Weight loss, training, and prednisone

Training
1

Hi all,
Was just curious if anyone had any helpful tips for navigating chronic systemic steroid use while training and trying to get back to racing. A quick two liner for context - I’ve been riding and racing since ~2010, initially mostly triathlons up to the 70.3 distance, but in 2020 switch to more bike focused activities (fondos in the summer like Triple Bypass, Copper triangle etc, Cyclocross in the fall, and XC MTB events over the past few years as well such as the leadville race series). Unfortunately, hit a wall in April after a viral illness and had a rapid decline in fitness/exercise tolerance on the bike. After 6 weeks of not improving, finally saw an MD, and after imaging, referrals, an Echo, and an EBUS, was dx’d with Stage II (Pulm/mediastinal) Sarcoidosis. (Unrelated, I am an MD, subspecialized in Inflammatory Bowel disease…. the irony).

Fortunately, over the past 8 weeks I’ve had a really robust response to prednisone thus far, and have been able to resume training, working my volume back up to >150mi/w, with appropriate FTP gains as well. I’m slowly being transitioned to a steroid sparing therapy, but will probably be on prednisone for several more months (currently at 30mg). The only aspect i’ve not been able to handle is the weight gain, i’m up about 10lb over the past 2 mo.

As the Cx season approaches, I’d love to think about getting out there a few times later in the season as my fitness slowly comes back. And so, finally, my question - Anyone out there battle steroid-induced weight gain, and how did you do it in the context of training and trying to build strength back?

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The only aspect i’ve not been able to handle is the weight gain, i’m up about 10lb over the past 2 mo.

Not sure how much I can help since you are the MD but here are some insights I learned the hard way. My weight went all the way up to 124KG before I learned how prednison affects the body specifically. Now I’m down to 80KG.

Some weight gain is caused by water retention (cushioning effect) and will go away once you lower the dose to 10g or less. But Prednisone also changes you metabolism to burn carbohydrates faster which leads to spikes in blood sugar which leads to increased appetite. To counter that it is best to avoid simple carbohydrates as much as possible or at least restrict them to times when you train and eat low carb when you are not.

Since prednison can also cause muscle loss, I would start weight lifting right away. And you might want to substitute calcium and vitamin D3 to counter Osteoporosis.