For decades we as veterinarians and horse owners have struggled with many equine health conditions and even soundness. It seems like in the past 20 years, we have made no further progress in the management of laminitis, metabolic concerns, sore feet, tendon injuries, allergies, EIPH, anhidrosis, and many other conditions. Despite applying the past knowledge and therapies with these conditions, some horses respond clinically while others are severely lacking. We have to look to recent research and apply what we have been given if we want to move forward. Fecal cultures and the digestive microbiome of the horse is just as important as that in humans, and the connection with overall health is staggering at times. This one concept, the microbiome, may shed more light on various conditions and allow us to have one more tool in the box to utilize to monitor and aid in recovery. The thing is that we have to use this tool, in one way or another, and the information that it provides. Otherwise we are potentially left wanting, over and over again. It’s really quite fascinating information that can be gained!
Just like many horse owners, I too have struggled with some patients and their conditions, whether if they are here in our hospital, part of a rehabilitation program, or a consultation. Initially in my career, I was left with only the options that were given to me during my college education, conferences, or transferred in the print of a hefty textbook by my peers. I’d apply what I was taught and read, but many patients continued to deteriorate over time. Laminitis cases were especially difficult, as they seemed to continue from one year to the next and with each year, I would dread their recurrence. Given this overall lack of efficacy in applying the knowledge I was told, I began to ask questions, began to dig deeper into these cases. This meant diving into research, understanding cellular pathways, disease processes, and fitting them all together with diet, husbandry, environment and influence of other organ systems in the body.
Over 12 years ago, I began this journey, truly seeking solutions for my equine patients. Not to just sell them medicine or provide hospital care, but to improve their health, watch them walk out of our facility sound, happy, and healthy. Most importantly, to see them not require ongoing care, month to month, year to year. That was my goal and what I strive to provide, but the answers or solutions are not readily available.
I’ve come to realize one thing, there is no one specific treatment, medication, diet, supplement, or horse shoe that will remedy every problem in every horse.
Frustrating isn’t it? Yes, but on another level it is fascinating to see how one regimen works for one patient, but yet, another totally fails to respond. That is not failure of the remedy, but more so, a failure of that specific horse to respond. Either it is the wrong approach for that one horse OR there is something going on inside or outside of that horse that is literally blocking healing from taking place. This is where careful observation, often over time, of that horse can really yield answers.
The Fecal Culture and the Microbiome in the Horse
In order to promote health in any person or animal, we need to take advantage of what is around us, especially in research. In the world of human medicine, they use various blood tests to pinpoint health problems, using them as a marker of risk of disease. Examples include cholesterol levels, blood glucose, and HbA1C. Although these markers are not specific indicators of any one disease, except diabetes in the case of glucose potentially, they are indicators that a state of health is not present. If that state of health is not corrected, then the patient is at a higher risk of disease in the future.
In the world of human medicine and research, the gastrointestinal microbiome has been a forefront target, making connections with a host of clinical disease. Today, if you or your physician desired, you could have your own feces analyzed to assess the balance of the microbiome or have genetic testing done on a sample of saliva. These are all tests that can be used to determine a state of health or a state of imbalance, which may predispose you to clinical disease.
In horses, we don’t have many of these tests readily available outside of research. Items that are routinely evaluated, mainly in the overweight horse, are leptin, insulin, and ACTH levels. Despite other being available, most practitioners do not take advantage mainly because they are unsure of their importance and what they mean clinically. If the test is abnormal, what do they do? Is there a medication? The answer to the second question is ‘no’, there is no medication, as history will tell us that even with medicinal intervention, many continue to fail to respond. This fact then creates a state of insecurity in the world of medicine, because it means that the only answer may lie in supplementation, dietary changes, or environmental factors. These are gray areas to most veterinarians, as we are not given this information in our college courses or in continuing education conferences. If we don’t feel secure in the answers, then there is no reason to test.
Medicinal cultures outside of traditional medicine clearly have stated over hundreds of years that health starts in the digestive tract. When there is a state of disease, digestion must be included as a focus in therapy. It’s time we started to pay attention.
Modern research, both equine and human, has shed light on this fact. Not really focusing directly on digestion, but more so the bacterial populations that are present in the gastrointestinal tract which foster digestion. In recent years, mainly in research, we have been able to evaluate the microbiome in the horse and are making connections. Despite it’s infancy, in comparison to human research, the fact that the microbiome is uniquely connected potentially with many conditions in the horse should raise some questions as to what we are doing and whether if this should be a part of every horse’s evaluation and monitoring? It could answer a lot of questions.
The Fecal Culture; What It Does and Does Not Tell Us
In our laboratory, for the past 4 years, we have performed over 300 fecal cultures on horses coming into our facility, research patients, and outside consultations. When you perform that number of cultures, one begins to get a feel for a trend. No different than doing 300 insulin levels on 300 overweight horses, seeing a trend toward high levels. However, the difference lies in the fact of what the information yields us in the end.
In the case of an elevated insulin or leptin level, this does not signify active disease, but more so is an indicator or marker that one pathway in the body is compromised, not functioning correctly. Despite seeing it, we don’t really have a specific remedy and if we were able to ‘fix’ it specifically, it likely wouldn’t amount to much in regards to clinical results due to the fact that this is just one piece of the puzzle.
In the case of a fecal culture, at least in our laboratory, we are able to evaluate specific groups of bacteria which include Lactic Acid Bacteria (LAB), Coliforms (E.coli), and Salmonella species. The main group of importance being Lactic Acid Bacteria, as research in both human and equine medicine indicates that when this group is over-represented, there is a higher risk of disease. This does not appear to be an ‘effect’, but potentially a ’cause’ in the development of disease. A microbiome that is out of balance, can and does directly impact cellular pathways in the body, i.e, inflammation and immune function, which then alter insulin function and levels, or contribute to allergies, as an example. This dysbiosis may be a cause, rather than an affect in many cases. If we can see the ’cause’, see that microbiome shift, then this gives us some usable information.
Through the evaluation of the fecal microbiome, we can:
- See a potential factor as to why a patient is not responding to therapy
- Monitor the progress of a patient more closely, using these levels as a guide in our therapy
- Implement specific regimens that may directly alter or improve this dysbiosis and promote a healthier digestive tract
- Potentially get to the root problem in many patients, alleviating the need for other therapies, supplements, and medications.
In our facility, every horse is cultured routinely, which means as often as every two weeks until we gain progress in that patient. Then the cultures are done more sporadically unless a negative change is noted, or conditions change somehow. I use the culture as a tool, no different than a blood glucose level check. A tool to indicate to me whether if I am on the right track, or need to consider something different, or potentially eliminate something from their current therapy.
The fecal culture is a tool, telling us if a problem exists and whether if it has been resolved or improved. It does not tell us what to do, or how to manage that patient. That is up to us as owners and veterinarians to determine, then monitor our progress with future cultures. We have no way of knowing if the problem exists, unless we test for it. The situation in that patient may be very suspicious of a microbiome imbalance, but testing is required if we truly want to know.
Options for Correcting the Microbiome Imbalance
Seeing the problem is one thing, correcting it can be something entirely different. Again, however, this is no different than checking insulin or ACTH levels in a horse. You can see the problem, but despite the solutions available to you, there is no guarantee and the only way to determine true progress is by repeat analysis. Now, of course, after seeing the problem and making corrections, if the patient is responding and doing very well, there may be no need to recheck blood or fecal cultures. We just assume based on progress that we are heading in the right direction. This is perfectly okay in my book, as it eliminates unnecessary testing and costs. However, if solutions are applied, and the patient continues to deteriorate or not make ample progress, tests should be repeated and used as a guide.
Correcting a gastrointestinal microbiome imbalance can be a challenge in some horses, while others seem to almost respond overnight. There are many factors involved in why this microbiome imbalance exists, and thus no ‘one’ solution will apply to any horse or case. Thus, we use the culture as a guide that changes need to be made, then assess the entire situation. This can take time, real thought, and then patience as therapies are implemented or conditions are changed. For more details on factors involved with the microbiome, check out this article.
Being a researcher and veterinarian, one is quick to believe that I or my colleagues have all of the answers. The fact is that we don’t. I don’t. What I do is ask questions, dig deeper, and often discover problems that are present, real contributors, but then ask what now? I do this in our own horses and patients that come to our facility for guidance.
The first thing I do is culture the horse, after a full evaluation has been done from feet to the topline, ears to rear. I want to know that horse’s level at that time and if an imbalance exists. The second step I do is evaluate the diet, make modifications, clean it up and improve nutrient levels naturally as I know this is a factor in many cases. The third step is to implement herbs, specific therapies, to target the gut, the microbiome and associated problems at that level. The fourth step is to make physical changes, whether if that is to the feet, saddle fit, stress levels, environment, or otherwise. Then, after making these changes, we re-evaluate in 2 weeks, generally re-culture, and evaluate the patient. Most are making progress, while some do continue to lack. If the horse is still lacking, then we dig further and in most there is something that is physically blocking that horse from making progress. That may be something in the diet, maybe something that is perceived by myself as being appropriate and healthy, but still may be creating conflict. Maybe it is a medication that the horse is on, as many with insulin or metabolic cases. We need to dig deeper, continue to assess, make changes, knowing and seeing that goal in mind.
One main formula that we have been researching and using for the past year, in an effort to provide a potential solution for better management of the microbiome and digestion, is the Cur-OST EQ Tri-GUT. This blend has been researched over and over, with modifications here and there to yield the results I have been seeking. In our recently released research trial, patients responded nicely with an improved microbiome and physical changes in a short period of time. This blend has become a staple, a cornerstone for all of my patients in more recent times and I will use it along with other blends to target the inflammatory response if needed.
The Cur-OST EQ Tri-GUT is unique from my point of view as it really targets the problem, which is the microbiome, but can also improve the overall intestinal environment, which is crucial. We are not relying on probiotics, as seen too often as solutions, but more so we are impacting current populations, altering growth patterns, and creating a better environment in the digestive tract to foster good bacterial growth and balance.
Every horse that I have used this blend on has improved in one way or another. Some exhibit bacterial changes on re-culture in as little as a week, with clinical improvement along with it. Some, despite the therapy, still desire more attention. They improve a little on repeat cultures, but not to the desired levels. When follow up improvement is minimal, this is a sign of two things:
- The medical condition in that patient is more severe, deeper rooted, and more time is needed to gain benefits
- There is something in the current program that is blocking us from progress
As we make progress in the patients that we work with, the benefits are seen in the entire body, which is due to the fact that the microbiome is intertwined with all organ systems. The horse’s feel better, more energy, more alert, more responsive, better hoof growth, body condition improves, appetite changes, tendons are stronger, injuries heal more rapidly. These changes can occur quickly with more subtle ones noted in days, not months. When this approach is coupled with whole-food nutrition, to fuel the body properly, the results can be even more dramatic. Through targeting the microbiome and GI tract specifically as a main part of therapy, it can often reduce other approaches that may be used or have failed in the past.
As a veterinarian, I wish I had this level of information and tools 20 years ago to aid my patients. If things were different then, we may have been able to help a larger percentage of horses. Now, I have them available and I try to use them in every patient to aid their recovery and health. I don’t always win or succeed in every case, but every case is helped to some degree and with every case I learn a little more. Can we go further? Absolutely, but time is what is needed to make further connections to provide additional value. We need to use the tools and research that is readily available to us, apply it, and make progress in the world of equine health and soundness. If we don’t, then what is the purpose?
If you desire more information, please contact us! To gain more information on fecal cultures, click HERE, or check out our vast library of articles. If you desire specific guidance with your horse, please check out a consultation with Dr. Schell.
Author: Tom Schell, D.V.M, CVCH, CHN