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Metabolic Syndrome and Insulin Resistance in the Horse; New Therapy Options

Equine metabolic syndrome and insulin resistance is an ongoing epidemic in current times.  Although the case load is very high, as is the morbidity rate, options for better management are not keeping up with nor offering improved outcomes for the horse.  Laminitis and chronic foot ailments are often associated with EMS and insulin resistance, which adds to the pain and suffering associated with the metabolic condition in the horse.  The laminitic condition is one common reason for euthanasia in the horse, many times associated with equine metabolic syndrome.  In prior articles, I have outlined the problem on many levels, correlating with our research findings.  In this final part 4 of the article series, I plan to outline specific therapy options that we are implementing in our equine patients with very high levels of success.

Equine Metabolic Syndrome and Ketones
EMS and Ketones in the Horse

Equine metabolic syndrome and insulin resistance is on the ever increasing rise in the horse world and the problem is complex.  Despite the complexity, most owners and veterinarians are seeking one option, one pill, one supplement, or one injection that will solve all the associated problems.  While this is desired, it is not reality.  The horse’s body, like ours, is very complex and there are many factors that are leading to and also being created as a result of that insulin level rise and overweight body condition.

There are various factors that need to be modified in every equine metabolic and insulin resistant horse, which include:

  • Diet (reducing and eliminating grains, improving forage quality)
  • Exercise (an absolute must component)
  • Proper foot care, trimming and balancing

If these factors are not modified, the results will be greatly diminished in every horse with EMS or IR.  There is no two ways around diet and exercise.  Despite claiming you are feeding a low NSC grain, or a low-carbohydrate forage, or even soaking your hay to reduce carbohydrates, this may or may not be acceptable for your horse and produce clinical improvement.  Step back, look at what you are doing, then ask yourself one simple question.

“Is what I am doing helping, hurting, or just holding my horse steady in his or her metabolic status?”

This question needs to be asked in every case.  The reason being is that most owners that I interact with are using the advice of another, applying it, and in the end have up to 10 different supplements and regimens in place, but despite, are still having problems regarding body condition, foot pain and ability to resume pasture life in their metabolic horse.  If this is the case, your regimen is not working.  There is no sense in continuing to do something that is not helping and could quite possibly be hurting your horse’s progress or health.

Step One for the Metabolic Horse:

In most metabolic equine patients, my goal is to address the internal inflammatory response and address digestive health, which is a known problem and addressed in many other articles I have posted. In almost every EMS or IR horse, I will start those patients on the Cur-OST EQ Total Support formula as a baseline.  This formula is dosed at full dose twice daily for 14 days, and can greatly assist us with promoting a healthy inflammatory response and regaining balance to the digestive tract.  The results are greatly increased in the horse if the diet is modified additionally and exercise is implemented.

In most EMS and IR patients, I personally discontinue ALL grains, and only utilize an alfalfa or other grass hay pellet as a medium for supplement administration.  In addition, I encourage owners to feed those horses a higher quality of hay forage, often an alfalfa mix, at 1.5% BW per day, which helps us to fulfill nutrient demands and provide higher quality fiber for digestive support.  All other supplements are discontinued in most cases, unless there is a medical need.  This includes all vitamin/mineral feed or ration balancers.  These are inorganic, synthetic nutrients often in a base of artificial flavoring and sugars to improve palatability.

You want to provide for your horse’s body naturally, ideally through food, not inorganic vitamins and minerals.  There are many positive aspects to ‘real food’ that are just not acquired through these feed balancers.  Your horse is missing out on the real benefits of true food.  Take advantage of it and help your horse to help himself.

As a part of monitoring in the EMS or IR horse patient, I will use insulin levels every 2-4 weeks to assess for progress.  In addition, I personally utilize fecal cultures initially and again 4 weeks after starting a regimen to assess for progress.  In our laboratory, I will also measure and monitor free radical and antioxidant levels in the blood.  It is also possible for you, as the owner, to evaluate blood or urine ketone and sugar levels.  All of these tests are very useful to indicate our progress and also to show us how much damage may already be present.  Through repeated monitoring, you can then adjust the regimen as needed, keeping in mind that not every horse is the same and different needs arise.

Step Two for the Metabolic Horse:

After 2 weeks of supplementation of the Cur-OST EQ Total Support, along with diet, exercise and proper foot care implementation, the horse should be re-evaluated.  Progress should be determined.  It is not expected to have a complete resolution to the body condition problem, reduction in elevated insulin levels, or even foot soreness.  What you are looking for is an improved circumstance or situation.  Is your horse improved?  Maybe more comfortable?  Able to walk more freely?  Not requiring the boots as much or not at all?  How does your horse compare NOW as compared to 2-weeks ago?

If there is improvement, then often I will choose to continue our course of therapy with the Cur-OST EQ Total Support formula.  If there is no improvement or there is a desire to take it to the next level, then there are many new therapy options available to do just that!

Let’s now enter the ‘Phases of Metabolic Support in the Horse”

Phase One Metabolic Support in the Horse

The first phase that I will often implement in the EMS and IR horse, not to mention the PSSM horse or any horse in need of improved cellular and energy support, is through the use of Cur-OST EQ Keto Oil. This first phase is often used in combination with the Cur-OST EQ Total Support formula along with a completely ‘grain free diet’ and higher quality forage, with exercise.

The Cur-OST EQ Keto Oil is a unique blend of medium and long-chain triglycerides derived from a combination of MCT, Coconut, and Flax Seed oils.  This blend provides a complete source of medium chain triglycerides which are readily absorbed from the digestive tract and used by the liver to produce ketone bodies.  Ketone bodies are an alternate fuel source for cells throughout the body and the real kicker here is that the higher the ketone level in the blood, the lower the insulin level.  This means that if you are able to drive up ketone generation in the body, cells are functioning on a higher level, and with that insulin and sugar metabolism are more regulated.

Ketone bodies serve many valuable functions to the horse and overall health.  They are used as a vital source of energy, regulate insulin and sugar, impact the immune response, immune function, and even the digestive health on a positive level.  A well balanced and complete source of medium chain triglycerides is the best option to encourage ketone generation in the horse’s body.  Supplementation with the Cur-OST EQ Keto Oil, even as a solo-therapy, has been shown to raise ketone levels post- prandial by as much as 0.5 mmol/ml.  However, not every horse responds as you would like them to.  This is where monitoring comes into play, although not absolutely essential.

Phase Two Metabolic Support in the Horse

A high percentage of metabolic horses respond very nicely to the Cur-OST EQ Total Support and the Cur-OST EQ Keto Oil.  However, some of those horses are very damaged on a cellular level and fail to respond as desired.  In fact, if you do some laboratory work on those horses with monitoring, you will find that those are the ones that fail to generate adequate ketones post-prandial and also demonstrate a lower than desired internal antioxidant and even free radical level load.  These are the more critical cases, indicating a higher level of damage on a cellular level.  Thus, they require more attention if we desire to reach our goals and help them to be more comfortable.

Phase two in the metabolic horse in our program generally involves the use of the Cur-OST EQ Cell Repair ATP & NRF2 formula.  This is a high level and potent antioxidant blend that addresses cellular health, mitochondrial function, and internal antioxidant production.  Very critical stuff when it comes to your horse’s health.  One isolated antioxidant is not helpful in these matters, such as vitamin C or E.  In fact, many times, these isolated forms can create more harm than good.  This is addressed in my article on Vitamin E in the horse.

You want and desire specific antioxidants that boost mitochondrial function and are not compromised in situations where the horse is not generating their own internal defenses such as glutathione.  The Cur-OST EQ Cell Repair formula utilizes a concentrated Astaxanthin 1.5% extract, Acetyl-Carnitine, Alpha Lipoic Acid, and Vitamin C at research doses to achieve cellular benefit.  In our research patients, we are able to raise the antioxidant level by over 300-400 points in one week of daily supplementation. In addition, the before below normal free radical level load is more often back up in the normal range, which indicates improved cellular function.  These specific antioxidants also impact insulin and glucose function, and do assist with ketone generation in the body.

In most horses, once we reach phase two, I will either maintain on the EQ Total with the EQ Keto Oil and add in the EQ Cell Repair, OR, I will discontinue the EQ Total Support and replace it with the EQ Cell Repair.  This decision is based on how the horse responded in the first 2-4 weeks to the prior regimen.  If I do go with the Cur-OST EQ Cell Repair, I will use the full dose once daily for 14 days, reassess and if the horse is demonstrating improvement, I will reduce the dose by half and continue. If at any time the horse begins to regress, the dose is immediately increased.  In almost all horses, I will use the EQ Cell Repair formula alongside of the EQ Keto Oil blend.  Very important for cellular energy production!

Phase Three Metabolic Support in the Horse

While it is labeled as Phase Three, this phase really coincides with phase two.  After the first 2 weeks, using diet, exercise and the EQ Total Support, the horse is re-evaluated, often with repeat fecal cultures and other parameters.  If the horse is making progress, and all parties are content, but yet, feel there is some improvement to be gained further, I will implement Phase Three, which is our Cur-OST EQ P450 formula.

I’m not trying to make things complicated, EMS is just complex by itself and each horse is different.  If that horse is showing improvement, that is good, but if the sugar and insulin levels are still elevated and not showing signs of budging, then we have some work to do, especially if foot pain is persistent.  However, some of these horses may not be as critical on blood work or on clinical exam and in need of a potent formula like the EQ Cell Repair.  This is where the Cur-OST EQ P450 comes into play.

Cur-OST EQ P450 is a unique blend of Astragalus membranaceus, Wild Yam, Wild Yam concentrated Diosogenin, Ginger Root, Turmeric Root, and Tangerine Peel.  All of these herbs are used in research doses, which means high levels.  Every one of these herbs has direct benefits when it comes to insulin and glucose function, digestive health, and inflammation.  The Cur-OST EQ P450 is added to the EQ Total Support and EQ Keto Oils to boost protection.  In many cases, after a couple of weeks, the horse is showing nice signs of progress clinically and on repeat blood markers.  In fact, many of these horses can have their EQ Total Support dose reduced by half or even eliminated.  This is due to the ability of the EQ P450 to modulate various health aspects in the horse.

Phase Four Metabolic Support in the Horse

The final phase of metabolic support in the horse revolves around ketone generation and is often reserved for those more stubborn horses that fail to respond to prior measures.  Ketones are one of the most potent substrates for energy in the body and can directly impact insulin and sugar levels, not to mention other health parameters in the horse.

We are attempting to boost ketone levels in all three prior phases, either directly through the EQ Keto Oil or indirectly through improvement of cellular function.  However, some horses are very damaged on a cellular level and cannot generate sufficient ketones for optimal cellular function.

Phase four revolves around the Cur-OST EQ Keto BHB formula, which is a direct ketone salt supplement containing the more prominent ketone body, beta-hydroxybutyrate, which is coupled with magnesium.  Through direct supplementation with a ketone salt, ketone levels are almost instantly raised without the need for the horse’s body to generate ketones.  The EQ Keto BHB formula is readily absorbed and in most cases will raise 2-hour post prandial ketone levels by 0.5-1.0 mmol/l.  This level can greatly enhance internal cellular energy production and directly impact insulin and sugar metabolism.  However, the levels will not remain high for long, as the ketones are used for energy in the body.  It is typical for levels to gradually taper off over 4-6 hours, thus twice daily supplementation is required.

In most cases, I will supplement the EQ Keto BHB at 20 grams twice daily, which does provide approximately 1800 mg of Magnesium.  Don’t forget that and factor that into your other supplements if using a magnesium supplement.  Most horses will respond to the EQ Keto BHB with a perceived state of relaxation, which is attributed both to the magnesium but also the ketone body and associated improved cellular function.  Ketones impact cellular energy and function, and additionally can impact pain pathways secondarily.  Thus, if pain is lower, there is a higher state of relaxation.

I will personally monitor the horse’s blood ketone levels before and after meals for about 7-10 days, along with their clinical response.  In most cases, I will decrease the dose by half, to about 10 grams twice daily after the first 10-14 days of usage of the EQ Keto BHB.  Most horses, if other the supplements are implemented, along with diet and exercise, do not require longer than 30-45 days of EQ Keto BHB usage.  The reason for this is that cellular function is often improved and the horse’s body is now capable of generating internal ketones.  In some horses, however, daily usage may be required or intermittent doses as needed.

EMS in the Horse; Wrapping it all UP!

Equine metabolic syndrome is a complex condition all by itself.  I also firmly believe that we, as man, as owner, create this condition over time due to the practices and regimens put into place.  Considering this, the solution lies in unraveling the condition that we have created and altering or restoring cellular pathways is not always an easy task.  There will never be ‘ONE’ thing to resolve the EMS epidemic that is occurring, no different than there will never be ‘ONE’ thing that resolves the obesity and diabetic problem present in humans.  These are conditions created out of choice and reversing our choices is not always easy.

Reversing equine metabolic syndrome in the horse and even laminitis is possible, but it takes work, patience, understanding and time.  The concepts posed within this article are extracted from the human side of research and medicine, demonstrating benefit in people under similar conditions.  The concept of ketogenesis, the ketogenic diet, inflammation, and oxidative stress cellular damage are not new concepts.  They have been around in research and mainstream medicine for decades, if not centuries in some cases, but are just ignored or not applied due to complexity in the approach.  The sad reality is that in all honesty, only these approaches stand the test of time and have real merit or potential in regards to managing health conditions in people and in the horse.

I encourage you, as the horse owner with an EMS horse, to take the time to read and re-read this article and prior articles in this series in order to gain a higher understanding.  Do not take me on my word, as that is not my goal.  Instead, research the principles, then put things into action step by step and assess your results.  Every horse is different and depending on the level of cellular damage present, some cases are just more challenging than others.

I have faith and full belief that metabolic syndrome and even laminitis in the horse can be remedied over time, with health being restored.  You just have to define your goals and realize that sometimes a higher level of effort may be required.  The bottom line is to restore health on various levels for your horse.  As you are able to do that, then the regimen becomes simpler and more defined, mainly due to changes in lifestyle now revealing their benefits.  As health is restored, there is less dependence upon veterinary care and your costs and concerns begin to vanish.

Recommended Reading:

Article One on the EMS Horse

Article Two on the EMS Horse

Article Three on the EMS Horse

Author:  Tom Schell, D.V.M, CVCH, CHN



4 thoughts on “Metabolic Syndrome and Insulin Resistance in the Horse; New Therapy Options”

  1. One major problem; many EMS horses are incapable of exercise due to laminitis
    or founder. Even with padded hoof boots they have trouble walking.

    1. Hi. Yes, this can be a problem in the initial stages which I would agree, however, with proper management of the feet, along with proper diet and targeted supplementation, this issue should be improved in a short period of time, allowing for increased exercise with improved comfort. Thank you!

  2. Thanks for the information. It’s a lot to absorb and I definitely agree that the hardest part is that each horse is an individual (not to mention a BIG puzzle) I will be rereading it several time. My 26 year old, IR and Cushings gelding is currently on EQ Pure. (I was waiting for this article but recently reordered to take advantage of the summer discount). He is not being ridden (I free lunge him) and is turned out in a dry arena for about an hour a day with buddies to keep them moving. He is sound at a walk but about a 1-2 at a trot. My goal is to give him a comfortable retirement. Using the EQ Pure I was able to discontinue use of NSAIDs (Equioxx). He has been on it for over 3 years and is a very happy customer (seeing his results I started on Tumeric/Curcumin supplement also!). My goal is to give him a comfortable retirement, but I also need to be reasonable about his supplement costs since I need to retire too!
    1) If I transition him over to the EQ Total Support, what ratio to the Pure would I use?
    2) He is on Timothy hay because a previous laminitic episode was triggered by hay with high clover content. So I avoid hays with alfalfa and clover. Do you find that some horses react to the higher protein in the hay or could this be something else? I was testing his hay and balancing the mineral content (as well as double checking the sugar) but I must admit I’ve been lax the last year since I board and I’m not always able to ensure that the hay is consistent. However in previous testings the timothy source was also the lowest in sugar. He is a hard keeper so right now he does get Triple Crown Senior. I definitely will be trying the Keto Oil to reduce/eliminate the senior feed. (I’m doing the Keto diet myself and I’m amazed at the benefits and reduced joint stiffness).
    3) Are supplements for horses with Cushings any different, or is it just knowing that it’s probably going to involve more figuring out since the cortisol affects the IR? He is on Prascend and has been tested using the ACTH / Insulin test. First Diagnosis at 14 (with laminitic episode). He is showing a thicker hair coat this summer but not the “Cushings” woolly hair. I have not tested this year. Is there any possibility of this protocol reducing the need for Prascend? (you discuss cellular changes so I was wondering if any of the progression is reversed).
    Thanks again for all your efforts and providing the research and articles to us.

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