Posted 4/12/2021 11:59 PM (GMT -6)
The standard recommendation is 40mg for 2-4 weeks, then start tapering. The average person experiences positive impacts on inflammation within one week. One week is typically how long adjustments in steroid dosages start impacting the body, whether the dose is increased or decreased.
You are not supposed to stay on high doses indefinitely, but if you are relatively new to steroids, the first course is not going to seriously harm your body. The effects of steroids are cumulative, over years. It's why steroids are meant to be rescue drugs, and then you switch to maintenance drugs. Prednisone really destroys the body over time, which is why people consider it a deal with a the devil.
Prednisone also has another little known downside. The more times you take it over the years, the less it works. You get more side effect and less therapeutic effect. It's called diminishing returns. When I took 40mg of prednisone in year 1, my flare got better within a week. Now, it takes up to a month for pred to work, and I have to combine it with herbal anti-inflammatories like high does curcumin and boswellia to really get the benefit. None of the maintenance drugs work on my UC, so I'm in a precarious position, but I don't want a colectomy.
I offset the side effects of prednisone (bone loss, moon face, muscle wasting) by taking DHEA and pregnenlone. MDs don't know about this so you will have to do your own research. I have been able to preserve my skeleton for a long time despite years of pred use. During periods of remission, I eat a high mineral diet and go to the gym. I usually regain skeletal mass pretty quickly (according to DEXA scan).
Despite doctors recommending calcium supplements, I find that magnesium, boron and vitamin D3 with K are much more important to preserving the skeleton while on pred. The research confirms a lot of this. I take 6mg boron and up to 400mg magnesium daily (in divided doses), along with 5000 IU vitamin D3. If you can tolerate dairy while flaring (I can't, and neither can a lot of UCers), then you have an easy source of calcium. If you can't tolerate dairy, then you will have to consume a variety of vegetables and their juices. I usually make soups with mineral rich veggies like celery, chard, parsley, etc... and pureed those. Don't do bone broth, it's not mineral rich; and don't do spinach, it's full of oxalate which is not good during flares because far more oxalate enters the blood stream when the colon is raw. I've had kidney stones from eating spinach during a flare.
I hope this info helps you, I am just brainstorming.