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Is PB/Lowcarb safe/compatible with Addison's disease?

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  • Is PB/Lowcarb safe/compatible with Addison's disease?

    I have a friend who almost died from an Addison's crisis.

    She was diagnosed and treated in time, but it is clear she no longer has functioning adrenal glands.
    She now takes hydrocortisone every day and will have to do it for the rest of her life.
    That's the easy part so far.

    The problem is that she is visibly gaining weight by the month. I'm afraid she will turn obese and diabetic very soon, because her doctor tells her to constantly eat carbohydrates to avoid the typical hypoglycemias of Addison's.

    Personally I've been Primal for almost a year, bordering sometimes on ketogenic, and have none but the greatest things to say about my experience (and so do a handful of friends and family who have followed me). I definitely know that most available carbs are unsafe and best avoided. But Addison's is a rapid killer condition that is best not to toy with.

    Soo... many doubts in my mind.

    1 - Is it really necessary to have carbs at hand when you've got Addison's? Can someone with Addison's safely follow a low carb / primal blueprint diet?

    2 - Does anyone here have the experience of having Addison's and practising PB/LC for a long time? If so, what are the problems and benefits?

    3 - In this specific case, which supplements do you take and why?

    And now some techy questions, because I really like to understand the mechanisms behind these problems and solutions.

    4 - It is said that cortisol is what triggers the liver to produce blood sugar. So, the typical hypos in Addison's seem to be caused by lack of cortisol to maintain blood sugar level, which could just mean the cortisone dose is too low / badly timed. Two ideas come from here:

    4a - too little cortisone will cause frequent hypos, at which point only ingested sugar can "save the day" by compensating for the blood sugar that the liver doesn't release; will this probably lead to non-alcoholic fatty liver disease, since the liver is filled with glycogen and does not release enough glucose into the bloodstream?

    4b - too much cortisone will eliminate the hypos, but will it speed up the development of obesity and diabetes because of too much blood sugar?

    4c - is cortisol necessary in the metabolism of fatty acids for energy, does she have to depend on it (increase hydrocortisone) to extract energy from a low carb diet?

    Thank you very much for your attention, this is a serious issue and time is running against us.

  • #2
    Have you tried Pubmed?

    addison's disease diet - PubMed - NCBI

    It's interesting to me that that search brings up a number of articles referring to celiac. I don't know about your specific questions, but I'd have thought that anyone with any kind of autoimmune disease would be wise to get wheat and all other cereal grains, legumes, and dairy products out of their diet.

    You might try Robb Wolf's site, too:

    Search Results for addison

    ... just checked that. It doesn't look like he's covered it in a podcast. Maybe you could submit a question:

    Contact Us


    Maybe a version of Paleo Diet specifically aimed at autoimmune conditions would be the way to go. I guess that might mean, for example, Dr. Wahls' protocol:

    Terry Wahls MD | Defeating Progressive Multiple Sclerosis without Drugs | MS Recovery | Food As Medicine

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    • #3
      Lewis and Sihana: thank you very much for your replies.

      Of course she is being monitored by an Endo. Anything else would be stupidly dangerous, she almost died the first time.

      Regarding the autoimmune aspect, I think it's too late to revert the damage done to the adrenal glands, so it's "just" a "nice to have" feature to avoid new complications. It seems to take a long time (many months) to actually observe the benefits of a gluten-free diet once you already have the auto-immune damage, so I'll reserve that for later. She's extremely skeptical of all of this line of thought (very conservative cereal girl) so I'm concentrating on the weight loss and avoiding diabetes first. After gaining her confidence with that, I'll probably be able to squeeze in the grain ban.

      Rob's insights seem to indicate it is probably OK to do low carb on Addison's, but adrenal fatigue isn't as radical as primary Addison's, so I'm looking for more consistent confirmation. I'll probably shoot him a direct question.

      The Wahls protocol is something to digest slowly. Too much info and hype, it seems. Merits further investigation.

      The "avoidance of fat for the sake of avoiding fat" is starting to look to me as the main reason why Addison's sufferers are recommended to eat an ultra-high protein diet. They don't have the metabolism to withstand high-carb, so they're told to go high-protein. And the ones that are told to have their carby snacks at hand just ride the sugar roller-coaster all day. Anything but high fat, because "everybody knows that's bad." Ugh.

      I'd like to see evidence that fat consumption is bad for Addison's patients (because of their specific situation), or evidence that it isn't (that study with the LCFAs doesn't say anything other than "in addison's people have high LCFA in blood"). With everyone focused on the issue of blood sugar in Addison's, there doesn't seem to be any attention to the alternative of ketones and fatty acids. Which is a large pity.

      I'd really like someone with Addison's on this board to comment. I suspect there is no one around, being that medical advice goes to insist in high-carb and high-protein...

      Comment


      • #4
        Found something interesting, although too thin on detail. This gives me hope that she will be better off on Paleo/Primal than on the standard thing.
        "Glucocorticoids (cortisone-related hormones) - hormones that mainly affect carbohydrate metabolism, as well as (lesser extent) fats and proteins."

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        • #5
          Apparently it has only been studied the impact of glucocorticoids (like cortisol) on fat tissue lipolysis and liver glucose production.

          Lack of cortisol will make you fat, excess will make you thin.

          Can't find anything relating cortisol to metabolism of ingested fatty acids.

          Comment


          • #6
            PB is not a low carb diet. I have been reading up on adrenal fatigue as I feel I'm in stage 2-3 of that and exhibiting 75% of the symptoms. What's key is that they suggest not to eat straight carbs at any time so as to limit the blood sugar spikes. Eating carbs with protein will provide a more steady stream of glucose to the body.

            Removing grains from one's diet can certainly help to avoid diabetes, have her read "Wheat Belly" for all the negative aspects that wheat could be doing to her body. One huge thing is the average 400 calories extra that the appetite stimulant in today's wheat causes wheat consumers to eat. That could be the cause of her weight gain.

            Comment


            • #7
              Originally posted by vnevoa View Post
              Lewis and Sihana: thank you very much for your replies.
              Thanks. I can't think what I put was much help, unfortunately.

              Regarding the autoimmune aspect, I think it's too late to revert the damage done to the adrenal glands, so it's "just" a "nice to have" feature to avoid new complications. It seems to take a long time (many months) to actually observe the benefits of a gluten-free diet once you already have the auto-immune damage, so I'll reserve that for later. She's extremely skeptical of all of this line of thought (very conservative cereal girl) so I'm concentrating on the weight loss and avoiding diabetes first. After gaining her confidence with that, I'll probably be able to squeeze in the grain ban.
              Yeah, what would worry me in this position would be I see no reason why lightning might not strike more than once:

              Patients with autoimmune Addison's disease (AAD) are prone to develop other autoimmune manifestations.
              Celiac disease in North Italian patients wi... [Eur J Endocrinol. 2006] - PubMed - NCBI

              Rob's insights seem to indicate it is probably OK to do low carb on Addison's, but adrenal fatigue isn't as radical as primary Addison's, so I'm looking for more consistent confirmation. I'll probably shoot him a direct question.
              I would. He's a nice guy whose definitely keen to help people, and knows where to look and who to ask. (He and the co-host are not above pillorying their own listeners on air if they send in what they regard as fatuous questions. I thought "ouch!" when I heard one of them recently say "you need to f--ing educate yourself" after reading out a question, and thought, "And this is to your own fans?" But where there's a genuine problem they will give their time.)

              The Wahls protocol is something to digest slowly. Too much info and hype, it seems. Merits further investigation.
              I don't think she's tried to hype it herself. There was a video of a talk she did and it went viral in the Paleosphere. That's where the high profile comes from. But her turn-around is pretty remarkable. Her protocol seems essentially a autoimmune version of Paleo -- or a version of "autoimmune Paleo", I guess, since that already exists. It seems to be characterized by an extremely high consumption of particular types of raw vegetables, on account of their vitamins and phytonutrients. But as to whether that's why it worked for her, or whether it's what she's not eating ...

              The "avoidance of fat for the sake of avoiding fat" is starting to look to me as the main reason why Addison's sufferers are recommended to eat an ultra-high protein diet. They don't have the metabolism to withstand high-carb, so they're told to go high-protein. And the ones that are told to have their carby snacks at hand just ride the sugar roller-coaster all day. Anything but high fat, because "everybody knows that's bad." Ugh.
              Oh, dear. If you're right, that would be a really silly reason.

              Comment


              • #8
                Originally posted by teach2183 View Post
                PB is not a low carb diet. I have been reading up on adrenal fatigue as I feel I'm in stage 2-3 of that and exhibiting 75% of the symptoms. What's key is that they suggest not to eat straight carbs at any time so as to limit the blood sugar spikes. Eating carbs with protein will provide a more steady stream of glucose to the body.

                Removing grains from one's diet can certainly help to avoid diabetes, have her read "Wheat Belly" for all the negative aspects that wheat could be doing to her body. One huge thing is the average 400 calories extra that the appetite stimulant in today's wheat causes wheat consumers to eat. That could be the cause of her weight gain.
                I also believe I'm somewhere in the early stages of that, and my symptoms have been getting progressively worse over the course of the last year. My doctor has point-blank refused to test me for it, instead stating that since I don't have a problem with my thyroid and I don't have diabetes I'm fine and it's all in my head. She then asked some questions which insinuated that I was either depressed, a hypochondriac, or had an eating disorder. I went to find another doctor who also refused to recognize Adrenal Fatigue as a legitimate syndrome. I'm so FRUSTRATED.

                Have you tried to see a doctor about your issues? I'd be curious to learn your experiences; my symptoms have been interfering with every aspect of my life.

                As to Addison's, I know that an autoimmune disorder doesn't quite fall under the same category as adrenal fatigue induced by other factors. However, I've been fully Primal for about 2 months now and have noticed an easing, albeit not reversal, of my symptoms.

                Comment


                • #9
                  Thanks for the correction teach2183, I've been bundling PB and Low carb a little bit too much. But considering the SAD, PB is pretty low carb-ish. Anyway, it focusses on low GI, which is what matters most in obesity.

                  Thanks for the tip on Wheat Belly, I'm aware of it but hadn't thought about it in this case. Her weight gain is probably a combination of insufficient cortisol causing hypoglycemias and carb binging to cover that up. She's always had cereal and bread and only now she is becoming heavier.

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                  • #10
                    Thanks for finding this. It will be handy to build up the momentum for Wheat Belly.

                    Comment


                    • #11
                      Originally posted by Pollux View Post
                      As to Addison's, I know that an autoimmune disorder doesn't quite fall under the same category as adrenal fatigue induced by other factors. However, I've been fully Primal for about 2 months now and have noticed an easing, albeit not reversal, of my symptoms.
                      Thanks for this confirmation, Pollux. Hang in there, 2~3 months seems to be the threshold for noticeable body changes from my point of view.

                      Comment


                      • #12
                        Originally posted by teach2183 View Post
                        What's key is that they suggest not to eat straight carbs at any time so as to limit the blood sugar spikes. Eating carbs with protein will provide a more steady stream of glucose to the body.
                        Ok, agreed on not taking carbs straight up. But my first alternative choice would be to take fats, not extra protein, to maintain a levelled metabolism. A partially ketogenic diet looks a lot safer to me than a high-protein one, be it because of blood sugar excess or protein metabolite toxicity.

                        Here's the part that I don't get: isn't high protein going to require extra cortisol? because gluconeogenesis seems to be driven by cortisol...

                        Comment


                        • #13
                          Originally posted by vnevoa View Post
                          I've been bundling PB and Low carb a little bit too much.
                          It's hardly surprising that you should have, since Mark, who devised the diet, does:

                          How many carbs should I eat each day? | Mark's Daily Apple

                          Why Fat, Not Carbs, Are the Preferred Fuel for the Human Body | Mark's Daily Apple

                          Comment


                          • #14
                            Originally posted by Sihana
                            7. Long-chain fatty-acids (found a lot in processed foods) may put stress on the adrenals. She should consume a lot of medium-chain fatty acid foods. Give her a bottle of coconut oil.
                            I'm totally on board with the coconut oil.
                            I've re-read the article and what it really says is that people with adrenomyeloneuropathy have high LCFA in blood and Addison's is another complication. Doesn't seem to be a relationship between the LCFA and Addison's. But this condition is very specifically a genetic brain disease with very specific symptoms not observed in my friend's case. Fortunately.

                            Comment


                            • #15
                              I realize that this thread is a few months old, but thought I would post my insight anyway.

                              I started trying to the PB (well diet portion - not exercise) about 2 1/2 years ago when my health started going downhill. Got VERY, VERY ill 3 days in so gave up. A month later started feeling a little better so tried giving it another go got sick again a few days in. Gave up the idea of giving up all carbs/grains for almost a year but did reduce them significantly (general kept them to b'fast only), but as my health continued to go downhill (and waiting months for a specialist referal) I decided to give it one last shot. I was a little ill on day 3, but not as severe as the first two times. Pushed through and have been fully primal since (almost a year and a half). This past December I finally saw the specialist and got my diagnosis of Addison's disease. The illness that I had when started primal the first time was an Addisonian crisis (glad I didn't know it at the time b/c it scares the he!! out of me now).

                              I find eating a primal diet really helps to keep my blood sugar under control. I do think that I need to add some starchy carbs back in as I have been crashing and exhausted a lot lately - probably in the form of white rice since I really want/need to get nightshades out of my diet so potatoes aren't a good option. I too am curious if the reason for my lethargy is that I don't have enough cortisol to convert fats into energy. If you find out any more I'd LOVE to hear it please. I really would love to have others to talk to about this - I feel so alone in my journey much of the time.

                              I find I have no problem keeping my weight in line with primal - I'm 5'5" and 125lbs. That can go up when I am on holidays/off plan, but drops back quickly when I cut the non-primal foods.

                              Exercise is still my demon. Unlike a normal person, exercising when I don't feel 100% is a bad idea - sure way to lead to a big crash. I need to pre-meditate my exercise and dose up on my hydrocortisone before hand and often a little after as well. If I'm sick at all, then I skip the exercise - even walks are a bad idea on those days.

                              Celiac disease is strongly correlated with Addison's. One of the first things my endo wanted to do was test me for celiacs (didn't work though as I was already gluten free). When I do cheat and have a bit of gluten though I feel rotten for days - have been doing that a lot less frequently b/c of it.

                              So, if your friend does decide on changing her diet/lifestyle please advise her to do it slowly. A big dietary change is stressful on the body and without the ability to make cortisol it could bring on a crisis. I would probably advise dropping carbs from one meal/day first - probably starting with supper. She'll need to evaluate how she feels as she goes along.

                              If she does decide to make the change and wants to talk to someone that is in a similar situation, please pm me and I can pass along contact info.

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