Hi has anyone tried the 16:8 version of this by delaying breakfast til c 11am . There are many health benefits including anti inflammatory and bone health in this process but I am wondering how my body might cope waiting for its steroids ? I guess it’s only 1 day out of kilter and then it’s just a new time ? Any experience out there ? Thank you ( ps I’m on 3mg of pred )
intermittent fasting - impact of delaying steroid... - PMRGCAuk
intermittent fasting - impact of delaying steroid intake
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Sydney0503
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I don't have experience of intermittent fasting but would query why 11am? Is it the number of hours or time of day that's important? Could you start your 8 hours at 9am and still be successful in the outcome you want?
I'm on 3mg and would worry that taking pred at 11am might have an effect on the pred being out of my system when the body needs it to be to encourage my adrenal glands to work towards functioning as they should without pred - but that's because I've had some symptoms of struggling adrenal function.
You could either adjust your dose timing before starting your intermittent fasting, or start your 8 hours on day 1 at 9am, day 2 at 10am, day 3 at 11am to ease yourself into the change.
Good luck and let us know how it goes 😊
3mg will be down to a very low level by midnight which is when it matters even taking it at 11am. At the slowest rates, it will be less than 1.5mg by 3pm, by 7pm 0.75mg and by 11pm 0.34mg.
Why does that matter? Is it because of the cortisol spike at 4? am?
Because a low level of corticosteroid in the blood at midnight is what triggers the HPA axis (hypothalamus, pituitary, adrenals) to switch on the process that produces the body's natural corticosteroid, cortisol, for the next morning, It peaks about an hour after getting up. While you are on higher doses of pred the body registers there is plenty around and doesn't produce more but at low doses the body needs to produce a top-up.
hi I’m not sure I follow ? If I take it at say 6am it would be out of my system even quicker ? Isn’t consistency the key or is it sometime to do with the 3am cyctoclines ( or whatever they’re called ) ?
It won't be out quicker - just earlier. Don't mix up the production of cortisol by the adrenal glands and the shedding of inflammatory substances which cause the PMR/GCA inflammation in the early morning. They are two separate processes.
Hi, what physiologically speaking is the best time to take pred if you are on 7mg?
Physiologically and medically speaking if you are taking pred to deal with inflammation - as you are in PMR - then 2-3am is the ideal. That places the peak dose of pred in the bloodstream in time for the shedding of inflammatory substances at 4-4,30am so it never gets a hold. It also leaves the maximum time for the pred to be eliminated from the body before midnight so interferes less with the trigger to the body to produce its own corticosteroid. Prednisone needs to be taken at 2, prednisolone can be taken a bit later as it only has to be absorbed and not processed by the liver.
apologies if I’m not understanding as I’m not sure what you’re advocating . It must vary for people based on what time they get up , travelling in different time zones etc . I’m not bad first thing at the moment so given the health benefits of fasting ( including anti inflammatory, cell renewal, bone health ) , it could be worth a go ? ( not sure about exercising though …. )
And I don't understand your point or what you are asking. Circadian rhythms establish over time and yes, it will vary slightly depending on the time someone gets up on a regular basis but the vast majority of PMR patients are older and probably get up 7 to 8am. No-one travels across time zones every day, day after day. Shift work totally messes up circadian rhythms and it isn't recommended for patients on pred to be working shifts ...
I’m new here & delighted to have found your comment regarding cortisol & circadian rhythm. I’m on 5mg of Pred but still suffer pain more than I think I should. Trying to avoid increasing the dose (probably foolishly) as I’m aware of the side affects. I take my Pred in the morning around 9am with breakfast & my symptoms often don’t subside until mid afternoon (sometimes they stay all day). On occasions I’ve been driven to taking just 1 NSAID (Nurofen) in the early hours & been amazed at how much better I’ve felt when I get up around 8am. It’s left me questioning why I’m taking steroids! From what you’re saying this is not a coincidence but a key part of how our bodies work/respond naturally. Could you go into further detail please - or post links to help me understand exactly what’s happening & how we can help ourselves? I’ve an appointment with a rheumatologist next week & would like to be able to question him on this. Actually, I’m wondering how our health providers can prescribe these steroids without advising us of the best time to take them. Thank you.
"I’m on 5mg of Pred but still suffer pain more than I think I should."
Which almost certainly means you are on too low a dose of pred - a low dose of pred merely means there is some inflammation lrft and it builds up over time until there is enough to cause symptoms. And you are adding to it by waiting to take the pred until so late in the morning - the process of forming new inflammation starts at about 4-4,30am and then it takes at least an hour for the pred to be in the system to do anything, That means inflammation has been added to for nearly 6 hours so there is more to do to even get you to the baseline which is probably higher than it need be. And don't imagine this is a case of pred is bad, no pred is good since low grade inflammation left active in the body long term lead to other problems including peripheral vascular diseasem heart disease and cancers.
hcplive.com/view/nighttime-...
is a report on the work Cutolo did which probably addresses your questions. It only discusses RA but the same applies in PMR though I don;t have a reference for the paper mentioning that. Lodotra was specifically developed for this scenario but was only approved for use in the UK for RA for a time and it is no longer an option. In the USA it is far more expensive - in the thousands of dollars. It is used here in Italy, I'm on it, and my rheumy says he finds it very advantagoues for morning symptoms.
However, we have quite a few people on the forum who set alarms to take their pred at 2am or take enteric coated pred before bed which has a similar effect. Others manage to split their dose so the antiinflammatory effect last better overnight, Yet others purchase enteric coated capsules which also delays the release of the pred for some hours.
Few doctors read all the publications and apply new thoughts to the procedure they learned in medical school. Pred has always been taken in the morning, they know natural cortisol peasks about 8am - so without thinking about the physiology that is the time you should take pred. It takes time to be absorbed so 8-9am is too late for good pain relief. In many people the anti-inflammatory effect of pred lasts 12-36 hours - so, on an adequate dose of pred which clears out ALL the inflammation, for most the effect lasts the full 24 hours - it is less critical what time the dose is taken as long as the time is adhered to because the last one is still working. But for the few for whom the effect doesn't last 24 hours, the pred has too much to do and it takes longer to work and it isn't 100% effective.
However - it is very unusual for NSAIDs (which also have long term adverse effects) to achieve relief of PMR symptoms and pain so if a single ibuprofen achieves that much relief - the question is as to whether this is really PMR. PMR isn't the disease, it is the name given to a set of symptoms with an underlying cause. In our case it is a pred-responsive autoimmune disorder but there are several others that don't respond as well to pred but do respond to NSAIDs. So is it REALLY PMR that is causing your pain that is being relieved by ibuprofen?
Oh - and do go and read the FAQs which include a lot of information collected together so we don't have to repeat ourselves over and over again. Then if you have questions you can't find an answer to, ask them. The link is below the main post at the top of every thread and in the Pinned Posts.
This is such useful info. I don't actually suffer from PMR but find this group to be so helpful. I have fibromyalgia/osteoarthritis, sai from long term pred use for ulcerative colitis and a blood thinning disorder and dysfunctional platelets. I'm just managed to taper to 7.5mg Preds daily. I normally take my morning preds at 6am, then a smaller dose at 11am and an even smaller dose at 3pm. I also use a 5mg pred suppository at 8pm for my uc. I am in pain all day in my fingers on my right hand and my back with other niggly pains all over. I take cocodamol but it only takes the edge off. Would I be better taking my 6am dose at 2am? Then readjusting my other doses accordingly?
I honestly don't know - though usually you would do better by taking a bulk of the pred to deal with the PMR inflammation in the early morning . You have to have a high enough bolus to deal with that morning shedding of inflammatory substances - if you just nibble away at it with small doses you are never clearing it out. Maybe that applies for you too?
However - UC can present with PMR symptoms
pubmed.ncbi.nlm.nih.gov/226...
I never actually thought about the smaller doses... I might just try 5mg at 2am and then 2.5mg at 12pm? And I didn't know about uc and PMR. That is so interesting. I shall look more into this. I always know when my uc is about to flare as my joints get extremely painful. The pred suppository is keeping it under control atm. But I am always in some sort of pain. As I said my right hand is causing me extreme problems atm. Swollen and paid full to the point I can't open lids or pick up heavy things. My rheumy said get a stress ball 🙄. Wasn't interested. Just wanted to give me tramadol and send me on my way. I didn't get on with the tramadol so back on the Cocodamol round the clock.
Plonker - if I try a stress ball it just hurts MORE! Have you got any numbness or tingling in the right hand?
That's what I thought lol... No just extreme pain especially in my first finger...
Morning! I took 5mg at 3am in the night and I've woken this morning with far less pain than usual! Hoping it's not just a fluke. I'll take another 2.5 at 11 and see how the day goes. So glad I saw this post! Will update in a couple of days.
Might be worth trying more at 3am or even half an hour earlier - the crucial bit is clearing out that morning bolus of inflammation altogether. Once you are down to a decent baseline, it is easier ongoing. In fact, a few days treating it as if it were a flare with some extra pred might work even better.
Noted. I'll try 7.5mg at 2.30am tonight and report back tomorrow. Thank you so much for all your help! 🙏🏻
It really is a case of working out what works best for you - but that early morning result is very important for most.
I’m not particularly achey in the morning right now so if I hold out a bit longer might that be ok ( 3 rheumatologists have disputed pmr ) but whatever it is , it does seem steroid responsive .
I burst the last stress ball I had. It would have been better being thrown........
Haha! Think I would do the same!
I think we can guess the potential targets!
Thanks for your informative response. I’ve set my alarm for 2am! Lots of reading to keep me busy here on the forum too. Hopefully, with all this info plus my Mediterranean diet I’ll kick the inflammation into touch (if only it was that easy hey?). I’d really like to learn what triggers PMR- mine occurred gradually after my first influenza jab & continued to get worse with each Covid jab. Coincidence? Who knows? I stopped all vaccines after 3 of each & wished I’d cottoned on to the idea that they may be the cause of the aching & weakness symptoms sooner.
I had my alarm set for 3am as I take prednisolone. Woke up this morning feeling great with much less pain. I hear you with the vaccines. I had the first 2 in 2021 and I haven't been the same since so no more for me either! Please let me know how you got on with 2am alarm.
They aren't the cause - they may be the trigger that tips your immune system over the edge but that could equally be the illness they are to mitigate or a whole range of other things that affect the immune system during your life - illness, trauma, stress of any sort, environmental and chemical, mental. The vast majority of people who have developed autoimmune disorders have never had a vaccine of any sort and the majority who have vaccines don't develop anything. If it hadn't been the jab poking at the immune system, it would have been something else. And one lady comments that her PMR improved after a jab - works both ways!
I hear you but there’s research out there that is looking into Autoimmune Inflammatory Syndrome Induced by Adjuvants that’s making interesting reading. The research has been brought about by the now recognised increase in PMR since the roll out of Covid vaccines. It’s not saying it’s the only cause - just a possible cause of increase.
I didn't say they weren't a problem - many of us are concerned about the use of adjuvants. But it is because they stimulate the immune system - the propensity to develop PMR (or whatever) must be present for it to then happen. Long Covid is a form of autoimmune disease and that has been obvious to those of us who have an autoimmune condition since it first appeared but doctors insisted in looking the other way for a long time.
Ditto to PMRpro’s comments and maybe read this intro/info post - still useful even though you are not new, new!
I don’t eat until 1pm and have brunch as I cannot face food when I get up. The downside is I tend to have low blood pressure in the morning and every so often I faint!!
Hi , is that when you take your pred at 1pm ? 🙏
No, I take mine at 2am in the morning with a piece of hard cheese. It works well for me.
Is that the only dose you take at 2am or do you take more in the day? I have secondary adrenal insufficiency with arthritis so I'm interested in this 2am dose. I currently split my pred dose.
I just take mine at 2am. It worked so I have not bothered to change it. Of course I don’t know if twice a day would be better or not. At least I only have to remember to take the tablets once a day!!
Just as a matter of interest, piglette, do you have to set your alarm in order to take your pred at 0200 hrs? Just curious. You may, of course, be awake at that time, which I regularly am, as I am a late bird! Also I know you always take it with a piece of hard cheese so is that enough food to employ? Presume it must be.
I am thinking to change my time of taking my pred. From the start ie last year, when PMR hit me, I have been taking it after breakfast but the problem is I am not regular in my habits, so breakfast can be any time twixt 0700 - 1100 hrs. After reading this thread thoroughly, I really am beginning to think I should take pred at a more regular time. May be I will try the 0200 timing as that appears to be the best time to take it.
Interested in your comments, s'il te plait😁
I go upstairs at around midnight, I then read in bed, check my emails and listen to the Archers, by that time it is 2pm!! I read somewhere about taking Swiss cheese with the pred, although I am rather partial to Comte!
I think it is a good idea to be reasonably regular on the timings. It is very much what works for you. Some people find that pred lasts for a shorter space of time than for other people. Je t’en prie.
Merci bien, piglette. Your plan sounds a good one to me though I'm not sure I'd manage to stay awake till 2 am, if I climbed 'up the wooden hill' at midnight! Still I could always set the alarm. Think I will give it a go...
I have always been a night bird and hate going to bed. I also hate getting up in the morning!
Funnily enough, I have always been a night bird too. I remember an old boss of mine saying, 'M's a night bird isn't she?' (as I struggled to keep my eyes open)! But, if I actually did go bed at midnight, I do think I'd drop off to sleep. I have always hated going to bed and, until PMR landed, have also hated getting up. Now, because of pain in arms, I do get up usually when I wake. Sure everyone is fascinated to know all this🤣
Hello! I do intermittent fasting, works well for me, as I do not wake up hungry. I take my pred around 8am with a glass of kefir, then eat lunch around 1pm. I realise this would not suit everyone, I eat my evening meal around 8pm. I am feeling pretty positive, I am very active, and I think the hiking, swimming and pilates definitely helps...
thank you , what IF pattern do you follow and what dose of pred are you on currently ? Good to hear a positive story x
Hello! I was diagnosed in sep 2018 and started on 15mg pred. I tapered very gradually, and a year ago I was feeling pleased to have got down to 2mg when I had a flare of my other auto immune condition, uveitis (inflammation at the back of the eye). After having to increase pred to get this under control, im now at 4mg, and hoping to reduce very slowly to find the optimum dose that will keep the eye under control! I do the 16:8 version of IF - I eat 2 meals a day within an 8 hour period of approx 12.30pm to 8.30pm - so no breakfast, but I take my pred about 8am with a glass of kefir, which I am hoping is keeping my stomach happy - I have not had any digestive problems, and choose not to take omeprazole. I do have enteric coated pred which may help?
I try to eat healthily, but dont avoid all the nice things like bread, cheese and wine - I have always had a small appetite but I love good food and eat out a lot too. My mantra is 'in moderation' - but good food and wine are important to me! As I said previously, I am very active, hiking around 25 miles a week, swimming, and pilates, and this works for me - I am very grateful to be an active 65 year old, and I try to always stay positive. I wish you all the best with your PMR journey - I know I have been lucky compared to some as it has been a long 4 years, but it has not stopped me doing anything - I am currently having a wonderful Canadian tour of the Rockies and Vancouver! I know everyone is different, but I did not gain much weight on pred, and I think IF (and exercise) has helped me. Good luck to you, and best wishes!
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