Complementary Care for Dogs with Cushing’s Disease

[Updated July 18, 2018]

Because the diagnosis and treatment of Cushing’s disease can be confusing, expensive, and fraught with adverse side effects, many caregivers turn to alternative or complementary therapies.

For those who prefer treatments that have been proven in double-blind, placebo-controlled clinical trials, unconventional therapies are themselves fraught with peril. Product testimonials and anecdotal reports don’t prove anything, and by turning first to an herbal preparation or glandular extract, one might deny the patient an opportunity for effective treatment. Online reviews of nutritional supplements or herbal preparations range from reports about dogs that appear to be cured to heartbreaking stories of dogs whose condition deteriorated rapidly. Success stories are often not documented by laboratory test results, leaving readers to wonder whether the dogs that improved so dramatically actually had Cushing’s.

At the same time, the cost of veterinary tests, surgery, or prescription drugs for a dog is sometimes simply prohibitive. Because drugs can only relieve symptoms and cannot cure Cushing’s disease or slow its progression, there is little harm in trying alternatives if your dog’s quality of life is not impacted.

For some, the decision to pursue nutritional and alternative treatments is philosophical. Holistic veterinarians look at Cushing’s disease and every other canine illness from a different perspective than do conventionally trained veterinarians. They are likely to try holistic or natural treatments first and turn to symptom-suppressing conventional therapies later instead of the other way around.

Phosphatidylserine (PS), a phospholipid derived from lecithin, has been demonstrated to have a natural cortisol-suppressive effect on the adrenal glands. It can also help with cognitive dysfunction. Oral PS is available both by itself and in many combination supplements.

Elizabeth Knight, of Portland, Oregon, had some success using PS to treat her Welsh Corgi, Jasper, who was diagnosed with Cushing’s at age 11 and lived for two more years. “Two substances worked very well for us. For quite a while phosphatidylserine helped him a great deal with restlessness. And a Chinese herbal formula, Si Miao San, also helped with his restlessness and thirst. His polydispia and polyuria (excessive drinking and urination), pacing, and panting were controlled fairly well. I would say they helped about 80 percent.” Knight suspects that Jasper also had canine dementia.

In their book, Herbs for Pets, Greg Tilford and Mary Wulff recommend herbal therapy to support organs and systems that are subjected to additional stress because of the disease. “Dandelion root, burdock, garlic, and nettle are good choices for supporting an overtaxed liver and digestive system and to help replace potassium that is lost as a result of increased urination. Adaptogenic herbs such as Siberian ginseng or astragulus help buffer adrenal response to stress.” They also recommend avoiding licorice, borage leaf, and other herbs that stimulate adrenal activity.

Susannah Blanchard of Wilmington, North Carolina, turned to holistic treatments when her 10-year-old Shih Tzu, Bandit, was diagnosed with pituitary-based Cushing’s. “At that time,” she says, “the conventional treatment was Lysodren [mitotane], but I had a really hard time putting him on something that could induce Addison’s disease and was almost restrictively expensive. So I researched and found Cushex, a blend of homeopathic and herbal ingredients from PetAlive/Native Remedies. We moved around some, and every new vet who saw Bandit was amazed that he had a Cushing’s diagnosis. I credit the Cushex for keeping his coat rather thick with none of the thinning that generally accompanies Cushing’s disease. Bandit lived another five years and passed away last June at age 15. Only in the last few months of his life did his coat and tailfeathers start to visibly thin out.”

(Editor’s note: Bandit’s initial diagnosis was never confirmed by later testing; it’s possible that his original symptoms were caused by something other than Cushing’s.)

Another plant-based product is Canine Vitex Plus (formerly called Cush X) from the English company Hilton Herbs. Medical herbalist Hilary Self, the director of Hilton Herbs, created the formula nine years ago for dogs with Cushing’s caused by adrenal adenoma. “However,” she says, “a virtually identical product formulated for equine Cushing’s disease, which is caused by pituitary adenoma, has proved to be equally successful. I would anticipate that it would work equally as well in dogs with pituitary adenoma.”

The formula is added to the dog’s meals. “Symptoms usually respond within three weeks,” Self says. “The supplement is by no means a cure, but it has proved to be beneficial to many dogs. It has enabled many owners to either delay having to use the conventional drugs or even reduce a drug’s dosage over a period of months if the dog is already on it. If the dog is on medication, it is vital for the dog’s veterinarian to carry out regular blood tests to measure the response.”

Glandular supplements can also support the adrenal glands. “I think highly of Standard Process glandular products,” says Anita Moore, DVM, of Anne Arundel County, Maryland. “SP Canine Adrenal Support contains ‘functional foods,’ which are ingredients that have shown to benefit various organs and tissues in the body. It helps normalize adrenal function, making it appropriate for dogs with both Cushing’s and Addison’s disease. It doesn’t cure either illness, but it may help improve symptoms, as it has done with some of my patients.”

Diets for dogs with Cushing’s disease should be high in protein, which can help to combat muscle wasting; high-protein diets are also good for the skin and immune system. Fat should be moderately low, as Cushing’s predisposes dogs to hyperlipidemia (elevated cholesterol and triglycerides) and pancreatitis.

There is a lot of outdated information on the web about Cushing’s dogs needing a low-fiber, low-purine diet. It all appears to come from a single source, which references the third edition of Small Animal Clinical Nutrition (Lewis, et al, 1987). The newer fourth edition (Hand, et al, 2000), however, has no reference to purines, nor does it make any sense to restrict purines for dogs with Cushing’s.

The newer edition of Small Animal Clinical Nutrition also suggests that a diet “lower in fat (less than 12 percent dry matter) and moderate in crude fiber (8 to 17 percent DM) . . . may aid in weight loss and control of mild hyperglycemia . . . in dogs with glucocorticoid-induced carbohydrate intolerance” as well as hyperlipidemia. Some of this reasoning is questionable, but the point is that it no longer recommends a low-fiber diet.

Dogs with Cushing’s are predisposed to the development of calcium oxalate bladder stones, due to elevated calcium in their urine. Avoid giving excessive calcium, which might be a contributing factor. Feeding a low-oxalate diet with other modifications, such as avoiding vitamin C, might be helpful (see “Stoned Again?” WDJ May 2010). Keeping your dog well-hydrated and allowing frequent urination can also help prevent stone formation. Make sure fresh water is available at all times.

It is not unusual for dogs with Cushing’s disease to graduate from holistic therapies to conventional treatments or to take both at the same time. Three years ago Stacy McDaniel of Kingman, Arizona, noticed that her Husky/Malamute, Mascara, was gaining weight, drinking, and panting more than other dogs. In addition, Mascara had a voracious appetite and was greedy and protective of her food. (She lives with four other Husky/Malamutes.)

“The closest holistic vet I could find was 100 miles away in Las Vegas, Nevada,” says McDaniel. “Mascara was placed on Energetix BioBalancer [no longer available], Rehmannia (a Chinese herb), melatonin spray, and essential oils. I also used selegiline [Anipryl]. Most Cushing’s dogs have a thyroid problem, and Mascara was placed on thyroid medication. This combination seemed to work, and every follow-up test was within the appropriate range until she was tested in February 2011.”

That’s when Mascara’s medication was changed from Anipryl to Lysodren (mitotane). “What a difference,” says McDaniel. “Mascara even acted different. She was like a puppy again, playing and jumping. I was initially terrified of Cushing’s, but I now understand it and have respect for the treatments that are available.

“Mascara will always be on her medication. Without it she would die an early death due to the havoc excessive cortisol wreaks on the body. I am all about the quality of life for my dogs, and right now, she has an amazing life.”