Fat and Foundered: Equine Metabolic Syndrome

1. Fat and Foundered:Equine Metabolic Syndrome

2. Introduction Recent survey of Equine Veterinarians revealed 3 top causes of laminitis: Cushings Syndrome (PPID) Metabolic Syndrome/Insulin Resistance Lush Pasture Do you have a horse that is often unexplainably foot sore? Did you know obesity could be linked to laminitis?

3. What is it? Equine Metabolic Syndrome (EMS) Obesity Regional fat deposits (regional adiposity) Insulin resistance Laminitis Previously thought of as hypothyroidism Long recognized syndrome in horses

4. Why Metabolic Syndrome? Similarity to horse findings: Obesity Insulin resistance High blood glucose Differences: Blood pressure triglycerides

5. Who is affected? Young to middle aged horses Mares and geldings Morgans, Peruvian Pasos, Pasofinos, Tennessee Walkers, European Warmbloods, ponies, Saddlebreds, Spanish mustangs, Arabs

6. Genetic Predisposition? Ossabaw Island Swine Abandoned by Spanish colonists ~ 500 y ago �Thrifty Gene� Survival method for seasons of feasting & famine Modern captivity & excess food� ?Metabolic Syndrome

7. Thrifty Gene Genetics of horses allow for extra fat storage for winter In nature, horses would eat less in winter and lose weight by spring In confinement, generous amount of food constantly available More efficient energy metabolism in previously mentioned breeds

8. Risk of Obesity Fat isn�t just repository of stored energy Adipocytes produce hormones (endocrine and paracrine activity) Leptin and Resistin Pro-inflammatory cytokines Raise total body inflammation Lower threshold for disease Increased weight on lamina

9. Obesity ? Laminitis Prolonged insulin elevation Prolonged glucose elevation Alters blood flow Experimentally induced obesity increases insulin resistance

10. EMS Diagnosis No definitive test Fasting insulin Fasting blood glucose Glucose tolerance testing Tests to R/O Cushings Blood Leptin

11. EMS Diagnosis Best predictors of laminitic events: Basal insulin levels Serum Leptin concentration Generalized body condition scoring Cresty neck scoring

12. EMS Diagnosis

13. EMS Diagnosis

14. EMS Treatment Goal?2 pronged approach Induce weight loss Reduce caloric intake Eliminate cereal grains Improve insulin sensitivity Diet exercise

15. EMS Treatment Induce weight loss Quality grass hay: 1.5% BDWT/day then lower to 1.5% of ideal BDWT/day over 2 weeks Access to trace mineral and vitamin block Eliminate grain & pellets No access to pasture Have hay analyzed Non-structural carbohydrate content < 10% ideal Dairy One forage 800-496-3344 $30/sample Soak in cold water 30 min reduces NSC 50%

16. EMS Treatment Medical Vit E up to 10,000 IU/day Levothyroxine 4 scoops/day 3-6 months to induce weight loss then taper 4 weeks Chromium and Magnesium and Vanadium Metformin (Glucophage)�insulin sensitizing drug Clenbuterol (Ventipulmin) for weight loss Traditional management of laminitis

17. EMS Treatment Exercise is key 20-30 minutes trot daily 5-6 days/week Improve insulin sensitivity in 2 weeks

18. What can you do? 1-9 scale 1�dead horse walking 5� ideal, feel ribs but don�t see them 6�7�fleshy, difficult to feel ribs, look for fat deposits 9�morbidly obese, crease on back holds water in rain

19. BCS 1

20. BCS 1

21. BCS 2-3

22. BCS 4

23. BCS 5

24. BCS 6

25. BCS 7 or 8

26. BCS 9

27. BCS 9

28. What can you do? Regular exercise for your horse Avoid sweet feeds Learn the BCS system Recognize�a fat horse won�t be a happy horse for long Test insulin on horses w/ previous bout of laminitis Cautiously introduce horses to lush spring and fall pasture

29. What about pasture grass? Spring/fall or immediately after heavy rain Horses consume in large quantities CHO overload on intestines CHO overload contributes to IR

30. Questions?