New member, question about feeding recommendations for thin horse with PPID
Hello everyone, I have a 31.5 year old Thoroughbred mare, BCS 3/9 with PPID and recently diagnosed with pyometra. She takes 1mg Prascend once daily, and bloodwork in the spring showed normalized ACTH levels at this dosage. We are doing medical management for the pyometra, and at least now we have some helpful info as to why she has been dealing with weight loss and low BCS. Our vet had said prior to this pyometra diagnosis that since she was a thin horse with PPID that it didn't matter what she ate, ie. that I don't have to be careful about sugars, etc. She is BAR, with a great interest in eating and in life, so I'd like to keep trying to do the best I can for her, until she tells me it's time. She currently eats 1.5 scoops of Triple Crown equine senior twice daily + hay (quality varies depending on what our facility can provide us). Turnout has been lacking due to facility limitations and she has not been eating much grass at all for two months now. I am interested in recommendations on what to be feeding my mare to promote weight gain in the face of her illness, while acknowledging the PPID. Any advice/references would be appreciated. Thank you.--
Amy Levinsky in Ohio 2021
Welcome to the group! In order for us to provide you with more accurate and custom information to help you with your mare, please complete a case history. I will also tell you, that sometimes when a test result says "normal" it isn't a safe bet. You can upload the lab results as well, so we can better see the big picture. For instance, when exactly was your mare tested and how? Was it a fasting test? What was the ACTH level?
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 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 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.
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.
No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:
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.
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.
If you have any technical difficulties, please let us know so we can help you.--
Primary Response Team
September 2018, Summerfield, FL
Shark's Photo Album
Hi Amy, I would not feel comfortable ignoring sugar and starch unless I had her insulin and glucose test results and they consistently showed no elevation when her ACTH is controlled. While it's true it's unlikely for insulin to be high in a skinny Thoroughbred, with PPID you cannot be certain without testing. Bacterial infections are another cause of laminitis even when insulin is normal, so she us already at risk with her pyometra.
Her ACTH (and insulin + glucose) should also be tested now to make sure it is still well under control coming in to the seasonal rise. General advice here is that if PPID isn't controlled, then it doesn't matter what you feed....they just won't gain weight.
If you can source some Triple Crown Naturals Timothy Balance cubes (dry or soaked, depending on how well she chews) and beet pulp (rinsed, soaked, rinsed), you could add these to her diet to replace the senior feed. Both are much better options for adding easy to chew, easy to digest, forage-based, and PPID-safe calories. The TCNTB cubes have some beet pulp in them, too, so they are higher calorie than other hay cubes (3 lbs TCNTB = 4 lbs hay). But they are guaranteed to be below 10% ESC+starch, and they are already mineral balanced so they can even be fed as a complete feed (with the addition of salt, vit E, and ground flax).
There are also some other safe feeds you can try:
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album
Eleanor Kellon, VMD
Spring is the best case scenario for ACTH numbers. You could see something very different now. Mentioning that because weight and muscle loss is often a sign of incompletely controlled PPID.
You may be surprised to know that horses with severe IR and diabetic range glucose are very thin. I'm not saying that's her for sure but you need blood tests for glucose and insulin to tell.
If she hasn't been dewormed recently, do that. The poor immunity, which is also a symptom of PPID, which led to the pyometra also weakens their resistance to parasites.
Finally, tooth wear and dental work over time change the angle of the chewing surface, making chewing less efficient. She may do better on a soaked cube diet - type to be determined by her blood work.
Eleanor in PA