Reducing Inflammation with Steroids
by David Dunaief
Nov 12, 2019 | 9197 views | 0 0 comments | 980 980 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Steroids make headlines related to their use as a performance-enhancing drug in sports. However, if we look beyond the flashy headlines, we see that corticosteroids, or steroids, play an important role in medicine.

Medical use

Steroids have an anti-inflammatory effect. This is critical since many acute and chronic diseases are based at least partially on inflammation. Chronic diseases that benefit include allergic, inflammatory and immunological diseases.

These types of diseases touch on almost every area of the body, from osteoarthritis and autoimmune diseases to asthma, COPD and eye disorders.

Steroids are delivered orally, topically, or via injections, intravenous solutions and inhaled formulations, and they can be lifesaving in some instances.

The bad

However, there is a very big caveat: They come at a price. Steroids cause weight gain, increased glucose (sugars), high blood pressure, cardiovascular events, osteoporosis, change in mood, cataracts, glaucoma, infection, peptic ulcers, Cushing’s syndrome, and the list goes on.

These are among the reasons medical professionals recommend using the least amount for the shortest time.

The role in pneumonia

Pneumonia is among the leading causes of death. In a meta-analysis (nine studies), there was no overall effect of corticosteroids in reducing the risk of mortality in community-acquired pneumonia.

Yet, when data were broken into subsets, the findings were different. For those who had severe pneumonia, there was a 74 percent reduction in mortality.

Unfortunately, there was a greater than two-times increased risk of abnormally high glucose levels with prolonged use. Thus, for prolonged use, it’s wise to check glucose levels.

Osteoarthritis: surprising results

Osteoarthritis, specifically of the knee, is very common, and joint injections directly into the knee are becoming routine. A study compared injectable hyaluronic acid to injectable corticosteroid. The results showed that over three months, corticosteroid was superior to hyaluronic acid in terms of reducing pain, 66 percent versus 43.8 percent, respectively.

Interestingly, over the longer term, 12 months, hyaluronic acid reduced the pain and maintained its effect significantly longer than the steroid, 33 percent versus a meager 8.2 percent. Thus, steroids may not always be the most effective choice when it comes to pain reduction.

Hyaluronic acid may have caused this beneficial effect by reducing inflammation, protecting cartilage and preventing cell death, according to the authors.

COPD: Length may not matter

It is not unusual to treat COPD patients with oral steroids. But what is the proper duration? The treatment paradigm has been two weeks with 40 mg of corticosteroids daily.

However, results in an RCT of 600 patients showed that five days with 40 mg of corticosteroid was equivalent to 14 days of the same dosage and frequency. The hope is that the shorter use of steroids will mean fewer side effects.

Dietary effect

Steroids reduce inflammation, which is the basis of greater than 80 percent of chronic disease. A plant-based diet involving lots of vegetables and fruits and some grains may have a similar effect, but without the side effects. The effect may be to modify the immune system and reduce inflammation.

The bioactive substances from plants thought to be involved in this process are predominantly carotenoids and the flavonoids. Thus, those patients who respond even minimally to steroids are likely to respond to a plant-based diet in much the same way.

Diet, unlike steroids, can be used for a long duration and a high intake, with a direct relationship to improving disease outcomes.

In conclusion, it’s always better to treat with the lowest effective dose for the shortest effective period when it comes to steroids. Steroid complications are enumerable and must always be weighed against benefits.

Sometimes, other drugs have better long-term effects, such as hyaluronic acid injections for knee osteoarthritis. A plant-based diet with anti-inflammatory properties may be a good alternative for chronic disease or may be used alongside these drugs, possibly reducing their dosage and duration.
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