Equine Metabolic Syndrome

Equine Metabolic Syndrome

Rebecca Hamilton-Fletcher MRCVS

This veterinary feature was first published in Horse & Hound 12 May 2005


Some ponies seem to get grossly overweight on nothing but fresh air and new thinking suggests that a condition called Equine Metabolic Syndrome may be responsible Anyone who has owned a native pony will be familiar with its ability to create fat out of thin air, and with the difficulties in management this causes. Now at last, as a result of work done at the University of Missouri, a condition called Equine Metabolic Syndrome (EMS) has been recognised.pony

This condition may explain why domesticated ponies are so prone to obesity and laminitis, and is possibly the result of evolutionary developments that enable native breeds to survive harsh weather and food shortages.In the wild, ponies are programmed to put on weight during the relatively lush summer and autumn months, with fat (stores of energy) distributed around the body in preparation for leaner times. Significantly, fat is preferentially laid down in the abdomen, where it is known as omental fat.Until recently, it was thought that these fat cells (known as adipocytes) were just benign stores of energy. But research has shown that adipocytes are in fact active and can produce a variety of hormones known as adipokines. These help control and regulate a number of body processes and are programmed towards enhancing our native ponies’ ability to endure periods of environmental harshness.It appears that the omental adipocytes produce an especially significant range of adipokines that, among other things, generate an increase in the level of circulating cortisol. This steroid is instrumental in inhibiting the action of the hormone insulin (which controls blood glucose levels), and results in insulin resistance and a degree of hyperglycaemia.

In relatively fat ponies entering the winter months, this insulin resistance has a physiological benefit. It preserves and prioritises glucose (and therefore energy) for essential areas such as the brain, at the expense of non-essential tissues like muscle.As the pony gradually loses weight during the winter, so the level of omental fat reduces and the state of insulin resistance becomes reversed. Eventually, spring arrives and the pony is in a lean but healthy condition — ready to indulge safely in the pleasures of rich grazing.

ponies on grasUnfortunately, this system has become unbalanced as a result of domestication. It has meant that the average equine diet is too rich and too plentiful. Grain-based feeds tend to be the main culprit, but even hay and other forages are now made from improved pastures and so have a high nutritional value.Many ponies enter the winter in an over-fat state and maintain this level of condition, so the state of insulin resistance is not reversed. Long-term insulin resistance has various undesirable consequences, which include chronic hypoglycaemia and hyperinsulinaemia (high blood glucose and insulin levels respectively). Ultimately, a condition of glucotoxicity (too much sugar) arises and this significantly increases the risks of laminitis developing.

“Metabolic syndrome” has been used to describe this scenario. It is well recognised in humans, where there is a very obvious link between obesity and cardio-vascular disease. Human glucotoxicity causes an increase in blood pressure (hypertension), which predisposes to coronary disease — and also insulin-dependent diabetes mellitus (due to the exhaustion of the pancreas’s insulin-secreting abilities).It is thought that hypertension in ponies could predispose them to laminitis rather than heart disease — and a state of diabetes mellitus is recognised but tends to be insulin-dependent because there is no evidence that the pancreas becomes exhausted.

EMS has many characteristics similar to Cushing’s disease, which is why it has often been termed “peripheral Cushing’s disease”. However, this is misleading because there is nothing wrong with the pituitary or adrenal glands in cases of EMS, as there is with Cushing’s. Referring to it as the “laminitis-hypothyroidism syndrome” is also inaccurate because there is no evidence of any thyroid malfunction. Other names include “obesity-related laminitis”, “equine syndrome X” and “insulin resistance syndrome” — but EMS is now universally preferred.

EMS can be difficult to recognise because the signs are often very subtle and it can be confused with Cushing’s or even hyperthyroidism. In general, EMS is seen in ponies, cobs and warmbloods under 15 years of age, whereas Cushing’s tends to affect older equines of any age.insulin resistant Common signs of EMS Obese adult horse (although a minority may be normal sized) Abnormal body fat distribution, eg thickened, cresty neck; excess fat around head of tail; fatty shoulders; flabby, fatty sheath; pot-bellied look“Good doer” who puts on weight easily and loses it with great difficultyUnexplained laminitis that may be obvious and severe or very subtle, eg abnormal hoof growth; laminitic rings on hoof wall and expansion of white line with no apparent lameness; Ravenously hungry all the time; Urinating frequently; Lethargic and lazy; Infertile or abnormal cycles in mares.

There is no one test for EMS. Raised blood glucose is strongly suggestive, especially if the animal is under the age of 15 and showing some of the signs listed. Occasionally, ultrasonography can be helpful in assessing levels of omental fat.  Often, a diagnosis of EMS is made only after elimination of similar conditions such as Cushing’s and hyperthyroidism (overproduction of thyroid hormones) from blood tests, for example, glucose tolerance and dexamethasone suppression tests.

Various forms of treatment have been tried, based upon products that influence thecarrot
pituitary and/or adrenal glands. But there is little rationale behind this because in EMS the pituitary and adrenal glands function normally. The results of trials have been inconclusive so far.  Similarly, the reasoning behind the practice of thyroid supplementation for EMS, which is popular in the USA, is weak because these animals are not hypothyroid. It may be that it helps simply because it encourages weight loss.  By far the most important aspect of controlling EMS is a combination of diet and exercise. A diet high in fibre and based on hay, non-molassed sugar beet and commercial products such as HiFi Lite is “good”. Sadly, grass, cereals and succulents such as apples and carrots are “bad”.

Supplements containing antioxidants, chromium and magnesium claim to be of help (possibly by increasing insulin sensitivity), but more work needs to be done here.  Exercise is essential — not only does it encourage a loss in omental fat, but it also promotes an increase in glucose uptake.  Work has shown that a fit pony (even if slightly overweight) will have an increased sensitivity to insulin and will lose weight faster than an unfit animal.




  1. Have short/heavy 15 yo AQHA mare properly shod with wide web shoes w/ sole pressure relief and side clips. Has chronic unilateral lameness w/”playing piano” movement worsened as foot grows out. More pronounced with turning. Occasionally points toe. Appears to want to place weight on heel vs toe. Does have white line issue and evidence of traumatic shoeing injury from previous farrier. Exaggerated startle response. Could live on air alone. I have researched navicular syndrome, metabolic syndrome, hyperthyroidism, white line disease, chronic subclinical laminitis, etc. Horse has done little work, never bred, is a pasture ornament (turnout managed so no lush grass exposure). Has had no known “events” associated with provoking laminitis but subtle signs on trims. Will be consulting vet soon but appreciate any comments. Thanks. Debbie

  2. Hi Debbie,
    In general, a unilateral lameness will not be metabolic in origin. A unilateral lameness is almost certain to be mechanical in origin, meaning, it’s the trim.

    Not to say that he isn’t metabolic and shouldn’t have his diet and lifestyle monitored, but you definitely need an expert opinion on his hoof form. I suggest you search on the websites that list qualified trimmers, or you can email me photos for a consultation and possible recommendation. The email is listed under ‘contact us’.

    Good luck

  3. I have a 14 year old Cleveland Bay X mare, only 15.3hh but very solid and always has been. Walks past the feed room and puts on weight! Started off around 4 months ago being sore in one fore foot, now sore all round, vet says not laminitis but I’m in regional Australia and don’t have access to another vet until I can get her on the float and take her to the city (she has some floating issues at the moment, accident related). No heat or pulse in her feet, the feet were quite long (I know, terrible, awful me) but have trimmed them progressively over the past week and have seen some improvement in her soundness. She is cresty and has a gutter down her back, with a big belly (looks pregnant with twins). The other thing that rang alarm bells was reading elsewhere about the teats in mares being swollen, the area just in front of her teats has noticeably swollen in the past month. Would be interested to find out what you think? Any help I can get at this stage until I can get her to a decent vet in the city would be brilliant. Emma

  4. Hi Emma,
    It’s hard of course to say whether your mare’s lameness is a result of mechanical problems or metabolic ones. It sounds like you might be on the right track with the trimming. Nevertheless your mare clearly has issues of a metabolic nature (weight, crestiness, false lactation, etc.). You definitely need to have this looked into, taking blood tests and checking insulin and thyroid levels. In the meantime consider a supplement that contains magnesium and B vitamins, such as Remission available in the US. I’m sure there is something comparable in Oz. Good luck.

  5. Thank you ever so much for your reply! Well it’s been a week and I have already seen marked improvement in my mare (Priscilla). I have now been able to trim her feet right down (a long process as she is still sore and doesn’t like to put excess weight on her back feet when I am doing the front ones) and she is in a small yard where the feed has very little substance to it. She is being fed stalky hay twice a day. I have not been able to track down a supplement yet, but when I do she will get this also. The best thing is, she can walk! I’ve been taking her out for daily strolls (on line) to try and get some more weight off her and she is almost sound at the walk, even on hard ground. She even offered a trot yesterday when she got stroppy! It was a shuffly trot and only lasted a few strides, but she offered it so I figure she felt reasonably comfortable to do it. Hopefully she will continue to progress as well as she is at the moment. Thankyou again for your advice! Emma (and Priscilla)

  6. Hi! I have a 26 year old Morgan. He has been on Thyroid Medication for years, and is tested a few times a year. He has been a jumper all his life and has remained very fit! Altough fit, has never been what you called “lean”. Definetly a little chub!
    The start of this winter, we noticed he was putting on ALOT of weight. I cut out all treats other than carrots, and the vet diagnosed him with EMS. He is on the Metaboleeze supplement, and we are not seeing any results, maybe even gaining more weight. He had been lame for quite some time, but still riding 4 days a week (not hard), to help get some weight off.
    Other than cutting out his grain completely, do you suggest keeping him on Metaboleeze? Or do you recommend a different supplement?
    Note: Has been on Metaboleeze for almost 2 months.

    • Hi, I have never heard of Metaboleeze before but a quick search shows that it seems to be more for tying up and preventing fatigue after hard exercise. Maybe you could try some of the supplements designed for IR that also contain magnesium, such as Remission. Good luck.

  7. I just had my horse diagnosed today with EMS. The vet claimed he could have had this for years since he has a cresty neck. My horse is morgan and has had that neck since a yearling. I have been unable to find any info on how this disease effects other areas of the body. My horse also has had suspention ligaments completely fail and is now bone on bone in entire back leg. He is post legged now due to this and he used to be a haler horse! We did geld him a month ago so he did have big hormone changes as well. No founder issues at all-just ligaments issues and hock failure. Is there a coaltion with this?

  8. Hi Tanya, what you describe is possible EMS and possible DSLD (suspensory ligament failure). I am not aware of any correlation between these two conditions but that does not mean it’s not possible. If your horse has been a stallion for many years I would attribute the cresty neck to being a stallion sooner than a symptom of EMS, especially since he has shown it since one year of age. Usually metabolic symptoms such as cresty neck do not manifest that early in life.

    The primary system that is affected by EMS is the metabolic system (endocrine, glands, liver, skin, hooves, etc.) and this can lead to such things as laminitis/founder as a result of Insulin Resistance or Cushings disease.

    However from your description I think your greater concern is the connective tissue breakdown. Having said that you might want to test for insulin resistance to rule it out (as Morgans can be very prone to this) and perhaps consider adding a magnesium supplement.

  9. Is Remission okay to give to a pregnant mare? I don’t see anything in the ingredients that look to be a problem, but also see where the product is not approved for use in pregnant mares.

  10. My 16 year old Fell mare has recently been diagnosed with EMS following an insulin resistance test and a cushings test (which was slightly abnormal at 29 but not identified as high enough to be cushings.)

    It was recommended that she start on metformin tablets (14 twice a day) and she’s been on them a couple of weeks now. I’m not sure there has been much change – her crest is still very hard and she is urinating quite frequently.

    Other than that, she is quite happy in herself – she’s being hacked out regularly and is happy to do this. She’s out in the field for 4 hours a day and in the stable with soaked hay for the rest.

    Is there anything else I can do? I’m in the UK and not heard of any supplements that may help over here.

    • I’ve not heard of metformin for this condition. Do you know what’s in it?

      Have you tried a magneisium supplement? That can be very effective if the dosage is high enough. It is just a mineral so you should be able to find it anywhere. Magnesium oxide is the most common form.

  11. Eureka !! I think this explains what is wrong with my mare ! 3 Years of no riding due to lameness ,vet convinced that she had horn infection I was convinced that she had permenant laminitus as heat in her feet and increased digital pulse , worse in the spring to autumn months , She is overweight 16.3 warmblood and has a very cresty neck , I have discussed this EMS with my vet but they are of the opinion that this is just another name for fat horse laminitus . I checked out lamineze supplement sachets and they contain 6.25g of magnesium and I would have to feed at least 2 sachets due to the weight of my mare , this means a cost of some £50 odd per month however I have also found equine Americas Magnitude which is sold as a calmer but is Mangnesium Oxide , 5g is the recommended dosage , would this be effective ? if so at what dosage ??

    • Congratulations on hitting upon your mare’s issues! So it is another name for ‘fat horse laminitis’, so what? Why do vets have to have such dismissive attitudes? Yes, it’s a ‘new’ name but with it comes newer treatment approaches such as supplementing magnesium.

      There’s no reason you should be paying 50 pounds a month for magnesium. It is an inexpensive mineral and here it is sold in 50 pound bags at the feed store as Mag Ox, very reasonably. The typical dosages on supplements specifically formulated for IR/laminitic horses such as Remission or Quiessence is between 5g and 7g per day, so you should be just fine. But look into getting it cheaper at the feed store.

    • Hi, i have a 13 yr old welsh cob she is the same cresty overweight puffy eyes. We went barefoot 5 months ago and wear easy boot gloves for riding. She is trimmed by barefoot trimmer and the changes are amazing. We had a pasture analysis done and only give her what she is short of 3 tablespoons of mag oxide or aspertate zinc, copper, seaweed, speediebeet (beet pulp) and micronized linseed bought from equemins in devon.

      Are u barefoot? my vet laughed you will never take this horse barefoot get some bloody shoes on no way and i nave not 3 abbsesses in shoes in a year none so far plaese research!!!!!! pete ramey. jamie jackson, sarah braithwaite. performance barefoot small lines in hoof known as grass rings or event lines are really low grade lamii have always rugged dont they dont need it want to know more please get in touch from a natural horse lover karen.

      • My mare is barefoot , always has been from birth , a lot of my problems started when I could not find a barefoot trimmer so I used a farrier for a couple of years , I now have a barefoot trimmer but he costs me just over £60 every 6 weeks or so , this is a bit too expensive so I am always on the look out for new ones closer to me . Berry is now being ridden , she is fed Dengie healthy hooves , non molassed sugerbeet , NAF slimline and hoof supplement from the laminitis clinic , she has lost a fair amount of weight and still needs to lose more , but now she is being ridden this should happen . She is lightly rugged as she is a Trakehner and doesnt tolerate the rain ,snow too well so I use a lightweight turnout , hopefully she will be back competing and I will be able to clip her this autum which means she will then be rugged .

  12. One week on and for the first time in months she is relatively sound on a hard surface ! I turned her out for 1 hour and she trotted !! Bucked and galloped off around the field I was stunned , still “footy ” on gravel but the bounding pulse has almost returned to normal so fingers crossed ! some more weight off and continue with the magnesium I may be able to ride again . Thank you so much ..

  13. Hi’iown a 13 year old welsh cob iam trying to take barefoot 4 months into transition it’s been an emotional time lots of ups and downs she is over weight and cresty always hungry is not fed any grain carrot apples or sweet stuff have had grass analysis done and mineral recipe sent she is short of zink,copper magnesium,seleinium,and lysine doing lots of research so as sore on gravel but sound in the field have had her measured for easy boot gloves i lung every day she is always willing a type hard to find i have also looked into water supplies as she wont touch tap water i found out it is high in nitrates that could be why observation is a great tool need to exersise her more keep u posted from a horse carer xx

  14. Hi. I have a 10 yr old grade mare (QH type). 18 months ago the area in front of my mares udder started to swell. Since that time it has only gotten larger and larger. We did a biopsy to make sure nothing was wrong. Additionally, since that time, she has put on several hundred pounds. She is barefoot (trims every 4 – 6 weeks). Within the last 4 months or so, she has dropped her soles and has a lot of separation in her front hooves. She is 15.1 hands and about 1400 pounds. I have no choice but to feed free choice round bales and I do so with 2 (yes 2) slow feeder nets over the bale. She gets no grain or treats whatsoever and she was started on Remission about 4 weeks ago. I wet it and put it over a cup of timothy pellets. She is turned out 24/7. Any other suggestions? Is this swelling around the udder area common with EMS horses?

  15. I have a 21 year old shetland just diagnosed with cushings and ems.She has had laminitis problems for the last few years.What is the best diet for her.She has hi fi lite, happy hoof,no sugar sugar beet and fibre pencils.She also has good quality hay as she won’t eat poor quality and no grass.Would it be beneficial to mix the hay with good quality straw.Any feeding suggestions would be helpful!

    • HI, for a metabolic pony the best diet is high fiber, low starch. It sounds like this is what you are feeding already. I am not sure what additional benefits feeding straw would confer. Be sure she gets a high quality vitamin/mineral supplement as that is sometimes compromised when calories and/or starch is reduced. A magnesium/chromium supplment may also help to regulate her blood sugar level.

  16. I have a Tennessee Walker horse who is who is 17 years old. I have had him for 6 years. The vet just diagnosed him with EMS. He has always had a big neck that is what I liked about him. I did not know it was the start of a very bad disease. After the first two years I had him he started getting sore feet only in the winter time. As the years went on it kept getting worse and worse then this year when it warmed up he did not get any better. Now he has a real hard time walking because the laminites is so bad. If only the vet had tested him when he first started to get founder this might have been prevented from getting so bad. I did not know anything about this disease. I was just told it was laminitis. I stopped feeding him grain but he has free range of pasture. I thought I was being good to him but I guess not. I also have another Tennessee Walker who is fine on grain and pasture. I can not give the one with founder any exercise because he can hardly walk. The vet has him on chromium picolinate for 6 weeks now but does not seem to be getting better. I wish there was something else I could do to help him. Any suggestions?

    • Hi Sue,

      Yes, pasture is tough on a horse that is sensitive to sugar. If you can’t move him to a dry lot, consider putting a muzzle on him. Also you should have your hay tested so that the NSC (starches/sugars) are around 10%. You may want to consider soaking the hay if it’s above that, to remove the sugars. And in the future, have the hay tested before you buy it. If you’re feeding beet pulp make sure it is not the kind that is coated with molasses.

      Six weeks is enough time for a supplement to make a difference. Usually chromium on its own is not sufficient. Consider a magnesium/chromium supplement such as Remission. Did the vet run bloodwork to see if he is insulin resistant and what his glucose is? Some other herbs that may control blood sugar are gymnema sylvestre and cinnamon. You should get professional help in deciding what supplements to feed for medicinal purposes. Also consider testing the thyroid, as well as a Cushing’s test, and treat accordingly.

      Good luck.

  17. I have a Quarab gelding of unknown age (estimated to be between 7 and 10). I have owned him for three years and every spring he contracts a mysterious offness in his gait. It is very subtle, and only detectable on the ground if you know what to look for. However, I am his only rider and am always able to pick up anything different in his movement. The first spring he abscessed, which was expected as his shoes were pulled just a few weeks earlier, but last year there was no apparent cause for it. He was lethargic and depressed, also. I was in contact with my vet and he was actually scheduled to do a lameness evaluation, but a few days before it was scheduled, my horse was acting miraculously better. This spring, he has the same symptoms. My trimmer has been recommending for months now to get him off of grain completely, however, he still gets a small amount against my will (long story). She also warns me now of laminitis. The pony he is with is potbellied and has cresty deposits on his neck and a swollen sheath. My horse has a fatty sheath, and a very slightly crested neck. I have spent countless hours both last year and this year researching and asking different people regarding my horse’s weird lameness and behavior, and I have not come to any sort of definitive conclusion until now. Do you agree that he might have EMS, along with the pony? If not, what else do you think it could be? Money is tight now, so unless there is a good chance there is actually something concerning about him, I’d rather not get the vet involved. If, however, you think he could benefit from getting some blood tests and examinations done, I will certainly do so.

    • Yes, absolutely your horse is showing many signs of EMS (and the pony too). It involves hormonal imbalances so even something like the fatty sheath is suspect. I would suggest trying a magnesium/chromium supplement (such as Remission) for starters and see if there is any improvement. It is very affordable and I know some horses who have been immediately helped by adding it to their diets. Then when you have the funds, do some bloodwork for insulin resistance and thyroid function (T3 and T4). But you really have to stop feeding all the grain. This is another area where I have seen a big difference, when people insisted the horse was getting just a little. That last little bit will really make a difference. If you have to feed him some ‘pretend’ grain like beet pulp without molasses or a very low starch grain.

  18. Hi,
    I have mini ponies. One is a chronic founderer who has been really good for a couple of years. That would be because I have a barefoot trimmer doing her feet monthly who is very knowledgeable on the subject of founder. Hay and chaff is soaked then rinsed.. She also gets Beet Pulp, a very low sugar feed called Zero, a herb mix designed for founder problems and vit/mineral supplement. She has more energy than any of my other ponies. When out she wears a grazing muzzle but I imagine she has been able to nibble the tiniest amount of very short grass through it.

    A couple of weeks ago she started to get a bit sore again. Not bad but definitely not good. I put an insert into her grazing muzzle so now she can’t get anything.

    My farrier said 12 months ago that she thinks it could be Metabolic Syndrome. The mare was (a long time ago) very fat, cresty etc. Now she is a pot bellied with a skinny neck but full of energy and joy.

    I have another who could live on air, built like a hippo…a constant worry and 2 siblings who have huge bellies but no crest at all. The rest of the ponies seem OK but there are a lot of stretched white lines amongst them.

  19. Hi…I’m at a loss. I have a 17 year old quarab paint cross? 14.3 gelding. When we moved to our acreage 5 years ago, is when founder reared its ugly head. I’ve had Cisco since he was one. I’ve managed to maintain it, somewhat, but every 2nd year, it seems to get worse, it gets really bad, so that he is lame this summer, its also been a very wet summer. I have had our pasture analyzed, and nothing odd showed up, but I think there is something that grows here that is causing his illness.

    I’ve had him on Remission for 1 month, with no results, in fact he is very lame after a light ride the other night. He does have a small crest and some fattiness on his tail base…but is not overweight. Even my farrier thinks he is slimmer than ever. I have him on very chewed down pasture and have started muzzling him during the day. I have not had him to the vet, I think that he may have EMS and will be enquiring about blood tests at the vet. Any suggestions?

    Thank you

  20. Hi, I am so glad to have found this post as I think it may be what’s wrong with my mare. I have a 16.1hh Friesian mare, who turned 7 a couple of months ago. She’s always been a good doer with several comments made about how fat she is. I used to ride her quite hard for an hour or so about 5 times a week with a day for hacking and she was immensely fit yet she still carried a LOT of excess weight, rolls of fat in front of the saddle. She has also a permanently huge crest, usually sitting on top of muscle from work. She’s always been starving hungry and gets very irate if she’s left without hay for a period of time, she has two nets of extra small holed nets, one inside the other and she gets one in the morning and one at night with roughly 2kg at the minute as she’s out at grass for about 6 hours a day. She has a ball to entertain her at night with about 10 pony nuts in and she gets an apple. Currently she is on a lot of supplements, garlic, apple cider vinegar and biotin, all of which are given at the recommended levels. She was also on oestress for a month due to her not coming into season at all this year and she is usually very regular and you can hardly tell the difference in her from temperament but she did get a lot of white staining on her hocks. The oestress did trigger a season a fortnight ago, which lasted a fortnight, however due to the problems I explain below we had to stop it for fear of it interfering.

    I have not been able to ride her for the past 3 months as in October she developed very swollen fetlocks which extended to almost below her hocks, they were relieved with exercise on a walker and under saddle twice a day each until the fields cleared up enough to turn out. Then about 3 months ago (roughly the same time the swelling in the fetlocks disappeared) she developed a severely swollen udder which was very sensitive to the touch and was obviously causing her great discomfort. A smear test just showed up chronic inflammation and there were no other signs of mastitis (she’s never been in foal). She has been on anti-biotics and anti-inflammatory’s for the majority of this period and had the udder is still slightly swollen, however dramatically improved. I had her shoes removed at the beginning of October due to my old farrier allowing one of his apprentices to fit shoes that were too small, I have since changed farrier and she had been barefoot for almost six months and extremely happy. About 3 months ago, again, she started to grow very little hoof and the new farrier recommended shoes which she has had on since, however, her rear hooves now do not grow and the fronts, only slightly. Her rear shoes were literally replaced exactly, after a little cleaning up, and the clamps in exactly the same place.

    Does this sound like she could have Equine Metabolic Syndrome to you? To me, from reading this article only, she sounds like a classic case but I would love some feedback and these past few months have been horrible and without answers. Anything would be helpful and reassuring at this point in time!

    Thank you,
    Laura and Maike, my horse

    • HI Laura, thanks for commenting and sharing your story and glad you found the info helpful. Some horses are more prone to this condition and Friesians are definitely one of them. The swollen udder indicates out of balance hormones which is characteristic of this conditions.

      I would reconsider your whole management plan. Hooves are not growing because there is inadequate circulation to the feet. This is emphasized by the swelling in the limbs – if there was adeqate circulation there would not be swelling. So further reducing the circulation by adding shoes is aggravating the problem, not solving it.

      Being so hungry like that is an indication of blood sugar imbalance. I recommend looking into all the blood sugar control supplements that are out there now (herbal) and seeking the services of a clinical nutritionist or herbalist. Also look into magnesium supplementation. Also examine your feeding program from square one. Consider low starch options, stay away from processed grains as much as possible, and give her as much exercise as possible. She is showing reactive stress to her environment and it is important to locate the source.

      Good luck.

      • Thank you so much for this, I cried with relief from your response! She’s my first horse and I’ve had her since she was 3. I am so glad that I finally have an answer to all the problems we’ve been struggling with! My farrier is coming out tomorrow to remove the shoes again and I have a nutritionist’s number to ring tomorrow thanks to a friends recommendation. I believe the source of stress is from her not being able to work as she LOVES working thankfully! Hopefully with the change in diet as you recommended we’ll be back on our four hour hacks again and both be much happier! Thank you!

  21. I am sure that my 9 yr. old Tennessee Walk has EMS. I have been researching the effects of gymnema sylvestre to help control the sugar. However, I cannot find the recommended dosage for horses. Can you help me with this? He is approx. 1200 pounds.


    • I would start with about one teaspoon per day and if you can split it into two doses per day 12 hrs apart that would be best.

      Have you tried any other supplements for it such as Remission, or Juniper Berries or Cinnamon, all supposed to have beneficial effects on blood sugar.

  22. Hi,
    I have a welsh section a that was diagnosed with metabolic laminitis 5 weeks ago, his hay is soaked, he is on limited grazing and has a handful of Happy Hoof mix specially for laminitecs so i can get the tables in him prescribed by my vet. I cant remember the name of the tablets but they are originally for human use.His count was 42 in his blood test. i am due my 2nd blood test next week but my pony still has laminitis, he has lost weight as you can see his ribs. He still has a bit of a crest but i cant exercise him because he is still lame even on a bute a day. I am really worried now as i can’t see how else to manage this….any ideas as he really isnt comfortable especially on concrete.

    • Hi Hayley

      Sorry to hear about the problems with your pony. It sounds like you have done most everything you can to manage this from a diet standpoint. Obviously I don’t know what medication you’re giving him but whatever it is you should consider a magnesium supplement such as Remission which might also help.

      It sounds like the last piece of the puzzle might be reviewing his trim and getting a second opinion from a different farrier or barefoot trimmer and make sure the heels are not too high.

    • Hi Hayley

      I have just posted below you. I think the medication will be metformin and i am interested in the dosage you are giving to your pony. We are really strugglin with our little mare and the exercise is a hard one. I think she is better on the bute being exercised, and now I have had the x rays done I feel more confident that the rotation is not severe. Good luck I see you posted a while ago so by now I m hoping you ahve some improvement.

      • HI Julie
        I’m sorry to hear about your pony but this problem is obviously becoming epidemic. It sounds like you are doing everything right. You might consider having her thyroid tested as well as IR and you might also consider seeking the advice of a nutrition specialist if the vet is not up to speed on metabolic issues as most aren’t. I am curious why you have resisted the metformin. Just wondering, because I have and am still resisting Pergolide.

        There is a homeopathic product for blood sugar, I know people who have great success using it on their horses. Here’s the website


        It’s a Canadian company and I know they ship to the US so they might ship to the UK as well. I am not associatied with this company, just passing the info along. Good luck.

  23. The medication will be Metformin if this is EMS or Pergolide if this is Cushings disease both are metabolic issues , this is a long and arduous task as there will be constant changes to the medication to try and get the balance right . Treat the laminitis , make sure the hooves are supported with frog supports or ensure a deep shavings/sand/peat bed to pack into the feet . this will help support the internal structures , A handful of Happy Hoof will not give your pony the nutrients he needs, supplement with Baileys number 14 which is a lo calorie feed balancer . I have found Global Herbs Alpha Bute fantastic and as effective as Danilon as a pain killer , also Global Herbs Laminitis Prone , these really do help I know from experience ,. Keep in touch and let us all know how things go , we have been through it as well !

  24. Well good news, I had a new supply of Hay delivered last Thursday and i have soaked it as normal and today he is completely sound! I noticed a difference as soon as Saturday. It must have been the Hay he was having before which i found out an additive was added to it to help with the moisture content. I think too much of a coincidence that the Metformin started to work after 5 weeks at the same time as changing the hay…. 2nd blood test was taken today so fingers cross we are on the right side of it now. The vet was really happy how he looked but I will look into the herbs etc as advised as its a place i don’t want him to end up in again as i really thought there were no other options, not pleasant ones anyway! I will give it a couple of days and ease him off the bute and try a natural source.
    Thank you for your advice!

    • Great news!

      Do you have your hay tested for NSC content as well? Probably not a bad idea if you’re not already doing that. I don’t supposed testing would discover the presence of this additive but your pony is obviously sensitive to it and imperative that you avoid such things in the future. And, the soaking didn’t remove the additive – obivously? Great news that you could find out about this additive.

  25. You can buy feed grade magnesium oxide at feed stores for $20 for a 50 pd bag,I tried it all winter did nothing to reduce my mare’s neck. I don’t grain her at all gets grass hay and her neck is huge like a stud horse,big hay belly also.
    She is out almost 24 -7 in the winter in the midwest so nothing to eat but the hay. I am trying thyroid L now.

    • Hi Tom,
      I think you just proved that feed grade magnesium oxide from the feed store isn’t the best solution. Also, how much MagOx did you feed? It is important to know that the oxide form of Magnesium is only about 40% bioavailable. So if you feed 1000 g. the horse absorbs about 400g. I just checked a container of Remission and their recommended dose is 6000 mg. It also contains a lot of other ingredients that help with insulin resistance besides magnesium.

      Your mare obviously has a serious problem as yet unidentified, judging by the hay belly alone. She’s not digesting her food properly for some reason. Have you also added probiotics and prebiotics to her diet? Have you done any bloodwork? Did your vet give you a script for Thyrol without bloodwork? There are many things that could be going on and off the top of my head I can think of quite a few herbs and supplements that are good for insulin resistance, thyroid problems, etc. But the trial and error approach isn’t the best, you should try and figure out what the actual problem is.

      I know of a similar horse with a giant cresty neck that the owner tried every possible remedy and supplement under the sun and finally had a nutritional consultation done. The horse is doing very well on a proper diet and specific targeted vitamins, minerals, etc. Starvation is definitely not the answer (not that you’re doing that, just wanted to mention it’s a common approach). If you would like to contact this nutitionist her website is http://www.Rivasremedies.com

      Good luck.

  26. I have a paso/TWH cross I transitioned to barefoot 2 yrs ago – he has always seemed tender on gravel and stones – fine on grass – he does not show any laminitic rings but has had a few abcesses which I understand is normal during transition – mainly in a hind foot that was his “worst” foot – I have had him in various types of front hoof boots but they do not stay on him well – he has a flicking action w/his front feet which flicks the boots off especially if we go through water and they get wet/heavy and I hate being paranoid having to look down to make sure his boots are still on all day long!! Plus he doesnt seem all that much more comfortable in the boots anyway… his feet are super – short toes and low heels, nice shape. No holes or cracks or white line issues. He is an easy keeper w/a cresty neck – I feed him a teeny bit of Ultra Fiber/forage first low carb pelleted feed by ADM and Hilton Herbs hoof n herb (seaweed/kelp/magnesium/rosehips etc) also a joint supplement w/hyaluronic acid and have just ordered Smartpak IR supplement and some Jiao Gu Lan.

    The mobile vet just came but wasnt able to test blood for IR as it wd have hemolyzed before he got back to lab so I am just assuming he has IR and has sl sore feet because of that – I dont know what else to think really… I will try the IR supplement and the Jiao Gu Lan and see if they help – I am going to restrict his grazing in summer as well and stop his food except for a teeny bit w/supplements… he is not fat at present and is quite trim and fit – we trail ride up in the mountains and he goes really well except for the gravelly bits…

    Otherwise I will have to assume he is always going to be sore on gravel… tho its been 2 years his feet still seem to be changing – they are becoming concave in the toe area now… loong transition!!! Any other ideas??

    • Hi Doramy, thank you for your comment. Wow, boots on a gaited horse, now there’s a problem I’ve never thought of before! Metabolic horses are obviously one of if not the biggest problems facing today’s horses. And both the breeds in your cross are subject to this condition. If you are still seeing changes in your horse’s hooves after two years than you can perhaps expect more improvement. But I would say given your description that ultimately your problem is metabolic. The IR pellet sounds like a good choice and I would wait to see if it produces any improvement.

      OTOH I would reconsider feeding anything from ADM. That is almost certainly full of all kinds of toxins, chemicals, pesticides, etc., that are almost surely the leading cause of EMS to begin with. Since you don’t have to feed much consider a healthier, higher quality feed (like an organic one). Or don’t feed any grain at all. Easy keepers do not need grain. And reconsider restricting his grazing in summer – reread the part of the article that talks about how ‘starvation’ is a self-fulfilling vicious cycle. Four hours of no eating and the hores’s ‘starvation’ mechanism kicks in.

      And follow through with the testing. It is important to know what you’re dealing with in order to treat it properly.

      As an aside let me just say that finally (after ten years) I have finally figured out my horse’s dietary issues with the help of a professional nutritionist. This is a serious condition and requires professional help. My horse no longer is ouchy on gravel even though he was otherwise ‘sound’, for the first time in ten years of being barefoot.

  27. I am actually going to go with Nutrena Empower Ration Balancer and stop all the ADM feed. I agree he doesnt need it. I am also going to bring him inside in summer afternoons and may also buy a grazing muzzle. By a process of elimination I have determined that its his feed that is the issue w/feet because everything else is perfect – it always seemed to me that the inflammation is inside the hoof and thats why the hoof boots didnt help really – his soles are good and hard, his hoof walls are sturdy, no thrush etc… so this will be interesting – I will report back – Thank you for your reply.

    • Sounds like a great plan Doramy. You’re absolutely right about inflammation in the feet. That is the result of insulin resistance, and as you have concluded, putting a boot on won’t help, unless you have an extremely soft pad for cushioning.

      And great decision about getting rid of ADM and switching to Nutrena. Nutrena is a much higher quality feed. When you bring your horse in for the summer, try to work it out, if possible, so he doesn’t go more than 4 hrs without eating.

      Good luck – I look forward to hearing your updated report.

      • I was enjoying reading through all these posts and comments and was impressed with the knowledge until this post. I have worked for both ADM Alliance Nutrition and Nutrena and been intimately involved with daily feed formulation and commodity purchasing. ADM and Nutrena source their ingredients from the same suppliers!!! However, having worked with both, I can tell you that ADM’s incoming ingredient standards are much stricter and they do not purchase or stock cheap fillers for production like so many other major feed companies (Nutrena included). The guidelines I had to follow with formulation, especially with horse feeds, were insane but well worth it. I have since changed jobs because my husband was transferred, but will continue feeding their premium horse feed line because my horses have looked and performed better than they ever did on other premium brands. I also find it amazing that every barn we’ve trained or boarded at for any length of time ends up switching to the premium ADM horse feed line. Never did I provide info on my feeding program without being asked. The low feeding rates and my horses out-shining all the others brought everyone to my tack closet at some point. As an educated individual with dual degrees in livestock nutrition and genetics (post doc work in ruminant nutrition), I beg you to please research before making such fictitious statements.

        • Thank you Redman War for your insight on this subject. I have no doubt that ADM adheres to ‘standards’, the issue is with what these standards are. The EPA has ‘standards’ too but our waters still have pollution dumped into them and lawns liberally applied with chemicals, for example.

          When you say ADM adheres to standards, it would be interesting to hear just what these standards are, without writing an entire treatise on the subject. For instance if I am not mistaken they are the largest producer/user of GMO foods, aren’t they? That would be an example of ‘standards’ being met but not being necessarily beneficial for consumers. Just parroting ‘we meet standards’ is not adequate to me.

          There is little doubt that equine metabolic syndrome has reached epidemic proportions and it is concurrent with the ‘manufacture’ of horse food replacing whole, natural ingredients. These manufactured highly processed foods are processed and digested much too quickly into the equine’s system leading to such problems as chronic laminitis, insulin resistance, Cushings, etc.


      • Thanks Redman War
        I have an update – I consulted my barefoot trimmer (who taught me to trim) and we determined to get to the bottom of the ongoing footy (tender) feet – we have found if I trim Oscars bars a lot lower and keep them low he is much much better. I have continued with ADM Forage First and am happy with it in small amounts for my easy keeper horse / he is light work only – I also give him Nutrena Empower Balance as a ration balancer and add ADM PowerGlo as needed in winter to keep up energy. He has free choice hay in winter and pasture 24/7 in summer so just supplement that depending on his weight and energy requirements for work. I only have 1 horse so I have time to fiddle around with his feed and create my own “custom” blends. I am happy with ADM and friend who also feed this are happy with it and all our horses look great and perform well. I like the Empower Ration Balancer from Nutrena but havent tried any of their other feeds.

  28. We have a 14 yr old 12hh Welsh Mountain pony and since last Nov she has been suffering from laminitis. The only prev spell of lami was a couple of years ago and this was very mild.Whilst she is a greedy pony her grazing has always been strictly controlled and although she has a crest and we sho her we have never had her in anything like a fat condition. Last summer infact we struggle to get weight on her belly and you could see her ribs. She is fed HIfi Lite, Low protein haylage which is marked for natives, bailey outshine (oil based which we have been assured by Baileys will not contribute to Lami in anyway) and Top spec Anti lam balancer.

    When she first showed signs of lameness she was box rested and then this was continued on advice of our vet who wanted her on limited bute, walked out daily… He did blood tests and these showed signs of slightly raised insulin levels. He requested our farrier fit heart bar shoes which was done. She had never previously been shod. He also wanted to put her on Metformin 30 tablets a day but I resisted this.Althought seemingly improving, coping without bute she kept relapsing, it seemed worse when the feet were trimmed and shoes replaced.

    In the new year, I was concerned that the trimming might be taking her feet in a ‘wrong direction’ so I discussed with the farrier about having x rays done. He agreed and this has now taken place and shows decent alignment. There is a very slight rotation in the off fore.

    The subject of metformin has come up again . I would be grateful for any suggestions.

  29. Sorry to hear about your mare, undoubtedly use the metaformin. My little pony is almost back to normal on it. Still on restricted grazing and he always will be and a little footy on hard surfaces but otherwise excellent. I ran out for 3 days and you could see he started to get a little uncomfortable. It’s a long process for it to kick in and get the correct balance but worth it. He is blood tested every 4 months to make sure he is on the correct dose. He is only on 4 tablets a day at the moment.
    A trim every 5 weeks and I got caught with my feeding, whilst I was feeding safe and sound feed for lamanetics it was still higher in sugar than others.
    I contacted an expert on feeding ponies with metabolic syndrom who advised me on the sugar content of feeds on the market. I cant add it to this post but if anyone would like a copy of it I need to email it to you directly, it makes interesting reading.
    I was told to keep clear of any haylage and only feed soaked or steamed hay.
    My welsh section is 11.2 and just 5!
    Good luck but it does take time!

  30. Hi, I bought a nine year old paint mare from a farrier that had her blood work done and she was diagnosed to have EMS. He said she didn’t completely founder but started to turn about a year before I bought her. She is sound now and I would like to keep her that way. I have had her for six months just came out of winter here in Wyoming……and after much Internet searching I have been feeding her 2 Cups of LMF Stage1 feed for horses with this condition……morning and night plus hay two flakes not soaked and in addition I give her SmartPak 1oz Metaboleeze to balence blood sugar, once a day mixed with her feed. I have her in a dry lot most of the day and turn her out with a grazing muzzle which allows her to eat tops of very short grass…..for about 5 hours a day……I keep her trimmed short and either ride or walk her for exercise. She looks good but seems hungry all the time. Is there any more or less I should be doing? Thanks for any help you can give. I love this horse…..her name is Sweetpea.

  31. Hi all

    It has helped me reading some of these issues.
    My 14 hand Section D mare has had laminitis since Sepember 2011. We got her back in to work in November only for her to relapse again. We had strip grazed her for several years and exercised her 6 days per week prior to this.
    I had 2 Cushings tests done 6 months apart and an IR EMS test done late last year. All came back negative. A more dynamic test in March showed her level after fasting to be 20 and after glucose 409. Another test in May after Metformin, 18 tablets per day showed a reduction after glucose to 200. We have her on no grass, a mixture of soaked hay and straw and 30 Metformin per day. She has remedial shoes on back and front. X rays in March showed some rotation and some sinkage but not drastic.
    We have her on 20 minutes walking and 20 minutes riding per day.
    Blood tests and comparative X rays tomorrow so fingers crossed, it’s a long and sad journey!


  32. I sent a message about my miniature mare and her ravenous appetite…how do I hear from you please?
    Tana Fowler

  33. Equine Metabolic Syndrome « Barefoot Hoofcare, was indeed a
    very good title to give this post. Where exactly could I actually read
    more about this?

  34. My welsh cob of 17 years old was retired last year due to head shaking syndrome and has just been diagnosed with ems. I have a plan with the vet for the next 6 weeks but I wondered what potentially the longer term outlook could be for my pony especially as I am totally unable to exercise him in any way. He stresses when on box rest so I’m not happy with very limited turn out long term. Just after a bit of advice. Thanks

    • Hi Jenna. Sorry to hear of your pony’s issues. Has anyone ever drawn a connection between the headshaking and the EMS or are they considered completely unrelated? Is the headshaking the issue that prevents exercise? EMS is very hard to deal with without exercise, your options are limited to nutritional ones.

      I have read about a connection between over-vaccination and head shaking syndrome. Especially ponies who get the same dose of vaccine as a large horse. I would look into homeopathic protocols and detoxification to try and address that.

      Then the usual supplements for EMS

      Good luck

  35. Hi thanks for your comments. Yes he is retired as the head shaking was so bad when ridden, I was happy for him to live out in the field whilst he was happy out there (head shaking seemed more controllable out there, linking the cause to the trimeganal nerve in the face from the brain being aggravated by increased blood pressure through adjacent ateries, hence work triggers the over reaction)
    I did ask the vet if there was a link, she said scientifically there’s been no link between but that some head shakers when under autopsy where found to have benign tumours on pituarty gland? This could appear like ems? I’m not sure though.
    Guess ill give the next 6 weeks a try and see what improvement I can make im that time then re consider my options if I’ve achieved little 🙁

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