Two Questions

[caftan]

My sister and I, both in our '80's, take Omeprazole. She takes it because she has digestive problems. She says I should take it ate least half an hour before breakfast. Is she right? It says nothing on the information leaflet and my GP never told me that either.

Question no. 2 is about sugar. I love my cake and have continued to eat it since I was diagnosed almost 4 years ago. I have always been slim and have never put on any extra weight since being on steroids. I love my chocoate too but try to eat this in moderation! I have read a lot on this website about not eating sugar when you have PMR. Is this because of weight gain or because it is particularly bad for PMR sufferers. I had a setback a few months ago after getting down to 4 and a half mg and had to go back up to 15mg. I am now back down to 10mg and taking it slowly, and listening to what my body is telling me.

[PMRpro Ambassador]

"Why is it important to take PPI before meal?

PPIs achieve maximal efficacy when they are administered before a meal because they only bind to actively secreting proton pumps, which are activated postprandially. The American College of Gastroenterology guidelines recommend that patients administer their PPI prior to breakfast"

What that means is that they need to be taken BEFORE a meal to be absorbed and get into the system so that once you have eaten and the proton pumps are working the PPI can circulate in the blood and block the pump.

Most people gain weight when put on pred. Pred also triggers the liver to release random spikes of glucose from the body stores into the blood stream, raising the blood sugar levels without having eaten. and if this is bad enough it can lead to the development of steroid-induced diabetes. You can't stop this random release of glucose but you can remove the effect of carbs in the diet by controlling how much you eat. Both the effects, weight gain and raised blood sugar, can be reduced by cutting out unnecessary simple carbs and added sugar in your diet.

Actually, sugar and simple carbs are pro-inflammatory and some people do find that sugar rushes make their PMR symptoms worse.

Remember that you aren't heading relentlessly for zero - you are looking for the lowest effective dose, the lowest dose that gives the same relief of symptoms as the starting dose did. What probably happened is that you slightly overshot it - had you just gone back up to the last dose where you were fine you probably didn't need to go back to the beginning. It is an error a lot of doctors make. Adding 5mg to the dose at which you flared for a couple of weeks is almost always enough and then you can drop back to just above the dose where the flare happened, having found the dose you are aiming for for the moment.

[caftan in reply to PMRpro]

but do I need to take it at least half an hour before breakfast?

[PMRpro Ambassador in reply to caftan]

It works best if you do.

[caftan in reply to PMRpro]

thank you PMRpro

[Exflex in reply to PMRpro]

”What that means is that they need to be taken BEFORE a meal to be absorbed and get into the system so that once you have eaten and the proton pumps are working the PPI can circulate in the blood and block the pump.”

Hope you don’t mind me asking… thought I read recently that a PPI and Prednisolone can be taken at the same time. However in the light of what I quoted above the PPI needs to be absorbed and in the blood to inhibit or retard the acidity, which will take a finite time. So wouldn’t it be better to delay swallowing Pred by some amount of time (I aim for 1/2 an hour)?

[PMRpro Ambassador in reply to Exflex]

Once you have been on them a while it is less important, the inhibition persists for the whole day so there is some effect left from the previous day. But in short term use, yes, quite right.

[Exflex in reply to PMRpro]

Thank you, you’d make a brilliant Medic!

[PMRpro Ambassador in reply to Exflex]

I was a medical scientist ...

[PUMC in reply to PMRpro]

You ARE a medical scientist. I value your information I read on this site.

[piglette]

Steroids can cause diabetes. This can be caused by eating too many carbohydrates, especially from simple sources like sugary drinks. My HbA1c is checked yearly as part of my blood tests. This is usually recommended if you have PMR.

[Raewynne in reply to piglette]

Hi PigletteI am worried about my diet.I eat mostly carbohydrates now because I had to have a colostomy. I have steroid induced diabetes and cardiac issues .I can't eat all the healthy food because my stomach can't digest them and I don't want a blockage.What can I do??I have a protein drink .It just worries me about my bad diet.

[PMRpro Ambassador in reply to Raewynne]

That is something to discuss with your dietician - but I wouldn't worry too much, you have other priorities.

[piglette in reply to Raewynne]

I did mention how I found thatvI was losing weight by mistake on another post. I had seen a TV program on health and they had shown one woman a table full if whhat she ate in a week. It was all beige. So I started to wonder if all my food looked beige too. I started to photograph everything I ate and stuck it on Dropbox. It actually made me very aware of what I was eating and actually quite fun. My diet was not beige but quite pretty colours.

[Bcol]

Hi Caftan. I think most of us work on taking Omeprazole at least 30 minutes before a meal but, you are correct that neither the NHS or the PIL seem to mention it. Re Pred, weight gain seems to be fairly dependent on individuals, some it hits badly, others have less or no problems. Sugar though can/will have an impact on the possibility of steroid induced Diabetes. An, annual (at least) Hba1c test will let you know how things are going and I do a prick BS test every week, which although only relevant to that moment, does give me a clue as to how things are going. Interestingly since PMR and Pred my Hba1c score has gone down from 41 to 36! Luck! Or am I just more informative about what I eat now. I don't think that I have changed my diet very much - who knows - I certainly don't. Good luck.

[caftan in reply to Bcol]

thank you. I do have regular blood tests and all ok so far

[PMRpro Ambassador in reply to Bcol]

The PIL I just found online says it can be taken on an empty stomach or with food. Presumably that is to accomodate people who struggle to take pills on an empty stomach but the ideal is to take it half an hour before food. Once you have been taking it for more than a few days continuously the antacid effects persists over the full 24 hours.

[caftan in reply to Bcol]

thank you

[Menno1525]

Depending on your dose you could also consider splitting it morning and evening. My maintenance dose of Omeprazole which I have been taking for years for gastric issues is 20 mg which I take half an hour or so before breakfast as people have said. Currently however I'm taking 40mg as I had a flare of gastric symptoms post covid last year and have just commenced steroid treatment for suspected GCA. I take the second 20 mg half an hour or so before bedtime to ensure I'm not waking up in the night choking on acid reflux. Seems to work well and my GP trusts me to titrate sensibly as I need. When I'm on my maintenance dose sometimes just a night time slug of Gaviscon or equivalent is fine. Will be hoping to reduce my Omeprazole once I know what the situation with my GCA is, as on the one hand, I will definitely need the stomach protection, but, on the other, the interaction of my stomach meds and Pred seems to be giving me a tendency to the runs.

[PMRpro Ambassador in reply to Menno1525]

Might just be the omeprazole - it may be for stomach probles but it can't half upset the GO tract in some people!