As horse owners, we are likely to be familar with lameness associated with tendon or ligament problems, but did you know that there may be a connection with digestion? In many cases, we have tried everything to get that tendon or ligament to heal, but all efforts are futile it seems, with the problem likely recurring. Now, I certainly don’t have all of the answers for every problem, but over the past years, I have made some observations and a connection with GI health.
Over the years of veterinary practice, it becomes obvious that despite having a group of horses present for the same clinical problem, no two horses often respond identically to the course of treatment. We can have two horses present with tendonitis, treating both horses identically, but only one of them responds favorably. Or we can have both horses respond initially to therapy, but in the long term, one does well but the other seems to have a recurrence. The same is true with any method of treatment, invasive or not. We can use stem cells, IRAP or PRP therapies on two identical cases of tendon injury but not every case responds. What is the connection and why do they respond differently?
I don’t claim to have all of the answers, but have made some good observations over the years, not only regarding lameness but also a host of other conditions. I have made these observations in our patients and our rehabilitation horses, which enables me to hopefully pass on our knowledge to benefit other horses. The hard part that comes is that in our patients and rehab horses, I have the ability to see the horse and observe them over time, watching for changes albeit positive or negative. In some cases, this allows me to alter my protocols from my initial supplement plan which then hopefully benefits the patient.
In other cases, I get emails from owners regarding failure to respond to my suggestions, only to find out that I was missing pieces of the puzzle that migh help to explain the inconclusive response. The problem is that we often focus just on the problem at hand, not seeing the entire horse and making connections with other clinical problems. So, with this we learn and I have come to also realize that I need to be more complete in my questioning so as to get a complete picture of the horse in question.
So, What is the Connection?
Many cases of lameness in the sport horse involve damage to soft tissue structures, meaning tendons or ligaments and not bone related. When a tendon or ligament is injured, it essentially means that the structure has been stressed beyond capacity, ending up with fiber or cellular damage. Knowing this, we have to then ask whether if the structure was simply over stressed or was there a deficiency in terms of strength of that particular tissue? If it appears that there was a weakness, then we have to question whether if there is a nutritional deficiency in terms of protein, vitamins and minerals or if ongoing inflammation is predisposing that tissue to injury. To go further, we can then ask if that deficiency is a primary problem related to diet or is there a secondary deficiency stemming from a gastrointestinal level?
This may seem complicated and for this I apologize as I tend to just ramble thoughts directly out of my mind at times. Essentially, what I am trying to get at here is that in some cases of soft tissue injury, the deficiency or problem area appears to be coming from the gastrointestinal tract, possibly related to digestion. We can supply all of the nutrients needed in terms of diet, but if that horse has digestion issues, the nutrients will not be properly absorbed, which may then equate to weakness of the structures and an increased liklihood for injury.
Speaking along those lines, it is not just a lack of ability to absorb nutrients but we have to remember that the GI tract is tied in heavily with systemic inflammation and immune function. In some cases, I believe that we not only have poor digestion, but that there is a breakdown in the intestinal barrier that contributes to a heightened level of systemic inflammation which then may contribute to weakened tissues as well.
This then creates a triple threat and a predisposition to injury;
- Poor digestion and assimilation of nutrients
- Heightened level of systemic inflammation
- Dysfunctional immune response
How do we know?
One of the first things that I try to evaluate when presented a horse with a soft tissue injury is the diet, determing roughly if there is adequate provision of nutrients and protein. In many cases, we have a high level competing horse that is expected to perform, but the diet is lacking for a variety of reasons. If that is the case, then we try to correct through supplementation during the rehab process.
If the diet appears to be adequate, then I try to get a feel whether or not there are digestive issues at hand. There is no exact method for accomplishing this, but we have to evaluate the entire horse and their history.
Here is my brief rundown that I do in my head.
- What is the horse’s body condition? Are they overweight, thin or in good body condition?
- Is there a history of metabolic syndrome or insulin resistance?
- Is there a history of laminitis?
- What is the quality of the hair coat?
- What is the quality of the hoof health?
- Is there a history of gastric ulcers?
- Is there a history of recent or recurrent colic?
- Is there a history of diarrhea or GI upset?
- Is there evidence of excessive stress?
- Are there any behavioral problems?
To go through all of these points is beyond the scope of this article, but overall, I try to gain a good feel for health of those tissue structures, which I then feel is reflective of nutrient assimilation or availability. One of the biggest problems that I see is an overweight body condition with symptoms of metabolic syndrome and even insulin resistance. In many cases, the owners are aware that these horses are ‘easy keepers’ or maybe that they have been diagnosed with metabolic syndrome, but there is no mention of it or connection with the concurrent problem at hand. In other cases, we have signs of digestive problems such as ulcers, but we also have a thin body condition, but yet very dry and brittle hooves and lack of luster in the hair coat. The bottom line is that there are concurrent digestive problems.
If we can make those determinations, which can be complex at times, then we can begin to see how and why the soft tissue lameness occurred and what we now need to do to hopefully keep things under control or better managed.
In these situations of soft tissue injuries, we often step up our rehab horses and patients to a combination of the Cur-OST® EQ Total Support and the EQ Immune & Repair formula for at least the initial stages of management. I believe that this combination helps us to address underlying gastrointestinal inflammation and provide overall support for healing of the gastrointestinal lining, which then may allow us for enhanced absorption and assimilation of nutrients.
How can this combination help with digestive issues? The EQ Total Support provides Curcumin plus several other herbs shown to modulate the inflammatory response. Curcumin has also been shown to maintain heavy concentrations in the bowel, which may enhance effectiveness in these cases. Additionally, herbs including Dandelion, Marshmallow and Parsley help to not only improve digestion but reduce inflammation and provide a soothing effect to the gastrointestinal tract. L-Glutamine, which is found in our EQ Immune & Repair formula, has also been shown to enhance gut health by supporting overall cellular function, but by actually helping to repair perceived ‘leaks’ that may be posing problems.
By taking this approach with many horses with recurrent soft tissue injuries, our results have been better. Now, that being said, we do need to realize that in many cases, we have additional stress coming from training or environmental factors, that is contributing to the gastrointestinal problems. We have to remember that with stress, we have increased acid secretion and increased incidence of ulcers, but we also have increased gas accumulation and overall GI upset. Think of yourself when stressed and the impact on your gut or bowel function. Same applies to the horse.
Considering this, in some cases, we do have to utilize a formula such as our Adapt & Calm, which helps to manage healthy stress levels and aids in ‘taking the edge off’ for some patients, thereby secondarily improving GI health.
The bottom line is that with some patients, we need to dig deeper and see all of the problems, hoping to make connections. I understand that many horse owners and riders want immediate solutions, often in a one supplement approach, but the reality is that the deeper we get into this, the more complicated it can become. There are many factors involved with soft tissue injuries and GI health is just potentially one of them.
I am happy to help and welcome your questions!
All my best,
Tom Schell, D.V.M.
Nouvelle Research, Inc.