A 41-year-old female, ongoing mood symptoms. Mother of three, history of childhood asthma and allergies, antibiotics. Has been on prednisone for nine months for worsening asthma and respiratory infections. Currently on 7.5 mg with plan for a reduction to 5 mg, but patient’s anxious. Because every time they reduce it, she feels she does poorly in terms of respiratory health. Not been able to exercise as she develops palpitations, feels that she’s out of shape. Sleeping less than seven hours due to prednisone, increases her background anxiety. HIstory of childhood trauma. Been gluten and dairy-free for many years. Has eliminated soy and corn as well. Brain fog, difficulty with focus and concentration, anxiety, mood symptoms, also cramps. How to best support her in the context of the prednisone taper. Like her to do CSA and Cyrex testing as well as host of labs. However many of her labs would be skewed by the prednisone. I’m not up to speed in GI testing. Recommended 30-day reset along with autoimmune diet as well as addition of magnesium, curcumin, l’theanine, and probiotic. I’d like to know her D level and supplement as needed as well as her TFT, TPO status. Any words of wisdom re: prednisone or taper, her workout post-steroid treatment, and how to best support that transition re: HPA axis?

Chris Kresser:  Yeah. So in situations like this, you really have to dial in the diet and lifestyle first more than anything else. And asthma is immune dysregulation, as you know, and the fact that a patient is on a gluten and dairy-free diet really, it doesn’t tell me much. She might have gone into more detail with you or maybe you have more detail, but that person could still be eating a lot of gluten-free baked goods, gluten-free cookies. Hopefully not, and given her other eliminations, it seems unlikely, but certainly a Paleo reset and if an autoimmune version of that would be what I would suggest is starting place. I’ve seen that completely or mostly deal with asthma and allergies in a 38- or 60-day time period, so we can’t underestimate the effect that these kinds of interventions can have. And optimized, normalizing your vitamin D level, a little bit of glutathione to help with immune regulation, that’s just the most important focus and starting place in getting her whatever kind of support and help that she needs.

Even actually notifying her and her doctor, asking her to be aware that as her immune system improves the dose of prednisone that she’s taking might actually need to be tapered and reduced because the dose that’s required now to deal with the immune dysregulation could potentially drop. That happens with thyroid medication when you start addressing autoimmunity and patients with Hashimoto’s, and it can happen in this situation too, so I would start there.

Then once she’s able to taper off the prednisone and get mostly off of it, then you can do the, if she’s completely off of it for two or three weeks, you can start doing the full-function medicine workup and look for triggers of immune dysfunction. With asthma and respiratory issues, you probably want to at least consider indoor air and mold biotoxin exposure, and that’s unfortunately a whole other ball of wax shall we say. We’re not going to be covering it in this course, but I have some podcasts and blog posts on it to get you started, but I would put that in as a sort of further off priority. I would address all the basics that we’re covering here first because those are going to be significantly more important for most people.