T Nation

Asthma and Gluco-Cortico Steroids


I have asthma, and have been taking gluco-cortico steroids since I was a kid. I seem to have developed a "spare tire", partly from lack of dilligent exersize, but I suspect also partly due to the systemic absorbtion of these steroids which tend to mimick and/or cause a secretion of cortisol, which is antagonistic to insulin, making me insulin resistant. A vicious cycle.

Question is: how do I combat this (or HELP combat this) with suppliment use?

I've weaned myself off of the rediculous doses the doctors were prescribing me while also using Serevent (not a steroid, but a mild stimulant) - I only take Advair once a day. (Advair is a combination of the steroid and the serevent) Reducing my intake of the steroid will I'm sure help with the spare tire, but what should I be taking to combat the excessive ammounts of cortisol in my system, and what can be done to restore my insulin sensitivity?

I'm currently taking Carbolin 19, and I'm planning to get myself some Flameout and Creatine as soon as both are available on this site.

Does anyone have any extra advice for me?



Well, first I'd like to congratulate you on keeping up with the cortisol treatment, most people don't grasp its monumental importance in asthma and COPD management.

Things shown to improve glycemic control and fight off insulin resistance to some extent:

-Reduced calorie-diet
-Reduced carbohydrate intake
-Reduced fat intake
-Increased fiber intake
-Increased omega-3 fatty acids (could also help with general inflammation)
-Post workout nutrition (carb/protein)
-Increased cardiovasuclar exercise
-Increased resistance training (through increased muscle mass/metabolism/adaptation)
-Weight loss
-Green tea, some evidence
-Cinnammon (1-6 g/day), growing evidence (through insulin receptor phosphorylation)
-Good vitamin status (vit.E 600mg, C 1000 mg and beta-carotene 32mg show some evidence of being usefull
-Reduced daily stress/stress management
-Medication, such as biguanide (Metformin, Glumetza) which increases insulin sensitivity.

This may seem like very broad and unspecific and not related with supplements because cortisol blockers don't work very well. (Phoshatidylserine for example, was shown not to be effective in reducing stress markers).

In a way, any supplements that should reduce your fat mass (HOT-ROX) or improve your lean body mass ratio (Carbolin 19) should also help with insulin resistance.

However, you should understand that there are at the present no effective supplements and medication shown to block cortisol receptors/action.(thiazolidinediones are a recent exception to this and are a new target area for research, these are PPAR agonists useds in Type II diabetes treatment but have the disadvantation of increasing bodyfat while reducing glycemia (because fat cells and muscles cells, but more fat cells are forced to take in more glucose)).

Some medication blunt cortisol production either through adrenolytic necrosis or through cholesterol side-chain modification inhibition.

However, considering you are already taking exogenous cortisol, production reduction would offer no benefit and might force you to up your cortisol dose to maintain the benefits on reduced airway inflammation.

So far, there is no cortisol blockers that could allow you to maintain airway inflammation control and reduce its effects on the rest of the body. That would kick ass, but we have no such compounds yet.

In a way you'll have to deal with the fact that you have an X level of cortisol and find ways around that to achieve your goals, either through increased diet control or more effective training programs and increased dedication.

I hope this has helped somewhat,

Stay healthy,


Kristoffer...I have asthma too, and take Advair for it. So, I'm in the same boat and have asked this question a couple of times on this forum...with no response.

AlexH...I appreciate your reply, although it is not exactly good news. I'm looking for ways to get off the Advair (safely, of course). Even when doing "all the right things" with diet & exercise, it doesn't seem enough to overcome the hold cortico-steriods have on bodyfat. Maybe the Flameout will help......



Thank you so much for the in-depth reply! I can see right away that there's good news to it and bad news to it. I suppose I'll simply have to resign myself to the fact that I'll be taking a gluco-cortico steroid in one form or another for the rest of my life, and as a consequence, I'll probably always have love-handles in one form or another. (two years ago, when I was in peak physical condition I still weighed 200 lbs, could do 20+ pullups, 80 or so push-ups, and my vertical leap was almost good enough to dunk a basketball, but still, I looked pudgy around the midsection)

If Omega-3 acids will indeed help, then I think I'll be buying a couple bottles of Flameout VERY soon. I've been using Surge after workouts, and it ALWAYS makes me feel great from that insulin rush. I'm glad to hear that I'm on the right path with the Carbolin 19... perhaps in a week or two I'll try stacking it with a low dose of HOT-ROX, and see how that goes for me.

That's a LOT of good advice, and I think I may be re-formulating a diet for myself with some help from a good friend who knows a lot about nutrition, based on the Anabolic diet for powerlifters. (perhaps a lower fat version?)

I'll have to ask my doctor about insulin sensitivity medication... that sounds promising! What sort of side effects could one expect with medication of that nature?

Less stress and more sleep are going to be the tough ones... I work like 14-18 hrs a day, and my wife always wakes me up when I'm sleeping so she can spend time with me. Sometimes I'm grouchy and manage to fend her off, but others I just can't bring myself to say no and go back to sleep. I think I'll go read the thread on insomnia too, I have been known to be an insomniac as well.

Alex, again, thank you so much for the valuable info. "S. Revenge", let's make it a point to talk about Flameout's results in about a month.



Well Kristoffer and Sweet Revenge,

I am glad that you appreciate the post and am sorry that there could not be better news. Chronic conditions like this are a tough thing to live with.

Eur Respir J. 2000 Nov;16(5):861-5. Related Articles, Links

Dietary supplementation with fish oil rich in omega-3 polyunsaturated fatty acids in children with bronchial asthma.

Nagakura T, Matsuda S, Shichijyo K, Sugimoto H, Hata K.

Dept of Paediatrics, Jikei University School of Medicine, Tokyo, Japan.

Omega-3 polyunsaturated fatty acids have anti-inflammatory effects in vitro, and high dietary levels are associated with a lower incidence of inflammatory diseases. However, only limited effects have been demonstrated in asthma. The effects of dietary supplementation with fish oil for 10 months in 29 children with bronchial asthma was investigated in a randomized controlled fashion. In order to minimize the effects of environmental inhaled allergens and diet, this study was performed in a long-term treatment hospital. Subjects received fish oil capsules containing 84 mg eicosapentaenoic acid (EPA) and 36 mg docosahexaenoic acid (DHA) or control capsules containing 300 mg olive oil. The daily dosages of EPA and DHA were 17.0-26.8 and 7.3-11.5 mg x kg body weight(-1), respectively. Asthma symptom scores decreased and responsiveness to acetylcholine decreased in the fish oil group but not in the control group. In addition, plasma EPA levels increased significantly only in the fish oil group (p<0.0088). No significant side-effects were observed. The present results suggest that dietary supplementation with fish oil rich in the omega-3 polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid is beneficial for children with bronchial asthma in a strictly controlled environment in terms of inhalant allergens and diet.

Intern Med. 2000 Feb;39(2):107-11. Related Articles, Links

Effects of dietary supplementation with n-3 fatty acids compared with n-6 fatty acids on bronchial asthma.

Okamoto M, Mitsunobu F, Ashida K, Mifune T, Hosaki Y, Tsugeno H, Harada S, Tanizaki Y.

Department of Medicine, Misasa Medical Branch, Okayama University Medical School, Tohaku-gun, Tottori.

OBJECTIVE: The effects of perilla seed oil (n-3 fatty acids) on bronchial asthma were compared with the effects of corn oil (n-6 fatty acids) in relation to the pulmonary function and the generation of leukotriene B4 (LTB4) and C4 (LTC4) by leucocytes. METHODS AND SUBJECTS: 14 asthmatic subjects were divided randomly into two groups: one group (7 subjects) consumed perilla seed oil-rich supplementation and the other group (7 subjects) consumed corn oil-rich supplementation for 4 weeks. Generation of LTs by leucocytes and respiratory function were compared between the two groups. RESULTS: The generation of LTB4 and LTC4 by leucocytes tended to increase in subjects (N=7) with corn oil-rich supplementation, and decrease in subjects (N=7) with perilla seed oil-rich supplementation. Significant differences between the two groups were observed in the generation of LTB4 at 2 weeks (p<0.05) and LTC4 at 2 weeks (p<0.05) after dietary supplementation. Significant increases in the value of PEF (p<0.05), FVC (p<0.01), FEV(1.0) (p<0.05) and V(25) (p<0.05) were found in subjects who received perilla seed oil supplementation for 4 weeks. And significant differences in the value of FVC (p<0.05) and FEV(1.0) (p<0.05) were observed between the two groups after 4 weeks of dietary supplementation. CONCLUSION: These results suggest that perilla seed oil-rich supplementation is useful for the treatment of asthma in terms of suppression of LTB4 and LTC4 generation by leucocytes, and improvement of pulmonary function.

So yeah, it looks good on paper. I would have liked to see more research on this, but hey.

As for glucose tolerence, the interesting coumpounding that's a first line treatment option is the biguanide Metformin.

Metformin is hypothesized to work through many mechanism.

-Delayed carbohydrate absorption in the intestine.
-Reduced neoglucogenesis in periods of existing hyperglycemia
-Increased peripheral (muscle) insulin sensitivity (transporter mediated)
-Increased (hepatic, I think) anaerobic glycolysis

And I think there is another one that I often forget, such as now.

As with any drugs there is a list of possible side effects (since its been used on so many people, that even the rarest of them have surface).

The most common style are


Nausea/ Vomiting




Abdominal Discomfort


Interestingly, the relative safeness of Metformin have lead many to reassess most of the counter-indications previously imposed on its use despite a lack of evidence to adverse effects (better safe then sorry they would say, but with the pandemic of obesity/diabetes, they are changing their tune.)

To be honest you quickly get use to some of the GI side effects and they are related to the amount of carbs that you take in. Going to a too high dose too quickly can give you nausea.

Of course, that would require getting a prescription, but hey, glucose resistance can be , hum, modified.

Good luck to you guys,


Thanks once more Alex, that's a LOT of great info.

I'm reconsidering going on the Anabolic diet (unless it's for a short period of time), because I was informed that low-carb diets can reduce your insulin sensitivity in the long run. I think I'll give the 'old Omega-3's a go, a la Flameout for a couple months, and maybe r-alpha lipoic acid, coroscolic acid, maybe some chromium (additional advice from a buddy of mine).

I'm also wondering if you've heard anything about delayed food allergy affecting Asthma - I'm planning to get an IGg test to help determine what foods I shouldn't be eating - I've heard that the inital irritation that makes the airways seceptable to an immune response (resulting in infamation) is often associated with diet. ...so for others out there with Asthma, this might also be a good thing to look into. (I'll see if I can post a link or two later - I'm at work at the 'mo).



Hey Kris,

for the anabolic diet, there is evidence showing that very low-carb car improves insulin sensitivity.


Obes Rev. 2006 Feb;7(1):49-58. Related Articles, Links

Low-carbohydrate diets: nutritional and physiological aspects.

Adam-Perrot A, Clifton P, Brouns F.

Cerestar R&D Vilvoorde Center, Havenstraat 84, 1800 Vilvoorde, Belgium.

Recently, diets low in carbohydrate content have become a matter of international attention because of the WHO recommendations to reduce the overall consumption of sugars and rapidly digestible starches. One of the common metabolic changes assumed to take place when a person follows a low-carbohydrate diet is ketosis. Low-carbohydrate intakes result in a reduction of the circulating insulin level, which promotes high level of circulating fatty acids, used for oxidation and production of ketone bodies. It is assumed that when carbohydrate availability is reduced in short term to a significant amount, the body will be stimulated to maximize fat oxidation for energy needs. The currently available scientific literature shows that low-carbohydrate diets acutely induce a number of favourable effects, such as a rapid weight loss, decrease of fasting glucose and insulin levels, reduction of circulating triglyceride levels and improvement of blood pressure. On the other hand some less desirable immediate effects such as enhanced lean body mass loss, increased urinary calcium loss, increased plasma homocysteine levels, increased low-density lipoprotein-cholesterol have been reported. The long-term effect of the combination of these changes is at present not known. The role of prolonged elevated fat consumption along with low-carbohydrate diets should be addressed. However, these undesirable effects may be counteracted with consumption of a low-carbohydrate, high-protein, low-fat diet, because this type of diet has been shown to induce favourable effects on feelings of satiety and hunger, help preserve lean body mass, effectively reduce fat mass and beneficially impact on insulin sensitivity and on blood lipid status while supplying sufficient calcium for bone mass maintenance. The latter findings support the need to do more research on this type of hypocaloric low-carbohydrate diet.

However, another factor comes in. Overall, insulin sensitivity is improved on low-carb, high-protein diets. But, since you switch you body from cabohydrate to lipid metabolism, it will take a few days for your cells to show some glucose metabolizing enzyme induction.

So it depends how you look at it, insuline sensitivity is improved but carbohydrate metabolism is impaired because the enzymes are not induced, therefore we should not confused the 2. Overall, fatloss and lean body mass retention is superior on a low carb, moderate fat, high protein diet then on a higher carb, low fat diet.

As for the alpha-lipoic acid, there is evidence in human of its use in increasing insuline sensitivity, similar to cinnamon in their post-receptor actions. The corosolic acid and chromium pincolate have very few studies backing it up in the metabolism departement, but if you should go that way (Glucosol0 use soft-gel capsule, they seem to have better bioavailability. On of the lastest (small) RCT on Chromium Pincolate showed no effect on glucose metabolism, lipids and cholesterol even with known higher serum levels of chromium.


Diabetes Care. 2003 Dec;26(12):3215-8.

Cinnamon improves glucose and lipids of people with type 2 diabetes.

Khan A, Safdar M, Ali Khan MM, Khattak KN, Anderson RA.

Department of Human Nutrition, NWFP Agricultural University, Peshawar, Pakistan.

OBJECTIVE: The objective of this study was to determine whether cinnamon improves blood glucose, triglyceride, total cholesterol, HDL cholesterol, and LDL cholesterol levels in people with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 60 people with type 2 diabetes, 30 men and 30 women aged 52.2 +/- 6.32 years, were divided randomly into six groups. Groups 1, 2, and 3 consumed 1, 3, or 6 g of cinnamon daily, respectively, and groups 4, 5, and 6 were given placebo capsules corresponding to the number of capsules consumed for the three levels of cinnamon. The cinnamon was consumed for 40 days followed by a 20-day washout period. RESULTS: After 40 days, all three levels of cinnamon reduced the mean fasting serum glucose (18-29%), triglyceride (23-30%), LDL cholesterol (7-27%), and total cholesterol (12-26%) levels; no significant changes were noted in the placebo groups. Changes in HDL cholesterol were not significant. CONCLUSIONS: The results of this study demonstrate that intake of 1, 3, or 6 g of cinnamon per day reduces serum glucose, triglyceride, LDL cholesterol, and total cholesterol in people with type 2 diabetes and suggest that the inclusion of cinnamon in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes and cardiovascular diseases.

Alpha Lipoic Acid

Free Radic Biol Med. 1999 Aug;27(3-4):309-14.

Oral administration of RAC-alpha-lipoic acid modulates insulin sensitivity in patients with type-2 diabetes mellitus: a placebo-controlled pilot trial.

Jacob S, Ruus P, Hermann R, Tritschler HJ, Maerker E, Renn W, Augustin HJ, Dietze GJ, Rett K.

Hypertension and Diabetes Research Unit, Max Grundig Clinic, Buhl and City Hospital, Baden-Baden, Germany. snjacob@med.uni-tuebingen.de

Alpha-lipoic acid (ALA), a naturally occuring compound and a radical scavenger was shown to enhance glucose transport and utilization in different experimental and animal models. Clinical studies described an increase of insulin sensitivity after acute and short-term (10 d) parenteral administration of ALA. The effects of a 4-week oral treatment with alpha-lipoic acid were evaluated in a placebo-controlled, multicenter pilot study to determine see whether oral treatment also improves insulin sensitivity. Seventy-four patients with type-2 diabetes were randomized to either placebo (n = 19); or active treatment in various doses of 600 mg once daily (n = 19), twice daily (1200 mg; n = 18), or thrice daily (1800 mg; n = 18) alpha-lipoic acid. An isoglycemic glucose-clamp was done on days 0 (pre) and 29 (post). In this explorative study, analysis was done according to the number of subjects showing an improvement of insulin sensitivity after treatment. Furthermore, the effects of active vs. placebo treatment on insulin sensitivity was compared. All four groups were comparable and had a similar degree of hyperglycemia and insulin sensitivity at baseline. When compared to placebo, significantly more subjects had an increase in insulin-stimulated glucose disposal (MCR) after ALA treatment in each group. As there was no dose effect seen in the three different alpha-lipoic acid groups, all subjects receiving ALA were combined in the "active" group and then compared to placebo. This revealed significantly different changes in MCR after treatment (+27% vs. placebo; p < .01). This placebo-controlled explorative study confirms previous observations of an increase of insulin sensitivity in type-2 diabetes after acute and chronic intravenous administration of ALA. The results suggest that oral administration of alpha-lipoic acid can improve insulin sensitivity in patients with type-2 diabetes. The encouraging findings of this pilot trial need to be substantiated by further investigations.


Diabetes Care. 2005 Mar;28(3):712-3.

Comment in:
Diabetes Care. 2005 Jul;28(7):1841-2; author reply 1842-3.

Chromium supplementation does not improve glucose tolerance, insulin sensitivity, or lipid profile: a randomized, placebo-controlled, double-blind trial of supplementation in subjects with impaired glucose tolerance.

Gunton JE, Cheung NW, Hitchman R, Hams G, O'Sullivan C, Foster-Powell K, McElduff A.

Full article accessible here:

I should have thought of those but when there is a lack of clear evidence, I tend to stay clear but keep an interested eye, and not fall in like others by prematuraly agrandizing the results of one or two studies, like the CLA trap that happened a couple of years back.

There is also the probleme with these compounds that we don't have any idea about there purity and this is something that has bothered me significantly since the supplement industry is one of the most dishonnest and unregulated industry out there. So unless I trust the maker, I usually refrain. Of course, if you can ''feel'' the effects than at least you know something is going on, like MAG-10 a few years back)

A number of studies on the then new Atkins style diet showed unequivocal improvement on insulin sensitivity over the 12 month period over which they were carried, significant improvement over the ''placebo'' low fat, high fiber American Heart Association diet.

As for the food allergy / asthma link/trigger, I've heard about it, and remember its pretty rare, but not wholly unexpected since atopia involves by simple definition reaction to many things.

The Connection Between Food Allergies and Asthma? from the Cleaveland Clinic Health Information Center, linked to the NIH (so it has some legitimity)


But I must say that is not an area of expertise of mine.

I hope this helps a bit, do a little research, not to fall into supplement traps which seem to work in the petri dish or on some mice, but might not work in humans, like are chromium friend here.

As for the other things such are corosolic acid and cinnamon the level of evidence is very, very, very low. I personally don't mind for the cinnamoon cause it tastes great in the shakes and seems to have a brighter future research wise then other compounds (its still a phenolic compound and those have always been full of research/result goodness) besides, it costs largely nothing.

If you have other questions, feel free.