There are many reasons a doctor might prescribe corticosteroids, a type of synthetic hormone medication that is mainly used to treat conditions characterized by inflammation. While these drugs have been used for decades in a variety of different contexts, they can still have a number of side effects that are difficult to manage. The most common side effects of corticosteroid therapy involve mild indigestion or an increase in blood pressure, but in some cases they have been known to cause other effects, like weight gain. One example of a corticosteroid that may lead to weight gain is prednisone.
What is Prednisone Used to Treat?
Prednisone is typically prescribed either alone or in combination with other medications as a treatment for symptoms related to having low corticosteroid levels. Corticosteroids are normally produced in the adrenal glands, and they are involved in numerous physiological processes, including stress responses, immune system activity, the metabolism of carbohydrates, and the regulation of inflammation. Prednisone can also be prescribed if a patient has normal corticosteroid levels, but in that case it is used to essentially enhance the normal function of these hormones and their effect on body systems. Below are some examples of conditions prednisone can be used to treat:
severe allergic reactions
some kidney disorders
some types of cancer
inflammatory bowel disease (IBD)
How Does Prednisone Work?
The main mechanism of action in prednisone is to mimic cortisol, a steroid hormone that, among other functions, suppresses immune system function. One of the body’s standard responses to disease or irritation is to trigger an inflammatory response from the immune system. Inflammation is the body’s default way of attempting to eliminate a pathogen or any other substance that might be causing irritation. This is why, for example, an allergic response to an airborne irritant causes a runny nose; the inflammation in nasal passages spurs the production of excess mucus to flush out the irritants.
Under normal circumstances, this inflammatory response is a good thing that removes potentially harmful substances and allows us to stay healthy. Of course the symptoms related to inflammatory responses are often unpleasant and can negatively affect our quality of life on a temporary or ongoing basis. Anti-inflammatory medications like prednisone and other synthetic steroids are beneficial, because they suppress this immune response and ease the symptoms. Prednisone is a much stronger medication compared to over-the-counter anti-inflammatory drugs, however, and so it is typically only used for the treatment of symptoms in severe conditions.
In some cases, the regular immune response becomes abnormal and mistakenly attacks an organ, certain cells, or an entire body system. These inflammatory conditions are called autoimmune diseases, and examples include lupus, multiple sclerosis, celiac disease, and various types of arthritis. In many patients with an autoimmune disease, the body doesn’t produce enough cortisol to suppress immune function. Therefore a corticosteroid like prednisone is needed to regularly inhibit the production of pro-inflammatory compounds called cytokines. Depending on the person and the severity of the condition, the medication may need to be taken indefinitely to continue preventing the symptoms.
Side Effects of Prednisone
Prednisone and other corticosteroids all tend to have similar side effects because of the basic way they interact with the body. Generally speaking, the number, type, and severity of side effects will depend on the dosage of the medication: a low dose tends to mean fewer side effects and a high dose tends to mean more side effects. There also tend to be a set of side effects experienced shortly after beginning the medication and a separate set that are possible after long-term use:
Short Term Side Effects
irritability or mood changes
Long Term Side Effects
increased risk of viral or bacterial infection
eye problems like glaucoma and cataracts
moon face, a rounding of the shape of the face
fatigue or weakness
easier bruising and slower wound healing
congestive heart failure
loss of muscle mass
Does Prednisone Cause Weight Gain?
Some recent research has indicated that there is a connection between corticosteroids like prednisone and weight gain, but it appears to be an indirect connection. In one study, for example, patients who took prednisone over a period of two years gained between 4-8% of their body weight. These same studies have also shown a tendency for fat redistribution in the body; this means that fat deposits moved from one area of the body to another, usually the face and extremities. This is one explanation for the side effect known as moon face, a rounding of facial features that is due to new deposits of body fat.
The explanation for why prednisone usage led to weight gain is multifaceted. One reason is because of water retention. One of the side effects of prednisone is that it causes the body to retain more sodium in the bloodstream; this, in turn, leads to excess water being drawn into the blood and distributed around the body in the form of swelling and bloating. The other explanation for weight gain is due to an increase in appetite; because of the way prednisone mimics cortisol, it can disrupt the hormones that regulate appetite. Over time, this can promote a tendency to overeat and consume more calories than are expended.
Dealing With Prednisone-Related Weight Gain
Not everyone who takes prednisone will gain weight, and even for those who do gain some weight, it may be a negligible amount. Nevertheless, if you’re on a prednisone prescription and weight gain is one of the side effects you experience, you may be able to talk with your doctor about switching to another medication. The good news is that you can also avoid more weight gain or lose some weight by making some adjustments in your daily life:
Low-calorie diet: It may be obvious, but since increased appetite is one of the main drivers of weight gain, it can be mitigated by simply reducing the number of calories consumed on a daily basis. One way to do this is by increasing the amount of dietary fiber in general and particularly through fruits and vegetables; fiber helps you feel full faster and longer and can help you control food cravings.
Exercise: Physical activity is important for health regardless of your weight, so find ways to move around more often or exercise. The more you move, the more calories you’ll burn and the likelier you’ll be to overcome a calorie surplus.
Reduce sodium intake: Fluid retention is the other main driver of prednisone-related weight gain, so switching to low-sodium foods and overall reducing your sodium intake can help bring down the swelling that the medication promotes.
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