Your doctor wants to put you on prednisone (or they already put you on prednisone), saying it will help improve whatever it is you’re concerned with. True enough. You’re grateful that there’s a treatment for what’s bothering you. What you’re not grateful for are the side effects that come along with it. Namely, weight gain.

            So if you’ve either experienced prednisone weight gain, or you want to prevent it from happening, this article is for you.

How Can I Lose Prednisone Weight Gain?
Original source: here.

            If you either have a friend, family member, colleague or client who experienced prednisone weight gain, send this article to them, because chances are they’re struggling with it.

            For this article, I collaborated with a pharmacist.  Her name is Kate Takopoulos, and she’s the only Registered Pharmacist (that I know of) who is also a Certified Clinical Nutritionist. Her unique knowledge in the area of drug-induced nutrient depletions combined with the expertise in clinical nutrition are the focal point of her practice. In the past, we’ve collaborated on my article about antidepressants and weight gain. A lot of this information is largely from her.

            In this article, we’ll cover:

  • What is prednisone and why is it prescribed?
  • What causes prednisone weight gain?
  • Why is fat gained specifically in the belly?
  • Is prednisone weight gain temporary?
  • Weight loss after prednisone

If you’d like some personalized help in getting rid of the fat you gained while on prednisone, we do offer a special online coaching program for that. If you’re interested in seeing whether this program is for you, just email me with the words “weight loss after prednisone.”

So let’s get to it!

What is Prednisone and Why Is It Prescribed?

            Prednisone is a type of medication used to relieve inflammation. This is the heavy artillery stuff when the “baby” anti-inflammatories are just not strong enough. They are typically prescribed for chronic inflammatory conditions, like:

  • Asthma
  • Rheumatoid arthritis
  • Multiple sclerosis
  • Lupus
  • Adrenal insufficiency

They’re also used to relieve the nausea that comes from chemotherapy. These are the general long-term uses of prednisone.

There are also short-term uses for prednisone, like severe allergies, and gout flares.

So it’s good to know that there are effective treatments for these conditions. Unfortunately, that treatment comes with a long list of side effects. Among them:

  • Insomnia
  • Greater risk of injury (especially tendon and ligament tears)
  • High blood pressure
  • Vision changes
  • Osteoporosis
  • Depression

…but the biggest one that pertains to this article: weight gain.

What Causes Prednisone Weight Gain?

            To understand why prednisone causes weight gain, let’s first describe what it is: synthetic cortisol. As the media has done such a great job of dubbing it, cortisol is the “stress hormone.” It’s a good thing in physiological levels, at the right time. But when we have a lot of it, it exacerbates the stress response.

            When we’re under stress, we release cortisol. Cortisol raises blood sugar. Prednisone raises blood sugar even higher, because it gives us more cortisol (synthetic, mind you) than what we make naturally. Now, short-term, small bumps in blood sugar aren’t a big deal. But long-term use of prednisone can lead to weight gain and diabetes. Why? Because, according to this study, long-term use can cause insulin resistance, meaning that the body stops “hearing” the message of insulin (that message is to lower blood sugar).

            Not only that, but the chronic inflammation that was the original cause of the need for prednisone can also cause insulin resistance, giving us a double whammy.

            So that’s two mechanisms by which prednisone causes fat gain. Another one is quite obvious: increased appetite. Except that often, you don’t even know that your appetite is increased, unless you’re deliberately tracking your food for long periods of time. And a small increase of just 100-200 calories per day can add up to a few extra pounds over a few months.

            Another mechanism by which prednisone may contribute to fat gain is through decreased metabolism. We know that with chronically elevated stress levels, the thyroid is suppressed. And the thyroid is the “gas pedal” on our metabolism. If high cortisol means low thyroid, would it mean that the use of prednisone would slow down the thyroid as well? According to at least one study, the answer is yes.

            When the thyroid slows down, the metabolism slows down, and even if your appetite didn’t increase, and you’re still eating the same number of calories as before, you’re now at a surplus. To make things simpler, let’s use an example:

            Before prednisone, you needed 2500 calories to maintain your weight, and you ate 2500 calories. So your weight was stable. After prednisone, you still ate 2500 calories per day (that hasn’t changed), but because your metabolism was slightly slower, you may now need only 2400 calories per day. What used to be maintenance calories is now a surplus. As a rough guideline, for every degree Celsius that your body is below 36.5-36.8 (as measured in the armpit), you burn 10-13% fewer calories.

Why Does Prednisone cause Weight Gain Specifically In the Belly?

            As we know from my article on biosignature, where you store your body fat tells us about your hormonal profile. The stomach corresponds to cortisol, and the love handles correspond to insulin (there are also other relationships between triceps, thighs, calves, and even the knee! Check out the article to learn the hormonal correlations of these). And what 2 hormones rise when we take prednisone? Cortisol and insulin.

            The fat cells underneath the stomach muscles are called “visceral adipose tissue”, as opposed to the fat cells between the skin and the muscle, which are called “subcutaneous adipose tissue.” The 2 types of fat are quite different. For instance, visceral adipose tissue cells are larger, they’re more inflammatory, more insulin resistant, and are more responsive to the fat-storage effects of insulin, according to this study.

            Hence why prednisone causes a preferential fat storage pattern in the belly (whereas other medications, like some type of hormone replacement therapy, and some types of birth control show a preferential fat storage for the buns and thighs).

Is Prednisone Weight Gain Temporary?

            Although exceptions exist, whether the fat gained on prednisone is temporary or permanent depends on both the dose and duration. The larger the dose and the longer the duration, the more permanent the fat gain. The opposite is true as well – the lower the dose, and the shorter the duration, the more fleeting the weight gain.

            But there are some unlucky individuals that have a pronounced response to prednisone, that even at low doses and/or for short durations, the fat gain sticks around even after the prednisone is no longer being taken.

Weight Loss After Prednisone

            Now you know what’s happening in your body – so what do you do about it? Well, start with the basics that apply to everyone regardless of whether they’re on prednisone or not:

  1. Sleep well. Go to bed between 10-11PM, every day, including weekends; eliminate all sources of light (including moonlight, streetlights, etc.); keep the temperature at around 18-20 degrees Celsius; and don’t keep electronics (including cell phones) in the bedroom.
  2. Exercise.

Once the basics are taken care of, there are some specific things you do when you’re on prednisone:

  1. Eat like a diabetic. Remember, prednisone increases both blood sugar and insulin resistance. You need to decrease it through diet. The bare basics of eating like a diabetic are:
    • Eat 40-50 grams of fibre per day. The best sources of fibre are buckwheat, whole grains, flax seeds, chia seeds, hemp seeds, psyllium husks, blackberries, blueberries, steel cut oats, etc.
    • Eat 1.6-1.8 grams/kg of protein per day. I talk about the best protein sources in this article (including things people often thing are great protein sources, that really aren’t, like cheese, eggs, beans, etc.)
    • Eat a low-carbohydrate diet. About 25-40% of your daily calories should come from carbs. Ideally, use high-fibre carbohydrates.

  1. Exercise like a diabetic. I wrote the most comprehensive article on the internet about exercise for diabetes, so if you’re curious, check it out. There are certain differences between exercising for diabetes vs. exercising for other goals.
  2. Consider taking the same supplements that may be recommended for diabetics. The biggest one, being berberine.
  3. Get your hormones (especially thyroid) tested and corrected. I typically send my clients to Dr. Dempster for things like that.
  4. Test the levels of different nutrients in your body, and get any nutritional deficiencies taken care of. Again, go to Dr. Dempster for that.
  5. If you’re taking other medications, and you want help figuring out the interactions between each of them, and whether they’re causing certain nutrients to be depleted, email Kate Takopoulos, my collaborator on this article.

There you have it – the complete plan for reversing prednisone weight gain. If you’d like help implementing this specifically for your body, and make sure you’re doing everything right, without hurting yourself, we have a special online program for that, called “Weight Loss After Prednisone.” If you’re interested in learning more about this program, and whether it’s right for you, just email me with the words “weight loss after prednisone” in the subject line.