Diet
People with a diagnosis of adrenal insufficiency do not need to adopt a special diet, and there are no particular dietary requirements (barring the advice below on grapefruit and liquorice), although a low-salt diet is best avoided for people with Addison's disease (primary adrenal insufficiency).
Read more about salt and Addison's disease
Grapefruit and real liquorice can amplify the effects of your steroid medication and are not recommended.
Steroid medication & bone health
Due to the lifelong need for steroid replacement therapy and other risk factors, people with Addison's and the other forms of adrenal insufficiency may be at risk of developing osteopenia (lower than normal bone density) or osteoporosis (weak/fragile bones, with an increased risk of fractures).
The good news is, there are plenty of ways you can help protect and strengthen your bones, including a healthy diet and regular exercise.
There is no robust evidence to suggest replacement doses of steroid medication negatively impact bone health. However, regular use of higher-than-replacement doses (“over-replacement”) can have a negative effect on bone density.
The NICE Guidelines on the Identification and Management of Adrenal Insufficiency recommend that people with Addison’s or adrenal insufficiency receive at least one bone density scan (DEXA/ DXA scan) within five years of diagnosis. This is further supported by the Society for Endocrinology in their Consultation Reference Guide
DHEA (dehydroepiandrosterone)
Low levels of dehydroepiandrosterone (DHEA), a hormone produced by the outer layer of the adrenal gland, are associated with reduced bone mineral density. Low levels can be found in people with all three types of adrenal insufficiency.
Studies have shown small positive effects on bone density for people (especially postmenopausal women) with adrenal insufficiency when supplemented with DHEA under the guidance of their endocrine team.
However, the impact is not as strong as conventional bone density treatments, such as calcium and vitamin D.
How Hormones affect Bone Mass
Peak bone mass is typically achieved between the ages of 20 and 25. From around age 40, bone density naturally declines gradually as part of the ageing process. This decline is more significant in women, largely due to the reduction in oestrogen levels leading up to and during menopause.
Oestrogen is essential for protecting bone health in women, just as testosterone plays a similar role in men. These hormonal differences help explain why patterns of bone loss is different between men and women.
Maintaining Bone Health
Factors such as smoking, alcohol consumption, weight, medications, level of activity and lifestyle choices can all affect bone density.
There are several ways you can support and strengthen your bone health if you’re living with Addison’s disease or adrenal insufficiency:
Get enough calcium and vitamin D
Calcium is essential for teeth and bone strength (amongst many other benefits), and as we get older, we tend to absorb less from the food that we eat. Online calcium calculators are a great way to assess whether you’re consuming enough calcium in your diet.
Osteoporosis Foundation Calcium Calculator
Vitamin D helps the body to absorb calcium. While we can get it from sunlight and diet, it’s often hard to get enough from these sources alone (especially during a British winter!), so many people benefit from supplementation.
The NHS advises everyone in the UK to take a vitamin D supplement during the autumn and winter months of 10 micrograms daily. If you are concerned about poor bone health, calcium and/or vitamin D levels, checks can be discussed at your next endocrine appointment or with your GP.
Other key nutrients that support bone structure include protein, magnesium and vitamin K.
Weight-bearing and muscle-strengthening exercises are important to strengthen and maintain bone health, and it’s not just about lifting weights! They involve any exercise where your body carries your own body weight (in a standing position). Examples include fast walking, running, stair climbing and dancing.
Aim for 30 minutes of weight-bearing activity, 3–5 times a week, if possible. This is where walking can be a great place to get started! If you’re looking to explore weight-bearing exercise, the Royal Osteoporosis Society has a brilliant “Exercise for bones” page, for more detailed guidance.
Read our page on Exercise to feel confident you have the right steroid cover for the activity you are doing.
Lifestyle Habits
Smoking and alcohol negatively impact bone health. Smoking is harmful to bones and alcohol interferes with calcium absorption in the stomach.
Personal Stories
Members can head to our online community platform to find out more about diet and exercise, and to chat with others, plus everyone can enjoy the shared experience of ADSHG members below:
