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

[vnevoa]

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.

[Lewis]

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:

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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

[vnevoa]

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...

[vnevoa]

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."

[vnevoa]

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.

[teach2183]

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.

[Lewis]

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.

[Pollux]

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.

[vnevoa]

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.

[vnevoa]

Celiac disease in North Italian patients wi... [Eur J Endocrinol. 2006] - PubMed - NCBI

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