This article will cover some of the basic treatments used by Harmany Equine Clinic, Ltd. Look for additional articles on this topic, including some more technical ones on how horses acquire this problem when you check back with this web site at a later date. Also see the August issue of Practical Horseman magazine (800-829-5910, Email: practical@palmcoastd.com) for more information and some wonderful photographs on how to support your horse’s feet during laminitis.

Introduction
Natural medicine provides another toolbox of treatments to help treat chronic cases of laminitis. Several of the major factors in helping a laminitis horse are to support their feet properly, correct the intestinal health, provide nutritional medicine to prevent and reverse damage to the lamina, and to return the horse's metabolism to proper balance. When managed correctly, with patience and attention to detail, most chronic cases can return to reasonable work. The poorly responsive cases can often be managed and kept relatively comfortable without the use of drugs.

It is important to remember when treating laminitis with natural medicine to approach each case individually. It can be detrimental to any case to use multiple supplements or treatment modalities without carefully evaluating the case. Because a product is natural does not rule out harmful effects or the negative effects of using too many products and overloading the body. Difficult cases may require many products, however, they should not selected carefully.

Clinical signs
The clinical signs most commonly associated with chronic laminitis long hair that does not shed out in the summer, weight problems (over- or underweight) and other signs that many people and vets call Cushing’s disease. In my opinion, these horses have altered glucose metabolism, similar to that of human diabetics, and not Cushing’s disease. Some of the symptoms that may be seen in the chronic laminitis horse include those listed below. If your horse shows any of these signs along with the laminitis, he is a good candidate for the natural treatments in this article.

long hair
not shed out well
difficult-to-treat laminitis
winter laminitis
laminitis with no outward reason for its occurrence
weight problems (over- or underweight).
sluggish thyroid glands
insulin resistance (see below)
muscle soreness
diabetes
drinking urinating frequently
collagen breakdown, or “old horse sag”, especially when it occurs before age 18-20 years
poor hair coat despite good worming and teeth care
frequent infections of the skin or other organs
colic
poor teeth
multiple dental abnormalities
lowered immunity to intestinal parasites
infertility
muscle wasting

Insulin Resistance
A relatively new condition is being recognized in human medicine, currently called syndrome X. This is a group of symptoms related to insulin resistance or hyperinsulinemia and an inability for the cells to transport glucose into them. The disease commonly called “Cushing’s syndrome” in horses has many of the same characteristics as syndrome X has in people.

Many laminitis horses have elevated insulin levels in their blood. The reason the insulin is elevated is that it is not able to get into the cells. Normally when a sugar or carbohydrate is eaten, the blood sugar levels increase, insulin is secreted by the pancreas, glucose is carried into the cells by the insulin and the blood sugar goes back to normal. In insulin resistance, the cell walls are too stiff to let the insulin do its job properly. So the glucose, instead of providing energy for the cells, gets stored as fat.

People that are susceptible to syndrome X are from a genetic type considered “thrifty” or in horse terms, “easy keepers.” In this type of individual, horse or human, the body is very efficient at storing fat for times of need, and in fact, if fed less, they often become more efficient at storing fat. In humans much of the fat stored from impaired glucose metabolism is distributed centrally, especially around the abdomen. Many horses store their fat in specific places; fat pads on their body and cresty necks.

The basic protocol in treating people with Syndrome X contains many of the ingredients used when treating the chronic laminitis horse. The idea is to help make the cell walls more permeable to insulin and to provide nutrients to help the insulin and glucose pathways function better.

Intestinal Health
Horses with laminitis are often in extreme amounts of pain. Consequently high doses of non-steroidal anti inflammatories (NSAIDs) are used over long periods of time. Research has been done regularly on NSAIDs effects and toxicity in the horse as well as in humans. One recent equine study showed inflamed small and large intestinal walls after 12 days of phenylbutazone administration.

Since high doses of the NSAIDs are detrimental to the integrity of the intestinal wall the drugs may contribute to a leakage of bacteria across the wall that triggers part of the breakdown of the laminae. Consequently, the use of NSAIDs in treating laminitis should be questioned. Clinically, in my experience the removal of the NSAIDs is one of the most important aspects of the success of the holistic treatment. The horses' symptoms are usually worse for three to five days after removing the NSAIDs, so they lie down more. That can be alarming to the owners and attending veterinarians, however, it is best for the horse, since the pressure is off the feet. The antioxidants can then work. When a horse feels better with natural medicine it is because he is better, not because the pain is masked.

Clinically I have found laminitis horses respond best when an attempt is made to repair the damage done by NSAIDs.

Nutrition
Nutritional support is critical in the laminitis horse. Nutrition includes the basics of feed, water and hay as well as specific nutrients for particular problems. As more experience is gained with new products, additional helpful or even critical nutrients may be discovered. The nutrients discussed here are ones I have found useful and are safe for the owner to administer. Complex cases that do not respond to treatments listed here, need the help of an alternative medicine veterinarian (see the links for organizations listing practitioners).

Feed
Once the digestive system is supported, high quality nutrients should be provided. The nutritional requirements for horses with laminitis are higher and often very specific. Horses with laminitis need high fiber, low carbohydrate diets. Wheat bran mashes are good for overweight horses. The small amount of bran needed for these horses may not upset the calcium phosphorus ratio, though the entire diet should be evaluated to keep it balanced. Blue-green algae can be added to the bran mash to provide amino acids and trace minerals and support hoof growth. Grass or other lower protein hays can be given free choice. The horse can have some alfalfa along with grass hay, especially if more protein is needed, but generally alfalfa should not be the only hay received.

The feed should be low in sugar, so all sweet feeds should be avoided. Read the label, if any sugar, corn syrup or molasses is present, do not feed it. When evaluating the feeding program be sure to look at the treats being given. Apples are better than most other treats as they contain fructose which is less of a problem than other types of sugar. Carrots may be desirable for some horses as a natural source of beta carotene. Plain corn (about 25%), barley (about 35%) and oats (about 45%) make a simple, clean mixture without sugar. Some of these grains may not be available or desirable to use in certain parts of the country or in certain years depending on the harvest situations. Some horses may not do as well on oats; if that seems to be the case, just use barley and corn.

Higher levels of protein (up to 14%) and calories may be needed in the horses with weight loss problems. Laminitis horses that are normal weight or underweight often do well on the senior diets, which are high fat. Many chronic laminitis horses lose weight due to the stress of walking in pain and actually need increased amounts of feed. Since these horses did not founder due to grain or carbohydrate overload, it makes no sense to restrict their calories, when they actually need extra calories to maintain weight.

Increased calories can be given as fats (vegetable oils, rice bran oil, or rice bran) and are well digested by most horses. Animal fat should not be used due to the preservatives added in the processing and the fact that horses are vegetarians and should not eat animal products. Increasing total calories by adding oil and more grain may be preferred to using high-protein feeds and hays, though some horses actually do need the higher protein.

Processed grains and hays may lose key ingredients during manufacturing since pellets and extruded feeds are made at high temperatures. In some cases horses have difficulty digesting processed feed, yet in my experience, when horses are fed plain grains they generally gain weight and are healthier. Some horses need digestive enzymes added to their food to aid digestion.

Antioxidants
Laminitis is a classic example of free-radical damage. High levels of anti-oxidants are needed until this process is reversed, then lower maintenance levels can be used. Using low doses of antioxidants over time is like trying to put out a forest fire using a garden hose. Over the counter, combination antioxidant products rarely have enough of any one ingredient to reverse free-radical pathology.

Coenzyme Q10 is very valuable in reversing free radical damage. The therapeutic dose is 300-600mg per day for the first week or two, then the dose can be decreased slowly to a maintenance of about 100 mg per day. Coenzyme Q 10 clinically seems to be one of the best antioxidants for use in the horse, and in laminitis cases can be so effective that the horses become more comfortable rapidly. Co Q 10 is most effective in laminitis cases when non-steroidal anti inflammatories such as phenylbutazone (NSAIDs) are not used. However, in many cases the owner is using the NSAIDs because the horse is at home and the attending veterinarian prescribes them. Co Q 10 can be used with the NSAIDs but the results are not visible clinically.

Vitamin C is an excellent antioxidant and nutrient for collagen support as well as organ and immune system healing. Doses range from 3 to 8 gms per day. Horses tolerate these doses well with few cases of diarrhea or stomach irritation.

MSM is a natural source of the antioxidant mineral, sulfur. It is also a mild diuretic. Sulfur is important as it helps make up the disulfide bonds in the laminae. The disulphide bonds are an important part of the connects the hoof wall to the healthy lamina.

Other antioxidant nutrients that can be useful are Vitamin E and superoxide dismutase (SOD). These antioxidants are generally used in the more difficult cases.

Minerals
One of the most important aspects of any nutritional program for horses is the use of free choice minerals, with the salt fed separately. If a commercial salt-mineral block is fed (about 94% salt), the horses cannot consume the amount of minerals they need. A laminitis horse will generally eat large quantities of minerals, when the salt is removed, for extended periods of time indicating their need for minerals. Sulfur may also be an important nutrient for these horses and can be fed free choice or in a supplement such as MSM.

There are several key minerals needed for glucose metabolism that help the Cushing’s horses. Magnesium affects insulin secretion and its action in the cells. Magnesium also helps the cells be more flexible and permeable to insulin. Chromium helps make muscle more sensitive to insulin so glucose can be taken into the muscle cells more easily. Chromium is also related to elevated blood sugar and has been shown to be effective in reducing fasting blood sugar levels. Vanadium or vanadyl sulfate has actual insulin-like effects on glucose metabolism which helps transport glucose into the cells.

Vitamins
It is important to supply high quality supplements. Prepared foods cannot have all the vitamins needed by a sick animal. However, formulated supplements which contain low quality, synthetic vitamins, inorganic minerals, and fillers may actually cause the horse's system to become more out of balance. Food-source vitamin mineral supplements include: blue-green algae, kelp, apple cider vinegar, carrots, and oranges. Several companies manufacture additive-free supplements.

Essential fatty acids
Essential fatty acids (EFA’s) are needed to help make the cell wall more permeable to insulin. The Omega 3 fatty acids are especially deficient in human diets and may be deficient in many equine diets. Most of the high fat equine foods use animal fat that is high in saturated fats and full of preservatives. Flax and hemp oil (or flax seed that has been stabilized naturally, not chemically) provide plenty of Omega 3 fatty acids that are palatable to the equine. Some horses’ symptoms improve with just the addition of fatty acids to their diet.

Homeopathy
I use constitutional homeopathic medicines selected according to the symptoms the individual is exhibiting. Homeopathy is important to the success of the treatment in many cases. You, as the owner, must be patient enough to work through a case properly with homeopathy and it is necessary to work with an experienced homeopath. Constitutional homeopathy needs be prescribed based on the history, clinical signs and personality. It is not possible to cover the details or remedies here.

Chinese Medicine
Chinese medicine, both with acupuncture and herbs can be used to help laminitis horses. It is best to work with a veterinarian experienced in either herbs or acupuncture. The International Veterinary Acupuncture Society and the American Academy of Veterinary Acupuncture have lists of qualified practitioners.

Western Herbs
Aloe vera is a nutritional herb, which will support healthy bacterial growth and help heal the damaged intestinal lining. Expect to pay $10.00-$12.00 a quart for good quality aloe, and feed at a rate of 2-4 ounces each feeding for 2-4 weeks.

Slippery elm bark is another nutritional herb, which protects and aids in healing the intestinal wall. It is especially useful with aloe vera to heal the intestinal irritation secondary to the use of non-steroidal anti-inflammatory drugs such as phenylbutazone.

There are some formulas designed to improve circulation in the feet that may be very useful. Some of the “Cushing’s” formulas may be helpful, but probably are not as effective as many of the other therapies listed in this paper.

Vaccinations
I would recommend not vaccinating or decreasing the vaccination program to the absolute minimum for the chronic laminitis horse to decrease stress on the body. Vaccine titers are available for most diseases, and most horses tested seem to be maintaining good titers from previous vaccinations.

Environment
Many horses are kept in high stress situations and it is important to decrease environmental stress as much as possible. Some of these horses may be past their high-stress years, and not be showing but the previous lifetime of stress, overvaccination, excessive drug use and poor nutrition are catching up.

Pasture turn-out time is very important; however it is common for a laminitis horse to be unable to have rich pasture without worsening symptoms. Do not to fertilize your fields or mow and manage them too carefully. Natural fertilization with trace minerals is a good practice, though if grass becomes too rich even from good organic practices an overweight horse will result. A few weeds (herbs) are a good thing. For many horses a “fat pen” will need to be built, just a small area outside with minimal grass so they can be out in the sunshine and near their friends, but not have too much grass. Most horses will adapt to wearing muzzle, which limits the amount of grass in each bite, yet allows more exercise and companionship staying with the herd.

Conclusion
Prevention is still the best way to manage laminitis in horses, however, chronic laminitis cases can recover with a multi-faceted, long-term natural treatment plan. Treat each horse as an individual and seek quality practitioners to help you.

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