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Fact sheet 2. Equine Metabolic Syndrome: Equine metabolic syndrome (EMS) is a relatively newly recognised disorder of equids. It doesn‟t relate to one particular problem but rather:
“A col ection of risk factors that are associated with an increased
susceptibility to laminitis.”
A horse with EMS is quite often referred to as “a good doer” i.e. It seems to
gain weight very easily on very little food intake. Those most susceptible
seem to be the native breeds, ponies in particular. This may be due, in part to
an evolutionary trait that enabled them to survive in harsh conditions on
poor/sparse pasture. The idea being that in the spring and summer when
there was plenty of food they would gain weight, then in the winter months
certain tissues (liver, fat, skeletal muscle) would become insulin resistant
an effort to ensure that their energy resources were used mainly by the
important organs of the body.
Insulin resistance is one of the risk factors associated with EMS. Insulin is
made and released into the body by an organ called the pancreas. For cells
in the body to work they require energy in the form of glucose. Insulin
attaches to the body‟s cel s and al ows them to take up glucose from the
bloodstream. If the body becomes insulin resistant then these cel s don‟t
remove glucose from the bloodstream, which results in a high blood sugar
(hyperglycaemia). The body then responds to this increase in glucose in the
blood by releasing yet more insulin from the pancreas thus causing a high
blood insulin level (hyperinsulinaemia).
The clinical history of an animal is often highly suggestive of EMS and will
lead us to recommend certain blood tests to enable us to come to a definitive
diagnosis and hence to then be able to work with you to manage the
syndrome. As indicated above these blood tests involve looking at the levels
of insulin and glucose in your horse‟s blood. The simplest blood test involves
a one off sample taken after your horse has been starved for a period of 5-
6hrs, however due to the compensatory mechanisms of a horse‟s physiology
this test can sometimes be inconclusive. If this is the case we then have to
carry out a dynamic blood test. This involves your horse spending an
afternoon at the clinic so that a catheter can be placed and successive blood
samples can be taken. The type of clinical history that would lead us to
recommend a blood test would include: Recurrent bouts of laminitis, enlarged
fat deposits such as a large crest, mammary gland, prepuce or tail base, a low
level of fitness. (It should be remembered that horses don‟t always read the
text books so may show all, some or none of these signs. EMS has been
recorded in some high-level competition warm bloods).
The role of „Fat‟:
Fat isn‟t a natural part of a horses diet. However once we start feeding
horses that have been designed to live on sparse moor land, rich, lush,
energy rich pasture, they quite quickly convert this to fat or adipose tissue in
an attempt to store this glut of energy in preparation for the harsh winter and
subsequent lack of food that maybe on it‟s way. However the harsh winter
and lack of food never comes as we then put nice warm rugs on our horses,
give them stables to shelter in and continue to feed them high-energy
Contrary to popular belief adipose tissue is not just an inactive lump of jelly
like material. It produces hormones and inflammatory chemicals called
adipokines (specifically, leptin, tumour necrosis factor- and interleukin-6).
These factors increase the likelihood of insulin resistance by blocking insulin
receptors on cells in the body. They can also result in altered blood flow to
structures in the foot, impairing nutrient delivery to hoof tissues and a
continual state of inflammation, all of which increase the chance of laminitis
Management of EMS:
Theoretically EMS is a reversible disease, hence with the correct
management the problem can be overcome and your horse can continue to
enjoy a good quality of life.
Diet: - It hopefully makes sense that a fat horse that has large stores of
energy should receive less energy in the form of feed than it requires for daily
In adult horses the daily maintenance requirements are approximately 1/8 of
their bodyweight expressed as mega joules (MJ) e.g. 400kg/8 = 50 MJ
However a horse generally likes to eat 2% of its bodyweight a day e.g. 400kg
x 2% = 8kg. Therefore the dietary intake should average no more than 6.25MJ per kg of dry matter
(50/8). The energy content of commercial feeds
should be available on the packaging or from the manufactures. If you
compare these to what is actually required you will find that many feeds are
well over the 6.25MJ/kgDE and this value is better equated to the energy in
very poor quality hay or straw.
High glycaemic feeds (cereals, carrots, apples) should be avoided, as these
will cause hyperglycaemia and hyperinsulinaemia potentiating the problem.
Likewise fresh grass should also be avoided. The diet should consist of hay
that has been soaked for several hours (to remove any laminitis causing
nutrients). This can be supplemented with high fibre feeds such as low
energy chaffs. A vitamin and mineral supplement is advisable in the absence
of fresh feed.
Exercise: - If laminitis allows it an increase in energy expenditure will help to reduce obesity with the added benefit that fitter horses are more sensitive insulin. Medication: - Although there is still a lot of research in this area the most suitable treatment is one that increases the bodies sensitivity to it‟s own insulin. This is known as Metformin
. This drug should not though be considered as the golden bullet that will cure all ills. There is evidence to show that the body can, after varying amounts of time become resistant to its insulin once again despite the medication. As such this treatment should be seen as an opportunity to carry out changes in the management of your horse (increase it‟s fitness and decrease it‟s fatness) such that it then has less of the risk factors that may make it susceptible to laminitis.
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