Nutritional considerations during steroid treatment-Part 1

Patient Expert

The medical use of steroids is constantly reexamined because the agents have numerous side effects. While popular media coverage highlights concerns regarding their risks, steroids do have a multitude of beneficial properties and are often a key component in the treatment of cancer and other chronic diseases. If your doctor has recommended steroids as a part of your cancer therapy, it's important to understand that he or she is doing so because the benefits of treatment outweigh any potential risk. The use of systemic steroids (taken by mouth or injected into a blood vessel) can affect your body's nutritional requirements; knowing what to expect and how to counter the side effects may alleviate fears and concerns.

The word steroid describes a number of naturally occurring hormones that affect many of the body's organ systems. Though there are similarities across sub-classes, primary functions and side effects can be quite different. Sex steroids like estrogen and testosterone influence reproduction and fertility, while other steroids called mineralcorticoids mainly affect fluid and sodium balance in the body. Anabolic steroids are the well-known group of hormones closely related to testosterone that promote increased muscle mass and masculinization. In contrast, the steroids typically used for medicinal purposes actually promote the breakdown of muscle, and are primarily used for their anti-inflammatory and immune-suppressive properties. Glucocorticoids, including prednisone, methylprednisolone, hydrocortisone, and dexamethasone, are the agents most often used in the treatment of cancer and other diseases. These medications have direct anti-cancer cell action and may enhance the effects of some chemotherapeutic agents. They may also be used to suppress nausea, stimulate appetite, and reduce brain swelling in patients with intracranial tumors. Despite their lifesaving properties, steroids are linked to a number of side effects that should be addressed prior to and during treatment to reduce or avoid any serious complications.

Though steroid treatment most often stimulates appetite, it also occasionally causes nausea, decreased appetite, constipation, and abdominal pain. Steroids are known to irritate the stomach lining, so doctors often recommend taking an acid-reducing medication during longer courses of steroid treatment (i.e. those lasting more than one week). Taking your medication with a small amount of food, limiting caffeine and dietary fat intake, and avoiding late night meals can help reduce stomach irritation and reduce the risk of developing an ulcer.

Most people know someone who has experienced weight gain related to steroid treatment. A temporary fluid weight gain of ten pounds is common for someone beginning steroid treatment, and steroids can produce a dramatic increase in appetite even over a short period of time, leading to further weight gain. Steroids are also known to alter the deposition of fat in our bodies, and patients on long-term steroid treatment can develop preferential weight gain in the belly, back, chest, and face called "centripetal obesity." This appearance can be exaggerated by muscle thinning in the arms and legs, an effect also related to treatment. Weight gain with steroid treatment is not completely avoidable, but consciously limiting sodium and calorie intake can modify the amount gained. Focusing on low-calorie foods like fruits and vegetables may alleviate cravings, and increasing physical activity can counter some additional intake. Keeping a food diary or counting calories to track your daily intake may help you recognize when you are over-eating.

Steroid treatment may also interfere with absorption of key nutrients, including calcium and vitamin D. One serious risk of steroid therapy is the development of brittle bones and fractures related to calcium and vitamin D deficiency. Your doctor may recommend a multivitamin with 400 IU's of vitamin D, and you may also need to take an additional calcium supplement since most daily vitamins do not provide the amount required for someone on steroid treatment. Milk is an excellent source of calcium and vitamin D, and additional vitamin D can come from short periods of sun exposure. Also, regular physical activity counteracts the breakdown of bone related to steroid treatment and generalized illness. Light to moderate exercise, like walking, stretching, or swimming, can also protect your bones from demineralization.

Healthy sources of calcium in your diet include the following:

  • Plain lowfat yogurt
    Skim or 2% milk
  • Calcium fortified orange juice
  • Calcium fortified cheese (especially mozzarella(
  • Soymilk
  • Chinese Mustard Greens
  • Chinese Cabbage
  • Salmon cooked or canned with bones
  • Other sources include clams, blue crab, soybeans, okra, and kale.

Dietary sources of vitamin D include:

  • Salmon, mackerel, and tuna fish
  • Sardines, canned in oil
  • Milk
  • Fortified margarine
  • Pudding prepared from a mix and made with vitamin D fortified milk
  • Ready-to-eat fortified cereals
  • Egg yolk
  • Cooked liver or beef
  • Cheese
  • Pure Cod liver oil (check the label because vitamin D is sometimes removed from refined cod liver oil)

Other nutritional considerations during steroid treatment include protein breakdown, high cholesterol, high blood sugar, sodium retention, and impaired absorption of vitamin C and potassium. These issues will be addressed in my next post. Stay tuned...