Addison's disease, also known as primary adrenal insufficiency, is a rare condition affecting the adrenal glands, which sit atop the kidneys. These glands are responsible for producing essential hormones, primarily cortisol and aldosterone. When the adrenal glands are damaged, they don't produce enough of these hormones, leading to a range of symptoms and potential health complications. This article provides a comprehensive guide to diet and nutrition for individuals with Addison's disease, aiming to help manage the condition and improve overall well-being.
Understanding Addison's Disease
Addison’s disease affects your adrenal glands. It is a serious and potentially life-threatening but rare condition caused by not enough cortisol or aldosterone hormones in your body. You need these hormones to regulate your immune system, blood pressure, and other important functions.
In Addison’s disease, the adrenal gland is damaged and doesn’t make enough hormones. Addison’s disease is rare. It usually develops as an autoimmune reaction when your immune system attacks your adrenal glands. Anyone can get Addison’s disease.
The adrenal glands produce several important hormones, including cortisol and aldosterone. While cortisol can get a bad rap as the “stress hormone,” it’s often helpful - if you’re running from an angry woodchuck or prepping for a big meeting, you want resources devoted to energy, not repair. Aldosterone regulates blood pressure and your acid-base, or pH, balance, which is crucial for most physiological processes in your body.
Addison's disease develops when your adrenal glands don't make enough of certain important hormones. These include the stress hormone cortisol, and aldosterone, a hormone that helps regulate your body's sodium and potassium levels - which in turn impact blood volume and blood pressure.
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Causes and Symptoms
Addison’s disease typically occurs when autoimmune deficiencies cause issues with adrenal gland function. Autoimmune conditions are the most common cause of this damage, and Addison’s disease generally. In Addison’s disease, without this aldosterone your kidneys are constantly leaking sodium salt, leading to symptoms including light headedness, postural dizziness, low blood pressure, a constant washed-out or generally weak feeling, cramps and spasms including in the legs, lower back and abdominal pain.
Symptoms of Addison's disease can be vague and develop slowly, so it's easy to miss them. Addison's disease is caused by damage to the adrenal glands - small glands that sit on the kidneys and produce a variety of hormones that regulate everything from metabolism and blood pressure to immune functioning. Rarely, Addison's disease can be caused by a genetic disorder, or by adrenal cancer.
Because cortisol and aldosterone play a role in so many of the body’s systems, symptoms of Addison’s disease can run the gamut. Addison's disease (adrenal insufficiency) symptoms can benefit from lots of salt in the diet. People with Addison's need extra calcium, too, as adrenal medications can make your bones brittle.
Symptoms of Addison's disease (primary adrenal insufficiency) include:
- Tiredness
- Weakness
- Weight loss
- Loss of appetite
- Darkening of the skin, especially on the face, neck, and back of the hands
- May also appear on scars, skin folds, elbows, knees, knuckles, toes, lips, and mucous membranes such as the inside lining of the cheek
- Nausea
- Vomiting
- Abdominal pain
- Diarrhea
- Low blood pressure on standing or sitting up
- Dizziness
- Lightheadedness
- Fainting
- Muscle pain
- Joint pain
- Salt cravings
- Loss of hair from the armpits and pubic area (in women)
- Decreased sex drive (in women)
- Irritability
- Depression
- Low blood sugar (hypoglycemia)
- Irregular or no menstrual periods
Addisonian Crisis
If you have Addison’s disease, you may experience sudden and severe symptoms when your body is stressed. Sudden and severe symptoms cause a condition called Addisonian crisis or acute adrenal insufficiency.
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When symptoms of Addison's disease become severe and life-threatening, it is called an "adrenal crisis." Adrenal crisis can occur when a person's body is under stress, such as from an infection or injury, or if a person is not taking their medicine regularly.
During an Addisonian crisis, cortisol and aldosterone levels fall to levels that are life-threatening if left untreated.
Symptoms of adrenal crisis include:
- Fever and weakness
- Nausea, vomiting, and stomach pain
- Confusion
- Passing out
- Shock
Adrenal crisis can be a life-threatening condition that requires emergency medical treatment. If you develop symptoms of adrenal crisis, give yourself an emergency extra dose of your corticosteroid and then call 911.
Dietary Recommendations for Addison's Disease
Diet plays an important role in managing Addison’s disease. Key considerations include eating a well-balanced diet, staying hydrated, and maintaining adequate sodium intake. It is important to carefully manage your diet to prevent symptoms Addison’s disease from worsening.
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Doctors do not prescribe a single specific diet for all individuals with Addison’s disease. However, people with Addison’s disease should maintain a balanced diet to ensure they have enough nutrients and energy, especially during times of stress or illness, when their hormone levels need extra support.
Balanced Diet
Try to consume a balanced diet that includes a variety of whole foods from different food groups, such as fruits, vegetables, lean proteins, whole grains, and healthy fats. This helps ensure that you receive essential nutrients. People with Addison’s disease should also eat a well-balanced, nutritious diet rich in fruits, vegetables, whole grains, and proteins.
Sodium Intake
People who have Addison’s disease with low aldosterone hormone can eat a diet high in sodium. The hormone aldosterone regulates the balance of sodium and potassium in the body. People who have Addison’s disease with low aldosterone may have low levels of sodium and high amounts of potassium. When your body does not make enough aldosterone, your body may lose sodium. This can potentially lead to low blood pressure and other concerns.
For some individuals with Addison’s disease - especially if you have the most severe form of the condition, which causes you to lose salt - consuming a diet that’s somewhat higher in sodium may be necessary.
Normal dietary advice to avoid too much salt in your diet does not apply to people with primary adrenal insufficiency, and this important feeling should not be ignored.
If you have Addison’s disease and you crave salt, you should eat salty foods. If you feel unwell due to salt deficiency, such as light-headedness, cramps or feeling generally washed out, to feel better quickly you will need to take some salt. I often recommend soup and salty crackers (or sodium tablets, see below). This is because taking extra fludrocortisone will stop your body leaking salt, but you still need to fill up your tank to feel better. If you crave salty or sour food, this is a clear message from your body that you should take something salty.
The recommended dietary allowance (‘RDA’) for salt is 6 grams each day for healthy people, however this is too little for people with Addison’s disease.
Good Sources of Sodium
- Grain products
- Eggs
- Cheese
- Chicken
- Soups
- Canned tuna
- Canned beans
- Salted nuts
- Salted seeds
- Added table salt
- Salted crackers or pretzels
The best choice of sodium-rich foods are nutritious foods like eggs, cheese, salted nuts and seeds, and poultry, but you may benefit from snacking on salted crackers or pretzels.
Caution
A high sodium diet can increase a person’s risk of a number of health conditions. This is why a person needs to consult a doctor before adding more sodium to their diet. A healthcare professional can make specific recommendations for individuals.
Calcium and Vitamin D
People with Addison’s disease take regular steroid medicine. Over time these medicines can cause damage to the bones and bone disease. You should eat foods that are high in calcium and vitamin D to help your bones. Treatment for Addison’s disease may include high doses of corticosteroids, which are linked to a higher risk of osteoporosis and bone fracture. People taking corticosteroids should ensure they get adequate calcium and vitamin D.
Good Sources of Calcium
- Milk
- Cheese
- Yogurt
- Ricotta cheese
- Soy milk
- Turnip greens
- Kale
- Broccoli
- Tofu
- Fortified cereal
- Fortified orange juice
- Vegetables and fruits
- Collard greens
- Soybeans
- Oranges
- Seafood
- Salmon
- Shrimp
- Sardines
- Plant-based milks (e.g. almond, rice, soy), fortified
- Orange juice and other fruit juices, fortified
- Tofu, prepared with calcium
- Oatmeal, fortified
- Cereal, fortified
Good Sources of Vitamin D
- Seafood
- Trout
- Salmon
- Sardines
- Tuna
- Meat and poultry
- Beef liver
- Chicken breast
- Ground beef
- Vegetables
- Mushrooms - white and portabella
- Dairy products
- Milk, vitamin D fortified
- Cheddar cheese
- Other
- Cod liver oil
- Plant-based milks (e.g.
Hydration
Stay well hydrated by drinking enough fluids, especially during warm weather or when experiencing illness or stress. Dehydration can be a concern for people with Addison’s disease.
Glucose-Rich Foods
People with Addison’s may experience symptoms similar to those of low blood sugar, such as fatigue and difficulty concentrating. A small 2010 study found that consuming glucose-rich foods improved these symptoms.
Foods to Limit or Avoid
It helps to be mindful of foods and dietary habits that could worsen your condition if you live with Addison’s disease. And if you’re taking certain medications, a healthcare professional may give you specific dietary guidelines to follow.
High-Caffeine Foods and Beverages
High caffeine intake can worsen the symptoms of adrenal insufficiency, such as nervousness and rapid heartbeat.
Processed Foods
While some individuals with Addison’s disease may need to increase their sodium intake, doctors typically advise that you obtain that sodium from sources like table salt or salt-containing foods (like pickles), rather than processed foods. Processed and high sodium convenience foods may not provide the best quality of salt and may contain unwanted additives.
Grapefruit and Grapefruit Juice
Grapefruit can interact with some medications used to treat Addison’s disease, such as glucocorticoids, by potentially increasing their strength.
High-Fiber Foods
Excessive fiber intake - particularly from raw, cruciferous vegetables like broccoli, cauliflower, cabbage, and Brussels sprouts and from whole grains - can interfere with the absorption of some medications. This includes hydrocortisone and other glucocorticoids. While fiber is generally a healthy part of your diet, it’s important to consume it in a balanced way and not around the time you’re taking certain medications.
Alcohol
Excessive alcohol consumption can affect how your body absorbs and uses medications. While moderate alcohol consumption is generally safe, consider consulting with a healthcare professional about your specific situation, if you drink.
Additional Considerations
- Consult a Healthcare Professional: If a person has Addison’s disease, they need to speak with a healthcare professional before making changes to their diet. Consulting a trusted health practitioner can provide you a good sodium intake range to aim for.
- Medication Interactions: Be aware of potential interactions between food and medications.
- Listen to Your Body: Your body can also be a guide to help dial your intake in. If you crave salty or sour food, this is a clear message from your body that you should take something salty.
Medical Treatment
Addison's disease treatments replace the hormones your body is no longer producing in sufficient quantities. You'll be given a prescription corticosteroid, usually hydrocortisone twice per day, to provide cortisol. Your health care provider will adjust your medication doses as needed.
If you're sick, injured, or even under a lot of stress, you may need to temporarily increase your dose.
If you have low aldosterone levels, you may need to follow a high-sodium diet. A dietitian can advise you on how much sodium you need daily, and the best dietary sources to get it from.
Most people with Addison’s patients will need lifelong hormone replacement to manage the condition. Glucocorticoid drugs like hydrocortisone and prednisone mimic the hormone cortisol, preventing low blood sugar. Mineralocorticoid drugs like fludrocortisone mimic aldosterone while regulating renin levels, preventing electrolyte imbalances.
Lack of aldosterone is compensated for by taking fludrocortisone tablets. However, many patients wonder whether the fludrocortisone is really necessary. In contrast to hydrocortisone, if you miss a dose of fludrocortisone you probably don’t notice an immediate effect on how you feel. Furthermore, if the weather is very hot, or you are working in a hot environment or exercising vigorously, you will lose more salt from your body through sweating. Young people and those who are physically very active often need to take higher fludrocortisone doses, occasionally five or six tablets daily.
As well as fludrocortisone, it is sometimes necessary to prescribe salt tablets for people, known as ‘slow sodium’ tablets. However, each slow sodium tablet contains only 0.6g (600mg) of salt, meaning that to get to the basic ‘RDA’ you need to take ten per day (of course we mostly get more than the RDA from our food alone). This is a really safe and extremely cheap medication, so if you habitually find yourself feeling faint or weak following exercise or after you have been in a hot place for a while, then swigging five or ten slow sodium tablets with a couple of glasses of water is a good start.
Living Well with Addison's Disease
Addison’s disease is a thorny condition that’s easy to miss and potentially life-threatening if left untreated. But with hormone replacement and nutritional therapies like a high-salt diet, bone health nutrients, and caution with caffeine and “energy” drinks in general, most people with Addison’s can live active, happy lives.
Regular visits with your doctor will help watch for and manage these conditions. Most people with Addison's disease live full, healthy lives.