That sore shoulder of yours, it could be a hidden cause of fatigue.
No, not from the pain itself. But from that cortisone injection, you got last week!
Cortisone shots make you tired.
When you scheduled your cortisone shot, I bet you didn’t consider that it could make you tired. I’d wager a great sum of money the doc doing the injection didn’t even tell you that cortisol can make you tired. You see, cortisone has a dark side. For all the pain-relieving benefits cortisone has, there’s a long list of potential side effects.
Before you book your next cortisone injection, read this post. Educate yourself on the potential risks. Make an educated and informed decision. Do not book the appointment thinking there are no risks.
Some of you are at greater risk than others. You should be a well-informed patient before booking an appointment. I’ll help you do just that today!
Let’s get going!
Cortisol vs Cortisone
You’re probably more familiar with cortisol; which is slightly different than cortisone. But they’re closely related. The main difference being that cortisol is released by your adrenal glands while cortisone is not. (1)
Your body will release cortisol in response to allergies or other inflammatory conditions. The reason being is that cortisol is incredibly anti-inflammatory. Cortisone mimics the effect of cortisol. But it binds to receptor sites even better than cortisol; making for an even more profound anti-inflammatory effect. This can be profoundly helpful when dealing with an injury that never seems to heal.
But cortisone does more than exhibit an anti-inflammatory effect. Cortisone is what is known as a glucocorticoid. And that means this steroid hormone will do much more than influence inflammation.
The dark side of cortisone
Your blood sugar and cortisol share an intimate relationship with each affecting the other. This relationship is so interconnected that blood sugar imbalances can cause adrenal fatigue. The same relationship exists between cortisone and your blood sugar.
Both cortisol and cortisone will increase your blood sugar. This effect is most profound when taking oral glucocorticoids like prednisone (LINK). But blood sugar abnormalities can also result from a cortisone shot.
Even though a cortisone shot is not done into the bloodstream, your blood sugar will still be affected. Both cortisol and cortisone increase blood sugar levels. Most Canadians and Americans are already dealing with a blood sugar issue – you just might not know it yet! Click here to learn exactly how healthy your blood sugar is.
When you receive a cortisone shot, your blood sugar is going to increase; sometimes dramatically. This phenomenon should be temporary. But for some of you who are already struggling to regulate your blood sugar, the cortisone injection could be the proverbial straw that breaks the camel’s back. Should this happen, your cortisone shot will make you tired. Very tired.
How could blood sugar affect energy?
Regulating the quantity of sugar in your blood is of utmost importance. Too much sugar in your blood and your tissues start to die. Too little sugar in your blood and you’re in a coma close to death. Much like pH, blood sugar needs to be tightly controlled.
For most of you, sugar (glucose) is analogous to the unleaded gasoline your car runs on. Without sugar, your body doesn’t have the means to create energy. When this occurs, you’ll experience it as fatigue. Fatigue is a self-preservation mechanism. By making you tired, your body is able to conserve what little energy it has. Fatigue prevents you from activities that require tremendous energy output – like running a marathon.
If your blood sugar is too high, too low, or fluctuating dramatically between highs and lows, you’ll experience this as alterations to your energy. When fatigue is the issue, blood sugars are always implicated. Let me show you how to achieve and maintain the perfect blood sugar – click here to learn more.
Cortisone’s hidden effects on blood sugar
As you now know, cortisone shots cause alterations to your blood sugar. All that cortisone will pull sugar out of your cells and into your blood. The resulting effect is high blood sugar levels. (2) In most cases, this is a temporary and transient effect. But for some of you, this could be enough to push your body into the realm of high blood sugar (hyperglycemia). And should this happen, you’re most certainly going to experience fatigue.
If you don’t have diabetes, monitor your blood sugar levels before and after a cortisone injection. If you’re diabetic, you need to regularly check your blood sugars before and after a cortisone shot. Follow a low-carb or keto diet for 2-weeks before and after your injection is a perfect way to stabilize your blood sugar – even after cortisone.
The key here is for you to ensure your blood sugars return to balance within two weeks following the injection. They should. But that’s not a guarantee. If your sugars do not return to normal, you’re on the fast track towards fatigue. You’ll need to alter your diet and lifestyle to get them back on track. If you’re getting a cortisone injection, be proactive; test your blood sugars before and after the procedure. Make sure your levels return to normal ranges within two weeks.
More ways cortisone shots make you tired
Your body uses something called the HPA (hypothalamic-pituitary-adrenal) axis to best handle the stresses of life. That feeling of your heart in your throat when you come accross a grizzly bear in the backcountry, that’s your HPA axis in action. The fight or flight and rest or digest responses are modulated by your HPA axis.
Adrenal fatigue describes a condition in which your HPA axis is no longer resilient. Instead of adapting to a stressful event, your body crumbles. Adrenal fatigue develops via three hidden stresses. But it can also develop by way of cortisone injections.
When you get a cortisone shot, your body is flooded with the hormone – the larger the dose, the larger the response. This triggers a phenomenon known as feedback inhibition. The high levels of cortisone brought on by the injection tell your body that there’s plenty of this hormone. Therefore, no need to make any more. When this occurs, your body slows its production of cortisol.
A single injection of cortisone has been shown to dramatically lower circulating levels of cortisol. (3, 4) Just like that, you’re experiencing adrenal fatigue. In the study I quoted, adrenal fatigue occurred in 9 out of 10 of the participants after receiving a cortisone injection. For the record, these participants were athletes – young, fit, and healthy eaters. Athletes are not members of the population to develop adrenal fatigue. Even two weeks after the injection, the athletes still had cortisol levels lower than before the injection.
If a cortisone injection causes adrenal fatigue in athletes, what do you think it will do to you?
How to keep your energy up after a cortisone shot
Step 1, balance your blood sugar. You can do this all on your own with some simple dietary changes. A keto diet will have your blood sugar balanced in no time. If that seems too radical for you, check out my eCourse, Stop Feeding Fatigue. I’ll show you how to identify exactly which foods are wreaking havoc on your blood sugar!
Step 2, determine if your cortisol levels following the injection are high or low. Laboratory testing is your best option here. If lab testing is not an option, skip to the bottom of this section to learn what to do.
High cortisol levels need to be lowered. This is best done using herbs like magnolia, cowhage, and eleuthero. Additional supplements known to help lower cortisol include GABA and phosphatidylserine. For a deep dive into the best supplements for adrenal fatigue, click here.
Low cortisol levels need to be increased. I recommend using adrenal glandulars combined with licorice root. Other herbs/supplements that can help increase cortisol include ginseng and cordyceps.
If you don’t know whether your cortisol is high or low, do not take the above supplements. The above are only to be used when you objectively know your cortisol levels. If obtaining lab testing is not an option, you’re going to want to use adaptogenic herbs. These herbs have a balancing effect on your cortisol; raising it when it’s low and lowering it when it’s high.
My recommendations for adaptogenic herbs include Rhodiola, Schisandra, and Ashwagandha. Opt for a combination of these three and you won’t make your fatigue worse.
Take the supplements until your fatigue improves. Just remember that you’re going to have to ensure your blood sugar remains balanced! Otherwise, none of these supplements are going to work.
Cortisone injections – more risks than feeling tired
I’d be remiss if I didn’t let you know the other adverse effects that have been noted with cortisone shots. You’re now an expert on how cortisone can cause fatigue. Next, let’s you an in-depth look at the negative reactions that can occur with cortisone. This way, you’ll be educated and informed when you decide to book an injection.
- Pain and swelling
- Skin discoloration
- Fat atrophy
- Tendon injuries
- Cartilage loss
- Allergic reaction
- Irregular menstruation
Pain and swelling
After an injection, cortisone can crystalize inside your body. This will intensify your pain signals – big time. Fortunately, this is a transient phenomenon. It will typically last just a few days. Should it happen to you, grab an ice pack and sit on the couch!
Months after your cortisone injection, you may notice that the skin surrounding the injection site is a different shade than your surrounding skin. This phenomenon is known as hypopigmentation. It has been noted to occur after cortisone injections. (5)
While not harmful or painful, the condition can be permanent. The darker your skin tone the more likely hypopigmentation is to occur. Rough estimates suggest this to occur in 1-4% of patients. (6)
If you noticed depression or divot surrounding your tissue that was injected, that’s due to fat cell atrophy. If the fat cells underneath your skin disappear, the skin and tissue will look to fall in on itself. The cells will regenerate but it can take upwards of 2-3 years. (7)
Be absolutely certain your physician is not injecting cortisone into your tendons. Cortisone weakens tendons making them more prone to tearing. (8) Ideally, cortisone is not even injected nearby tendons.
Should your injection need to take place in close proximity to a tendon, ensure you rest the affected joint for a few days following the procedure. No heavy lifting or athletic endeavors are recommended.
Cortisone is a catabolic hormone. Meaning it breaks down tissues. This includes cartilage. One study found that cortisone injections in the knee caused more than 0.1cm of cartilage loss (that’s a lot!). (9)
FYI, cartilage loss is what occurs in osteoarthritis. Meaning continued cortisone injections into joint spaces will cause long-term, irreversible, degenerative changes. No bueno.
Allergic reactions won’t occur to cortisone itself. But allergic reactions can occur in response to the local analgesic used before a cortisone injection. If you’ve reacted to anesthetics before, make sure your doctor knows about it!
To be clear, sex-related side effects are rare. But they have been recorded. They tend to only occur in women. Sex-related side effects include irregular menstruation, disturbances in lactation, and excess hair growth. (10)
Can cortisone shots make you tired? – final thoughts
Cortisone shots can be a ridiculously fast and effective means to relieve chronic pain. I’m not at all against the use of cortisone. But I take a strong stand against the uninformed use of cortisone – and any hormone.
There is risk involved with cortisone shots. It could leave you fatigued. It could negatively affect your blood sugar. It could cause the atrophy of tissue you really don’t want to atrophy. While these effects may be relatively rare, heed the following:
Check your cortisol levels before scheduling your injection
- I recommend a cortisol test that involves testing at four different times throughout the day.
- At the very least, opt for an AM cortisol reading with your family doc.
- If your levels are either low or high, postpone that injection!
Monitor your blood sugar
- High blood sugar and low blood sugar readings are both indicative that your body is struggling to balance its sugars.
- Should you have irregularity in your blood sugars, I recommend avoiding the cortisone shot until they’re properly balanced. Let me show you how to do that, here!
If the cortisone injection didn’t work the first or second time, don’t keep scheduling appointments.
- Cortisone breaks your tissue down. You don’t want this to happen.
- The more injections you get, the higher your risk for cartilage loss and tendon injuries.
- Cortisone shots should not be a regular occurrence.
Ask your family members about adverse reactions.
- If your mom, dad, brother, or sister had an allergic reaction to cortisone, you’re more likely to experience a similar reaction.
- Talk to your doctor about alternatives to cortisone
- There’s plenty of injectable therapies that won’t trigger fatigue yet still offer pain relief.
- Protein-rich plasma (PRP), hyaluronic acid, and prolotherapy are three alternatives to help improve your joint pain while not affecting your hormones.
Ok, now you know all the risks associated with a cortisone injection. If your fatigue came on after a cortisone shot, be sure to check your cortisol levels! You’re likely dealing with adrenal fatigue.
It’s time for me to hear from you!
How did cortisone affect your energy?
What steps did you take to improve your energy after the injection?
Leave your answers in the comments section below!