For people with congenital adrenal hyperplasia (CAH), good nutrition is essential. While no foods or beverages are totally off-limits with CAH, some are better to avoid or limit.

That’s because CAH impacts hormone levels. As a result, the condition itself raises the risk of certain health conditions later in life. Certain foods and drinks, if consumed regularly, can further raise those risks.

In addition, CAH is mostly managed with steroids, which can come with side effects. If you have CAH, you can aim to eat a diet that reduces your risk of complications and unwanted treatment side effects.

Here are some helpful tips on what foods and beverages to avoid with CAH. We’ll also cover how to plan a balanced diet for congenital adrenal hyperplasia.

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🗳️ Which food or beverage category would you find it easiest to give up if you had to?

Ultra-processed food like chips, fast food, or meal replacement shakes

Sweetened drinks like sodas, juice blends with added sugar, or sports drinks

Caffeinated beverages

Alcohol

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Potential Complications of CAH

One of the most common problems facing people with CAH is obesity. Obesity is a medical diagnosis generally based on having a body mass index (BMI) score greater than 30. BMI is a ratio calculated from a person’s height and weight, but it does not always reflect a person’s overall health.

Studies suggest that obesity affects 30 percent to 40 percent of people with both major types of CAH (classic CAH and nonclassic CAH).

The corticosteroids (or simply steroids) used to manage CAH may further raise the risk of obesity. The combined impact of obesity and steroids also makes people with CAH more likely to develop diabetes and heart disease.

Another concern with CAH is weak bones. Glucocorticoids used to replace cortisol can prevent your body from absorbing calcium, which is essential to maintain strong bones.

Fortunately, healthy food and lifestyle choices can help manage these risks.

Foods To Avoid

Some food and drinks can make CAH symptoms worse and raise the risk for developing other health problems.

Cutting back on the following categories in your diet can help protect against some of these risks.

Ultra-processed foods are far removed from their natural state. They usually come in packages and have long, complicated ingredient lists.

Examples of ultra-processed foods include:

• Chips, pretzels, and other salty snacks
• Fast food meals
• Some granola and protein bars
• “Meal replacement” shakes
• Sugary breakfast cereals

Ultra-processed foods also lack key nutrients and may replace more nutritious foods that people with CAH need to thrive. Instead of filling your cart with ultra-processed foods, focus on whole foods that have more to offer.

Weight Gain

Growing research shows that ultra-processed foods aren’t good for the human body. They add extra calories, which can promote unhealthy weight gain and inflammation.

Studies show that people who eat a diet high in processed foods consume more calories and are more likely to gain weight. Making the shift to a less processed diet can help lower calorie intake and support weight management.

Sodium

People with salt-wasting CAH, the most severe form of classic CAH, may be encouraged to eat salty foods to help replace the sodium lost in their urine.

For people with other forms of CAH, a high-sodium diet may increase the risk of high blood pressure and kidney problems. Glucocorticoid therapy used to restore cortisol levels can cause the body to retain or hold onto sodium. Processed foods tend to be high in sodium.

Avoiding high-sodium foods, including processed meats like sausages, can help lower your sodium intake.

Added sugars aren’t good for anyone when consumed in excess. And sugary drinks can be one of the sneakiest ways sugar is creeping into your diet.

Aside from regular soda, sugary beverages also include:

• Cocktails and alcohol-free mocktails
• Juice drinks that aren’t 100 percent juice
• Milkshakes and flavored milks
• Sports drinks
• Sweetened coffee and espresso drinks
• Sweet teas

Sweetened drinks can be a highly concentrated source of sugar. Many food manufacturers use supersweet syrups to give their products a sweet taste.

Higher intakes of sugary drinks raise the risk of obesity, diabetes, and heart disease, even in children and teens. Cutting out sugar-sweetened drinks can help people with CAH live healthier lives.

Appetite and Satiety

Compared to solid food, sugary drinks aren’t very filling. You may not realize how quickly your sugar intake is adding up when you’re consuming it in liquid form.

Studies suggest that sugar-sweetened beverages may impact appetite and food cravings in different ways than solid food. They may have a stronger effect on the brain’s reward systems in response to sugar.

Liquids are also processed faster in the digestive system. They don’t require chewing and may not trigger feelings of fullness like solid food.

People with salt-wasting CAH are more prone to symptoms like:

• Dehydration
• Diarrhea and vomiting
• Low blood pressure
• Low blood sugar
• Irregular heartbeat

Staying consistent with your prescribed medication and supplements can help keep these symptoms under control. On the other hand, adding alcohol or caffeine to the mix may make symptoms worse.

Caffeine

Caffeine can affect heart rhythms and make it easier to become dehydrated. It can also affect your ability to absorb calcium, which is already a concern for people on steroid treatment.

Some people are more sensitive to caffeine than others. For most, the effects of caffeine last four to six hours.

Caffeine isn’t just found in coffee. It’s also in tea, energy drinks, chocolate, and some medications. Paying attention to caffeine from multiple sources can help you get a better idea of your total intake.

Alcohol

Alcohol may impact your blood sugar, blood pressure, and digestive system. Long-term intake of alcohol raises the risk of bone fractures and organ damage throughout the body.

Nutrition Tips With CAH

A balanced diet for CAH should include a variety of unprocessed foods. Aim to include a balance of foods such as these on most days:

• Beans
• Dairy products, such as yogurt
• Eggs, fish, poultry, and lean meats
• Fruits
• Nuts
• Vegetables
• Whole grains

Protein and Calcium

Steroids for CAH don’t just affect bone health. They can also weaken your muscles. Lean proteins and calcium in your diet can help counter these effects.

You can find these nutrients in milk, meat, seafood, and beans. Pairing a healthy diet with regular physical activity is the best way to promote strong muscles and bones.

Fruits and Vegetables

The benefits of fruits and vegetables can’t be overstated for people with CAH. These foods are naturally low in sodium and good sources of vitamin C, fiber, and potassium.

As a result, fruits and vegetables can help people with CAH avoid high blood pressure, maintain a healthy immune system, and balance their electrolyte levels.

Healthy Replacements and Meal Ideas

Small swaps can make meals and snacks more nutritious without requiring a lot of extra time or planning. Here are some ideas:

• Choose brown rice instead of white rice for more heart-healthy fiber.
• Drink water, plain milk, and unsweetened tea and coffee instead of sugary drinks.
• Keep fresh apples or bananas on hand to grab for a quick snack.
• Have whole wheat toast with peanut butter or eggs for breakfast, lunch, or dinner.
• Make unsweetened oatmeal instead of processed breakfast cereal.
• Stock up on frozen veggies and add them to your meals.

CAH is a lifelong condition. It’s OK if some days are healthier than others. Instead of setting strict rules for your diet, focus on making one healthy choice at a time. If you’re looking for more medical advice on your diet, meet with a registered dietitian nutritionist for help.

Join the Conversation

On CAHteam, people share their experiences with congenital adrenal hyperplasia, get advice, and find support from others who understand.

Have you made any changes to your diet to be healthier with CAH? Let others know in the comments below.