Metformin vs pergolide Spirulina and wheat bran


Lesley Bludworth
 

I am reading to educate myself to advocate for my IR horse. So far vet thinks l L thyroxine is the way to go and adding platinum performance supplement which has magnesium and chromium yeast. Arguing against metformin, saying would use pergolide instead although ATCH challenge test not done.
Sophie is already on magnesium and chromium but not the chromium yeast, which may be better??
This article  from the Journal of Veterinary Internal Medicine says metformin for short term and maybe pergolide?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430910/
It also mentions suplementation of spirulina and wheat bran as being promising. 
She is on spirulina. Wheat bran as a prebiotic appears to be very effective as an anti inflamation agent in humans with metabolic syndrome 
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History


Eleanor Kellon, VMD
 

Thyro-L does not influence insulin sensitivity https://trace.tennessee.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=2019&context=utk_graddiss .  Chromium could be an issue if your hay was grown locally but magnesium supplementation should be based on hay analysis. Pergolide is for PPID, not EMS. Metformin works for many horses at least short term, some long term, some not at all. Spirulina and wheat bran are not the solution here. Diet control, treatment of PPID, exercise are. Wheat bran is much too high in starch for EMS horses and not a very good prebiotic in the equine diet.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lesley Bludworth
 

Understood. Not sure how to advocate when vet thinks otherwise and suspecting new vet will have similar opinions.
This article at least advocates for metformin.  
I would like to pay for a consultation with you Dr Kellon if the is an option. 


From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Eleanor Kellon, VMD <drkellon@...>
Sent: Monday, July 18, 2022 9:41:27 AM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: Re: [ECIR] Metformin vs pergolide Spirulina and wheat bran
 
Thyro-L does not influence insulin sensitivity https://trace.tennessee.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=2019&context=utk_graddiss .  Chromium could be an issue if your hay was grown locally but magnesium supplementation should be based on hay analysis. Pergolide is for PPID, not EMS. Metformin works for many horses at least short term, some long term, some not at all. Spirulina and wheat bran are not the solution here. Diet control, treatment of PPID, exercise are. Wheat bran is much too high in starch for EMS horses and not a very good prebiotic in the equine diet.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


--
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History


Sherry Morse
 

Hi Lesley,

How much does Sophie weigh now?  Thryo-L will not do anything for insulin levels although it can help jump start weight loss.  If she doesn't need to lose weight she doesn't need to be on it.  Heiro has very good marketing but will not do anything for your horse without all other pieces of the puzzle (weight control if needed, diet correct for an IR horse and in the right amounts and exercise if possible) in place.  We do not recommend it for this reason.  

We are now in the time of year when doing a TRH Stim is not recommended so starting on pergolide would be a guess at best as far as if it would help control the insulin level or not. At this point I would focus on getting the diet correct (following the guidelines for the emergency diet as outlined in your welcome letter) and starting her on Metformin to get her insulin down as quickly as possible.  How long Metformin will work varies by horse but for many it will help in the short term while you get your diet sorted out and weight off the horse if needed.

IR is a condition that is controlled by management. Some supplements can help but there is no magic bullet cure and based on your description of Sophie's issues with her feet as well as her crest and fat deposits she's probably had these issues for at least 4 or 5 years.  Is she in boots to help her feet?  

What bran is not an option for an IR as it is much too high in starch.  Chromium is only needed if your hay needs it be balanced, which you only know by testing. Same with Magnesium beyond what is recommended in the emergency diet.  




Lesley Bludworth
 

thank you, good to know about timing of ATCH challenge test and I would not want to stress her system even more at this moment. She is in boots,they do help.. I get this is a diet and exercise management issue and at the moment,  Its the vet I need to be able to convince to try the metformin and all I have is this 1 article and saying, well The ECIR group and Dr Kellon says otherwise.
Below is a 2012 study with horses using a portion of the bran that
does indeed sound promising. Gut microbiome is a powerful place to make changes.... but how to do it safely and effectively!

Effects of Aleurone Supplementation on Glucose-Insulin Metabolism and Gut Microbiome in Untrained Healthy Horses

https://www.frontiersin.org/articles/10.3389/fvets.2021.642809/full

On Jul 18, 2022 9:55 AM, "Sherry Morse via groups.io" <sherry_morse@...> wrote:
Hi Lesley,

How much does Sophie weigh now?  Thryo-L will not do anything for insulin levels although it can help jump start weight loss.  If she doesn't need to lose weight she doesn't need to be on it.  Heiro has very good marketing but will not do anything for your horse without all other pieces of the puzzle (weight control if needed, diet correct for an IR horse and in the right amounts and exercise if possible) in place.  We do not recommend it for this reason.  

We are now in the time of year when doing a TRH Stim is not recommended so starting on pergolide would be a guess at best as far as if it would help control the insulin level or not. At this point I would focus on getting the diet correct (following the guidelines for the emergency diet as outlined in your welcome letter) and starting her on Metformin to get her insulin down as quickly as possible.  How long Metformin will work varies by horse but for many it will help in the short term while you get your diet sorted out and weight off the horse if needed.

IR is a condition that is controlled by management. Some supplements can help but there is no magic bullet cure and based on your description of Sophie's issues with her feet as well as her crest and fat deposits she's probably had these issues for at least 4 or 5 years.  Is she in boots to help her feet?  

What bran is not an option for an IR as it is much too high in starch.  Chromium is only needed if your hay needs it be balanced, which you only know by testing. Same with Magnesium beyond what is recommended in the emergency diet.  




--
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History


Eleanor Kellon, VMD
 

On Mon, Jul 18, 2022 at 04:15 PM, Lesley Bludworth wrote:
https://www.frontiersin.org/articles/10.3389/fvets.2021.642809/full
I've seen that study. First, it was done in Standardbreds (not IR) that were also fed concentrate. The minimum aleurone dose to have any effect was roughly half a pound per day, equivalent to over 3 lbs of wheat bran which would send any horse with EMS immediately into laminitis.

There are no short cuts, no magic bullets. Even the extremely effective -flozin drugs won't work well if diet and PPID medication is not correct.
 
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lesley Bludworth
 

Dr. Kellon, 
This study used aleurone, which is the protein extract from the wheat bran, not full wheat bran itself.  Aleurone is a protein.  Aleurone can be purchased as as an extract without the starch aspect so it may not spike insulin at all but rather act as an antioixidant.  Its used in baking like gluten which can also be seperated from the starchy part of the grain.
The minimum dose of aleurone, 200 g had a beneficial effect and up to 400 g was beneficial if I read it right.  It also was studied in pregnant pigs with benefits that slowed/lowered insulin and glucose. 
Since it had a benefit in normal horses, seems like the next logical study would be in IR/EMR horses if metabolic control/benefits are the aim of the study. 


From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Eleanor Kellon, VMD <drkellon@...>
Sent: Monday, July 18, 2022 1:40 PM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: Re: [ECIR] Metformin vs pergolide Spirulina and wheat bran
 
On Mon, Jul 18, 2022 at 04:15 PM, Lesley Bludworth wrote:
https://www.frontiersin.org/articles/10.3389/fvets.2021.642809/full
I've seen that study. First, it was done in Standardbreds (not IR) that were also fed concentrate. The minimum aleurone dose to have any effect was roughly half a pound per day, equivalent to over 3 lbs of wheat bran which would send any horse with EMS immediately into laminitis.

There are no short cuts, no magic bullets. Even the extremely effective -flozin drugs won't work well if diet and PPID medication is not correct.
 
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


--
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History


Maxine McArthur
 

On Tue, Jul 19, 2022 at 06:15 AM, Lesley Bludworth wrote:
Its the vet I need to be able to convince to try the metformin and all I have is this 1 article and saying, well The ECIR group and Dr Kellon says otherwise.
Lesley, you can show your vet the European College of Equine Internal Medicine consensus statement (in our Files here: ECEIM consensus statement on equine metabolic syndrome (groups.io)) that states metformin is a suitable treatement for high insulin; metformin is also mentioned on page 14 of the EEG recommendations for EMS 200592_EMS_Recommendations_Bro-FINAL.pdf (tufts.edu) ; the Rendle paper in our Files also supports the dosage we recommend: Effects of metformin hydrochloride on blood glucose and insulin responses to oral dextrose in horses (groups.io) . There are a couple of older papers but they list a lower dosage than current research supports. 

I think it's important to remember that ECIR does not pluck the things we recommend out of nowhere. There is research backing it up. What we try to do is put the research into practice by giving owners the knowledge to distinguish which management/medications work, and which don't. 
 
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Nancy C
 

Further support of Maxine's comment, below is the mission statement of the ECIR Group Inc.
I think it's important to remember that ECIR does not pluck the things we recommend out of nowhere. There is research backing it up. What we try to do is put the research into practice by giving owners the knowledge to distinguish which management/medications work, and which don't.  
The mission of the ECIR Group Inc. is to improve the welfare of equines with metabolic disorders via a unique interface between basic research and real-life clinical experience. Prevention of laminitis is the ultimate goal. The ECIR Group serves the scientific community, practicing clinicians, and owners by focusing on investigations most likely to quickly, immediately, and significantly benefit the welfare of the horse.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



Sherry Morse
 

Hi Lesley,

Unless you can find a study that was done showing that aleurone actually was beneficial to IR horses when you set out to use it as it was done in a study of normal horses you are essentially doing a one horse study on it and you need to be prepared for the consequences of that (it may help, it may do nothing, or it may do harm).  You also need to be aware that if you want to prove that aleurone is having the effect you want to see you need to control for all other factors which means not changing anything else but that one management aspect.  

Personally that's not a chance I'd be willing to take with a horse with extremely elevated insulin who's already shown signs of subclinical laminitis for several years.





Eleanor Kellon, VMD
 

Lesley,

I understand they used aleurone, not wheat bran, but aleurone is not readily available and likely very expensive. Aleurone is not a protein. It is a layer of the grain that contains many different nutrients https://www.sciencedirect.com/science/article/abs/pii/S0733521021000667 . Also see table 1 of the article you linked.

It produced a change in normal horses, not necessarily a benefit. The mention of antiinflammatory effects does not apply to EMS like it does to rats and people. As they said, the lower rate of glucose peak may be due to slowed digestion of these concentrate meals. None of this means there would be any benefit for IR  horses on low carbohydrate diets.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lesley Bludworth
 

It is readily available, I could buy 2500 lb of it today but that would be ridiculous for me as an individual.
I have contacted the lead investigator of that study to see if studying this effect in IR horses could be the next natural progression of her research.  But I am a nobody!
I will contact each author of that study to see if they are interested in what the implications of their study could mean for metabolic issues in IR horses. 
Again, I am nobody, but I can certainly ask intelligent questions, of intelligent people who have power.
New ideas can be progressed by passionate people.  I'm certain progress in this field will continue to be made by investigating new ideas and that takes time, money but mostly asking questions !


From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Eleanor Kellon, VMD <drkellon@...>
Sent: Tuesday, July 19, 2022 6:06:39 AM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: Re: [ECIR] Metformin vs pergolide Spirulina and wheat bran
 
Lesley,

I understand they used aleurone, not wheat bran, but aleurone is not readily available and likely very expensive. Aleurone is not a protein. It is a layer of the grain that contains many different nutrients https://www.sciencedirect.com/science/article/abs/pii/S0733521021000667 . Also see table 1 of the article you linked.

It produced a change in normal horses, not necessarily a benefit. The mention of antiinflammatory effects does not apply to EMS like it does to rats and people. As they said, the lower rate of glucose peak may be due to slowed digestion of these concentrate meals. None of this means there would be any benefit for IR  horses on low carbohydrate diets.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


--
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History


Eleanor Kellon, VMD
 

Lesley,

You are not a nobody, but passion alone does not guarantee results.  Many ideas that looked promising have failed to pan out in horses. One good example is chromium. Human diets are low in chromium, and chromium supplementation actually helps glucose handling in horses on high carbohydrate diets but it failed to help EMS horses.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lesley Bludworth
 

Dr Kellon,
I meant im a nobody to be influential for research. Human research is finally probing how to optimize the gut microbiome for health.
Horse microbome optimization to combat inflamation, is in its infancy.
I am so thankful for your advocacy and leadership here.  So many suffering horses and humans, this really is a priceless service


From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Eleanor Kellon, VMD <drkellon@...>
Sent: Tuesday, July 19, 2022 10:56:53 AM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: Re: [ECIR] Metformin vs pergolide Spirulina and wheat bran
 
Lesley,

You are not a nobody, but passion alone does not guarantee results.  Many ideas that looked promising have failed to pan out in horses. One good example is chromium. Human diets are low in chromium, and chromium supplementation actually helps glucose handling in horses on high carbohydrate diets but it failed to help EMS horses.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


--
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History