Category: General

Steroid inhalers are used in the treatment of bronchial asthma and COPD. They deliver the steroid drug directly into the respiratory tract, and only a tiny fraction of the same crosses into the blood circulation. Steroid inhalers are excellent medicines, dramatically improving the symptoms and quality of life of people with respiratory diseases.

Other than minor irritations like sore throat, rare voice hoarseness and mild tongue coating, steroid inhalers are mostly safe. Some concerns with the use of steroid inhalers are

1. Effect on the natural steroid secretion by the adrenal glands
2. Adverse effects on bone health
3. Adverse effects of growth in children
4. Increased risk of lung infections
5. Increased risk of cataracts and glaucoma (increased eye pressure)

The adverse effects are more when there are larger doses, more potent steroids and more frequent use of steroids. Some people may be more vulnerable, like growing children and elderly. If you have concerns about the adverse effects of steroids, please talk to an endocrinologist.

Dr.Mathew John ,MD,DM

Steroid creams treat conditions like eczema, psoriasis, and allergic reactions. While effective, misuse or prolonged use can cause side effects.

Local side effects include skin thinning, bruising, stretch marks, worsening acne, steroid-induced rosacea, perioral dermatitis, pigmentation changes, impaired wound healing, and potential fungal, bacterial, or viral infections. Allergic reactions causing contact dermatitis may also occur.

Systemic side effects are rare but can result from extensive use, especially on thin or broken skin. These can include Cushing’s syndrome, adrenal fatigue, high blood sugar, hypertension, and growth retardation in children.

Using steroid creams near eyes may lead to glaucoma or cataracts. To minimize risks, follow your doctor’s prescription, avoid extended use unless directed, apply only to affected areas, monitor for unusual reactions, and consult your doctor if adverse effects arise.

Dr. Tittu Oommen MD, DM

Dehydroepiandrosterone (DHEA) is a hormone produced in the adrenal gland and helps to produce sex hormones, including testosterone and estrogen. Natural DHEA levels peak in early adulthood and slowly fall as you age.

A synthetic version of DHEA is available in tablet, capsule, powder, topical cream, and gel forms. These are considered health supplements and not therapeutic medicines. People use DHEA as an anti-aging therapy, for infertility, to improve physical performance, and to treat depression and menopausal issues.

As an anti-aging medicine and for enhancing performance, no significant data supports its use. The National Collegiate Athletic Association has banned DHEA use among athletes.

In women with primary adrenal insufficiency, less DHEA is produced by the adrenal. So, it is recommended as a replacement to improve libido. There is limited long-term scientific information that supports its use. DHEA is extensively used in infertility treatment to improve the quality of eggs and to help implantation. However, there is no substantial evidence to support its regular use.

DHEA can increase the levels of androgens and has steroidal effects. Hence, DHEA might increase the risk of cancers like prostate, breast, and ovaries. Further, DHEA can cause acne, oily skin, and increased hair loss. Avoid using DHEA if you’re pregnant or breastfeeding and when you are on multiple other medicines, as there can be drug interactions.

There is little evidence for using DHEA, and reputable organizations like the Mayo Clinic advise against DHEA supplements. They have limited evidence for benefit and have the potential to cause unwanted side effects. Talk to your healthcare provider if you are thinking of taking these supplements.

Dr. Deepa G, MHSc (Diab), Dip (Diab)

Cortisol, referred to as the “stress hormone,” is essential in managing stress, regulating blood sugar, and maintaining blood pressure. The body releases cortisol during various types of stress, such as short-term, long-term, or traumatic stress. Persistently high cortisol levels may indicate health concerns.

Hypercortisolism, or elevated cortisol levels, can result from chronic stress, adrenal gland disorders like Cushing’s syndrome, prolonged use of corticosteroids, or other endocrine issues such as pituitary tumours. Symptoms linked to hypercortisolism include weight gain around the abdomen and face, high blood pressure, fatigue, muscle weakness, mood changes, sleep disturbances, and decreased immune function.

To diagnose hypercortisolism, tests are conducted on blood, urine, or saliva for cortisol levels, ACTH levels are checked, and other relevant examinations are performed. Treatment varies according to the cause and may involve lifestyle modifications, medication adjustments, or surgery for tumours. If high cortisol levels are suspected, it is advisable to consult a healthcare professional for comprehensive evaluation and guidance.

Dr. Tittu Oommen MD,DM

Nuts are calorie-dense and a good source of healthy nutrients. Nuts do not increase cholesterol; instead, they can help lower bad cholesterol (LDL) and increase good cholesterol (HDL) when consumed in moderation. Nuts are rich in unsaturated fats, fiber, and plant sterols, which help reduce LDL cholesterol and improve heart health. Regular consumption of nuts has been linked to lower cholesterol levels and reduced risk of heart disease.

How Nuts Affect Cholesterol:

• Increase Good Cholesterol (HDL): Helps remove excess cholesterol from the bloodstream.

• Reduce Bad Cholesterol (LDL): Nuts contain healthy unsaturated fats, which help lower LDL cholesterol.

• Contain Healthy Fats: Monounsaturated and polyunsaturated fats support heart health.

• Rich in Fiber & Plant Sterols: Block cholesterol absorption in the intestines.

Best Nuts for Managing Cholesterol:

Almonds, walnuts, pistachios, pecans, and hazelnuts are high in healthy fats and antioxidants.

Avoid salted or sugar-coated nuts – Added salt and sugar may increase health risks.

Tips: Moderation is key. Consume a small handful (about 28g) of unsalted nuts daily as part of a balanced diet for heart health.

Ms.Sreekutty.S, Msc

Cortisol is a hormone produced by the adrenal gland. The cortisol levels can go up in various conditions, some of which are physiological, and some are pathological. Like many other hormones, cortisol is produced in a circadian rhythm: cortisol levels are highest on waking up and lowest during sleep. Cortisol is vital in the body’s response to stress; it helps increase blood pressure and glucose production and plays a crucial role in maintaining normal blood pressure.

Cortisol increases during stress. It can also increase during intense exercise, pregnancy, trauma and infections. Cortisol levels can get altered during anxiety, depression, insomnia and night work.

There is a complex relationship between weight and cortisol levels. Persistent high cortisol levels associated with chronic stress are believed to be one of the mechanisms for weight gain ( but not the only one !). Further, obesity itself leads to high cortisol levels.
However, high cortisol levels leading to obesity are found in a condition called Cushing’s syndrome. In this condition, high cortisol production directly from an adrenal tumour or from a pituitary gland tumour producing ACTH leads to a constellation of symptoms called Cushing’s syndrome. This is a rare cause of obesity.

So, high cortisol per se is a rare cause of obesity, but cortisol can be considered a cause of weight gain. By managing stress, getting 7-8 hours of sleep and regular exercise can help you keep your cortisol levels under check!

Dr. Mathew John, MD,DM

The adrenal gland is a set of glands on top of the kidneys that produce cortisol, aldosterone, sex steroids and adrenaline. Cortisol is a hormone that is increased during stress. There is a theory that chronic stress can drain the adrenal dry of cortisol, leading to inadequate cortisol, which is called adrenal fatigue. However, the proponents of this theory believe that routine blood tests cannot detect this deficiency.

However, modern science does not agree with this. People can have various degrees of adrenal deficiency detected by blood tests. This deficiency is not due to chronic stress but various diseases that destroy the adrenal cells.

If you have tiredness, low blood pressure, nausea, loss of hair, or sleep problems, meet an endocrinologist to find out if you have any hormonal issues. Don’t self-administer steroids or any adrenal supplements. They could be potentially dangerous.

So, adrenal fatigue is not a medically recognized disease. Chronic stress does not cause adrenals to fatigue. Hence, try to alleviate your stress with other lifestyle measures like yoga and regular exercise and treat your symptoms only after proper medical consultation.

Dr. Deepa G, MHSc (Diab), Dip (Diab)

Although obesity medicines produce weight loss, which helps with many obesity-related diseases, they are not for everyone. A small proportion of people with obesity are not suitable for anti-obesity medicines. Another group, although appropriate, may discontinue these medicines due to the adverse effects.

Orlistat cannot be used in people with malabsorption syndromes, those conditions that lead to blockage of bile (cholestasis) or allergies to the drug. Some people who start Orlistat may discontinue it due to tummy issues like oil leakage in stools.

Liraglutide, Semaglutide and Tirzepatide are contraindicated in people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.

Around 5 to 10 % of people who are on Liraglutide, Semaglutide and Tirzepatide may experience nausea, vomiting, bloating, diarrhoea or constipation, leading to discontinuation of these drugs. This happens especially during the dose escalation stages of the drug.

Dr. Mathew John MD, DM

Obesity is regarded as a chronic disease, necessitating medication that may be required for the long term or even lifelong to sustain weight loss and enhance health. The duration of anti-obesity medication treatment varies based on an individual’s health objectives, the effectiveness of the treatment, and their physician’s recommendations. Some patients may experience benefits within a few months, while others may require ongoing use to maintain results. Should an individual not achieve at least 5% body weight reduction after taking the full dose of a medication for 3 to 6 months, it is likely that their physician will adjust the treatment plan, potentially switching to an alternative medication.

Discontinuation of anti-obesity medication should always occur under medical supervision. Establishing and adhering to healthy dietary practices and increasing physical activity can assist in minimizing weight regain or maintaining weight loss. A supervised exercise regimen may also help reduce the rate of weight regain, and many individuals will likely need to continue medication in the long term.

Dr. Tittu Oommen MD,DM

Anti-obesity medications can have an impact on other health conditions such as diabetes, high blood pressure, and high cholesterol. Some weight-loss medications like Metformin,GLP-1 analogues help to improve insulin sensitivity, regulate blood sugar levels, and may reduce the need for other diabetes medications also. Similarly, weight loss can lead to lower blood pressure and improved cholesterol levels especially LDL and Triglyceride levels and thus reduce the risk of future cardiovascular diseases.

However, these medications may have potential side effects or interactions with other medications used for these conditions. The efficacy of these drugs can vary depending on individual factors like the initial weight ,the adherence to diet and exercise and also adherence to medication .Hence it is essential to consult a healthcare professional before starting any anti-obesity treatment to ensure that it is safe and suitable for your specific health needs. Regular monitoring of your health parameters ,lifestyle changes including low carb diets and exercises along with proper medication adherence may help in managing weight and associated health conditions effectively.

Dr. Deepa G, MHSc (Diab), Dip (Diab)