Disclaimer. I could be talking total nonsense, but I don’t think so. It all makes good logical sense to me. Lots of maybes on this page though as I have no personal experience of what I’m about to try. But I can’t just sit back with this and watch my body go to shit – it was in bad enough condition as it was (my life choices) even before I was diagnosed with PF. And I even believe it could be me being overweight that was partially responsible for causing my autoimmune system to break. Damn. Damn.
It’s fairly common knowledge that if your Doctor puts you on steroids (corticosteroids) for any length of time, then there are a number of side-effects that may or may not happen to you, depending on your personal physiology, or genetic lottery as I like to think about it.
One of those is putting on weight and / or redistribution of fat around the body.
But why?
These two pages – mainly the first one in this case – explain in technical / biological / medical terms the reasons behind what corticosteroids do what they do to our bodies. I’ll try to convert that into normal conversational English so that we can all (me too) understand what’s going on.
https://www.ncbi.nlm.nih.gov/books/NBK13780/
http://www.sciencedirect.com/science/article/pii/S2405525515000096
There are two categories of effects of corticosteroids on the human body. These are called glucocorticoid (think about glucose being sugar, and sugar turning into fat), and mineralocorticoid (think about minerals, salts, dissolving in water).
As I said above, it could be the genetic lottery affects if and how much these effects apply to you, but a component is also the type of drug that you’re taking. A cortisol type drug (Prednisolone) causes the glucocorticoid type effects, and an aldosterone type drug (Aldactone) mainly causes water retention type effects. But while on corticosteroids it looks like you can experience BOTH of these, they’re not totally exclusive of each other.
Most people see them by the looks of it, but some don’t, and the ratio between the gluco and mineral effects ranges from all one and none of the other, and vice-versa.
As you might expect, it’s the glucocorticoid effects that cause both weight gain in the form of fat, and also redistribution of that fat to different parts of the body, typically the face, upper back and chest, and abdomen – away from your extemities of arms, legs, etc. It’s these that are now just beginning to affect me as I write this (August 2017) after 2 weeks at 30mg, and 2 weeks at 60mg Prednisolone.
So what’s going on?
It turns out that the glucocorticoid effects turn muscle into fat, but not the other way round – your body turns into a one-way street. In other words, over time with high doses of steroids you will experience muscle weakness (another side-effect) and increased fat. And as part of this conversion process there will be more glycogen and glucose in your system, which then steers you towards diabetes (another side-effect).
Shit.
That sounds pretty bad doesn’t it for a number of health reasons? Can we do anything?
Maybe.
It looks like even though the steroids cause the conversion of muscle to fat, it doesn’t necessarily mean ALL of the muscle mass will get converted. If you starved yourself then yes it will, but if you eat protein in your diet (yeah we do that), then your body can use the amino acids in the protein to add to your own muscle mass. So NOT the big disaster it looks like on that front.
Going on from there, then maybe a higher protein diet (got to be careful with this), and exercise to build your muscles back up will reduce the effects of protein to fat conversion and reduce the chances of becoming the moon-faced-fat-backed person we don’t want to become. Exercise (and a calcium and vitamin D supplement) will also help prevent loss of bone mass (osteoporosis – another side-effect).
That seems to all be making sense to me right now just by sheer logic, but I could be totally wrong if I’m missing something in this explanation of what I understand to be going on.
Then the issue becomes one of what kind of diet, and how much exercise. I have a feeling my daily 30 minute walk isn’t going to be enough. Also, while taking corticosteroids which are causing these issues, we have to be careful not to trigger other potential problems in our bodies such as bone damage to our spine if we exercise too hard. I am already hearing little clicks and pops when I sit down and stand up or move my head too fast. It’s scary.
My opinion as I write this is that gentle but prolonged exercise (stamina training) is a better option than stressful strength training, and I hope that makes sense to you too.