Laminitis doesn’t have to be frustrating in most cases. Better outcomes can be readily achieved through an understanding of the process at hand, and through utilization of other therapies outside of the traditional ‘normal’. In part one of this article, we discussed considerations or factors involved in laminitis in the horse. Through a seeing of these factors, it becomes clear in most situations that certain aspects of the disease are not being managed. Through a better understanding, options and possibilities become clearly evident which just may alter the course of the disease condition. Laminitis doesn’t have to be a death sentence, nor should it result in endless suffering or financial expenditures. There are many options available, but ultimately it becomes a question of which approach you wish to explore.
Laminitis is a preventable disease, much like other health and lameness conditions impacting the horse. Most disease is preventable or at least better managed through a better understanding of the process at hand, and through utilization of therapies outside of the traditional norm. In reality, when it comes to health for our horses or ourselves, we have a choice in all matters. Our choices become better with an increased level of understanding.
The bottom line problem in the development of laminitis in the horse is unregulated inflammation, which is a potentially negative cellular process. Good in some situations, bad in others. This inflammatory response, when chronic, impacts cell function and tissue health. It opens the door for metabolism concerns, insulin dysfunction, circulatory concerns, cell turnover, digestion, immune health, and tissue regeneration. All of these outcomes are connected, not separated. The goal with any laminitis patient is to disrupt the negative inflammatory patterns and restore balance. If you do this properly, success and better management for that horse is just around the corner.
Easier said than done in some cases….but not impossible.
Balancing Inflammation in the Laminitic Horse
Inflammation can be triggered by many events and there are many contributors, including:
- Stress (physical and emotional)
- Body weight
- Digestive Concerns
- Genetic influences
Seeing the numerous factors that can play a role, it becomes obvious that stabilizing that inflammatory pattern in any one horse can prove to be a challenge. However, if all parties involved are on the same page with the same level of understanding, then the chances of success improve dramatically.
“D.I.G.E.S.T” and Inflammation Management
When I consult with equine patients with health and lameness conditions, I tend to refer to the acronym “D.I.G.E.S.T” in aiding the client in gaining a better understanding when it comes to inflammation in their horse.
There are 6 main areas of focus that are contributors to inflammation in that patient:
- Inflammation (from existing problem or body condition)
- Gastrointestinal Dysfunction
- Stress (physical or mental)
- Toxins (including infection)
If our goal is to aid that patient and their inflammatory status, all 6 areas must be assessed, corrected, and better managed. All 6 areas play a role in that patient’s health status. You can’t just focus on one, but assume that likely, all 6 are playing a role. There is no one supplement or therapy that is going to remedy the problem, because that health problem is intertwined with other factors. This is also why focusing just on the feet in a horse with laminitis will never solve the problem in the long term.
Diet and the Laminitic Horse
A high majority of chronic laminitic horses are overweight. Some the owners will admit to the fact, while others simply enjoy seeing their horses be more robust in body weight. The fact is that with a higher body weight comes higher levels of inflammation, especially if that body weight is fat. The solution for most is to provide a low carb diet, using low carb hays or forages, along with a processed low carb grain. This approach is okay, but mainly is assuming the fact that the problem with laminitic horses and weight gain is purely related to carbohydrates and/or sugars. You have to remember that everything is connected when it comes to inflammation, and really, if that horse cannot tolerate higher carbs in their diet, it is not the fault of the carbohydrates, but more so dysfunctional metabolism on a cell level due to the inflammatory process. Feeding a ‘low carb diet’ can be helpful, but it is rarely the solution as most owners know.
In our patients, I look at the diet as having one purpose and that is to provide nutrition to the horse. They are in a negative health state currently, the body is trying to mend, but requires proper nutrition to do this. Using a commercial feed is not my choice and instead, I rely on whole-foods, good old mother nature to provide those nutrients. I do not use synthetic vitamin-mineral supplements, but instead rely on whole foods for provision of protein, fats, carbohydrates and micronutrients. Synthetic nutrient substitutes have a bad habit, based on our research, of encouraging digestive changes, which can alter the microbiome and contribute to more inflammation.
Everything in moderation is the key here, and even with whole-foods, sometimes it can be overdone. For our hay choice, I use high quality alfalfa or an alfalfa-mix for nutrient provision. The hay is fed at 1.5-2% of BW per day, dependent on the horse’s body condition. In addition, I recommend light turnout on pasture for the laminitic patients. In terms of grains, we use whole grains, keeping in mind that the grains are NOT A MEAL, but more so are a SNACK and act as a medium for supplement administration. We feed whole-oats, less than 1 lb per feeding, in addition to maybe black-oil sunflower seeds (1/2 cup), alfalfa pellets (0.5-1.0 lbs) or even Chia seeds (1/2 cup). We often will add in peas and carrots to their feed regimen for added nutrients and flavor. These grains provide nutrients to the horse, but when we feed in smaller volumes the carbohydrate load to the horse is minimal and technically comparable to a low starch feed. You do not need high volumes, just enough to act as a snack, a treat, a medium for supplementation. Overdo those foods and carbohydrates and you can exceed the digestive capacity of the small intestine, which leads to carbohydrate overflow to the hindgut and microbial imbalance.
That is it for nutrition, plain, simple, and straightforward. We do not use oils, flax, or other fat supplements for one main reason, the horse does not need to gain any more weight and any additional fat to that animal can increase the inflammatory status. That is true regardless of the type of fat or whether if it is perceived as ‘healthy’ or not. Fat equates to calories and calories equate to weight gain.
Diet is one area that is made more complex than it really is. Look at it simply, using whole-foods, the way nature intended. You will never find a research paper on type-II diabetes and how a synthetic one-a-day vitamin supplement reversed their condition, nor will you find this in cancer studies. Instead what you will find is research on whole foods, whole plants, and their self evident benefits to the disease process. This is what we are trying to do in these laminitic patients. Food can either be a friend or foe, the choice is yours. We are often fearful of some foods, such as fruits, berries, and even oats, when in reality they are extremely beneficial to the disease process. Need more proof? Research these foods for yourself and see the possible benefits. You won’t match them with a processed food that is ready to serve.
Inflammation and Laminitis
Inflammation is an ongoing process in the body and is the root cause of laminitis, but also tied in with other injuries, health ailments, and even the aging process. Look at inflammation on a scale of 0-10, with a level of 4-5 being normal and vital for health. Anything above that is abnormal and impacts health, while the same can be said of a level less than 4. Too much equates to bad things and too little also equates to negative outcomes.
In many cases of equine laminitis, you often not only have an ongoing inflammatory response, but in some it is precipitated by a prior issue. In some you have sore feet with thin soles, creating inflammation. In another, you may have a prior tendon injury or even a laceration, which is contributing to the laminitic inflammation. In all cases, you have inflammation which must be controlled and so, in addition to our other approaches, you must target that inflammation process directly.
You modify the inflammatory process secondarily through the ‘D.I.G.E.S.T’ approach, but additionally, you should use specific foods or herbs that are proven to impact the inflammatory cycle. Most of these foods and herbs impact inflammation by modulating the express of transcription factors on a cellular level. One main herb that we often use in high doses is Curcumin, often a 95% extract. Turmeric can offer some benefits, but really has to be given in high doses to achieve clinical benefits. There are many other herbs additionally, including some foods, such as berries, alfalfa, and others which all have anti-inflammatory properties. When it comes to the stress pathways and managing them, a high percentage of those herbs also have tremendous anti-inflammatory properties, so there is a double-whammy type of effect. The key here is that dose or volume is critical. You can’t give 1 tsp of Turmeric or even Curcumin 95% and believe you will achieve the desired results. A laminitic horse often has an inflammatory level in excess of 10, on a scale of 0-10, so a high dose approach is warranted, often twice daily or more often.
Gastrointestinal Health and Laminitis in the Horse
The GI tract in the horse is more than just a digestive vat producing fecal balls. This is an organ system in and of itself, with thousands of bacteria, fungi, and protozoa living in harmony. If the gut environment is disturbed due to years of an improper diet, medications, or stress, it will impact the health of the horse and their inflammatory status.
In many laminitic horses it is common to diagnose stomach or hindgut ulcers. These, when present, are a sign not just of ongoing stress but also a disturbed digestive tract. In almost 98% of all laminitic horses, based on my experience, there is also a dysbiosis or negative shift in the population of the bacteria within the hindgut. This imbalance then impacts digestion, nutrient absorption, and strongly contributes to ongoing inflammation. It is imperative to right the wrong in the digestive tract.
A hindgut dysbiosis is a ‘risk factor’ for ongoing health problems on many levels. In order to correct the situation, there are several things that can be done. First and foremost is correction of the diet and removing items in that diet that may be contributing to bacterial population and environment changes in the gut. Prebiotics are favorable, but ideally given in natural form through proper foods. Probiotics are not ideal and can lead to some problems and overgrowth in my opinion. Secondly, in order for a probiotic to provide benefits, it must survive and thrive. If the environment in the gut is not satisfactory for normal ‘good’ bacteria to grow and thrive, how can it possibly be proper for a probiotic? I think that our time is better spent on proper nutrition and managing other factors involved in GI health.
Given the high extent of the dysbiosis problem in many laminitic patients, our research has been exploring newer options. In many patients, the GI tract is severely damaged and changes to the diet can help, but is not enough to aid in the repair process. Currently, we have developed a new research formula that has proven 90% effective in balancing the microbiome in the horse. This approach utilizes herbs with antibiotic and prebiotic properties, while also demonstrating anti-inflammatory benefits to the GI tract and the entire horse. These properties help us to reduce the numbers of ‘bad’ bacteria, while fostering the growth of beneficial ones, and aiding in the repair process of the intestinal lining which then helps to manage the ‘leaky gut syndrome’ which is often present.
Exercise and the Laminitic Horse
This has always been an area of debate. Should you exercise a laminitic horse? Of course, this is dependent on their level of pain and willingness to even walk. However, the concept of exercise is a double edged sword. If you favor caution and restrict the horse to a stall or dry lot, then exercise is reduced, metabolism is impacted, as is the mind and mental outlook. Depression often sets in with these horses, which then compounds the problem. In the right amount, proper exercise can be a real asset to gaining control of health ailments as it can aid in reducing inflammation, improving blood circulation, digestion and mental well-being of that animal.
Again, here you have to look at the type II diabetic human model. The better they eat, the more exercise they get, the better their health. This is true for these horses. In reality, most chronic laminitic horses exist due to the sedentary lives they live combined with a high load of calories per day. This encourages weight gain, which then equates to inflammation, which then becomes progressive over time.
I highly encourage our clients to exercise their laminitic horses, if their status permits it. At the very least, I recommend hand walks several times per day for long distances. Then, as things improve, increasing that to a trot on a lunge line several times per week. Over time, maybe it is possible to saddle up and actually ride. The possibilities are endless and the outcome is dependent on how much effort you put into the whole process. Just remember that a horse turned out onto a pasture or paddock IS NOT exercise. Watch them. Most of the time, their heads are down eating.
Stress Management in the Laminitic Horse
This is a critical area of management when it comes to the laminitic horse and really, any other horse with a health or lameness condition. Stress, either physical or mental, is a killer. The stress response by the body to a stressor is intended to aid the body in adapting, becoming stronger, more resilient. When the stress response is activated for a prolonged period of time, the opposite becomes true and the body is damaged on many levels.
In most cases, the average horse owner just equates stress with stomach ulcers, which is true on a basic level, but this is just tip of the iceberg. You can see a stomach ulcer, but in most cases, the damage done by the stress response and altered hormone circulation is microscopic, damaging the digestive tract, the immune response, hormone production, circulation, tissue health, and inflammation. This stress response also alters cognition, resulting in anxiety and depression. These effects are also closely tied in with dysbiosis in the digestive tract as bad bacteria proliferate.
I have yet to encounter any horse that I wouldn’t say was stressed on some level. If that horse is in any degree of pain, they are physically and mentally stressed. If the horse is on a dry lot or stall, separated from his mates and not allowed to run, they are stressed. If the horse is given too high of a calorie load or simply too much food in a short period of time, they are stressed. In short, if you have a laminitic horse, consider them stressed on some level.
This connects us with many laminitic horses that are also diagnosed as PPID or Cushing’s patients. Is it truly the disease or is it an altered stress response? Both result in an altered pituitary-adrenal axis with excess secretion of damaging cortisol.
Many herbs and foods benefit the stress response, either directly or indirectly. Curcumin, Turmeric, Ashwaghanda, Schisandra, Hawthorne, Eleutherococcus, and many other directly impact the stress cycle. Foods filled with nutrients support it secondarily by strengthening cells and aiding recovery.
Current Solutions: Cur-OST EQ Adapt, Cur-OST EQ Adapt & Recover (Research blend)
Toxins and Impact on the Laminitic Horse
Xenobiotics are synthetic substances that are considered foreign to the body and often elicit an inflammatory or immune response. When you refer to toxins present in the horse, which contribute to disease, this is usually what is being referred to. These xenobiotics can be chemicals and preservatives found in foods, pesticides, herbicides, vaccines, medications, and even fly sprays or other chemicals used on that horse. Simply using old remedies such as turpentine on the sole of a horse is a xenobiotic which can elicit a response in the animal and contribute to more health ailments.
When I am consulting with a laminitic horse, it is imperative to remove the xenobiotics from the environment and personal exposure. This means that there are no vaccines given, no dewormers, no pesticides, and often no medications. Your goal is to stabilize that horse and any of these chemicals can create disruption. In fact, many of them may have contributed to the current state that your horse is experiencing.
Your goal is to create a state of health for that animal. An environment that does nothing but encourage cellular health, balance and healing. No matter how important you believe that vaccine is, it will create problems. This is why many horses experience vaccine reactions or even become laminitic post vaccine administration. Their inflammatory status was already elevated and your use of the vaccine pushed them over the edge, increased the body’s inflammatory status.
No medications, no vaccines, no chemicals until that horse is stable and improving. This includes most processed foods with synthetic additives, nutrients and fillers. Even after your horse is making improvement, you must think carefully about what is given and why. In many cases, use of some medications is warranted, such as a NSAID or light pain medication, but this is often all that is needed and usually for a very short period of time until the other therapies become effective.
When a complete approach is taken with targeted herbal therapy, in many cases the body’s ability to process and eliminate these ‘toxins’ is enhanced. Herbs including Curcumin, Spirulina, Alfalfa, and many others support liver and kidney function, which are the two main organs of elimination in the body.
Foot Care for the Laminitic Horse
This is another crucial, yet, not isolated, step in managing a laminitic horse. You should focus on the feet, but don’t forget about the horse and the main underlying issues that we have discussed. Foot care is paramount, mainly due to the reason that it is tied back to the inflammatory process. The more pain that animal is in, the higher the inflammation. Control that pain and create comfort, then the inflammation process is one step closer to being controlled. However, in order to control the pain in the foot, you have to treat the entire horse as outlined above.
If you are trying to grow out your hair, you to need to feed your body for proper hair growth and health. You also need to trim it often to encourage more growth and health. The same holds true for the hoof as really, it is an extension of the hair.
Laminitic horses need to be trimmed properly with the end goal of re-establishing the coffin bone alignment with the dorsal hoof wall. Medial-lateral balance is also paramount, as is heel height and palmar angle. The hoof wall in most laminitics is severely damaged and separated, often with white line disease, abscesses, and thrush. By balancing with each trim, usually every 2 weeks, you foster growth and balance. It takes time to grow that hoof down, rebuilding a new sole and proper laminar attachment, but with each week there is positive change. This is especially true when the whole regimen is put into force. You cannot solve a case of laminitis with egg bar shoes, wedge pads, clips, or silicone injections. You must re-establish balance over time. If after years of trimming and shoeing your horse still demonstrates coffin bone rotation or ongoing thrush or white line disease, then the correct approach has not been taken.
When the right approach is taken with a laminitic horse, from diet to stress, the hoof growth can be incredible and rapid. If you wait 6-8 weeks for a trim, there will be separation. Thus, look at it like a Bonsai tree, waiting to be molded, shaped, every 2 weeks, at least initially.
Gaining Control of the Laminitic Horse
Laminitis is a preventable disease and one that can be managed even after onset. Most horses continue to suffer on some level because a factor is out of place and balance is not achieved. If we, as man, can create this disease, which we do, then we can reverse or prevent it. All you need to do is reverse what is currently being done. If you have a set regimen in force currently, from diet to supplements, but yet, things are not going well for your horse, then re-group. Take a new approach and carefully scrutinize what is being done, taking into consideration the points made in this article.
When I have a laminitic horse that is being treated and managed, and he or she is doing well, but then all of a sudden problems arise, I know that something was altered somewhere. Either a supplement is not being given properly, environment has changed, or the feed is altered. In some cases, the owner went ahead and gave vaccines or a dewormer. They may seem like innocent interventions, but they can lead to huge negative impacts on that animal. Most of these horses are extremely fragile on certain levels and it takes time to regain stability.
The end result is up to you as the owner. Advice can be given, supplements provided, but in most cases there are other factors that need to be controlled that only you can see and analyze. This is where we must be on the same page with a similar level of understanding. There will never be an outright cure for laminitis, nor will there ever be a specific shoe, a brace, or even a feed that remedies the problem. The condition of laminitis is too deep rooted and intertwined with many other bodily functions.
Through the proper ‘whole-horse‘ approach, the possibilities are endless!
Author: Tom Schell, D.V.M, CVCH, CHN