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‘Keto’ Diet May Ease Cushing’s Symptoms, but Delay Diagnosis



A young man switched his standard food plan to a ketogenic, or “keto,” food plan that’s low in carbohydrates and high in fats to shed pounds, and saw a few of his symptoms of Cushing’s disease ease, in response to a recent report.

But he wasn’t diagnosed until his symptoms got here back or worsened over time, suggesting that a special food plan may mask a disease’s symptoms to some extent where it could delay or prevent a diagnosis.

“Diseases typically related to poor lifestyle selections, like obesity and hypertension [high blood pressure], can often have alternative causes,” the researchers wrote. “Assuming that they’re resulting from poor dietary adherence, can allow them to go undiagnosed.”

The report, “Ketogenic Diet Initially Masks Symptoms of Hypercortisolism in Cushing’s Disease,” was published in Metabolites.

Cushing’s occurs when the body has an excessive amount of of a hormone called cortisol. This condition, called hypercortisolism, ends in symptoms resembling weight gain and fat accumulation, fragile skin, and hypertension.

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Masking Cushing’s with ketogenic food plan

When paired with other treatments, a special food plan that’s low in carbohydrates may help limit or counteract a few of these symptoms.

A research team within the U.S. described the case of an Asian man in his 30s who saw a few of his symptoms ease with the assistance of a ketogenic food plan that limits the quantity of carbohydrates (or “carbs”) eaten in a day to lower than 30 grams, concerning the amount present in a single medium ripe banana or two tablespoons of white sugar.

The person had a history of easy bruising, blood in urine (hematuria), headache, and hypertension. He also had excessive amounts of fat across the waist (central obesity). In 2015, he was at his heaviest weight at 179 kilos. His body mass index, a measure of body fat, placed him throughout the obese range.

He ate a typical American food plan and was energetic. A typical standard American food plan features a high intake of pre-packaged (processed) foods, refined grains, and high-fat dairy products.

Diseases typically related to poor lifestyle selections, like obesity and hypertension [high blood pressure], can often have alternative causes. Assuming that they’re resulting from poor dietary adherence, can allow them to go undiagnosed.

“He ate a food plan of vegetables, fruits and carbohydrates, but he was not in a position to shed pounds,” the researchers wrote.

To shed pounds, the person switched to a ketogenic food plan where he ate “green leafy vegetables, low carb fruits, fish, poultry, beef and dairy products.” This caused him to lose about 35 lbs over 1.5 years.

He later switched to a carnivore food plan, a style of ketogenic food plan that consisted of “a wide range of different meats, poultry, fish and eggs,” however the switch didn’t help him lose any more weight. Despite this, his waist looked thinner, and his blood levels of sugar, cholesterol, and triglycerides (a style of fat) were inside the conventional range.

But during 2021, the person had episodes of hypertension that recurred despite treatment with blood pressure-lowering medications and a advice for a low-salt food plan.

“The patient reported strict adherence to his carnivore food plan by sharing his well-documented meals on his social media accounts,” the researchers wrote.

Reaching a Cushing’s diagnosis

A physical examination revealed a rounded (“moon”) face and stretch marks across the waist. This led doctors to suspect he might need Cushing’s.

Laboratory testing revealed he had higher than normal cortisol levels within the saliva late at night after they are normally low. They didn’t drop in response to a low-dose dexamethasone test, confirming hypercortisolism.

Dexamethasone is a medicine that cuts short the production of cortisol, lowering its levels within the blood of healthy people, but not in those with Cushing’s.

In lots of individuals with Cushing’s, the brain’s pituitary gland makes an excessive amount of adrenocorticotropic hormone (ACTH), a hormone that drives the adrenal glands to provide cortisol. While the person’s ACTH blood levels fell inside the conventional range, they were suggestive of ACTH-dependent Cushing’s.

A brain MRI scan revealed a tiny benign tumor, or microadenoma, measuring about 4 mm in diameter because the possible source of the pituitary gland producing excessive amounts of ACTH. Based on these findings, doctors made a diagnosis of Cushing’s disease.

“This case serves as a reminder of the ability of nutrition to handle metabolic derangements and concurrently as a reminder to diagnosticians to never depend on lack of dietary adherence as a reason for persistent metabolic symptoms,” the researchers wrote.

The person is scheduled to have surgery to remove the microadenoma, the primary line of treatment for Cushing’s disease.

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