Ally & high insulin continued, Zero


Sherry Morse
 

You can retest 10-14 days after a diet change to see if you're going in the right direction




Mary T
 
Edited

I don’t have the insulin we drew back yet.  And yes, I think it was too soon.  Also, I wanted her totally back on soaked low carb hay & off the Zero after that high insulin, but I learned the feeding guy didn’t understand that—so he kept feeding Zero, that means the test we drew is likely worthless.  I now have Ally on Standlee low carb teff pellets for 3 meals/day (4.75-5# per meal in a mash) plus one 5# meal of soaked low carb hay.  She was started on the teff Friday 5/20/22.  I will start her R/S/R BP next.  How long should I wait until drawing labs?  Today I watched her drink after her 4:30 PM meal—she just sipped a little, no guzzling.  They keep her stall very clean, mucked twice/day, I don’t see excess pee.  I will have her vet draw ACTH & TRH, when we draw labs next, to be cautious.  Her digital pulses are gone.  Her walk is forward.  She is blowing her coat on schedule.  Ally looks great & is a happy girl.  No goopy eyes, which she gets when PPID not controlled. I haven’t forgotten the history—I will have to do it on my phone, as all I have atm—but please just ask me in the interim!
I filled her water bucket today when I left.  I don’t know when it was filled—she has an automatic waterer also, but prefers her bucket.  The waterer has a meter we can check.  I will have them text me what she drinks tomorrow as the barn is closed Monday.

I just reread my earlier post about Ally’s Cabergoline dose, which I said was at 2.9 cc.  That’s a typo made on my phone—sorry!  She’s at 2.6 cc.  We did not start there.  I’m not home & don’t have my notes with me.  But we began much lower & worked up over time, calculating Ally’s dose based on her labs & her clinical status.  She needs her shot every 10 days.  We keep her ACTH (from memory) no higher than the low 20’s.  The last level was I think below 20 

The Cabergoline has been heaven sent for Ally, who became severely resistant to Pergolide—she was frankly at death’s door when we started it in 2018– laminitic, about to founder.
.Now, she looks great.  She does not look or act like a 26 year old horse!

She was diagnosed with PPID in 2006 at age 10, after an accident —> serious injury & over a year of stall rest.  Very unusual situation.  She had all the typical PPID symptoms (muscle wasting, hirsutism, etc), & in retrospect, I think it had been coming on for a year before diagnosis.

Going through my email tonight for previous labs—all Cornell
3/11/2022 Insulin 15.36
1/14/2022 Insulin 8.89, ACTH 18.8, leptin < 1
11/30/21  Insulin 23.31 (she reached WAY under the fence on her knees to get to weeds, I don’t know how she is that limber at her age, but she is very determined!  Little stinker :).   Weeds were then pulled even farther from the fence & area treated) ACTH 20.8, leptin < 1.  

7/23/2021 Insulin 9.29, ACTH 18.0, leptin < 1
Anyway, there’s a start.  So you can see why I freaked out when we got an insulin of 114 after the feed change!

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Thank you!
Mara & Ally
2006 PNW


Mary T
 

Yes, I do need to do that history.  But cannot for a few days, due to work.  We have increased her Cabergoline as needed to control ACTH, since starting in 2018.


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Mara & Ally
2006 PNW


 
Edited

Hi Mara,
This is a bit difficult to follow without the case history to review.  I’d be happy to try to help you get started on a new one if you like.  As others have said, start with Ally’s situation at present.  If concerns arise about her past, we will ask and you can add those details as needed.

You have Ally on cabergoline.  She’s been on the same dose for a number of years.  Have you considered increasing her dose, either in amount or frequency?  PPID is a progressive disease and it’s expected that she would need an increased dose with age.  You mentioned increased pee, which as Dr. Kellon says is a sign of uncontrolled PPID.  I had my horse on cabergoline for awhile, before I lost him to a colic.  I increased to higher doses than were first recommended in order to control his symptoms.  When I reached that point, he looked incredible for a 31 year old horse.  Those larger pee spots are one thing you can monitor but you may notice other symptoms of advancing PPID as well to pay attention to.
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Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Nancy C
 
Edited

Hi Mary

You are working very hard for your girl. I wanted to offer a couple of thoughts.

ECIR does not recommend canola.

Regarding EMS/IR and inflammation, equines are not the same as humans.  Have a look please at Dr Kellon's 2017 NO Laminitis Conference proceeding

Inflammation in Equine Metabolic Syndrome (EMS)

You can down load it for free here https://www.ecirhorse.org/proceedings-2017.php

TRH was hopefully done in your absence. PPID can drive higher insulin. If it is the Zero, you'll know after it has been withdrawn, although I agree with Sherry the re-draw could have been a tad early.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



Mary T
 
Edited

I was very unfortunately unable to be at the vet appt due to a migraine, so BO took over.  Frustrating.  I would have insisted on a few things different. I had them do lateral rads out of an abundance of caution.  They were very good, no issues.

I am convinced the cause is the Zero.  I was a bit concerned when I started it, but it was what I had & Ally was OK with it as a carrier.  This elevated insulin seems to be directly correlated to the feed change, though I understand correlation is not causation :).  Ally’s labs have been excellent up until now— ACTH mid normal, insulin 8 then 15 (sometimes, she snags a weed through the fence) since the first of the year.  She is easily shedding her coat.  We stopped the Zero & put her back on the soaked hay as soon as you responded—pulses now gone.

I’ve been digging into the ingredients of the Zero more & remembering Ally’s history from 2006-2008, & even prior.  Here is something I read:
The “roughage products” in Zero are canola meal.  I personally avoid anything to do with canola, as it is one of the worst oils, very highly processed using hexane solvent.  The meal is a by-product.  It’s full of omega-6 & highly pro-inflammatory.  (BTW I am a retired nurse with a bit of knowledge about human nutrition).
Here’s a bit more about canola:  https://www.marksdailyapple.com/dear-mark-canola-oil/#axzz3KUUalqWk  
The lupine flakes are a legume grown in Australia.  
Rice bran oil is high omega-6 & pro-inflammatory.  
So 2 of 3 primary ingredients are highly pro-inflammatory.  I don’t touch them myself.  I won’t feed them to my dog.  Until I thought I had nothing else, I did not feed them to Ally except in small amounts as a carrier or to make her “soup”.  IF her insulin is not a fluke (that’s what vet thought & why she redrew), I’m suspicious it’s driven by inflammation.  We know inflammation drives IR.
The percentage of fat in Zero is 4%.  I know from experience that fat will drive IR in Ally.  I wish I had all my years of notes.  I have tried complete low carb
feeds with higher fat levels years ago, IE 2007-2008, then tested insulin.  Invariably, low carb complete feeds w/ fat (except 2-4 OZ flax) drove up insulin.  Every time.
The rice bran oil is the third ingredient on the label.  If the Zero puts her dietary at 4% pro-inflammatory omega-6’s, & what Dr. Kellon advises in the files is to stay under 3-4% fats at most for a horse w/ PPID/ IR, then I would have no room to add omega-3’s, which she must have.  (BTW, we’ve been giving her 2-4 OZ flax, didn’t help—I think the ratio was still off).
For 16 years, the only fat she’s had is 2-4 OZ flax/day—so switching to a diet with 4% fat from rice bran oil is not a good thing at all.  I’m not surprised in retrospect her insulin popped up—I think the pro-inflammatory food drove it up.  I think maybe the product works with a less sensitive horse—but not Ally.
I recognize canola is in everything now & is touted as a healthy product.  But it’s not.  I think marketing, money, & bad science.  But I also don’t agree with the entire way the US eats—high carb, processed food, high use of seed & canola oils—> epidemic of pre-diabetes, IR, diabetes —> heart disease, Alzheimer’s, etc.
If I had known about the low carb teff hay pellets, that’s where I would have started, & that’s where I want her.  They are pure hay, rather than byproducts made using toxic solvents & full of omega-6’s.

I thought about Metformin.  I want to eliminate the Zero first.  Same with additional PPID testing.  In 2006, when I first contacted Dr. K, Ally had been put on rice bran oil.  Dr. K. had me take her off it, as she said it would drive her IR.  I had to reach back 16 years to remember.

Ally comes first, always.  The thing that bothers me is Ally looks fabulous & not at all like 26.  She does VERY well.  I would be riding her but for a period of insane work.  And no, I am not in denial.  BTW, she is on 2.9 cc Cabergoline every 10 days, since 2018.
Thank you so much!

RE canola oil from Mark Sisson:

Canola was a hybrid derived from rapeseed to reduce the high erucic acid content of traditional rapeseed oil, which had a bitter taste and toxic effects from the acid. Canola oil is also called LEAR (Low Erucic Acid Rapeseed). Like most cash crops, the largest share of the market is by far GMO-based, and one corporate GMO giant, Monsanto, has been accused more than once of the release of unapproved GMO seed varieties. Despite all the genetic engineering, somehow canola remains one of the most heavily pesticide-treated crops. Hmmm – wonder how that all works.

Continuing on the canola’s journey now…. Once harvested and graded, seeds are heated to facilitate oil extraction. Most canola oil is chemically extracted using the harsh petroleum-derived solvent hexane. Even when expeller pressing is used, a process common to organic brands, the massive force of industrial presses still produces heat. True “cold-pressed” canola oil (extracted with millstones) does exist but can be hard to find and is more expensive.

Following extraction, canola oil must be de-gummed to remove unappealing solids that settle during storage. The process involves heat and sometimes the addition of acids. Next stop, the oil is then bleached and separated. Finally, the oil (known for its stench) must be deodorized through heating methods that use temperatures as high as 500 Fahrenheit.

(Frankly, the whole process is rather unappetizing if you ask me. Seriously.)

This brings us back to the omega-3 issue. Polyunsaturated fats aren’t the most stable fats out there. In fact, they’re pretty sensitive to heat and will turn rancid quickly. Obviously, canola oil undergoes a good deal of heating and heat-related degeneration in its processing. Needless to say, this is no good. Whatever omega-3 benefit there might have been is gone – like keys in lava, as one of the old Jack Handey quotes put it. What’s more is, you end up with a small but damaging amount of trans fat in your “heart healthy” oil. How’s that for irony?

My thinking is this: why bother with something so processed and unhealthy when there are umpteen other, better options out there? 



 as I r as I reach back in time & memory, I recall what Dr. Kellon specifically advised me when we first contacted her for help & nutritional advice after Ally’s PPID diagnosis.  At that time, a vet had put Ally on a high fat diet with rice bran oil, because she had tied up years prior.  Dr. K was not pleased about the oil for Ally.  She did not like Ally on the oil & said it was most likely exacerbating her IR.  As you know, just being Arabian, she’s going to be baseline IR.  We took her off the oil, along with her soaked hay—with huge improvement.  After that, as below, I experimented with complete feeds w/ oil with poor results.
I understand PSSM horses need oil.  But maybe they’re not sensitive thrifty Arabians.each back in time & memory, I recall what Dr. Kellon specifically advised me when we first contacted her for help & nutritional advice after Ally’s PPID diagnosis.  At that time, a vet had put Ally on a high fat diet with rice bran oil, because she had tied up years prior.  Dr. K was not pleased about the oil for Ally.  She did not like Ally on the oil & said it was most likely exacerbating her IR.  As you know, just being Arabian, she’s going to be baseline IR.  We took her off the oil, along with her soaked hay—with huge improvement.  After that, as below, I experimented with complete feeds w/ oil with poor results.
I understand PSSM horses need oil.  But maybe they’re not sensitive thrifty Arabians.

 as I reach back in time & memory, I recall what Dr. Kellon specifically advised me when we first contacted her for help & nutritional advice after Ally’s PPID diagnosis.  At that time, a vet had put Ally on a high fat diet with rice bran oil, because she had tied up years prior.  Dr. K was not pleased about the oil for Ally.  She did not like Ally on the oil & said it was most likely exacerbating her IR.  As you know, just being Arabian, she’s going to be baseline IR.  We took her off the oil, along with her soaked hay—with huge improvement.  After that, as below, I experimented with complete feeds Arabians.
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Mara & Ally
2006 PNW


Sherry Morse
 

Once you have your test results back you'll have a clearer path forward.  Did you have them do a TRH Stim test as suggested by Dr. Kellon (https://ecir.groups.io/g/main/message/277388) to see if PPID is possibly an issue or discuss Metformin as Dr. Kellon suggested here: https://ecir.groups.io/g/main/message/277358

Is there a reason you had her insulin redone today since you just had it done a week ago?  Unless you changed her diet the day the blood was drawn it's unlikely to be a different result now.