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Cushings Disease is a disease seen commonly in dogs and rarely in cats, where a benign (not cancerous) but functional tumor in the pituitary gland over-secretes a hormone that over stimulates the adrenal glands in the abdomen to produce too much of the hormone, cortisol. Cortisol is a stress hormone that has powerful anti-inflammatory properties, and prepares the body for the “fight or flight response,” where peripheral circulation is minimized and pooled centrally, the heart rate increases, the pupils dilate, and the gut slows down, leaving the body primed for a fight or rapid flight from danger. Make no mistake, cortisol is a very important and essential hormone, but too much of it over time is damaging to the body.
Among its deleterious effects, over time hyper-cortisolism caused by Cushings Disease, may lead to obesity, skin infections, thin hair coat and even hair loss, pigmentary changes of the skin, urinary tract infections, loss of lean muscle mass, anxiety, diabetes, heart enlargement, kidney failure, and cataracts of the eyes. Excessive cortisol also has a diuretic effect, commonly causing dogs to drink and urinate excessively, in some cases, never seeming to be able to quench their thirst.
Conventional treatment for Cushings Disease is to treat with a medication called trilostane that enzymatically inhibits the production or cortisol at the level of the adrenal gland, thereby neutralizing the over-stimulation caused by the functional pituitary gland tumor. It is an effective and safe treatment course, but it is also expensive. What’s more, I commonly see canine patients that I know have Cushings Disease, but repeatedly test negative for the disease. If a veterinarian cannot conclusively prove Cushings Disease, then he/she cannot treat it aggressively because of risk to the patient. I call these cases “Cushings Disease in waiting.”
There are also patients that are very mildly positive for Cushings Disease where treatment may be overkill, and of course patients with owners that have serious budgetary concerns that make treatment with trilostane cost prohibitive. Thus, while I will always maintain that for conclusively proven, unequivocal Cushings Disease patients, that the best course of action is treatment with trilostane, for borderline Cushings Disease patients, the aforementioned Cushings Disease patients in waiting, and for proven cases of Cushings Disease where treatment is cost prohibitive, I advocate for dietary and natural management of disease. What’s more, even for patients that are undergoing trilostane therapy for proven cases of Cushings Disease, natural management has the ability to reduce drug doses, thereby saving the client money, while overall increasing the safety of the patient who may end up less reliant on a pharmaceutical solution.
Natural management of Cushings Disease in dogs (and cats when disease rarely presents itself – I have only seen one case in all my years of practice) must begin with diet. Sodium restriction is key in management of Cushings Disease, as sodium levels will tend to be high in Cushings patients. This will help reduce the excessive thirst and urination, help reduce hypertension and therefore reduce the impact of Cushings Disease’s role in causing kidney failure and heart disease, respectively.
Since so many pet diets are high in sodium because of its appeal to canine and feline palates, it is difficult to find foods that have restricted levels of sodium. As such, you may want to consider prescription diets for kidney failure and/or heart disease that are sodium and phosphorus restricted. If you have a little bit more time on your hands, cooking a home cooked diet for your pet would be ideal, since you can keep refined and processed grains out of the diet. 50% fresh vegetables (green beans, peas, baby carrots, and broccoli are good choices) chopped, steamed, or puréed into a paste, served with a low sodium meats (rabbit, chicken, turkey, venison) served cooked or raw with no salts added give the benefit of low sodium, fresh ingredients with no preservatives, as well as unprocessed nutrients and beneficial antioxidants and free radical scavengers. If you choose to feed raw meat, be certain to choose reputable sources to prevent raw meat bacterial food toxicity. My preference are sources that exist solely for the purpose of providing raw meat for pet consumption that freeze the meat on site and ship frozen, for the per owner to then freeze upon receipt and thaw as needed.
Melatonin is a hormone that is normally secreted by the pineal gland, and has several important functions in the body. Research at the University of Tennessee, College of Veterinary Medicine, suggested that Cushings Disease patients not only suffer from the deleterious effects of excess cortisol, but also from excess female hormone, estradiol that the adrenal gland also is responsible for secreting. We believe that estradiol, not cortisol, may be responsible Cushings in waiting cases, where patients show hallmark clinical signs of disease, yet repeatedly come up negative on cortisol based testing for Cushings Disease. Melatonin has been shown to inhibit estradiol production and inhibit cortisol production. The dose for a dog under 30 pounds is 3 mg administered once every 12 hours, 6 mg every 12 hours for dogs over 30 pounds. The dose for cats is 1.5 mg administered once every 12 hours. Use regular, not extended release products.
Maximum success treating with melatonin is seen when used in combination with flaxseed lignans (flaxseed hulls). The lignans have a direct phytoestrogentic effect, while also serving to lower estradiol and cortisol production. Flaxseed oil is also rich in omega-3-fatty acids, which not only directly condition and nourish the skin, often a problematic area for Cushings patients, but also are naturally anti-inflammatory and protective to the skin, and other tissues and organ systems. Thus, I would try to find a product that has both flaxseed oil with lignans included. The dose is 40 mg every other day for dogs weighing less than 30 pounds, once daily for dogs weighing over 30 pounds. For cats, the dose is 20 mg every other day.
Make no mistake, for serious, clearly diagnosed Cushings Disease in dogs and cats, natural treatment for Cushings Disease alone, may only be successful in borderline positive cases, or cases where Cushings is strongly suspected, but has yet to be proven diagnostically. However, for cases of Cushings where financially treatment with trilostane is cost prohibitive, a natural approach can be very helpful, and worth a try. At the very least, a natural approach can do no harm. For confirmed cases of Cushings disease where treatment with trilostane is indicated and underway, I would advise this Cushings natural management approach in order to attempt to reduce trilostane doses over time, saving cost and increasing the safety of the patient.
Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. In addition to being passionate about integrative veterinary medicine for which he is a nationally renowned expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport. He is president of Maybeck Animal Hospital , runs the successful veterinary/animal health blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care, and fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.