Hello Emma,
I think most of our members have faced the same dilemma of how to get our horses to eat what is good for them!

If you haven't read about the Emergency Diet yet here is a link: https://ecir.groups.io/g/main/files/1%20Start%20Here/2.%20Emergency%20Diet.pdf
This is a good place to start with her diet. You can save money by switching to flax seed instead of the oil. You buy "stabilized" cold milled flaxseed or buy whole seed (cheapest) and grind it yourself daily. You can feed it whole, cheapest and easiest ,but you will need to feed about 50% more per day. 

Here is a helpful document: https://ecir.groups.io/g/main/files/9b%20Pulling%20it%20Together/Picky%20Eaters%20Checklist.pdf
I have a picky eater who is IR. I originally started him on the emergency diet but once I tried to add needed minerals it was a struggle to get him to clean up his bucket feed. Reducing the minerals to a pinch at a time and doing a sloooooow increase may help. I found he was much more inclined to eat Soyhull Pellets which I found available from a large feed mill that makes a variety of in-house feeds with the pellets added. Soyhulls and soyhull pellets are a safe feed for IR horses.

Here is a link to info about a Canadian Timothy hay cube that is safe for IR horses: https://ecir.groups.io/g/main/files/5%20Core%20Diet/Ontario%20Dehy%20Timothy%20Balance%20Cubes
Many of us have used them for our horses bucket feed or as a complete hay replacement. They are a smaller cube that will expand into soft short hay pieces. You can use this instead of beet pulp or in addition to beet pulp. You should be able to find these to purchase.

Apple sauce should really be limited as apples have high sugar naturally. Instead you can try sugar-free "Flavoring" syrups. You can make your own, using food grade extracts like peppermint oil, anise oil, etc. My horse is eating much better since I have been adding Fenugreek powder and Brewers yeast. I don't know which one he likes better so he is getting both. The brewers yeast also has dietary benefits.



You can do your own searches for useful files. Just click on the "Files" button in the column to the left. For "How-To" help click on the Main group "Wiki" also in column on left. You can search the messages here also as there is a Search button at the top of each page.

Please join our CaseHistory group, you should have received info about how to do that. Joinging the group and getting your first case history created will help our moderators to help you. They need the details about your horse that go into the case history in order to give you safe and applicable advice and timely responses.

We also have the ECHorsekeeping group and the ECHoof group.  Each group has to be joined individually. You'll find a lot of good info posted in the other groups also.

Welcome to the group! 

The ECIR provides the best, most up to date information on Cushing's (PPID) and Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquette, what goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: IR is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

• low carb (less than 10% sugar+starch)
• low fat (4% or less) 
• mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine. If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers. 

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISE: The best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

ECIR Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

Hi all!

I am looking for suggestions on a feed for my PPID/IR mare - Rozee. She was on Tribute Essential K previously (prior to diagnosis) and then was switched to MadBarn Omneity / Madbarn AminoTrace+ (in addition to beet pulp and flax oil). Unfortunately, she won't eat either of them so she is currently just getting beet pulp and flax oil.

My first question is: would it be safe to add unsweetened apple sauce to her feed to entice her to eat it? Or is that a no-no for PPID/IR horses?
My second question is: are there any feeds in Canada that aren't widely expensive that would be beneficial to her? I've seen the suggested feeds from the website but they are all from the states (with the exception of MadBarn which she won't eat) and well outside of my budget (I can't afford $100 USD a month for her feed).

Open to any and all suggestions!

Also, in terms of work/caloric needs she is:
- 15 hh paint mare, 15 years old
- On a dirt paddock, free choice hay during turnout and then about 2 flakes morning and night in her stall
- Eats beet pulp and 1 pump flax oil currently
- Ridden about 3-5x a week (typically 4). 3 days a week moderately intense ride, 1-2x a week more relaxed stretchy ride/hack.

Looking forward to your suggestions!
--
Emma B.
emma.bradshaw2@...