A new paper recently co-authored by Dr. Tro Kalayjian, DO, highlights the unique hormonal effects of a ketogenic diet in a patient with an undiagnosed brain tumor that typically excretes stress hormones and causes weight gain. The case highlights how the diagnosis evaded his medical team but ultimately how the disease state, called Cushing’s Disease, was worked up and diagnosed.
Published October 28, 2022 in Metabolites, an open-access Journal, the report is entitled “Ketogenic Diet Initially Masks Symptoms of Hypercortisolism in Cushing’s Disease.”
The paper reports of a patient who was dogmatically told to lose weight, cut salt and cut calories, when he actually had a brain tumor. A male patient in his thirties, struggled with weight for years but finally adopted a low carb diet and lost significant weight. He presented, years later, to his doctors with easy bruising, central obesity, headaches, hematuria, and hypertension. His diet had initially been so effective at managing his blood pressure but now it wasn’t working. Doctors recommended cutting salt, cutting calories and ultimately he was hospitalized with a condition called “hypertensive emergency” when the blood pressure is not only very elevated but potentially life-threatening.
At the hospital, the patient underwent imaging and other tests but the cause of his marked hypertension couldn’t be found. He was discharged on several medications and eventually followed up with several doctors to try to find answers, but he got few answers, more emphasis on medications and sometimes cursory recommendations on diet.
It was a chance encounter that the patient established care with Dr. Tro and shared his social media profile, including his diligent carnivore meals but also what he found was a change in his face often seen in hormonal issues, called moon facies, which is the development of subtle fat only around the face and neck.
This observation comparing his social media profile picture with his current appearance hinted at the diagnosis, which ultimately led a long workup that revealed the answer.
The key takeaway from the paper is the importance for clinicians to consider alternative pathology. As depicted in this case, the patient lost 35 lbs. while on a LC diet, despite having hypercortisolism, presumably for months/years prior to the diagnosis of his condition. Strict dietary adherence can have profound impacts on even the most severe hormonal pathology! But ultimately, this case serves as a reminder of the power of nutrition to address metabolic derangements and simultaneously as a reminder to diagnosticians to never rely on lack of dietary adherence as a reason for persistent metabolic symptoms. The reflexive advice to “not gain weight” and “lower salt intake” in retrospect appeared both dogmatic and careless.
Ultimately, Dr. Tro says, “I got lucky. I took the time to listen to my patient and review his social media profile which was filled with mouth-watering steaks and dishes. We just happened to see a clue that led us down the right path. We are just happy that the patient got the care he needed and deserved.”
If you are interested in reading the full report, check out the links below.