Addison’s disease diet: foods to eat and what to avoid

If you're living with Addison's disease, you already know that small choices can make a big difference. Food isn't just fuel hereit's part of your daily toolkit. The right plan can steady your energy, protect your bones, and even help you sidestep those scary dips in blood pressure.

In this friendly guide, we'll walk through exactly what to eat (and why), what to limit without fear, how to personalize sodium, and the vitamin D and calcium-rich foods that love your bones back. I'll share practical swaps, easy routines that reduce fatigue, and a sample day you can copy. Ready to feel more grounded and confident about your plate?

Quick basics

Let's set the scene. Addison's disease (primary adrenal insufficiency) means your adrenal glands don't make enough cortisol and aldosterone. Why does that matter for food? Cortisol helps with blood sugar balance and your stress response. Aldosterone helps your body hold onto sodium and water, which affects blood pressure and overall hydration. Without enough of these hormones, sodium can slip away, blood pressure can dip, and energy can skid.

Think of an Addison's disease diet as a steadying hand: it supports your meds, maintains fluid and electrolyte balance, and gives your bones and muscles what they need to thriveespecially if you take long-term steroid replacement. The big goals are simple: stabilize blood pressure, prevent hyponatremia (low sodium), steady energy, and protect bone health while helping your medications work as intended.

Before you tweak your plate, it's wise to check in with your care team. Your needs are uniqueespecially if you're on hydrocortisone and fludrocortisone, or if you also manage blood pressure, kidney, heart, or blood sugar issues. A quick reality check with your endocrinologist or a registered dietitian can save you a lot of guesswork.

Core foods

Let's talk about what to say "yes" to more often. These aren't rigid rulesmore like a menu of choices that tend to help people with Addison's feel more stable and strong.

High sodium foods (when advised)

Because aldosterone is low in Addison's, some people need more sodium to keep blood pressure and hydration in a good zoneespecially if they take fludrocortisone. Everyday options: savory broths, olives, pickles, cottage cheese, salted nuts, and electrolyte drinks. These are simple to add between meals or alongside a snack when you feel droopy.

How much sodium? It varies. Some folks do well near general guidelines (around 2,300 mg/day), while othersparticularly those on fludrocortisonemay feel best higher than that, guided by labs and symptoms. Your doctor may use renin and electrolytes to dial this in. If you're thinking, "So do I just salt everything?"not blindly. We'll cover smart personalization below.

Vitamin D foods for bones

Long-term steroid replacement can nudge bone density downward over time. Vitamin D helps your body absorb calcium and supports bone remodeling. Food sources include fatty fish like salmon and sardines, fortified dairy or plant milks, and eggs. Many people still need a supplement based on blood levels, but food first keeps your base strong. Your clinician may check 25(OH)D and set a personalized target.

Calcium-rich foods to protect bones

Calcium is your bone's best friend. Dairy (yogurt, milk, cheese), calcium-set tofu, canned fish with bones (like salmon or sardines), and leafy greens are all great. A quick absorption tip: spread your calcium-rich foods across the day and pair greens with a little fat (like olive oil) to help your body use more of what you eat.

Steady-energy carbs and fiber

Without cortisol's steadying hand, blood sugar can zigzag. Choose carbohydrates that trickle energy instead of dumping it: oats, quinoa, beans, lentils, fruit, and colorful vegetables. Space your carbs out3 meals and 12 snacks is a simple rhythm. You'll cut down on those mid-morning crashes and late-afternoon slumps.

Quality proteins and healthy fats

Protein helps stabilize blood sugar and energy, and it supports muscle and bone. Good choices include fish, poultry, eggs, Greek yogurt, legumes, and tofu. For fats, think olive oil, avocado, nuts, and seedsthese carry flavor, satiety, and nutrients without bogging you down.

Hydration and electrolytes

Hydration is huge. With Addison's, you might lose sodium more quickly, and water won't stick as well without it. Aim for regular fluids across the day, and add electrolytes when you're sweating, sick, or traveling. Oral rehydration solutions are helpful on harder days. If water seems to "go right through you," pair fluids with a salty snack or broth.

What to limit

Food shouldn't feel like a minefield. This is about balance, not fear. Still, a few things are worth watching.

Very low-sodium diets

Unless a doctor tells you otherwise, a super low-sodium diet can be risky. It may worsen dizziness, cause more pronounced drops in blood pressure, and trigger hyponatremia. If you notice morning lightheadedness, salt cravings, or dark urine, it might be a sign your sodium intake isn't matching your needs. On the flip side, swelling or rising blood pressure may mean you've overdone ittime to check in and adjust.

Ultra-processed, high-sugar foods

Think soda, candy, pastries, and refined snacks. These can spike and crash your energyexactly what you don't need. Better swaps: fruit with salted nuts, whole-grain crackers with hummus, or Greek yogurt with a pinch of salt and herbs (trust me, savory yogurt is wildly satisfying).

Excess caffeine and alcohol

Caffeine and alcohol can dehydrate and mess with sleep, which compounds fatigue. Coffee is fine for many people in moderate amounts, but pay attention to jitters or afternoon crashes. Alcohol can lower blood pressure and impair hydrationbe extra cautious on hot days and after exercise.

High-oxalate foods if calcium is low

If you're not getting enough calcium, large amounts of high-oxalate foods like spinach, beets, and almond flour might not be your best friends. You don't have to ban themjust pair them with calcium-rich foods so your body puts the oxalate where it belongs (out) instead of where it doesn't (kidneys).

Grapefruit and med interactions

Grapefruit can interact with many medications by altering how your body processes them. While the classic warning is for certain blood pressure, cholesterol, and anxiety meds, always check for interactions with hydrocortisone, fludrocortisone, and any other drugs you take. When in doubt, ask your pharmacist.

Sodium guide

Here's where things get personalin a good way. You'll fine-tune sodium based on how you feel, what your labs say, and what your care team recommends.

Signs you may need more vs. too much

You may need more: persistent dizziness when standing, salt cravings, dark or low urine, headaches, or that "foggy" fatigue that lifts after something salty. You may have too much: swelling in your hands or ankles, new or higher blood pressure, or feeling puffy. Take these signs as signals, not judgments. Your body is talking; you're just learning its language.

Labs and logs help

Many clinicians track renin and electrolytes to adjust fludrocortisone and sodium. You can help by keeping a simple log: morning symptoms, hydration, salty foods, workouts, and orthostatic blood pressure checks (seated vs. standing). It sounds nerdy; it's actually empowering. Over time, patterns pop out.

When needs change

Hot weather, exercise, fever, vomiting, diarrhea, and travel can all increase your sodium and fluid needs. On those days, plan extra broths, electrolyte drinks, and salty snacks. A small pre-workout sodium boost can prevent mid-exercise crashes.

Practical sodium strategies

Season generously with salt, citrus, herbs, and spices for flavor. Sip broth between meals. Keep portable salty snackssalted nuts, olives, jerky, cottage cheese cups. For workouts or heat, consider electrolyte tablets or packets. One client told me her summer survival kit is a water bottle, electrolyte powder, and a bag of pretzels in every totesimple and effective.

Smart supplements

Supplements can helpbut they work best when guided by labs and coordinated with your clinician.

Calcium and vitamin D

Food first: dairy, calcium-set tofu, canned salmon or sardines, fortified milks, and leafy greens. Many adults aim for about 1,0001,200 mg calcium daily from food and supplements combined, and vitamin D targets are individualized based on blood levels. Your provider might suggest a supplement if food alone doesn't meet your needs or if a DEXA scan shows bone loss.

Magnesium and potassium

These electrolytes matter for muscle function, heart rhythm, and overall energy. Good sources include beans, nuts, seeds, leafy greens, bananas, and potatoes. Symptoms of imbalance can be subtlecramps, palpitations, or fatigueso discuss persistent issues with your doctor. Don't supplement high doses without medical guidance.

B vitamins and iron

If fatigue lingers despite balanced meals and appropriate steroid dosing, your clinician may screen for deficiencies (B12, folate, iron). Focus on food sources first: lean meats, fish, legumes, leafy greens, eggs, and fortified grains. Supplement only if labs point to a gap.

Stay safe

Avoid megadoses. Keep your care team in the loop, especially if you change doses of hydrocortisone or fludrocortisone, because electrolyte needs can shift too. Regular lab monitoring keeps everything aligned.

Daily rhythms

Eating is not just about whatit's about when and how. A few simple rhythms can reduce fatigue and smooth out your day.

Meal timing that works

Try 3 balanced meals plus 12 snacks. Don't skip breakfastyour body needs fuel after the overnight stretch. If you exercise, a small salty snack and fluids beforehand can keep your stamina steady. Think of your meals like anchors that keep you from drifting into energy lows.

Prepping for sick days and flares

When illness hits, a plan beats panic. Stock easy-to-digest salty foods: broth, salted crackers, pretzels, mashed potatoes, rice, yogurt with a pinch of salt. Keep oral rehydration solutions on hand. Follow your sick-day rules for medsthis is crucial for preventing adrenal crisis. If vomiting or diarrhea is severe or you can't keep fluids down, seek urgent care.

Travel and eating out

Pack shelf-stable helpers: electrolyte powders, nuts, jerky, instant miso soup packets, and oats. Scan menus for balanced platesprotein, fiber-rich carbs, and something salty if you need it. No shame in asking for extra broth or pickles. You're managing a medical condition, not being fussy.

Sample day

Use this as a starting point and flex it to your tastes and needs.

Moderate-sodium baseline day

Breakfast: Oats cooked in milk, topped with sliced banana and a spoon of peanut butter, plus a pinch of sea salt. Coffee or tea, and water.

Snack: Greek yogurt with chopped cucumber, dill, olive oil, and a sprinkle of salt; whole-grain crackers.

Lunch: Tuna and white bean salad with olives, cherry tomatoes, lemon, olive oil, and parsley; side of leafy greens; sparkling water.

Snack: Apple with salted almonds; broth mug if you're feeling lightheaded.

Dinner: Grilled chicken or tofu, quinoa, and roasted vegetables; side of cottage cheese or calcium-set tofu for extra calcium. Drizzle of olive oil and a squeeze of lemon.

Hydration plan: Water throughout the day, plus one electrolyte drink if you exercised or it's warm.

Hot-weather or workout day

Small tweaks: Add a pre-workout salty snack (pretzels or salted yogurt dip) and an electrolyte drink during or after activity. Include broth with lunch or dinner. If you tend to crash late afternoon on hot days, plan a salty mini-meal around that time.

Easy swaps

Little changes, big impact. Here are some painless upgrades.

Pantry staples

Canned fish (salmon, sardines), broths, olives, beans, oats, and a few electrolyte powders or tablets. With these on hand, you can build a balanced meal in minutes.

Fridge and freezer

Greek yogurt, cottage cheese, eggs, leafy greens, frozen fish, fortified milks, and frozen veg. These are the building blocks of fast, nourishing meals.

Simple swaps

Swap sugary snacks for savory yogurt with herbs and salt. Pour a mug of broth instead of soda. Choose whole-grain crackers with hummus over chips. Keep nuts and fruit within reach for a stable energy combo.

Risks and care

As you fine-tune your Addison's nutrition plan, keep an eye on trade-offs and know when to call for backup.

Too much salt

Watch for swelling, sudden weight gain, or rising blood pressure. If these show up, step down your sodium and let your care team knowespecially if you take fludrocortisone. It may be a sign your dose or intake needs adjustment.

Protecting your bones

Steroid replacement can affect bone density over time. Ask about DEXA scans, aim for adequate calcium and vitamin D, and include weight-bearing exercise (walking, strength training). These habits stack up to stronger bones and a steadier you. According to clinical guidance from endocrine societies, bone health monitoring is a standard part of long-term management for adrenal insufficiency, so advocate for it during visits.

Urgent red flags

Severe vomiting or diarrhea, confusion, collapse, or very low blood pressure are emergenciesactivate your adrenal crisis plan and seek urgent care. Keep an emergency steroid injection kit where you can grab it quickly and make sure your close contacts know how to use it.

Care team

You don't have to do this alone. Your endocrinologist and a registered dietitian can help align your diet, fludrocortisone dose, and labs so they work together rather than against each other. Bring your symptom and BP logs, plus notes about what you ate on good and tough days. It's incredibly helpful data for fine-tuning.

Ask about practical supports too: referrals to nutrition counseling, lab frequency, DEXA scheduling, and any coverage your insurance offers for supplies like electrolyte solutions. You deserve a plan that's both medically sound and doable.

A quick story

One summer, a reader told me she kept "bonking" after her morning walksdizzy, foggy, a little shaky. We added 8 ounces of broth and a few salted crackers before she laced up, plus an electrolyte drink afterward. Within a week, the crashes vanished and her midday energy felt steadier. Small tweaks, big wins. That's the spirit of an Addison's disease diet: listen, adjust, repeat.

Helpful note

If you like digging into the "why" behind these tips, guidelines from endocrine groups discuss how aldosterone loss increases the need for sodium and how replacement therapy interacts with fluids and electrolytes. You can find well-reviewed overviews on adrenal insufficiency and bone health in endocrinology society publications and peerreviewed reviewsone helpful primer on adrenal insufficiency management is available as an open review (see this clinical review), which also highlights the role of individualized sodium and fludrocortisone dosing.

Wrap up

A thoughtful Addison's disease diet can steady your daysmore reliable energy, safer blood pressure, stronger bones. Start with the basics: enough sodium for your body, consistent hydration, vitamin D foods, calcium-rich foods, and balanced meals you actually enjoy. Then personalize. Track how you feel in hot weather, note what happens after workouts, and bring your observations to your next appointment so your team can help you dial it in.

Most of all, be kind to yourself. This is not about perfection; it's about building a plan for normal days and a backup for sick days. What small change will you try this weeka broth mug in the afternoon, a savory yogurt snack, or an electrolyte boost on exercise days? If you have questions or want to share what's working for you, I'm all ears. You've got thisand you don't have to do it alone.

Medical disclaimer: This article is educational and not a substitute for personalized medical advice. Always follow your clinician's guidance, especially about medication dosing, sodium targets, and sick-day rules.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.