Understanding and Managing Autumn Laminitis

Autumn laminitis can be challenging to manage. A late season flush of grass, Insulin Resistance or PPID can trigger a cascade of events that lead to laminitis. Best practice is to monitor and regulate ACTH levels, reduce sugar (ESC) and starch intake and provide regular exercise to help manage weight and Insulin Resistance. When laminitis has already occurred, exercise is not an option.

Elevated insulin levels are a risk factor for laminitis (Carter et al, 2009; Menzies-Gow et al, 2017). The higher the insulin levels then the more severe the laminitis (Walsh et al, 2009). Likewise, PPID cases with high insulin levels have a poorer prognosis (McGowan et al, 2004).

Research shows that baseline blood insulin levels are inherently higher in the autumn than the spring in normal and laminitis prone ponies. (Borer et al, 2012). Laminitis prone ponies show a bigger autumn rise than normal ponies (Borer et al, 2012).

Laminitis prone ponies are more sensitive to dietary challenges in the autumn than normal ponies. Their blood insulin levels rose more and stayed elevated for longer when fed 500g of a commercial branded chop (Borer et al, 2012).

Metformin can be prescribed to increase insulin sensitivity, but its efficacy is in question (Liphook, 2017). Also, administering metformin requires a carrier feed, which may inadvertently elevate insulin levels. A single daily feed of 500g of a leading brand of chop – marketed as suitable for laminitis prone horses and ponies, having 10% Water Soluble Carbohydrates and 4% starch – raised insulin levels by 5 to 10 times above the baseline in normal and laminitis prone ponies (Borer et al, 2012).

It has been demonstrated that different types of forage can influence baseline blood insulin levels (Bailey et al, 2007; Borer et al, 2012) and alter sensitivity to dietary challenges (Borer et al, 2012). Laminitis prone ponies adapted to a hay only diet in the autumn had lower baseline insulin levels compared to a pasture only diet (Borer et al, 2012). A hay only diet was also associated with lower peak and total insulin levels over a 60 hour period following a dietary glucose challenge in laminitis prone ponies (Borer et al, 2012).

Horses and ponies need to eat 1.5 to 2% of body weight of forage per day (DM basis) to stay healthy. A 350 kg pony will need to eat 7kg forage per day. If the forage averages 12% sugar then this pony will consume 840g of sugar per day, which is equivalent to 2.4g/kg of bodyweight. If the forage contains only 5% sugar, then consumption drops to an equivalent 1g/kg of bodyweight.

The effect of different feed ingredients on insulin levels seems significant but is poorly characterised. Administration of a single dose of 1g/kg of glucose raised insulin levels by 2 to 5 times above the group control in laminitis prone ponies. Normal ponies also showed elevated insulin levels but their group control was lower initially (Borer et al, 2012). Whereas responses to a single dose of fructose or inulin (a form of fructan) were less marked but still significant (Borer et al, 2012)

Feeding a hay based diet, low in sugar is indicated to lower blood insulin levels in the autumn and reduce the risk or severity of laminitis.

In practice, the actual sugar and starch content of hay is usually overlooked, but knowing and exploiting the nutritional value of hay could have significant implications for the prevention and management of laminitis. It was this realisation that lead to the development of feetfirsthay™ – a quality controlled horse hay that is always below 10% combined sugar (ESC) and starch. Typical sugar content is 5 – 8%. Full nutritional and mineral analyses are always supplied to customers.

As a management tool to support veterinary advice and medication and where laminitis is a risk or has already occurred, feetfirsthay™ is simple, reliable and flexible.

Simple:
As it is inherently low in sugar and starch, feetfirsthay™ can often be fed without soaking, saving owners time and effort and making owner compliance easier. It can be used where there is a risk of laminitis or when clinical signs are already evident.

Reliable:
The same grass species are always used in a customised grass mixture and every batch of feetfirsthay™ is fully analysed and identified by a lot number. Several lots are currently available so the most appropriate one can be selected, depending on the animal’s individual requirements.
feetfirsthay™ provides a stable baseline of nutrition and takes the variability out of the diet. It is a more reliable, scientific and systematic approach than feeding randomly selected or untested hay which may still be too high in sugar, even after soaking.

Flexible:
If accelerated weight loss is required without reducing forage intake, feetfirsthay™ can be soaked for a short period to reduce the energy content. When the target weight is reached, soaking can be gradually eliminated and it can be fed dry for weight maintenance.
16 September 2017
feetfirsthay™ is exclusively produced by College Farm, Inglesham, Swindon, Wiltshire, SN6 7QU. For more information contact Hilary Snow on 07802 270844 or email [email protected] or visit www.feetfirsthay.com

References
Bailey S.R., Menzies-Gow N.J., Harris P.A., Habershon-Butcher J.L., Crawford C., Berhane Y., Boston R.C., Elliott J..2007. Effect of dietary fructans and dexamethasone administration on the insulin response of ponies predisposed to laminitis. J Am Vet Med Assoc. Nov 1;231(9):1365-73.

Borer K.E., Bailey S.R., Menzies-Gow N.J., Harris P.A., Elliott J.. 2012. Effect of feeding glucose, fructose, and inulin on blood glucose and insulin concentrations in normal ponies and those predisposed to laminitis.
J Anim Sci. May 14. [Epub ahead of print]

Carter R.A., Treiber K.H., Geor R.J., Douglass L., Harris P.A.. 2009. Prediction of incipient pasture-associated laminitis from hyperinsulinaemia, hyperleptinaemia and generalised and localised obesity in a cohort of ponies. Equine Vet J. Feb;41(2):171-8 (PubMed)

Liphook Equine Hospital, 2017. Equine Metabolic Syndrome. Information Leaflet. [On-line] http://liphookequinehospital.co.uk/wp-content/uploads/equine-metabolic-syndrome.pdf [Accessed 16 September 2017].

McGowan C.M., Frost R., Pfeiffer D.U., Neiger R.. 2004. Serum insulin concentrations in horses with equine Cushing’s syndrome: response to a cortisol inhibitor and prognostic value Equine Vet J. Apr;36(3):295-8

Menzies-Gow N.J, Harris P.A., Elliott J.. 2017. Prospective cohort study evaluating risk factors for the development of pasture-associated laminitis in the United Kingdom. Equine Vet J. May;49(3):300-306. doi: 10.1111/evj.12606. Epub 2016 Aug 25.

Walsh D.M., McGowan C.M., McGowan T., Lamb S.V., Schanbacher B.J., Place N.J.. 2009. Correlation of Plasma Insulin Concentration with Laminitis Score in a Field Study of Equine Cushing’s Disease and Equine Metabolic Syndrome. Journal of Equine Veterinary Science Vol 29, No 2

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