Laminitis, Insulin Resistance, PPID (Cushings Disease) & Metabolic Syndrome in Horses


Endocrinopathic (hormonal) dysregulation can result in development of the following diseases or conditions:


· Insulin Resistance or IR (more accurately termed Insulin Dysregulation)

· PPID (Pituitary Pars Intermedia Dysfunction), otherwise often called Equine Cushings Disease

· Metabolic Syndrome (where horses display symptoms or conditions associated with the above but may not necessarily fit any one diagnosis upon diagnostic testing.


IR and Metabolic Syndrome are considered Metabolic types and are treated primarily through appropriate management (diet, exercise and hoof care) whereas PPID is a progressive disease and should be treated through medication primarily as well as management to reduce risk factors and limit the occurrence or duration of associated diseases or conditions such as laminitis or infections.


It is important to know that horses with these conditions have reduced resilience and it directly impacts their soundness and hoof health and potentially also their hoof score.


A loss of resilience increases the horse’s risk of experiencing trauma, injury, disease, and infection and this can occur locally in the foot or anywhere in the body as they are connected and must be viewed holistically.


Horses rarely develop metabolic diseases overnight, however they may suddenly develop associated symptoms such as laminitis due to a loss of hormonal balance or exposure to a trigger such as frosty grass. Observing changes in your horse and documenting hoof shape, body score, hoof score and weight are all useful ways to discern if your horse is losing health and if you need to discuss any concerns with your vet.


It is much less painful for your horse and much less stressful for you, your family and your bank balance if early signs of metabolic imbalance are recognised and major loss of health, injury and disease prevented.


Indications your horse may have a hormonal disorder include:

· Changes in hoof capsule shape and quality of hoof material and presence of infection

· Increase in distortion or pathology in the hoof including divergent horizontal growth rings, wall flare, upright heels, long toe, stretched white line, red or bruising in the wall, sole or white line, flat or convex soles

· Raised digital pulses (chronically or after changes in management or environment, including trim, diet, wormer, vaccination or post stress)

· Indications of chronic pain (such as changes in stance, posture, breathing, coat direction, gait, behaviour, performance and attitude)

· Changing posture; especially standing with the front and hind limbs further under the body

· More difficult to stand on 3 legs to be trimmed or shod or for routine hoof care

· Reluctant to be saddled, mounted or be exercised in general

· Weak cartilage in the foot with loss of soundness and hoof health including low, under run heels, thin soles and/or hoof wall cracks or high, stretched heel bulbs

· Low palmar P3 angle or high palmar P3 angle

· Weight loss or gain anywhere in the body without obvious cause

· Swollen abdomen yet ribs palpable

· Pendulous abdomen and/or saggy back

· Cresty neck or fat pockets around the eye, rump of tail and sheath/udders

· Inability to lose or gain weight easily

· Changes in appetite and thirst

· Changes un urination

· Lameness without clear cause

· Presence of laminitis, respiratory disorders, itch skin, arthritis and other inflammatory conditions

· An increase in infections and parasites

· Increased (or decreased) sweating and/or coat changes

· Seasonal loss of health or performance (autumn/early winter)

· Grass or haylage/wrapped hay intolerance

· Intolerance to chemical wormers, sedatives or vaccinations

· Intolerance to stress/pain/cold or hot weather

· Body Condition Score of 7/9 or more increases the risk of endocrinopathic laminitis

· Apparent depression, apathy and less predictable behaviour



There are useful online guides which can help recognise, diagnose, treat and manage endocrinopathic disease and risk factors such as:

· https://www.ecirhorse.org/assets/documents/ECIR-Brochure.pdf

· https://www.careaboutcushings.co.uk/resources/downloadable

· https://liphookequinehospital.co.uk/wp-content/uploads/PPID-diagnosis-and-treatment.pdf

· https://liphookequinehospital.co.uk/wp-content/uploads/equine-metabolic-syndrome.pdf

· https://sites.tufts.edu/equineendogroup/files/2020/09/200592_EMS_Recommendations_Bro-FINAL.pdf

· https://thehorse.com/164978/body-condition-scoring-horses-step-by-step/


Testing for Metabolic Disorders

Autumn (August and September) is a good time to test for early or advanced PPID as the hormone ACTH (adrenocorticotrophic hormone) rises then and rising levels are associated with the development and progression of PPID. There are several tests which help diagnose metabolic conditions and the safest and easiest to do are blood draws for:


· Endogenous ACTH

· Baseline Insulin

· Baseline Glucose

· Adiponectin


There are other tests which might be performed, some carry a risk to the horse and others more costly whereas the baseline testing is quick, less stressful and cheaper. Free ACTH blood testing for PPID diagnostics is available once or twice yearly (if your horse is prescribed Pergolide) under a voucher scheme via https://www.careaboutcushings.co.uk/


Metabolic diseases are complex and some horses may have positive results and show no signs of ill health, whereas some horses can have borderline results and show marked loss of health and soundness. While it is important to discuss your horses test results and concerns with your vet, It is also important to obtain a copy of your horses blood test results, do your own research and advocate for your horse. I highly recommend the ECIR Group for both support and quality information: https://www.ecirhorse.org/ecir-group.php


Hoof health is impacted by excess weight and predisposes horses to laminitis and metabolic disorders and to help prevent any form of laminitis and promote well-being and resilience, horses should ideally be a body condition score 4 or 5 out of 9. If you horse is suspected of having a metabolic disorder or has been diagnosed with one; it is important that the horse is carefully managed. To learn more about this, download the resources here: https://www.careaboutcushings.co.uk/resources/downloadable


Prevention and Management of the Metabolically Challenged Horse

To reduce excess weight and help maintain a healthy BCS and help regulate hormonal systems and reduce the risk of IR or laminitis, the following dietary recommendations are useful:

· Feed either 2% in dry matter (hay) of ideal body weight in kg’s or 1.5%-1.7% of the current body weight if overweight, whatever is the greatest amount of hay. Hay seems to be better digested than wrapped hay or haylage.

· Feed a low-sugar combined Ethanol Soluble Carbohydrates (ESC) and starch feed below 10%. Soaking hay reduces sugars by an average of 30% (typically 30mins – 1 hour max soak followed by drainage). Grass may need to be restricted or eliminated entirely until the horse is a healthy body condition score (ideally 4/9), and has no signs of laminitis and having completely recovered from any previous attacks. It is worth re-testing for metabolic disorders before grazing and during grazing to measure responses to grazing. Bucket feeds should also be 10% or less.

· Watch for so called laminitis approved bucket feeds and forages higher than 10%, feeds containing alfalfa which can be problematic for sensitive horses and fillers made from intensive agricultural by-products (see next bullet point)

· Don’t feed or bed down on straw or other edible non-organic bedding – glyphosate has been shown in laboratory testing to contribute to the development of metabolic disorders in rats. See also: https://0d9f6dca-bd09-4946-9010-59fb9adf9e1c.filesusr.com/ugd/7e3998_652b30ede8564fea95df4ad4d6930971.pdf

· Consider supporting the gut microbiome which is highly influential in supporting both the immune system and nutritional absorption and assimilation. Tests can provide more info and tailored dietary support for the gut microbiome. See: https://www.equibiome.org/

· Consider supporting the digestive organs via herbs. Re-mount seems to be a useful liver support and ULC-ex (powder and liquid) for the lining of the GI tract. See: https://www.holisticequine.co.uk/search-results/q-RON%20FLEIDS/qc-products

· Feeding from a small-holed net which can be placed on the ground (if horses are barefoot) is useful to slow down eating and help prevent stress, boredom and ulcers. We use these nets: https://www.nibbleze.net/



We have used Remount on the YEWCROFT HERD and recommended Remount to owners and had incredible results with improved gait and hoof scores in a very short time space! - Beccy Smith



Example of a plain bucket feed suitable for most horses (and low ESC/starch) on a grass restricted diet:

· Thunderbrook Healthy Herbal Muesli: https://thunderbrook.co.uk/shop/equine-feeds-balancers/healthy-herbal-muesli-15kg/

· Thunderbrook Linseed Plus: https://thunderbrook.co.uk/shop/equine-feeds-balancers/micronized-linseed-plus/

· If your horse doesn’t tolerate linseed, other omega supplements can be sourced online.

· Thunderbrook Daily Essentials balancer: https://thunderbrook.co.uk/shop/equine-feeds-balancers/daily-essentials/

· Thunderbrook Organic Herbalite: https://thunderbrook.co.uk/shop/organic-range/organic-herbalite/

· Thunderbrook Vitamin E: https://thunderbrook.co.uk/shop/herbs/vitamine/

· Sea Salt: https://thunderbrook.co.uk/shop/organic-range/sea-salt-organic-10kg/

· Proferm Spelt based probiotic and Actiferm holistic microbiome approach for the yard and paddock: https://www.holisticequine.co.uk/product-page/5kg-proferm-prebiotic-probiotic-horse-feed-additive

· If your horse is prescribed Pergolide (Prascend), studies have shown APF, an adaptogenic herbal product to be 100% effective in preventing common side effects known as “pergolide veil”. This can be purchased here: https://www.holisticequine.co.uk/product-page/equine-apf-advanced-protection-formula-for-horses



“APF has been 100% successful in preventing the depression and appetite suppression you can get from pergolide.”
Eleanor M. Kellon, V.M.D. Equine Nutritional Solutions

We recommend testing your forage and soil for nutritional imbalances. Forage Plus offer a detailed analysis service and can provide a bespoke supplement provided to balance your horse’s diet: https://forageplus.co.uk/product-category/forage-analysis-for-horses/


Hoof (and Body) Care

Regular and appropriate trimming is important for all horses however, endocrinopathic disease impacts connective and cartilage tissue health and functionality. If cartilage health is impacted, the inner foot can deform more readily. Early studies on ungular cartilage in horse’s feet have shown tissue changes similar to changes in human cartilage health in people diagnosed with rheumatoid arthritis. Cartilage is found all over the body and horses with metabolic disease may require more frequent trimming, therapy and exercises designed to mitigate imbalances and keep tissues structurally balanced and sound. In addition, the posture and gait in horses with metabolic disease often changes and this is potentially associated with cortisol changes and the effects on soft and dynamic tissue such as ungular cartilage and ligaments as well as joint surfaces.


The postural and gait changes which accompany the metabolically challenged horse can also be due to digestive tract challenges so dietary consideration aimed at helping the microbiome and digestion should be carefully considered. Helping the horse stand, move and feel more comfortable can positively influence the horse’s health and well-being, including the metabolism and endocrine system. Supporting the body and how this functions greatly impacts the foot and hoof health and balance too. I am happy to sign post to a therapist in your area who can support you and your horse.


Common trimming practices often involve trimming the heels to bring them back to the widest part of the hoof with or without intentionally loading the frog. The reality is that the vast majority of horses have weak inner feet conformation due to the environment of domestication which, on the whole, I feel doesn’t provide horses with all they need to be healthy. Therefore, the outer hoof is often deformed and trimming to already deformed boundaries can further reduce health and prevent a foot from healing. It requires skill and knowledge to truly restore or support as far as possible, the restoration of the inner foot and hoof capsule. As such, and due to the reduced resilience generally in metabolically challenged horses, trimming should be performed diligently and tactfully to help prevent laminitis and infections and provide the best possible base of support for the horse.


Finding an appropriate trimmer might prove challenging as different hoof care professionals trim according to their understanding of foot function and not all methods produce what we consider to be a desirable outcome. We may be able to assist horse owners and offer online/remote and trimming/consultation services found here: https://www.holisticequine.co.uk/consultations




Horses with weak hooves or metabolic disease are more prone to hoof infections and laminitis. Combined with appropriate trimming, having a selection of products at hand is sensible and these include:



· Pure Green 24 disinfectant: https://www.holisticequine.co.uk/product-page/puregreen-24-disinfectant-deodorant

· Hoof Clay: https://www.holisticequine.co.uk/product-page/hoof-clay-1-25kg

· Hoof Stuff (for white line disease, seedy toe, abscesses and deep central sulcus’: https://www.holisticreflections.co.uk/product-page/hoof-stuff-190ml

· Clean Trax and Clean Trax soaking boots: https://www.holisticequine.co.uk/product-page/clean-trax-hoof-cleanser

· Therapeutic pads available by request

following consultation:

https://www.holisticequine.co.uk/consultations


The Microbiome of the horse (sometimes called the equibiome), soil & environment

Pasture should be managed to encourage biodiversity and healthy soil and grass for a healthy horse. The use of chemicals to improve grass and reduce weeds on pasture land for grazing or hay making is discouraged. Advice on sensitive management and soil health can be found here:

· Equiculture and The Equicentral System: https://www.holisticreflections.co.uk/equiculture

· Agriton group: https://www.agriton.co.uk/wp-content/uploads/2018/10/Equibiome-cataloge-FINAL-27-9-copy-1.pdf - all Agriton products are available from us at our online shop: https://www.holisticequine.co.uk/shop and https://www.holisticreflections.co.uk/shop


It is good practice to have a dry lot or surfaced all weather area with shelter in which to keep your horse when it is not grazing or stabled. Do not allow a metabolically challenged horse to get too hot or too cold. Rugging in the winter is often encouraged to prevent IR but if your horse is sick, he may suffer stress laminitis if he is forced to burn calories to stay warm. In addition, cold weather can induce laminitis due to compromised blood flow to the body and foot. The key thing to bear in mind is that metabolically challenged horses don’t cope well with a changing environment – they often lack the resilience displayed by healthy horses. Options must be available and at hand to keep horses safe and minimise stress due to seasonal and daily weather changes.



Above: Equicentral system and track system designed and constructed by Beccy in East Yorkshire (2008)








Beccy Smith BSc ADAEP EBW

Diploma in Advanced Applied Equine Podiatrist and Independent Equine Podiatrist, Consultant and Therapist

CEO and Founder of 100% Non-Profit Community Interest Company Holistic Reflections CIC


If, like our clients, you want to learn a PRO-Active approach to hoof care and wish to prevent lameness in your horse, consider booking us for an Integrative Podiatry Consult, Educational Event, Mentorship, On-line Course or join our new VIP membership where you can learn top tips straight from an expert!

We take an integrative and holistic approach to whole horse hoof and body health. We appreciate the relationship between body, limb and hoof and seek to address imbalances while positively influencing appropriate static and dynamic hoof balance and biomechanics.


Beccy Smith BSc DAEP EBW – Independent Equine Podiatrist and CEO of Holistic Reflections CIC

Holistic Reflections CIC – a 100% non-profit organisation promoting wellbeing and resilience in people, horses and the environment - for the benefit of all.

www.holisticequine.co.uk | www.holisticreflections.co.uk