Weight gain but loss of appetite

I have had PMR for 9 months and am currently on 8mg Prednisolone (increased recently recently from 5mg due to flare). Also have been on Alendronic Acid from the start. Pain-wise things are not so bad now apart from first thing in the morning. I am walking for 30mins per day and have recently upped my exercise to include running (???!!!) up and downstairs a few times and some light weights.

Having struggled with my weight for as long as I can remember, and having previously lost 49lb I now find my weight is increasing for no apparent reason even though I don't have the appetite I used to. I stick to a Mediterranean diet with little sugar and few carbs. I know my body and know when I should be losing or gaining weight and know when I'm kidding myself! My GP tells me it's not the steroids that increase weight, but the associated increase in appetite. If he is correct, then why am I putting on weight while having a decreased appetite and eating less?

I've had thyroid blood tests a few times in the last couple of years which are apparently normal, though I do have some nodules on the thyroid.

Whilst this doesn't seem like a major problem in light of what some people are going through, it's not entirely vanity. I'm 60 and want to live a long and active life without lugging round extra weight! Can anyone throw a light on this?

[SnazzyD]

Hello,

I have found that even a small bit of carbohydrate for more then a few days will put on the weight. So I eat virtually no pasta, potato, rice, maize, anything with flour in it. I also watch root veg like carrots, parsnip, swede etc. but eat a bit every day. If I'm wanting a different texture to protein and veg I'll have a spoonful of quinoa. I don't avoid fats because of their nutritional benefit but I don't eat actual meat fat on the edges. I still have about 300-500ml 11-12.5% wine per week and have a couple of squares of 85% dark choccy daily because science says I should and who am I to argue with that!😉

Salt is another big issue and quickly causes fluid retention and extra weight within a day or two. Therefore I avoid salt in sauces, snacks, processed foods. Never added salt to cooking. Good thing about fluid retention weight is that I've found it is easy on easy off in about 2-3 days. I make sure I have good sources of potassium and magnesium in my diet and occasionally to table salt made of mostly a potassium salt if I'm desperate.

I'm sure you'll get more tips but meanwhile it is worth looking at related posts because this topic comes up very frequently.

[Hidden in reply to SnazzyD]

Thank you. Although I do consider my diet to be generally good, maybe I need to pay more attention to detail. I rarely eat processed food but checking my salt intake is a good idea. Meanwhile I'll check out related posts.

[SnazzyD in reply to Hidden]

Yes, before Pred I had what most would say was a very good diet. Pred has demanded special measures. Cutting carbs has really controlled the blood sugar swings I had with Pred too. The hunger was no better but at least I could sate that by eating veg and protein. I forgot to say about fruit. I haven't cut it out but I know some do. On a daily basis I eat an apple, about 5 black grapes, two handfuls of mixed berries, a small orange, and a greenish banana twice a week. An occasional treat is a fig or a persimmon but luckily they have a short season and the supermarket specimens here are tiny. I do take a weekly multi Vit B supplement ( no idea if it's enough but more upsets me) because I have so little wholemeal in my diet due being gluten free anyway.

Good luck!

[Hidden in reply to SnazzyD]

I've cut down on fruit, though I still eat an apple and berries every day. Occasionally I have a greenish banana (can't remember why you should eat them when they're green but I prefer them then anyway).

[SnazzyD in reply to Hidden]

A source of potassium, and some fibre.

[SheffieldJane]

I still think that your Thyroid function or rather lack of it could be at fault. I suspect medical thinking keeps us at a nice safe level of thyroxine so we are always slightly hypo. I have not been the same since radio iodine treatment for Graves' disease in the 80s - really slow metabolism. My dear friend mucked about with TCH is it called- the substance that the thyroid gland strives to make. She took it directly and felt lively and lost weight. She was later diagnosed with heart failure, so perhaps this is why they keep us at plodding donkey rate?

Sorry for the the amateur mumbo jumbo. Metabolism does play a part and we've had ours assaulted with various conditions. Fasting works on me but it's supposed to be dangerous. I was getting somewhere with the 5.2 diet ( on the days you are allowed to let rip, you stop wanting too).

You're doing well and this is not your fault. Keep on batting away, your choices are healthy, that counts for something.

[Hidden in reply to SheffieldJane]

Thank you Jane. I do seem to have a lot of the symptoms of underactive thyroid - weight gain, fatigue, constipation, low mood, dry skin - but blood tests always come back normal for that. I guess the symptoms can equally be put down to the medication, though. I do fast to a certain extent - I don't eat between 6.30pm and 7.30am. I may adjust my diet, keep up the exercise and hope for the best.

[PMRpro Ambassador]

Sorry - your doctor is wrong. Pred makes your liver release spikes of glucose into the blood randomly - which results in a spike of insulin to bring it back down. There is some insulin left over and that encourages deposition of fat when there is any glucose about.

Snazzy has already discussed the rest - you may be on low carb, but perhaps it isn't low enough with pred. I have to eat a VERY low carb diet to maintain my weight. Depending on what else you eat, your fruit intake alone could be as much as 30-40g utilisable carbs - add veggies and dairy and you easily come well above 50g which for me would probably mean weight gain, it would certainly mean no weight loss.

[Hidden in reply to PMRpro]

Thank you so much - that is really useful. I think I need to study carb values and really make the effort. It seems that what I've always considered a good diet (and certainly would be for most people) is not good enough when you have PMR. I feel really (well, relatively!) energised and optimistic now that I know I can probably do something about it. Thanks again.

[PMRpro Ambassador in reply to Hidden]

As SJ commented - I used the 5:2 diet at first to help me reassess portion sizes and it made a major difference to what i expected/needed to eat. I now fast from 8pm when we eat dinner and 1.30pm when we eat lunch. Breakfast is a rare experience (in hotels where it was included in the price!) and when I have had my eggs and bacon then I really don't need lunch.

It isn't it wasn't a good diet - the pred moves the goal posts! And a decent amount of fat and a good amount of protein is essential when on pred.

[Hidden in reply to PMRpro]

I could happily miss breakfast - usually just a boiled egg - but that is when I take the Pred and I've always thought you should eat when taking it. Am I wrong? I take it at that time as it keeps my stiffness away for the rest of the day.

[PMRpro Ambassador in reply to Hidden]

Should really to reduce stomach issues. I tend to forget about that fact - my pred is the form you take at night, within 3 hours of a meal. But a boiled egg won't raise the insulin level so effectively is still fasting really. The soldiers are another matter though ...