Research on Steroids
Research is piling up that steroids can have adverse downstream issues.
We used to think this was mostly from extended use, but in some of you it can occur from even using steroids for a few days.
A population-based study of more than 2.6 million people found that taking corticosteroids for 14 days or less was associated with a substantially greater risk for gastrointestinal bleeding, sepsis, and heart failure, all which can occur up to 30 days after you stopped taking the steroids.
Patients were tracked from 5 to 90 days before treatment for various conditions when steroids had been prescribed.
With a median duration of 3 days of treatment, increased risks occurred for GI bleeding, sepsis, and for heart failure.
Over the years, some literature has been suggesting that long-term bone loss and fracture is an issue, for example, from even one epidural. The more epidurals, the more risk.
Other research refutes this. Like everything in medicine, it can be confusing.
Who gets steroids? Almost 60% of scripts for them are for skin disorders, such as eczema and severe rashes, for respiratory tract infections, sinusitis and acute pharyngitis.
Long-term use of steroids has been linked to increased risk of blood sugar and immune issues. This has been known for a long time.
I have a close girl friend whose daughter was on steroids for chronic joint pain for many years. Then, in her 40’s she developed a rare blend of type 1 and type 2 diabetes that to this day is not well controlled. I have always wondered if she is living with an iatrogenic effect (drug induced).
The University of Michigan, my alma mater, ran a study in 2017 on more than 1.5 million privately insured US adults. The researchers looked at longer “steroid bursts” of up to 30 days’ duration. These Michigan investigators found that use of the drugs was associated with a greater than fivefold increased risk for sepsis, a more than threefold increased risk for blood clots, and a nearly twofold increased risk for fracture within 30 days of starting treatment.
Risk Vs Benefits
Steroids Assault Bone Integrity
The increased risk for blood clots and fracture (bone thinning) persisted at prednisone-equivalent doses of less than 20 mg/d. You don’t have to take a lot to have increased risk.
Glaucoma and Steroids
I have glaucoma and steroids are always a concern for their effect on intraocular optic nerve pressure. If you have disc disease and you get a number of epidurals, how often does your orthopod doc confer with your eye doc to make sure you aren’t making your vision worse?
In medicine it is not easy for the right hand to know what the left hand is doing. And as we get older and have more issues, the complexities increase and so does the chance for one treatment for one condition to make another condition worse.
The Michigan study also found that during the 3-year period from 2012 to 2014, over 20% of patients were prescribed short-term oral corticosteroids. Almost a fifth of patients.
Steroid use is as common as handing out M & M’s for diverse issues that aren’t going away.
While life-style, food, gut health, are not part of the evaluation or treatment in too many cases.
The understanding that corticosteroids are associated with adverse events has been building for decades even though they are so widely used.
Most patients don’t think anything of taking them.
Short-term corticosteroid ‘bursts’ are being prescribed for minor ailments while research is clearly showing that even 3 days use may increase risk for serious events in both young and old.
And keep in mind, these increases were seen in young, healthy people, not just in people with preexisting conditions.
Some patients get great relief from them. If you have a severe flare from rheumatoid arthritis or inflammatory bowel disease, they may be life-saving.
That’s medicine. Risk versus benefits? How do your possible gains compare to your possible downstream issues?
When I worked in Tulsa we used a very effective plant-based steroid called Seraphin, which of course, was banned by the FDA. It had the benefits of steroids without the downstream nasty issues. You could even use it for epidurals. But… no more.
Why don’t we look at food, nutrients, gut health, and functional alternatives like low dose naltrexone? These can help some patients, not all, but many. I’ve consistently seen this to be true over many years of practice. And so have so many of my colleagues. But if we mainly look at health from Big Pharma doctor bags, our patients miss out on getting to the “root cause” of why they are ill with safe more long term answers.
Avoid oral steroids when you can. Look to safer alternatives whenever possible.
Additional Links of Interest
- Association Between Oral Corticosteroid Bursts and Severe Adverse Events Annals of Internal Medicine July 7 2020
- Short term use of oral corticosteroids and related harms among adults in the United States: population-based cohort study (Published 12 April 2017) BMJ 2017;357:j1415