Nutritional considerations during steroid treatment - Part 2

Patient Expert

My last post reviewed some of the common adverse nutritional effects caused by steroid therapy, including stomach irritation, weight gain, and vitamin D and calcium deficiency. Additional complications of steroid treatment include protein breakdown, increased cholesterol levels, high blood sugar, sodium retention, and impaired absorption of potassium and vitamin C. Knowing what to anticipate and how to counteract some side effects may help you maintain a healthy appetite, a well-balanced diet, and the energy needed to withstand other cancer therapies.

Prolonged steroid therapy can lead to the breakdown of protein to release short-term energy sources, a process called protein catabolism. While the process can be beneficial in times of stress, over time it results in severe loss of body protein, muscle wasting, poor tissue healing, and an increased risk of infection. If you're taking steroids as a part of cancer therapy, eating a protein source at each meal can limit additional breakdown of muscle and bone and help avoid weakness and poor wound healing related to protein deficiency. Healthy sources of dietary protein include fish, white-meat poultry, eggs, beans, soy, lean beef, milk, cheese, yogurt, and eggs.

Elevated glucose level (high blood sugar) is another complication of both short-term and long-term steroid use. Steroid agents elevate blood sugar by triggering the breakdown of protein and fat, which leads to increased availability of molecules used to make glucose, including amino acids and glycerol. Persistently high blood sugar associated with prolonged steroid use is a risk for dehydration, recurrent infections, and heart disease, and in some cases increases the risk of developing type II diabetes. Maintaining a healthy body weight and increasing physical activity are the best ways to counter this risk. Also, your doctor will likely follow blood sugar levels and may even recommend treatment with insulin to avoid the risks of high blood sugar.

In a similar fashion, steroid therapy can also raise cholesterol and triglyceride levels, even over a short period of time. During steroid treatment you should decrease your intake of dietary cholesterol and saturated fats and use alternatives like mono-unsaturated fats (like canola or olive oil instead of vegetable oil) and egg substitutes. You may also want to limit yourself to four egg yolks per week. Substitute fish for red meat at some meals, and limit your intake of baked goods, cookies, and crackers to special occasions.
Steroids also influence fluid and electrolyte balance. Sodium retention caused by steroid treatment contributes to weight gain and generalized fluid retention, and may increase your risk of high blood pressure. When starting steroid therapy you should consider limiting the amount of processed foods and added salt (salted chips, high sodium soups) in your diet, and discuss concerns with your doctor if you are already being treated for high blood pressure.

In addition to their affect on sodium and water balance, steroids can inhibit the absorption of some vitamins and minerals, including both potassium and vitamin C. Potassium is a mineral needed to maintain muscle strength and a normal heart rhythm. Low potassium levels can cause fatigue and palpitations, which can limit your energy and exacerbate other side effects of cancer and cancer treatment. Eating at least two potassium-rich foods daily is generally recommended, with options including orange juice, apricots, bananas, cantaloupe, baked potatoes, and tomatoes. Vitamin C depletion related to steroid therapy can reduce resistance to infections and impair wound healing, similar to the effect of protein catabolism. Vitamin C is found in many foods and drinks, including citrus fruits and juices, potatoes, broccoli, bell peppers, and tomato juice.

I must reemphasize that despite the long-list of potential complications of steroid therapy, these agents provide numerous health benefits and are a key component to some cancer therapies. If you're feeling overwhelmed at the prospect of taking steroids, keep in mind your doctor has recommended them because the benefits of treatment are likely to outweigh any potential risk. Being aware of what to expect while taking steroids can help you minimize or avoid some complications.