Cushing’s disease dogs – The dog food and dog treats they need to remain healthy

Cushing’s disease in dogs

We will follow the information flow below:

• What it is
• Treating it
• Food and dog treats for it

Cushing’s disease or Cushing’s syndrome occurs in dogs when they create too much of a hormone called cortisol.

Naturally produced Cortisol in the dogs body is very important for the dog to respond to:

• Stress
• control their weight
• fight infections (immunity)
• blood sugar levels

Cushing’s is also known as hyper-cortisolism or hyperadrenocorticism and can be very difficult for vets to diagnose and can significantly reduce a dogs life expectancy when untreated.

CUSHINGS disease SYMPTOMS

Because of the breadth of symptoms, and often that they are subtle to begin with the disease can be delayed in being diagnosed. It mostly occurs in middle aged and older dogs, and can be more prone in certain breeds. There are MANY symptoms, but these are the main reported ones:

• Extreme thirst and constant drinking which leads to frequent urination and accidental peeing inside.
• Panting (connected with increased adrenaline)
• High hunger
• Hair LOSS and thinning skin
• Pot belly
• Lethargy and inactivity (no interest in walks)
• Immunity issues (caused by a weakened immune system and increasing chances of diseases and infections)

Dog Cushing’s disease Causes  

There are several types of causes for the excess cortisone levels – each requiring a different treatment (surgery or medication).

1  Pituitary dependent.  This Cause is responsible for 80% to 90% of the dogs with Cushing’s. It is caused by a very small tumour in the  pituitary gland (at the base of the brain) – this is typically very difficult to treat with surgery, so is handled by medication for life.

2 Adrenal dependent Cushing’s is about 15% of diagnosed dogs, and is caused by a tumour in the adrenal gland. This gland is a peanut sized and sits on top of the kidneys.

Ideally this form is treated by surgery, but if it cant be, medication can be available.

Disclosure. About 3 years ago my dog Archie was diagnosed with adrenal gland cancer. The only symptom we noticed before accidental diagnosis was random night panting.  The reason for this is when the adrenal gland was under stress, it would randomly spit out 300% of the regular maximum cortisone levels. His body would then respond to this false flag to a ‘stressful’ situation.

Archie wasn’t diagnosed with Cushing’s so much as the whole adrenal gland turned cancerous and spread tentacles into his vena cava (the main vein to the heart). Treatment was removal of the gland and tentacles. Afterwards we were told, and for a while it occurred, that his other adrenal gland would take over the load for creating cortisone, that typically the two adrenal glands would do, so it might increase in size.

Six months, then yearly after the operation we had CT scans of his body to see if the cancer had spread, and 3 years on, after a 2022 scan, it was found that his remaining adrenal gland was normal size, and the cancer had not spread. He is essentially healthy as he was before the diagnosis!

3   iatrogenic Cushing’s syndrome is the rarest form, and occurs in some dogs who have had a LONG history of steroid treatment for other conditions.  The reason that this Cushing’s syndrome occurs is that cortisol is ONE of the dog’s natural steroids, and adding another steroid medication to their system, can confuse it. The treatment is typically to attempt to reduce and remove steroid medication (finding another treatment for the original existing condition).

There are several standard Diagnosis and treatment methods, after which the owners are requested to monitor that the symptom behaviours reduce, while the vets monitor certain blood and enzyme levels and adjust medications as required.

But this article is mostly about what modifications to diet (dog food and dog treats) are required for Cushing’s disease diagnosed dogs.

Cushing disease dog food and DOG Treats recommended

Let’s keep in mind that the disease is caused by extra cortisone in the dogs blood. And review what the symptoms of the disease are. This will give a good insight into why certain nutrient are recommended.

Petmd site keeps it fairly simple. They say that the food should meet the aafco recommendations for ADULT maintenance diet (but not one that is for all life-stages). They say that this will “compensate for the muscle-wasting associated with this disease and will not be as calorically dense as other life stages, such as the puppy stage.” Ref 2

NOTE,  ANY dog food sold globally (including Australia) conforms to the aafco standards if it is to be legally sold as dog food (allegedly whole and complete). HDT and many dog nutritionists, say that aafco protein min levels are VERY low, and that there is an excess of minerals and vitamins (to preclude natural food sources).

The above petmd caveat suggests that any Mature dog formulation abiding by aafco will work, along with the following supplements targeted at helping with the Cushing’s symptoms.

SPECIFIC TWEAKS to a regular dog food diet

• Low in Fat With Moderate Fiber
• Highly Digestible Protein
• Low in Sodium and Chloride
• Fish oil supplementation
• Keep water levels up

THE DETAIL of what those Cushing disease food mods

What Dog Diets, Low in Fat With Moderate Fibre mean

“Dogs with Cushing’s disease have elevated levels of cortisol, which increases triglycerides and cholesterol. To help combat these increases, a food that’s lower in fat (less than 12 percent on a dry matter basis, or DM) and moderate in crude fibre (8-17 percent DM) is reasonable.” Ref 2

Lets look specifically what FAT changes are needed

Triglycerides  “when you eat, your body converts any KJ it doesn’t need to use into triglycerides. The triglycerides are stored in your fat cells. Later, hormones release triglycerides for energy between meals.”

Cholesterol is a waxy substance found in your blood. There are “good and bad” forms of cholesterol, and eating food with high cholesterol levels DOES NOT specifically create more cholesterol in your own blood.

Aafco nutrition table values for FATS are shown below:

Petmd suggested to consider the adult minimum aafco diet and as you can see it aafco recommendations are extremely vague when it comes to a regular ADULT dog diet.

They suggest CRUDE fat MINIMUM value of 5.5% for healthy adult dogs (not puppy or pregnant).

Let’s look a fat example for Gravy, instant beef,  Ref 3

I have chosen this form of beef, as it seems in total fat form, to be consistent with typical beef jerky in dog treats.  It says :

• Total fat = 9.5%
• Saturated fat 4.9%
• Monosaturated fat 3.7%
• Polyunsaturated fat 0.9%
• NO trans fats
• Total omega 3 = 68 mg
• Total omega 6 = 870 mg

Beef jerky and chicken jerky dog treats are typically around 10% fat (within acceptable limits for a Cushing’s disease dog diet).

Aafco says Linoleic acid minimum 1.1 %

Linoleic acid  =  “predominant n-6 polyunsaturated fatty acid  from vegetable oils such as sunflower, safflower, soybean…”  ie  Affco say  Omega 6 should be 1.1% of the total dry matter food intake.

Aafco alpha-Linolenic acid  0.08% is only for PREGNANT dogs.  They don’t give a value for a regular dog diet.

“alpha-Linolenic acid (ALA), also known as α-Linolenic acid is an n−3, or omega-3, essential fatty acid.”

ALA for regular dogs is shown as NDd  ‘=   “Not Determined. While a minimum requirement has not been determined, sufficient amounts of omega-3 fatty acids are necessary to meet the maximum omega-6:omega-3 fatty acid ratio.”

Aafco Eicosapentaenoic + Docosahexaenoic acid % , 0.05% is only for PREGNANT dogs.  They don’t give a value for a regular dog diet.

“Eicosapentaenoic acid (EPA) along with docosahexaenoic acid (DHA).is one of several omega-3 fatty acids. It is found in cold-water fatty fish, such as salmon and kangaroos.

THIS IS WHERE AAFCO Fats recommendations get vague.

aafco give values for pregnant dogs for ALA and  EPA + DHA for pregnant dogs, but all these decades later have not come up with a value for the vast majority of the dog population.

Why TWO (ALA  and  (DHA + EPA) Omega 3 values?

“Key dietary sources of omega-3s Sources of omega-3s include fish, krill, calamari, green-lipped mussel, and algae.  Only about 10% of ALA converts to the more active EPA and DHA; therefore, using marine sources is preferred.”  Ref 4

Most kibble (and some wet commercial dog food) uses Flax seed as a main source of Omega 3.  “flaxseed oil contains alpha-linolenic acid (ALA), a form of omega-3 fatty acid that is only converted in small amounts to active forms of omega-3, like EPA and DHA “

If your dog food has 0.05% Omega 3 from Flax seed, then they are really only getting 0.005% EPA + DHA Omega 3.  These omega 3’s work as a catalysts and in conjunction with inflammatory Omega 6.

The last fat row of the affco above says “ (Linoleic +Arachidonic):(alphaLinolenic +Eicosapentaenoic +Docosahexaenoic) acid Ratio 30:1

That means that the Omega 6 to Omega 3  ratio should be a max of  30: 1

Or in acronyms, Linoleic acid  to (ALA + EPA + DHA)  should be a max of 30:1

Highly Digestible Protein for dogs

This is the definition of BIO AVAILABLITY of Protein for dogs.

MEAT is bio available to dog’s digestion. Most plant-based material is not.

SO, if your dog has Cushing’s or NOT,  Meat based dog food or dog treats – are REQUIRED.

Low in Sodium and Chloride

Aafco recommendations for Regular dogs =Adult dogs Maintenance Minimum % dry weight values

Min sodium = 0.08%

Min Chloride = 0.12%

NOTING That aafco have only MINIUM values calculated, NO maximum values, so dog food can have ANY amount of salt in them, and still be classed as dog food, as long as enough dogs eat the sample in the trials (if they are testing by trials).

NOTE on ingredient listing in dog food and dog treats.

Manufacturers have to give INGREDIENT lists, ONLY starting with the Largest Percentage ingredient downwards.  ACTUAL absolute amounts or percentages do not have to be given.

Many dog foods, and composite dog treats have small amounts of sugar and salt added. For regular dogs this isn’t such a bad thing (though we suggest that for treats NO added sugar or salt should be necessary.

We sell MANY 100% single ingredient dog treats, and because of the high expense of lab testing, and the fact that they have NOTHING extra added to them … it can be difficult to learn what percentage of trace ingredients like NATURAL salt are in them.

For our own education, we often research specific jerkies, like beef and chicken .. but we also know that values can vary considerably between breeds within a species, or even batches.

If your vet wants to preclude your dog eating a certain meat, because of its high natural salt content  then that would preclude the meat being used in dog food and dog treats.

OTHER TWEAKS on Cushing’s disease dog food

A long article by ‘darwins pets’ lists a horrendous number of side effects from Cushing’s disease.

If your dog has Cushing’s disease as diagnosed by a vet, you probably have been made very aware of potential health issues that can occur. This article is about the best food for your dog, so we will still continue on that avenue.

The darwin’s article gives a long list of herbal options. But these should be trace elements, NOT macro amounts.

They also have compiled a list of “Specific Foods that Are Good for Dogs with Cushing’s

The meat options section says these meats are good –  “beef -chicken without skin or bones -fish (except sardines) -shellfish -salmon -kidneys -liver -eggs”

The exact same article summarizes their overall suggestions

• Foods high in protein
• Foods low in fat
• Foods low in fiber
• Foods with low purine levels (avoid organ meats)
• Foods low in carbohydrates
• Foods low in calcium
• Foods rich in lignans(including whole grains, nuts and seeds, legumes, fruits, and vegetables)

Google says “causes of high levels of purines are a Purine-rich diet — liver, game meat, anchovies, sardines, gravy, dried beans and peas, mushrooms, and other foods.“’

An ‘aplaceforpaws’ article says “Finding foods low in purines is slightly more difficult – you find purines in all proteins BUT all are not created equal.  Items like beef and pork liver and kidney as well as sardines and some fishes should be avoided. “

“Moderate purine foods include chicken, beef (non-organ meat), turkey, tripe, rabbit, pork and lamb.   “

“Organ meats will always have a higher purine amount than non-organ meats with the exception of tripe.  Overall, avoiding most seafood as well as beef Liver and pork liver is key.  Little has been done on the effect of cooking and purines but initial experiments have shown that cooking actually breaks down the purines making them easier to absorb and therefore worse for your Cushing’s dog)”

It would appear that a key micro nutrient for Cushing’s dogs, is that they require a restriction of PURINE

“Purines are compounds that the body produces naturally. This natural production accounts for the majority of purines in a DOGS system. However, many foods and drinks can contain small amounts of purines.”  Ref 8

Foods low in purine are:   low fat dairy products,  whole grains, vegetables, non-soy legumes, fruits and fruit juices, eggs  REF8

They say – “Foods high in purine are:  game meats such as veal, venison, and duck, red meat,  seafood (including tuna, sardines, anchovies, and herring), organ meat, such as kidneys and liver.”  REF8

As YOU CAN see,  the raw feeding site says “Moderate purine foods include chicken, beef (non-organ meat), turkey, tripe, rabbit, pork and lamb.   “  whereas other sites suggests you need to almost become vegetarian. Which would be complete against giving high quality bio available protein foods !

Kangaroo is said to be high in Purine – yet the raw site says “cooking actually breaks down the purines making them easier to absorb”  and all of our treats are well cooked meat based.

The one thing they all seem to have in common is outlawing any OFFAL such as kidney and liver, and Sardines.

We will drill down on the purine mystery below in this article by looking at specific references tables for various foods.

REVIEW of EXAMPLES OF COMMERCIAL DOG FOOD Recommended FOR CUSHINGS DISEASE DOGS

To understand how crucial diet is for a specific disease, its always worth noting what restrictions in nutrients are recommended through several different sources, as well as what specific commercial dog food blends have in them.

While Cushing’s disease in dogs has some very bad symptoms and potential impact on quality of life, the over all recommendations seem to be :

The very basic requirements for dog food by (AAFCO) adult maintenance –

(a very commercial site stresses “no homemade, raw, or ‘all life-stages’ diets.”  But except for the potential inclusion of foods high in purine (which a generic dog food does NOT guarantee against, it would appear that this recommendation is to ensure that you only buy their recommendations from them).

• Low in fat (<12%)
• moderate fibre
• Contain highly digestible protein
• Low in Sodium and Chloride (for blood pressure).

The above four dot points are in line with previous sites recommendation NOTING that most meat jerkies cover ALL of the dot points, except for maybe some fish types like sardine, that can be higher in purine and salt.

They recommend these basic dog food:

Advance Healthy Weight:

Key Nutrient analysis:  Protein: 27.3%
Fat: 9.8% min – 14.2% max
Omega 3 (min): 0.10%
Omega 6 (min): 1.2%

Analysis-  this LOW protein level is typical of food that are low in meat content. In fact the first ingredient on their list is RICE. The fourth ingredient is dried beet pulp (a major fibre ingredient) .  So curiously this product appears quite unexceptional, just low in meat, for no reason, and just as high in fat as a beef or chicken jerky treat.

Hill’s Perfect Weight:

Key nutrient analysis: Protein: 28.7%
Fat: 11.2%
Omega 3: 0.76%
Omega 6: 2.2%

The first five ingredients are :  Chicken, Cracked Pearled Barley, Brown Rice, Pea Fibre, Corn Gluten Meal,

With only 28% protein, it suggests that the four vegetable ingredients following the chicken are in total a very high percentage of the overall food.

They say “inclusion of pea and oat fibre for gut health, coconut oil and flaxseed for healthy skin, and a few extra fruits and veggies for natural vitamins.”

We say – including separate ingredients mainly for additional fibre, when Cushing’s aims to have low to medium fibre makes this product a strange selection for ideal Cushing’s dog foods.   Our analysis on oils used for dogs suggests that coconut oil adds KJ for little extra benefit, while flaxseed as discussed above is a VeRY poor substitute for fish oil for Omega 3 content.

The next product is from another major commercial brand and is also in the LIGHT WEIGHT category.

It would appear that the recommendations are based on selling low meat content, relatively LOW KJ foods, because Cushing’s dogs can develop pop bellies and have reduced exercise because of the ailment.

There is NO reason that Cushing’s dogs should not have a high meat content diet (with the purine caveat).

CONCLUSIONS

It would seem that the main take-aways for diet for Cushing’s disease dogs is still:

• Highly Digestible Protein (MEAT)
• Low in Fat (less than 12%) With Moderate Fiber
• Low in Sodium and Chloride
• Fish oil supplementation

Meat is one of the most bio available foods to carnivore dogs in existence.

When they recommend low fat, and commercial dog food sites are classing 12% to be low enough, almost EVERY meat jerky fits within this requirement.

Meat is typically so low in fibre, that using it and commercial dog food, will not add any significant fibre to a dogs diet.

All of the commercial dog food diets tend to be weight control dog food, with chicken as one of its top two ingredients (to reach aafco min protein requirement of 18%.

 “Unlike other conditions such as Kidney disease or Diabetes, a strict Prescription Diet is not required for Cushing’s Disease. Most high-quality adult diets – particularly those formulated for weight management – will meet the above criteria and keep your Cushing’s disease dog nourished and healthy.” Ref 7

One of the main supplements is Fish oil to help reduce circulating triglycerides and fats, and keep coats shiny and reduce inflamed skin. ALL dogs should have additional Omega 3 fish oil (or from animal meats) – unless vets advise specifically against it.

The last thing a Cushing’s disease dog owner needs to KNOW and review when selecting treats is purine content.

It would appear that cooked chicken and beef, lamb and pork products are fine but Kangaroo is possibly high in purine, as is sardines.

Avoid offal such as beef liver and roo liver, any animals kidneys or even beef lung.

Because most sites don’t give purine levels of individual ingredients, and that would be difficult to look up for every possible dog food meat ingredient, a have found a great extensive table on the Purine contents of foodstuffs see the REFERENCE section – ref 9 and ref 10.

I have included some examples of these foods from the two different tables, showing how even between two sources, purine levels reported can vary greatly.

ALWAYS CONSULT YOUR VET WHEN CONSIDERING A FOOD SUITABLE FOR A CUSHINGS DISEASE DOG

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Some purine content examples:

Noting that these meats that are given as being ok, still tend to have purine levels around 100 mg / 100g of meat

Purine per 100g of food

LOW Enough Purine meats

• Roasted chicken leg  98 mg (ref9)  V  Chicken (chicken for roasting), average 115 mg  (ref 10)
• Pork flesh  63 mg   (ref9)  V  Pork belly  110 mg (ref 10)
• Lamb Flesh 76 mg (ref9)  v   Lamb (muscles only)   182 mg (ref 10)
• Roast beef Chuck  120 mg (ref9)  v  Beef, shoulder 110 mg (ref 10)

 HIGH PURINE (not recommended for Cushing’s dogs)

These are some of the foods/ treats that articles suggested were too high in purine.  As you an see the purine levels are not massively different from the low purine meats.  The too high values seem to start at about 150 mg and go to well above 300 mg / 100g of dried meat.

• Beef Liver 231 mg
• Beef Lung 166 mg
• Mackerel with skin  167 mg
• Sardine 144 mg  (ref9)  V   Fish, sardine, pilchard  345 mg  ref10
• Mussels  154 mg (ref9)  v   Mussel  112    (ref 10)

Meats that were said to be HIGH in purine ???

The following meats were suggested by some articles to have too high purine levels for Cushing’s dogs, yet, from several purine content sources, the values don’t seem to be too different from beef or chicken meat.

• Duck 64 mg  (ref 9)   V   Duck, average 138 mg   ref 10
• Rabbit 71 mg  (ref 9)   v   Rabbit/Hare (average)  105 mg (ref 10)
• Deer 67 mg
• Veal 63 mg (ref 9)   V  Veal fillet  140 mg  (ref10)
• Salmon cured 100mg   (ref 9)    V  Fish, salmon   110 – 250 mg)  (ref 10)

We strongly recommend discussing purine content with your vets, and using a table source that they trust and recommend.  At least that way you will have some more independent advice on this serious topic.

References

1  ‘Cushing’s Syndrome in Dogs’  Petmd site ,   By Melanie Winderlich Preis      06, 2021

2  What’s the Vet-Recommended Diet for Canine Cushing’s Disease?  Petmd site, Laci Schaible, DVM, MSL, CVJ   PUBLISHED: JUNE 27, 2019

3  nutrition self data  Gravy, instant beef, dry Nutrition Facts & Calories

4  Exploring the role of omega-3 supplementation in cats and dogs,  September 17, 2021   Laura Gaylord, DVM, DACVIM (Nutrition)

5  Treating Cushing’s Disease in Dogs — Diets, Natural Remedies, and Medicines   (darwinspet ) 4/28/19

6 Canine Cushing’s Disease – Change The Diet?     aplaceforpaws .com/canine-cushings-disease-change-the-diet/

7  Canine Cushing’s Disease  31 JULY 2022     Pet circle

8  Foods to eat and avoid on a low purine diet.    medicalnewstoday .com/articles/322590#foods-to-eat

9  Purine content of foodstuffs   dr-barbara-hendel .com/en/nutrition/tables/purine-content-table/

10  MORE purine table and information   elevatehealthaz .com/wp-content/Purine%20Table.pdf