I was recently asked for my opinion on steroids for inflammation for an article for Total Shape which you can read here.
Corticosteroids are typically used as a second line of treatment for inflammation, after NSAIDs like ibuprofen, in conventional medicine. But what are they and why should we be weary of this practice?
What are corticosteroids?
There are two types of corticosteroids: mineralcorticoids and glucocorticoids. Mineralcorticoids help balance mineral concentrations in the blood like sodium, whereas glucocorticoids, like cortisol, are involved in metabolism and stress. They are collectively called corticosteroids because they are secreted from the cortex of the adrenal glad. These are not the same class of steroids that are used to increase muscle mass.
For our discussion on inflammation, we will focus on glucocorticoids.
Cortisol, the main glucocorticoid in the body, promotes gluconeogenesis which is how the body rapidly produces its own glucose. Cortisol is released upon wakening in the morning to give you the energy you need to start your day and is tapered off throughout the day to help you have a restful sleep at night. However, cortisol is also released during times of physical and psychological stress.
Why this matters
The human body is almost the same now as it was hundreds of thousands of years ago in our hunter-gatherer days. We needed a boost of energy to run away from or to fight wild animal attacks. We also needed a boost of energy to go find water during times of dehydration. Now while we may non longer need a boost of energy for those reasons today, stress is stress and the body will react the same no matter what the source of stress is or how great it is. So this means you will have the same surge of cortisol, and therefore, glucose if you are stressed from less life threatening things like being stuck in traffic or being scolded from your boss.
If you are using the surge of glucose for physical reasons you will burn it off no problem but if you are not physically active during times of stress, like you are still sitting in your car or at your desk, then you will not utilize this excess glucose. Such excess is very detrimental to the human body. It can lead to excess cholesterol synthesis, insulin resistance (a major contributor to autoimmune diseases and the development of type 2 diabetes), heart and arterial disease, weight gain, and increases your risk of certain cancers.
Cortisol and glucose once aided the stress response. Now it worsens it.
Why corticosteroids are given for inflammation
When administered, usually by injection for acute injuries, corticosteroids lower lymphocytes (type of white blood cell) and decrease the production of phospholipase A2, prostaglandins, and leukotrienes which all contribute to inflammation synthesis.
Inflammation is typically synthesized in large amounts after injury, like spraining your ankle. Inflammation has a few roles. It helps to stabilize joints so that you do not move damaged and unstable body parts, it stimulates blood flow to the injured area to help bring nutrients to heal and clear out debris, and it increases pain to highten your awareness to the injured are.
Since pain is a very undesirable symptom, most, if not all, conventional therapies are aimed at eliminating pain as quickly as possible. The administration of corticosteroids is actually the closest conventional medicine gets to treating the cause of pain. Pain medications, like opioids, just inhibit the pain signal from reaching the brain. Corticosteroids help decrease the source of the pain causing chemical. But no treatments have been deployed to help treat the injury and heal the damaged tissues.
Why corticosteroids don’t work
These steroids, like cortisone, hydrocortisone, prednisone, and methylpredinsolone, are very effective at rapidly reducing acute inflammation but they do not treat the injury, the damaged tissues. As long as there is damage, the body will continue to produce more inflammation. Inflammation is vital to the healing process. We just tend to produce too much inflammation because of our diets and lifestyles. When too much inflammation is present for too long then it becomes a problem.
Corticosteroids are not an effective therapy for chronic inflammation because the source of the inflammation is different. Chronic inflammation is more systemic in nature. It is produced by a different pathway than acute inflammation is and its production is stimulated by diet and lifestyle factors, not injury. Chronic inflammation in more damaging than acute inflammation because it is not as visible. Therefore, you don’t realize its presence and don’t attempt to treat it. Most people, especially those with chronic pain have low grade, systemic, chronic inflammation that will not respond to corticosteroids, whether ingested or injected. Not only is the steroid not working, but it is causing harm.
Why corticosteroids are harmful
By inhibiting the ability of leukocytes (white blood cells) to respond to mitogens and antigens (substances that stimulate an immune response such as a virus) you weaken your immune system. This makes you more susceptible to illness no matter the time of year. Therefore, long term steroid use should never be administered outside of organ transplants to prevent rejection.
Corticosteroids also present other issues such as bone weakening and destruction of soft tissues like tendons and ligaments. Such tissues are trying to heal after an injury. By administering a corticosteroid you can effectively decrease inflammation but you significantly prolong the healing process.
What to do instead
The fastest way to fully eliminate inflammation is by treating the cause of the inflammation. If the inflammation is acute and damaged tissues are involved, treat the tissues so that they can heal faster and inflammation is no longer needed. If the inflammation is chronic and tissue damage is no longer present, you have to cut off the source of the inflammation but correcting the pro-inflammatory diet and lifestyle choices you are making. This looks differently in everyone so finding a doctor who can assess and treat your individual needs it crucial. But be cautious because “the right anti-inflammatory drug for you” is still not treating the cause of your inflammation.
Regardless, a good place to start is by supplementing high EPA fish oil and turmeric. These help stabilize the two primary inflammatory pathways without producing side effects and more harm.