@RawPetMedics Tuesday Live: Adddison's and Cushing's

Good evening, good evening.

I'm in the middle today. I like this. Am I in the middle for both of you guys, or is it just—

Yeah, no, no, you are.

Yeah, the power.

He's the man in the middle.

Here we go. Welcome all. I always get a bit nervous at the first 20 seconds. For people that don't watch us on our screen, it might happen on Facebook, Bren, but you know the way we can see the people dropping in on the right-hand side? Yeah, I'm always a little bit anxious at the first 20 seconds. And, oh, there we go. Tor Hoops and Janet Nixon.

Good to go.

Janet Nixon's always—

Janet.

Yeah, lovely. Good stuff. Thanks for joining us, Rach.

Is always— Rach is always very quick on the mark. She's third today, so the bronze medal for her, but a medal nonetheless.

She loves a freebie, Rachel Mac. She just loves a freebie, so she loves these shows.

You are in so much trouble if the gold, silver, or bronze medalist, uh, fail on the dope test. You are getting a medal.

Yeah, absolutely.

Yeah.

Jensen. Yeah, you are all right, guys.

We are, we are Raw Pet Medics, uh, thanks for joining us tonight. Um, you are going to find us over on patreon.com/rawpetmedics. Every little bit helps, and if you can afford the price of a cup of tea or coffee that keeps us going here, we deeply appreciate it. And if you can't, not to worry at all. Tonight we're going to be talking about Addison's and Cushing's and other such adrenal issues and whatnot, I'm sure. And it was a learning curve for me as I tried to prepare for today, and I now I realize this is very much a veterinary matter, so I know I'm going to be sitting at the back of the bus for this one and listening impatiently. I've lined up my questions, though, you'd be glad to hear. But aside all that, before we get to that, anything exciting happening this week that anybody wants to regale us with a tale?

Oh, you've got to, you've got to talk about the, um, next bit in the vegetarian saga. Go on, come on, Nick, you were all over it over the weekend.

The vegetarian saga?

Another story came out for the—

oh yeah, Johnny was, was our Silver Surfer. Greetings, Johnny, if you're there. Um, he has been, uh, feeding us some information, as it were. Not, not, uh, vegan food, uh, I'm pleased to say. And, um, I can't remember because, like, guys, I've been visiting my old 85-year-old auntie in Monaco over the weekend. So that sounds like a real trip in, you know, in paradise. But it was a 12-hour journey there and back. Okay. And I was only there for about 36 hours. So although it's lovely in Monaco and I did paddle my toes in the Med on Saturday morning after a very, very pleasant coffee, that was about it. Did you know Monaco— it just gives you some It's 3 miles long, 1 mile deep, and it's got the highest density of people in the world. Tokyo has a population density of about 7,000 people per square kilometer. Monaco has a population density of 18,000. So it is the most densely populated chunk of land in the world.

Most of them living underground. What's going on?

Well, yeah, there's a lot of underground stuff going on, but there's nowhere to walk a dog, so it's not the place for me, methinks. It's worth seeing and it's very historical and everything else, but you can't walk a dog, so, um, not my cup of tea.

Somebody said that about a place I asked them how they got on on some holiday they went on, and they said, uh, worth seeing, not worth going to see, because they didn't like the journey and the hassle of getting there. One of those places you check out on YouTube. Um, that sounds nice. We actually saw Monaco. I didn't go down into it, but we, we had a beautiful holiday, south of France. We flew into wherever you're flying to in the south of France.

Nice.

And we— yeah, nice.

Yeah.

And we got this, uh, train. There's loads of little old trains along the south of France. You do all the towns starting from the very poshest there on the left, and you do— and you do, uh, and all that sort of stuff here in Saint-Julien. And, uh, and then you go past Monaco and you can go across into Italy to the bottom of the Alps. I think I told you about this before, and the trains are really cheap and old, and you pull the glass down. But we just went past Monaco, but it doesn't look like high-riseville. It looks like beautifully well-built, although, you know, nestled in there. I wouldn't have thought there was that many people in it. Wow, I'm surprised.

Yeah, it's absolutely packed. I mean, beautiful and everything else, and, you know, lots of Gucci and lots of Prada and all that stuff, whatever that is. Yeah, you know, um, but, but yeah, all good, really. All good, all good, all good. Um, what was I going to say? Yeah, so that's what I was doing. So I was absolutely knackered for the first couple of days, but I'm feeling like a human being now, so that's all good. So that was my excuse for not remembering what happened on the vegan—

I had a quick look at vegan food for dogs. Did you have a look at it, Brent? Another study has come out to show that vegan pet food, plant-based pet food— look, guys, when we're slagging off vegan, we're not slagging off human vegans, which is far more appropriate for our species, which is, you know, more likely for our species, I should say. We're talking about pet food here, particularly the plant-based pet food. But another study has come out, I can't remember the authors, but this time it wasn't, it wasn't Knight. But, and it kind of was a similar study to one that was done many years ago by Knight where they followed these dogs for a year. Well, they didn't follow them for a year, they tested them at the end of the year and they tested a number of parameters. I mean, it was impressive. They tested a number of parameters like from blood and bloods and 3 or 4, I had messaged you there recently what they were. It was an improvement on the study they did previously. But the issue is with us is that what they compare these dogs to are dogs fed meat-based dry foods. They make a point of saying meat-based all the time in these studies, meat-based dry foods. And it's like, well, you know, you are comparing that to cereal-based pet food. It's not meat-based if one of the ingredients is 4% and the other ingredient is 60%. You know, that's not meat-based. That's like corn-based or wheat-based. And so, and when we say 4%, meat in some of these dry foods with chicken, with beef, many of the veterinary brands are with chicken, with beef. That means 4% beef bone meal, which, you know, hardly any meat at all. So what you're actually doing is you're comparing your food to other virtually vegan plant-based foods. And so I find that something of an unfalsifiable comparison. It's like, okay, your dogs can blow within these accepted norms for cereal-based, cereal-fed dogs. Don't forget, your raw-fed dogs are being compared to dry-fed dogs as if this is the normal iron level for a normal fed dog. It's like, well, it's not for a raw fed dog because they eat more natural iron and they eat more protein, so the protein levels are higher. Perhaps these little norms need to change. But, uh, so this study did show that they— that these dogs, uh, could, could blow, uh, within the accepted norms for these, uh, for these bloods. And that's what that study found. So it's not that the study was nonsense. And if anything, as Bren rightly pointed out, it's not like raw dog food companies are doing longevity studies or putting dogs through 2, 3, 4 years. We would say in that defense, yeah, but we're not the ones jumping to some really strange idiotic food. You know, if you're going to do that, you have to prove that it's safe for dogs. And your dogs will blow the same blood readings as dogs on other plant-based foods. That's what that study shows. It didn't follow— it didn't compare to 100 raw-fed dogs and check you know, the strength and condition in these dogs or any such things, or even the longevity, or what's the incidence of disease will be in these dogs in 4, 5, 10 years. None of that. Didn't check the biome, didn't check any of that. But, you know, if you needed to rest your head, you'd say it's— they're probably not— they're no more harmful than the cereal-based pet foods sold in the vets. Did you get a chance to look at it, Brent?

I haven't looked at that study. I was actually loving your article on the phytoestrogens and soy in the vegetarian diets and where they're going with that, because I bet they didn't test that in those studies as to the effects of that was going on. And that sort of leads us into tonight, because they're all getting impatient. I can see them, they are getting impatient. They want to know how does that involve Addison's and Cushing's. Well, let me tell you, hormones, okay? It's all hormones. So we have the phytoestrogens having an effect on the body's constitution, I'm going to call it just for a matter of a word, and its effects on metabolism and fats and fat deposition, all of those things. Well, there's some other hormones that are affected, and many people just assume that this is a hormonal imbalance. But I really would like to bring to people's attention Addison's, which can be life-threatening in the acute form as well. And Cushing's, which is a longer form. And this is really— and this is where we're going to round it up to Addison's being an autoimmune disease. Okay, so we can talk about nutrition and how to reduce autoimmune diseases because it's an attack on the adrenal glands. And Cushing's, which is a tumor, usually of one area or the other. So the pituitary gland, okay, or the adrenal glands. So pretty much, I'm going to just show you a quick diagram there, okay, hand-drawn. Pituitary gland up in the brain, adrenal glands sit just in front of the kidneys, okay, down.

Adrenal means just on top of the adrenals, which is the kidneys. That's where adrenal comes from, which is quite cool.

Oh yes, yes, thanks, that's very interesting.

There you go, so that's where you find them, just by the kidneys.

Sorry, carry on. So what is— give us one of them, Bren. What is— let's start with Addison's. Yeah, exactly. Yeah, let's do alphabetically. Diseases by alphabet. What is Addison's? Give me the elevator pitch for Addison's. What are we talking?

Okay, so Addison's is often seen as a waxing and waning disease, as many autoimmune diseases are, and that means it can be quite difficult to diagnose. But it is quite critical in the sense that the normal signs are gastric upset, so usually vomiting and diarrhea and collapse. Okay, hang on, hang on, Bren.

What is it? What actually is—

so it is an inadequacy of your steroid production from your adrenal glands. Okay, and that's the thing. So the adrenal glands produce natural body steroids, both corticosteroids and also the mineralocorticosteroids, which are the ones which maintain your normal electrolyte balance. Okay, and that's the critical bit because we often see in Addison's the vomiting and the diarrhea, but also the collapse are very often related to an excess of potassium, a reduction in the sodium, and therefore you will get a reduction in heart. So this heart will slow dramatically. Okay, you'll get some irregularities in the normal electrical activity of the heart, and That can be really critical, but you'll get a lot of dehydration, and obviously that can lead, if undetected, to really severe cases. One of the old tests— I used to work with a guy who used to say, look, if it's coming collapsed, you know, and you're hearing a really slow heart rate, just give it a shot of Dex. It's not going to do any harm. Just see whether it gets it right. And usually within 20 minutes, they are up on their feet.

What's Dex?

If they're Addison's. So that's dexamethasone.

Okay, yeah, because I heard cortisone, treat them with cortisone. So what you're saying is treat them with the thing you think may be missing, and if they respond really well, it's kind of like, do you think this is EPI? Well, pop digestive enzymes in the food, and if your dog does significantly better after the digestive enzymes, as I just had last week, I mean, it's like 24 hours later, this dog's doing a better poo, 48 hours later, oh my God, it's of course it was EPI. So that's interesting. So you add in the thing that was missing. And so your vet obviously would do that. We don't want people— well, where else are you going to get them?

No, please don't. So now that's fine in the acute, you know, but usually you're going to look at electrolytes, okay, to look at that ratio between sodium and potassium. If it drops below 27, you know, 27 parts sodium to 1 part potassium, then you know that actually that's pretty likely to be Addison's. You can get atypical Addison's where they actually don't get that electrolyte change but they still have all of the other symptoms. But that's what we call atypical. They still will respond to corticosteroids.

Okay, that sounds good. Nick, what about the other fellow? If Allison's on one side of the fence, what's Cushing's?

Cushing's. Okay, so I'm just going to give you the Peter and Jane. I like the Peter and Jane approach to these things because, like I say to everybody, if you can't read Peter and Jane, you can't read Tolstoy. Okay, so let's go with Peter and Jane. So Your adrenal glands are all about producing hormones. They produce two types of hormones. One is called cortisol, which we know is cortisone. Okay, the other one, which is to do with maintaining sugar, and it runs along with adrenaline. If you get a really terrible shock, then you will get a peak of adrenaline, which allows you to run away from the saber-toothed tiger. But then you'll get a peak of cortisol, which will then gradually disappear. But the cortisol is there to help you with any injuries and with reducing any inflammation from the battle or the saber-toothed tiger or whatever it might be. Okay, so very, very clever stuff. That's what the cortisol is all about. Your mineralocorticoids, on the other hand, from the adrenals as well, they are much more subtle. And they are, as Bren was saying, they're to do with balancing your sodium and potassium, your mineral, your mineral balance. Okay, so cortisol is to do with your sugar and inflammatory response and what have you. But within the same gland, Mother Nature is very, very— it likes to do things as simply as possible. You've got the mineralocorticoids, and so that's what they do. And so if things go wrong with the adrenals, it's usually either the cortisol— if there's there's either too little or too much cortisol. And what we find is that if there's too little cortisol, this is Addison's, you'll often see the problem with not enough mineralocorticoids. And so you have to help with that side. You can't just give steroid, you sometimes have to help with the balance of the mineralocorticoids. I'm not sure if that helped or hindered with the description of where we are. Hopefully, That's it. Basically, if you want to say, so Cushing's disease is too much cortisone and Addison's is the opposite, too little cortisone. That's a really good place to start with thinking about this stuff.

Okay.

Addison's, too little.

Keep that one in my head.

Cushing's, too much.

Yeah.

So 3 types of Cushing's. Okay. You've got one which is because the pituitary hormones are going wrong. Okay.

Which is pituitary is here, right here in your brain. Right in the middle.

Two is that you've got a lump on your adrenal gland, so it's producing corticosteroids because of the lump on the adrenal gland.

Yeah.

And the last one is if your dog has been given corticosteroids.

Yeah.

And it's constantly being given them at too high a rate because that's the only way to suppress their skin problem, for example, or they're on immune modulation, you know, to try and suppress an autoimmune disease, and they're on high levels of corticosteroid, and we call that iatrogenic. So that is effectively, we have caused it to happen to your dog.

Okay, so can we come back to the skin conditions? Let's say a vet is using non-steroidal anti-inflammatories. Would that have the same effect? The clue in the name are non-steroidal, so would they have the same effect?

It wouldn't. Non-steroidals tend to affect the gut, give you ulcers. If they're going to cause a problem at all, they tend to be quite safe these days, and that's even kind of Mr. Holistic saying that. But if they're going to have effects, it'll be perhaps liver and kidney. They'll change your liver and kidney parameters. But what they— what, what— and I find Metacam, I see a lot of dogs who can't tolerate Metacam. As soon as they have Metacam, they get vomiting, diarrhea, and really quite, quite dramatic results. So with non-steroidals, we get other— we get kind of reaction to the toxicity or the problems with the drug itself. With steroids though, steroids are fantastic things. If you give them at low level, they will just abolish many, many, many itchy diseases. They won't cure it because as soon as you remove the steroid, you're back to square one and you're itching as before. And there are side effects with fatty liver, putting on weight, losing hair, and what have you. But if you give too much steroid for too long, you will get this iatrogenic. Iatros from Greek for doctor. It's basically a doctor-induced disease. Yeah, anybody here, anybody really, if they just give too much steroid to their dog, they will just create Cushing's disease. That's another good way to remember it, is if you just get— if you have too many of these pills for too long, you will produce Cushing's disease. And with Cushing's disease, you'll see a pot belly, you'll see perhaps You'll see alopecia, balding. Yeah, it's kind of symmetrical.

Says the man with the hairy back, obviously.

I've got a hairy back. So you'll get symmetric alopecia, you'll get an increased thirst, you'll get an increased appetite, and you can get this thing, calcinosis cutis, where it looks like somebody's slipped areas of rocky, gritty material under the skin, which is quite bizarre. And, and so that— so if it's a relatively easy diagnosis in many, many ways, you take your dog to the vet, they'll do blood tests for Cushing's, which is too much steroid. They will do, they will do tests for Addison's, which is too little. Different tests, but there are some related. And then you're quite confused though, isn't it, at that point?

Because there's probably 4 to 5 tests out there for Cushing's at the moment. And so the blood tests that we were all brought up in uni on, for me, was ACTH, which is the stimulating hormone from the pituitary that we stimulate the response and look at baseline cortisol where it's stimulated to. And that's the sort of overriding one that will determine if they're Addisonian or if they're Cushingoid or, you know, one of those things. But it's, it's not that specific for whether it's the adrenal or the pituitary gland. And so there are then low-dose dexamethasone tests and high-dose dexamethasone tests again, which will differentiate further for Cushing's. So low dose is much more accurate at working out whether it's Cushing's or not, and the high dose is really differentiating the adrenal versus the pituitary source of that Cushing's.

Okay, just before we go past this, can we get the top 5 symptoms of Addison's versus the top 5 symptoms of Cushing's? I think we've gone through Cushing's there, Nick's kind of gone through that. What are the top 5 things people should be looking out for with Addison's?

So, top 5 things: slow heart rate, collapse, vomiting, diarrhea, pale mucous membranes.

Ah, okay.

However, vomiting and diarrhea can— there's a thousand things that will cause vomiting and diarrhea. Yeah, so with the collapsing dog, because you need steroid to cope with stress, yeah, like saber-toothed tigers, if you haven't got enough steroid and you go into a stressful event, that's why you collapse. However, so if every time you, I don't know, you go to town, your dog collapses, then you might think, oh, that's strange, dog gets a bit stressed and suddenly collapses. Now, your vet is immediately going to think of heart disease and all sorts things, but Addison's is way up there. You need it because if your dog is collapsing because of stress, if your dog gets stressed because the dog next door barks, your dog gets a bit stressed, you can— you, you then collapse. It's very difficult because your dog seems to be collapsing all the time, and you may not have put two and two together. So collapsing dog, there is a list that your vet will go through in their head which will involve heart disease, neurological disease, epilepsy, and also Addison's, for which they can do a blood test and that will help them with that diagnosis. So just be aware that many of them— so all the symptoms that Bren has said are really common to just normal life. Yeah, having pale mucous membranes. Yeah, you may be a bit shocky. There may be lots of different reasons, but if you have some of these together and you take a blood and you go, oh look, the sodium potassium ratio is way out of whack, then you're on the way to diagnosing Addison's disease.

It sounds tricky because a lot of the symptoms are so similar. It's really when you get into the blood work. There's a vet here who's all about Addison's, and she was saying, look, essentially if her symptoms are worse after a stressful period, that's the biggest red flag. And so that might be helpful for people, as you just said there already. And also she said, look, a little bit of cortisone, if that really helps the dog, it's a really important clue and it points you the right way. And then she said in the bloods, as you've already mentioned again, reduced red blood cells, which is what you were talking about with the anemia in the gums there, guys, was it? Increases in two kinds of white blood cells. This is all veterinary stuff. It's less for us non-vets to be thinking about, but just in case people listen, eosinophils and lymphocytes will be increased. And then other things will be out of whack, potassium, sodium going down and that kind of stuff. So there is checks. So if you're not quite sure what it is, you can't quite get that gut issue right, because you can imagine if you've got an excess production of cortisol, so now I'm thinking of Cushing's, isn't it? Cushing's is the excess, isn't it?

Excess.

Yeah, so if you've got excess of cortisol going through your body, can you imagine what effect that's gonna have on your gut? Because when people, you get a good shock, you know, you clutch your gut, you don't you? Everyone wants to jump into fight or flight stance when somebody gives them a scare, but you don't you clutch your gut? That's the effect of all that stuff, adrenaline and cortisol squishing your guts, no time for digesting. So is that why the poos are bad, is because it just plays havoc with the guts to have that stuff coursing through you without control? Is that, is that the impact?

So it's generally the cortisol. So for me, it's the, the imbalance with your normal insulin levels. Your fat deposition will go up. You'll— so actually for the Cushing's disease and the excess of cortisol, I think there's so many other little things. So they might become diabetic. Sometimes some people will see that excess thirst as the first thing and there's a bit of a liver driver there. But there's also issues with they can become diabetic because it effectively makes them insulin resistant and therefore that the fat deposition is massively up. So they get a pot belly, their thirst goes through the roof, they may have glucose in the urine and that people will think they're diabetic. But actually there's other diseases that can be causing that. So Cushing's becomes one of the differentials there. I didn't mention actually the fourth test, which is actually now readily available, which is the urine cortisol creatinine ratio. And so literally, if you do a urine test, if you don't want to do bloods and you sort of just want to submit urine first, then you can get them to send that away. And if the ratio of cortisol to creatinine is above 34, pretty much that's a red flag that they need testing for Cushing's.

Cool, that's good. Yeah, because a lot of people get a bit sick of kind of prodding smoking their dog. And so urine test is a good way to go about it. Michelle makes a good post or makes a good comment here on the side because remember Addison's dogs can react to good stress too. Distress is negative stress, eustress is positive stress, but it just animates you and gets you to work in the morning and whatnot. So these dogs can react to good stress too. That's a great tip. Like they see, when they see people they really get excited about, their symptoms can pop up. That's a great tip, Michelle. Nice one for that. Okay, so guys, what can we do about it? We have a dog with, where do we start with Addison's? What do you, where do we start? Who wants to do Addison's? Who wants to do Cushing's?

I'll do Cushing's.

Okay, okay.

So, um, from Addison's, um, I think a lot of people get really concerned here because they say, oh, you're going to be talking about withdrawing the steroids that they've been put on for their Addison's, and that's really terrible, you can't do that because that's life-threatening. What I would say is, look, first and foremost, I'm not advocating that you just whip away without veterinary attention any current treatment. There are some great innovative mineralocorticoid injections now, which are full, you know, every 4 weeks. You can give Xycortol, which is one of those drugs. I think it is under a different name in the States, but there is Xycortol every 4 weeks. You can be trained just like with giving insulin for diabetes, an injection to give every 4 weeks, and that pretty much will stabilise the Addisonian patient. It's not like the bad old days where we used to give corticosteroids as the only way to maintain them. And actually that is now reserved really only for atypical Addisonians where they're not showing the electrolyte imbalances that are going on. So do, do talk to your vet. That's the standard conventional. I have gone on from there because once you realize that this is an autoimmune disease, you have to start unraveling all of the things that you would look at for autoimmune disease and therefore where your gut is maybe heightening inflammation because of poor diet. You've got to think, you know, one of the things to do, we would advocate raw to reduce that inflammatory process going on in the gut. We would advocate good microbiome to reduce that inflammation in the gut. We would reduce insulin dependence because that will advocate increase inflammation within the body. So we want to reduce inflammatory processes. To that, there are people talking about glandular support. So you can actually feed some adrenal tissue. You can actually give homeopathic glandular support, which I've done with. Or if you can't get that, that particular glandular, you can actually get ACTH and cortisol. And I've used that. And actually, once you get them over the autoimmune inflammatory process and actually start to control that holistically, some of these dogs come back to actually producing their own steroids again, which is why it's worth the effort. And I would say you then have to very gently reduce the steroid supplement that they're having because you need to— at one time that is going to suppress— the body will say, oh, I've got enough of that. Hormone, I don't need more of it. So therefore there's a balance and a very gradual reduction. But think of it this way, it is an autoimmune disease. There is actually a genetic test as predisposition for this as well, especially in poodles. So there is a predisposition. I think that was also being looked at. A great friend of mine was looking at the genetic testing in bearded collies and Colleen, I'll give you a shout out now because you're probably listening to this tomorrow because she always listens the day after. And she, she was, she got a whole group together because it was quite a prominent issue within bearded collies at a time.

So can I swerve on that, on this little bit here? Because you've just mentioned something. So with the iatrogenic Addison's, which is caused where the person has caused it by, by administering too much steroids.

And no, that's Cushing's.

That's Cushing's.

Sorry, too much.

It's the non-vet here. And is that— sounds a bit like kind of insulin resistance. It sounds like too much of this is coursing through the blood and it comes to the point that the organ, uh, is it then is just switched into a hot— like is asked to produce more and more. How does that—

and I saw somebody had a confusion over that. No, giving the steroid doesn't cause the body to excrete too much. For iatrogenic Cushing's, the solution is to withdraw the steroids and the body should recover.

It is literally— slowly, slowly.

Yeah, the artificial steroid is what's causing iatrogenic Cushing's. Okay, so it's literally the drug that we're putting in the front end is actually causing all of those symptoms of excess.

Okay, so it sounds like you can improve it very quickly by steps you can take. So that's stress.

So I'm just going to take you through that very briefly. So you've got a normal dog in front of you. Okay, so this is a 3-year-old Springer Spaniel in perfect condition, and you, because you're not a very nice person, want to do an experiment to create Cushing's disease. All you do is you give an excess of prednisolone, say, which is, which is cortisone. Okay, so you give maybe 20, 30 milligrams of prednisolone which is the common one, the little white tablets that you get, 5mg, you just give it and give it and give it, and within a day or two, your dog is going to be drinking more and have an increased appetite. Within a week or two, you may induce a slight pot belly. Okay, within months and months, you might induce the alopecia. On the back. And after a year or two of that, if the dog still survives, then you might be into calcinosis cutis kind of territory. And the treatment for this otherwise healthy dog is that you just gradually reduce it. And the reason that you reduce it slowly is because the body becomes dependent on that level.

Yeah.

So if you withdraw it, there's no safety net. So what you've got to do, even though this is causing the problem, You would remember this is a mind experiment. Nobody in their right mind would give a normal dog steroid. Okay, but we've induced iatrogenic Cushing's disease, and to cure that dog of this man-made disease, you just gradually reduce the cortisol. And then once you're back down to normal, the dog, if there's no side effects, is back to normal.

Okay. And what about for the other types of Cushing's, Nick?

So, uh, that's it. That's essentially what— so that's, that's, that's, uh, the estrogenic. So naturally, naturally produced Cushing's. Okay, so your dog, you go, you go to the vet and they say your dog has Cushing's. It's, it's, it's important to the vet whether it's a pituitary or it's adrenal Cushing's, but to you it's, it's the same. Okay, what you do is they will offer you the conventional treatment, is called Vetoril. Vetoril. Not sure what it's called in the States. I suspect it might be the same.

Yeah.

V-E-T-O-R-Y-L. And what that does, it just stops your adrenals producing cortisol. Does it cure the disease? No, it doesn't. Does it cure the symptoms and the way the body is producing the symptoms? Yes, it does. If you stop using Vetoril, does your disease just come back willy-nilly? Yes, it does. But it does what it says on the tin. However, there are side effects, and I've got a little list of side effects. And if you, if you go on to Veteril and you don't see these side effects and the dog is absolutely great, well, thank your lucky stars, that's fantastic. You can stick on that for as long as your vet is happy that your dog is on the Veteril. But if there, there are some side effects that you want to just look out for, don't kind invite them by thinking, oh my God, are they doing this? Are we doing that? But just be aware to look out for the following, he says. Okay, so going off food, lethargy, depression, vomiting, diarrhea, increased liver enzymes, increased potassium, la la la, blood parameters can change, If you give too much Vetteril, yeah, because you've got increased cortisol, you can go into not enough cortisol because you're giving too much of the drug, and thus you can develop Addison's by giving this drug. Yeah, the body is producing too much cortisol. If you give the right level of Vetteril, you bring it back to the normal level of cortisol. If you give a little bit too much Vetteril, you go to too little cortisol in the blood and you become man-made Addison's, okay? And you start collapsing and slow heart rate and all that stuff. Shaking renal insufficiency. So if your dog has liver disease or kidney disease, you want to be really careful and you want to have a really good chat with your, with your vet about using Veteril and look for the side effects of Vetteril. I don't want to tell tales out of school, but they can be quite severe. Okay, so if I just go through treatment for Cushing's just now— for this is, this is if the Vetteril doesn't work or you choose not to do Vetteril, there's a couple of treatments. I've got some examples here, and then Brent can talk about treatment for Addison's in a sec. So you would— the baseline would be a fantastic raw food diet, the best antioxidant, anti-inflammatory nutraceuticals, plenty of really good quality, well-cared-for fish oils, and vitamin E and selenium and what have you. Okay, so you're just thinking anti-inflammatory, antioxidant, just to calm. And those are valid for any dog, whether it's got Addison's or Cushing's or anything. Yeah, yeah, we live in an inflammatory environment. So doing those is a great idea. But once you've done all the basics, you've done the food and the nutraceuticals and everything, and that's all hunky-dory, what can you do on top? What specific things can you do for, for Cushing's disease? Now, one is that I will use as a base to my— many of my herbal supports. I'll give liver support and, and what have you, but Vitex agnus-castus is the chaste tree because they used to give it to people to calm them down and not have libidinous thoughts and all that kind of stuff. Look at— look at— if you don't know what that means, look at you.

Look at that.

I'm just trying to be—

what happens when you go to Monaco? Yeah, yeah, yeah. Those thoughts.

How do you know? Okay, so, so, so, uh, herbs. So the, the take-home message, guys, let's keep it simple. They're taking— herbs can be very useful when you're, when you're dealing with too much cortisol because your adrenals are producing too much cortisol. Herbs are wonderful for these things, possibly even more so. And the way I cut my teeth on homeopathics— I'm going to talk to you about homeopathics in a minute— is even from my very first days in, in practice, we were treating ponies with Cushing's disease because back in the day there was a bit of Cushing's disease in ponies, and you could see it because they didn't lose their coats and they got a pot belly and they got fat pads above their eyes and all these things that horses do that dogs may not do. And so we were, we were talking, we were, we're treating. So we've been treating, I've been treating We— I, I used to work with an amazing homeopath called Mark Elliott, and he came up through witchcraft— he came up with a mix of homeopathics. I'm not sure if you can read that. No, you probably can't. Okay, so it's ACTH, ATT, Quercus robur, which is oak. Yeah, so ACTH in potency Quercus robur, which is oak in potency, and uranium nitricum, which is the stuff they make nuclear bombs out of, which is quite interesting because if you are exposed to radiation, you can get cancers, which— cancers like pituitary cancers, which can give you Cushing's disease. So he's come up with that mix, and I find it's really, really useful. I've got several dogs who can't take Veteril who we keep in great control using Vitex Agnus-Castus and a few liver and general body support remedies. And also we use these— this is a 200C, this is a 30C potency. And very simply, with those we can get good control.

Brent, You, you're going to say, yeah, I mean, certainly for the Cushing's, I've generally not gone for the nuclear option, uh, purely and simply it scares the bejesus out of most people. So I usually just use ATTH, cortisol, and the Quercus rubur mix, which, um, was in one of the original papers. I think he sort of mixed it up a little bit, but I don't think he dared to publish that last one in the Vet Record. Uranium nit, I think was Yeah, it might just have pushed some people over the edge. But you're absolutely right. I mean, that this, you know, the pituitary axis, as we call it, has such a vital role in controlling not just your cortisol levels and what's going on with your adrenals, but actually also what's happening in your thyroid, what's happening with your sex hormones. You know, it has a vital role.

And the smallest—

I mean, these can be a millimeter across and smaller, you know, and they have such devastating effect on the rest of the body because of the impact of the hormones and how they act. So be aware, you know, some people talk about radiotherapy for those pituitary gland tumours where they'll actually just focus a radiation beam to blast the pituitary to bits effectively. That always scares the bejesus out of me. So when people start talking about that, but that's you know, where they will look at highlighting those sort of treatments to try and cure those cases. I always look at it as, look, this is treating a tumor. So I look at the plessing protocols. I do use Mark Elliott's protocol. There are some great Chinese herb protocols which will also bring in some of the mushrooms which are anti-cancer into those supporting the liver. Okay. Your ALK phos will go through the roof, the ALT will go through the roof. But that's not because of the tumour being in the liver or anything like that. That is literally the hormonal effects and the inflammation that starts to develop in the liver. So you need to sort of control that and monitor, you know, whether liver function is truly being interfered with or whether we just have hepatomegaly. That's an increase in liver size because of the effects of those steroids.

Okay, and I have, I have a little bit here on adrenal gland. Can I just read out a couple of paragraphs here, guys? So this is Addison's, a couple of little tips for Addison's. Someone's already mentioned it for Cushing's. CBD for both issues. So CBD is shown to reduce cortisol, anxiety, and stress and all that kind of stuff. And I've heard nothing but good for CBD in both conditions. Google it at your leisure, but CBD keeps coming up on the side, so it's well worth mentioning. but Google at your leisure. Another one here, which if Caroline Ingram was listening, which I doubt she is, but if she is, she will be screaming licorice, which is glycyrrhizic acid. Am I saying that? Glycyrrhizic acid. Glycyrrhizic acid is the active component in licorice, and licorice is anti-inflammatory, anti-allergy, anti-ulcer, anti-estrogen balancing properties, all sorts of cool stuff. But it's been used for years for Addison's disease. There's a great piece here. It suggests that glycyrrhizic acid increases the half-life of circulating cortisol in the body by inhibiting its metabolism or breakdown. So if you've got Addison's and you've got a very low amount of this stuff, this helps it regulate, self-regulate a little bit. So licorice seems like a good thing. But glandular extract, right? Coming back to organotherapy, this is the feeding like feeds like. So, you know, if you're in Addison's mode and you've got a low production of these things, you might hope that if you fed the extract of the gland, you might kind of harvest some of the hormones that are in there to your benefit. And that's definitely the case. I mean, if you feed beef thyroid to a dog, he is gonna suffer from the hormones that are in that thyroid, as what happened in the US about 20 years ago. So yes, you want to be careful with that. But in small, normal dose, as with everything, there may be benefits. And organotherapy, we know it works. We know from studies in the '20s, '30s, and '40s, they were mad about organotherapy to the point that they were trying to investigate, like, you know, they were taking semen from bulls and injecting it into men, trying to make them stronger and all sorts of stuff. Loads of famous actors had it done. Loads of people died. So that didn't go too well. But they also started looking at pancreases to find out what was going on with insulin resistance, and they were doing these horrible studies on dogs, but they found out that actually feeding a dog pancreas had a better effect on their long-term prognosis, on their longevity. So they took the pancreas away from these dogs, fed them high-sugar diets, and to one they fed insulin, and the other ones they fed raw pancreas, and the ones eating raw pancreas did better for longer. So this organotherapy started taking off, and in the '20s, Addison's disease was the focus— adrenal cortex. The gland from pigs, sheep, cows, was a big focus in the '20s. So during the early 1920s, adrenal cortex extract was often recommended for use for patients with Addison's disease, human. And so in the 1940s is when it really took off. It's— adrenal cortex extract was used by doctors to combat symptoms associated with what was then commonly referred to as hypoadrenal syndrome. So it's low adrenal syndrome and also low blood sugar amongst the symptoms adrenal cortex extract was touted as addressing issues including insomnia, concentration issues, faintness, lightheadedness, fatigue, nervousness, depression, amongst many others. In 1932, they found it balanced blood sugar and they found that was a way of testing how good your adrenal cortex supplement was. So they would feed it and they would check the blood sugars and if they went up or down, whichever way it's supposed to be, that's how you measure how good your gland, your thing was. So the problem is that modern science doesn't like adrenal gland Cortex because, you know, it's just a simple bit of meat that you would feed and they need double-blind RCTs to promote a product, you know, these days. And so I find there's a bit of a kickback, certainly in the literature. If you go to any of the Google kind of related websites like Healthline and whatnot, they will say, well, there's not enough evidence. There's never enough evidence for the non-patented stuff. But there is some little bits and pieces out there to suggest that it has been useful. Certainly in the past, but the problem was that they started producing synthetic extracts from the gland, and those don't work as well as feeding the actual gland itself, like feeding insulin, as I mentioned, to the pancreatic dogs, to feeding raw pancreas. So actually feeding the gland itself in dry tablet form, which you can buy online, there may be something to it. And so the question will be— and I said I was going to ask this at the start— but the question would be, um, they describe how you can prepare it yourself, but you guys are just going to buy your own adrenal glands, where you're not going to be harvesting adrenal glands from local pigs. But, um, so, uh, there was many case studies have been published on this, so it's not without evidence. Because these days they don't want to talk about case studies, but case studies were a really important part of science because they didn't have 100 people to work on. They had 2 or 3 patients in their clinic and they tried this. And certainly adding adrenal gland, 20 to 30 capsules of dried adrenal gland, to some of these Addison's patients saw complete turnarounds. Got this, uh, 2 of them in Australia got these electricians back on their feet and back to work. And, uh, so there was success that. The question is, Lance, is there any harm in trying dried adrenal gland extract? I mean, if you were to feed whole prey to the dog, whole fish, whole baby birds, I mean, the dog is a whole prey eater, they would always get some thyroid and adrenal gland in moderate normal dose. Is there any harm in trying a little bit of adrenal gland extract in Addison dogs?

I'm not sure whether you can get it in the UK. In the US you can because they are crazy about organotherapy. Okay, so yes, go for it. In the United States, I would always suggest though, these are serious diseases. These are potentially— especially Addison's is potentially life-threatening. So I would suggest don't do it yourself. Make sure that you've got a vet who is on board with what you're feeding, with nutraceuticals, any herbs and homeopathics that you're doing. You've had a chat about the pharmaceutical options and you know where you are. And I would suggest best get stability before you start doing anything, and definitely before you start using any organic therapy. And in the UK, I don't think you can get hold of it, so I think it's a bit of a slam dunk.

Yeah, it's not looking good. No, no.

And don't forget, you know, somebody was asking, well, what's EPI? And you know, that's another immune-mediated disease where you've got an attack on the release of the enzymes from the pancreas, you know, exocrine pancreatic insufficiency, you know, you can get— so it's a little bit of a flag if you've got other autoimmune diseases, keep an eye out for this. Now, often things like Addison's as part of that immune system complex is masked because so many of those cases will have steroids given to them. So it is something as I'm saying, talking about treating it as an immune-mediated disease and trying to do all of the things that we would do to control that, yes, that should also help all of these other issues with immune-mediated disease to keep an eye out on.

Okay, gents, I'm gonna say, uh, make sure that you catch up with us on your podcast, whichever your podcast provider is, because we're there. Please do follow us on Patreon if you can. We'd be really, really, really, really grateful. And I think now we should pop over to Patreon to just finish our chat on Cushing's and Addison's disease. What do you think, boys?

Sounds good. Brilliant.

That was great to see you all. Brilliant.

That's great. I learned so much. Cheers, lads.

We're gonna nip over now, and it's ready for you to listen to in about an hour. Hour or so. So in the UK, that will be after about 9:00, 9:30 tonight. Okay guys,