UnderstandingEquine Metabolic Syndrome

Lydia F. Gray, DVM, MAMedical Director/Staff Veterinarian

Jessica NormandSenior Director – SmartSupplements™

March 22, 2012

Your Presenters

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Agenda• How is EMS different than Cushing’s?• What is Equine Metabolic Syndrome (EMS)?• What causes EMS?• What types of horses commonly get EMS?• What does EMS look like?• How is EMS diagnosed?• How is EMS managed?• Questions & Answers

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How is EMS Different from Cushing’s?• Cushing’s Disease Overview:

– Senior horses (ages 18+ years)– Caused by dysfunction of the pituitary gland– A collection of clinical signs caused by chronic elevation of cortisol in the blood

• Hirsutism (long, curly coat)• Weight loss and muscle wasting OR weight gain and abnormal fat deposits• Increased appetite• Increased drinking (and urination)• Delayed wound healing/increased infections• Chronic laminitis

– Requires treatment with medication (Prascend® or pergolide)

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EMS vs. Cushing’s

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Cushing’s DiseaseEquine Metabolic Syndrome

What is Equine Metabolic Syndrome?

• A syndrome in middle-aged horses that includes:1. Obesity (or regional adiposity)2. Insulin Resistance3. Laminitis

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Prevalence of obesity in mature horses: an equine body condition study. Thatcher CD, Pleasant RS, Geor RJ, et al. 2008. Journal of Animal Physiology and Animal Nutrition. 92(2): 222-222.

What is Equine Metabolic Syndrome?• Definitions

– Insulin: A hormone secreted by the pancreas that stimulates the uptake of glucose (blood sugar) by tissues when sugar is abundant (after eating)

– Insulin Resistance: Failure of tissues to respond appropriately to insulin

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What causes EMS?• Although there is a strong genetic influence, obesity is

the primary problem that sets off the cascade of metabolic abnormalities.

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What types of horses commonly get EMS?• Generally, between 8 – 18 years of age• “Easy Keepers” / “Hardy” types• Most common in these breeds:

– Pony breeds– Peruvian Pasos and Paso Finos– Morgans– Tennessee Walking Horses– Saddlebreds– Domesticated Spanish Mustangs– Norwegian Fjords– Also Warmbloods, Arabians, Quarter Horses and even Thoroughbreds

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What does EMS look like?• Obesity (7-9 body condition score)• Abnormal fatty deposits:

– Crest of the neck, behind the shoulders, over the tail head, above the eyes, sheaths of male horses

• Insidious onset of laminitis• In mares, abnormal estrus cycle/difficulty breeding

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Body Condition Scoring• A system for estimating fat cover over 6 different body areas to

develop a single score for overall condition; ranges 1 – 9:

1=Poor2=Very thin3=Thin4=Moderately thin5=Moderate (Ideal)6=Moderately fleshy7=Fleshy8=Fat9=Extremely fat

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Image used with permission from Dr. Clair Thunes, PhD and Summit Equine Nutrition, LLC

Body Condition Score 5 (Moderate aka Ideal)

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Body Condition Score 6 (Moderately Fleshy)

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Body Condition Score 7 (Fleshy)

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Body Condition Score 8 (Fat)

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Cresty Neck Score• A system for assessing fat accumulation in the crest, a

particularly “risky” place for fat that may be associated with an increased risk of laminitis; ranges from 0 to 5

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Apparent adiposity assessed by standardised scoring systems and morphometric measurements in horses and ponies. Carter RA, Geor RJ, Staniar WB, etal. Vet J

(2009) 204 - 210

How is EMS diagnosed?• Physical appearance of the patient• Results of routine blood tests• Elimination of causes of similar findings• Fasting hyperinsulinemia• Glucose tolerance tests (CGIT, FSGIT)

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How is EMS managed?Reverse the obesity:1. Increase exercise2. Restrict calories/sugar3. Complete and balance the diet4. Add targeted metabolic supplements5. Consider appropriate use of Thyro-L® (Rx)

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1. Increase Exercise

Guidelines:• Under veterinary supervision if laminitic• Start slowly/increase gradually• Turnout is not sufficient exercise for obese horses

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Effect of short-term exercise training on insulin sensitivity in obese and lean mares. Powell DM, Reedy DR, Fitzgerald BP. Eq Vet J. 2002 Sept;34(S34):81-4.

Effects of exercise training on adiposity, insulin sensitivity, and plasma hormone and lipid concentrations in overweight or obese, insulin-resistant horses. Carter RA, McCutcheon LJ, et al. Am J Vet Res. 2010 Mar;71(3):314-21.

2. Restrict Calories/SugarForage Guidelines:• Hay should be the basis of the diet

– Feed 2.0%, then 1.5% of current body weight daily– Make sure Non-Structural Carbohydrates (NSC) are < 10%

• Soak hay to remove sugars– Warm water: 30 minutes– Cold water: 60 minutes– Dump water!

• Limit grass– Dry lot turnout– If pasture turnout is necessary:

• Use grazing muzzle• Turnout at night

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2. Restrict Calories/Sugar:Products to help with forage guidelines

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Grazing Muzzle

Small Hole Hay NetFreedom Feeder

The Natural Feeder®www.TheNaturalFeeder.com

2. Restrict Calories/Sugar

Grain Guidelines:• Ideally, do not feed grain• Definitely do not feed sweet feed or other high sugar/starch grain• For horses fed outside in groups: prevent scavenging

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Average Sugar, Starch & NSC Values of Selected Feedstuffs*

*Values are from Equi-Analytical Laboratories of Ithaca, NY; reported

on dry matter basis.

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Feedstuff NSCSoybean Hulls 6.30%

Alfalfa Pellets 9.30%

Alfalfa Cubes 10.20%

Alfalfa Hay 11.30%

Grass Pasture 12.10%

Beet Pulp 12.30%

Bermuda Grass Hay 13.60%

Grass Hay 13.80%

Soybean Meal 16.20%

Barley Hay 20.40%

Rice Bran 21.20%

Oat Hay 22.10%

Wheat Bran 30.80%

Wheat Middlings 32.00%

Carrots (wet) 43.69%

Oats 54.10%

Barley 61.70%

Corn 73.30%

2. Restrict Calories/Sugar:

Other Feeding Guidelines:• Generally, avoid molasses and other sources of sugar in the diet• Choose supplements formulated without added sugar• Choose sugar-free treats

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Withers & Withers Insulin Resistant

Horse Treats

Hilton Herballs

3. Complete & Balance the Diet

• Horses not being fed fortified grain need an alternate source of nutrients from:

– A Ration Balancer (provides vitamins, minerals and protein)– A Multi-Vitamin Supplement (provides vitamins and

minerals)

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4. Add Targeted Metabolic SupplementsGoals of support:• Fight oxidative stress with antioxidants• Support cellular health with Omega 3 fatty acids• Maintain healthy blood sugar levels • Manage normal insulin response• Combat regional adiposity by mobilizing stored fat

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4. Consider Metabolic SupplementsIngredients to look for:• Antioxidants

– Vitamin E, Vitamin C, Grape Seed Extract, Alpha Lipoic Acid, Super Oxide Dismutase, Bioflavonoids

• Omega 3 Fatty Acids– Flax Seed, Chia Seed, Fish Oil

• Specific Minerals– Chromium, Magnesium, Selenium, Iodine

• B Vitamins– Biotin, Thiamine (B1), Niacin (B3), B5, B6,

• Specific Amino Acids– Taurine, Tyrosine, Carnitine

• Targeted Herbs– Cinnamon, Banaba Leaf, Bitter Mellon, Quercetin, Ginseng,

Ginger, Fenugreek

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“I have 2 horses on this and noticed a definite difference within a few weeks. Cresty necks are slimming down and weight is more easily managed.”– Cindy H, Andale, KS

5. Consider Appropriate Use of Thyro-L®• Thyro-L is not used as a treatment for hypothyroidism• Administration of Thyro-L (levothyroxine) was associated with

weight loss and increased insulin sensitivity in adult horses and may be useful for the treatment of obesity and insulin resistance in horses

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Effects of long-term administration of levothyroxine sodium on glucose dynamics in healthy adult horses.

Frank N, Elliott SB, Boston RC. Am J Vet Res. 208 Jan;69(1):76-81.

5. Consider Appropriate Use of Thyro-L®

• Two additional medications being researched– Metformin “The effect of oral metformin on insulin sensitivity in insulin-

resistant ponies.” Tinworth KD, Boston RC, Harris PA, et al. Vet J. 2012 Jan;19(1):79-84.

– Pioglitazone “Effects of the insulin-sensitizing drug pioglitazone and lipopolysaccharide administration on insulin sensitivity in horses.” Suagee JK, Corl BA, et al. J Vet Intern Med. 2011 Mar;25(2):356-64

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Summary

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EMS Cushing’s

Who? •Middle-aged horses (6-12 years)•Easy Keeper breeds/types

•Senior horses (18+ years)

What? •Obesity•Insulin Resistance•Laminitis

•Pituitary dysfunction-This leads to increased cortisol and immunosuppression-Laminitis and/or IR may also develop

Diagnosis •Obesity or regional adiposity•Blood insulin measurement•Combined Glucose-Insulin Test (CGIT)

•Hirsutism•Low Level Dexamethasone Suppression Test (LDDST)•ACTH Measurement

Medication •Possible use of Thyro-L •Prascend®, pergolide or cyproheptadine

Diet •Low sugar/starch •Low sugar/starch

Supplements •Multi-Vitamin•Targeted metabolic support (e.g. SmartControl IR)•Antioxidants, Omega 3s, etc.

•Antioxidants•Immune support•Omega 3s•Weight Support (if needed)

EMS Management Program Overview• Consistent daily exercise• Dry lot turnout/pasture turnout with grazing muzzle• 1.5-2% of body weight from grass hay, soaked to remove sugars• No grain; pelleted multi-vitamin or ration balancer instead• Sugar-free treats• Targeted supplement such as SmartControl IR for additional

metabolic support• Possible use of Thyro-L® (Rx)

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Questions & Answers

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Questions1. Would you please recommend a feeding program for an easy keeper that gives him a

sense of having lots of "grain" to eat but not get him into trouble with weight gain / laminitis?

2. What type of foods to avoid feeding knowing the breed is more likely to develop EMS? 3. What testing should be done?4. What specific adjustments in feed need to be made for a Grand Prix dressage horse with

EMS in full work & one in maintenance exercise? He seems to need to carry a bit more weight to have the strength & energy to at the top of his game for competition.

5. What lower cost supplements can I use to help my horse's metabolic balance ? (in addition to restricting high sugar feeds/ spring grass etc)

6. What kind of exercise program could benefit a horse with this problem? 7. What is the safest way to manage this with nice green grass starting to grow? 8. What are the early signs of Equine Metablic Syndrome? 9. Smart Control IR is really working now that he's lost weight how can you decide the right

amount of grazing to allow?

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Questions10. Please address supplements and feed requirements for an older mare needing to

lose 100 pounds safely. This is for a 22 yo mare with EMS/IR diagnosed two years ago. Starting back in with light riding, her feet have recovered after laminitis.

11. My horse was diagnosed as insulin resistant. I monitor her grazing to under 1 hr. in the evening (sugar lower). I exercise her. I use netted grazing bags (helped). I want to get rid of the cresty neck. I give handful of soaked beet pulp 2x wk. Any advice?

12. My 18 year old Mustang gelding has been on SmartControl IR pellets for about 3 years. In December 2010 after an episode of laminitis he was prescribed Metformin. His glucose levels are now under control. Do we need to continue the SmartControl IR pellets?

13. Is there a way to reduce a cresty neck and abnormal fat pockets? Even though my horse's ribs show, he keeps a cresty neck since he has gotten older (14).

14. Is there a need to use a probiotic on an "Easy Keeper" that bloats badly on pature? I reduce her hay and grain consumption greatly when on pasture. I cannot limit her access to pasture.

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Questions15. Is obesity caused by Equine Metabolic Syndrome or does it develop as a result of

obesity?16. Is grass/timothy hay the best choice of hay for metabolic horses? Should you free

feed thus hay or use a hay net?17. Is a blood test all that is needed to detect this syndrome? 18. I just had a negative thyroid panel result on my mare. Are there false negative

thyroid results? 19. I have a TWH/Clyde cross who is an easy keeper. He is on pasture (12 hours

summer )He gets 1lb light feed twice a day mainly to get him to eat his joint supplement. Hay when stalled. Is this enough nutrients? He seems healthy and shiny.

20. I have a paso fino horse & a belgian/racking horse that are easy keepers on pasture. I can hardly feed them any feed because they get fat so I know they are not getting the nutrition they need. Any advice?

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Questions21. I have a Morgan gelding who is 11 y/o who boards here, who was tested and found

to be hypo-thyroid. He is now on Thyro-L. We are super careful about managing his diet, but worry a lot when we introduce him to green grass each Spring. How much is "safe?"

22. I have a Grade AQHA Gelding that is such an easy keeper that I have to only feed him 5-7 pounds of feed 2x/ day. What can I give him to help keep him sound, as well as get him fit for competition? (He is overweight, under-ridden and is my daughter’s horse.)

23. I HAVE A 15 YEAR OLD MULE THAT GRASS FOUNDERED 2 YEARS AGO FOR THE FIRST TIME ON GRASS IN THE SPRING. IS THERE ANYTHING ELSE I CAN DO OTHER THAN ONLY LETTING HER OUT FOR A COUPLE OF HOURS A DAY TO START WITH IN THE SPRING AND WEARING A GRAZING MUZZLE?

24. How to manage an IR horse prone to ulcers?25. How to manage an easy keeper on full turnout. How to make sure your horse is

getting all the minerals and vitamins with a small amount of grain.

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