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Dietary Guidance for Cushing’s Syndrome

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Cortisol, aka the “stress hormone.” It’s one of the body’s most important regulators. However, “too much of a good thing” rings especially true when it comes to cortisol production. Prolonged high levels of cortisol can lead to Cushing’s syndrome, also called hypercortisolism.

Overproduction of cortisol is called Cushing’s disease (a type of Cushing’s syndrome) and affects around 40 to 70 of every 1 million people. Tumors, especially those around the adrenal glands, can significantly increase cortisol levels. Pituitary tumors alone account for 80 percent of Cushing’s cases.1Cushing’s Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 29, 2024. https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome

Understanding cortisol’s basic purpose and function is important in grasping Cushing’s impact on various health conditions, such as infections, high blood pressure, high cholesterol, heart attack, stroke, type 2 diabetes, depression, and memory loss.1Cushing’s Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 29, 2024. https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome Cortisol controls essential functions such as blood pressure, blood sugar, and the inflammatory response, and helps us deal with stressful events (via the fight-or-flight reaction). Your body’s use of carbohydrates, fats, and proteins depends on it.

Patients who take high doses of glucocorticoids (cortisol-like medications) over long periods are most at risk for Cushing’s. Glucocorticoids treat rheumatoid arthritis, lupus, and asthma by suppressing inflammation and the immune response. More than ten million Americans take glucocorticoid medicine, but exactly how many will develop Cushing’s syndrome is unknown.1Cushing’s Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 29, 2024. https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome

Cushing’s Syndrome Symptoms and Related Health Conditions

Man stands on scale

Symptoms vary but generally include weight gain, a round face, fat accumulation at the base of the neck and between the shoulders, weak muscles, easy bruising, wide purple stretch marks, and thin arms and legs. Women may notice excess hair growth on the face, neck, chest, abdomen, and thighs, and have irregular periods. In men, common symptoms include a lower libido, decreased fertility, and erectile dysfunction. Children with Cushing’s syndrome tend to be obese or grow slowly.1Cushing’s Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 29, 2024. https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome

Conventional Treatments for Cushing’s Syndrome

When the root cause of Cushing’s is related to tumors that produce too much cortisol, conventional treatments include surgery to remove the tumor(s) or a combination of radiation, chemotherapy, and cortisol-lowering medication. Doctors may prescribe a lower glucocorticoid dose or frequency or replace it with a non-glucocorticoid medicine.1Cushing’s Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 29, 2024. https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome

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Eating for Optimal Health with Cushing’s Syndrome

Low-Carbohydrate and Ketogenic Diets

Plate of grilled salmon

The weight gain that typically accompanies Cushing’s diagnosis is more harmful than it may seem. Visceral fat surrounding the stomach, liver, and intestines accumulates deep within the belly, unlike subcutaneous fat, which lies beneath skin’s surface. Just as the thyroid gland, adrenal glands, ovaries, and testes are classified as endocrine organs, so is visceral fat—a precursor for elevated cortisol levels.

Low-carbohydrate diets can improve Cushing’s symptoms by facilitating weight loss and reducing inflammation and cholesterol. They can also bring down blood pressure and cortisol levels, with results similar to cortisol-blocking medications.

For people with Cushing’s and poorly controlled diabetes, sugar restriction is especially important.2Dugandzic MK, Pierre-Michel EC, Kalayjian T. Ketogenic diet initially masks symptoms of hypercortisolism in Cushing’s disease. Metabolites. 2022;12(11):1033. doi:10.3390/metabo12111033 Replacing high-sugar foods with whole grains, fruits, vegetables, and polyunsaturated fats may support the natural release of cortisol during stress.

A ketogenic diet suppresses ghrelin, a hormone that triggers hunger, and may help keep cortisol in check.2Dugandzic MK, Pierre-Michel EC, Kalayjian T. Ketogenic diet initially masks symptoms of hypercortisolism in Cushing’s disease. Metabolites. 2022;12(11):1033. doi:10.3390/metabo12111033 Keto allows even fewer carbohydrates than many low-carb plans but includes more fat. Designed for short stints, the diet targets ketosis, where the body generates ketones for energy instead of relying on carbs. Studies show the ketogenic diet can improve metabolic and cardiovascular conditions often associated with Cushing’s disease.3Guarnotta V, Amodei R, Di Gaudio F, Giordano C. Nutritional intervention in Cushing’s disease: the ketogenic diet’s effects on metabolic comorbidities and adrenal steroids. Nutrients. 2023;15(21):4647. doi:10.3390/nu15214647

Very low-calorie ketogenic diets—VLCKDs—are even more restrictive. In a 2022 study that monitored 30 obese males on a VLCKD for eight weeks, scientists attributed the notable decrease in cortisol levels to reduced weight and less inflammation.4Polito R, Messina G, Valenzano A, et al. The role of very low calorie ketogenic diet in sympathetic activation through cortisol secretion in male obese population. J Clin Med. 2021;10(18):4230. Published 2021 Sep 18. doi:10.3390/jcm10184230

Calcium and Vitamin D

Were you aware that Vitamin D functions as a hormone? People with Cushing’s disease tend to have lower vitamin D levels, and there’s a connection between high cortisol levels and vitamin D deficiency. Supplements may help stabilize sugar and fats in the bloodstream.5Guarnotta V, Di Gaudio F, Giordano C. Vitamin D deficiency in Cushing’s disease: before and after its supplementation. Nutrients. 2022;14(5):973. doi:10.3390/nu14050973

Vitamin D also helps strengthen bones and increase bone density, reducing the risk of osteoporosis (commonly seen with Cushing’s syndrome). Because vitamin D is needed for optimal calcium absorption, it does double duty in supporting bone health.5Guarnotta V, Di Gaudio F, Giordano C. Vitamin D deficiency in Cushing’s disease: before and after its supplementation. Nutrients. 2022;14(5):973. doi:10.3390/nu14050973

Diet and supplements are two ways to ensure adequate vitamin D and calcium intake. Plant-based sources, like dark leafy greens (kale and spinach), broccoli, tofu, and mushrooms, are naturally rich in both D and calcium. Trout, salmon, eggs, and lean, high-quality proteins will also help in meeting daily requirements and fortifying weak muscles, a common complaint among people with Cushing’s syndrome. These powerhouse vegetables, legumes, and proteins are some of the few that contain vitamin D and calcium:

  • Okra
  • Collard greens
  • White beans
  • Sardines
  • Perch

Salt, Alcohol, and Caffeinated Beverages

Cup of matcha tea and whisk on table

One of cortisol’s many roles in the body is balancing salt levels. With Cushing’s syndrome, too much salt can further elevate blood pressure and contribute to weight gain. Replacing processed foods with fresh vegetables, fruits, and high-quality complex carbohydrates like peas, beans, and whole grains is the easiest way to reduce sodium intake.

What you drink also matters. Excessive alcohol consumption can damage the hypothalamic-pituitary-adrenal (HPA) axis, a hub for endocrine pathways that produce and distribute hormones, including cortisol. Less daily drinking goes a long way in supporting the body’s stress response, lowering blood sugar, and staying hydrated.

Steer clear of coffee and highly caffeinated beverages (like energy drinks), which can overstimulate the nervous system. Green tea is a healthy swap. Antioxidant-rich matcha and Sencha, while not without caffeine, are good alternatives.

People with Cushing’s should avoid soda and other sugary beverages, as blood sugar and cortisol spikes are linked. To lower the risk of diabetes, nerve damage, and cardiovascular disease, replace sweet drinks with homemade iced tea. Try brewing a pitcher with fresh herbs or steeping boxed tea with ginger, mint, lavender, or tulsi.

Footnotes

  • 1
    Cushing’s Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 29, 2024. https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome
  • 2
    Dugandzic MK, Pierre-Michel EC, Kalayjian T. Ketogenic diet initially masks symptoms of hypercortisolism in Cushing’s disease. Metabolites. 2022;12(11):1033. doi:10.3390/metabo12111033
  • 3
    Guarnotta V, Amodei R, Di Gaudio F, Giordano C. Nutritional intervention in Cushing’s disease: the ketogenic diet’s effects on metabolic comorbidities and adrenal steroids. Nutrients. 2023;15(21):4647. doi:10.3390/nu15214647
  • 4
    Polito R, Messina G, Valenzano A, et al. The role of very low calorie ketogenic diet in sympathetic activation through cortisol secretion in male obese population. J Clin Med. 2021;10(18):4230. Published 2021 Sep 18. doi:10.3390/jcm10184230
  • 5
    Guarnotta V, Di Gaudio F, Giordano C. Vitamin D deficiency in Cushing’s disease: before and after its supplementation. Nutrients. 2022;14(5):973. doi:10.3390/nu14050973

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