It’s Tuesday. That’s the day I re-fill my pill box for the week. Sometimes, given all the bottles I need to juggle to the counter, this makes me laugh. Sometimes, it’s the opposite.
The silver lining to spending a week in the hospital and donating countless vials of blood for testing is that you get a very accurate picture of what your body does and does not need.
The medication to treat the Addison’s was a no brainer, but based on my blood work, my endocrinologist also recommended a number of other supplements. I was lucky in that my doctor is also an athlete and an ultra-runner herself and was able to tailor some of the supplementation toward maintaining an active lifestyle with endurance sports.
Ideally, I’d use a high-quality diet not a pill to replace or make up a deficiency, but everyone is unique and the lifestyle I enjoy most (endurance training) calls for some supplements to stay healthy.
Here are the pills and supplements and the reason why I take them:
As a quick refresher, Addison’s Disease is a rare (lucky me!), chronic condition brought about by failure of the adrenal glands. In my case, it was autoimmune and we will never know why my adrenals pulled up stakes and left.
Without adrenal glands, I need to take steroids each day to replace the cortisol and aldosterone that the adrenals would have produced for me.
The hormone cortisol helps the body respond to stress, but also helps regulate blood pressure, blood sugar, and the immune system.
Aldosterone helps regulate blood levels of sodium and potassium and keep them in balance. This balance is important because it affects your overall blood volume and therefore your blood pressure.
I take two doses of hydrocortisone (this is synthetic cortisol), a larger one in the morning when I wake up and a smaller does around dinner.
I take one dose of fludrocortisone each day in the morning (this is synthetic aldosterone).
I consider those my base dosages. On days where I do a big workout or I am very busy (i.e., stressed), I might add a little extra of one or the other throughout the day.
The addition of the fludrocortisone last year has made a big difference in keeping my electrolytes more in balance and helping me stay hydrated and avoid the crazy cramping that developed last summer.
I take this once a month because I eat a mostly plant based diet and B12 is the one nutrient that you can easily become deficient in without small amounts of animal products.
Yes, some people argue you can get this from “dirty” produce, not washing organic produce and getting the B12 from the soil, but why risk it. The dangers and drawbacks of low B12 aren’t worth it in my opinion.
Vitamin D is unique in that it can be absorbed through the skin. You probably knew that. You are also likely deficient in Vitamin D. This is the one that surprised me the most, but is almost an epidemic at this point, especially among athletes. Vitamin D plays a key role in overall health, bone density, immunity and inflammation.
With Addisons’s and requiring, even low doses, of steroids, I am at risk for long term bone density issues. This is one reason why working out and staying fit is especially important for me. Vitamin D, along with calcium, plays a key role in bone density and preventing osteoperosis. For runners, low or deficient vitamin D levels can lead to an increased risk of stress fractures.
After intense exercise, endurance athletes experience inflammation due to elevated levels of pro-inflammatory cytokines. Vitamin D reduces the production of these cytokines while increasing the production of anti-inflammatory cytokines, thereby speeding the recovery process between hard workouts.
In a February 2009 study published in the Archives of Internal Medicine, Vitamin D3 levels were tested in 19,000 Americans. Studies have shown that those with low levels of vitamin D also had the highest incidence of colds and influenza. A heavy training load puts a lot of stress on the body and can naturally lower immunity. Lower vitamin D levels can leave you even more vulnerable to getting sick and missing workouts. Why risk it?
Iron is critical to endurance performance. It is an essential component of haemoglobin, the protein that carries oxygen and carbon dioxide in your blood and also plays a key role within the mitochondria to produce ATP, which is your body’s primary energy source. Iron is stored as ferritin in your liver until it is needed.
Research shows that having low ferritin levels can result in fatigue and ultimately could lead to reduced endurance.
To avoid developing low iron levels, it’s important to be aware of getting enough iron in your diet. This isn’t just dependent on eating plenty of iron rich foods, but also on ensuring that you absorb as much iron from these foods as possible. There are two forms of iron in food: haem and non-haem.
Haem iron is found in animal foods and about 25% of the iron is absorbed.
Non-haem iron is found in plant foods, and a smaller proportion of this is absorbed and utilized. Even though I incorporate many iron-rich foods in my diet on an almost daily basis (beans, tofu, pumpkin seeds, chick peas, nuts and broccoli), as a plant-based athlete, I just find it easier to add the supplement than worry about getting enough through diet alone.
This is one that I hope to ditch soon. I originally started taking magnesium last summer during a time where I was getting almost constant muscle cramps and twitching. In flailing for an answer, someone suggested magnesium. Turns out the aldosterone medication did a good job of regulating my electrolytes and backing off the cramps, but I kept taking the magnesium out of habit.
For athletes, a shortfall of magnesium can limit energy production, leading to fatigue, lethargy, reduced power, and those fun muscle twitches. Magnesium is also lost through sweat, so athletes training hard or who sweat a lot in general (hey – that’s me!) might further increase their risk of being magnesium deficient.
Neuromins DHA (Fish Oil)
It’s no shock that endurance training creates inflammation and adrenal stress. Having no adrenal glands at this point, I take a vegetarian version of fish oil to help reduce inflammation stress. Consistent inflammation can actually degrade muscle mass and affect the health of organs and tissues. Omega 3 oils can help decrease inflammatory factors and improve recovery times from hard workouts.
I’ll admit this one is less necessary and more of nutritional “insurance.” I only take half each day and nothing in the multivitamin contains more than 100% RDA of anything. I don’t think I’m in any danger of overdosing or creating any toxicity. This is another one I might review during my next appointment. I originally started taking this one right after the hospital and now 18 months on and eating a high quality diet, I might no longer need this to cover any deficiencies.
In the end, I am quite happy (how that’s for an understatement) that medications exists to treat my condition and allow me to continue the active and athletic lifestyle I consider vital to my sanity and health. I also think that smart supplementation, not using a pill to overcome a bad diet, is a smart way to assist our bodies in recovering from training and performing at high levels