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Q
How to Handle a Hormonal Disease?

I have been diagnosed with Addison's disease and am having a lot of difficulty with low blood-sugar attacks. Is there a certain amount or type of protein that I should be getting?

A
Answer (Published 3/23/2004)

Addison's disease is a rare disorder that occurs when the adrenal cortex (the outer layer of each adrenal gland) fails to produce enough cortisol and other vital hormones. Cortisol is key to the body's stress response. It helps maintain blood pressure and cardiovascular function, and suppresses the immune system's inflammatory response. Cortisol also helps balance the effects of insulin in breaking down sugar for energy, and regulates the metabolism of proteins, carbohydrates and fats.

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In Addison's disease, production of another hormone, aldosterone, may also be affected. Aldosterone helps maintain blood pressure and helps the kidneys regulate the body's salt and water balance.

Most cases of Addison's disease are autoimmune in nature - that is, the disorder is due to an attack on the adrenal cortex by the immune system. Symptoms, which usually come on gradually, include fatigue, muscle weakness, loss of appetite, weight loss and, in about half of all cases, nausea, vomiting and diarrhea. Blood pressure is typically low and can drop even lower when you stand up, causing dizziness and fainting. Many people with Addison's disease also experience darkening of the skin, which is particularly noticeable in skin folds, on the elbows, knees, knuckles and toes.

If you have Addison's diseases, you need to be under the care of an endocrinologist, a physician who specializes in treating hormonal disorders. Treatment involves replacing cortisol with hydrocortisone tablets. Aldosterone is replaced with fludrocortisone acetate (Florinef), also taken orally. Your blood pressure should be monitored regularly, as these hormone supplements can cause hypertension. It is also important for patients with Addison's disease to maintain adequate dietary intake of salt.

Your protein needs are not different from those of people without Addison's disease, but to help stabilize blood sugar, I recommend taking 200 mcg of GTF chromium daily. You also should familiarize yourself with the glycemic index, a measure of the effect a given food has on your blood sugar (glucose levels). I recommend reading "The Glucose Revolution" by Thomas M. S. Wolever, MD, PhD, et al. In addition, you might try eating five to six small meals daily rather than three large ones. This can help keep your blood sugar stable. Be sure to discuss any concerns about low blood sugar with your physician.

Andrew Weil, M.D.

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