INSULIN RESISTANCE

Click here to download Heiro Protocol

Heiro in combination with the best hay, grain, and snacks is nutritional therapy.
• The only Horse Insulin Resistance supplement that’s tested to ensure safe sugar and starch content. You have no idea of the levels of these important ingredients in other products.
• The only Horse Insulin Resistance supplement double-lab tested for mineral amounts. These tests show how safe HEIRO is on levels of over ten (10) important minerals.

Click here to download In Depth Heiro Protocol
Ingredients:
1. Natural Herbs: Proprietary herbal blend exclusive to HEIRO containing natural herbs: Fenugreek, ocean kelp, spirulina, cinnamon, meadowsweet, MSM, chia, milk thistle, ginko, pine, willow, magnolia, ginger, aspen, alfalfa, oregano, cat claw, boswellia, peppermint, arginine, ashwagandha. Per scoop: Zinc Sulfate: 293 mg, Magnesium Oxide: 288 mg, Vitamin C: 117 mg, Vitamin E: 4755 IU.No fillers, no artificial colors or preservatives. All natural, great tasting blend.
2. Vitamin E Concentrate - 128,190 IU/Ib
3. Magnesium Oxide Mineral - 6,360ppm
What makes HEIRO a proprietary blend?
The amount of each herb, the part of the plant used to make the herb, and the unique blending process to bring the Herbs into a combination with Vitamin E and Magnesium. Hundreds of Insulin tests were run on horses using different types and amounts until we got real results that showed in how the horse moves, their ability to get back on grass and lab test improvements.
State of Pennsylvania Animal Diagnostic Laboratory System
Results on HEIRO documented at the State of Pennsylvania Animal Diagnostic Laboratory System (PADLS) on December 12, 2008. All electrolyte/mineral levels reported as SAFE. Actual levels of these important elements in HEIRO as follows:
Only 1.3 mg of Iron per scoop in Heiro. Heiro is the low iron choice to help your horse.
• Tested Melamine Free- state lab certified. Tested negative for salmonella, E. Coli, Listeria.
• Tested Pesticide Free- state lab certified. Tested low in sugar and starch.
• Tested Lead Free- state lab certified. Tested negative for Aflatoxin.
• Tested Drug Free- state lab certified.
HEIRO shows you actual lab tests for safety and purity – more than any other supplement.
HEIRO has the advantage of having a low iron level similar to grass hay. Some doctors are studying high iron possibly causing Insulin problems, so HEIRO is the choice for a tested safe low iron Insulin supplement.
HEIRO is using organics to provide natural, powerful, and safe minerals.
HEIRO is using organics to provide natural, powerful, and safe minerals.HEIRO has been tested extensively for safety and content.
Equi-Analytical Laboratories
The top commercial feed testing lab in the country. Results show low sugar (ESC) and low starch so it is SAFE. Results show a protein level of grass hay and a non-fiber carbohydrate (NFC) in the normal range of beet pulp. Results show a HUGE Vitamin E amount that comes to over 8,000 IU/oz. That is, by far, the best level of any supplement. The test results confirm the significant levels of ten (10) electrolytes and minerals.
• Report date: February 2013 – Iodine – 12.7 ppm
• HEIRO is the ONLY Equine Insulin Resistance product showing Iodine levels. At 12.7 ppm, 1 tablespoon scoop dose is .12 mg a day.
* High Insulin is like a small hammer banging on your horse's foot. No shoe nor amount any amount of Bute will help unless you first stop the hammer!

• No Dextrose (corn sugar)
• HEIRO is not cooked or processed – at times you will actually see the entire seed of the herb in HEIRO. Cooking takes vitamins/minerals out.
• Unsafe amounts of unknown items – HEIRO’s herbs are natural and double-lab tested for content and safety. In 2000, the State of California Department of Health Services put out a warning that five (5) Chinese herbal mixtures for Diabetes contained two (2) pharmaceutical drugs. Vet. Practice News, May 2006.
• No fillers – this is why you only give one (1) tablespoon a day.
• Not a diluted tea – again, vitamins and minerals are lost.
• No sugar additives – HEIRO is the only supplement tested to be low in sugar and starch. Our starch is only 0.5% and our simple sugar is only 3.8%.
• No preservatives. No artificial colors. All natural.
• No untested, unknown sources of herbs. HEIRO contains only the best, top rated, 100% Natural Herbs. There is no finer source of herbs for people or horses.
• Heiro is Non-GMO and tested free of Roundup (Glyphosate)
• PA state lab tested negative for Heavy Metals.
• No melamine– state lab certified.
• PA state lab tested negative for drugs, pesticides.
• PA state lab testednegative for Salmonella, E. Coli, Listeria.

In today’s world of tainted dog and cat foods and baby formula, you need to know HEIRO is safe.

* Proper diet and exercise is essential for horse health. HEIRO is a supplement to help maintain horse health. This product is not intended to diagnose, treat, cure, or prevent disease.

1. Heiro has 10 years of proven results. Noble was produced only in 2019.
2. Heiro has many herbs not in Noble. In Heiro, Not in Noble: Chia, Ginko, Pine, Magnolia, Oregano, Boswellia, Cat Claw, Arginine, Ashwagandha, Vitamin C, Zinc Sulfate.
3. Heiro has demonstrated the ability to lower insulin levels that has been seen in hundreds of horses. Noble has none.
4. Heiro is state certified to contain no drugs, herbicides, pesticides, or lead. Noble has no lab tests for these available on their site.
5. Heiro is lab tested for low SUGAR and low starch. Noble does not provide and testing on their site verifying what you really get.
6. Heiro is safe in pregnant mares and has helped dozens of mares avoid laminitis. Noble is NOT approved for pregnant mares.
7. Heiro is safe to use in combination with medicines like Banamine/Equioxx/Bute. Noble is NOT approved to use with these medications.
8. Heiro is designed to help horses get back to the pasture. Noble has no information on this important aspect.
9. Heiro is backed by an experienced veterinarian, Dr. Reilly, who can answer your questions for free and provide a free tailored program for your horse. Noble does not.
10. Heiro has a free website full of extensive information on the best hay, balancers, snacks, and insulin testing. Noble has none.
11. Heiro is a proprietary blend developed after years of research. The parts of plants used, and the quantity of each herb is unique to Heiro. Proven results on thousands of horses is why Heiro is a winner.

Imagine a cake mix – Flour, water, eggs, salt, SUGAR…But no idea of type of flour (corn, wheat, rice…) , no idea of the quantity 1 tablespoon or 1 pound of salt, no idea of 2 or 20 eggs. This is the problem with noble and why Heiro is a unique product to help keep horses healthy.

1. Hay Eating – In the right amount and right rate, your horse will have 24/7 forage, which will reduce insulin surging.
2. Rotation Balancer – higher protein in these lower insulin 3 ways. They are also low carb.
3. Thyroid Function – Low in all Insulin Resistance horses – now at bottom of normal range for T4 = sub-optimal. Need to be in top of normal range which is proven to help insulin sensitivity and help reduce nerve pain in feet.
4. Heiro – 1 scoop 2x a day for 10 days, then 1 scoop 1x a day.

*Note: if sore, will need a 5th step on pain management due to pain, increases insulin in all animals, so piles on top of metabolic insulin.*

A. Insulin is a hormone produced by an organ in the abdomen called the Pancreas. Using a Quarter Horse for reference, the Pancreas is about two feet behind the girth of the saddle on the right side and weighs approximately ¾ of a pound.

About 98% of the Pancreas produces enzymes to break down food in the gut and only 2% make hormones such as Insulin. Hormones are chemicals produced by one type of tissue that are transported to target tissues that have special receptors for the hormone; once the hormone and the receptor connect, the hormone will facilitate reactions inside the target cell.

B. What Does Insulin Do?

Horse Insulin has many jobs and many targets to different tissues in the body. Insulin has a direct action on almost all cells in the body and helps carbohydrate, protein and fat breakdown products enter cells. Insulin levels will increase after meals and then reduce back to baseline, so its levels are not constant all day. Insulin baseline levels peak in the morning and then gradually lower throughout the day.

Insulins' main job involves carbohydrates metabolism, these are broken down to simple SUGARS in the gut and as these SUGARS move into the bloodstream, they eventually go to the pancreas. At the pancreas, the glucose SUGAR (a carbohydrate) triggers the release of insulin into the bloodstream. Lower baseline levels of insulin will go up to 2 to 3 times as these higher blood levels of sugar signal to the pancreas to pour out insulin.

The mechanism of glucose and insulin works similar to a lock and key mechanism. The insulin escorts glucose to a cell – at the cell a reception that the insulin “key” unlocks, to allow glucose to enter the cell.

As insulin does its job, Glucose levels in the blood start to drop (glucose is now in the cell and not in the bloodstream). As glucose levels in the blood reduce, the pancreas senses this and insulin flow out of the pancreas is reduced to the baseline levels.

C.What causes insulin resistance? Basically, the lock and key system are broken. This occurs in several ways; some ways combine to make IR worse.

Way for Pathological Hyperinsulinemia

1. The receptor (the lock) on a target cell directly damaged, so when insulin comes along (the key) with glucose, there is no lock and Key connection to be made. With no connection, glucose can’t get in the cell and the blood glucose levels are not dropping normally. This artificial elevation triggers the pancreas to pour out more and more insulin until the problem is corrected.

   Result: Higher than normal insulin is traveling to tissues.

   Imagine a hotel with 10 doors – and due to IR, 7 doors are “closed” – your key does not let you into the hotel.
2. The number of receptors on the cell is lower than normal. Again, this produces the same result as above, higher than normal glucose leading to higher and higher insulin. The receptors work but there are less of them.

   Imagine a hotel with only 2 doors – the other 8 doors have been bricked up – there is no door to even try a key.
3. The final result is that Insulins Normal Action is directly inhibited – the target cells are resisting to work with insulin. So the pancreas pours out higher and higher insulin to “push” glucose into cells to maintain blood sugar (glucose) Levels.
   D. Regarding fatty tissue which is another target tissue for Insulin:
   • Horse Insulin promotes Glucose into fat cells which help in fat synthesis
   • Simultaneously, Insulin promotes enzymes that help increase fat synthesis
   • At the same time, Insulin inhibits another type of enzyme that normally breaks down fat
   This is a “triple-barrel shotgun effect” — all of which promote fat. This action by Insulin is normal in your horse but you can already hear warning bells if things go wrong. Too much Insulin means too much fat and that puts weight on your horse.
   

A. The Definition: Insulin resistance (IR) is the inability to respond to and use the insulin produced by the body. Because the insulin is not functioning properly, the blood glucose is not moving into the cells, as usual, so the pancreas senses its original increased output is not working, so it pours out more and more insulin to try to reduce glucose.

In early IR 4x and 5x insulin output, it allows for glucose to be controlled.

Example: Normal post-meal insulin is 50uml. (2x-3x baseline) Early IR, might resurge 100-150uml to get glucose under control.

The hallmark to IR is High Insulin/ Normal glucose.

But as IR progresses it takes huge insulin surging to try to control glucose – sometimes 10-15x more than usual. So, insulin can be over 500uml in advanced cases.

In normal horses you get a normal hyperinsulinemia spike after meals, that will in a few hours return to normal baseline levels. In IR, you set extended pathological hyperinsulinemia (blood levels of insulin higher than normal) that can last 24 hours a day and be at very high levels. This constant high insulin damages cells. According to the American Diabetes Association, IR and diabetes in people can have a 7-12-year decreased life span. In the horse, this translates to losing 2.5-4.5 years of life.

In Horse Insulin Resistance, the base level of Insulin is about 3 times higher, so there is a constant elevation during the day. When an Insulin Resistance horse has a grain meal, there is a pathological Hyperinsulinemia that sees the level of Insulin go up 30, 40, 50, and over 100 times usual levels, and can remain elevated much longer than normal.

B. What are common problems that create IR - What is breaking the lock and key system?

1. Obesity – Inflammatory mediators damage receptors. Also, high insulin itself blocks insulin's normal action. So, the pouring out of more insulin to overcome IR will work in early IR, but it's setting up for later problems.
2. Cushings (PPID) – High ACTH hormone interferes with insulin action also. In addition, this disease further increases glucose which is not helpful – it's going to trigger more insulin output from the pancreas. This disease also reduces muscle mass – muscle is the biggest user of insulin hormone, so less muscle means fewer receptors for insulin to work on. Note: Studies show high ACTH by itself (Cushings/PPID alone with no IR also) does not cause laminitis. Need to be IR or IR + Cushings/PPID for laminitis. This disease is pouring gas on a fire, but it’s not the fire – it's adding to IR which the #1 cause of laminitis. Only Cushings/PPID? No Laminitis, not even microscopically.
3. Infections – Fevers will jump up glucose and that can increase IR. Endotoxins are shown to also cause insulin surging and contribute to IR
4. Pain- Can increase glucose, ACTH, cortisol – all leading to insulin surging.
5. Excess carbohydrates – often seen in cases of too much fresh forage or too much high sugar fresh forage. Excess grains/feed/snacks.
   Click here to see Dr. Sandow’s 2018 study showing high insulin exposure directly damages laminae.
   See Below 26 Ways Heiro Helps your Horse:
   3. Does My Horse Have Horse Diabetes?
   No. Horses do not get Diabetes like people.
   Equine Insulin Resistance is mistakenly called Horse Diabetes, Horse Pre-Diabetes, Horse Early Stage Diabetes, or Horse Type 2 Diabetes – for years and it created confusion. Horses and people can both get Insulin Resistance, but horses do not go to the next step of Diabetes. In people, they can advance on to Diabetes if Insulin Resistance is not controlled.
   In Insulin Resistance: Blood Insulin is high but Blood Glucose (Blood Sugar) is normal for both horses and people. In people, Early Stage Type 2 Diabetes occurs if Insulin Resistance is not controlled: Blood Insulin is High, Blood Glucose is also high. Horses do not get this type of Diabetes. In people, if Early Stage Type 2 Diabetes is not controlled, the Pancreas cells “burn out” and can’t make Insulin any more, so Blood Sugar goes super high and Insulin shots are required. This is called Late Stage Diabetes. Again, horses do not get this type of Diabetes.
   * Horses are lucky they do not get diabetes. In people, it is now the most expensive disease to treat. Diabetes is the fastest growing health problem and Diabetes is the #1 cause of blindness in people.
   Rarely in horses, Glucose values can be elevated such as in Equine Cushings, extreme infections, or high fevers. If the horse is already having Equine Insulin Resistance with high Insulin, then will see high Insulin and High Glucose. This is not true Horse Diabetes but an overlapping of diseases. Once the horse is treated, Glucose levels will drop back down to normal.
   4. Cushings Disease
   Cushings disease can lead to Insulin Resistance in several different ways. The horse can have Cushings and Insulin Resistance at the same time. Why?
   1. High ACTH levels in Cushings can directly interfere with Insulin’s action. ACTH is damaging the keys.
   2. High ACTH levels lead to Cortisol abnormalities. Cortisol is responsible for increasing blood Glucose levels by causing stored sugars in muscle/liver to be released. The higher levels of Glucose trigger more and more Insulin.
   3. Cortisol, like ACTH, can directly interfere with Insulin’s action. More keys are damaged. This is why it is smart to test the ACTH level and the Insulin level of a Cushings horse on a regular basis. Your Cushings horse could have normal Insulin and later become an Insulin Resistance horse on top of Cushings in a large number of cases. You are treating it with Pergolide but not treating the Insulin Resistance and wonder why they have Laminitis still— now you know why!
   * A pony with a cresty neck is 19 times more likely to have Insulin Problems.
   5. Stress
   Mental/Physical— surgery, infections, shipping… Increased Epinephrine causes increased ACTH, increased Cortisol, leading to more Insulin Resistance.
   1. Increased Cortisol will interfere with sleep, so more stress.
   2. Increased Cortisol will depress immune system leading to more infections that lead to higher Insulin levels.
   3. Increased Cortisol breaks down muscle which results in muscle weakness— often see in Cushings horses -skinny with fat pads.
   4. Increased Cortisol decreases muscle synthesis.
   * High insulin is like a small hammer banging on your horse's foot. No shoe, no amount of Bute will help unless you first stop the hammer.
   6. Insulin Resistance in horses creates cardiac changes – new finding.
   
   The heart is directly affected by Insulin Resistance in a 2017 study from a Swiss Veterinary School. Heart rate is higher (37% had over 48 beats a minute) than the controls which accrued 40-41 beats per minute. This is important for Vets to know due to the heart rate is a parameter measured for health status.
   Also of interest, the Insulin Resistant horse’s Insulin resting rates were only 10 uU/ml, but on a challenge they jumped way up to 145 uU/ml, further showing the need for a challenge to find true Insulin Resistant horses. The heart, itself, had changes in wall thickness in areas in Insulin Resistant horses also. Insulin Resistance effects not just the feet, but total body systems. Click here to see Dr. Heliczer’s article in JAVMA on Cardiovascular findings in ponies with equine metabolic syndrome.
   7. New study via Dr. Reilly – “Insulin Resistance – New Triggers”. More research results pending.
   Genetic lock– diet/exercise is not controlling Insulin.
   Owners have tried multiple management techniques but the horse is still foot sore, has repeat Laminitis, can’t be turned out on grass, and stays big on little food. Also the horse is a candidate for future problems and the owner would like to avoid a problem instead of waiting for the problem to occur. These are the horses the HEIRO program can help.

*Note the Dramatic Drops*

*IR horses have normal Glucose/high Insulin

*Normal post feeding levels are under 60 u/U/ml for Insulin

If over 60 uIU/ml or 430pmol/L for Insulin, your horse is Insulin Resistant.

Click Here to See Video on How to Test a Horse for IR and Cushings

Solo on Heiro and Moving Great!

The key is to control carbohydrate metabolism by eating the right foods in the proper amounts. The HEIRO™ program will greatly assist your horse in this project by helping to manage Insulin.

Your horse ideally will get: some fresh grass, some hay, some grain, and some snacks. Often the scenario is that the horse gets too much of one item and it triggers Laminitis.

We will go over several items: Grass intake management, hay to feed, fats/oils, grain, good and bad snacks, hay testing.

Goal: Practical, straight forward, understandable items to stop Laminitis and help your horse live a good life.

In the past, (2006, 2005, …) you would see the term NSC standing for non-structural carbohydrates. This term is still used by feed companies to categorize low carbohydrate feeds of about 10-15% NSC. When you test your hay or fresh grass you will not see this NSC listed any more due to recent changes in the way sugars are categorized. The new category for sugar content of hay/fresh grass is called ESC because it contains sugars and a partial amount of fructans.

The starch category is the same as always.

This new category can not be compared to your past analysis. Know that NSC is not ESC and that past sugar tests can not compare to ESC.

A. Horse Insulin Resistance Hay – Goal – slow, sustained release of nutrients all day long with no long periods of fasting.

1. Hay is essential in helping prevent Laminitis. Your horse can not be on grass all day and cannot get grass in the winter/bad weather. Hay provides fiber to steady Glucose levels. Hay provides eating activity for your horse (they eat 70-80% of the day). Hay decreases stress which can steady stress hormones. Hay stimulates the gut tone and motility. Steady hay eating avoids a problem. If the horse has fasted several hours and then is fed, can get Insulin surge beyond the normal which can be harmful. We want a slow, constant, low level of hay moving through.

Good products to ensure long/slow hay feeding to avoid gobble/starve/gobble…problem which leads to huge insulin surging and foot pain.

Best Option

The best , easiest way is a slow hay feeder.

Click Here to see article in 2023 study!

a.) Slow feeder hay nets reduced fighting over hay

b.) Slow feeder hay nets reduced hay intake by 38%

c.) Slow feeder hay nets were same as natural grazing in time spent with this net – mimics how horses take time in eating.

In addition, can help protect feet if hay has slightly higher sugar.

Example: Say a horse eats 20 pounds of hay a day of a low sugar hay rated 5/10 (10 = higher sugar) = 100 sugar units but if gobbles in 5 hours, 20 sugar units an hour = high amount of sugar per hour.

Example: Same horse, same 20 pounds of hay a day, but higher sugar = 7/10 sugar units so 140 sugar units – but eats it over 24 hours in slow hay net is only 5.8 sugar units an hour – so safer than low sugar hay gobbled.

2. Spread the hay — make horses walk to multiple small piles in the field to increase exercise.

3. Soaking hay— this can lower Carbohydrate levels and as a bonus has been shown to decrease allergens in “heave” horse reactions. At times this is not practical in cold weather — you get a “hay sickle” in the bucket — the water freezes into ice. This is a great time to test hay in fall when you are stocking up to feed it in the winter. If it has low ESC/sugar/starch you will not need to soak it. Also, test your horse’s Insulin level after a few days on the new hay. This will let you know if all is OK. Most Laminitis is via fresh grass and not hay. Pasture-associated Laminitis accounts for 54% of Equine Laminitis. (USDA Lameness and Laminitis National Health System 2000) Dr. Watt’s work on grass/hay sugar levels has been very helpful.

4. What hay to feed and what levels do I look for if tested?

• Timothy Grass Hay in Horse Insulin Resistance – Good choice, easy to get. If tested, want 8-12% protein, low end of normal range of ESC (Simple Sugars) that is 4.7-10.9%, and low end of normal range of starch that is 1.5-4%. Example: If 15% ESC and 6% starch, do not buy it – probable Laminitis trigger. If it is 5.7% ESC and 1.8% starch is OK to buy and no need to soak.
• Alfalfa Hay in Horse Insulin Resistance – Can mix with Timothy up to a 50:50 ratio. It has a slightly lower ESC, starch, and sugar than Timothy Hay. The Equi-Analytical web site has a printout showing its safety. If someone tells you Alfalfa is a problem in Insulin Resistant horses, they do not have the facts. ESC is 4.2-8.2% Starch is 0.8-3.2%. I usually will not go above a 50:50 ratio because higher amounts of Alfalfa seems to cause more gas and runny manure. Click here to see 4 Misconceptions about Alfalfa Hay, The Horse, 2017.

  Also, you can see chart comparisons of grass and alfalfa hay at equi-analytical.com. They are the largest hay tester in the USA. Click here to go to their site.
• Orchard Grass Hay – Very similar to Timothy Grass Hay. A good choice.
• Teff Grass – Tests we have run show it to be safe on sugar and starch, so, again, it is a good choice, When you test, you want similar values as Timothy. Can have mixes of Teff with Orchard or Timothy.
• Bermuda Hay – A grass hay. There are 2 types of horse hay from this variety that are mainly grown in the south (Florida, Texas…) due to hardy in a variety of weather.
  • Coastal Bermuda Hay
  • Tifton 85 Bermuda Hay in Horse Insulin Resistance.
    These hays are usually “stand alone” – not blended with other hays like Timothy or Alfalfa. They are unique in that they have more dry matter and cure faster than any other hay types. Click here for more information on Bermuda Hay from Dr. Newman at the University of Florida Forage Extension: Coastal vs. Tifton 85 Bermudagrass for horses. Facts & Myths.

• Avoid Totally: Wheat hay, Oat hay, Barley hay – all very bad, high starch.
  5. Your horse, if not getting any fresh grass, will need 2% of body weight in hay daily. In most Insulin Resistance horses, we want to reduce weight, so will feed less hay. A normal 1,000 pound horse needs 20 pounds of hay. To assist your horse in weight loss, instead of feeding the normal horse 2%, feed 1.8% or 18 pounds of hay. To slow him down on eating, we covered the ways of putting in a field alone, blocking their view if in a stall. Another way is to put the hay in a hay net. The net will slow their ability to get big mouthfuls of hay.
  At times, a horse may still go through his hay too fast even with a hay net and get stressed, then Insulin surges due to fasting. Put one net into another net. This is your plan B, because it will really slow down the rate of eating. Perhaps try a double net in the night and a single during the day — your horse will talk to you. To weigh hay, get out the bathroom scale and weigh the bale.
  6. Avoid feeding Blue Seal’s Hay Stretcher – it has molasses and a NSC of 22%. It comes in a large pellet.
  7. Often, the horse grazes during the day and is in at night. They eat the hay given to them between the 6:00 PM feeding and 9:00 PM, the horse is out of food, and goes with no food for 10 hours until the 7:00 AM feeding. When they are re-fed, they get a huge Insulin surge that can be 700% higher than normal. Essentially, the horse is being given a high-dose shot of Insulin every morning. No wonder they put on lots of fat and get Laminitic. The fresh grass intake is monitored but its the “in the stall with hay that doesn’t last” scenario that can be the real health danger. Ten pounds of hay that they eat throughout the night will cause less weight gain and protect the feet better than feeding five pounds of hay with almost half a day (or night) with no food.
  B. Horse Insulin Resistance Fat and Oil Supplements
  1. Do NOT use in Insulin Resistance horses. A study by the University of Kentucky’s Dept. of Veterinary Science in 2002 by Dr. Sessions showed that an infusion of fat actually induced Insulin Resistance in horses in less than 2 hours time. This can lead to a Laminitis trigger. High fat diets can cause a crisis.
  Click here to see Article
  2. High Insulin levels already are promoting fat which in turn release toxins to further cause more and more Insulin. This cycle is not helped by promoting more fat with a high fat diet.
  3. What to avoid:
  • NO ADDED OILS IN HORSE INSULIN RESISTANCE– No corn oil. No rice bran oil.

    
  • NO RICE BRAN IN HORSE INSULIN RESISTANCE –three big reasons.

    
  • According to a USDA study by Dr. Marshal in his 1994 Rice Science Study (465 page report), it is approximately 16% fat. This is going to promote fat on your horse, add weight, and cause problems.
  • Rice bran is loaded with starch. Dr. Marshal has it at 16% and Equi-Analytical Labs at almost a 20% average. This is 5 to 7 times more than timothy/orchard hay or beet pulp. Rice bran has an NSC level of about 25 which is extremely high.
  • Rice bran’s NSC is very close to that of Wheat bran (30). Both need to be strongly avoided in these horses.

4. High FAT makes Insulin go up 25 Times! Study: Journ. Vet Sci, Dr. Schmidt, 2001, Shetland Ponies fed a high fat-enriched diet led to a 25 fold increase of plasma Insulin levels after only on it 2.5 months.

5. On the bag of ingredients of many low carbo, low fat feeds you may see rice bran. DO NOT panic. They put in an extremely small amount for flavor. These products have low NSC values (10%) and low fat values (3-5%). The main point is not to add more of rice bran or wheat bran to the diet.

C. Horse Insulin Resistance Grain (Ration Balancer)

Yes, you will feed grain to an overweight Insulin Resistance horse. Why?

1. An all-hay diet will lead to problems due to vitamin/micro nutrient deficiency. If you hear that the solution to Laminitis in an Insulin Resistance horse is feeding it just hay and keeping it on a dirt lot, you are getting inadequate and incorrect information.

In the winter, grass options are lost, so grain is even more important at this time.

2. What type of feed for my Insulin Resistant horse?

• You want a low NSC pellet feed which will provide vitamins/micro nutrients and a high amount of protein. These special feeds are very concentrated so you will only feed a small amount to your horse each day. Normal horses can get up to 1% of body weight in grain a day for maintenance — that is 10 pounds of grain in a 1,000 pound horse. With a low NSC concentrated feed, that same horse gets only 1 pound a day. You will mix the HEIRO in with the morning feed. With Insulin Resistance horses, we want to reduce weight, so we will feed grain and HEIRO only once a day in the morning — your horse’s natural circadian rhythm has Insulin highest in the morning and we want HEIRO working then to control Insulin all day.
• There are many low NSC/low carb pellet feeds on the market but they are not all good for an Insulin Resistant horse because they may also have high fat. We want a low carbohydrate (low NSC), high protein, and low fat diet. To compare, sweet feeds have a NSC of 40% due to the sugars/starch of lots of corn, oats, and molasses and some feeds have 12-30% fat.
• See a study proving balancers lower insulin - Click Here

Horse Insulin Resistance Balancer Chart

*Avoid Essential K GC Plus which contains Glucosamine

**Avoid Gro’n Win GC which contains Glucosamine

Which low carbo feeds to avoid? Ones with extra fat such as Purina Ultium, Ker Re-Leve, and Blue Seal Carb-Guard. These are great options in tie-up, PSSM, and Cushings horses with no Insulin Resistance. Summary: Not all “lite” feeds are best for Insulin Resistant horses.

HEIRO is directly available all over Canada. Click here to see a list of retailers.

Horse insulin resistance balancers are available around the world.

Ration balancers in Canada: Purina Optimal, Nutrena Empower Topline, Masterfeeds 30% Supplement

United Kingdom and Europe Measurement Equivalent:

1 Baking Cup = 240 ml in volume, so 720 ml volume = 1 pound.

In England, a pint glass holds 568 ml, about 1-1/4 pints = 1 pound.

Why These? Horse insulin resistance balancers the better choice.

Which low carbo feeds to avoid? Ones with extra fat such as Purina Ultium, Ker Re-Leve, and Blue Seal Carb-Guard. These are great options in tie up, PSSM, and Cushings horses with no Insulin Resistance.

Summary: Not all “lite” feeds are best for Insulin Resistant horses. You will feed a very small amount of one of these four in the morning along with HEIRO™, beet pulp, and a handful of alfalfa pellets.

An example of one of these feeds – Purina’s Enrich Plus.

1,000 pound horse gets 1 pound feed once a day in the morning (Option: Split into 2 feedings.)

Large pony gets ¾ pound feed once a day in the morning (Option: Split into 2 feedings.)

Small pony gets ½ pound feed once a day in the morning. (Option: Split into 2 feedings.)

• 1 cup of “Enrich Plus″ weighs 0.38 pounds
• ¼ cup of “Enrich Plus″ weighs 0.1 pound

1,000 pound horse – Feed 3 cups in the morning (Option: 1 1/2 Cups AM + 1 1/2 Cups PM .)

Large pony – Feed 2 cups in the morning (Option: 1 Cup AM + 1 Cup PM .)

Small pony – Feed 1 1/2 cups in the morning (Option: 3/4 Cups AM + 3/4 Cups PM .)

My horse is a hard keeper – always too thin, especially in the winter. How to add weight safely using a ration balancer and senior feed. Horse insulin resistance balancers also help add safe weight.

• You will combine a ration balancer and a senior feed to bring back muscle and topline.
• Ration balancers have higher protein to help add muscle.
• Both ration balancers and commercial senior feeds are low carb. We need that due to many are Insulin Resistant and are also COPD. This plan will also help breathing muscles that are damaged in COPD.
• To see an example of what to feed, how much, and when to ladder up the volume, Click here for Safe Weight Gain Plan.

What cup to use: a kitchen measuring cup from the grocery store. Not a scoop, not a coffee can, not your Snoopy coffee cup.

A 2016 Study showing Carbohydrates in diet is top reason for higher insulin numbers. Click here to see Dr. Bamford’s Article.

Ways to help us monitor the right food needed

There are 2 methods to choose the right foods and to monitor what is in the food. The best way is to use both systems to plan the diet. The systems to monitor are called the “Glycemic Index” and the “Carbohydrate Level test”.

1. Glycemic Index of food

This compares food’s effects after eating to that of a similar amount of pure Glucose. Glucose has a rating of 100 and the closer to 100 (higher the Glycemic Index) the faster that food delivers its Glucose into the blood stream. We want low Glycemic Index foods to avoid Glucose surges which trigger Insulin surges. Example: A carrot has a high Glycemic Index number of 71, while peanuts have a low Glycemic Index number of 14. Conclusion: avoid carrots, feed roasted peanuts in the shell as a nutritious snack to your horse.

2. Carbohydrate Level Test

When you get grass or hay tested to see if it is safe, there are two items to look at to see Carbohydrate levels. They are sugar and starches.

The main nutrient of hay/grass is Carbohydrate. As we went over earlier, sugar and broken down starch will enter the blood stream as Glucose. We want to avoid high sugar/starch forage or, if we see it, monitor and manage the intake.

Grass will change during the season and if you have a concern, test the grass and test the horse’s Insulin together. If the grass is high in sugar but your turnout time with a muzzle shows a good Insulin level, then all is well. Just because the grass is high in sugar, does not mean you lock the horse in the stall; you just manage the horse differently.

Grass pasture — normal levels of:

ESC (Simple Sugars) 5-15%

Starch .5-6%

Timothy grass hay – normal levels of:

ESC (Simple Sugars) 4.7-10.9%

Starch .9-3.7%

Side note on fiber:

Fiber is also a Carbohydrate but it requires the bacteria of the large intestine to break it down. The sugar/starch Carbohydrates go into the bloodstream at the small intestine. Fiber rolls past the small intestine and goes down the tract.

There are two types of fiber:

1. Soluble fiber – bacteria break it down, nutrients absorbed
2. Insoluble fiber – cellulose seen in stems, seed hulls

Is fiber important? Yes.

1. It creates a sensation of fullness because it is not digested at the small intestine level, so your horse eats less due to not being as hungry.
2. Assists in slow, steady delivery of Glucose to the small intestine due to its bulk — slows release out of stomach of sugars.
3. Soluble fiber can account for 50% of the energy needs of your horse.
4. Hay and beet pulp have excellent amounts of fiber. Hay has about 30% and beet pulp about 20%. For comparison, corn has only 2% fiber which means it is mainly sugar/starch— that is why corn is avoided in Insulin Resistance horses.

Yes, your horse can still get many types of snacks. You love to give them and your horse loves to have them. It is one of the best parts of having a horse. The important thing is to know what can and can not be eaten.

Horse Insulin Resistance Good Snacks — Low Glycemic Index, Low Carbohydrate.

1. Beet Pulp with no molasses added:

1. There are two types of beet pulp. You want the type with no molasses.
2. Beet pulp is a great way to provide fiber to your horse’s diet – added fiber lowers Insulin levels and it gives your horse a feeling of being full which cuts appetite and hence intake. Grass hay and beet pulp have similar fiber.
3. The sugar part of sugar beets has been mostly removed as it was processed. What is left over is beet pulp which is 97% “sugar free” which is very good. Wet beet pulp is only a 3% ESC simple sugar. Studies have proven that it will not raise Insulin levels and, in fact, is a good product to feed horses. Do not get beet pulp mixed up with bran mash. Bran mash is extremely high in sugar and cannot be given to these horses/ponies.
4. Beet pulp has about the same protein level as grass hay (9-10%).
5. You do not need to buy “designer” beet pulp. It only costs over twice as much as regular beet pulp and that is without added shipping costs on top. Your local feed store has non-molasses beet pulp at about $15.00 per 40 pound bag.

You can feed a 1,000 pound horse beet pulp 1-2 times a day. Soak 2 cups in 4 cups of water for 4 hours.

You can add HEIRO to the morning beet pulp along with the low NSC grain.

I can’t find plain beet pulp! Now what?

If you prepare beet pulp with molasses you can feed this safely – it actually has less sugar than soaked, plain beet pulp. We were surprised at this fact. This is probably due to our soaking and rinsing process.

Steps to Feed Beet Pulp with Molasses to Horses (How we prepped)

1. 1 cup of beet pulp into a bowl with 4 cups of water. Soak this for 24 hours – This is just what you will do in the real world for making it up in the morning to use the next day.
2. Next, we poured it into a colander (K-Mart $6.00) and hand pushed it down for 5 seconds to squeeze out water.
3. Then, we rinsed it in cold water for 30 seconds and squeezed it out again for 5 seconds.
4. All done – ready to feed. Easy, quick, inexpensive.

Conclusion: Prepped Beet Pulp is a safe product for the Insulin Resistant horse.

Also, you should soak plain beet pulp because dry, plain beet pulp has a simple sugar of 9.2 which drops to 2.4 if soaked. Go to the Equi-Analytical site to see this additionally surprising fact!

2. Strawberries, roasted peanuts, whole pumpkin and sunflower seeds and celery are great snacks for horses.

• Strawberries are a healthy, delicious snack for your horses.
• Roasted peanuts in the shell, like you have at baseball games, are another great snack – high fiber, good protein. Make sure the peanuts are roasted – this means they have been soaked in brine and roasted so they are safe to eat for you and your horse.

** DO NOT FEED RAW PEANUTS TO HORSES – they may contain aflatoxins if they have not been roasted.

• Whole pumpkin seeds and sunflower seeds are high in fiber and easy to give or add to feed.
• Many owners tells us their horses LOVE celery sticks– again, high in fiber, low carb, easy to find and cheap!

3. Special Candy for Insulin Resistant Horses.

Where can you find these? In supermarkets, they now all have special aisles for diabetic foods and this is where to go. You can also find sugar free candies online. Stevia zero calorie candies are tasty and come in many flavors.

a. Stevita candy comes in grape, strawberry, orange and cherry flavors – available on Amazon.com or Walmart.com

b. Why stevia? In studies, it is shown to NOT cause insulin surging – it’s also zero calories and has a very sweet taste that horses love.

Click here to see Dr. Anton’s article about effects of artificial sweeteners on insulin levels in 2010 Appetite via University of Florida research.

c. Avoid candies with xylitol – this artificial sweetener can cause toxic reactions in animals.

Sugar Free Syrups with Stevia

NuNaturals Nustevia Simple Syrup – also comes in ginger and pumpkin spice flavor. All zero calorie – pour on grain, mix in so Heiro/ThyroL sticks – yummy! Go to NuNaturals.com to see more.

4. Hay cubes for Insulin Resistant Horses - Why hay cubes under snacks and not under hay?

• Horses eat cubes 25% faster than hay which means there will be extended periods of fasting with no forage. Fasting causes Insulin to surge way beyond normal when the horse is fed again. This is exactly what we do not want. The goal is steady release of nutrients all day long and not eat – starve – eat – starve.
• Expense. Cubes are much more expensive than hay per pound of feed. A 1,000 pound horse will go through a bag in 2-3 days and if you compare that to the cost of hay (even $6-$7 a bale), cubes will run about $1,000.00, per year per horse more.
• Hay cubes are finely chopped so they leave the stomach faster – regular hay slows the process down.
• Hay cubes are a good snack to give in the afternoon. You can slice them up into 4 pieces per cube and give 2-3 cubes (8-12 pieces). Either alfalfa or timothy cubes are fine to use. One bag will last 3-4 months – that is about $0.12 a day for this snack.

5. Alfalfa Pellets for the Insulin Resistant Horse – a handful in the morning feed or as an occasional snack is fine. Good fiber, low glycemic index. Again, only as a snack because as the main forage it is too expensive, leads to fasting like cubes. Alfalfa pellets have an added bonus of helping to prevent stomach ulcers due to its buffering ability. (The Horse, February 2008)

6. Chopped Low NSC Hay – These are GOOD snacks but are NOT a primary forage due to three reasons:

• Studies show that horses eat these too fast. Most horses will blow through 5-10 pounds in less than 1 hour. If it is the only forage, horses will go 11-15 hours with no food.
• Finely chopped means it will go out of the stomach quickly, so the horse gets an empty stomach quickly. This is not our goal.
• These feeds have the advantage of you knowing they are low in sugar/starch, so they are safe to add to the high protein/low carb grain. Add 1-2 pounds per feeding. Horses seem eager to eat these products and owners often comment their horses enjoy this forage.

SAFE CHOICES (3)

Note: Not all chopped hay is safe for an Insulin Resistant horse – other types add molasses which we don’t want.

7. SAFE Flavorings for Horse Insulin Resistance: For Feeds and to get medicines into your horse.

A. Most horses enjoy the high protein/low carbohydrate hay ration balancers and HEIRO. If you take the lid off HEIRO and smell it, you see why horses look forward to eating it.

B. Usual Program: Add the HEIRO to your high protein/low carbohydrate hay ration balancer and sprinkle in a little water to let the powder bond to the food. If you add wet beet pulp, this works well when you mix the hay ration balancer and the HEIRO together. Most horses clean the tub.

C. But some horses are “Finicky” or at times need medicines in their feed to help them. Here are suggestions that we have successfully used to get horses to eat and are low carb safe:

1. Sugar-Free Syrup with Stevia
2. Handful of alfalfa pellets (are low carbo)
3. Cut up 2 alfalfa cubes into 3-4 cookie wafers
4. Add a handful of salted peanuts in the shell
5. Add 4-5 tablespoons of sugar-free applesauce
6. Add 4 sugar-free candies
7. Sprinkle on a small amount of turmeric or garlic powder
8. Handful of sunflower or pumpkin seeds
9. Stevia granular powder – 2-3 tablespoons. Example: Truvia

You can try one of these at a time or do a couple together to find the combination that works.

8. Commercial Horse Snacks for Insulin Resistant Horses. Standlee Apple/Berry Cookie Cubes – made with Timothy plus Alfalfa Hay and a small amount of Cranberry/Apple Juice. Starch only 1.6%, Sugar only 7%, Low Fructan at 5%, 17% Protein, only 1.5% Fat.

Horse Insulin Resistance Bad Snacks — High Glycemic Index or High Carbohydrates or both

* Avoiding problem snacks is important

1. Cookies – loaded in corn, oats, sugar, and molasses. The cookies at the tack shop need to also be avoided.
2. Candy – only use special candy (see Good Snacks).
3. Bran mash – lots of Carbohydrates. Higher Glycemic Index than many grains. Wheat bran and rice bran should be avoided. Rice bran has 8 times more starch than alfalfa cubes and over 10 times more than beet pulp.
4. Certain grains – corn, oat, wheat – even a handful is a bad choice.
   According to Equi-analytical, Oats have a starch of 43.73 and an NSC of 48.7 making it:
   15 times the starch and 4 times the NSC of alfalfa.
   4 times the NSC of low carb/high protein feeds.
   13 times the starch of fresh grass pasture.
   22 times the starch of wet beet pulp and 9 times the NSC
   Click here to see the Equianalytical chart on OATS: Interactive Common Feed Profile - Equianalytical Oats
5. Certain fruit/vegetables – apples, carrot, watermelon
6. Other items we have seen fed that need to be avoided – jelly beans, yogurt, pretzels, chips, lawn clippings, and frosted mini-wheats.
7. Syrups – These are 100% carbohydrates, with no protein and no fat, so it is best to use sugar free pancake syrup

Note: Agave Nectar is also 100% carbs. It is 60 calories per tablespoon. Table sugar is 48 calories per tablespoon and is also 100% carbs. Agave syrup and Agave nectar are both 100% carbs – the nectar is processed at a lower temperature. Agave is 70-90% fructose and High Fructose Corn Syrup is only 55%, with most fruits only 5-6% is fructose. Just a quarter cup of Agave has about the same calories as a Snickers candy bar (250). Agave has more sugars (60 grams) in a quarter cup than a Snickers bar (27 grams).

Oats – not a good choice in IR

1. Oats are 70% carbs.

2. Oats are large in calories – 607 calories in 1 baking cup.

3. They have a backwards calcium: phosphorus ratio –

Ideal in horse = 2:1 cal/phosp.

But oats are 1:8 cal/phosp. – very out of balance.

This can cause bone deformity, growth issues.

*Click Here to see Nutritional Data Article

4. High phosphorous diet in horse leads to hormonal imbalances and inhibits calcium absorption. *Click Here to see Oklahoma State University Article

5.

**Click Here to go to this lab’s Test Charts

6. High Glycemic Index – 57 (Glucose sugar = 100/100)

To Compare: Sweet corn on the Cob = 60, Ice Cream = 57, Short Bread Cookies = 64.

**Click Here for List of Foods from Oregon State University

1. Glycerol is a carbohydrate
2. As a sugar, it has more calories than table sugar. Per teaspoon: glycerol – 27 kcal, table sugar – 20 k cal
3. US Academy of Nutrition and Diabetes categorizes it as a carbohydrate – so does FDA.

   Glycerol/Glycerin is 60-75% as sweet as table sugar.
4. This carbohydrate is absorbed into the blood stream at the small intestine.
5. In a study with humans, glycerol increased insulin “insulinemia was markedly increased by glycerol”
   Click on the articles to read more
   • Metabolism Dr. Zanoboni
   • Food Insight K. Sollid, Registered Dietician
   • Shape Reclaimed
     

If your horse has Insulin resistance but also has joint issues/stiff/puffy joints, you can use Heiro and Comfort Quik together!

Why important?

Pain in all animals increases insulin. If your horse has joint problems, then this can increase insulin which can lead to laminitis.

If your horse has IR, high insulin not only creates foot problems, but also inflames joints.

A study by Dr. Jane Manfredi has shown horses with insulin dysregulation correlated to increased weight and body conditional score and hind limb lameness (in joints). See Study Here

30 year old Ritzy on Heiro and Comfort Quik. Looking Good!

There are many benefits of exercise, all of which will decrease Insulin levels and help to stop Insulin Resistance. The weight loss needed in overweight horses is a therapy and not just a way to take weight off the Laminae of the hoof. How does this work and what do I need to do with my horse?

A. Horse Insulin Resistance Exercise: How and Why It Works

1. Nervous system during exercise will lower Insulin output from Pancreas. If exercise one hour, can drop it over 30%.
2. Increase muscle – muscle has the largest number of receptors for Insulin, and by providing more receptors (locks), you allow Insulin to have more sites to bind to, which lowers blood levels of Insulin. Click here for Dr. Votion’s 2012 study on Physical Fitness and Mitochondrial Respiratory Capacity in Horse Skeletal Muscle
3. Increase blood flow – exercise can increase flow by 700%. Better circulation allows Insulin to the target cell faster, so Glucose is delivered faster. Due to the nervous system, we already have a smaller amount of Insulin in the bloodstream and this smaller amount, with more circulation, is able to work more efficiently than with too much Insulin (keys breaking keys). When a smaller amount of Insulin can do the work, this is called “increasing Insulin sensitivity”. By increasing Insulin sensitivity, this leads to lower and lower levels of Insulin until you get back to normal levels.
4. A second way of increasing blood flow – just the lowering of Insulin via exercise. Insulin, itself, at high levels irritates blood vessels leading to poor circulation and Laminitis. By removing the irritant, exercise helps flow another way.
5. Exercise has the ability to keep blood Glucose levels slightly low for 6-12 hours after exercise — a Hypoglycemic effect. Since blood Glucose is low, Insulin levels go low. The effect of exercise lasts much longer than the time exercised.
6. As one source puts it, “The fatter you are, the more Insulin Resistant you are to your own Insulin”. Even a small weight loss helps a lot.
7. Exercise can reduce appetite to further help in weight control. If eat less, is less Glucose, so less Insulin. If less Insulin, less fat being made and more fat being burned off. Click here for Dr. Steig’s 2011 article in the American Journal of Physiology on exercise and appetite.
8. Food moves through the digestive tract faster if there is exercise which means less will be absorbed.
9. Moving allowed horses to reduce body score and body fat down 4.95%. This is important information in IR horses. Click here for Dr. Laat’s 2016 article in Journal of Veterinary Internal Medicine.
10. Short-term exercise even with no weight loss helps increase Insulin sensitivity in a 2010 study. “Improved Insulin sensitivity occurred in obese mares without a long interval of exercise and in the absence of change in body weight.” D. Powell, University of Kentucky, Eq. Vet. J. 2010. Click here to view Dr. Powell’s 2010 study.

B. Horse Insulin Resistance Exercise: What Do I Do?

1. Walking burns 4 times the calories of standing. Walking also helps with circulation to the feet to help prevent Laminitis. Often, people do not have time to ride/lunge their horse and that is why it is important to turn your horse out in a field with a muzzle. Many people keep their overweight horse in a small dirt lot thinking that will protect them. This is not the best solution. In a small dirt lot your horse will walk less and lay down more. This is not helping to solve Insulin Resistance. In a field, they will walk 10% of the time. For example, if you turn out 4 hours, they walk for 24 minutes— that is very helpful. Turn out is a therapy. Your horse will need a muzzle when turned out and grass is available to eat from April to December in regions with a cold winter. Year-round muzzling may be needed in year-round warm areas. If your horse slips the muzzle, call us. We have tricks to stop that problem.
2. Routine turn out allows consistent exercise even when you are not home or can’t lunge or ride your horse. If you go out to dinner or on vacation your horse is still exercising. If you get home late or in the winter and its dark, your horse has already exercised. Turn out is practical, real-world therapy. You probably can’t lunge or ride every day and that is OK because turn out is therapy. Click here to see an Ohio State University study on pace of walking and walking benefits in humans.
3. “But I am afraid of turn out, even with a muzzle.” Do not worry. We have a way to give you peace of mind. Do not just test forage, test your horse. Your horse’s response to forage is what is most important. This is a key point in Dr. Reilly’s Laminitis prevention that you will not see anywhere else. Test their Insulin to see how they are handling your feed program. At times of lush pasture, test Insulin levels to see if turn out time is correct and make adjustments. This system allows you black-and-white evidence to warn you if Insulin is climbing. Example: Turn out with muzzle for 2 hours a day for 5 days and test. Have a baseline drawn prior to start of turn out.
4. If you turn a horse out alone, they graze less. This will, again, decrease carbohydrate intake and decrease Insulin.
5. If you turn a horse out alone, they walk more. The more walking, the more therapy. Certain horses will thrive in groups. The pecking order of dominance may help certain horses exercise more if they are lower on the ladder. The dominant horses may chase/force exercise on the Insulin Resistance horse.
6. In times of lush pasture (early spring, fall), they eat 10% more an hour. This means the food has more carbohydrate and they are putting in a greater volume of it into the stomach — double jeopardy. You may need to turn out less. This is when to start lunging and riding more. Monitor Insulin. Sugar levels of grass is lower at night, so many owners will turnout then. Horses also rest more and eat less at night, so the intake is less.
7. A horse turned out in an adequate continuous grazing pasture, will gain less weight than if you keep rotating them into new fields. The continuous grazing pasture must not get over grazed. The rotational system in a study showed yearlings gaining about 2 pounds a day more than continuous grazing pastures. Keep pastures mowed at about a 4 inch level. Do not mow pastures like a golf course. Example: Turn out horse in a 4 acre field by itself.
8. At times, you cannot exercise and need to stay in— rain, snow that is deep. Your horse will eat 15% less hay by just blocking off the view of other horses in the barn. This is about 3 less pounds of hay per day.
9. Exercise numbers:
   • Slow trot burns three times the calories of a slow walk (per hour). A slow trot is about 7.5 miles covered in one hour or about an 8:00 minute/mile pace.
   • A slow trot/slow canter for one hour burns five times the calories of a slow walk.
10. Exercise may help in reducing Cushings advancement.

    2013: Animal studies by Dr. Rhodes, University of Illinois, found that physical exercise boosted the number of brain cells (neurons). They saw the benefits in only one (1) month of increased exercise in several different sections of the brain. Equine Cushings is due to a loss of neuronal function in the pituitary. Exercise increases blood flow, so more nutrition, more oxygen can keep your horse’s brain in better shape. Click here to see how exercise helps the brain in a Harvard Study.
11. Swimming your horse can help lower insulin. A 2017 study found “particular benefits for horses with insulin dysregulation.” Click here to see Dr. Bonelli’s study in Vet Journal.
12. Older horses have higher resting insulin numbers – it’s a fact of aging due to muscle loss. After exercise, older horses will reduce insulin but the amount reduced is less than in younger horses. Older horses need to add many items to help lower insulin (Heiro, diet, sleep, rate of eating, increased protein, Thyro-L, etc). Click here to see 2002 study by Dr. Malinowski in Equine Vet Journal.

A. Several studies in human and animal medicine show that bacterial components can trigger Insulin Resistance temporarily in normal individuals. Most horses exposed to Lyme/showing disease/being treated do not get Laminitis because most are not already Insulin Resistant before infection. Normal (non Insulin Resistant) horses get an Insulin surge from bacteria but the level is not enough to trigger Laminitis.

B. Another reason horses being treated for Lyme usually avoid Laminitis is due to Tetracycline antibiotics (Doxycycline tabs, Minocycline Powder, Oxytetracycline IV) have an anti-inflammatory effect on top of their antibiotic effect. This two-for-one bonus helps avoid problems.

C. The Big Problem: Horses with already-in-place Insulin Resistance being exposed to the Lyme bacteria causing a horse with already high Insulin to go sky high and trigger Laminitis. The double teaming of bacteria and the Insulin surge take a horse already on the edge and push them off the cliff.

D. If you have an Insulin Resistance horse or a probable one (body type, Laminitis history), it is a good idea to test the Insulin level if diagnosed with Lyme. Click here for in-depth information on Horse Lyme Disease.

E. What can I do?

1. This disease highlights the important concept of needing to control Insulin now in order to help avoid a problem later.
2. Prevention – Our RK Topical Spray is 300-600% stronger than what you are using. You want to get off the merry-go-round of Doxycycline/Minocycline? Spray two times a day for total protection.

See our Marketing Comparison Chart for RK Topical Spray:

Click here to purchase RK Topical Spray.

Simply, by moving your horse away from the edge to a safer Insulin level, it gives the horse a buffer zone so that if a surge occurs (Lyme, colic, trauma, surgery…) it is not enough to go over the edge into Laminitis. I call it my “Grand Canyon Concept”. If we are not near the edge, we can’t be pushed off the cliff.

At times, you will see ads for products with lots of Magnesium to help with cresty necks/fat deposits. Know that the new Insulin Resistance diet along with the HEIRO™ already has increased your horse’s levels of Magnesium to the right level. Do not waste money on supplementing more Magnesium.

1. HEIRO has the highest correct concentration of pharmaceutical grade (USP) Magnesium of any equine supplement on the market. We are also lab tested safe.
2. Of the many types of Magnesium, HEIRO uses the natural form yielding the highest correct amount of the mineral for the horse. National Research Council 2007. Click here to See Why Super High Magnesium doesn’t work.
3. HEIRO uses only the natural form of Magnesium. Other products use forms that have been artificially produced in a lab. We use the form seen in human multivitamins like products from GNC, Twin Labs, and Sunshine vitamins seen in your grocery store or pharmacy.
4. The HEIRO program provides added Magnesium for Equine Insulin Resistance to the diet like no other plan can:
   • High protein of the grain mixes we list help increase Magnesium absorption from the intestine. Oregon State University Pauling Institute.
   • Peanuts as a snack is one of the top 10 sources of Magnesium, providing 48mg in just one ounce.
   • Alfalfa increases Magnesium digestibility in the diet to increase absorption. National Research Council 2007.
   • Beet pulp has twice the level of Magnesium needed for maintenance, which is an added bonus.
   • *** HEIRO is the only supplement with a goal to get your horse on pasture and maintain it there. Magnesium is part of chlorophyll, the green pigment of plants, so the fresh grass is a high Magnesium source. Solid evidence why horses can still get Laminitis on dirt paddocks. They need green leafy material.
5. Magnesium assists in Equine Insulin Resistance increasing the blood flow, improve Insulin levels, and assist in gastric ulcer repair. With this in mind you want the tested safe, highest concentration of pharmaceutical grade (USP) Magnesium you can get, which is HEIRO.
6. HEIRO’s concentration of Magnesium means you only feed 1/2 an ounce once a day. This small amount is 2, 3 or 4 times less volume then other supplements, and does not require giving twice a day – just once scoop and done.
7. The ration balancers we recommend are a great source of Magnesium for Equine Insulin Resistance. Many are 2-3 grams Magnesium per pound of these feeds which is 30-40% of the daily Magnesium needs in a 1000 pound horse according to the Nutritional Requirements of the Horse.
8. Hay is also a source of Magnesium. Alfalfa hay is 50% higher in Magnesium than grass hay according to Equi-Analytical Labs.
9. Our Equine Insulin Resistant Snacks section has excellent sources of Magnesium. According to USDA, just 1/2 of a baking cup a day of pumpkin seeds has over 600mg of Magnesium.
10. Equine Insulin Resistance Magnesium needs are naturally covered with the HEIRO program: Forage (Fresh grass/hay) + ration balancers + HEIRO + Good snacks = proper Magnesium levels.
11. Magnesium is only 1 part of the Equine Insulin Resistance Puzzle. We want to provide the right healthy amount and not overdose horses with Magnesium. HEIRO is unique in having natural herbs and Vitamin E also.

In a study by Dr. Chameroy, University of Tennessee Veterinary School, Eq. Vet Journal, 2011, showed high levels of Magnesium and Chromium in a supplement had no effect. “Chromium and Magnesium evaluated in this study did not alter measurements, blood variables, resting insulin concentrates or insulin sensitivity in laminitic older horses.” Click here to see the article Effects of a supplement containing Chromium and Magnesium.

As you can see, you are covered on Magnesium with the new Insulin Resistance diet and HEIRO supplement.

A. Equine Insulin Resistance horses all have low thyroid function. (not hypothyroid). Why? Inflammation reduces thyroid gland output (see 3 articles on this in why thyroid function low in COPD)

B. Equine insulin resistance horses on a thyroid test, will test in the bottom of the normal range = suboptimal.

We need in the top of the normal range in the 2.5 - 3.0 level. We are not looking to create hyperthyroid levels, only to get in A+ level of normal to help avoid/treat laminitis.

C. The total T4 normal range at Cornell is 1-3. Equine insulin resistance horses will test at 1.2, 1.5 - low end of range.

D. Owners, get a copy of your test results. Do not accept “it’s normal” on a test - we know it’s normal, but we are not looking for barely normal, mid range. C - levels, we need top of normal.

E. Equine Insulin Resistance Thyroid Powder - how to give it properly?

1.Vet tests total T4 - recommend Cornell lab - see below on proper way to test.

2.Will be low normal suboptimal. Horses over 500 pounds will get 2 scoops a day (small blue schoop in ThyroL can) = 24mg 1 x a day in AM. In 30 days retest T4 to see if near 2.5 - 3.0. If not, go to 3 scoops 1x a day in AM, retest in 30 days. On for life. Horses under 500 pounds will get 1 scoop a day = 12mg 1x a day in AM. Retest in 30 days to see if T4 near 2.5-3.0. If not, goto 2 scoops 1x day in AM, retest in 30 days. On for life.

F. Equine Insulin resistance thyroid powder costs: 1 can is $24.00 and lasts 2 months, cheap.

G. Equine Insulin Resistance thyroid powder yearly retests: Retest T4 1x/year at time of coggins test on vaccines.

H. Equine Insulin Resistance thyroid powder why not want hyperthyroid doses of ThyroL - its a poor therapy.

1.Creating a hormonal imbalance to treat a hormonal imbalance (high insulin) makes no sense due to insulin resistance is not a disease solved by 1 therapy - need multiple modalities working together.

2.Hyperthyroidism creates drawbacks: muscle weakness, make them edgy/nervous, increase intolerance to hot weather so heat stress/heat stroke.

I. Equine Insulin resistance thyroid powder: what items can interfere with proper testing?

1.Avoid Yucca in horse joint supplements - why? Creates thyroid testing problems - Effects thyroid hormones - reduces them which can make equine insulin resistance worse. *Click Here

2.Avoid high iron supplements (lixotric, red cell, glow cell, high iron containing mineral blocks in stalls/pastures) - why? These block thyroid powders abiltiy to be absorbed correctly.

3.Avoid metformin - creates thyroid testing problems - effects thyroid hormone levels. *Click Here

4.High doses of glucocorticoids (cortisore - like drugs like Dexamethasone, depo-medrol, predef, vetalog) will drive down thyroid levels within hours - creating thyroid testing problems.

a. *Click Here

b. *Click Here

c. *Click Here

5.Prascend/Pergolide for cushings affects thyroid hormone levels. Horses on this med should be getting routine T4 testing, to see how much ThyroL needed to maintain in upper normal range. Pergolide can lower Thyroid Hormone Levels.

a. *Click Here

b. *Click Here Can Cause Hypothyroidism on drug insert to FDA

c. *Click Here Dogamine agonists diminish levels of thyroid hormone

d. *Click Here

6.NSAIDS - Bute, Banamine create thyroid testing problems - create false low numbers. Need to be off these 10 days in order to see true T4 numbers.

*Click Here

J. Equine Insulin Resistance Thyroid Powder: How to do test for Thyroid.

1.Best lab to send samples: Cornell Veterinary School - run more thyroid tests than any labe in USA, boarded pathologists, quick turn around. Phone: 607-253-3900. Turn around 1-3 days.

2.Range: 1-3 ug/dl Horse

3.Collect serum in a red top tube - avoid SST (tiger top) red tubes due to gel at bottom can pull in hormone creating false low. If sending plasma, will get extremely false low numbers.

4.Ask for total T4.

5.Do not accept as an owner “it’s normal” - get test result copy, see the problem - 1.2, 1.5 is not what need.

K. Equine Insulin Resistance Thyroid Powder: Why Need It

1.Dr. Frank’s Study - AJVR 2005 Oral Thyroid Powder in Horse

a.Insulin sensitivity increased by over 2x.

b.Lowered inflammatory lipids.

c.Increased insulin disposal - which reduces inflammation

Click Here!

2.Equine insulin resistance thyroid powder proven to help foot comfort by helping reduce pressure on nerves, help nerve repair.

a. Mayo Clinic - reduces fluid retention in swollen tissue that exert pressure on peripheral nerves. Click Here

b. Dr. McQuarrie study neurol. Sci - thyroid medication helped in nerve repair - that would help a foot sore horse improve. Nerve regeneration was 200% faster on thyroid hormone treatment. Click Here

c. Dr. Batakat - Walters Neuro bio 2002 study: Nerves have thyroid receptors. Thyroid hormones help in central and peripheral nerve regeneration. Injected thyroid hormone into sciatic nerves, proved enhanced nerve repair in a quick way that long lasting. Click Here

d. Dr. Wang 2002 study: Local administration of thyroid hormone in just one treatment, helped create long lasting nerve regeneration. Click Here

e. Dr. Voinesco 1998 study

Nerve that cut bathed in thyroid hormone - in only 4 weeks had early regeneration - 140% more than control. By 8 weeks, significantly more 0 over 200% - long lasting/stimulating effect. Click Here

f. Dr. Begin 2008 study

Thyroid problems seen in older age – start to lose cognitive performance. Click Here

g. Dr. Voria 2006 study

Thyroid plays important role in regulating regeneration of the nervous system. Adding thyroid hormone to a sciatic nerve that has been cut is able to increase protein levels 2x during regeneration process. Also, the thyroid hormone increased the number of axons with enhanced protein. Conclusion: enhanced peripheral nerve regeneration. Click Here

h. Dr. Wangs 2002 study

Beneficial effects of thyroid horomones upon peripheral nerve may have considerable therapeutic potential. Click Here

L. Equine insulin resistance thyroid powder - connection between COPD Breathing and thyroid powder.

1.Many horses have bad breathing problems from COPD and there is a link to also needing thyroid powder in this disease due to inflammation reduces thyroid hormone from the thyroid gland just like in IR.

2.Thyroid powder helps both COPD and IR.

3.Many horses have both COPD and IR - important to know that COPD increases problems of IR and IR makes COPD breathing worse - need treat both to help both.

Go to our In Depth section on COPD to learn more.

M. Equine insulin resistance thyroid powder - what product to use and what to avoid

1.Best Product: Lloyds Labs Thyro-L. Why? Use in lab tests on horses in university studies with shown and proven effect. Is economical at $24/can lasts 2 months. Is easy to get from your vet, is the one with the most years of experience in horses. Is FDA approved - important.

2.Avoid:

a.Armour Thyroid Pills - made from pig thyroid glands. Not FDA approved in horses.

b.Thyroid stimulating supplements - unproven, not FDA approved to increase T4

Studies have shown Pergolide alone will not help in Insulin Resistance cases. If your overweight horse is being given Pergolide and does not have Cushings Disease,you are getting the wrong medicine. Pergolide is not cheap and has side effects. It is excellent in treating Cushings Disease but has no place in the treatment of a horse with Insulin Resistance alone. Many horses have Cushings and Horse Insulin Resistance together. These horses that are on Pergolide but continue to get Laminitis need HEIRO™ to help support the body and maintain Insulin control. If you are on Pergolide and are lame or on a dirt lot, you need to add HEIRO to get back on pasture and avoid lameness.

All older horses are found to have Insulin Resistance problems whether horse is a Cushings horse or just older.

• University of Kentucky, College of Agriculture, 2013, found that older horses and older horses with Cushings had a 75% decrease in Insulin sensitivity. “It seems our average aged horses may be as much for risk for Insulin Resistance as our horses with PPID (Cushings).” Decreased Insulin sensitivity might occur as a normal part of aging.

  Again, the University of Kentucky study clearly proved high fat causes Insulin surges in horses. If your horse has both Cushings and Insulin Resistance, and you do not know yet about the Insulin Resistance, it is a problem. Many Cushings horses will go on to Insulin Resistance and that is why you need to test yearly for Insulin Resistance if you have a Cushings Horse.

• A Michigan State University study (2018) finds that even healthy older horses with no Cushings have insulin problems. This same problem is seen in older humans and now IR is being considered more and more as a “normalcy of aging”. Why is this happening? Muscle loss is seen in aging – the less muscle, the more IR problems in people and horses.

Click Here to read more about the study on Horsetalk.

Prascend Tablets are the best form of Pergolide to use in the horse due to being stable. Stable? This means the drug stays in its active form for at least 1 year. Prascend is the only FDA approved Equine Pergolide due to this fact. You can keep box at room temperature in full light with no problem.

Pergolide exposure to people is a real problem in liquid or powder forms. FDA withdrew this drug in humans due to cardiac problems, but people had it on their hands skin, or inhaled it when using on horses. Prascend tablets are encoated so there is no longer a problem.

A. Problem with liquid Pergolide at room temperature undergoes “extensive degradation by day 14.” Even if you keep it in the dark, it undergoes “Excessive degradation by day 35”. Dr. Davis, University of North Carolina School of Veterinary Medicine. JAVMA 2009. Conclusion: Liquid Pergolide, even in a dark container and in the refrigerator “should not be used over 30 days after produced.”

B. Powdered or capsule Pergolide compounded problems:

1. “Capsulated products degraded more slowly then suspension, but potency variability among capsules made it difficult to access and interpret these products.” “Many products fell far below labeled potency upon delivery to the test lab.” Dr. Stanley, University of California, Equine Analytical Lab Report, 2010 AAEP.

C. The Prascend tablets come in 1 mg of Pergolide per tablet.

• Retest ACTH levels 30 days after starting. We find results this fast on blood tests in our practice.
• Retest ACTH yearly in the Spring.
• Pergolide will NOT stop or slow seasonal rise of ACTH in our studies. This surge in ACTH does not appear to be controlled by this medicine.
• Always test Insulin if testing ACTH.
• Two times a day dosing may be the best with Pergolide. Pergolide dosing might be wrong for Cushings horses. Past studies in 2013 (Rendle, EVJ) with oral Pergolide, showed that 1/2 of the drug in horses is eliminated within 5.8 hours on average. This was using a dosage per pound of the 1 mg per 1000 pound horse. This is what is used in the Prascend pill (1 mg pill). Recent (See link below) IV study just this year has it at 5.64 hours and in both studies they said “twice-daily dosing may be more appropriate than once-daily dosing.” Horses with hairy coats or horses with ACTH numbers still up when testing after on Pergolide already, may not need a bigger dose (and hence a bigger bill to owners). Instead, try giving 1/2 mg in morning and 1/2 mg in evening. This is a better way than giving 2mg (doubling the dose). After 30 days on the 1/2 & 1/2, retest ACTH or see if signs of Cushings is lessened.

Click here for Study Links:

• Pharmacokinetics of pergolide after intravenous administration to horses.
• Pharmacokinetics of Pergolide Mesylate in horses.
• Package insert for Prascend.

D. Chastetree Berry

1. Many clients with Cushing Horses will add this to the diet either as whole berries (available in health food stores and online herbal stores) or teas of Chastetree Berry such as with Evitex.
2. This herb does help many with shedding out and Chastetree Berry is an adaptogen, so helps with stress.
3. Chastetree Berry can be given with Pergolide (Prascend). They will not fight each other.
4. BUT, Chastetree Berry is NOT an herbal substitute for Pergolide. Chastetree Berry will not lower ACTH levels like Pergolide can do. Once your horse’s ACTH levels start climbing and you have been using Chastetree Berry, then it is time to add the Prascend.

Click here to see article on Chastetree Berry not lowering ACTH hormone.

E. Tasigna in horses and Nilotinib in Horses.

1. October 2015 study showed this anti-cancer drug could help with Parkinson’s neurodegeneration. Click here to see the article on Cancer Drug Improved Cognition, Motor Skills in small Parkinson’s Clinical Trial.
2. Tasigna in horses may be coming! Or other medications in this category used.
3. Why would Tasigna in horses be tried? Parkinson’s is a dopamine receptor losing disease as is horse Cushings Disease. They are different parts of the brain but very similar.
4. October 2015 study showed this anti-cancer drug could help with Parkinson’s neurodegeneration.Dr. Dianne McFarlane at Oklahoma State Veterinary school has been a pioneer in the horse Cushings/Parkinsons Link. Brilliant Doctor.

F. Probiotics to Help Cushings Disease

Parkinson’s disease in people and Cushings in horses are both dopamine receptor loss diseases of the brain. See a study showing the gut flora can have direct effect on the progress of Parkinson’s disease.

Click here to be brought to the article.

G. Cushings alone will NOT cause laminitis – must be Cushings and Horse Insulin Resistance to get laminitis.

a. Horses with only Cushings and no laminitis had normal insulin

b. Horse with Cushings and Laminitis also had high insulin

c. Conclusion: ONLY those with both conditions were associated with laminar pathology

Click here to see Dr. Karinkoski’s 2016 article in Equine Veterinary Journal, featured in American Farrier Journal

Click here to see Dr. K study in Equine Vet Journal directly.

d. PPID (Cushings) horses 4 times more likely to get laminitis.

e. PPID horses 2.7 times more likely to also have high insulin (insulin resistance).

Click Here For Dr. McGowan’s 2018 Study.

H. Cabergoline Problems in Horses with Cushings

1. Cabergoline is NOT FDA approved in horses.
2. No long-term studies have been done on cabergoline in horses to see side effects.
3. No long-term study has been done on cabergoline in Cushing horses.
4. The form of the medicine on the market is a 1 time a week, intramuscular shot. Prascend is an oral pill – easier, FDA approved and proven to help in long-term studies.
5. The cost of cabergoline is 255% more a week than Prascend pills.

   BET Labs price for cabergoline is $375 a bottle with 10 doses = $37.50 a week.

   Prascend pills (1mg a day) is $14.70 a week (from Valley Vet’s website).

   Cabergoline is $1185.60 more expensive a year to use than Prascend. A year of cabergoline is $1950, a year of Prascend is $764.40.
6. Shots once a week is not easy with cabergoline.

   Click here to see a 2017 long-term study of Cabergoline in people with Cushing’s Disease – note that “only 20-25% were good responders” in the end.
7. See Mayo Clinic for a list of Cabergoline side effects.

   Rapid weight gain, swelling around the eyes, racing heartbeat, confusion, etc.

   Click here for a full list of side effects from the Mayo Clinic website.

I. Ginger Helps Equine Cushings

Many owners comment their horses with cushings shed out better and feel better when Heiro is added to pergolide – why?

Equine cushings is due to a less of dopamine receptors in the brain and Ginger can help protect these dopamine neurons.

Click Here to see how Shogaols in Ginger helps the receptors (Dr. Park, 2013).

• Ginger helped reduce inflammatory markers in the brain
• Ginger helped reverse cell loss in brain
• Shogaols exerts Neuroprotective effects on Dopamine Neurons

Click Here to see how ginger can reduce toxic effects (Dr. Waggas, 2009).

• Ginger increased Dopamine in the brain
• Ginger was a Neuroprotective against a toxin

Click Here to see how Paradol metabolites of Shogaols from ginger have therapeutic potential in brain disorders (Dr. Gaire, 2015).

• Paradol lowered inflammatory mediators
• Paradol protects brain after injury

Ginger is in Heiro!

J. Be wary of high ACTH in Fall – don’t jump to pergolide too quick – might not need it.

1. IR horses with no cushing signs will have high ACTH in 6/10 cases in a study below when tested in fall – wait until Dec. 1 – June 1 to retest ACTH.
2. If a young horse in full (under 15 yr.) tests high ACTH in fall, retest later Dec. 1 – June 1 – a 7 yr. mare testing high ACTH in FALL does NOT have cushings.
3. Look for cushings (PPID) signs/look at age/look at history.

   Pergolide is expensive – consider waiting to retest later if no signs of ACTH.
4. Note: FALL ACTH rise is NOT controlled by pergolide – so doubling or tripling pergolide is NOT a good decision in fall.
5. Note: Remember, cushings alone is proven to NOT cause laminitis – need to be IR or IR + cushings – many owners on pergolide get surprised when their horse gets laminitis – this is due to IR was NOT addressed – can have a normal ACTH while on pergolide but founder! Due to had IR along with cushings.
   Click Here to See Article

Meds like Invokana, Jardiance, Velagliflozin

1. SGLT2 inhibitors

a. Used in Type 2 diabetes

b. Lower blood sugar (glucose) by causing kidneys to remove sugar from the body through urine. *Click Here – FDA Information Bulletin

Note: Not approved for insulin resistance

Not approved to lower insulin.

2. FDA confirms risk of leg/foot amputations with Invokana (2017).

FDA’s highest Black Box Warning put on this drug. *Click Here – FDA Information Bulletin

Study of SGLT2 in horses never came close to lowering insulin to normal levels – was on average 148% above normal when used. Article in Holistic Horse

Australian study fails to come close to normal insulin levels in a 2018 Study

• Treated group was far from peak of normal – 88 points too high – not near normal.
• The experiment was funded by a pharmacy company and they had a full time employee of the company as a co-author and the company “played a significant role” in design of study. Tremendous conflict of interest.
• Only pony breeds used
• Note: 3 years later, no further trials done, no drug to market in horses.
  3. Some owners trying Invokana in yahoo horse group – several have shown severe elevation of Triglycerides, many not responding or responding slightly but reverting backwards.
  High triglycerides can lead to fatty liver disease in horses – which can be fatal. See article
  Can also cause pancreatitis. See article
  4. There is no FDA approval of this class of drugs in horses – veterinarians using this risk liability lawsuits and possible license action by state veterinary boards.
  

You should AVOID this drug in horses for several reasons:

1. Equine Insulin Resistance Metformin: Equine Insulin Resistance is high Insulin levels with normal Glucose levels. But Metformin is a human Diabetes drug that has one job – to lower Glucose. It makes no sense to give a drug to lower Glucose in a horse with already normal Glucose. Metformin is for Type 2 Diabetes which most horses never get. Click here – Does my horse have Horse Diabetes?
2. Equine Insulin Resistance Metformin: Oregon State’s Veterinary Research Team in May 2009 found this drug is not absorbed by horses. It is going in one end and out the other and so is your time and money. Conclusions of the Study: only 4-7% of Metformin giving orally 2 times a day is absorbed and is “insufficient to achieve plasma concentrations of drug comparable to the therapeutic range achieved by humans.” AJVR 2009, May, Dr. Hustace. Click here to see article Pharmacokinetics and bioavailability of meformin in horses.
3. Equine Insulin Resistance Metformin: Metformin had no effect on Insulin Sensitivity in horses. K. Tinsworth, Australian Science Symposium, 2010. Click here to see article Pharmacokinetics of metformin after enteral administration in insulin-resistant ponies.
4. Equine Insulin Resistance Metformin: Dr. Pratt, Professor at North Carolina State Universtiy, College of Vet. Med., stated, “Human drugs like Metformin have not proven to be effective in horses.” Morris Animal Foundation.
5. Equine Insulin Resistance Metformin: “Metformin is not an effective long-term mono therapy for increasing Insulin sensitivity in horses.” M. Vick, University of Kentucky Dept. of Vet. Sci, Reprod. 2006. Click here to read Dr. Vick’s study
6. Equine Insulin Resistance Metformin: No FDA approval for use in horses – creates liability issues.
7. Equine Insulin Resistance Metformin: One small study in England, years ago, thought they saw effect, but no university or institute can replicate these findings. This study was before Oregon State’s Veterinary School found the drug was not even being absorbed in any useful manner. Also, the English study tried 2 times per day dosing which is difficult on clients. The cost to try it was over $2000.00 a year.
8. Severe side effects seen in people on this drug that you need to be aware of according to the Mayo Clinic – 2008:

   • Lactic Acidosis (known as “Tie-up” in a horse). “Severe muscle pain and cramping.”
   • Gastrointestinal Upset (known as “Colic” in a horse) “Need to take with food to reduce stomach and intestinal side effects.” “Vomit, stomach ache, passing gas, heart burn.”
   • Thyroid Condition – Drug can interfere with Thyroid medicines. Some horses need Thyroid supplement.
9. Equine Insulin Resistance Metformin: Can suddenly not work anymore. “At some point this medicine may stop working and your blood glucose will increase.” Mayo Clinic, 2008.
10. Equine Insulin Resistance Metformin: Emergency Kit recommended. “Carry an Emergency ID Card and Glucagon Emergency Kit for emergencies” due to hypoglycemic reactions. Mosby’s Drug Guide. Not practical with horses.
11. Equine Insulin Resistance Metformin: Requires constant/multiple blood testing to monitor. More expense.
12. Equine Insulin Resistance Metformin: No study of long-term effects on horses. Your horse is not a guinea pig.
13. Equine Insulin Resistance Metformin: On package insert inside box of Metformin. “If lactic acidosis does occur, it can be fatal in up to half the people who develop it.”
14. Equine Insulin Resistance Metformin: Can cause severe respiratory problems. “Respiratory alkalosis may be an early adverse event induced by Metformin prior to developement of lactic acidosis.” Am J. of Therapeutics, 2004 .
15. Equine Insulin Resistance Metformin: 2013 Study on Metformin had multiple flaws in the experiment

    • Did not use Insulin Resistant horses – used young thoroughbreds and standardbreds that were normal AND which are not even Insulin Resistant. No idea if can help the horses with the problem.
    • Had to tube the Metformin 1 hour prior to feeding. This is not a real world situation. Are you going to treat your horse 1 hour before every meal? Treat at 6 AM, feed at 7 AM – Probably NOT! AND, horses are continual slow feeders, so Metformin effects are not working all day. Are you going to squirt Metformin in their mouths 24 times a day. Probably NOT!
    • They used large doses of Dexamethasone steroid to try to create Insulin Resistance in the healthy thoroughbreds and standardbreds. This is not how your horse became Insulin Resistant – highly artificial model and not the natural way Insulin Resistance happened in horses via genetics, diet, age, and management. Click here to see the article and why had problems and why 1 year later Metformin is not used with success.
16. Equine Insulin Resistance Metformin: Dr. Morgan’s 2015 study on equine metabolic syndrome found with metformin

    • “No perceived benefit from long term drug administration [of metformin”
    • “Recent research shows a lack of efficacy of the drug on Insulin Resistance”
    • Click here for Dr. Morgan’s article.
17. Equine Insulin Resistance Metformin: Metformin reduces Thyroid stimulating hormone in cases of underactive Thyroid – up to a 55% increased risk of low TSH.

    • Click here for American Diabetes Association Study, Dr. C. Cappelli, 2009.
    • Click here for 2014 Article about Metformin Causing Thyroid and Heart Problems, from the United Kingdom.

A. Equine Insulin Resistance Glucosamine. Why Avoid Glucosamine?

Many studies are showing Glucosamine can do the following:

Glucosamine – makes insulin resistance worse in several studies

High insulin from insulin resistance is the #1 cause of laminitis in the world.

1. The infusion of glucosamine causes insulin resistance. Glucosamine infusion also in this animal study impaired exercise – stimulated glucose turnover. Dr. Reilly – cushing horses already have high glucose so they need to avoid glucosamine. Click Here: Diabetes, 2001 Dr. Miles.
2. Glucosamine inhibits liver enzymes, leading to abnormal glucose levels – elevated. Click Here: Diabetes, 1996 Dr. Barzilai.
3. Glucosamine induces insulin resistance in skeletal muscle in an animal study. Click Here: Diabetes, 1999 Dr. Patti
4. Glucosamine is already used in laboratory settings and animal studies to induce insulin resistance. Glucosamine interferes with the liver’s ability to control glucose production. Click Here: National Center Health Research, Dr. Bravo
5. Oral glucosamine used to treat osteoarthritis worsens insulin resistance. Click Here: Am J. Med sci, 2007
6. Glucosamine infusion mimics pancreas cell dysfunction of non-insulin-dependent diabetes mellitus. Glucosamine causes insulin resistance in peripheral tissues and has been implicated in pathogenesis of glucose toxicity. Click Here: Metabolism, 1998 Dr. Shankar
7. Glucosamine-induced insulin resistance in fat cells – induced complete insulin resistance. Click Here: AM J Physio Endocrin,2000, Dr. Heart
8. Glucosamine induces insulin resistance and that reduces blood flow. Click Here: Diabetes 1999 Dr. Homaug
9. Glucosamine infusion lead to inducing peripheral insulin resistance in this animal study. Dr Reilly: Insulin resistance is the top cause of laminitis in horses. Click Here: Diabetes 1996 Dr. Hawkins
10. Oral Glucosamine caused an increase in Glucose levels in people. Dr. Reilly: Cushing Horses already have high glucose – so this glucosamine study shows a large potential problem. Click Here: Ann Rheum Dis 2007 Dr. Biggee

B. Equine Insulin Resistance Glucosamine. Glucosamine – not helpful in osteoarthritis: neither is chondroitin.

1. National Institutes of Health

• Animal study showed “long term use of moderately large doses of glucosamine might damage the kidneys.”
• Glucosamine might affect the way the body handles sugar, especially if you have diabetes or other blood sugar problems, such as Insulin Resistance.

2. There is little evidence that glucosamine has beneficial effects on joint structures.

• American College of Rheumatology has recommended people with knee or hip osteoarthritis not use glucosamine or chondroitin.
• Overall, those who received the supplements Glucosamine / Chondriotin had no significant improvement in knee pain or function.
  • Click Here: NCCIH, 2014 Glucosamine and Chondriotin

3. University of California Department of Orthopedic Surgery

• "Glucosamine does not appear to slow arthritis progression over the long term and has many potential complications. The most common adverse effects are epigastric pain or tenderness, heartburn, diarrhea, and nausea. Glucosamine also may cause allergic reactions in patients with seafood allergies, as a product of lobster, crab, and shrimp shells. Glucosamine may interact with various pharmaceuticals, such as warfarin (Coumadin) and diabetes medications, dangerously modifying their efficacy.”
• ”Similarly, chondroitin sulfate appears not to provide meaningful benefit for patients with OA, and their combination has not proven effective for either pain management or functional improvement. OARSI and NICE no longer recommend the use of glucosamine or chondroitin sulfate alone, or in combination, if no effects are observed after 6 months or radiographic changes are marginal.”

4. ”A network meta-analysis of 10 trials in 3,803 patients by Juni and collaborators in 2012 found no clinically significant improvements in OA pain alleviation or JSN parameters with glucosamine, chondroitin, or combined treatment compared with placebo.”

5. Quotes and information in this section (section 12) are from: Christiansen, Blaine A, et al. “Management of Osteoarthritis with Avocado/Soybean Unsaponifiables.” Cartilage, SAGE Publications, Jan. 2015.

6. Glucosamine and chondroitin sulfate – “Clinical trials have compared separately and together, against placebos but found no difference. There is no convincing evidence that these supplements repair cartilage or change long-term outcome.”

• Information in this section (section 13) is from: Harvard Medical School, Harvard Health publishing under joint supplements for arthritis, Dr. Shmerling. 2014

7. Compared with placebos, glucosamine, chondroitin and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover costs of these preperations. New prescriptions to patients who have not received treatment (glucosamine/chondroitin) should be discouraged. Click Here: BMJ, 2010, Dr. Wandel

8. Little evidence suggests that glucosamine is superior to a placebo treatment in restoring auticular cartilage. Click Here: J. Orthoped surg, 2009, Dr. Kirkman

9. Glucosamine is no more effective than placebo in treating the symptoms of knee osteroarthritis. Click Here: AM J Med, 2004, Dr. McAlindow

C. Equine Insulin Resistance Glucosamine. Glucosamine can cause kidney, eye, liver and lung problems.

1. “…demonstrate that induction of Insulin Resistance by glucosamine results in reduction of the blood flow rate as well as the uptake of glucose…” Diabetes Journal 2000.
2. Oral Glucosamine supplementation’s role in increasing intraocular (eye) pressure – “possibility that permanent damage can result from prolonged use of Glucosamine supplementation is not eliminated.” FYI: Increased intraocular eye pressure is one symptom in Glaucoma. >Click Here: Ophthalmol, 2013, Dr. Murphy
3. Due to it being linked to increasing problems with eyes, Insulin Resistance/Diabetes, Asthma, Skin, blood pressure, and cardiac events. Mayo Clinic: Cataract risk, dry eyes, asthma, Diabetes. Click here: Mayo Clinic, 2017
4. Glucosamine Supplement makes asthma worse. Click here: NCBI, 2002, Tallia
5. Glucosamine can lead to liver injury. Click here: NCBI, 2013, Felden
6. National Institutes of Health
   • Animal study showed “long term use of moderately large doses of glucosamine might damage the kidneys.”
   • Glucosamine might affect the way the body handles sugar, especially if you have diabetes or other blood sugar problems, such as Insulin Resistance.
   • There is little evidence that glucosamine has beneficial effects on joint structures.
   • American College of Rheumatology has recommended people with knee or hip osteoarthritis not use glucosamine or chondroitin.
   • Overall, those who received the supplements Glucosamine / Chondriotin had no significant improvement in knee pain or function.
   • Click Here: NCCIH, 2014, Glucosamine and Chondriotin
7. Liver toxicity associated with glucosamine and chondroitin in patients (human) with chronic liver disease. Dr. Reilly: If your horse has elevated liver enzymes, need to not use glucosamine – chondroitin – not worth the risk. Click Here: World J Gastro, 2013, Dr. Cerda
8. Drug induced acute liver injury mimicking autoimmune hepatitis after intake of dietary supplements containing glucosamine and chondroitin sulfate. Click Here: Int. J. Clin Parm, 2013, Dr. Von Felden

D. Equine Insulin Resistance Glucosamine. What to look for to accidentally not give glucosamine?

90% of joint oral supplements for horses have this – if you see “flex”, “joint”, “glyco” look carefully at label.

Many laminitis products have glucosamine – surprising but true.

Many senior horse feeds have it – do not use them.

Pentaussie Pentosan– has Glucosamine added to Pentosan. Do not use.

Equine Insulin Resistance Glucosamine. Polyglycan Injectible – has Glucosamine added to Chondroitin/Hyaluronate. Do not use.

Equine Insulin Resistance Glucosamine. Some senior feeds are adding Glucosamine to mix. Avoid these feeds.

Many insulin resistance horses also have joint problems and those joint issues can be worsened by laminitis – they horse stands unusual due to sore feet so ankle/hocks stressed by overloading the joints. Also if a laminitis horse has a problem joint in a front leg, it might weight overload the opposite leg leading to standing leg laminitis.

So Comfort Quik with Hemp CBJ Complex can help with laminitis recovery.

Never use Glucosamine in any IR/Cushing horse.

Click Here to See List of 32 Products with Glucosamine

Click Here to See Why Glucosamine is Not the Right Choice

Glucosamine increases insulin in several studies - that can create sore feet/laminitis, but also high insulin irritates joints – a bad circuit to be in.

Equine Insulin Resistance Chromium

A. Adding in chromium to your horse’s diet has no effect and may create problems.

1. You may see ads for using chromium in your horse for equine insulin resistance (weight loss, fat loss) - but studies have proven it does not lower insulin and adding it may create toxicity.

2. In Europe, it is illegal to add chromium to animal feed due to possible problems

B. Equine insulin resistance chromium - why not add chromium to a horse’s diet.

1. Proven in a university study on horses that adding it had no effect on insulin levels or insulin sensitivity.

Click Here to see the study by Dr. Chemeroy, University of Tennessee Veterinary School, 2011

a. High levels of chromium had no effect on resting insulin blood levels or insulin sensitivity.

b. High dose chromium failed to work, had no effect.

c. No effect on weight.

2. Equine insulin resistance chromium: Natural research councils nutrition of horses 2007. “No evidence has ever been found of chromium deficiency in horses”

3. Equine insulin resistance chromium: Equine and comparative Exercise Philosophy

Click here: Study from Vervuert at the Institute for Animal Nutrition, 2005

a. Chromium supplementation had no beneficial effect.

b. Blood insulin levels - no effect with chromium at rest or in exercise.

4. Equine insulin resistance chromium: Effects of chromium tripicolinate supplementation on plasma hormone

Click here: Study from Dr. Gentry, Journal of Equine Vet Science, 1999

a. No effect on blood glucose or insulin. Concentrations with chromium supplements

b. No effect on blood glucose or insulin levels in glucose tolerance tests.

5. No study in veterinary or human medicine has shown chronic low chromium in insulin resistance. No study in veterinary or human medicine has shown adding chromium lowered high blood insulin levels.

6. Equine insulin resistance chromium: European College of Equine Internal Medicine

Click Here: Study from European College of Equine Internal Medicine in Journal of Veterinary Internal Medicine, 2019

Equine insulin resistance chromium

a. Chromium use is popular but efficacy is questionable and unproven.

7. Equine insulin resistance chromium: Chromium effects on yearling horses.

Click Here: Study by Dr. Ott, Journal of Animal Science, 1999

a. No effects on insulin sensitivity

b. No effect on development

C. Equine insulin resistance chromium - too much can cause toxicity problems

1. Equine insulin resistance chromium: Click Here: European food safety authority, 2009

a. No symptoms of chromium deficiency in animals has been demonstrated in experimental conditions or in the field.

b. Not allow chromium addition into feeds.

2. Equine insulin resistance chromium: Click Here: Chromium Toxicity - 1998

a. Person took chromium for weight loss - required blood transfusions/dialysis

b. Liver problems, kidney problems

c. “Chromium supplements can cause serious kidney impairment” They are not harmless.

3. Equine insulin resistance chromium: Click Here: Chromium Toxicity, Dr. Vincent 2003

a. After 10 years of human studies, chromium had not demonstrated effects on body composition

b. Chromium can have bad effects - damage to DNA, mutations

4. Equine Insulin Resistance Chromium - chromium is in many horse products but has no positive effects in any study.

USE WITH CAUTION IN INSULIN RESISTANT AND PAST LAMINITIS CASES.

Equine Insulin Resistance Clenbuterol

1. Bronchodilator will increase Insulin in horses.

   “Insulin levels were higher in the group that received Clenbuterol.”

   Click here for article by Dr. Ferraz, J. of Equine Veterinary Science.

   Equine Insulin Resistance Clenbuterol
2. Human study showed it had profound effect on raising Insulin.

   “Raised serum glucose by 174% and Insulin to 379% of control.”

   Over three times the control! Within 30 minutes of administering.

   Click here for article by Dr. Edwards, Life Sciences

   Equine Insulin Resistance Clenbuterol
3. “Clenbuterol and exercise decreased blood volume by an average of 10% resulting in a DECREASE of aerobic performance.”

   Click here for article by Dr. Kearns, Med. Science Sports Exercise.

   So when on it, take it easy on the horse.

   Equine Insulin Resistance Clenbuterol

Dr. Reilly Comment: Good for short-term use of no more then 5 days in a row. I have seen an Insulin Resistant pony being controlled on Insulin for years, flip into Laminitis after on Clenbuterol for 30+ days in a row.

Equine Insulin Resistance Yucca Facts.

1. Yucca is high in sugar, which is important to avoid in Insulin Resistant horses, Cushings horses, overweight horses, and/or horses with previous laminitis history.

This horse does NOT need Yucca

ESC – 12.7 – Very high

WSC – 11.5 – Very high

Yucca is also very high in Iron (1900 ppm). High Iron can also make Insulin levels higher.

Equine Insulin Resistance Yucca exclusive information.

We are the only veterinary practice in the USA that tested Yucca, because we recognize that owners want black and white numbers to use to make decisions about their horses health. Many owners are unaware of this terrible problem.

2. Yucca is in over 35 different joint products for horses. Click here to see a list of these to avoid in IR and Cushings.

Joint products that contain Yucca cannot be used in Insulin Resistant horses, Cushings horses, overweight horses, or horses with previous laminitis history.

3. Yucca proven to raise insulin “Plasma insulin significantly increases.” *Click here to see 2013 Study by Dr. Oztasan

Why equine insulin resistance tied to yucca.

4. Yucca proven to reduce T4 Thyroid levels. * Click here to see: Dr. Kucukkart, 2016, Science Direct Why a problem? Thyroid hormone crucial in immunity and proven to help in insulin sensitivity. Equine insulin resistance yucca creates hormonal changes also.

5. Yucca proven to create hormonal changes in females which can lead to problems. “Yucca affects ovarian function” Click Here to see Dr. Vickova 2017 study. Equine insulin resistance yucca affects reproductive tract also.

“Yucca promotes progesterone release” in animal study. Click here to see: Dr. Stochmal 2015 study

Over 50% of joint supplements have yucca - why take chances with your mares?

A. Horses with insulin resistance are more prone to adverse vaccine reactions then the general population. WHy? Insulin in high levels is inflammatory not only to laminae in feet but also the entire body, including muscle where vaccines are placed.

B. Equine insulin resistance vaccines need a specific protocol to avoid laminitis flare ups, sore necks. IR horses can get laminitis when vaccines are not given properly - many owners have seen this.

C. Equine insulin resistance vaccines given incorrectly can also result in colic or large swellings at vaccine sites. Owners report having seen this year after year.

D. Equine insulin resistance vaccines - how to give?

1. Vaccines in the equine insulin resistance horse are split into 3 sessions - do not give all vaccines for the year at once.

2. Equine insulin resistance vaccines are NEVER given in the neck. All vaccines in gluteals. It is illegal in Europe to vaccinate horses in the neck.

3. Avoid combo vaccines with 4-5 antigens in one shot in equine insulin resistance vaccines. These provoke reactions due to many antigens in one site. Instead in equine insulin resistance vaccines, do just flu/rhino, just rabies, just enceph/tet, just west nile, just potomac, just botulism.

4. In equine insulin resistance vaccines, need to skip a week between sessions.

Example:

Session 1: Flu/Rhino shot, separate west nile shot

Skip Week

Session 2: Enceph/Tet shot, separate botulism shot

Skip Week

Session 3: Rabies shot, separate PITF shot.

5. In equine insulin resistance vaccines you give 500mg Banamine to a 1000lb horse/ 250mg Banamine in a 500lb horse,125mg Banamine in a 250lb-300lb mini. How?

6.In equine insulin resistance vaccines, you split vaccines up on gluteals - one shot right gluteal, one shot left gluteal.

Example: Session #1: Flu/Rhino shot left gluteal, west nile shot in right gluteal.

E. Rabies vaccine in equine insulin resistance.

1. The rabies vaccine is the most common vaccine to create a problem in the insulin resistance horse due to the strong antigen in it.

2. Rabies vaccine is crucial to give in all horses.

3. By splitting sessions, by pre-loading with Banamine past, by never using the neck for vaccines, this vaccine will not cause problems.

F. How else to avoid equine insulin resistance vaccine reaction in your horse? Get on the Heiro 4 step program to lower insulin, which lowers inflammatory reactions.

G. Broodmare in equine insulin resistance vaccines.

1. Broodmares given Banamine prior to vaccines is safe.

2. Heiro is safe in broodmares all the way from start to birthing, nursing, weening.

3. Split into sessions, no neck vaccines, gluteal split.

4. Consult broodmare vet on pregnant mare vaccines schedule.

H. Equine insulin resistance vaccines - do they work in these horses?

Insulin Resistance in horses does not negatively affect the immune response to vaccines – Good! In a 2016 study at the University of Kentucky, they found the humoral response to the influenza vaccine was similar to controls, so the protective ability of the vaccines is in place. This is great news because in other species, Insulin Resistance can cause lowered protection post vaccine. Click here to read the study.

In humans, a 2019 study found that in obese people, vaccines created a lower protective immune response. In the 2016 University of Kentucky study, they did not see this in horses, but they cautioned. It was a group of moderately obese horses that they were working on and that they were unsure if it was true in very obese horses. Click here to read the human study.

You will only get this information on our website. This is original research.

A. Weeds

Horses doomed to dirt lots are going to eat anything they see – even weeds. Horses need grass and turnout, not weeds. We tested several weeds to show why they are no good. Equine Insulin Resistant horses need their iron levels controlled to help in lowering Insulin.

Documented: Weeds are high reservoirs of Iron. Weeds raise Insulin and need to be avoided. Surprisingly, their sugar/starch content is not high.

Horses will seek out certain weeds like Chickweed. The super high Iron causes HUGE INSULIN SURGES leading to foot pain. Horse Insulin will increase if your horse is constantly receiving high iron from weeds. Iron levels in horses can be controlled by proper field management or if the horses are on a dry lot, to eradicate weeds. Often people will say he is “only on a small lot with some weeds to eat so he is not exposed to high sugars.” This study shows that those weeds can get your horse’s Insulin elevated by high iron.

B. Science of why to avoid High Iron in Equine Insulin Resistance

• “Metabolism of Insulin reduced with increased Iron stores leading to peripheral hyperinsulinemia.” Diabetes 2002.
• Evidence high Iron overload leads to skeletal muscle being effected, the main effector of Insulin. Diabetes 2002.
• High iron leads to toxic-free radicals. Diabetes 2002.
• Inflammatory cytokines increase Iron uptake and deposition leading to Insulin increases. Diabetes, 2002.
• Iron in high levels leads to Insulin Resistance. Alim. Pharmaco Ther. 2005.
• Decreasing Iron stored can increase Insulin sensitivity. Clin. Chem 2005.
• Systemic Iron overload contributes to abnormal glucose metabolism and elevated Insulin. Diabetes Care 2007.
• Excess Iron in the body increases susceptibility to bacterial infections. Horse Nutrition, Davies, 2009.
• Equine cases where chronic Laminitis attacks were alleviated by removing excess Iron supplements from diet. Feed your horse like a horse, J. Getty, 2010.
• Michigan State University looked at blood ferritin (iron) levels and effects on Insulin. Horses with high ferritin had higher Insulin responses. “If a horse is overweight or not given sufficient exercise, then it might warrant trying to give feed stuffs lower in Iron or, more importantly, not giving as much feed or feed higher quality.” Dr. Neilson, 2012, J. Zoo Wild Med. Click here to see Dr. Nielsen’s article.
• High Iron directly disrupts fat cell metabolism. Fat cells (adipocytes) breakdown is higher when blood iron levels are normal. “Transferrin and iron induces Insulin Resistance of glucose transport in adiopocytes.” Dr. A. Green, 2006, Metab Clin/Experim.
• Ferritin can also lower a hormone Adiponectin which helps in Insulin sensitizing. “As Ferritin increased Adiponectin decreased.” Animals fed high iron diet had lower Adiponectin also. “Serum Ferritin was negatively associated with Serum Adiponectin.” Dr. Gabrielsen, 2012, J. Clin Invest. Click here to see Dr. Gabrielsen’s article.

C. Supplements which to use and which to avoid

A. Commercial supplement grains are ok due to about 700 ppm Iron and are only fed at a 1 pound rate, so are getting only about 300 ppm total. They are ok to feed.

B. AVOID:

• Mineralized salt blocks – contain high levels of iron that your horse does not need if they have Equine Insulin Resistance.
• Liquid blood builders with words like: “Super Cell”, “Mega” “Red Cell” “Iron” “with added high Iron”. Good for race horses but NOT horse Insulin Resistance.
• Many vitamin/mineral powders are very high Iron – if not on the label, call and ask. If they can’t tell you, do not get it. If you want, you can send it to Equi-Analytical Labs to make sure.
• High Iron will interfere with Thyroid Powder Action – you need to be aware not to add more iron to the diet. Click here to see Dr. Gabrielsen’s article.

Only use Vitamin/Mineral Supplements that are below 100 mg per 132 grams powder. Many are over 200 mg. They are ok for racehorses but not for Equine Insulin Resistant horses.

D. How to test to see if my horse’s iron is too high?

A. A serum iron test in equine chemistry panels is NOT, by itself, accurate. It can show normal and the horse’s iron levels are high.

B. Best, more accurate is a 3-test combination of:

• Serum blood level
• TIBC blood level
• Ferritin blood level

C. Your Veterinarian’s normal lab will NOT be able to do this test. It requires a special lab at Kansas State Veterinary School.

• Test is $49.00, results in one (1) week.
• Your vet will collect blood (red top tubes), within 30 minutes spin and harvest serum and place in a plastic tube, freeze solid, FedEx to:

Kansas State University Vet Diagnostic Lab

Attn: Sue Chavey

Dept: DM/P Comparative Hematology

1800 Denison Avenue

Manhattan, KS 66506

785-532-4424

They even do these three tests on Elephants and Beluga Whales!

E. What can cause problems in Equine Iron Test results?

1. Pregnant mare can see total serum iron drop and TIBC level go up.
2. Liver disease makes TIBC go down and serum iron go up.
3. Infections, severe inflammation can make ferritin go up even if there is no excess iron intake. So if painful in the middle of Laminitis, it is not time to test iron.
4. High ACTH (Cushings perhaps) will make TIBC go down.
5. Progesterone hormones like Regumate might make TIBC go up.

F. Water as Iron Source

In many parts of the country, the water can be high Iron. You can quickly see this if the sinks and toilets have iron staining. In some barns, filters are available to lower Iron. In many barns and fields, filters are not practical. The key is to do what you can by avoiding weeds and Iron supplements that cause Insulin to go up.

Many clients have put a Waterboss Filter in the barn to reduce the iron. Only $350.00. Can get at HomeDepot. Click here for the link to the Waterboss Filter.

G. Heiro Ingredients Helping to Maintain Proper Iron Levels

1. Cinnamon in Heiro

• Cinnamon had highest ABTS – radical scavenging activities against cation (free iron is a cation).
• Cinnamon had the highest hydroxyl radical scavenging activity.
• Click Here for Food Chemistry, 2007 Dr. Su Article

2. Milk Thistle in Heiro

• “Potential iron chelator”
• Patients with hereditary high blood iron improved when milk thistle added – blood iron decreased
• “Potential to reduce iron absorption”
• Click Here for Eur. J. Clinical Nutrition, 2010 Dr. Hutchinson

3. Vitamin E in Heiro

• “High iron can increase oxidative stress and exacerbate disease”
• High iron caused inflammatory bowel disease increases, but adding vitamin E, “decreased inflammation.”
• “High iron increased disease activity and detrimental effect on disease activity reduced by Vitamin E.”
• Click Here for Journal of Nutrition, 2002 Dr. Carrier

4. Fenugreek in Heiro

• Fenugreek powder nullifired aluminum induced memory loss, aluminum is another cation in free state, like iron.
• High aluminum given in study created brain dysfunction, such as memory loss/learning impairment.
• Fenugreek stopped aluminum’s damage
• Click Here for an article on the Neuroprotective effect of Fenugreek seeds, 2016.

5. Peppermint Leaf in Heiro

• 127% hike was note in serum (blood) ferric (iron) reducing antioxidant power in a study.
• Bactericidal against e.coli and staph
• Natural source of bioactive phytochemicals
• Heiro contains a small amount of this, but it helps in iron control
• Click Here for an article from Pharmacogn Mag., 2010 Dr. Sharafi

The high insulin creates laminae stretching which leads to disruption of the white line of hoof (junction between inner hoof wall the stratum internum and the sole).

Once this white line seal is breached, bacteria/fungus invade the non-pigmented inner hoof wall leading to white line disease. The actual disease is in the inner hoof wall.

This white line disease (WLD) is infection and separation of the hoof wall from the sole.

When you see horses with WLD, many of these are actually horses with IR (insulin resistance) and it’s a flag of upcoming or pre-existing low-grade laminitis. Pouring hoof paints and dressings into WLD will have little effect because the anatomy has been damaged by IR – until IR is addressed, chronic WLD keeps occurring.

A. In the Fall (September – December), many weather changes create an increase in the Fructan level of the grass. This same surge is also seen in rapid growing Spring grass, and is a reason why spring grass triggers many Laminitis cases. On hay tests, Fructans are part of the WSC component. Fructan % is approximated by taking WSC level and subtracting the ESC. Dr. Getty 2010, Chpt. 2.

B. Fructans increase several ways in the Fall:

• Drought – Often can go weeks with no rain. This stresses the grass so it does not grow upward and so fructans build up higher and higher.
• Cooler weather – again, fructans level increase.
• Frost – can create and three times increase in fructans in just a few hours. Keep horses off early season frost grass until later in the morning (6:00-8:00 AM).
• Sun – direct sun increases fructans, so pastures in the shade or at night (after 8:00 PM) have lower fructans. Dr. Byrd, 2006, JAS – Fructans lowest at 4:00-5:00 AM (15% WSC). Fructans peak at 4:00-5:00 PM (22-24% WSC). As you can see, fructans can jump up quickly within the day. So night (after 8:00 PM) or early morning (up to 8:00 AM) will be a better time to graze. If can only graze small amounts, do 6:00 AM – 8:00 AM or 8:00 -10:00 PM.
• Mowing – Fructans in grass are at higher levels at the base than at the tip of the grass and higher in the stems than the leaves. Smith, 1967, Crop Sci, Pavis, 2000, New Phyto. Click here to see Article from Pavis on Fructans and Fructan-metabolizing enzymes in leaves of Lolium Perenne. So in August-September, you need to really make sure not to over mow the grass. It is slowing on growth and you want to keep it at 4-5 inches. This allows less fructans into the horse. The base of the grass is super high in fructans so mowing like a lawn makes things bad for your horse. 4”-8” mowing, height lowers sugars in grass. A. Cairns, Grassland Institute.
• Soaking hay can bring NSC down 19% in thirty minutes and 31% in sixty minutes. Equus, 2004.
• Cutting for Hay – cut late at night – Why?

  • If cut in bright sun, hay has higher sugar. Individual leaves remain alive for 50 hours after they are cut. So if cut in the sun, still has photosynthesis and accumulate sugars.
  • “Course stemmy hay can have high sugar, soft leafy hay can be low sugar. It depends on if it was cut when stressed, or drought, or sudden cold spell prior to cut.” Dr. Pollitt, 2010, Aust. Gov.

C. High levels of fructans can lead to Laminitis – this is why often after the first frost, grazing time is cut back to 4-6 hours with a muzzle until grass is dead, and grazing is kept to early morning or later at night.

Dead Grass? Fructan levels in Winter will drop faster if it is a wet Autumn. A drought/little rain Autumn means higher levels of fructans going into Winter. Grass must be totally brown prior to increasing pasture time or removing the muzzle. Brown and green grass mixes can be very high in fructans such as seen sometimes in December grass with mild weather.

Once totally brown, rain and snow will leach out fructans from grass allowing muzzles to be removed. “Sunny days, frigid nights with grasses in no way lush that dark green, half dead grass had very high sugars and fructans.” K. Watts, Rocky Mountain Research.

Steps in Fructan Laminitis:

A. The large intestine has a normal population of bacteria to breakdown food. These bacteria can handle normal amounts of fructans seen in hay/grass. The bacteria mix with the Fructan sugar and ferment, much like sugars and yeast coming together to ferment in making beer/wine.

B. Food eaten by the horse will have simple sugars to be absorbed at the small intestine. After that, the body’s pancreas notes this increase in blood sugar and Insulin pours out. Pancreas to escort it to the cells.

C. On the other hand, Fructans pass unaltered to the large intestine where it undergoes fermentation. Longland, 2012, J. of Sci food/ag.re. Fructans are not degraded by mammalian enzymes but by bacteria. Nilsson, 1988, J. of Nutrit.

D. But too large a Fructan load creates too much rapid fermentation leading to problems.

• Pasture-Induced Laminitis
  • “Pasture-induced Laminitis can be from over consumption of carbohydrate in the form of simple sugars, fructans, or starch.”
  • When fed frutans, in excrement, fecal pH dropped.
  • When fed fructans, in excrement, amine levels increased.
  • Produced increased in bacterial fermentation products.

Click here to see Dr. Crawford’s article in Journal of Animal Science, 2014, Dietary fructan carbohydrate increases amine production in the equine large intestine: Implications for pasture-associated laminitis.

• Spring Pasture, Weather, Overgrazing

  • Drought or frost increases fructans by up to 30%.
  • Fructans are stored in the bottom 2 inches of grass – avoid overgrazing.

• Fructan Metabolization
  • Fructans metabolized in the liver can lead to Insulin Resistance.
  • Fructans metabolized in the hind gut can increase permeability resulting in toxin release.

Click here to see Dr. Johnson’s article in the Journal of Equine Science, 2013, Fructans, Fructokinase, Intestinal Permeability and Metabolic Syndrome.

• Microbial Ecology of the Equine Hind Gut
  • Introduction of high levels of fructan resulted in large scale changes in high gut microbiota. Rapid proliferation of Strep bacteria occurred, followed by a rapid decline and a huge pH decline.
  • Previous study, all horses had diarrhea and huge pH drops in the cecum following high fructan dosing. They also have high fevers for 24 hours post dose and high heart beat rates.

Click here to see Dr. Milinovich’s article in the ISME Journal, 2008, Microbial ecology of the equine hindgut during oligofructose-induced laminitis.

• Changes in the Equine Hindgut
  • Bacterial counts in the gut markedly changed in population increases.
  • pH also dropped.

Click here to see Dr. Milinovich’s article in the Enviorn Microbiol., 2006, Changes in Equine Hindgut bacterial populations during oligofructose-induced laminitis.

• E. Now What? Within 8-12 hours of Fructan overloads, strep exotoxins seen in blood. Within 24-48 hours Laminitis. Pollitt/Visser, 2010 Vet Clin. Next can come Diarrhea, fever, shock, and death.

Fructans Possible Treatment

In a 2014 study using sodium bicarbonate (baking soda), they demonstrated by tubing approximately 1 pound down of it with water could alkalinize (increase pH) of the large intestine. This study has huge possible therapy options for Veterinarians/owners trying to avoid or treat this type of Laminitis. We highly recommend now if your horse is suspected of frost grass or spring grass Laminitis to have this baking soda treatment to help treat your horse. We also recommend to try to help your horse in October/November and April/May/June by feeding a 1000 pound horse 2 tablespoons AM and 2 tablespoons PM of baking soda in the feed (add sugar-free pancake syrup to flavor). This daily prophylactic attempt to alkalinize pH needs further testing to see effects, but it is an easy, simple step to try to avoid issues and over the last 2 years has helped many horses we have worked with to avoid relapses. Click here to see Dr. Taylor’s study in Equine Vet J., 2014, Effect of orally administered Sodium Bicarbonate on caecal pH.

* HEIRO is certified in Omega 3's to decrease inflammation

Pasture Turnout

1. Your horse is meant to graze and play in a grass pasture. Too often, you will see statements that grass must be “severely curtailed or totally eliminated”. This is NOT TRUE!

By being on HEIRO™, along with proper diet and snacks, your horse can get back to where they belong. We’ve helped hundreds of horses get off dirt lots and get back to grass. Lab tests show that Insulin can be controlled if on the right program.

2. Dr. Divers, at Cornell’s College of Veterinary Medicine, put it best in that grazing “may even have advantages over totally dry lot confinement by supplying essential nutrients and antioxidants that may not be available in commercial feeds and stored hay.” J. of Equine Science, 2008.

3. In human studies, diet and exercise were able to help diabetics control blood sugar, in 60% of the cases. This means 40% were still in trouble. The same goes for horses. Many Equine Insulin Resistant patients “have such thrifty genes that high body scores are maintained in spite of consistent exercise and nutritional programs”. Dr Divers, J. of Equine Science, 2008. These are the horses that people have tried everything but the horse still gets foot sore and stays in jail. These are the horses needing HEIRO the most. Your Veterinarian will do testing to see where the Insulin levels are and how well HEIRO works after 60 days. Once the numbers improve, a controlled pasture turnout program can be started. Many horses are back to 8 hours a day within two months of starting on grass.

4. Muzzles in Equine Insulin Resistance

Yes, you’ll need a muzzle to slow down the horse in order to have a continuous, slow and steady feed intake.

• Get a muzzle that clips to the halter – avoid the muzzles that have the built-in halter. This type is easier for the horse to rub off or for other horses to pull off.
• The Velcro clip design is good but needs help. Go to a hardware store like Home Depot or Loews and get Gorilla tape. Split the tape and wrap it around each Velcro strip where the muzzle is attached to the halter. This stops other horses from ripping the muzzle off the halter.
• Keep the muzzle right against the nose- do not leave a 2-3 inch gap from the nose to the muzzle. That is so loose that they will slip it off. You do not need to smash it against the nose but it should touch.
• Do not panic if it comes off. We had many calls from new HEIRO users very worried that their horse had the muzzle off when they came home. A single episode resulted in no Laminitic cases in all of 2008. The key is not to let them pig out for multiple days in a row. So if they continue to take it off you need to figure out a way to stop them.
• Make sure the muzzle is still working – look at this picture (to the right) of one that basically was worn out to the point of not restricting food intake. Get a new one every 12-18 months.

  New Types of Muzzles:

  A. Dr. Joyce Harman created a flexible muzzle that is put in warm water, then can form around your horse’s muzzle easily. This design will allow more air flow, so good in hot climates. The area they graze with has the ability to customize amount gives – it’s not just one hole. Also, it can be washed and disinfected easily.

  B. GreenGuard Muzzle – Again, more air flow, can wash and disinfect.

5. Do the math to see why turnout will help protect feet.

A brumby horse, in Australia, will walk on average over 20 miles a day, but studies on horses in fields have it at 3-5 miles. So at 4 miles a day is about 1/6th of a mile per hour or about 266 yards each hour (about 1/2 a lap of a running track at the high school). So just 6 hours a day is 1 mile of walking or 30 miles a month of walking.

When it is dark at 5:00 PM and you have no indoor, your horse walked a lot. When you are out of town, your horse walked a lot. When you can add riding/lungeing, great, but sitting in a dirt lot means your horse misses, in just 6 hours of turnout a day, 365 miles a year. No wonder dirt lot/confined horses have more foot problems. Turnout is exercise.

1. The term “Founder” is a much more than a common term for the painful condition in the horse’s foot. The term has been around for hundreds of years and its origin comes from a naval term. A ship “foundered” on the rocks or sand was unable to move, much like a foundered horse was unable to walk. When the coffin bone would actually “sink” and go through the sole, the naval-termed horse founder was set even more.

The term “Laminitis” is seen in veterinary books in only the last 100 years – doctors were able to identify the tissue damaged in the horse’s feet and applied a name to the tissue – Laminae. By adding the “itis” to the tissue’s name, it denoted inflammation in that tissue, so “Laminitis” was a more scientific name.

2. Through the centuries, owners were able to see different types of founder – the most common type of horse founder was “Road Founder” from overuse on hard roads. The foot underwent too many concussive events per day and the Laminae were affected. The second most common type of horse founder seen long ago was “Grass Founder”, especially in pony breeds. Horse Insulin Resistance problems have been with the horse since their very start.

3. Time changes types of horse founder

Due to people’s need for large amounts of work to be done by the horse, few horses were overweight centuries ago. Exercise pushed back Equine Insulin Resistance. Also, grain was expensive and difficult to harvest, so most farm animals did not get it fed in large amounts, which further controlled horse founder. As mechanized farm equipment and trucks were able to plant, harvest and move more grain cheaply, the grain meal size increased and exercise decreased. Equine Insulin Resistance became a larger and larger problem and now is the #1 cause of horse founder. The term “Grain Founder” and “Grain Overload” were used more often as the years went by. From the start of horses, horse founder from Colitis/Colic, infections, retained placentas, too much weight on one leg if other leg is injured…have been around. Nowadays, true Road Founder is rare.

4. So is it having “Laminitis” or is my horse “Foundered”?

From the AAEP 2005

• “The term Laminitis and Founder are used interchangeable. However, Founder usually refers to a chronic (long term) condition associated with rotation of the coffin bone, whereas acute Laminitis refers to symptoms associated with sudden initial attack including pain and inflammation of the tissue.”
• Often, horses will undergo many Laminitis events before movement of the coffin bone occurs either by sinking down or rotating forward. Doctors will see a Laminitis episode and radiographs taken at the time are often not showing coffin bone shifts, but as years go by, small changes occur and updated radiographs show position changes. Recent studies show that coffin bone pathology is taking place microscopically right from the start of Laminitis. We just could not see it on radiographs, but CT Scans of coffin bones and stained sections of bone show the damage right away.

  

The coffin bone is changing in early-stage Laminitis even if there is no movement (sink, rotate, etc.). Early on, radiographs can be normal, but CT Scans/microscopically the coffin bone is affected – it did not escape damage, it just was not damaged as badly as to change position.

Your doctor will take films of the foot to see either:

1. Changes from the last set of films.
2. Changes seen now which could be from 5 years ago or in just the last few days – there is no time clock to tell if just happened.
3. Often take films 2-4 weeks after the first set to see if went from Laminitis to Horse Founder or to see if previous Horse Founder is advancing.
   • “A horse can have Laminitis, heal, and not Founder.” Dr. Scott Morrison, AAEP member for AQHA, Daily, 2013 (sharp Vet). Well Put – Laminitis injury occurs, healing required.
   • The more and more Laminitis episodes pile up (“goes lame twice a year”) the more chances it will become Horse Founder.

     

5. Can my horse become un-Foundered?

Yes, many talented Veterinary-Farrier teams have had cases with large amounts of sinking/rotating on radiographs and with hard work and time were able to get the coffin bone back in place. I have seen follow-up films on Foundered horses that you could not tell they ever had a problem. Improvement on the position of the coffin bone on a Horse Founder case is an important goal.

Equine Insulin Resistance Pain

10 Foot Neuritis Signs in your Horse (Neuritis/Neuropathy)

1. Hoof test ok but foot sore.
2. No increased pulses but foot sore. Radiographs same as in the past or are even improved (less rotation) but foot sore.
3. Talented farrier sees improved foot from past but foot sore
4. Talented farrier does routine hoof trim and horse is sore 1-2 days after – this is not an error, this is a sign of Neuritis.
5. Middle of the winter and no grass or on dirt lot with no grass and suddenly foot sore. Ouchy across rocks/gravel/hard ground, the others are ok on. Allodynia – excess pain response to normal stimuli.
6. Middle of winter standing in snow or very cold over 5 days in a row and suddenly foot sore. Note: Icy therapy which helps treat Laminitis is all around the horse but is sore due to this is Neuritis and not Laminitis.
7. Bute of little help – did help in the past but even on it daily for weeks is still foot sore.
8. Stall rest/DMSO IV/Ace which helped in the past not helping now.
9. Shoes/Boots do help some but less than 50%.
10. Lame for months and months even after trying many things.

* These 10 signs are Neuritis caused by past Laminitis and not new/acute Laminitis.

Equine Insulin Resistance Pain.

What happens to horse’s nerves in Laminitis resulting in neuritis?

1. Direct irritation and damage to the nerves by high levels of insulin. “Insulin Neuritis Syndrome seen in people starting insulin therapy.” Dr. Vinik, 2004, CME, Diab. Neuro.

2. Insulin Resistance leads to:

• A reduction of neurotrophic signaling which contributes to nerve pathogenesis.” Dr. Hosseini, 2013, Oxid. Med. Insulin’s usual action is to promote nerve growth, but Insulin Resistance blocks insulin’s normal function.
• “In neuron, Insulin Resistance disruptions of pathways leads to mitochondrial dysfunction, oxidative stress and dysfunctions or death of the nerve.” Dr. Hosseini, 2013, Oxid. Med.

3. Less blood flow (vasoconstriction) to nerves damages them. Insulin at high levels causes vasoconstriction.

• “Blood vessel endothelial dysfunction” seen in diabetic people with neuropathy.” Dr. DeVriese, 2000, Br. J. Pharm.
• “Oxidative stress and inflammatory activity reduce nerve blood flow.” Dr. Kellogg, 2006, Antiox/Redux Signal.
• “Selective COX2 inhibition helped in preventing nerve blood flow and nerve conduction velocity deficits in experimental neuropathy.” Dr. Pop-Busvi, 2002, Diabetes, University of Michigan.
• “Neuropathy is a microvascular complication of diabetes.” Dr. Hosseini, 2013, Oxid. Med.

4. Physical crushing of nerves.

• In all Laminitis, bone density is lost. This leads to nerves not being protected by being exposed to more shear forces and in horses shifting weight and pressing harder on areas of foot, leading to nerves bearing more weight.
• As blood flow is lost, coffin bone can sink and press on nerves.
• As horses founder (rotate), the shifting coffin bone smashes the nerves/blood vessels.
• In human medicine they are looking into neuroma formation in diabetic people’s feet – very possible in horses also. Damaged nerves hypertrophy into bundles of tissue creating pain.

5. Inflammatory mediators create damage to nerves both locally in the foot and in the spinal cord.

• “Oxidative stress and reactive oxygen species lead to progressive nerve damage, dysfunction, and loss.” Dr. Hosseini, 2003, Oxid. Med.
• Blocking COX2 helped in preventing nerve blood flow and nerve conductive velocity deficits. Dr. Pop-Busvi, 2002, Diabetes. COX2 is an enzyme creating prostaglandins. Certain medicines like Equioxx and Previcox are COX2 specific blockers, to lower prostaglandins.
• “PGF2-alpha, PGE2 (prostaglandins) are vasoconstricting.” Dr. Kellogg, 2005. So when the horse is inflamed there is less blood flow to the feet and nerves in the feet.

  Equine Insulin Resistance Pain
• COX2 inactivation had “protective effects against nerve function and biochemical deficits, shows support for major contribution of the COX2 pathway activations/enhancement oxidative stress relationship in diabetic neuropathy.” Dr. Kellogg, 2006. He also, by inactivating COX2, lowered prostaglandins by 5 times and also nerve catalase by 4 times and lipid peroxidation by 2 times.
• *** “Evidence that inflammation in COX2 is major pathway accounting for 75% of PGE2 prostaglandins.” Dr. Gross, 2002, AJ Phys.; Dr. Langenbach, 1999, Ann. NY.
• “PGE2 prostaglandin, Thromboxane is not unique to COX2 pathway in normal circumstances but in pro-inflammatory conditions such as diabetes, their function is mainly via COX2.” Dr. Kellogg, 2002.
• Inflammatory path cross talk makes painful events. Prostaglandins made by COX2 enzymes are able to increase LOX enzymes on a different pathway and LOX products like HETE can increase only COX2 enzymes (but not COX1) “Cross activation greatly augments progress of neuropathy.” Dr. Xu, 2006, Kidney Int.
• See how a Cox2 blocker helped in lowering peripheral neuropathy in an animal study. Also see how Gabapentin Family Med also helps. Click here to see: Etodolac, a Cyclooxygenase-2 Inhibitor, Attenuates Paclitaxel-Induced Peripheral Neuorpathy
• In Spinal Cord See below why Equioxx/Previcox helps so much in Neuritis.
  • Dr. Orsini, Head of the Laminitis Institute, alluded to this in his study of Equioxx in arthritic horses. “Improvement by day 7-14 in Osteoarthritis horses may have reflected in the past a neural effect such as a central down regulation of Allodynia associated with chronic pain.” AJVR, 2012.
  • Dr. Bevtone, in a study, “COX2 involved in central nervous system pain responses and COX2 actually in CNS is increased in peripheral inflammation.” and “COXib medications (like Equioxx and Previcox) cross blood brain barrier they may provide analgesia centrally as well as peripherally.” JAVMA, 2008.

    Equine Insulin Resistance Pain
  • Why Cox-2 blocker like Firocoxib (Equioxx/Previcox) needs to be used in early Laminitis pain. In a carbohydrate overload study testing various cytokines, inflammatory marks, the Cox-2 expression in laminar tissues was the one seen – not white cell cytokines, not nitric oxide enzymes. The Heiro program of pain relief over the last 5 years is in total agreement with this 2014 university study. Click here to see study: Laminar Inflammatory events in lean and obese ponies…

• Nerve in foot and nerve/s in spinal cord damaged in Laminitis. “Anti-neuropathic analgesic treatment may have a role in management”.

Click Here to see study: Neuropathic Changes in Equine Laminitis Pain

How to Help Stop Neuritis Pain In The Feet Of These Horses? 3 Steps.

1. Need to control high insulin – if this is not done, you are throwing Dixie cups of water on a forest fire. Slow/steady hay eating plus ration balancers with extra protein plus HEIRO = SUCCESS.

Eventually after testing, will slowly start a turn out program.

2. Physically protect feet – shoes, boots, casts, pads, impression material – to allow nerves to rest. Confine to a small area for 1 week.

3. Medications: Equine Insulin Resistance Pain

• COX2 blocking agents are most effective. 640 times more COX2 specific (Firocoxib in Equioxx). Dr. Orsini, 2012, AJVR.
• The key is to get high levels into the horse quickly, then drop dose down but extend its use. Early on, we would get great effect then stop or cut the dose – big mistake, the horse would be sorer than before. Avoid the black hole by using COX2 blockers 21 days in a row.
• We will combine a COX2 blocker Equioxx with Tylenol (Acetaminaphen) for 7 days in a row and then go to only Equioxx another 14 days for 21 total days.
• Often COX2 medications like Equioxx or Previcox are used but at doses too small to stop nerve pain. Arthritis dosages are not helpful in the beginning of therapy.

Plan for a 1000 pound horse: Equine Insulin Resistance Pain

Day 1 – Equioxx – 2 Tablets AM and 1 Tablet PM

Tylenol 500mg Tabs – 27 Tabs AM and 27 Tabs PM

Days 2-14 – Equioxx – 1 Tablet in AM

Tylenol – 18 Tabs in AM and 18 Tabs in PM

NOTE: In rare circumstances, some horses will still show soreness at day 10 of this program. If that is seen, will add Gabapentin to Equioxx.

Why?

See benefit of COX2 blocker Equioxx and Gabapentin working synergistically. 1+1=3.

Dr. Chizh, 2007, Brit J. Anesth. Study:

1. Gabapentin in human studies did act centrally (spinally) on pain with a 30-40% reduction in Allodynia/hyperalgesia. Dr. Cilron, 2006, Exp Rev Neurotr.

• Dr. Reilly – I agree. I would get some effect in cases but it was not a “wow” and it takes about a week to work.

2. In his study, he combined a COX2 blocker with Pregabalin (Gabapentin’s brother called Lyrica).

• “Pregabalin combined with COX2 specific paracoxib was more efficacious in attenuating measurements of control sensitization than paracoxib alone. Combining Gabapentin-like drugs and COX2 inhibitors may provide an efficacy benefit in chronic pain states where central sensitization is key mechanism for neuropathic pain.”
• Click here to see the study: Effects of Oral Pregabalin and aprepitant on pain.
• “Combinations of analgesic mechanisms could lead to improved efficacy.”
• Dr. Reilly – Now I knew why it helps, where it helped. I needed it rarely, but if I did need it, will combine it.

How to dose Gabapentin?

There is a great study on Gabapentin in Horses – Click here to see Dr. Terry’s article in J. Vet Pharm. Therap., 2010, Pharmacokinetic Profile and behavioral effects of Gabapentin in the horse.

What I have learned over the years:

1. The drug has a short half life, so need 3 times a day dosing. I have tried twice a day with failure and 3 times a day with great success.
2. I have tried the 20mg/kg dose but horses seemed very sedated (“zonked” according to owners), so I tried 15mg/kg with similar results, so use a 10mg/kg, 3 times a day dosage and horses good and comfort is improved.
3. Gabapentin has a low bio-availability (16%) so it takes abut 3-5 days to see effects. Do not get upset if in 2 days you only see a little.
4. If going to work, will see it by Day 8.
5. I always combine with Equioxx Tablets at the same time. Study on site (see link) shows works better than Gabapentin-like drugs alone. 1+1=3 Synergy.

   Equine Insulin Resistance Pain.

Can Tylenol Help My Horse?

• At the 2016 AAEP Convention, Dr. Foreman from University of Illinois Veterinary School (old professor of mine) did combine Equioxx and Tylenol and found this combination effective in pain relief.
• The exact mechanism of how Tylenol works is unknown, but there are opinions that it may be through the Cannabinoid Receptors in the brain of people and horses.
• Click here to see Dr. Foreman’s article where he is quoted, “I wouldn’t put down another Laminitic horse without suggesting this to a client as an alternative to try.” The article in the Horse, Acetaminophen Could Relieve Laminitis Pain.
• Click here to see why Tylenol and Equioxx combined helps horses: Firoboxib, Acetaminophen Eyed as Laminitis Treatments.

• 5-18 Tablets of Tylenol may be too much for some ponies/horses to eat in their feed — We have the answer!

  • Place all tablets in a 60cc dose syringe
  • Suck up 30cc of water from a cup
  • Tablets will dissolve in 3 minutes! Use syringe to squirt mixture into your horses mouth

    *Click Here to see Dr. Mercer’s Study – new dosing – 30mg/kg of 500 mg Tylenol extra strength caplets. So 27 caplets AM + 27 caplets PM up to 21 days in a row if needed. .

    *Click Here to see article on Tylenol in horses mentioning this brilliant study. .

    Equine Insulin Resistance Pain

NOTE: Ponies/Minis that are 250-500 pounds dose of Firocoxib (Equioxx)?

A. Dosing for these weight:

500 Pounds:

Day 1:

Equioxx – 1 Tab AM and 1.5 Tab PM

Tylenol 500mg Tabs – 13 Tabs AM and 13 Tabs PM

Day 2-14:

Equioxx – 1/2 Tab a Day in PM

Tylenol – Continue 13+13

If sore at day 10, add Gabapentin.

250 Pounds:

Day 1:

Equioxx – 1/2 Tab AM and 1/4 Tab PM

Tylenol 500mg Tabs – 7 Tabs AM and 7 Tabs PM

Day 2-14:

Equioxx – 1/4 Tab a Day in AM

Tylenol – Continue 7+7

If sore at day 10, add Gabapentin.

Equine Insulin Resistance Pain

Helpful Hints to Help Avoid Nerve Pain:

1. Boots – Physical barrier between earth and foot to protect nerves – also in winter keeps feet warmer avoiding cold-induced hyperalgesia.
2. Socks inside boots – Help wick away moisture – plain white socks.
3. Leg wraps/blankets in winter to keep feet warmer.
4. Increase time inside barn in winter to keep warmer.
5. Mats if outside to, again, protect nerves. Also acts as a barrier against cold earth in winter.
6. Deep Bedding – Protecting feet.
7. Pads in soles – can use sole guard if no shoes – will help in bare feet or in shod horses, add pad prior to shoe placement.
8. Frequent picking out feet to remove stones/snow.
9. Indoor turnout with cushion, no rocks to avoid flares.
10. Shovel snow allowing a dirt area and not just standing in 6 inches of snow. Put saw dust, shaving, used straw in area for traction.
11. Don’t skip trims – huge problem setting off flares.