Re-addressing fructan level #Fructans


freddelskutar@...
 

Hello ECIR.
  I am posting this topic because there is a nearby horse that has laminitic symptoms even after months of diet change. This horse is on the same low sugar hay as mine. It was mentioned that the hay could till be a trigger as it's fructan level is greater than 2. In this case the WSC is 10.08, ESC is 5.44, Fructan of 4.64, Starch 0.41 (DM). The horse breed is a Morgan, in case you were wondering. 
  I was wondering if there was any new research on acceptable dietary levels for IR/EMS horses?  And on fructan levels? I realize this may be re-opening a subject that has been discussed many times before but I felt I needed to ask. 
  Thank you.
--
DS and Julie
BC, Canada
3/2018

Case History: https://ecir.groups.io/g/CaseHistory/files/Delli%20and%20Julie

Photos: https://ecir.groups.io/g/CaseHistory/album?id=88389

 


Sherry Morse
 

Hi Delli,

Fructans have long been disproved to have anything to do with endocrine laminitis:


Now, having said that - as you should know there are more than just diet changes associated with endocrine laminitis.  Has this horse been tested to be IR or PPID? If yes, have there been further tests after diet changes to see if the bloods have improved?  If the horse was overweight, has it lost weight?  Have there been adjustments to the trim to address issues in the hooves?  What else is the horse eating besides hay? 

That's just the tip of the iceberg on questions but if the horse is IR or PPID you can help the owner by directing hm/her to this list so we can help the horse directly by having answers to all those questions.



 

In addition to Sherry's excellent and accurate response, a reminder to go full circle with "diagnosis."

First and foremost, what is the cause of the laminitis? We often forget that laminitis is a secondary outcome. Treating laminitis is like trying to get the cows back in the barn - how did they get out in the first place?

If the horse has or had documented high insulin and that is the known cause of the laminitis, the question should be, "Did the diet change result in a reduction of insulin?" If yes, then the diet is effective and the source of the current symptoms need to be investigated. Other things to consider - does the horse have unmanaged PPID? Does the horse have abscesses brewing from post-laminitic damage? Is the trim/hoof support adequate? Is there an underlying infection?

If fructan is an issue related to laminitis, then the mechanism is through endotoxemia or "sepsis-induced laminitis." In that case (which, BTW, has never been documented on pasture and certainly not hay), then there would be symptoms accompanying or preceding the laminitis, like a gut upset. 

In the experiments where researchers triggered sepsis-induced laminitis using rapid induction of inulin fructan, they needed a minimum of 5 lbs to trigger laminitis in 30% of animals and 8 lbs in 100%. That's pure fructan, delivered to the gut all at once. If this horse is eating hay (slowly) with 4.64% estimated fructan, fed at 2% bodyweight per day, that's about 1 lb of fructan, and a different form of fructan than that derived from artichokes, delivered over the course of the day. I would be more than happy - thrilled actually - if someone could explain to me how that would trigger sepsis-induced laminitis. Even the unproven theory that there is a release of fructose/glucose molecules as the fructan is being fermented and that somehow results in hyperinsulinemia is squishy in this case because even if you use NSC (WSC+starch), it's barely above 10%. So... where's the logic?

Sorry - don't mean to shoot the messenger and you were absolutely correct to ask. It's just that, after over 10 years of illogical argument with no data to support it, it gets annoying. Take this quote for example,

"Although laminitis has yet to be induced experimentally by feeding fructan-rich pasture or a fructan-rich extract, there are anecdotal reports of clinical laminitis occurring when diets are below 10% ESC+starch but high in NSC." Again... what is the cause of the laminitis? Notice that it doesn't say, "there are reports of hyperinsulinemia..." again (and again) pointing to the outcome, not the cause. The paragraph concludes with, "Until specific research data are available, horse and pony owners would be well advised to avoid feeding high-NSC pasture and hays,... to soak... to use grazing muzzles."

As a scientist and advisor to this group, I find this completely illogical. It basically says, "There is no proof, but let's put the burden on the horse owner." Not only is there no proof, there's no physiologic basis for the rationale. Fructans are pre-biotic and are likely more beneficial than not. They certainly don't have a role in glucose or insulin production unless the horse is a species unlike all other mammals. 

Argh... sorry - it's not you - it's this topic!
--

Kathleen (KFG in KCMO)

Director and Research Advisor, ECIR Group Inc.

Missouri, USA, 2005

https://scholar.google.com/citations?hl=en&user=3-I7UI0AAAAJ 

 


Sherry Morse
 

Thank you so much for filling in more information Kathleen.  I too have a huge issue with some of the misinformation out there about IR and PPID (particularly when I hear it coming from a vet) but this is a great summary of this particular topic. 





 

Sherry,

It always comes back to the fundamental, NO Laminitis!

If it's too late, then you treat the cause and support the hoof.

You don't treat laminitis with diet. You treat hyperinsulinemia with diet. You prevent hyperinsulinemia with diet. You treat PPID with Pergolide, (sorry - no prevention for PPID). Because these are the most common causes of laminitis, this is where our focus goes. But, I could go on:

You prevent fructan induced laminitis by not delivering 8 lbs of artichoke-derived fructan through a naso-gastric tube (to date, the only documented cases of fructan-induced laminitis).
You prevent grain induced laminitis by locking the door to the feed room.
Then there are the causes of laminitis like concussive, support-limb, placental retention, Lyme disease and on and on. Laminitis is always secondary and without understanding the root cause, can never be adequately dealt with.

--

Kathleen (KFG in KCMO)

Director and Research Advisor, ECIR Group Inc.

Missouri, USA, 2005

https://scholar.google.com/citations?hl=en&user=3-I7UI0AAAAJ 

 


freddelskutar@...
 

Thank you Sherry and Kathleen. 
This is a relief since my horse is also on this hay and she had laminitis off and on for 2 years. I will pass on your helpful replies. 
--
DS and Julie
BC, Canada
3/2018

Case History: https://ecir.groups.io/g/CaseHistory/files/Delli%20and%20Julie

Photos: https://ecir.groups.io/g/CaseHistory/album?id=88389

 


Sherry Morse
 

If Julie is still having issues with laminitis we can help, but we really need updated information to help you help her.