Do steroid inhalers cause IBS?

I‘d like to clear up a misunderstanding about steroid inhalers used to help control asthma, and the effect they have on the gut microbiome.

I made a Facebook video recently highlighting the fact that steroid inhalers may detrimentally affect the gut microbiome, and increase the risk of developing lower gastro-intestinal problems, in particular bloating, cramps and irregular bowel movements, typical IBS symptoms. There is also evidence to suggest that steroids may increase the risk of developing inflammatory bowel disease such as Crohn’s disease and ulcerative colitis. 

I’m talking about the brown inhaler here that contains a small amount of steroid, not the blue ‘reliever’ inhaler that contains salbutomol. 

A couple of people contacted me to say that was not possible and that steroids in inhalers are absorbed through the stomach and don’t get into the gut. This is not true at all. The effect of steroids is a systemic one.

Anything that is taken into the body via the oral route (down the throat) can end up in gut, via the oesophagus and stomach, and this includes corticosteroids. The steroids have the propensity to increase dangerous clostridia species and reduce protective lactobacillus species in the gut by quite large amount and this will increase the risk of developing gut problems and immune disorders, especially if steroid inhalers have been used over a long period of time. 

Let’s use the analogy of cigarette smoke.  The smoke from cigarettes is inhaled and carried into the lungs.  If the smoke just entered the lungs, via the trachea, and didn’t get down the oesophagus, then there would be no cases of oesophageal cancer, stomach cancer and bladder cancer, cancers that we know are caused by smoking. 

It doesn’t seem to matter how the steroids are administered, they have an effect on the gut microflora and also lung microflora. All types of steroids seem to have an effect and change the bacteria mix in the gut etc.

We also know that steroids, in particular the one used in brown inhalers is beclomethasone, and this is an anti-inflammatory, synthetic glucocorticoid, used topically as an anti-inflammatory agent to treat psoritic skin conditions, and as an aerosol in asthma. However, glucocorticoids are known to slow down wound healing, including inhibit the production of fibroblasts crucial for the production of strong tissues and they also decrease collagen production. My concern here is that long-term use of steroid based asthma aerosols may also increase the risk of developing diverticular disease. 

iverticular disease mainly affects the large bowel, located on the lower left side of your abdomen, and is characterised by bulges or pockets that develop in the wall of the bowel. These damaged areas of the bowel can fill up with faecal matter and can then become sites of inflammation and infection. Ageing affects the integrity of the bowel wall, weakening it, and so can straining during constipation, but what about the effects of the long-term use of steroids. We can’t rule out the fact that they may be having a detrimental effect on the integrity of the bowel wall. If steroids affect the production of collagen, then it stands to reason that the bowel is going to be affected.

Are you taking steroids? If so, have you noticed that you’re getting more gut problems, similar to the ones I’ve mentioned above? If you have IBS or any other gut problems, did they appear after you started using a steroid inhaler? 

I’m not asking anyone to give us their steroid inhalers, but what I do is advise everyone, including children who have to rely on a steroid inhaler, to also take a probiotic capsule twice daily before meals, to ensure their friendly gut bacteria is being topped up daily. Not only may this help to mitigate the effects of the steroids, but also support the immune system, and hopefully help to reduce the asthma attacks. I would also recommend daily Vitamin C for its anti-oxidant properties and essential fatty acids in the form of Omega 3 fish oil capsules, if not eating oily fish at least twice weekly, for their natural anti-inflammatory properties. 

Vitamin C is the King of all vitamins, a super vitamin, when it comes to helping reduce inflammation and infections in the upper respiratory areas, including sinuses, throat and lungs. If you want to know best and most bio-available form of Vitamin C, please get in touch.