Laminitis

Laminitis is an extremely painful condition which affects the hooves of horses and ponies, and can have significant, long term impacts on soundness.

Laminitis means inflammation of the laminae – the tissue between the coffin bone and the hoof. Simply put, the laminae anchors the coffin bone within the hoof capsule. When the laminae are inflamed they become weakened and the pull from the deep digital flexor tendon (as seen in the image below) can cause the coffin bone to rotate, or sink within the foot. In extreme cases, the toe of the coffin bone can penetrate through the sole of the foot.

The clinical signs of laminitis include:

• Weight shifting
• Rocking back off the toes and loading the heels (often the hindlimbs are further underneath the horse so they can lean away from their forelimbs. This is known as ‘camping under’)
• Lying down, unable to stand
• Bounding digital pulses
• Heat in the coronary bands
• Lameness

Laminitis is a multifactorial disease, but cases can be divided broadly into three categories:

• Laminitis secondary to other sources of inflammation (e.g. diarrhoea, retained placentas, certain infections)
• Laminitis secondary to underlying endocrine disease (e.g. Cushings, EMS)
• Laminitis secondary to mechanical overload (e.g. in cases of fracture or severe trauma, if a horse bears all its weight on the opposite limb it can develop laminitis in the weight bearing limb as a result)

If your horse develops laminitis it is crucial to consult your veterinarian. Every horse is different, and the underlying reason for a laminitic episode should be discussed and investigated with your vet. Typically, we make dietary changes with horses and ponies that develop laminitis and these will be outlined below, however for individual dietary advice, seek veterinary consultation.

Broad Recommendations for Feeding Laminitic Horses:

Reducing the carbohydrate content in the diet of horses and ponies, with, or at risk of laminitis is critical. This is thought to be due to the role insulin plays in inducing laminitis, and the relationship between insulin levels and carbohydrate intake. An important step in achieving this, is removing these equines from grass. Grass has a hugely variable carbohydrate content, which can be as high as 40% during certain times of year. Instead, horses with, or at risk of laminitis should be maintained on a forage source that has a low carbohydrate content, such as low quality hay. Soaking hay for a minimum of 1hr prior to feeding helps remove excess sugars from the hay to further reduce carbohydrate content. It is critical to regularly change the water you soak hay in order to prevent fermentation. Baleage, lucerne and clover should be avoided, as they have a higher digestible energy and carbohydrate content than soaked or poor quality hay.

Forage is hugely important for normal gut health in horses, and should be fed at a rate of about 1.5% of the horse’s body weight. Horses that have a tendency to guts their hay may benefit from a slow feeder or small holed hay net to ensure the fibre matt in the stomach is maintained – see the nutrition hub section on gastric ulcers for a more detailed explanation on the importance of this.

In terms of hard feeds, it’s important that cereal based feeds are avoided in order to keep carbohydrates to a minimum. Carbohydrate sources in feeds tend to come from grains such as corn, oats and barley, or byproducts of grain such as wheat bran. Unsweetened sugar beet and chaffs and low starch, low sugar and grain free feeds are a better option for laminitic equines. Fats in the forms of oils can be added to the diet if they require additional calories.

Once laminitic signs have resolved, if you want to reintroduce your horse to pasture it is best to consult with your veterinarian so they can advise the best way to do so. Grazing muzzles are often used to help reduce the amount of grass eaten, but still allow horses to exhibit normal behaviours which are integral to their wellbeing, such as grazing and socialising.

Forme Equine products recommended for at risk horses and ponies:

Below is a selection of low starch, low sugar and grain free feeds which are suitable for horses at risk, or recovering from laminitis. Horses fed fibre only diets may benefit from a low calorie balancer pellet or vitamin and mineral supplement to ensure that they are receiving the important nutrients they need to recover, particularly if they are being maintained solely on low quality or soaked hay. Gastric supplements may also be of use if your horse is on NSAIDs or experiencing increased levels of stress under their new management regime.

If your horse/pony has developed laminitis, or you are concerned about your horse/ponies condition, seek immediate veterinary advice.

Here are some links which include more comprehensive information around feeding and managing equines at risk of laminitis:

Feeding a Horse with Laminitis

How to nutritionally manage horses with laminitis?

Is your horse a candidate for a grazing muzzle?

Grazing Overweight Horses: Restricted Access Appropriate at Times

Feeding Suggestions for Laminitis-Prone Horses

What to feed a horse with Laminitis

Metabolic Syndrome and Obesity

Equine metabolic syndrome is an increasingly important endocrine disease. It is characterised by obesity or localised fat deposits, insulin resistance, and subclinical or clinical laminitis. EMS is overrepresented in ponies and certain breeds of horses, but can affect any equine.

EMS horses are often referred to as “good doers” and are typically overweight, cresty, and middle aged. EMS horses are also prone to bouts of laminitis. It’s thought that this could be due to insulin resistance, which causes horses to overproduce insulin, thus inducing laminitic signs. However, much is still yet to be understood about the role insulin plays in laminitis, and this is still a developing area of research. Testing for insulin resistance in horses with EMS should be discussed with your veterinarian.

At its core, treatment of EMS centres around exercise and dietary management, although there are other therapeutic options that your vet can prescribe as well. EMS horses are fed like laminitics because we are aiming to reduce carbohydrate intake. Often these laminitic horses are EMS horses as well, and addressing the endocrinopathy will help address the laminitis. Exercise is very important with EMS patients, however only if appropriate (i.e. the horse is not lame). Monitoring weight in response to your management changes is critical to ensure that what you are doing is working. Weigh bridges are the most accurate way to monitor this. Weight tapes are less accurate but can help monitor changes easily.

For more information around feeding EMS and laminitic horses, see the nutrition hub section on laminitis.

Forme Equine products recommended for at risk horses and ponies:

Below is a selection of low starch, low sugar and grain free feeds which are suitable for horses with EMS or obesity. Horses fed fibre only diets may benefit from a low calorie balancer pellet or vitamin and mineral supplement to ensure that they are receiving the important nutrients they need, particularly if they are being maintained solely on low quality or soaked hay. Gastric supplements may also be of use if your horse is experiencing increased levels of stress under their new management regime.

If you think your horse/pony has laminitis, EMS, or you are concerned about your horse/ponies condition, seek veterinary advice.

Here are some links which include more comprehensive information around feeding and managing equines at risk of metabolic syndrome and/or obesity:

Grazing Overweight Horses: Restricted Access Appropriate at Times

Strip-Grazing: Management Tool to Fight Obesity

Omega-3s Helpful for Horses with Metabolic Syndrome

Pasture Management For Horses With Metabolic Related Disorders

Feeding Horses With Equine Metabolic Syndrome (EMS)

Understanding Obesity

Does Soaking Hay Really Reduce Carbohydrate Content?

Metabolic Disorders In The Modern Horse

What Type of Roughage is Best for Your Horse?

The Problem with Pasture

Horse Management: Grazing Muzzle Musings

FeedXL is also a great resource.

Ulcers

Ulcers are small wounds to the stomach lining caused by stomach acid. They are one of the most common medical conditions seen in horses and ponies across all ages and disciplines.

Horses produce stomach acid continually, and are evolved to always be grazing. This ensures there is always saliva (and bicarbonate) coming into the stomach with the food to help neutralise acid. Additionally, because of the continual grazing, the stomach is emptied into the intestines often, so acid moves through into the rest of the digestive tract. The stomach can be divided into 2 regions. The large bottom region, the glandular stomach, is where the acid is made. This area protects itself against ulceration by secreting bicarbonate to buffer the acid, as well as a mucous layer. The top region, the squamous stomach, does not have these protective mechanisms but is protected from the acid by the presence of feed material in the stomach causing a fibre mat that stops the acid sloshing up and damaging the tissue. 

image from https://feedxl.com/8-avoiding-gastric-ulcers/

Ulcers are categorised into two types:

Squamous: these are ulcers that affect the squamous part of the stomach (the top region in the image). Usually, this is secondary to acid sloshing about. Improving the fibre content of the horse, and ensuring that there is an adequate fibre mat in the stomach, particularly prior to exercise/travel is a crucial part of feeding horses that are prone to these kinds of ulcers.

Glandular: these are ulcers that occur in the bottom region of the stomach. These are caused usually due to disruptions in the blood flow to this region, and decreased mucous or bicarbonate production.

Causes and Clinical Signs:

What causes ulcers is multifactorial and complex. Individual horse temperament, stress levels (physical, environmental and social stress), underlying conditions or diseases, exercise (increased sloshing of the stomach contents), and diet have all been implicated. 

Ulcers can cause a multitude of clinical signs. Some horses with severe lesions in their stomachs present with only mild signs of discomfort, and others with mild lesions suffer from regular low grade colic as a result. Ulcers can cause horses to be “girthy”, uncomfortable being brushed or tacked up, reluctant to move forwards under saddle, colicky, reluctant to eat or finish their feeds, poor performance etc. The range of clinical signs means that ulcers are often blamed for a horse’s poor performance or behaviour change, however these are not signs specific for ulcers. Therefore you should consult your veterinarian to obtain a diagnosis and create a treatment plan tailored to your horse.

Feeding the EGUS horse:

Diet is an extremely helpful additive to an ulcer treatment plan, and knowing how to feed these horses will help maintain a healthy stomach after treatment has been completed. However, these are broad recommendations to complement your veterinary treatment and advice and are not to be treated as a replacement for therapeutic medications if these are prescribed.

Firstly, adequate fibre is crucial to maintain a healthy gut, and increasing the fibre content of feeds is often recommended for horses with ulcers.Total forage intake for horses should equal 1.5-2% of their bodyweight, and should not drop below this. Chewing long fibre stems such as hay, promotes saliva and bicarbonate production which will help neutralise the stomach acid. Lucerne may also be helpful to help buffer the stomach acid, as it is calcium and protein rich. 

Where possible, horses should be turned out in paddocks to allow for constant grazing and fibre access. This helps ensure there are no long periods of time that the horse has no fibre in its stomach, so the fibre mat is maintained. If paddock turn out is not possible, it is hugely important to allow horses access to adlib hay, and ensure they have access to fibre at all times. For horses who tend to guts their hay, or who are overweight, small hole hay nets or trickle nets are a good option as they slow hay consumption, meaning the horse eats less over a long period of time. This both maintains the fibre matt in the stomach and prevents over consumption. Similarly, providing horses with small amounts of fibre (such as lucerne, hay, chaff or a fibre dense feed) before exercise and travel has been found to be helpful in ulcer management and prevention as it ensures a healthy fibre mat is present, which reduces the risk of stomach acid splashing up into the squamous part of the stomach during exercise.  

Further, studies have shown that when horses are removed from pasture and fed more than 2g/kg body weight of starch a day, the likelihood of developing EGUS increases significantly (Sykes et al., 2015). That is not to say grains can’t be fed, but it is recommended to keep these as low as possible (below 2g/kg body weight of starch a day). As many horses with/recovering from ulcers are reported to have lost weight or be low in energy, vegetable oils offer a good source of energy dense calories without the addition of grains/starch. Small feeds often are also better than one large feed a day as this helps maintain the fibre matt in the stomach. 

Finally, there are a multitude of gastric supplements on the market, many of which have limited peer reviewed studies. However, provision of supplements that aim to buffer acid (e.g. magnesium oxide) and other products such as lecithin have been the subject of some studies that show it may have some use, but these do not replace veterinary medication.  

Forme Equine products recommended for at risk horses and ponies:

Here are some links which include more comprehensive information around feeding and managing equines at risk of ulcers and hindgut acidosis:

Equine Gastric Ulcers – Using Feeding Management to Reduce Their Incidence and Severity

Symptoms of Gastric Ulcers in horses?

Prevention of Gastric Ulcers in horses

Why do Gastric Ulcers appear in horses?

What are Gastric Ulcers in horses?

Refill and re-buffer the horses stomach

Mind the Hindgut

Does My Horse Have Gastric Ulcers? Causes, Signs, Treatment & Prevention

Ulcer Treatment For Horses: Why And What To Do?

[Video] Diagnostic And Treatment Of Gastric Ulcers In Horses

Hindgut Acidosis In Horses

EquiShure Video: Hindgut Balancer Explained

RER and PSSM Induced Tying Up

Exertional rhabdomyolysis (tying up) is characterised by sporadic or chronic painful muscle cramps.

During a tying up episode, the muscles around the horse’s lumbosacral region and gluteals feel firm and painful. Horses may sweat, breathe rapidly, and show reluctance to move. In extreme cases, horses will pass red tinged urine which has been discoloured from myoglobin that has been released from damaged muscles. This can cause kidney damage. It is critical to consult a veterinarian in cases of suspected tie up so that they can assess your horse and determine what treatment is required.

Sporadic ER occurs when horses over exert themselves, usually from exercising beyond their normal fitness level, or due to stress or environmental factors. Exercising for long periods of time in heat, such as in endurance races, can cause tie up episodes due to electrolyte shifts in the horse associated with sweating, dehydration and the level of exercise required. These horses do not have underlying muscular issues.

Chronic ER can be due to either recurrent ER (RER), or due to an underlying condition known as PSSM (polysaccharide storage myopathy). PSSM can be broken into two categories, type I and II. Type I PSSM is a genetic mutation that causes muscles to store too much sugar as glycogen. Excessive storage of glycogen affects the ability of the muscle to function normally. Type I PSSM can be tested for, and passed onto offspring. Quarter horses are one of many breeds affected commonly by this genetic mutation. Type II PSSM describes excessive glycogen storage without genetic mutation. The aetiology of this type of PSSM are unknown, but both types can cause recurrent tying up in horses.  If your horse ties up repeatedly, you should consult your veterinarian and investigate the underlying cause. 

Feeding the horse that recurrently ties up:

Management of horses that tie up sporadically or recurrently centres around an appropriate fitness regime and a balanced diet that meets the caloric needs of the horse, while providing the appropriate vitamins and minerals. Good quality electrolytes are often recommended for high performing animals, or horses exercising on hot days. Vitamin E and Selenium are important antioxidants which help maintain healthy muscle tissue. Whilst deficiency does not directly cause horses to tie up, keeping selenium and Vitamin E within normal ranges can aid muscle function and recovery. Most feeds are already selenised, and many fortified with vitamin E, so it is important to ensure that you are not over supplementing. Over supplementation of selenium can cause toxicity, so it is advisable to get your horses selenium and vitamin E levels checked prior to beginning supplementation.

Dietary management and exercise is especially crucial for PSSM affected horses. Restri4cted grazing is often recommended (usually via grazing muzzle to allow paddock turnout), as well as feeding hay and good sources of forage. Altering the diet to be low in carbohydrates is useful, as high carbohydrate diets will result in further glycogen deposits in the muscles. Aim to feed grain and cereal free feeds to these horses (i.e. no oats,barley, bran, corn etc). Fats, such as oils, should be used to provide energy rather than grains.

Forme Equine products recommended for at risk horses and ponies:

Below is a selection of grain free, low starch and low sugar feeds for horses with PSSM, or those prone to recurrent episodes of tying up. It is important to check the ingredients lists of feeds, particularly for horses with PSSM, as feeds will often claim to be grain free or low GI, but include grain by products such as mill mix, bran or pollard. If the overall carbohydrate content of your horse’s diet is low enough, these are unlikely to cause issues, but in situations where vigilance is required these can be detrimental and lead to further tying up episodes.

Here are some links which include more comprehensive information around feeding and managing equines at risk of tying up:

How to manage horses that tie up

Dietary management with RER in horses

Dietary management with PSSM in horses

Tying-Up, Signs, causes, Managment & Prevention

Polysaccharide Storage Myopathy (Pssm): What Should I Feed?

Tying Up in Horses

Targeting ‘Tying -Up’ – Dunstan Race Ease

Feeding Horses That Tie Up

PSSM – How Do The Different Forms Affect How You Should Feed?

Adding Topline and Condition

The first thing to consider when aiming to add topline and condition to horses, is the possibility of any underlying conditions which could be impacting their ability to gain and maintain condition.

For example, ulcers, dental pain/pathology, low selenium, worms and musculoskeletal pain can all cause weight loss and make it difficult for horses to gain condition. Therefore, it’s hugely important to seek veterinary consultation in order to rule out any underlying conditions prior to making dietary changes.

Other simple things to consider are the horses’ paddock dynamic and environment. Are they being bossed away from their feed/hay by others? Is there something stressing the horse out which is reducing their appetite? Changes in this area can make a significant difference to the horse’s appetite and overall body condition.

However, some horses just do not hold weight as easily as others and once the aforementioned factors have been ruled out, increasing condition/ topline in horses is a very individualised process that involves a lot of personal preferences as some horses respond better to different feeding regimes than others. In essence, feeding horses to gain topline and condition involves increasing calories through good quality feed that contains digestible and usable macronutrients. Fat is also a hugely important energy source, and has the added advantage of not adding bulk to the diet if added in oil form. The importance of fibre in any horse’s diet, but particularly those who are underweight cannot be stressed enough. Total forage intake for horses should equal 2% of their bodyweight, and should not drop below this. Feeding energy dense sources of fibre, such as baleage, alongside a high fat/energy feed can be a great way to increase horses’ condition, particularly in the colder months when pasture quality is poor.

Forme Equine products recommended for at risk horses and ponies:

Here are some links which include more comprehensive information around feeding and managing equines at risk of laminitis:

Why Can’t I Get My Horse Fat?

Advantages of Feeding Rice Bran to Horses

How to achieve weight gain in your horse

Feeding your OTTB

Weight gain Fact Sheet PDF

How to feed for topline

How to feed your horse for muscle building

Feeding horses in winter

Developing a healthy horse topline

Building Topline

Feeding for weight gain

Feeding Broodmares

When feeding a broodmare the goal is to maintain her in good condition without excessive weight gain in the early stages of pregnancy.

It’s important to ensure that the mare is receiving adequate vitamin and mineral intake throughout the whole of her pregnancy, but provided that she is in a healthy body condition, and has plenty of fibre with a balanced diet, she should not require an increase in feed until month eight of pregnancy. It is important to avoid overfeeding mares as fat mares can have a harder labour, and are more prone to lameness and laminitis.

Most foetal growth occurs in the last 3 months of gestation. Therefore, as foaling approaches look to increase the caloric density of her feed to support lactation and foal growth. This can be achieved by feeding broodmare mixes and oils, alongside adequate supply of good quality forage. At foaling, the mare will require more protein, energy, phosphorus and calcium to provide good milk for her foal as well as maintain her condition and return to breeding. Mares may require up to 2-3% of their body weight in feed a day, so ensure that there is plenty of pasture and hay available as well as a quality feed designed for a lactating mare (i.e. good levels of protein and appropriate energy, calcium and phosphorous levels).

Monitoring the weight of your mare is essential throughout this time, and body condition scoring is a great way to keep track of how your mare is doing. Lactation is a large drain on the body, if you are concerned that your mare is losing weight, despite an adequate feed regime, consult your veterinarian to assess the mare to ensure she is healthy.

Forme Equine products recommended for broodmares:

Here are some links which include more comprehensive information around feeding broodmares and young horses:

Feeding broodmares

Feeding foals weanlings and yearlings

Feeding broodmares without adding more weight

Mineral content of pasture affects hoof composition in foals

Baby weight keep broodmares in healthy body condition

Lactation in mares nutritional notes

Broodmare nutrition: Now or neven

Feeding the lactating mare

Getting broodmare nutrition right without spending more than you need to

Feeding Aged Horses

As horses age a number of changes can occur which affect how we may need to feed them. Not all old horses have all of these changes, but these are commonly seen and impact our approach to their diet.

1. Dental disease. As horses age, they are more likely to develop dental disease such as periodontal disease. This can be secondary to feed getting trapped between teeth, and often causes dental pain. This may affect how your horse chews, and you may notice they start to ‘quid’, salivate, lose weight, or stop eating their hard feeds and hay. As horses age, teeth may also start to become mobile and fall out, and therefore horses start to have trouble chewing feed like hay.
2. The intestine and hindgut starts to lose its ability to digest feed material. Reduction in fermentation in the hindgut affects how much of the feed the horse can utilise, and a reduction in the ability of the intestine to absorb nutrients may also affect their condition.
3. Older horses with underlying liver or kidney disease may struggle with high protein diets as they cannot excrete waste products from protein metabolism as well as they used to be able to
4. As horses age, arthritis is a common ailment and it can impact horses ability to move around and graze. It will also affect their muscle tone and ‘topline’ as they move less
5. PPID (Cushing’s) is a disease of older horses so there is a proportion of this population with this endocrine disorder that impacts many body systems. Typically these horses ‘waste’ muscle quickly
6. Geriatric horses are more prone to picking up gastrointestinal parasites which can further compound weight loss, so ensure that you develop a worming programme with your vet. 

General Guidelines: 

• High quality fibre is a key component of old horse diets to ensure maintenance of gut health. Keeping feeds soft so they are easily eaten, yet still high in fibre is key. Lucerne, good quality grasses and hay, as well as soaked sugar beet or soy hulls are good examples. 
• As older horses tend to lose weight easily and lack muscle mass, provision of good sources of protein (but not in excess) is important. Lucerne and commercial senior horse feeds can provide good protein sources. If grains are fed, highly processed (e.g. mironized, extruded etc.) are recommended especially in the presence of severe dental change, as they are easier to chew and digest. Oils are also an excellent source of energy, and allow you to increase the calories of your feeds without increasing the volume. Feeding older horses smaller volumes more frequently is recommended to ensure adequate caloric intake. 
• Ensure vitamins and minerals are fed, especially in horses that are not able to graze as effectively. Good quality bone and joint supplements may be useful, however cannot remove arthritic change once present. These work best to help maintain healthy joints and preserve the fluid within them (synovial fluid) that nourishes the joint.

Forme Equine products recommended for feeding older horses and ponies:

Here are some links which include more comprehensive information around aged horses and ponies:

Forage choices for aged horses with dental problems

Feeding the oldies