Dr. Harman Speaks on Equine Metabolic Syndrome (Cushings) and Laminitis
By Dawn Jenkins

Excess haircoat that does not shed out is just one of the possible symptoms of the frustrating and all-too-common Equine Metabolic Syndrome.

Founder. Laminitis. Two dreaded words to horse owners. Both affect the feet. Triggered by a metabolic change, or by damage directly to the hooves, laminitis (inflammation of the hoof capsule laminae) can result in founder (separation of the laminae that hold the inner coffin bone to the hoof wall), causing pain and lameness that shorten many horses' lives.

Today, a more subtle type of laminitis/ founder is on the rise that involves glucose intolerance similar to diabetes. This form of laminitis stems from condition called Equine Metabolic Syndrome that was previously thought to affect only older horses.

Holistic veterinarian Dr. Joyce Harman of Virginia sheds light on what has in the past been called Cushings-related laminitis. "T he new term that has been accepted in human medicine and now in equine medicine is Equine Metabolic Syndrome. This is a very large syndrome rather than a specific disease," Dr. Harman says. "It is being diagnosed with increased frequency and the condition is being seen in younger horses. T he primary causes are overfeeding rich feed, sweet feed, soybean meal, stress, genetics (thrifty genotype as it is called in human medicine), over-vaccination, and overuse of steroid drugs and antibiotics leading to internal stress - basically modern horse life that is not all that different from what humans are going through.

The symptoms for Equine Metabolic Syndrome are numerous. According to Dr. Harman they include: hirsutism (long hair that does not shed out in the summer), refractory laminitis, winter laminitis, weight problems (over or under weight), sluggish thyroid glands, insulin resistance, thyroid dysfunction, muscle soreness, diabetes, stocking-up of legs (especially hinds), polyuria/polydipsia (drinking and urinating excessively), collagen breakdown, poor hair coat, frequent infections of the skin or other organs (including chronic hoof abscessing), poor teeth, multiple dental abnormalities, increased colic, lowered immunity to intestinal parasites, decreased intestinal wall integrity, infertility, and muscle wasting.

"Laboratory diagnosis of Equine Metabolic Syndrome can be unrewarding, as it is difficult to test for accurately," Dr. Harman says. "If a horse has even just a few of these symptoms, with or without chronic laminitis, it is probably related to Equine Metabolic Syndrome.

"Equine Metabolic Syndrome is very closely related to what's called in people insulin resistance, or Syndrome X, which is where the cells basically become too stiff to allow the insulin to carry the glucose into the cells. Glucose is needed by each cell for fuel to burn for energy. Glucose comes out of all foods but is very concentrated in sweet feeds and rich green grass. Many horses are basically easy keepers and are very sensitive to the effects of too much glucose.

"As the body gets bombarded with excessive amounts of glucose and the cells become too stiff to allow the insulin to carry the glucose into the cells, the insulin system becomes essentially worn out. Consequently, when the insulin is not utilized correctly by the body, the glucose ends up being stored as fat rather than being used as fuel.

"This sets up numerous metabolic disorders, of which one of the complications is chronic laminitis.

"Another thing that happens in a lot of these horses is that they have high levels of steroids internally, or endogenous steroids, and those seem to weaken the elastic tissue of the hoof wall. The steroids are the body's natural response to stress, and this stress can come from many reasons, including regular travel and shows, keeping horses in confinement without turnout, overcrowding in fields, illnesses, chronic disease and constant drug treatment to name a few things.

Dr. Harman refers to the work of laminitis researcher Dr. Chris Pollitt of Australia and the Streptococcus bovis bacteria he discovered that stems from the hindgut, multiplies and triggers enzymes that cause the lamina to separate. Her concern, from a holistic standpoint, is that many of our standard stable management practices increase intestinal permeability, causing "leaky gut", and therefore laminitis.

"When the gut wall becomes inflamed, it leaks undigested food particles through to the liver," Dr. Harman continues. "The liver detects the foreign material and goes into overdrive trying to solve the problem. Many of the vaccines and drugs we use on a regular basis over-tax the liver, and it has a difficult time coping with the overload. This, in turn, stresses the immune system, and can contribute to arthritis and other symptoms of internal stress that increase the body's steroids (well documented in the human literature), which we treat with drugs, particularly anti-inflammatories that can further inflame the gut wall, resulting in a vicious cycle.

"Leaky gut can be caused by overuse of antibiotics, which kill off both the good bacteria and the bad," Dr. Harman says. "Yeast (candida) overload also inflames the gut wall, as well as phenylbutazone (bute). Throw in a little stress, and you have a recipe for potential laminitic disaster.

"One of the problems that we see is that we feed an awful lot of phenylbutazone to laminitic horses. Also, a lot of horses live on bute long before they become laminitic, and bute itself causes inflammation of the gut wall and actually makes the gut wall leaky. If we are indeed helping to make this gut wall leaky, my big question is, are we allowing this [ Streptococcus bovis ] bacterial toxin to migrate more easily?

"I think that we are. So when we remove the bute and treat these horses holistically, we get a much better response to the treatment. The horses might be uncomfortable for a few days as they are getting accustomed to not having the bute, but in the end, they start to heal, usually in about three to four days."

And how does Dr. Harman treat these horses holistically? "To treat these horses naturally requires more than just throwing a few natural substances at them," she says. "It really takes a concerted effort to figure out what each individual needs.

"Equine Metabolic Syndrome is one of those perfect examples of what alternative or holistic medicine is about. We have to really look at the individual horse. I cannot emphasize this enough. Some horses need one minimal treatment with one or two ingredients. Some horses need multiple ingredients because their systems have already started breaking down so much, they cannot repair themselves without a lot of support."

Ponies, Morgans, Arabs, Mustangs and gaited breeds have perhaps inherited the ability to conserve their metabolism for times of hardship and an overload in feed can throw them into laminitic disaster. Dr. Harman says, "ALL the easy keepers, whether a breed or just an individual within a breed, are susceptible to being fed too much as are horses that are just plain overfed even though they have normal metabolisms if fed normally. You always have to take into consideration the individual horse and the availability of feed in the area they live. Alfalfa can be a very good source of protein for horses, if they can tolerate it. There is nothing in it that makes it hard to digest; for many horses it is too rich. For the horse that is underweight or has lost weight during a bout of laminitis because grain has been taken away, grain or alfalfa is needed to increase protein levels. Those horses are protein deficient. The average overweight horse does not need much grain or rich hay of any sort; grass hay can be too rich if it is made well. Many horses need only a late-cut rough hay, not moldy, just cut too late to look really nice and green. If horses are supported nutritionally and, even better, with homeopathy or Chinese herbs, it is possible to feed some grain or rich hay and the horse will be safe.

Dr. Harman views nutritional supplementation as critical to helping these horses, particularly mineral supplementation. She recommends beginning with probiotic treatment to repair the gut, and cheap isn't better - buy the best you can. Fermented probiotics balance the pH level of the gut and help repair the gut wall. Keep non-fermented probiotics refrigerated and feed as directed. Glutamine, an amino acid, helps the gut wall and can be fed, as well as the herbs slippery elm and aloe vera. Digestive enzymes are also helpful, and a candida type herbal cleanser may be necessary.

Basic nutrition includes unprocessed feeds low in sugar. Free choice minerals are very important, especially trace minerals, and should be available separate from the salt. Equine Metabolic Syndrome horses require extra minerals, especially magnesium, chromium, and vanadium. MSM, a sulfur, can be helpful, as it relieves sore muscles, adds flexibility to the cells, and repairs scar tissue. Glandular supplements, available from veterinarians, work well for stimulating hair to shed and enhance the function of the hormonal system. Vitamin C also aids the immune system. Coenzyme Q10 (500-600 mg/day) is an important antioxidant in the early stages of laminitis, and is helpful in lower doses later on. Omega 3 essential fatty acids (found in hemp oil and flax oil or meal) make the cells more permeable. High doses are needed to be effective, with 4-6 ounces twice a day of the stabilized meal or 4-6 tablespoons of the oil. A high quality multivitamin and whole foods such as apples (have a lower glycemic index than carrots) and rice bran are recommended."

"The horse also needs stress reduction, and help for the rest of the body, therefore chiropractic, acupuncture, Chinese herbs and homeopathics may be called for. Homeopathy is one of the branches of natural medicine where you really need to be working with a professional homeopath that is accustomed to dealing with laminitis cases," Dr. Harman says.

"But that's part of the key in taking most of these horses off of bute; you don't just walk up and say, 'OK, I'm going to take him off the bute' and leave him hanging. You have to use the rest of the tools available.

"To help prevent Equine Metabolic Syndrome, it is best to keep your horse physically fit and trim with plenty of turnout time and friends to keep him happy. This sounds great on paper, but the realities of life are that this is not possible much of the time, but is a good goal to work towards. Only feed as much low protein, low sugar grain as it takes to maintain body weight. If your horse is getting fat, you may need to use a muzzle if he is on grass, or make a small pen where there is little grass. Reduce stress as much as possible; think about competition schedules and giving time off between them. Think about the amount of drugs and other chemicals you are putting into his body. Even chemical fly spray may contribute by affecting the thyroid gland. If you see any signs of lumpy fat that looks like cellulite on the crest or near the tail, that is a serious sign of trouble brewing. As a baseline, feed fat horses supplements with high levels of flax or hemp as well as minerals to keep the glucose metabolism as healthy as possible. And above all, ride and have fun; that keeps the fitness part going.

"Equine Metabolic Syndrome is becoming more frequently recognized and overall a bigger problem in equine medicine. The more you can learn about health from a natural perspective, the better off your horse will be."

© 2003 Dawn Jenkins

Natural Horse Magazine and Dawn Jenkins thank Dr. Joyce Harman for her invaluable expertise and assistance in preparing this article.

Joyce Harman, DVM, MRCVS graduated from Virginia Tech in 1984. She operates Harmany Equine Clinic, Ltd., a holistic veterinary practice in Northern Virginia . Dr. Harman can be reached at: (540) 675-1855, heoffice@shentel.net .

Dawn Jenkins is a farrier and freelance writer in the mountains outside of Los Angeles, California . She can be reached at: (661) 245-2182 dawn@frazmtn.com .