Equine metabolic syndrome (EMS)

Equine metabolic syndrome (EMS) has become more and more prevalent in our equine community. It is most often found in middle-aged horses (ages 8 to 18). EMS is characterized by a combination of three main symptoms:

• Obesity with regional adiposity in the neck, tail head, and supra-orbit (pouch above the eye)
• Laminitis, both acute and chronic
• Insulin resistance (aka insulin dysregulation)

Since not all obese horses have EMS and not all EMS horses are obese, an episode of laminitis is often the first indicator of the syndrome. Upon further testing, insulin dysregulation is revealed. It is the combination of these symptoms that yield the diagnosis of EMS. Some EMS horses go on to develop PPID, but not all.

Pituitary pars intermedia dysfunction (PPID) aka Cushing’s disease

Pituitary pars intermedia dysfunction (PPID) aka Cushing’s disease is commonly found in older horses (18-plus years of age). PPID shares several characteristics with EMS so the two are often confused. Some EMS horses will develop PPID, but not all horses with PPID develop EMS or insulin dysregulation. While PPID and EMS horses have some similar symptoms, such as obesity with regional adiposity, laminitis, and insulin dysregulation, PPID is most easily differentiated by the presence of additional symptoms, such as:

• Abnormal sweating
• Delayed shedding
• Hypertrichosis (long, curly hair)
• Increased drinking and urination
• Infertility
• Lethargy
• Neurological deficits, including blindness
• Recurrent infections
• Skeletal muscle atrophy

Supportive Management Practices

For optimal results, supportive management practices should be combined with medication and supplement therapy.

Dietary adjustments

In overweight horses the total calorie intake should be adjusted to encourage weight loss and then maintenance of a healthy weight. Limit sugar and starch (nonstructural carbohydrates) intake. Restrict access to pasture grass.

In hard keepers or horses that are still competing maintenance of a healthy weight is critical. Much needed calories should be derived from high fat and fiber concentrates. Limit sugar and starch intake. Feed alfalfa with caution, as excess protein can cause issues in some metabolically challenged horses. Monitor weight closely and adjust calories accordingly. Don’t allow a horse to become overweight.

For all EMS or PPID horses:

• Pasture should be eliminated or severely restricted by using a grazing muzzle. Pasture is particularly dangerous in the spring and the fall in areas where cool-season grasses flourish.

• Avoid high starch and sugar feeds and treats. Choose feeds with a nonstructural carbohydrate (NSC) level of 10% or less.

• Limit dietary NSC in forage to 12% or less. 10% is optimal, particularly in horses with a past history of laminitis. There are several specialized hay chaff or hay cube products on the market that meet this criterion. Long hay should be tested before fed to determine NSC levels.

• Soak hay that is above 10% NSC to reduce sugar content. Completely submerge hay for 60 minutes in cold water, or 30 minutes in hot water. Drain well before feeding.

• In overweight horses, to encourage weight loss, slowly reduce forage intake from 1.5% to 1.25% of ideal body weight over 30 days. Do not feed less than 1% of ideal body weight. Once ideal weight is attained, increase level fed to 1.5% to 2% of ideal body weight. Sudden feed restrictions should be avoided.

• If additional calories are needed once optimal forage intake is achieved, supply fortifi­ed concentrates that are 10% or less NSC.

• Adequate exercise is important. Physical exercise has been shown to reduce insulin resistance by assisting in weight management. Horses that are sound should be exercised on a routine basis. Caution must be used with laminitic horses; exercise should be restricted until the horse is sound and then introduced slowly to protect damaged laminae.

Recommended Supplements

InsulinWise™ is a cutting-edge supplement proven to increase insulin sensitivity in IR horses. It is a synergistic blend of polyphenols and amino acids, including leucine, that support normal insulin regulation and healthy body weight. The proprietary blend of ingredients in InsulinWise are research-proven to reduce body fat, sustain lower insulin levels, and increase adiponectin levels (a marker of increased insulin sensitivity). Maintaining normal levels of these hormones provides a clinical benefit by reducing the risk of laminitis. Available through veterinarians only, ask your vet about InsulinWise. Learn more.

Elevate® Maintenance Powder provides the natural vitamin E missing from diets where grazing on fresh green grass is restricted. Horses need adequate levels of vitamin E in their diets to maintain proper muscle and nerve functions, as well as to sustain a strong immune system. This is very important in EMS and PPID horses that are often challenged by poor immune response and muscle atrophy. Learn more.

Micro-Phase™ provides the vitamins and trace minerals needed to meet nutritional requirements in horses that are not consuming the suggested amount of a fortified feed. If your horse is eating less than recommended amounts of a fortified concentrate, or no concentrate at all, then choose Micro-Phase to fill in the nutritional gaps. Learn more.

Contribute^TM provides the omega-3 fatty acids that help fight damaging inflammation often associated with EMS and PPID. Omega-3 fatty acids are considered essential nutrients, which means they must be provided by the diet. Contribute contains both important plant and marine sources of omega-3. Learn more.

Ker-A-Form™ is a well-balanced hoof and coat supplement that supports healthy hoof growth in feet that are recovering from a bout of laminitis. Grow back the healthiest foot you can by choosing Ker-A-Form. Learn more.

Neigh-Lox® Advanced supports a healthy and well-balanced digestive tract. This is particularly important when horses are stressed by diet changes, medications, and/or grazing restrictions. Neigh-Lox Advanced buffers excess gastric acid and coats the sensitive stomach lining, which supports a reduced incidence of gastric ulcers. The prebiotics and probiotics, particularly Saccharomyces boulardii (a true probiotic), contained in Neigh-Lox Advanced sustain a healthy environment in the small intestine and hindgut. Neigh-Lox Advanced supports a reduced incidence of colonic ulcers, diarrhea, and hindgut imbalances. Learn more.

If you think your horse is challenged by EMS or PPID, seek the advice of your veterinarian. He or she will help you chart the best treatment and management plan for your horse’s individual circumstances.

Related articles:

• Also check out our section on easy keepers and metabolic syndrome – https://kppusa.com/category/horse-easy-keeper-metabolic-syndrome-blog/

• Tips on how to get your picky metabolic syndrome horse to eat supplements.

• Grazing Management for Horses with Metabolic Syndrome

• Picking Hay for Sugar/Starch Sensitive Horses

• Spring horse feeding tips

• The Trouble with Fructans

• What is Fructan Overload?

• Managing the Easy Keeper

• Vitamin E Necessary for Optimal Health in Horses

• Soaking hay before feeding is one way to lower the sugar levels, but it reduces more than sugar.

• Feeding Starch/Sugar Sensitive Horses

• Feeding Strategies to Prevent Laminitis in Easy Keepers

• Spring Turnout Tips for Your Horse

• Equine Metabolic Syndrome/Insulin Dysregulation: Don’t Forget About Protein

• How to tell if your horse feed is low starch

• Teff hay for metabolic horses: just the facts

• Hay Management for Horses with Equine Metabolic Syndrome (EMS) and Cushing’s Disease (PPID)