Corticosteroids effects on gastrointestinal and immune system health

Allergy, Eczema, Asthma | March 27, 2017 | Author: Naturopath

allergy, eczema, Asthma, autoimmune

Corticosteroids effects on gastrointestinal and immune system health

Corticosteroids are a class of the steroid hormone group that function mainly to regulate physiological functions such as stress, immune and inflammatory responses, the metabolism of carbohydrates, the regulation of blood electrolytes, the catabolism of steroids, among other important functions. Organically, these hormones are produced by the outer part of the adrenal gland known as the cortex. 

Medical uses

For people with conditions that have a disruption in the production, secretion or regulation of corticosteroids, there are synthetic drug forms of the hormone available.

The most common conditions that warrant the medical use of corticosteroid hormones include:

  • Inflammatory bowel disease (Crohn’s disease, ulcerative colitis, etc.)
     
  • Autoimmune diseases (Autoimmune hepatitis)
     
  • Joint and muscle diseases (Rheumatoid arthritis, polymyalgia rheumatic)
     
  • Asthma and allergies
     
  • Cancer (certain types)
     
  • Addison’s disease

Even though steroids can be a very effective treatment for various inflammatory and autoimmune conditions, synthetic steroid hormones are known to cause gastrointestinal and immune system side effects. The degree to which these side effects occur may vary from one individual to another, depending on various factors such as the dose and/or the period of time for which the drugs are being taken.

Immune system

In order to treat autoimmune diseases, steroids work to suppress the immune system. Long term, this can affect the protective role of the immune system which can increase the chances of bacterial and/or viral infections. Corticosteroids can even reduce the efficacy of some vaccines and antibiotics.

Gastrointestinal

Steroids interfere with the production of protective mucous layer produced in the stomach. 

Even though steroids can be prescribed to treat some gastrointestinal symptoms such as Crohn’s disease, these have shown to increase the risk of developing duodenal ulcers, stomach ulcers and gastrointestinal bleeding. The risks for these side effects are especially increased if steroids are taken along with non-steroidal anti-inflammatory drugs (NSAIDs); examples of these include ibuprofen and aspirin.

Natural therapies

Natural therapies aim to reduce or eliminate the side effects of corticosteroid drugs by taking a holistic approach which includes lifestyle, dietary, nutritional and herbal suggestions.

Boost the immune system

The immune system is the body’s cornerstone for health and wellbeing, when it is compromised, pathogenic disease can take over.

Simple natural ways to boost and help the immune system include:

  • Getting enough sleep
  • Enjoying exercise and relaxation
  • Avoiding tobacco smoke and limiting alcohol intake
  • Eating a wholesome diet filled with fresh vegetables, fruits, nuts and seed. 
  • Avoiding processed/packaged foods.

Probiotics

Being that 70% of the immune system resides in the digestive tract, it would seem obvious to make gut health a priority. The health of the gut is directly proportional to the health of the entire body, immune system and digestion. To maintain good digestive health, the body needs tens of thousands of good bacteria. Including yogurt, sauerkraut, soft cheeses, kefir, sourdough bread, sour pickles, tempeh and apple cider vinegar in the diet may help. Since it is almost impossible to source the required number of probiotics through diet alone, especially to make up for the effects of corticosteroids, it may be beneficial to take probiotic supplements.

Vitamin D

According to an Albert Einstein College of Medicine research report published in the online edition of The Journal of Clinical Endocrinology and Metabolism, it has been found that people taking oral steroids are twice as likely as the general population to develop a severe vitamin D deficiency. Besides calcium malabsorption, vitamin D deficiency has been linked to some cases of inflammatory bowel diseases as well as higher rates of colon cancer. 

It is becoming more apparent that vitamin D may have a very significant role in anti-inflammatory and immune modulating effects.

Healthy and effective sources of vitamin D include foods such as: 

  • fatty fish
  • foods fortified with vitamin D like dairy products, orange juice, soy milk, cereals, beef liver, cheese and egg yolks.

A more realistic source would be a vitamin D supplement.

Zinc and other micronutrients

Micronutrients such as essential fatty acids, vitamins A, B6, C, E, folate, iron and especially zinc are easily depleted by corticosteroids use. Studies in animals have found this alters immune responses. Although the same has not been positively proven for humans as yet, the results are concerning. In case of dietary restrictions, taking supplements such as multivitamins can help to ensure that the body’s immune system gets all the vital nutrients that may seem miscellaneous but can actually make a huge impact on overall health and immunity.

Diet

Food is a very important element when treating or managing gastrointestinal and immune system health, especially when on corticosteroids. These drugs are known to cause weight gain, possibly due to the fact that they can cause an increase in appetite.

The diet is also a vital as steroids deplete essential nutrients in the body.

A balanced, healthy diet to support the immune system and overall gut health would include the following:

  • Dairy (in moderation; milk, cheeses, yogurts and other dairy products that are as close to natural state as possible)
  • Vegetables (include vegetables of all colors and textures, but pay special attention to dark leafy greens and colorful vegetables).
  • Fruits (fruits rich in vitamins C are especially recommendable to help the immune system, as well as bananas, as corticosteroids depletes potassium, and  fruits from other families, at least 5 different fruits per day).
  • Whole grains (pastas, breads, legumes, nuts, seeds and other whole grains are sources of essential vitamins and minerals such as vitamin B).
  • Protein (lean meats and fatty fish, turkey and other sources of proteins should be taken in moderation, especially red meats).

Exercise and physical therapy

Light to moderate exercise that gets the heart rate elevated and the metabolic processes active are important to build immunity and stamina.Yoga, meditation and massage therapy can help with stress and relaxation - essential elements for immunity and gut health.

Herbal Medicine

Some herbs are particularly good for supporting the body’s immunity and gastrointestinal health and helping to treat and manage gastrointestinal and immune system symptoms caused by corticosteroids.

Gastrointestinal herbs

Since corticosteroids tend to interfere with the secretion processes in the gastrointestinal system, bitter herbs are suggested. This can help to prevent ulcers by ensuring that the gut has sufficient mucous to protection against its own acids. Carminative and other gastrointestinal herbs can help with soothe and heal. Recommended herbs include: 

Bitter herbs Promote secretion and aid digestion

  • Gentian (Gentiana lutea)
  • Barberry root (Berberis vulgaris)
  • Dandelion (Taraxacum officinale)
  • Artichoke (Cynara scolymus)
  • Milk Thistle (Silybum marianum)
  • Chamomile (Matricaria chamomilla)

Carminative herbs Warm up the digestive tract, speed up and increase digestion and reduce gas and bloating. 

  • Fennel (Foeniculum vulgare)
  • Cardamom (Elettaria cardamomum)
  • Dill (Anethum graveolens)
  • Cumin (Cuminum cyminum)
  • Caraway (Carum carvi)
  • Lemon balm (Melissa officinalis

Mucilages Herbs that create a healing slime that coats and soothes the gut wall 

  • Marshmallow root (Althaea officinalis
  • Slippery elm bark (Ulmus rubra
  • Mullein leaf (Verbascum spp.)
  • Psyllium (Plantago spp.)
  • Oats (Avena sativa L.‚Äč)

Fibre absorbs moisture, increases stool size, aids peristalsis

  • Pectin (fruit, flaxseed, chia seed and oat bran)
  • Psyllium (Plantago spp.)

Immune system herbs

The body’s overall immune system, including the lymphatic system, can be boosted using a variety of herbs that have special properties. These herbs can help to rebalance the adrenal glands as corticosteroids may disrupt the normal functioning of these vital structures. The best herbs include:

  • Echinacea (Echinacea auuusifolia or purpurea)
  • St Johns Wort (Hypericum perforatum)
  • Eleuthero (Eleutherococcus senticocus)
  • American ginseng (Panax quinquefolius)
  • Astragalus (A. membranaceus)

Although corticosteroids can have these and other side effects, it is often the result of long term use of these drugs that has been especially noted to cause problems. Many people do in fact go on to use corticosteroids without experiencing any problems. The use of corticosteroids should not be stopped suddenly as this can also cause corticosteroid withdrawal symptoms, especially if not so instructed by a doctor or medical professional.

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References

  1. Bolognia JL, et al. Drug reactions. In: Dermatology Essentials. Philadelphia, Pa.: Saunders Elsevier; 2014. http://www.clinicalkey.com. Accessed Oct. 6, 2015.
  2. Adkinson NF, et al. Glucocorticosteroids. In: Middleton's Allergy: Principles and Practice. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2014.
  3. Nieman LK. Pharmacologic use of glucocorticoids. www.uptodate.com/home. Accessed Oct. 6, 2015.
  4. Firestein GS, et al. Glucocorticoid therapy. In: Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2013.
  5. Brunton LL, et al. Adrenocortical steroids. In: Goodman & Gilman's the Pharmacological Basis of Therapeutics. 12th ed. New York, N.Y.: The McGraw-Hill Companies; 2011.
  6. Jameson JL, et al. Glucocorticoid therapy. In: Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2016.
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539293/
  8. Albert Einstein College of Medicine. (2011, September 30). Oral steroids linked to severe vitamin D deficiency in nationwide US study. ScienceDaily. Retrieved March 13, 2017 from www.sciencedaily.com/releases/2011/09/110929144639.htm
  9. nnan A., Katz D.R., Nunn J.D., Barker S., Hewison M., Fraher L.J., et al. (1987) Dendritic cells from human tissues express receptors for the immunoregulatory vitamin D3 metabolite, dihydroxycholecalciferol. Immunology 61: 457–461 [PMC free article] [PubMed]
  10. I., Mayberry J.F. (1999) The effects of migration on ulcerative colitis: A three-year prospective study among Europeans and first and second-generation South Asians in Leicester (1991–1994). Am J Gastroenterol 94: 2918–2922
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