Ask-a-Survivor: Fitness and Hateful, Hateful Dex

Directly inspired by online interactions/mentoring.

Patrick Koske-McBride
3 min readFeb 21, 2024

Q: So, you have cancer; at least you’ll lose weight!
Is that something people actually tell humans in a life-or-death situation?
Q: I’ve heard stories from my leukemia friends.
A: Isn’t this some cute way to get to the central theme of the week?
Q: I was diagnosed with cancer three months ago; I’ve just started treatment, and, instead of losing weight; I no longer fit into my trophy jeans. What up?
A: Are you on a prescribed steroid?
Q: Yes, prednisone. My oncologists are discussing dexomethasone if my pain continues.
A: Ah, hateful, hateful dex! We’ve arrived in my wheelhouse!
Q: Clearly. So, why did I gain 40 pounds in 3 months? And will I return to my previous weight?
A: So, Dexamethasone and Prednisone are in a broad class of anti-inflammatory steroids. Steroids as medication is much more frequently seen in professional sports, when you need a starting defensive line back to get over that sprained ankle really quickly. Unlike anabolic steroids (which the athletes get, not you), medical steroids won’t make you bulky.
Q: Aw, damn!
A: Yeah, but they do generally prevent injured body parts from swelling up with inflammation and killing patients. You take the good with the bad.
Q: So, my weight gain…?
A: Most medical steroids belong to a larger class of biochemicals called corticosteroids or glucosteroids.
Q: So, my weight gain…?
A: Is likely caused by the fact that these drugs make you emotionally volatile, hungry, and inhibit fat loss.
Q: They gave me fat pills to treat cancer? This profession is riddled with quacks!
A: I won’t argue against the latter; the former is because steroids are superb anti-inflammatories, and, because you’re going to be pumped full of poison and radiation, you might not want organs swelling up and killing you, in response.
Q: That happens?
A: I wouldn’t know; I took Dex and trusted my physicians.
Q: So, if I’m being kept artificially fat by drugs that make me hungry, and prevent weight loss; the fat should just fall off of me when my physicians take me off of steroids, right?
A: Maybe.
Q: Maybe?
A: I can only attest to my own, personal body, but I tend to stay around 90 kg if I’m exercising and eating properly. I would not wait until the steroid taper to get into an exercise routine and healthy eating, though.
Q: Why? Chemoradiation is hellish.
A: Well, to return to hateful, hateful Dex (or Prednisone — they aren’t the same drug, but they have similar effects), as horrible as it is; it does kill pain and chase away nausea and fatigue. So, while you may not feel like hitting the bench press and eating a ton of fiber and protein right now; you’ll be even less-motivated when you’re off steroids.
Q: I’m already quite ill; isn’t taking up tennis and eating better the Yuppie equivalent of, “Have you tried essential oils and yoga?”
A: Sort of; I noticed that my misery decreased exponentially when I was regularly in the gym and eating healthy.
Q: Define, “Eating healthy,” everyone from J. Mercola to Sanjay Gupta has a different opinion.
A: Every single cancer survivor tells newly-diagnosed folx about the importance of nutrition, and then we become suspiciously vague. That’s because we’ve learned that your individual, personal body is unique to you, and what works for us won’t work for you. My grandmother is 98 years old, despite eating nothing but frozen food, fast food, and gummy worms (from what I can tell), but that would kill anyone else within a few weeks.
Q: You’re evading the implied question.
A: I ate at least a half-kilo of raw or minimally-processed fruits and vegetables a day, 20–50 grams of lean protein, and I avoided refined sugars when convenient.
Q: And did that help?
A: I lost the Dex weight inside of 10 weeks, and stayed regular throughout treatment with almost no laxatives. Again, your mileage may vary, but my ultimate goal was to remain so healthy that my oncologists would retain their trigger-happy approach to treatment. I’m still here, six years out of treatment, which is really the only objective metric of success I use in these matters.



Patrick Koske-McBride

Science journalist, cancer survivor, biomedical consultant, the “Wednesday Addams of travel writers.”