable, particularly the face (moon face), back of the neck (buffalo hump), and abdomen. The higher the dose and the longer the treatment, the greater the effect. To some extent these changes can be minimized by exercise and the dietary changes described below. If you find this confusing, a consultation with a registered dietitian or nutritionist may be helpful. Ask your doctor for a recommendation.
Avoid salt Most of us consume much more salt (sodium chloride) than our body needs. Normally, our kidneys keep our body in balance any excess salt is excreted in the urine. Prednisone causes sodium retention and potassium loss which may lead to fluid retention, weight gain, bloating and low blood potassium levels. In some patients, this can cause high blood pressure or worsen a pre-existing condition. We suggest a no-added salt diet and avoidance of highly salted pre-packaged convenience foods. Use fresh herbs whenever possible. Read food labels. Don't add salt to cooking and remove the salt shaker from your table. Instead use low-salt spices to add flavor to your meals. Ask your doctor about using salt-substitutes which are helpful since they contain extra potassium. It may be helpful to add high potassium foods such as bananas, citrus fruits, melons, and tomatoes to your diet. Be sure that your blood pressure and blood tests are checked regularly.
Avoid fat Most Americans also eat too much fat. Fat has over twice the calories per gram than proteins and carbohydrates. By limiting the fat in your diet, you automatically reduce the calories and may lower your blood cholesterol at the same time. With the new food labels, it is easy these days to find low-fat items in your supermarket.
Avoid simple carbohydrates Most foods contain some fat, protein, and carbohydrates. Carbohydrates (sugars and starches) can be either simple molecules or complex molecules. Avoid simple carbohydrates which are digested too quickly and leave you hungry. Complex carbohydrates are more satisfying since they must be broken down by the digestive process and are absorbed more slowly into your system. Simple carbohydrates are foods like candy, cakes, pies, white bread Complexwould include whole wheat bread, rice, beans, sweet potatoes, high fiber cereals, sugar-free candies.
Small frequent feedings To combat increased hunger, snack frequently on low-calorie foods such as fruits, vegetables, low fat dairy products, low salt rice cakes, and sugar free candies. Instead of three large meals, eat smaller more frequent meals.
Eating out When eating out, tell the waiter what you need. Don't be embarrassed or apologetic. Just ask directly for what you want. In our health conscious culture, most restaurants are used to special requests - just tip accordingly. When flying, call the airlines and request a low-fat low-salt meal in advance. They are quite prepared to help you. If you are in a situation where a special meal is not possible, don't panic. Eating salty high fat or sugary foods occasionally is not going to make much difference. Just enjoy them in moderation and be more careful the next day.
Female sex
Caucasian or Asian heritage
Small, thin frame
Lack of regular weight-bearing exercise
Poor calcium intake in diet
Family history of osteoporosis
Early menopause or removal of ovaries
Low testosterone levels in men
Tobacco use or heavy alcohol use
Overactive thyroid Thyroid hormone pills
Diabetes
Prior ulcer surgery
Crohn's disease
Eating disorders like anorexia
Eat calcium rich foods Increasing the amount of calcium in your diet can lessen the risk of osteoporosis. Your goal should be 1500 mg per day. Low fat dairy products (skim milk, low fat yogurt, fat free cottage cheese) are a good source of calcium. Many new products are even fortified with extra calcium. Certain vegetables are a good source of calcium including kale, turnips, collard greens, and broccoli. Another simple way to add extra calcium is by taking Tums tablets that contain calcium carbonate. Take two tablets during a meal twice a day.
Take vitamin D Just eating more calcium is not enough. Vitamin D is required to help calcium be absorbed into your system and strengthen your bones. Vitamin D is obtained by exposure of your skin to sunshine, vitamin D fortified foods, and taking a vitamin supplement. We suggest about 800 mg per day - more can be harmful. One way to add calcium and vitamin D is a combination such as Citracal caplets + D which can be purchased without a prescription in the vitamin section of your local pharmacy. Take two tablets twice daily with food. This will provide an extra 1260 mg. of calcium and plenty of vitamin D each day. It is also recommended that you take a multivitamin supplement daily.
Exercise Prednisone can also cause muscle weakness and atrophy. A low impact daily exercise program will help burn up more calories, improve your sense of well-being, and help prevent muscle and bone loss. Exercise can also help prevent the weight gain that often occurs during prednisone therapy. This exercise program should include both aerobic exercises which burn calories and improve cardiovascular fitness as well as moderate weight-training which strengthens muscles and slows bone loss. It doesn't have to be complicated and you don't have to join a gym. For bone and muscle strength, weight-bearing exercises are especially important. A simple walking program is a good way to start. Start slowly and do the best you can. You don't have to be jock. If you are too fatigued one day, just try harder next time. The important thing is to have a program of regular exercise.
Estrogen replacement Estrogen, a female sex-hormone, protects and strengthens bones. After menopause, estrogen levels drop and women become more susceptible to osteoporosis. Adding prednisone to the picture more than doubles the risk. The good news is that taking a low dose estrogen supplement helps prevent this problem. If you are a post-menopausal woman and on prednisone, ask your gynecologist if you would be a candidate for hormonal replacement therapy.
Medications to strengthen bones In addition to diet, vitamins, exercise, and estrogen, two new drugs show great promise in prevention of osteoporosis. Miacalcin (calcitonin) is given as a nasal spray once a day and reduces bone loss. Fosamax (alendronate) is another new drug that has been shown to actually strengthen weak bones. It is given as a tablet, but may cause ulcers of the esophagus in some patients. Be sure you know how to take it correctly before starting treatment. Much research is being done and other new drugs are on the way.
Measuring bone density A simple painless x-ray is called a bone densitometry test can tell your doctor if your bone density is normal or below normal. In general, the lower your bone density, the higher your risk for fracture. Since osteoporosis has no early warning symptoms, beginning. its first visible sign may be a debilitating. Now we can better estimate who is at risk. If you are on long-term prednisone therapy, ask your doctor about bone densitometry.
Phats
Great Stuff. Prednisone in a Nut shell !!
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