How We Ranked These
Every food on this list was scored using KibbleIQ’s ingredient analysis rubric, which evaluates protein quality, filler content, preservative safety, and ingredient transparency on a 0–100 scale. For dogs with Cushing’s disease, we weighted the ACVIM 2013 Consensus Statement on the diagnosis and treatment of canine hyperadrenocorticism (Behrend et al., JVIM), the ACVIM 2022 consensus on chronic enteropathies for concurrent pancreatitis risk, Scott-Moncrieff 2015 endocrinology framework, and Feldman & Nelson 2015 on canine endocrine management. Cortisol excess from pituitary-dependent or adrenal-dependent hyperadrenocorticism drives polyphagia, polydipsia/polyuria, hepatic lipidosis, protein catabolism of skin and coat, and elevated pancreatitis risk — dietary priorities are therefore moderate-fat, moderate-to-high quality protein, steady-carbohydrate release to manage insulin fluctuations, and controlled portions to counter steroid-driven appetite.
Our ranking leads with therapeutic-tier weight-management and GI-support formulations because Cushing’s dogs are at elevated pancreatitis risk per Hess 1999 and Xenoulis 2010, and pancreatitis is the most common acute complication of hyperadrenocorticism management. Premium OTC formulations with moderate fat and high-quality protein are appropriate for stabilized dogs with well-controlled ACTH-stimulation results, but the clinical priority in active disease or newly-diagnosed patients is pancreatitis-risk reduction through fat moderation.
Our Top 5 Picks
1. Hill’s Prescription Diet w/d Multi-Benefit — B (76/100)
Hill’s Rx w/d is a multi-purpose weight-management formulation that addresses the three most common Cushing’s comorbidities in one diet: weight gain from cortisol-driven appetite, insulin dysregulation risk (many Cushing’s dogs develop concurrent diabetes mellitus), and fiber support for GI stability. Moderate fat at 8.5% dry matter, elevated fiber at 16%+ DM, and L-carnitine supplementation all align with the ACVIM hyperadrenocorticism consensus recommendations for dogs on trilostane or mitotane therapy. The multi-benefit framing is particularly useful in Cushing’s because concurrent endocrinopathies (diabetes, hypothyroidism) are common and a single diet that addresses multiple metabolic targets simplifies the feeding regimen.
Requires veterinary prescription. Not appropriate for growing dogs or pregnant/lactating bitches. Read our full Hill’s Rx w/d review → · Shop on Amazon →
2. Purina Pro Plan Sensitive Skin & Stomach — B (76/100)
For Cushing’s dogs without diagnosed concurrent diabetes but with skin/coat issues from cortisol-driven dermatologic changes (thin skin, calcinosis cutis, recurrent pyoderma), the Pro Plan Sensitive Skin & Stomach formulation provides salmon-based protein with omega-3 support and moderate fat at ~16% DM. Palatability is strong, which matters when polyphagic dogs will eat almost anything and owners are trying to enforce strict portion control. The feeding-trial substantiation through AAFCO gives this diet a stronger real-world track record than purely formulation-substantiated alternatives.
Fat level is higher than Rx w/d — use only in dogs without active pancreatitis history. Read our full Pro Plan Sensitive review → · Shop on Amazon →
3. Hill’s Prescription Diet i/d — B (78/100)
For Cushing’s dogs with documented pancreatitis history, GI symptoms, or elevated cPLI on baseline monitoring, Hill’s Rx i/d provides low-fat (~13% DM) highly-digestible nutrition with prebiotic fiber support. Xenoulis 2010 documented that Cushing’s dogs have 2–3x the pancreatitis incidence of the general dog population, and recurrent pancreatitis is one of the most common reasons trilostane therapy is complicated or abandoned. Using a low-fat GI-support diet proactively in the first 6 months of trilostane therapy is a reasonable risk-reduction strategy even in dogs without prior pancreatitis events.
Not a weight-loss diet — pair with strict portion control or use w/d if weight gain is the dominant concern. Read our full Hill’s Rx i/d review → · Shop on Amazon →
4. Wellness Complete Health — B (82/100)
For Cushing’s dogs stabilized on trilostane with normal ACTH-stimulation results and no concurrent endocrinopathy, a premium OTC formulation with moderate fat (~14% DM), real deboned chicken or whitefish, and glucosamine/chondroitin support provides higher baseline ingredient quality than therapeutic diets. Wellness Complete Health’s whole-food orientation and absence of artificial preservatives is a reasonable fit once the disease is well-controlled and daily portion-control protocols are established. The Complete Health Adult line is our preferred entry point because the high-protein variants (CORE) may be excessive for geriatric Cushing’s dogs with reduced activity.
Choose this path only if your vet has confirmed stable post-ACTH cortisol results and no active pancreatitis risk. Read our full Wellness Complete Health review → · Shop on Amazon →
5. Blue Buffalo Life Protection — B (78/100)
As an OTC alternative for Cushing’s dogs with stable disease and no concurrent endocrinopathies, Blue Buffalo Life Protection provides real deboned chicken, LifeSource Bits (antioxidant/vitamin/mineral blend), and moderate fat (~15% DM). The broad availability of this brand at mainstream retailers makes continuity of feeding straightforward during travel or in multi-dog households where a Cushing’s dog eats alongside healthy housemates. Blue Buffalo’s absence of corn, wheat, soy, and poultry by-product meal also reduces inflammatory-ingredient exposure that some owners prefer when managing chronic disease.
Monitor weight monthly — Cushing’s dogs gain easily on any non-portion-controlled diet. Strict measured feeding required. Read our full Blue Buffalo review → · Shop on Amazon →
What to Look for in Food for a Dog with Cushing's Disease
Confirm the diagnosis and monitor treatment before dietary micromanagement. Cushing’s diagnosis requires ACTH-stimulation test or low-dose dexamethasone suppression test (LDDST) results — elevated ALP alone is not diagnostic. Per ACVIM 2013 consensus, pituitary-dependent hyperadrenocorticism (PDH, 80–85% of cases) is managed with trilostane (Vetoryl) with periodic ACTH-stim monitoring; adrenal-dependent hyperadrenocorticism (ADH, 15–20%) may require surgical adrenalectomy. Diet adjustment is a supporting measure, not a primary treatment — never reduce trilostane dosing based on a food change, and always monitor ACTH-stimulation results at 10–14 days, 30 days, 90 days, and quarterly per consensus protocol.
Moderate fat to reduce pancreatitis risk. Xenoulis 2010 and Hess 1999 both document elevated pancreatitis incidence in Cushing’s dogs compared to the general population, and pancreatitis is the most common reason trilostane therapy becomes complicated. Target dietary fat at 8–15% DM for dogs with any pancreatitis history; under 15% DM for stable Cushing’s dogs without pancreatitis events. The therapeutic-tier low-fat diets (Rx i/d, Rx w/d) sit in the 8–13% DM fat range, which most OTC formulations exceed.
Control calories because cortisol drives polyphagia. Dogs with active Cushing’s develop dramatically increased appetite — food-seeking, counter-surfing, and garbage raiding are all hallmark behaviors. Without strict measured feeding, weight gain and obesity are inevitable. Use a measured cup or kitchen scale every meal, enforce a no-table-scraps household rule, and schedule feedings rather than free-feeding. The AAHA 2014 Weight Management Guidelines are a useful framework even for non-obese Cushing’s dogs because the obesity trajectory is so steep.
Moderate-to-high-quality protein to preserve muscle mass. Cortisol excess drives protein catabolism, which manifests as muscle wasting, thin skin, and coat changes. Diets with 22–28% DM crude protein from named animal sources (deboned chicken, salmon, beef meal) support muscle preservation better than plant-protein-heavy or by-product-heavy formulations. Severe protein restriction (below 18% DM) is not indicated in Cushing’s disease unless concurrent renal disease independently requires it — and concurrent renal disease changes the dietary priorities entirely.
Steady-carbohydrate release for concurrent diabetes risk. Approximately 10% of Cushing’s dogs develop concurrent diabetes mellitus, and cortisol-driven insulin resistance is well-documented. If a dog has confirmed diabetes alongside Cushing’s, fiber-elevated diets (Rx w/d, Rx r/d) with slower-release carbohydrates (brown rice, barley, oats over white rice or potato) provide better post-prandial glucose curves. ACVIM 2022 small animal diabetes consensus favors complex carbohydrate sources for all diabetic dogs, and the overlap with Cushing’s management is natural.
Watch for PU/PD impact on feeding logistics. Cushing’s dogs drink and urinate dramatically more than healthy dogs — polyuria/polydipsia is a diagnostic hallmark. Free access to water is essential (never restrict water in a Cushing’s dog), and feeding routines should account for nighttime urination. The PU/PD also affects urinary tract infection risk: Cushing’s dogs have 40–50% UTI incidence per Forrester 1999, often subclinical, so periodic urine culture even without clinical signs is a reasonable monitoring practice. Diet doesn’t directly modify UTI risk, but hydration status and bladder health are downstream of the feeding routine.
Bottom Line
Diet is a supporting measure in canine hyperadrenocorticism — trilostane or mitotane therapy (or surgical adrenalectomy for ADH) is the primary intervention, and diet adjustment never replaces the medical management. For Cushing’s dogs with stable disease and primary weight-management concerns, Hill’s Rx w/d Multi-Benefit is our first pick. For dogs with concurrent pancreatitis risk, Hill’s Rx i/d is the low-fat GI-support option. For stable OTC-preferred cases, Wellness Complete Health or Blue Buffalo Life Protection work once the disease is well-controlled on medication. Always coordinate dietary changes with the supervising veterinarian, monitor ACTH-stim per ACVIM consensus, and enforce strict portion control to counter steroid-driven appetite.