How do steroids affect lipid metabolism?
While glucocorticoids (steroids) are extremely useful medications, it’s important to know that they have a big impact on the way your body breaks down and uses lipids (cholesterol and other fatty molecules). Lipids perform a variety of important tasks in your body. As part of cell membranes, they help control what goes in and out of your cells. They’re also key to how your body absorbs vitamins, makes hormones and stores energy.
However, having lipid levels that are too high can be harmful to your cardiovascular system (heart and blood vessels). So, it’s important to keep a close eye on your lipid levels if you’re taking steroids.
Steroids can affect the way your body metabolizes (breaks down and uses) lipids in the following ways:
Increase in triglycerides (the main component of body fat)
Steroids can increase the creation of triglycerides in the liver. A raised triglyceride level can lead to a condition called hypertriglyceridemia, which can increase your risk of developing pancreatitis and cardiovascular disease.
Increase in so-called ‘bad’ LDL cholesterol
These medications can also raise your LDL cholesterol levels. This can put you at an increased risk of atherosclerosis, a condition in which fatty deposits build up in your arteries, causing them to narrow and harden and increasing the risk of heart disease or stroke.
Decrease in so-called ‘good’ HDL cholesterol)
Steroids can lower your HDL level, which is known for its protective role in removing cholesterol from your arteries and transporting it back to the liver for excretion in your urine (pee).
Steroids affect how your body breaks down and uses cholesterol and other fatty molecules.
Why does this happen?
Steroids affect the enzymes and pathways involved in breaking down and using lipids. They also enhance the action of enzymes that make lipids in the liver and decrease the clearance of so-called ‘bad’ LDL cholesterol from the blood.
Each of these processes is a part of natural steroids' role in preparing the body to handle stress, by ensuring that energy in the form of glucose and fatty acids is readily available to the muscles. However, when these processes are activated time and time again through long-term medication use, they confuse the body’s normal production and can lead to lipid imbalances.
Top tips for managing lipid levels
Managing your lipid levels while taking glucocorticoids can involve a combination of medication management, lifestyle changes and regular monitoring. Here are some practical things you can do to help you manage this side effect:
1. Monitor your lipid levels regularly
Work with your doctor to monitor your blood lipids regularly with a simple blood test known as a lipid panel. This will help you both track changes and adjust your treatment plan as necessary. For patients on long-term steroid treatment, you can expect to have a lipid panel check at the start of your steroid treatment and then every six months.
2. Try to eat a balanced diet
Eating a heart-healthy diet that’s rich in fruits, vegetables, whole grains and lean proteins is one of the best things you can do to support the health of your cardiovascular system. Try to limit your intake of saturated fats, trans fats and sugars, which can worsen lipid profiles. Where you can, try to incorporate foods that are high in omega-3 fatty acids, such as fish and flaxseeds, which can help improve your lipid levels.
3. Stay active
Regular physical activity can help lower so-called ‘bad’ LDL cholesterol and raise so-called ‘good’” LDL cholesterol. Aim to keep as active as possible, but always in close consultation with your doctor.
4. Avoid alcohol and smoking
Alcohol can raise triglyceride levels, and smoking is a major risk factor for cardiovascular disease. Limiting alcohol and quitting smoking can significantly benefit your lipid profile and overall health.
5. Discuss adjusting your medication with your clinician
If lifestyle changes are not enough to manage your lipid levels, your doctor might adjust your steroid dosage or prescribe lipid-lowering medications.
The bottom line
While steroids are incredibly effective at managing inflammation and autoimmune diseases, their impact on lipid metabolism can pose additional health risks, particularly to your all-important cardiovascular system. By being proactive about lifestyle changes, adhering to regular monitoring, and maintaining open communication with your doctor, you can effectively manage these risks and maintain a healthy life, even while on glucocorticoids.
Remember, always consult your doctor before making any changes to your medication or lifestyle to ensure the best care for your specific health needs.