High-calorie glucose-rich food attenuates neuroglycopenic symptoms in patients with Addison's disease.
OBJECTIVE
Patients with Addison's disease often suffer from fatigue, faintness, lack of concentration, and memory deficits, i.e. symptoms reminiscent of those of neuroglycopenia. Suspecting that a lack of central nervous glucose contributes to these symptoms, we examined whether they can be attenuated by the intake of palatable food rich in glucose ("comfort food") in these patients and, furthermore, whether comfort food reduces hypothalamus-pituitary-adrenal axis activity as observed in animal studies. Design/Setting/Patients/Outcome: Ten Addison patients with primary adrenal insufficiency and acutely discontinued cortisol substitution and 10 matched healthy controls each participated in two experimental sessions in which they were offered a free-choice high-calorie buffet (comfort food) and green salad, respectively, after a mental stress test. Neuroglycopenic and autonomic symptoms, cognitive function (short-term memory, attention), and hormones of the sympathoadrenal system (ACTH, cortisol, catecholamines) were assessed throughout the sessions.


RESULTS
Scores of neuroglycopenic symptoms were persistently higher in Addison patients than in controls and were improved by comfort food in comparison to salad (P < 0.04), whereas control subjects did not show such changes. Attention was generally reduced in patients as compared to controls (P < 0.05) and was slightly improved by comfort food, as was memory (each P < 0.07). Sympathoadrenal hormone concentrations remained unaltered.


CONCLUSIONS
High-calorie comfort food reduces symptoms of neuroglycopenia in Addison patients, suggesting that Addison's disease is associated with a deficit in cerebral energy supply that can partly be alleviated by intake of palatable food. It will be important to investigate whether additional oral glucose supply may be helpful in improving patients' well-being.
Klement
Johanna
J
University of Lübeck, Department of Internal Medicine I, Ratzeburger Allee 160, House 32, 23538 Lübeck, Germany. Johanna.Klement@uk-sh.de
Hubold
Christian
C
Cords
Hannah
H
Oltmanns
Kerstin M
KM
Hallschmid
Manfred
M
Born
Jan
J
Lehnert
Hendrik
H
Peters
Achim
A
D000224:Addison Disease / Q000178:diet therapy* / Q000523:psychology; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003071:Cognition; D002149:Energy Intake; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000502:physiology
D001786:Blood Glucose; D007328:Insulin; D000324:Adrenocorticotropic Hormone; D005947:Glucose; D006854:Hydrocortisone