Laminitis is Not a Disease

Read almost any horse-related magazine, forum, bulletin board or newsletter, and eventually, a discussion of laminitis will surface. “My horse has laminitis. What’s the best way to treat it?

The first thing to realize is that laminitis is not a disease unto itself. Laminitis - meaning “inflammation of the laminae” - is a symptom of something else going on in the horse’s body.

In other words, to control the laminitis, you must determine and treat the cause. Administering all the anti-inflammatory and vasodilating drugs on the planet will not help if the root cause is not addressed at the same time.

In TREES' case, the laminitic horses we care for all suffer metabolic disorders, some related to Cushings Disease, some not. In every case, though, all tend to have high insulin levels unless their diets are very carefully managed. In every case of active laminitis, the insulin levels were well above what is considered normal, sometimes as much as ten times the norm seen in unaffected horses.

To manage those horses' insulin levels, we think of their management in the same way we think of caring for diabetic humans. Foods low in sugars and other simple carbohydrates, small frequent meals, maximum turnout (exercise - also beneficial in keeping arthritic joints moving, and guts functioning properly), and plenty of water. In the food category, no sweet feeds, no apples, carrots, or other starchy treats, no sugar cubes, no peppermints or other candies, no cookies, no applesauce, no corn syrup, no maple syrup, no ....well the list is endless. What IS allowed is a feed low in non-structural carbohydrates, soaked alfalfa cubes, and hay (remember, though, that all hays are not created equally and greatly vary in sugar content.) That's it!

Do our horses feel neglected or unloved because they get no "treats." Of course not! Grooming, scratches and personal attention fill the definition of "treat" as well as any peppermint could. (An added plus of the "no edible treats" rule is that we don't have horses rooting around in our pockets while trying to work with them, or pushing and shoving each other when visitors arrive.)
And, of course, the ultimate benefit of eliminating every source of sugar we reasonably can eliminate is an appreciable reduction in laminitic episodes in even those horses previously deemed "chronic."

We do take a deep breath any time one of our "metabolic" horses takes one bad step but most often that bad step is not because of laminitis. Should laminitis, however, rear its ugly head again, we'll re-evaluate, find the cause, and work to resolve the underlying issue as we also nip the inflammation in the bud.

Meanwhile, since personal attention is our herd's "treat," please consider a visit. All you need to bring is your fingers! For an appointment: info@equineelders.org

Feeding the Metabolically Challenged Horse

Article reprinted from Rappahannock Equine Veterinary Clinic newsletter, Vol 2, Issue 1 (january 2009) with author's permission:

Feeding the Metabolically Challenged Horse
Amanda Blanton, DVM

Establishing an appropriate feeding plan for a horse with an endocrine disorder (PPID/Cushings disease, Equine Metabolic Syndrome, and/or Insulin Resistance) can be challenging and is tailored to each horse’s specific situation. As a result, it is important to discuss your horse’s endocrine status and nutritional needs with your veterinarian and to closely monitor your horse’s body condition, appetite and presence of any foot soreness (in those horses that are at high risk of developing laminitis.)

The goals in feeding a horse with an endocrine disorder are to decrease body fat in obese horses and to avoid feeds that will worsen insulin resistance (IR.)

Weight Loss
Overweight horses (body condition score 7-9) require a strict program of dietary management and exercise. It has been shown that the risk of developing insulin resistance (IR) increases as the length of time a horse is overweight increases, and studies have shown that IR horses are more likely to develop laminitis. As a result, it is imperative to get the excess weight off these horses. Obese horses should be fed a diet of hay plus a vitamin and mineral supplement. Since they will be receiving no other calories, these horses should be fed enough hay to meet their energy requirements: 1.5-2.0 % of their body weight. This is equivalent to 15-20 pounds of hay per day for a 1000 pound horse.** Obese horses that are not actively laminitic should also be exercised daily to further reduce weight.

Avoiding Insulin-Resistance Causing Feeds
The key here is to avoid excess sugars and carbohydrates. Most sugars in a normal horse’s diet come from pasture grasses. As a result, when managing IR ponies or horses, you must restrict or eliminate pasture from the diet. Options for pasture restriction include strict dry lots, use of a grazing muzzle, free grazing for 1-2 hours a day and strip grazing with electric fencing. It has been shown that grasses are highest in sugars during dynamic stages of growth. Therefore, it is important to avoid grazing during the following times of year: spring (when grass is growing quickly and turning green,) early summer (when grass is starting to dry out,) following heavy summer rains (when grass is rapidly growing,) and fall (when grass is entering winter dormancy.) Sugar content in pasture grasses also varies with the time of day. Sugar content is low early in the day and high later in the day. As a result, it is best to graze horses with metabolic issues in early morning versus late afternoon. However, since each case is different, consult with your veterinarian to determine the best option for you and your horse.

Unlike the obese horses, some horses with endocrine disorders (lean horses in regular work and/or ribby horses with regional adiposity) will require supplemental calorie sources. How do you increase caloric intake without increasing the sugars and carbs that can lead to IR? If your horse is one of these and needs to be fed a concentrate, look for those feeds that are low in sugars and carbohydrates. Dividing the feedings into smaller, more frequent meals is a great way to decrease your horse’s natural glycemic response to each meal. It is also good practice to feed hay before concentrates to slow the transit from the stomach to the lower digestive tract where many carbohydrates are broken down into harmful sugars. You will also want to feed a hay that is <12% non-structural carbohydrates. To achieve this, you can send away hay to be tested or you can soak your hay for 60 minutes in cold water (30 minutes in hot water) prior to feeding it to your horse.

Other additives that may be used in tailoring a diet specific for your horse’s needs include rice bran, rice bran oil, or corn oil as high calorie, low carb supplements. Molasses free, soaked beet pulp is another great way to add calories and fiber to the diet while avoiding carbohydrates. Again, ask your veterinarian for recommendations to meet your horse’s specific requirements and tastes. Remember to make all feed changes gradually, at least over 10-14 days. And don’t forget to stay away from high sugar treats (no sugar cubes!)

As you can see, there are many factors to consider when establishing a feeding plan for a horse with a metabolic disorder and it can be challenging to create a plan that is feasible for you and palatable for your horse. However, it is very rewarding to see the results when an appropriate feeding plan is couple with exercise and appropriate medication (if needed.)

References
1. Frank, Nicolas. How to Feed Horses with Endocrine Disorders. AAEP’s 53rd Annual Convention Proceedings. 2007:186-192
2. Gordon, M.E. et al. The effects of dietary manipulation and exercise on weight loss and related indices of health in horses. Longview Animal Nutrition Center, Land O Lakes Purina Feed, Gray Summit, MO.
3. Gordon, M.E. The Effects of Nonstructural Carbohydrate Content and Feeding Rate on Glucose and Insulin Response to Meal Feeding in Equine.


** TREES note: Feeding only hay may not be possible in elder horses with advanced dental problems. Talk to your vet about finding a suitable replacement.

For more on pasture in relation to metabolic disorders visit SaferGrass.org

Notes and Thoughts from the “Green Horse Seminar”

On May 17, Traveller’s Rest attended a seminar in King George, VA, called “The Environmentally Friendly Horse: Caring for Your Land.” The program focused on keeping horses healthy while also keeping farms and pastures “healthy” through proper management.

One of the most interesting aspects of the seminar was the discussion of how modern horse owners try to force horses into a particular management style rather than molding a management plan to fit the horses’ natural requirements. Developing a “natural” management program is becoming more difficult in Virginia as farm sizes shrink and stocking rates increase. Poor management and crowded farms are leading to less healthy horses. Of particular note is the increase in unfit, overweight and obese horses. A study by Virginia Tech determined that 51% of horses surveyed were overweight or obese (only 5% of owners surveyed felt their horses were too fat.) Surprisingly, grain-based feeds do not seem to be the problem.

(This little butterball now wears a grazing muzzle and has lost ~ 75 pounds since February)

Horses evolved to graze “scrub” plants, ranging 8-15 miles a day to meet their nutritional needs. Even though, in the wild, horses would spend most of their time eating, they were constantly on the move while they ate. Today, in many areas, horses are grazing lush grass pastures or eating rich grass or legume hays, often standing in one place or walking over very small areas. Both the food and the method in which it is presented are contrary to the way equine species evolved. Richer pasture + less exercise = fat horses!

Many of us with overweight horses try to manage the problem by restricting grazing time. Guess what? That doesn’t work, unless by “restricting” you are talking about limiting grazing to only an hour or two a day. Horses, if healthy and left to their own devices, will eat the amount of forage their body says it needs in any given day. During 24-hour a day turn out, a horse may consume 0,8 – 0.9 pounds of forage (dry matter) per hour. A horse on pasture only part of the day, however, may eat up to 3-4 times that amount per hour to “make up for lost time.” Simply cutting back on hours spent grazing will not necessarily reduce total calorie intake. Instead, consider turning out on a dry lot with hay, or using a grazing muzzle when turn out is on pasture. Oh, and ramp up that exercise program!

For more on the “Fat Horse Study,” see “University Researchers Lead Pioneering Study in Equine Obesity.”