Addison’s disease diet : foods to eat & avoid in adrenal insufficiency

What is Addison’s Disease?

Addison’s disease is a rare condition that happens when the adrenal glands do not produce enough cortisol and aldosterone hormones.

Addison’s disease affects the adrenal glands and is also known as hypoadrenalism or primary adrenal insufficiency. It is a serious, potentially fatal, but uncommon condition caused by a lack of aldosterone or cortisol hormones in the body. These hormones are required to maintain the immune system, blood pressure, as well as other vital functions of the body.

The adrenal glands, which are located on top of the kidneys, produce crucial hormones such as cortisol and aldosterone. To release these hormones, they communicate with the hypothalamus and pituitary gland.

In Addison’s disease, the adrenal glands do not synthesise adequate amounts of these hormones due to the damage to the glands. Also, sometimes, when the pituitary gland is damaged, the adrenals do not release aldosterone or cortisol. 

Addison’s Disease Symptoms

People with Addison’s disease may experience a variety of symptoms. While symptoms differ from individual to individual, the following are among the most common ones:

• Fatigue (chronic)
• Appetite loss
• Weight loss
• Skin darkening—most evident on skin folds and scars, knuckles, lips, and gums
• Muscle weakness
• Pain in the abdomen

Addison’s Disease : Occasional Symptoms

• Hypoglycaemia (low blood glucose levels)
• Diarrhoea
• Vomiting
• Nausea
• Irregular or missing periods
• Low blood pressure
• Joint pain
• Mood symptoms, such as irritability or depression
• Low libido (little interest in sex)
• Craving salts

Addison’s Disease Causes

Addison’s disease or primary adrenal insufficiency is caused by damaged adrenal glands not producing enough cortisol and aldosterone. Common causes for addison’s disease are - autoimmune response, infections like tuberculosis, cancer spreading to the adrenal glands, bleeding into the adrenal glands and genetic factors like adrenoleukodystrophy. 

Secondary adrenal insufficiency can occur when the pituitary gland is damaged, often due to tumors, surgery or radiation. This condition affects hormone production and can have many underlying causes like autoimmune reactions, infections, cancer, bleeding, genetic conditions and damage to the pituitary gland.

Other than these, some other addison’s disease causes are – 

• Fungal infection
• Surgically removing a part of the pituitary glands, hypothalamus or the adrenal glands.
• Tumour in the Pituitary glands
• Pituitary glands radition therapy.

Addison’s Disease Diet : Foods to Eat

While there is no specific Addison’s disease diet that can cure Addison’s disease, certain dietary changes can help manage the symptoms and prevent complications.

A high-sodium diet may benefit some of Addison’s disease patients with low aldosterone. Aldosterone, one of the hormones produced by the adrenal glands, helps regulate blood pressure and balance the fluids in the body. When the body does not produce enough aldosterone, blood pressure can drop, which can cause dizziness and fainting. In order to maintain their blood pressure, people with Addison’s disease may need to consume more sodium than normal. Therefore, it is important for people with Addison’s disease to consume more salt. This can be done by adding a pinch of salt to food, using saltier seasonings, or eating salty snacks. Also, a doctor or a nutritionist can provide guidance on the proper sodium sources and the amount of sodium one should consume each day.

Other sources containing sodium include:

• Eggs
• Chicken
• Grain products
• Cheese
• Salted nuts
• Canned tuna
• Salted seeds
• Canned beans
• Soups

One should consume salty foods if they have Addison’s disease and crave salt. Although nutritious foods such as eggs, poultry, cheese, salted seeds, and nuts are the best sources of sodium, people with this condition may also benefit from consuming salted crackers or pretzels as snacks.

The doctor may, however, recommend steroid medications that can help individuals balance their salt intake, thereby allowing them to eat a normal diet.

Addison’s Disease Treatment

In Addison’s disease, doctors suggest taking high doses of corticosteroids as a part of the treatment for Addison’s disease. These high doses of corticosteroids might lead to an increased risk of osteoporosis, a disorder where the bones become porous and more prone to fracture. So patients who take corticosteroids may need to take calcium and vitamin D supplements to protect their bones. A doctor or a nutritionist can advise on the amount of calcium one should consume based on their age.

Corticosteroid users should make sure they get enough vitamin D and calcium. Calcium-rich foods include the following:

• Seafood ◦ Shrimp ◦ Sardines ◦ Salmon
• Fruits and vegetables ◦ Soybeans ◦ Broccoli ◦ Collard greens ◦ Kale ◦ Oranges
• Dairy products ◦ Yoghurt (plain, low-fat, or Greek) ◦ Ricotta ◦ Skim milk ◦ Cheese (Mozzarella or cheddar) ◦ Cottage cheese
• Fortified foods ◦ Orange juice and other fruit juices, fortified ◦ Tofu (prepared with calcium) ◦ Cereal ◦ Oatmeal ◦ Plant-based milks (e.g., soy or almond)

Vitamin D-rich foods include the following:

• Seafood ◦ Sardines ◦ Tuna ◦ Salmon
• Meat and poultry products ◦ Liver of beef ◦ Liver of beef ◦ ground beef
• Vegetables ◦ White and portabella mushrooms
• Milk and dairy products ◦ Cheddar cheese ◦ Milk with added vitamin D
• Other ◦ Cod liver oil ◦ Eggs ◦ Cereals fortified with vitamin D ◦ Plant-based milks (e.g., soy, almond, and oat), fortified with vitamin D

Sunlight exposure is another source of vitamin D.

Also Read : All about Addison’s disease medications

Addison’s Disease Diet Plan / Chart

Here’s a sample diet for someone with Addison’s disease. It’s balanced nutrition with adequate sodium and nutrients for adrenal health. Always consult a healthcare provider or dietitian before making big changes.

Sample Diet for Addison’s

Day 1:

Breakfast:

• Oatmeal with sliced banana and cinnamon
• 1 cup low-fat yogurt
• Herbal tea or water

Mid-Morning Snack:

• Handful of mixed nuts (almonds, walnuts)

Lunch:

• Grilled chicken salad with mixed greens, cherry tomatoes, cucumbers and olive oil dressing
• 1 slice whole grain bread

Afternoon Snack:

• Apple with almond butter

Dinner:

• Baked salmon with lemon and herbs
• Steamed broccoli and quinoa
• 1 side of roasted sweet potatoes

Evening Snack:

• Low-fat cheese and whole grain crackers

Day 2:

Breakfast:

• Scrambled eggs with spinach and feta
• 1 slice whole grain toast
• Fresh orange juice

Mid-Morning Snack:

• Carrot sticks with hummus

Lunch:

• Turkey and avocado wrap in whole grain tortilla
• 1 side of mixed fruit

Afternoon Snack:

• Greek yogurt with honey and berries

Dinner:

• Stir-fried tofu with veggies (bell peppers, broccoli, carrots) over brown rice
• 1 side salad with olive oil dressing

Evening Snack:

• 1 dark chocolate square and 1 handful of pumpkin seeds

Hydration:

• 8-10 cups of water a day.
• Electrolyte drinks if advised by your healthcare provider.

Notes:

• Adjust sodium as recommended by your doctor.
• Include a variety of colorful fruits and veggies for vitamins and minerals.
• See how your body reacts to different foods and adjust as needed.

This can be rotated or modified to your liking.

Addison’s Disease Diet : Foods to avoid

A long-term use of steroid medications makes people with Addison’s disease highly likely to develop obesity and osteoporosis. As a result, some foods should be avoided or consumed with caution. These are some examples of such foods:

• Black tea
• Green tea
• Coffee
• Bananas and oranges
• Salt substitutes
• Alcohol
• Foods containing high sugar and fats (e.g., chips)

In studies, some foods have been shown to raise the likelihood of osteoporosis and are advised to be avoided in Addison’s disease. 

Examples of these foods are:

• Refined grains
• Soft drinks
• Processed meats
• Fried foods
• Desserts

Addison’s Disease Diet  : Takeaway

Addison’s disease is a rare and chronic health condition that occurs when the adrenal glands do not produce enough amount of aldosterone and cortisol hormones. While there is no specific diet that can cure Addison’s disease, certain dietary changes can help manage the symptoms and prevent complications. Salt intake, protein intake, and hydration as well as eating balanced meals that include a variety of fruits and vegetables are important measures for people with Addison’s disease. It’s important to work with a healthcare professional and a registered dietitian to determine the best dietary approach for an individual’s specific needs.

References:

1. Eating, Diet, & Nutrition for Adrenal Insufficiency & Addison's Disease. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [Internet]. https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease/eating-diet-nutrition. Accessed Jan 20, 2023.
2. What Diet Is Best for Addison’s Disease?. HealthCentral [Internet]. https://www.healthcentral.com/condition/addisons-disease/addisons-disease-diet. Accessed Jan 15, 2023.
3. The Diet in Addison’s Disease. Journal of the American Dietetic Association [Internet].  https://www.sciencedirect.com/science/article/abs/pii/S0002822321429330?via%3Dihub. Accessed Jan 10, 2023.

4. 10 Foods to Eat If You Have Addison's Disease. MedicineNet[Internet]. https://www.medicinenet.com/10_foods_to_eat_if_you_have_addisons_disease/article.htm. Accessed Jan 12, 2023.

5. What Should I Eat If I Have Addison's Disease?. eMedicineHealth. https://www.emedicinehealth.com/what_should_i_eat_if_i_have_addisons_disease/article_em.htm . Accessed Jan 15, 2023.