carbs on Prednisolone?

[Gca629]

Hi Just been diagnosed with GCA

Been prescribed Prednisolone 50 mg for 6 weeks by GP and referred to a Specialist

I saw a brief comment about avoiding carbs on Prednisolone

Could some explain or expand please.

Thanks

[PMRpro Ambassador]

One of the side effects of pred is that it triggers the liver to release random spikes of glucose into the blood from the body stores in liver and muscle. Excess glucose in the blood is acted on by insulin to deposit it as fat stores in specific places due to the action of pred. This can lead to weight gain and the random spikes of glucose can be enough to lead to the development of steroid induced diabetes, You can't influence the production of these random spikes but you can lower the average level of blood glucose by restricting the contribution made by dietary carbs,

How much you need to cut carbs varies from person to person - some of us need to get down to almost keto levels, other can get away with more. However, it is almost impossible to use the keto diet concept of ketosis since the random spikes of glucose are often enough to take you out of ketosis and you cannot influence them.

[PipandDots in reply to PMRpro]

Can I ask whether a very dose (0.5mg) will still cause these random spikes of glucose into the blood? Thank you PMR pro

[PMRpro Ambassador in reply to PipandDots]

Don't know - I suspect it depends on the patient.

[PipandDots in reply to PMRpro]

ok thank you for your reply

[Louisa1840]

I wish I had known about not eating carbs when I was first diagnosed with PMR six and a half years ago! I have gained over 15 kgs and I am NOT happy about it! It's so easy to put it on and SO hard to take it off!!

[Gimme]

I was diagnosed pre diabetic January 2022 and had reversed it by Oct 2022 by following the diabetes prevention diet, which very simply is no foods containing added sugar, limiting white starchy carbs, plenty of veg with each meal, and plenty of protein to prevent hunger. There's a bit more to it than that, but that's for brevity. It is a low glycaemic index diet, rather than no carbs.

Then came a PMR diagnosis in Nov 2022 and I started on 15 mg of pred in Feb 2023. I went straight back on the diabetes prevention diet and I didn't put any weight on at all, until I fell off the wagon a bit in Oct 2023 and hey presto, I started to put on weight. I didn't eat more to put on weight, just the wrong things. With a new year, I am back to controlling my carbs to try to get back to the same weight that I was at the start of pred. On the plus side, my hba1c is still within the normal range.

[Gca629 in reply to Gimme]

Thanks for that.

I’ve gone straight to Dr Michael Mosleys 800 cal a day diet to try to prevent weight gain.

Been prescribed 50 mg a day for 6 weeks until I see a specialist so hopefully can keep it off and maybe start to taper off the pred.

Cheers

[Gimme in reply to Gca629]

800 calories a day is pretty drastic for a man, unless you need to lose weight very quickly, especially if you are active or still working. The very fast 800 diet is a fasting style diet for weight loss, not really intended for weight maintenance or for long term. The maximum recommended is for 12 weeks. Same applies to Mosley's diet (not sure if they are the same thing, as I am not a fan of ultra low cal diets). You really need something that is more sustainable and you also need to be able to eat enough to make sure that you are getting all your micronutrients to maintain good health. For a sustainable option, I would consider following the dietary recommendations for diabetics, which is designed to minimise blood sugar spikes, and still enables you to get all the essential nutrients that you need.

[Gca629 in reply to Gimme]

Thanks,

Not really overweight but have done the 5:2 fasting diet occasionally

Were using recipes from BHF and Diabetics UK web site so should hopefully be Ok

Thanks