Monday, May 1, 2017

Even short-term and low-dose corticosteroids (like prednisone) carry significant risks – explore alternatives!

Steroids are commonly prescribed for all kinds of health issues like allergies, back pain, joint pain, as well as respiratory problems including sinusitis and a variety of lung diseases.  Sometimes they are essential to recovery, but most of the time they are surprisingly optional.  Although the serious risks of long-term steroid use are well known, the short-term use of even low-dose corticosteroids also carries significant risks.  For example, within 30 days of beginning steroids at modest doses (such as less than 20 mg of prednisone daily) the risk of a major complication such as serious infections, broken bones, or blood clots (venous thromboembolism) increases by 2–5 times normal.  Once steroids are stopped, the risk rapidly decreases. [1] 

My recommendation:
Whenever steroids are recommended, don’t assume they are essential; ask your doctor exactly how important they are and whether you can recover without them.  Most of the time steroids are prescribed for problems which are self-limiting, so will get better (eventually) even without steroids. 
  1. If you must take steroids, ask for the lowest reasonable dose for the shortest possible time.
  2. Explore all possible alternatives, and take extra care to make the food and lifestyle choices that will give your body the best chance to heal.  For information about anti-inflammatory steps to take, see our August 2016 newsletter.
Miles Hassell MD

[1] Waljee, A. et al. British Medical Journal 2017;357:j1415