Can we talk about the use of corticosteroids?

I predict that the next wave of "oops, we swung the pendulum too far" will be regarding the use of corticosteroids. We have overdone it on opioids and are in crisis. We overused our antibiotics and now are in crisis mode. You would think we would learn. 

Our culture demands instant gratification -- we want answers, treatment, cures...and we want it now. Oh, and we want it cheap and at our convenience. 

Part of my job in preparing patients for surgery is to reconcile medications. In my work as a wellness coach, frequently health goals that come up involve "I would like not to be taking so much medicine." On social media, I don't think a day goes by that I don't see somoen posting about how many rounds of steroids they have endured in effort to combat their discomfort. (If it's not working, why do we just keep trying?)

Corticosteroids are prescribed by physicians for infectious diseases including the common cold, viral respiratory infections, pneumonia / bronchitis. This will work to suppress the symptoms, create a false sense of feeling 'high on life' while sick, and possible contribute to high marks on a patient satisfaction survey.

Short term benefit at long term expense to health.  

For decades we have avoided these immunosupressive medications that rob you of your health behind a symptom-free facade (false front). But since we have created a crisis surrounding antibiotics and opiods, and patients demand for something to help them feel better, we have resorted to quick fixes.
 
Corticosteroids include oral meds like prednisone, methylprednisolone/Medrol dose pack, and Dexamethasone/Decadron. Topical forms range form the lowest strength being hydrocortisone, and six classes of stronger ones above this that will make your skin thin incredibly and the underlying cause and condition worsen and rebound once the med is stopped.  
 
These steroids suppress immunity and the ability for tissues to heal and maintain their integrity and strength. Blood supply decreases to exposed tissues and small blood vessels break easily (capillary fragility). The supposed benefit is a decrease in inflammation but inflammation is linked to the repair and healing process.  Another use is to reduce allergic reactions. This is potentially life saving in life-threatening allergic reactions like anaphylaxis or severe asthma.  So, they are not all bad. When you need them, you want them! Used over a long period of time though, while symptoms are managed, the underlying cause may be compromised greatly. 

When a doctor suppresses an inflammatory / 'autoimmune' disease like asthma, inflammatory bowel disease, lupus, arthritis or skin rashes with immune suppressing drugs like corticosteroids, THE UNDERLYING DISEASE IS going to get worse. 
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Cortisol is a stress hormone that is catabolic meaning it breaks the body down and weakens tissues, breaks down protein and muscle. It helps your body get through stressful times but at a price. Anabolic hormones are testosterone, DHEA, and growth hormone which increase protein synthesis and healing and regeneration. They strengthen you and increase lifespan. This is why we must rest and eat well and exercise not in excess so that we have good anabolic hormones and less catabolic hormones. 

The side effects of corticosteroids are too many to list all here but here are some that come to mind. Corticosteroids, especially oral or IV cause susceptibility to infections, cancer/ tumor growth, diabetes, glaucoma, cataracts, skin thinning, muscle wasting, bone loss/osteoporosis, increase fat especially in the belly, obesity, psychosis, insomnia, mood disorders, rebound worsening of the underlying condition, impaired wound healing, and death of the head of major bones such as the ball (head) of the femur.  This condition is called AVN (avascular necrosis of the head of long bones; necrosis means death; avascular means no blood supply). AVN is frequently silent and the hip or shoulder just suddenly crush and fail. I know a patient who has MS who took prednisone and other oral corticosteroids and ended up having both hips and a shoulder replaced. All it takes is one seemingly harmless injection of a corticosteroid for poison ivy to cause problems later on -  The more exposure to them, the higher the risk. 
 
Another huge negative effect is that corticosteroids cause suppression of the pituitary's production of ACTH, a hormone that stimulates your adrenal gland to be healthy. This causes adrenal deficiency following the steroid use. 
 
Common uses of corticosteroids are:
 
ORALLY: Inflammatory bowel disease, arthritis, allergic reactions, skin rashes, asthma, chronic lung diseases, auto-immune conditions such as lupus. Nowadays, doctors prescribe them when they never did before such as for a common cold or real infections to reduce symptoms!  

TOPICALLY: psoriasis, eczema, rashes, poison ivy, hair loss. Topical and oral corticosteroids account for the majority of treatments recommended by dermatologists. 

AGAIN I WILL NOTE THAT IF YOU CANNOT BREATH AS A RESULT OF SEVERE ASTHMA OR ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS, THEN YOU MAY NEED A CORTICOSTEROID. Other than that, the use of corticosteroids should not be considered as a first line of defense. Ask what other options may be available to support your body in the healing process. Consider natural options first - dietary changes, herbs, behavioral changes, detoxificaiton, essential oils. 

Let's just good consumers. Let's be proactive and dligent in our health care. Let's be informed and willing to ask questions, to ask for alternative solutions.