LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

steroids

Nutrition More Effective Than Steroids in Children With Crohn’s Disease – (06-06-02)

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Nutrition More Effective Than Steroids in Children With Crohn’s Disease

Okay, so if this is more effective for children, why do most adults not get the same therapeutic thrust? Personally, I feel that yeast overgrowth is a major factor in many patients with Crohn’s. This would necessitate avoiding sugars and alcohol and supportive probiotics.

Read entire article here

DDW Annual Meeting: Abstracts 103976, 107178. May 19 and 21, 2002.

Nutritional therapy achieves better long-term outcome than steroids in children with active Crohn’s disease, according to 2 studies presented May 19 and 21 at the Digestive Disease Week annual meeting in San Francisco, California. “In children with Crohn’s disease, clinical trials have demonstrated that polymeric or elemental diet therapy is as effective as steroids in inducing remission, whilst avoiding steroid side effects,” write Bhupinder Sandhu and colleagues from Bristol, England.Of 44 children (median age at diagnosis of Crohn’s disease, 12.8 years) elemental diet therapy induced clinical remission in 40 (90%). Median time to remission was 6 weeks (range, 2-12 weeks), and median duration of first remission was 54 weeks (range, 4-312 weeks). At follow-up, 17 children (38%) had not relapsed, and the remaining 27 children suffered a total of 52 relapses. Of 16 children whose relapses were treated with elemental diet therapy, 12 (75%) went into remission. “This data suggests that there are significant long-term benefits to using elemental diet therapy as first-line therapy for Crohn’s disease,” the authors write. “Steroids may be avoided in nearly half the cases, or their use postponed by 68 weeks.”In a second study from Naples and Rome, Italy, 37 patients, aged 7 to 16 years, with active Crohn’s disease received nutritional therapy, while 10 comparable patients received methylprednisolone, 2 mg/kg/day for 4 weeks, with subsequent tapering over at least 4 weeks. Nutritional therapy included polymeric diet given orally and semielemental or elemental diet formulae infused with a pump through a nasogastric tube. Within 8 weeks of treatment, 32 of the 37 children assigned to nutritional therapy and 9 of the 10 given steroids went into clinical remission. Mean time elapsed to achieve remission was 2.5 weeks for those on nutritional therapy and 3.7 weeks for those on steroids (P<.05). Seven patients on nutritional therapy and none on steroids showed complete mucosal healing (P<.005). “In children with active Crohn’s disease, exclusive nutritional therapy shows a more rapid effect than steroids in inducing clinical remission and is markedly more effective than steroids in producing healing of mucosal inflammation,” write Roberto B. Canani and colleagues. “Nutritional therapy alone is the preferred form of therapy for children with active Crohn’s disease.”

CEREAL ALLERGY WITH COW’S MILK ALLERGY RELATED WITH ATOPIC DERMATITIS – (08-14-03)

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Concurrent cereal allergy in children with cow’s milk allergy manifested with atopic dermatitis

I just recently had a patient whose 4 year old son was put on steroids for a skin reaction of unknown etiology. There was never a recommendation to avoid common food allergens. Mind you, steroids in a child that young really do concern me. Remember that an elimination diet is one of the more powerful tools we have in natural medicine to address a wide range of complaints.

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ARE STEROIDS BAD FOR MY BONES?

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Most people are aware that long term use of steroids is bad for the bones and can lead to osteoporosis. But what about short term use? What about use for a year? A day?

Steroids are used to control inflammation. Our body produces its own cortisol (as opposed to the synthetic cortisone), but this is under very tight regulation with feedback loops. Of course, with poor lifestyle changes and chronic stress this balance can get disrupted and create dysfunction.

This particular study gives us a better idea of just how little it can take to begin to destroy our bones with the use of steroids to control inflammation. Long term use of steroids is typical in many conditions such as lupus and rheumatoid arthritis. Short term use is also used far too common in musculoskeletal complaints like shoulder, neck and low back pain.

It is established the the risk for osteonecrosis in long term (>1 year) use of steroids increased the risk an incredibly massive 212,200 times (OR 212.2). I have personally never seen an odds ratio this high before. To put this in some degree of perspective, one would have to smoke maybe 20 packs of cigarettes through a hole directly in the trachea for 100 years to increase your risk this much for lung cancer.

While this study focused on the use of steroids for lupus and RA, we can begin to see how short term use of steroids for musculoskeletal conditions are largely inappropriate.

 The risk of osteonecrosis was quite striking and most often affected the hip. Researchers identified some very interesting trends. The first set of items they looked at was how long ago someone who experienced bone death was exposed to steroids. Oral, injected or IV did not appear to be different. In other words, you took a course of steroids for low back pain last week—how much did this affect you vs taking a course 3 years earlier….

  •  Use ONE day to 90 days ago risk was increased 580%
  • ½ year to 1 year increased 890%
  • More than 2 years earlier 430%

 Can we begin to see that routine use of steroids (for conditions that would very likely respond well to chiropractic care) can increase the risk for serious long term consequence even years later?

 So, while my opinion as a chiropractor is clearly biased, the decision to use a non-drug effective alternative to any musculoskeletal complaint continues to be strongly supported by the medical literature.

TAKING A SHORT COURSE OF STEROIDS FOR PAIN?

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Medrol dose packs are commonly used to calm down inflammation and pain in musculoskeletal injuries.  This pack starts with a high dose of steroids that tapers down over the next 6 days.  Doesn’t fix the injury or restore the mechanics of an injury, but it sure curbs the inflammation associated with the injury.  So what could be wrong with that?

For starters, any diabetic can tell you that steroids wreak havoc on blood sugar.  They should–one of the jobs of cortisol in the body is to break down muscle to make glucose.  That may be fine when you skip a single breakfast, but with time you lose muscle mass and head towards diabetes.

But what about healthy patients?  A short course of steroids won’t do any harm, right?

Other than the aforementioned fact that it does nothing to actually heal an injury and will actually weaken the tissues leading to increased concern for future injuries, but, in this particular study, a single week of low dose prednisone in healthy males worsened the way insulin worked in the body by 33%.

This is NOT a good thing given that the effectiveness of the way our bodies use insulin is a (if not THE) critical component to a long, disease free life.  As usual, my bent as a chiropractor here in Mesa is that ANY musculoskeletal problem should be treated without medications first.  Anything less may produce greater harm than benefit.