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EMS - Laminitis

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Understanding Equine Metabolic Syndrome
and Laminitis

Equine Metabolic Syndrome (EMS) has become a household word for many horse owners. As we discuss this complicated syndrome, keep this KEY POINT in mind: horses with EMS do not handle sugar and carbohydrate normally. Therefore, strict dietary management is essential for successful treatment.

Horses with EMS tend to be overweight, with an abnormal distribution of body fat. A cresty neck, soft fatty lumps at the tail base, and an enlarged sheath or mammary gland are hallmark signs. All horses with EMS are at high risk of laminitis, and often are first presented to a veterinarian with the complaint of sore feet.

Our bodies use sugar (glucose), carbohydrate, and fat as fuel. The hormone insulin directs the flow of these various fuels depending on the body's demands and the composition of the diet. Carbohydrates are long chains of sugar molecules, present both in hay and grain. When your horse eats, his blood sugar rises, triggering the production of insulin. Insulin drives glucose from the blood into the tissues where it provides energy to meet metabolic demands. Horses with EMS are insulin resistant. The receptors on cells which normally are activated by insulin to take up glucose do not respond. Horses with EMS keep making insulin until they have enough to overcome the low sensitivity of cell receptors. The result is a horse with normal blood sugar, but high insulin

So why is high blood insulin a problem? Because insulin does a lot more than just control blood sugar. Insulin also plays important roles in regulating blood vessel constriction and cellular inflammation. When EMS horses eat carbohydrate rich foods, they experience surges in insulin which can cause severe inflammatory responses in other tissues in the body. Specifically, high insulin can cause devestating changes in blood flow and cellular activity within the hoof. Laminitis is a painful condition that can result in permanent damage to the mechanical structure of the hoof. In severe laminitis cases, unmanageable pain and mechanical tissue destruction can be fatal.

Let’s try to understand the connection between EMS and laminitis more completely. Laminitis, commonly called founder, is an inflammatory condition. The horse’s outer hoof wall is connected to the deeper, sensitive tissues of the foot like a tongue and groove floor, where each layer interlocks in a repeating pattern. However, unlike a floor, the horse's foot is alive and in motion. The hoof utilizes glucose at an exceptionally fast rate compared to other tissues in the horse’s body, constantly remodelling in response to the tremendous dynamic forces of the horse’s weight, and the effects of the environment .

For the foot to remain healthy, glucose must be able to reach the tissues bonding the hoof layers together. But remember, the EMS horse is insulin resistant. This creates a double-whammy for the hoof:
First, glucose transport is compromised by a poor response to insulin, impairing the energy supply to the living tissues of the hoof, and
Second, insulin, which constricts blood vessels and triggers inflammation, becomes abnormally high in an effort to improve energy supply, triggering damaging mechanical effects within the tissues of the hoof which already are starved for critical energy.

Careful dietary management is the key to successful treatment of horses with EMS. Our goal is to feed a diet composed of high quality energy sources with low glycemic index, reducing insulin surges while meeting metabolic demands.

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