Metabolism

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Is there a dosage at which one regains their metabolism when on prednisone, or does one have to be off it all together for that to happen?

My normal winter weight gain before PMR was 5 pounds. After a few weeks of morning golf, I was always back to my desired weight.

Since PMR and prednisone, no amount of summer golf reduces that weight in the slightest. (I played well over 100 rounds last summer on a par 70 course.)

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  • Posted

    I don't think it has much to do with your metabolism. I'm sure Eileen can explain to you what it is about Prednisone makes you gain weight but I do know that carbs are a big thing to stay away from to keep from gaining weight. I don't know that exercise alone can keep you from gaining weight especially just golf. I'm not say that golf is not good exercise but I think that you're going to have to watch your intake as much as your outgoing calorie.

    • Posted

      I'm so well aware of the carb intake aspect. I also know that I've read where people who are ardent workout "freaks" find no amount helps in any way, rid themselves of those pounds. Just as I was saying my golf game always had until prednisone.

      I'm totally convinced it's the fact that ones metabolism is compromised.

      The only way for all, then, while on prednisone, is to eliminate carbs to lose the weight.

      Which brings me back to my initial question: Is it only when one is off prednisone that the metabolism kicks in again, or when one gets to a certain dose?

  • Posted

    Pred affects "intermediary metabolism": (This is an extract from Physiologic and Pharmacologic Effects of Corticosteroids by Lorraine I. McKay, PhD and John A. Cidlowski, PhD in a book called Cancer Medicine which you will get access to online by searching).

    "Glucocorticoids stimulate the conversion of protein to carbohydrate through gluconeogenesis and promote the storage of carbohydrate as glycogen. ...  Glucocorticoids stimulate the process of hepatic gluconeogenesis, resulting in elevated plasma glucose, which, in turn, promotes the deposition of liver glycogen.34 Increased hepatic gluconeogenesis/glycogenesis is due to direct effects of glucocorticoids on the hepatic expression of genes that code for enzymes required for glucose and glycogen biosynthesis. Prolonged exposure to glucocorticoids leads to a diabetic-like state due to the increase in plasma glucose, while low glucocorticoid concentrations lead to hypoglycemia, decreased glycogen stores, and hypersensitivity to insulin. Glucocorticoids also decrease facilitated uptake of glucose in peripheral tissues to provide more glucose for glycogen formation in the liver. ...

    There are two established effects of glucocorticoids on lipid metabolism. One is the redistribution of body fat in hypercorticism; the other is facilitation of effects of lipolytic agents. Large doses of glucocorticoids lead to redistribution of fat to the upper trunk and face, with a concomitant loss of fat in the extremities."

    Taking out carbs does help reduce these effects on the body. I lose weight as long as my carb intake is almost zero but more than about 20g available carb intake per day and I don't lose, much more and I gain weight.

    What it also does do is cause fluid retention in some people which can be helped by reducing your salt intake and causes the liver to release frequent spikes of glucose into the blood for no reason - and that triggers production of insulin to bring the blood sugar level back to normal. The problem is that more insulin is released than is required and it is just a short spike, not the sort of long drawn out level due to a meal. The insulin sends the BS level crashing down too low causing you to crave carbs to raise it again, which stimulates more insulin production. Rinse and repeat! This is the cause of steroid-induced diabetes in some people. And is also the cause of weight gain as the excess insulin encourages your body to lay down stores of fat in the usual pred places, around your middle, on your face and the back of your neck.

    If you can cut your carbohydrate intake it helps a lot to reduce the amount of insulin produced and you will probably lose weight even while still on pred. I lost 36lbs while still on between 10 and 15mg pred. Others who have cut carbs from the start avoided weight gain and the moon face in the first place. One lady on the forums gained over 6st/85lbs within a short time of starting high dose pred for GCA. She lost not an ounce until she stopped pred and a few months later discovered she'd lost weight when her skirt fell down in a shop! redface She hadn't eaten more, hadn't eaten less - it just happened. She needed a wheelchair for a long time.

    So it is the usual story - everyone is different and all anyone can do is try cutting carbs or any other dietary approach to see if it works for them. There are several ladies on another forum who are on long term pred and have lost large amounts of weight using the slimming world approach. My 17 year old grandaughter turned vegan over a year ago - she had gone from a very dainty UK size 8 to an 18 because of high dose pred for severe asthma. We are fairly sure it is dairy that makes her asthma so bad - but her mum sent me a photo this morning and she appears to be back to about a UK size 10, certainly under a size 12. I think she is still on pred though her asthma has been much better since she went vegan so maybe she isn't. I've yet to hear from her!

    • Posted

      Thank you so very much, Eileen! What would this site be w/o you!

      I knew from the start about weight gain, so I have always monitored my carbs and dairy; thank God. The most I've been overweight is 9#.

      I am 2 years into this, and on the reduction plan you promote. Almost through my first phase of going from 10-7.5. My next try will be from that to 5; then

      maybe take it by 1/2mg steps from there.

      How devastating for your teenaged granddaughter! I hope she's soon back to her dainty self. Oh, what she could have learned from her oh-so-knowledgeable grandmother, had she only asked, huh?

    • Posted

      Have you been doing it 2.5mg at a time? Has it worked OK? I have told people it should work in theory if you go slowly enough but the proof of the pudding is, as we know, in the eating!!!
    • Posted

      I don`t need much these to fuddle my brain, but my daughter-in-law like your ladies you know has lost a lot of weight, and still is....with slimming world, but how can we lose it if we can`t have carbs....she eats loads of them it`s "allowed" and dosen`t have to be (syned) counted!...sorry if I`m missing the point  here, but I have gained 9 pounds and feel very uncomfortable, it is adding to my pain.  I get very bored with salads....so if we can`t have carbs, what do we eat for a snack (meals aren`t a problem)

      ?Glad your grandaughter is getting her weight down, I have one the same age, and they are obviously more self-conscious at that age than us (or me anyway)

      Thanks for any suggestions.....

    • Posted

      My younger daughter also has a load of pred weight to lose and does it with SW - seems horribly complicated to me! And really not eating-out-friendly! 

      I suppose I'm lucky - I'll eat salads until the cows come home! I don't eat snacks - I eat lunch about 1.30pm and dinner at 7.30pm and that is it. I grew up in the 1950s in a household that didn't "do" snacks. You ate at mealtimes - and that was it. I guess it was good training! When I need food outside mealtimes and the meal table (travelling for example) I eat carrot and cucumber sticks, cherry tomatoes, lumps of cheese, hard boiled eggs, slices of cold meats. If you google low carb you will find loads of suggestions - and then it is a case of finding the foods you like amongst it.

    • Posted

      PS - often thinking you need a snack is actually your body trying to tell you you want fluid - drinking a glass of water and going of to do something for 15 minutes often means you forget you wanted something to eat! 
    • Posted

      I must be going mad...it`s this heatwave!, well that`s my excuse....don`t know why I put snack, meant lunch....I don`t have a problem with eveningveggie/meat/fish meals etc....it`s when I can`t have bread/pasta/rice etc....and don`t like salads mid-day....so thank you will look up what you said...it dosen`t bother me either to be somewhat hungry, would rather that than feel bloated which I do lots of the time....

      ​Have to say my daughter-in-law eats loads.....but still loses up to 2 pounds a week on slimming world, and with all those carbs.....can`t see how........Thanks again......

    • Posted

      Yes, Eileen, this was the first time I tried it--the program and going from 10-7.5.  You said that one would immediately know whether the dosage was right or not.  I suspected that with this theory, phantom pain is virtually nonexistent.  I think the end of this first cycle ends around the 4th of June.  I have not had one day of setback.  I'm my usual, fortunate, peppy self--able to work never-ending hours on difficult tasks--cleaned out 30' of Russian Sage last week in 6 hours; worked on reorganising my closets for over 12 hours one day, with just short meal breaks.  Once prednisone was prescribed, I was rid of all pain with the first, 10mg tablet (2 years ago).

        I think I'm going to go directly into the 4th-day-start (did it with the above, too) right after this first cycle is over.  I'll let you know how that works.  If I have any side effects, I may consider laying off a few weeks before attempting it again--that restart would tell me whether it's possible, or whether I still need that extra dosage, or a less severe reduction, to curtail the inflammation.

    • Posted

      You need to be careful below 7 mg because it isn't just the inflammation any more - it's also the adrenals and waking them up from their pred induced holiday so they provide you with enough cortisol to sustain life, eventually without pred.  

    • Posted

      Thank you, I will. The slow method gives me the leeway to test its viability as I work toward the lowest level of prednisone my body needs.
    • Posted

      Hi Linda. I'm wondering what "slimming world" is. This is the second time I've heard of it

    • Posted

      I'm assuming it's like weight watchers?

       

    • Posted

      Yes, you are given what you can and can`t eat,  ( booklet) and I think you can have up to 15 "syns" a day....she can eat all the carbs she likes and not have to count them, so she feels very full....one thing she has to remember is when she roasts potatoes, or fries anything is to use a product (don`t know if I can name it on here) that you spray onto roasting tin, instead of oil...it begins with F.......

      ?She has tried dieting before and struggled, but not with this.....and like W/watchers you are weighed in weekly.....and have the "talk" if you like.

      ?Like Eileen has said....she isn`t taking pred like us.......shame because I do like rice/roasties......and without bread (certain type on S/World you can eat) I struggle with lunchtimes......I`ll get there though, because the extra weight (9lbs) makes my posture worse and backache.....already have scoliosis...so extra on back of neck/torso not welcome!!sad

       

    • Posted

      I did SW a couple of years ago pre Pred. The disadvantage is that although as you say you can eat potatoes, they don't have to have any fat used with cooking them except the 1% spray. No butter with new potatoes! Each slice of bread is 5 Syns as well so really you can't eat all the carbs you like actually. It does work but I did find it difficult not eating bread.

    • Posted

      Yes, I agree.....this is what I would find hard, I do like midday to have something on toast, or nice sandwich.....daughter-in-law takes mixed pasta or rice with her to work...........
    • Posted

      As Anhaga says - a slimming club. Also to be found online. And, if anyone is interested, although it is UK based, it is now present in the USA as I discovered by googling "slimming world". But it is quite low-fat centred so no use to me! I think my daughter finds eating out quite difficult so abandons it when on holiday or travelling - which really isn't the point of weight loss. Whatever you choose has to be a lifestyle change that works for you - and that includes both losing weight AND being able to live with it for a long time!

    • Posted

      Linda17563, there is nobody on the face of this earth that enjoyed PASTA more than me. When we were first married my wife would ask me, what would I like for dinner? And the answer would always be the same, PASTA! Those were the days when the thinking was complex carbs we're okay for diabetics. Yes, I miss my PASTA, but want to be healthy. How about trying Quinoa instead of Pasta. You might enjoy it and good for you. Keep smiling!

    • Posted

      Have been on forum couple of years and PMR 3 years. Never had an explanation of effects of carbs regarding glucose and insulin. Makes a lot of sense. Watched carb intake but not closely enough. Will start low carb diet today. Thank you so much.
    • Posted

      Thank you for that, my grandson at 15 is a pasta fanatic just like you say you were...he does a huge amount of sport so we don`t complain about it, he says it`s where he gets his energy from.....whatever is energy I ask myselfwink

      ​I have had quinoa in the past....I have several vegetarians in my family who serve it.....and I do like it.....tomorrow I start to do different to lose my weight...and will include it....a good suggestion thank you....

    • Posted

      Good luck, I`m starting that too....it`s something to do with summer clothes feeling tighter methinks as well!.....
    • Posted

      Anyone who did endurance sport ( triathlon, 10K runs or longer, long bike rides) will tell you about "carb loading"  or "carbohydrate loading" before the race.  You can google on either and will see.  Even now, with PMR, I cant live without carbs; that is what gives me energy for my exercise. 

      There are basically two chices to controling or maintaing weight : you either decrease the intake or increase energy you expand.  Body (muscles) need carbs for energy.  Calories from carb are used by our bodies without any "conversion loss". If you use calories from fat, conversion factor is about 0.8 and from protein is 0.7 - which means you need larger quantity of proteins (+30%) compared to carbs.

    • Posted

      There is actually a blog somewhere from a long distance runner who does it on a low carb diet.
    • Posted

      there is always exception to the rule...typical endurance athlete will do carbo loading before the race. There are 3 "modes" of creating energy

      You know that muscle use ATP (adenosine triphosphate )for energy needs:

      1- for short burst anaerobic form of energy (less then 15 sec) ATP stored in the muscle is used

      2- then muscle starts converting  carbohydrates into ATP (carbo -->glucose-->glycogen-->glycolysis which is converted to ATP + lactic acid) for any effort up to 2 min. Mode 1 and 2 are anaerobic

      3- Much more complex methabolic system can produce ATP from carb, fat or protein in aerobic process (using oxigen), but with different efficiency, which is what I was pointing out.

      very short 4 min video can be found on youtube under the following title

      "Energy Systems - ATP Energy In The Body - Adenosine Triphosphate - Glycolysis". It explains all 3 energy modes...

      Even after carbo loading, reserves are depleted after 30-45min, and then system switches to fat burning.

    • Posted

      My deleted posts were about a study done on a fairly large group of such athletes...
    • Posted

      Thank you for that, yes I know it`s basically maths with energy...but I have pain and stiffness and this is very limited, so with trying to lose weight means eating less....my family don`t think I eat too much now....so it`s not easy...but will try to fill up on anything but carbs, many things don`t suit me, I also have Fibromyalgia, which makes me sensitive to lots of foods....it`s a minefield.....I have never had the extra weight where the pred has given it to me.....horrible.....

      ​My guilty pleasure is two squares of dark chocolate each evening, that`s enough for me...I have never drank alchohol, so this is my treat......redface

    • Posted

      could you send me a link via private email pls?
    • Posted

      linda17563, you are welcome , glad to be of help. You can do it, please believe me. Keep smiling!
    • Posted

      Linda, look up little quinoa patties on the internet. Epicurious. I found I had to figure out different proportions for the instructions on cooking the quinoa, and it made far more than the recipe indicated, but they were very good!

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