Diverticulitis

In Addison's disease (primary adrenal insufficiency), near-total failure of DHEA synthesis occurs alongside cortisol and aldosterone deficiency, but DHEA is not routinely replaced. Multiple RCTs demonstrate that adding 50 mg/day DHEA to standard replacement improves psychological well-being and quality of life in women, and reverses loss of bone mineral density at the femoral neck.

Licorice root's active compound, glycyrrhizin, inhibits 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2), the enzyme that converts active cortisol to inactive cortisone, thereby extending cortisol availability. A published RCT in the European Journal of Endocrinology (Methlie et al., 2011) enrolled 17 Addison's disease patients and found that licorice significantly increased the area under the curve for serum cortisol versus placebo (P<0.05). The British Herbal Pharmacopoeia also lists licorice as indicated for primary adrenocortical insufficiency.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH) explicitly recommends that people with Addison's disease who have low aldosterone can benefit from a high-sodium diet, because aldosterone deficiency causes sodium wasting and consequent hyponatremia and hypotension. This is a standard, evidence-based nutritional intervention recognized by official health bodies for managing aldosterone deficiency in Addison's disease.

The adrenal cortex contains the highest concentration of vitamin C (ascorbic acid) of any organ in the body. Vitamin C is a documented cofactor for adrenal steroidogenic enzymes including 11β-hydroxylase (which converts 11-deoxycortisol to cortisol) and is released from the adrenal glands in response to ACTH stimulation. Ascorbate deficiency impairs aldosterone synthesis in animal models. These biochemical roles are directly relevant to Addison's disease, where both cortisol and aldosterone production are deficient.

The NIDDK (National Institutes of Health) specifically recommends that Addison's disease patients on corticosteroid replacement therapy obtain adequate vitamin D and calcium to protect against corticosteroid-induced osteoporosis. A pilot trial (Penna-Martinez et al., Nutrition, 2018) investigated high-dose vitamin D in Addison's disease patients and found immunomodulatory effects on T-cells and monocytes. A systematic review (Frontiers in Endocrinology, 2022) documents correlations between vitamin D status and Addison's disease, including shared autoimmune pathways.

Adrenal cortex extracts were the primary medical treatment for Addison's disease in the early 20th century, before synthetic corticosteroids became available. Documented use dates from the 1890s through the 1940s, when clinicians used dried or freeze-dried bovine adrenal cortex material orally and by injection to manage adrenocortical insufficiency. It was eventually displaced by purified synthetic hormones and removed from the drug market in 1978.

Ashwagandha (Withania somnifera) is an Ayurvedic adaptogen with documented traditional use specifically for supporting adrenal health in Addison's disease contexts. Its withanolides modulate the HPA axis and ACTH signaling, and Ayurvedic texts and modern naturopathic practitioners document its use in managing Addison's disease as an adjunct. Clinical studies show HPA axis modulation, though RCTs specifically in Addison's disease patients are lacking.

Eleuthero (Eleutherococcus senticosus), known as Siberian ginseng, is an adaptogenic herb traditionally used in Traditional Chinese Medicine to energize and support adrenal function, and is specifically cited in naturopathic treatment literature for Addison's disease. A 2010 review by Panossian and Wikman identified it as one of the most thoroughly studied plant adaptogens, with evidence supporting its use in adrenal-related conditions.

Whole adrenal glandular preparations (freeze-dried or desiccated whole bovine adrenal gland) were used historically, including specifically for Addison's disease, in the early 20th century prior to synthetic corticosteroid availability. Clinical records from 1920s Mayo Clinic series and a published PMC paper document oral whole adrenal gland use as a treatment approach in Addison's disease patients. As a dietary supplement category, no modern clinical trials have validated efficacy.