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Cortisone is an excellent anti-inflammatory drug, but it exposes one to a number of so-called "metabolic" risks, such as muscle loss, osteoporosis and "fat abnormalities” (dyslipidemia). To combat these complications, several dietary measures are necessary.
Limit quickly absorbed sugars (sugars for coffee or tea, sweets, pastries ...): do not deprive yourself of everything but limit quickly absorbed sugars. A pastry for example is possible once a week.
Have a balanced protein diet to fight muscle wasting, in combination with regular physical activity.
Limit animal fats (cold cuts, cream ...), and replace them by "good fats" (vegetable oils).
Avoid hidden sugars (fruit juices, sodas, confectionery) and an excess of starchy foods (bread, pasta, rice, potatoes...) to reduce the risk of "dyslipemia" and therefore atheromatosis.
Follow a diet that is low in sodium (in case of kidney damage) but rich in potassium, because cortisone facilitates its elimination. Regarding bread, despite being rich in slow sugars, it also contains salt. It is not recommended to use bread without salt, but to limit bread to 4 or 5 standard slices at most per day.
Have a diet that is rich in calcium with an adequate intake of vitamin D to limit the risk of osteoporosis (in addition to physical activity). Vitamin D can normally be provided through diet and sunshine (because it is synthesised by the skin under the effect of the sun). In lupus, since sun exposure is often not recommended, it is better to consider vitamin D supplementation (for example, 50.000 UI of cholecalciferol every month at least during the winter). The recommended intake of calcium is 1200 mg/day, or 4 servings of dairy products per day. In addition to dairy products and cheese, rich in calcium but also rich in fat, certain mineral waters can improve the calcium intake. Some water is rich in Calcium (Calcium > 150 mg/l) and contains very little salt (sodium between 0 and 15 mg/l). But be careful, some waters are salty (Na >150 mg/l) or very salty (sodium up to 1700 mg/l) and are not recommended when taking cortisone. In case of prolonged corticosteroid therapy, a real medical follow-up will be needed, including questioning to assess bone fracture risk, a screening for bone fragility (by bone densitometry) and possibly, in adults, a preventive medical treatment of osteoporosis, most often using a molecule of the bisphosphonate family. These drugs help reduce the risk of bone degradation.
Taking cortisone, especially in high doses, justifies an adapted diet, that is:
- Balanced in protein, to fight against muscle loss
- Rich in potassium, to limit the loss of "salts" by the kidneys
- Rich in vitamins and calcium, to fight against bone damage (osteoporosis induced by cortisone)
- Low in fats and sugars, to fight against weight gain, the risk of heart disease and diabetes
- Low in salt in case of high doses of corticosteroids to avoid high blood pressure