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How can I prevent weight gain while having steroid injections?

Our experts answer questions on the best way to prevent weight gain while taking steroids, and how to overcome a stitch while running


I have a steroid injection every four weeks, given to me before I receive an infusion of a drug called Tysabri, for multiple sclerosis. I have been gaining quite a lot of weight since starting it despite my diet not changing. I receive the steroid to try to reduce a side effect of the Tysabri, which was causing skin lumps. Is there anything I can do to prevent weight gain?


Although the reason you need steroid medication is uncommon, steroids in general are used for a wide range of conditions including more severe types of arthritis and other inflammatory or allergic conditions like asthma and eczema.

What matters is how much of the steroid gets into the body. An asthma inhaler, for example, delivers almost all of the steroid only to where it is needed; the tubes of the lungs. Eczema creams stay largely on the skin. In both cases very little steroid is absorbed into the rest of the body so side effects can be kept low. Steroid tablets or injections are different because the drug is absorbed and distributed throughout the body by those routes.

To some extent steroids make your metabolism a bit more sluggish, and they can unmask a tendency for someone to become diabetic. It may help therefore to restrict your overall calorie intake slightly as your previous intake may now be a bit more than you need. If you are able to take some more exercise, this will help.

Your doctor is likely to be keeping an eye on your blood sugar (glucose) level. If it has been a while since it was checked ask to have this looked at, just in case you are beginning to drift up into the diabetic range, which may require specific treatment.

The main way to minimise the side effects of steroids is for their dose to be kept as low as possible, but there is a limit to how far this can be done and still get the necessary benefits. Unfortunately one cannot completely uncouple the good from the bad sides of steroid treatment.


Over a longer term, high doses of steroids, given frequently, might lead to side effects including weight gain, mood changes, sleep disturbance, high blood pressure and thinning of the bones – although these side effects are more likely to occur with steroid pills than injections. As with all medications, your doctor will be weighing the benefits against the risks of these problems. But there are ways to reduce your risk of some of them – for example, making sure your diet contains plenty of calcium from low-fat dairy products, fish with edible bones (salmon, sardines), legumes, dark green vegetables and calcium-fortified products (soya products, breakfast cereals) and taking calcium and vitamin D supplements can help to protect your bones.

To stop gaining weight you will have to reduce your calorie intake and increase your physical activity (although this may be difficult due to your MS).

The easiest way to eat fewer calories without feeling hungry is to fill up on high-fibre (whole-grain breads and cereals) and low-energy foods (such as fruit and vegetables) and to include a source of protein at each meal (lean meat, chicken, fish, pulses, Quorn). Don’t be tempted to skip meals, especially breakfast, as you are likely to snack on high-fat/calorie foods instead. Kick start your metabolism with a healthy breakfast such as porridge or another whole-grain breakfast cereal with lower-fat milk, or a poached egg on wholemeal toast – this should keep you going until lunchtime. For lunch, go for whole-grain sandwiches and lower-fat fillings such as chicken and salad, hummus or grilled vegetables. Also good are baked potatoes with baked beans, which will provide you both fibre and protein.

It is worth keeping a simple food diary for a couple of days – not necessarily to “calorie count” but so that you can spot easy ways to cut back.

Drinks can also make a substantial contribution to calorie intake, and simply having a filter coffee instead of a latte, opting for diet drinks or water instead of standard soft drinks and cutting back on alcohol can all make a difference.

Use the diary to look at your eating patterns and identify the times when you eat most or are likely to snack on higher-calorie foods. If you continue to gain weight, it might be worth joining a slimming group to give you some support or asking your GP if you can be referred to a dietitian for more advice.


While your MS needs to be looked at from a medical, nutritional and stress-reduction point of view, try to find a place for some exercise in your armoury if possible. Weight gain can sometimes be, in part, down to the fatigue associated with the condition.

The chronic, unpredictable nature of MS makes it difficult to manage. It is understandable that you won’t always have a willingness to take part in physical activity but consider exercise as part of an overall management plan.

Regular cardiovascular activity will increase levels of serotonin, improving your mood. Improved mood and reduced stress will help you make wiser food choices.

Exercise does help, even if it is only 10 minutes of walking – some days that may be all you will feel like. Other days you may add some low-impact dumbbell strength exercises which help your muscular strength, power and endurance leading to an increased muscle mass and subsequent improved metabolism. Low-impact exercise may be more suitable for you since there is less strain on tendons. Swimming and aqua aerobics are good choices.

You might also consider Tai Chi or yoga. Tell your doctor you are exercising and especially if you experience any change in your symptoms.

Running with a stitch

Q What’s the best way to conquer a stitch when jogging? They always make me give up too easily.


Stitches are a muscle spasm of the diaphragm, the dome-shaped muscle that separates the chest cavity from the abdominal cavity. As you take air into your lungs your diaphragm moves down; as you breathe out it moves up.

Muscle spasms can occur when you are jogging because of the bouncing movement of the internal organs. Runners sometimes contribute to the problem as many tend to breathe out when the right foot hits the ground, so repeatedly forcing the organs on the right side of the body to move down.

Try to avoid shallow breathing since this encourages the diaphragm to remain in a high position, which prevents the connective ligaments of the liver from relaxing and makes a stitch more likely.

While breathing out, pretend you are blowing out the candles on a cake. If your stitch is on the right, try to exhale when the left foot lands, since the organs attached to the diaphragm on the left side of the body aren’t as big, so there is less strain on the diaphragm.

If you do get a stitch, lean forward slightly and push into the abdomen on the right side, up under the rib cage, and forcefully exhale a deep breath at the same time.

It’s always best, of course, not to develop the stitch in the first place. Improving your fitness level – in particular, strengthening the core muscles – will help.

Don’t forget to warm up and gently and increase the intensity of your exercising rather than setting off quickly when you go for a jog.


The cult of misdiagnosis and over-prescription plagues us all

the current medical enthusiasm, as recently featured in this column, for diagnosing, on slender grounds, diabetes and similar conditions in all and sundry has prompted several further cautionary tales. A Cornish reader writes to tell how last year she learnt a blood test had revealed she had diabetes, and was advised accordingly she must forgo the pleasures of chocolate, biscuits and the like. During the same consultation her family doctor renewed her prescription for her blood pressure-lowering pill Bendroflumethiazide. Reading the information leaflet enclosed with her pack of pills on the bus home she discovered they can raise the blood sugar level which might, she reasoned, more than account for her recently diagnosed diabetes.

While it would be absurd to suggest that family doctors should be aware of the more obscure side effects of all the drugs they prescribe, this situation is rather different. Bendroflumethiazide is one of the commoner drugs prescribed for raised blood pressure and it is well known to cause diabetes in almost 10 per cent of those taking it. So for her family doctor to fail to make the connection is definitely a bit odd. She did the sensible thing and binned her pills. Gratifyingly, her “diabetes” has since cured itself, and for good measure, her blood pressure has also remained satisfactory.

In a further perplexing incident, a Kent reader describes how he was advised, following a brief hospital stay for an episode of numbness in the hands, that all investigations were satisfactory and he could return home.

The ward sister advised he would first have to wait for “pharmacy”, and an hour or so later he was given a letter for his family doctor reporting he had suffered a mini stroke or transient ischaemic attack. This was accompanied by a large brown bag containing pills to both lower his blood pressure and cholesterol level – both of which he had just been informed were normal.

It is difficult to say whether these two instances are typical of modern medical practice but they are certainly compatible with the drive to mass medicalisation, and the remorseless rise in the nation’s drugs bill.

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