Food-Drug Interactions: Corticosteroids
Corticosteroids, also known as steroids, are a group of hormones used to control problems with inflammation and the body’s immune system. They also are involved in balancing the body’s water, salt and potassium.
When taking corticosteroids like prednisone for greater than a month, you may retain water, gain weight and have an increased appetite. Long-term use may also weaken your bones.
Do I really need to watch my salt (sodium) intake?
A high salt intake can increase water retention and increase loss of calcium in your urine.
To prevent “holding” water, decrease your salt (sodium). intake.
- Avoid salt and salty foods. If it tastes salty it has too much salt!
- Limit the amount of processed foods like frozen dinners, packaged entrees, and canned soups.
- Restrict your intake of salted or smoked meat or fish. Avoid luncheon meats, bratwurst, and bacon.
- Try herbs and spices such as garlic or onion powder instead of garlic salt or onion salt. Use salt free spice mixes and marinades such as Mrs. Dash®.
- Read food labels to pick the products lowest in salt.
- Be careful using condiments that are high in salt like catsup, pickles, relish and sauerkraut.
Will my weight change?
You may feel hungrier while taking corticosteroids. If you do not want to gain weight, you may have to control the amount of calories and fat you eat. Eat only at meal times and limit your portion sizes. If you are still hungry, fill up on raw vegetables and fresh fruits. Try eating a tossed salad with a low calorie dressing before lunch and dinner to help slow down your intake of other high calorie foods.
How can I prevent problems with my bones?
To prevent bone weakness and fractures you will need to increase your calcium and Vitamin D intake. Steroids increase bone loss, decrease your body’s ability to make bones, and decrease the amount of calcium your body can absorb. Exercise helps keep your bones strong. Get out and walk to help keep your bones and muscles in good shape.
What are good food sources of calcium and Vitamin D?
Milk and milk products like yogurt, aged cheeses, and milkshakes are the best food sources of calcium and Vitamin D). Your doctor or dietitian may also suggest that you take extra calcium with Vitamin D or a multivitamin. This is especially important if you do not tolerate milk or dairy products. Calcium fortified orange juice can also increase your intake of calcium. Liquid supplements (Ensure, Boost, Carnation Instant Breakfast or Scandishakes) are good sources of calcium and Vitamin D, but may contain more calories than you need.
Food Sources of Vitamin D
Food |
Amount |
Vitamin D International Units |
Cod Liver Oil |
1 teaspoon |
455 |
Salmon |
3 ounces |
309 |
Mackerel |
3 ounces |
296 |
Shitake mushrooms, dried |
4 |
249 |
Tuna, canned |
3 ounces |
200 |
Sardines, canned in oil and drained |
1 ¾ ounces |
250 |
Quaker Nutrition for Women Instant Oatmeal |
1 packet |
154 |
Milk (whole, reduced fat or nonfat) Vitamin D fortified |
8 ounces |
98 |
Soy Milk, fortified with Vitamin D |
8 ounces |
100 |
Shiitake Mushrooms, fresh |
3.5 ounces |
100 |
Orange Juice, fortified with Vitamin D |
4 ounces |
50-65 |
Cereal, fortified |
1 serving (3/4-1 cup) |
40-50 |
Egg yolk from hens fed Vitamin D |
1 |
20 |
Liver, beef |
3 ounces |
13 |
Cheese, Swiss |
1 ounce |
12 |
How much protein do I need?
While taking corticosteroids, you need to make sure you eat enough protein. Milk, meats, eggs, peanut butter, nuts, tofu, dried beans or peas are high in protein. If your kidneys are working well, you should get at least 2-3 meat servings a day.
Will eating sugar cause problems?
In some patients, long-term use of corticosteroids raises blood sugar levels. If your blood sugar level is above normal, talk with your dietitian or doctor. They may suggest diet changes or insulin therapy. You may be able to improve your blood sugar levels by avoiding sugar-containing beverages and fruit juices, and being careful to avoid eating more calories than your body needs.
What do I need to know about Potassium?
You may need more potassium in your diet while taking prednisone. These are good sources of potassium: bananas, oranges and orange juice, cantaloupe, Carnation Instant Breakfast®, beans (chili, kidney, refried, etc.), potatoes, Boost®, prunes, milk, tomatoes, tomato juice, V-8®, winter squash, ScandiShake®.
Is it okay to use Dietary Supplements, such as, herbal products?
Some dietary supplements can damage the liver, interact with your other medicines or cause other side effects. Be sure to tell your doctor if you are taking anything in addition to your prescribed medicines. Let them know about all over the counter medications and diet supplements … even if they are natural!
Vitamin D Requirements and Supplements
- Standard vitamin supplements usually provide 400 International Units of
Vitamin D. This level meets the needs of most people. - However, during treatment with steroids, it is recommended that most patients take 800 International Units of Vitamin D per day.
- Patients over 70 years old should take 1000 International Units Vitamin D per day.
Liquid Vitamin D³ (Cholecalciferol) Supplements
Supplement |
Vitamin D (International Units=IU) |
Comments |
Ddrops® |
400, 1000 & 2000/drop |
Gluten-free |
Enfamil D-Vi-Sol® |
400 IU/drop |
Gluten-free |
Life Time Liquid Vitamin D3 |
1000 IU & 4000 IU (High Potency) per Tablespoon |
No gluten, milk, soy, or egg Contains agave nectar |
Wellesse Liquid Vitamin D3 |
500 IU/teaspoon |
BerryFlavored No artificial flavors/colors |
Carlson for Kids Cod Liver Oil Lemon Flavored
|
200 IU Vitamin D 425 IU Vitamin A 5 IU Vitamin E 550 mg Omega-3 (DHA/ARA/ALA) Per ½ teaspoon |
Free of detectable levels of mercury, cadmium, lead, PCB's and 28 other contaminants Note: The Fish Oil has Vitamin A & D removed |
Vitamin D³ (Cholecalciferol) Supplements
Supplement |
Vitamin D3 (International Units=IU) |
Comments |
Finest Natural |
1000 IU per soft gel |
No gluten, lactose, artificial colors |
Freeda
|
400, 1000 and 3000 International Units (IU) per Tablet
|
Kosher. No gluten, yeast, dairy, animal products, artificial flavors and colors, nuts, and sugar |
Kirkman Labs
|
400 IU – Hypoallergenic 1000 IU– Hypoallergenic Per Capsule
|
No gluten, sugar, starch, wheat, casein, milk, corn, preservative, yeast, gelatin, flavoring or color |
Nature’s Made® |
400, 1000, and 2000 IU |
Tablet or soft gels (gluten-free) Chewable in 400 IU (call regarding gluten status) |
Nordic Naturals |
1000 IU |
Soft gels with olive oil |
Solar D Gems |
2000 & 4000 IU per soft gel 115 mg Omega 3’s 1 IU Vitamin E |
Contains cod liver oil |
Calcium Requirements
Children Age |
Adequate |
While Taking Prednisone |
0-6 months |
210 mg |
400 mg |
6-12 months |
270 mg |
600 mg |
1-3 years |
500 mg |
800 mg |
4-8 years |
800 mg |
1200 mg |
9-18 years |
1300 mg |
1500 mg |
Adults Age (years) |
Adequate |
While Taking Prednisone |
19-50 |
1000 mg |
1500 mg |
51-70 |
1200 mg |
1500 mg |
>70 |
1200 mg |
1500 mg |
What do I need to know about Calcium Supplements?
- Ask your pharmacist to assist you in finding an appropriate supplement.
- Calcium carbonate requires stomach acids, so should be consumed with food at the end of the meal. Calcium carbonate should not used if you are taking antacid medications. Some people have increase gas, bloating or constipation with larger amounts.
- Calcium citrate can be taken between meals. Calcium citrate contains half the amount of elemental calcium as calcium carbonate so the pills will be larger to provide the same amount of calcium
- Your body can only absorb 500-600 mg of Calcium at a time. If your doctor wants you to take 1000 mg of calcium per day, divide the dose and take 500 mg twice daily for maximum absorption.
- Do NOT use bonemeal or dolomite as a source of calcium. They may contain lead.
- Look for “USP” on the label or “United States Pharmacopoeia” which have standards that require that the supplement contains less than 3 parts per million of lead. It also means that the supplement has been tested and will dissolve properly in normal stomach acid.
Calcium Supplements [Note: some also contain Vitamin D]
Name |
Elemental Calcium (mg) |
Vitamin D3 (International Units = IU) |
Form of Calcium |
Comments |
Caltrate 600+D |
600/ Tablet |
400 |
Calcium Carbonate |
No gluten ingredients; not tested |
Caltrate 600+D Plus Minerals (Chewable or Tablets) |
600/ Chewable |
400
|
Calcium Carbonate |
No gluten ingredients; not tested; chewable contains soy |
Citracal Maximum |
315/ Caplet |
250 |
Calcium Citrate |
Gluten-Free |
Citracal Regular 250mg + D |
250/ Tablet |
200 |
Calcium Citrate |
Gluten-Free |
Citracal Petites + D |
200/ Tablet |
250 |
Calcium Citrate |
Gluten-Free |
Citracal Kosher |
200/ Tablet |
0 |
Calcium Citrate |
Gluten-Free |
Kirkman Calcium Magnesium Liquid |
200 mg Calcium/ teaspoon |
25 |
Calcium Carbonate |
125 mg Magnesium Gluten/Allergen-Free |
Kirkman 250mg + D |
250/ Chewable |
80 |
Calcium Carbonate |
|
Kirkman Calcium + D3 Powder (Flavored) |
333/ ¼ teaspoon |
58 |
Calcium Carbonate & Calcium Citrate |
Gluten/Allergen-Free Contains sorbitol, natural chocolate flavor & stevia |
Kirkman Calcium + D3 Powder (Unflavored) |
500/ ¼ teaspoon |
88 |
Calcium Carbonate & Calcium Citrate |
Gluten/Allergen-Free |
Os-Cal 500 + D |
500/ Tablet |
200 |
Calcium Carbonate |
Gluten-Free |
Os-Cal 500 + Extra D |
500/ Tablet |
400 |
Calcium Carbonate |
Gluten-Free |
Os-Cal Chewable |
500/ Chewable |
400 |
Calcium Carbonate |
Gluten-Free |
Tums Regular |
200/ Chewable |
0 |
Calcium Carbonate |
Gluten-Free |
Tums E-X 750 |
300/ Chewable |
0 |
Calcium Carbonate |
Gluten-Free |
Tums for Kids |
300/ Chewable |
0 |
Calcium Carbonate |
Contains Gluten
|
Tums Smoothies |
300/ Chewable |
0 |
Calcium Carbonate |
Contains Gluten, Milk, and Soy |
Tums Ultra 1000 |
400/ Chewable |
0 |
Calcium Carbonate |
Gluten-Free |
Viactiv Calcium Soft Chews |
500/ Soft Chewable |
500 |
Calcium Carbonate |
40 mcg Vitamin K Flavors: Milk Chocolate, Caramel, Raspberry, Chocolate Mint; Gluten-Free |
Teach Back:
What is the most important thing you learned from this handout?
What changes will you make in your diet/lifestyle, based on what you learned today?
If you are a UW Health patient and have more questions please contact UW Health at one of the phone numbers listed below.
Nutrition Clinic 608-263-4360 |
Nutrition Clinic 608-262-9181 |
Nutrition Clinic 608-265-7405 |
The Spanish version of this HFFY is #6005
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 02/08/2013
Copyright © 02/08/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5332
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