Karen Hannah, London

The side-effects of long-term steroid use — particularly weight gain — can cause real angst. It sounds bizarre, but try a sniff of vanilla essence every time you crave something sweet. Cravings often disappear if you can distract yourself.

Avoid sweet foods such as honey, chocolate, squash and fizzy drinks, or any of the other high-GI foods, such as bananas, mashed potatoes, wheat breads, popcorn, etc. While your initial craving might be satisfied, you’ll experience a rapid sugar high, and your sugar levels can come crashing down, making you want to eat more. The cycle just repeats itself and the weight piles on.

Choose instead mainly low-GI foods, and stick to a regular eating pattern: three meals a day and maybe fruit snacks in between. Great low-GI foods include porridge and oatmeal; whole-grain rye bread; brown and white rice; white and whole-grain pasta; dried apricots, apples, cherries, fresh dates, grapefruit, grapes, kiwi fruit, mangoes, oranges, peaches, pears and plums; avocados, raw carrots, green, leafy vegetables, peas, potatoes (not mashed) and sweet corn; lentils and beans; organic soya (to avoid GMs) products.

Low-GI foods take longer to digest and keep the blood-sugar level constant so that cravings for sweet stuff are less likely. It is a mistake to skip meals to keep weight down: although the decrease in calories should lead to weight loss, the opposite usually happens because, as blood-sugar levels drop, you get tired and cravings increase.

Also, if you haven’t eaten for a while, you often end up bingeing on quick-fix, high-fat, high-sugar convenience stuff, so that your total calorie intake is higher than if you’d had a proper meal. This is the logic behind including regular healthy snacks in your diet: fresh fruit mid-afternoon will keep blood-sugar levels constant and stop you reaching the “I’m-starving” stage in the evening.

Some steroids (usually those taken orally as opposed to inhalers, but check with your doctor if you’re a long-term inhaler user) may increase the risk of osteoporosis. This is a real downside — discuss your bone status with your doctor, who may want to arrange a bone-density scan. To help to prevent this, take as much exercise as possible.

After the age of about 20, when bones stop growing, keeping active reduces the likelihood of fractures: not only does it stimulate the body to continue laying down strong new bone, but people who take regular exercise are less likely to fall badly (and so reduce the risk of fractures). I would try to boost your intake of bone-friendly calcium. Many people think that dairy products — milk, cheese, yoghurt — are fattening, lead to high cholesterol levels, cause catarrh, they upset the bowels, etc, and so cut down on their intake. However, dairy products provide some of our best sources of bone-building calcium, so that it’s important to include these in your diet.

Rather than choosing full-fat varieties, save calories by buying skimmed or semi-skimmed milk (calcium is held in the non-fat part of milk) and lower-fat cheeses such as Edam, Gouda and cottage cheese. It’s advisable to stick to lower-fat dairy products anyway to limit your intake of saturated animal fats, which reduce your body’s ability to make the bone-protecting hormone progesterone.

In the UK the reference nutrient intake (RNI) for adults aged 19 to 50 is 700mg calcium daily, but many nutritionists, myself included, think the US recommended 1,000mg is more like it. This equates to roughly 200ml of milk, a pot of yoghurt, or a matchbox-sized piece of cheese. Non-dairy sources of calcium include leafy green vegetables, small-boned fish such as sardines, fortified soya milk, orange juice, cereals, seeds, nuts and dried fruits. Unfortunately, calcium from non-dairy foods isn’t as easily absorbed by the body, so non-dairy-eating people taking steroids should ask their doctor about supplements.

Bones also need magnesium, found in chickpeas, beans, tofu, almonds, cashews, lentils, potatoes and oatmeal. The recommended intake is 270mg for women and 300mg for men, which equates to 66g of Brazil nuts or 100g of pine nuts. In addition, the body needs vitamin D to make strong bones. Fifteen minutes in the sunshine every day will do the trick, but if this isn’t possible some scientists recommend taking 200 to 400 international units (IU) of vitamin D daily if you are under 70, and 600 IU if you are over.

Some fizzy diet drinks contain phosphoric acid, which increases loss of calcium from bones; salt also increases calcium loss, so try to keep your intake low. Oily fish, walnuts, walnut oils and hemp oil boost the essential fatty acids that build and maintain healthy bones, but, as with full-fat dairy products, the quantities shouldn’t be excessive, as they can pile on the weight. You can get enough beneficial omegas from a couple of 140g portions of oily fish (fresh tuna, salmon, sardines, mackerel, etc) a week, or by using seeds and oils on your salads. You could also consider taking the omega oil supplement MorEPA, or any of the others I mentioned last week, that are available from: www.healthyandessential.co.uk

DO YOU NEED ADVICE?

Send your nutritional problems to jane.clarke@thetimes.co.uk or to Jane Clarke, times2, 1 Pennington Street, London E98 1TT. Her replies cannot apply to individual cases and should be taken in a general context. Consult your GP with any health or specific conditions. Jane cannot enter into personal correspondence.

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