Maintaining weight on senior IR/Cushings gelding.

Starshine Ranch

Love what you said about Fanny... you've done such good work with her! ... especially since she's currently boarded and not under your watchful eye 24/7.
Linda in Grass Valley, CA  2020  Midnight and Ostara

Pamela Swartz

My beloved 25yo mare lost a bunch of weight when we moved from California to the PNW in March. 

She can chew hay but sometimes quids. Had her teeth checked and did very limited dental in August and the quidding reduced but she has bridging on her molars so not all hay is masticated and makes it to the back molars. 

I have been feeding her twice daily 5 lbs TC Timothy Balance Cubes, 8 oz ground flaxseed and 2-3 pounds dry r/s/r beet pulp with her supplements and she has really turned around. She is on 25 compounded pergolide and her ACTH this September was mid 20’s. Her attitude is back to fire cracker and when I’ve ridden her (limited so she puts energy into weight gain) she’s always willing to GO and tosses in a few bucks for good measure when we canter - just like she used to do. Makes my heart sing so I don’t reprimand her. She’s having fun and so am I! 

Pamela Swartz
Fanny 25 yo, Beau 20yo, Finney 15 yo. All PPID/IR

Eleanor Kellon, VMD

Loss of chewing strength isn't necessarily PPID related.  The angle of their chewing surface changes with age and influences chewing even in teeth appear to be in good repair, but the negative effect is even worse if they have issues like smooth or missing teeth.
Eleanor in PA 
EC Owner 2001
The first step to wisdom is "I don't know."

Chris Pennbo

Hi Kathleen and welcome, I have an almost 29yr old Morgan who is PPID but not IR.  However the first indication I had something was wrong, 3 or 4 years ago, was his extreme weight loss. Even after getting his levels under control I could not get weight back on him. I was frantic that I might lose him due to nutrient deprivation! That was when I learned that a little talked about side affect of Cushings is lack of muscle strength- especially in the jaws. It all made sense- the cuds dropped everywhere and the ensuing weight loss.  We removed the hay and started feeding soaked Triple Crown Natural Balanced Timothy Cubes supplemented with everything recommended here. I am happy to say that Monte started gaining weight immediately and is a great weight, shiny, and healthy now. It requires some effort on our part as he is part of a small herd and he would rather eat their hay while they would rather eat his cubes- thus separation during mealtime is a must! LOL
Anyway I just wanted to bring that to your attention. Good luck with your boy!
May, 2019  Big Bear Lake, California  

Kirsten Rasmussen

Hi Kathleen,

We need to send a Case History with the results of his insulin and ACTH testing, but I agree with Martha that when a PPID horse has trouble keeping on weight it's usually because the PPID needs better control with pergolide.  Several members here have reported this.

Switching the senior feed to the Triple Crown Naturals Timothy Balance cubes will be a much safer source of calories for a horse with metabolic issues.  They can be soaked or even just steamed in a closed container with a bit of boiling water poured in, if chewing is difficult.

Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Snickers' Case History
Snickers' Photo Album


Hi Kathleen,

Your first post here triggers our lengthy welcome letter, containing all sorts of ECIR related information.  Keep it in mind as you work your way through the care details.  What might not seem important now may well be later.

The first thing that comes to mind when I read that he’s PPID and too thin is that his PPID isn’t being controlled by the amount of pergolide he’s getting.  The other factor that weighs in is that PPID results in the loss of musculature, including in the jaw.  You may not see quids of unchewed hay but the chewing he does may not be adequate for the best digestion.  And the muscle loss with PPID might make him look thinner than he actually is.

Does he get his insulin and ACTH tested regularly?  PPID is a progressive disease and often requires increasing the dose to maintain control.  Even apparently good control as evidenced by low ACTH may not be enough as ACTH is not the only hormone involved, just the one we can measure.  1mg of Prascend is essentially a starting dose, which you and your vet can increase to see if it makes a difference.  There’s no reason a little more pergolide would cause him any issues.

I have several guys in their 30’s now and their diets are pretty much entirely Triple Crown timothy balance cubes.  The Triple Crown Senior is likely to be pushing his limits in terms of the sugars and starch it contains.  The oils we feed are flax oil and CocaSoya, but in very small amounts as large amounts of oil can result in an increase in insulin resistance.

My horses get blanketed in winter but this year is confusing because it’s been so warm here where it’s usually threatening snow.  If you do blanket, be sure to do regular checks on his condition.

And now for the welcome I promised.  Don’t hesitate to ask any questions and for further clarification.  We are here to help you find your way taking care of your IR/PPID horse and potentially his brother.  Don’t forget to fill out and post his case history and photos.  Those help us immensely in guiding your care.


Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/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 etiquettewhat 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 Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/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 EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*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: EMS 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 EMS/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 (look under the Hay Balancing file if you want professional help balancing). 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 EMS/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 EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR 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.

EXERCISEThe 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. 

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

Kathleen Slinger

I have an almost 28 yr old Arab gelding. He is IR and has Cushings. He gets about 10 cups of Triple Crown Senior, with Camelina Oil and rice bran daily Free (tested) hay 24/7. He also get one full Prascend pill. He is a very happy guy and active. He shares a small property with his brother who is his best friend and they roam free all day, but have shelter. I have trouble keep weight on him, especially now that cold weather in Idaho is setting in. I would appreciate any dietary suggestions or any other advice to help him maintain a good weight. Thank you.

Kathleen S in ID 2020