Diet (2024)

Emergency diet for a horse with endocrinopathic laminitis

Feed:
Forage - usually grass hay - feed approx. 1.5-2% bodyweight hay (depending on whether weight loss is needed (1.5%) or not (2%) - 7.5-10 kg for a 500 kg horse, 3.75-5 kg for a 250 kg pony), soaked for at least 1 hour then drained to reduce sugars (or analysed to show combined sugar/starch no more than 10%). Note hay will usually contain 10-12% moisture (or more), so 7.5 kg on a dry matter basis = 8.5 kg as fed weight for a hay with 12% moisture content, 10 kg on a dry matter basis = 11.11 kg as fed weight for a hay with 10% moisture content. Haylage can be fed if analysed and sugar, starch and energy levels are appropriate, but should not be soaked. Straw can make up part of the forage (up to 1/3).

Low sugar chaff to carry minerals, e.g. Dengie HiFi Molasses Freeor Spillers Fibre Lite (weight loss/maintenance) or unmolassed sugar beet (weight gain/maintenance).

Balancer or vitamin/mineral mix, containing good levels of zinc (400 mg), copper (100 mg) and selenium (1 mg) The total diet should provide 400 mg zinc, 100 mg copper and 1 mg selenium for a 500 kg horse that's not in work, and as forage rarely meets these levels The Laminitis Site suggests providing 75 - 100% of the daily requirement in the balancer or mineral mix (recommended daily amounts from theNRC Nutrient Requirements of Horses 2007). The Laminitis Site uses and recommends Spillers Lite + Lean.

Vitamin E - when horses do not have access to grass, feeding approximately 400 IU/100 kg bodyweight (so 2000 IU for a 500 kg horse, 1000 for a 250 kg pony) may be beneficial - check amount in mineral supplement/balancer and add more if necessary, human vitamin E capsules can be added to the feed. These amounts are based on natural vitamin E.

Salt - total daily salt requirements are 25 g 500 kg horse not in work, 12.5 g 250 kg pony (a tablespoon of salt weighs around 21 g) - check salt/sodium amount in the rest of the diet and add more if necessary, plain table salt can be used.

Micronised linseed may be fed to provide essential fatty acids and omega 3, at the rate of 50 - 100 g, or this may be added to the diet later. Suppliers in the UK include Charnwood Milling and EquiSupermarket.

Do not feed:
Grass
Cereals (oats, barley, maize) or bagged feeds containing cereals or molasses with combined sugar/starch exceeding 10%.
Treats containing sugar/starch.

NB
Never starve a horse with laminitis - this can cause hyperlipaemia (which has a high fatality rate) particularly in pony, donkey and miniature horse breeds. Feed at least 1.5% of the horse's bodyweight unless under close veterinary supervision.

​Recovery/maintenance diet

Your horse's diet needs to provide all the nutrients considered essential for health - energy, protein (amino acids), minerals, vitamins, essential fatty acids (and water). Diets for horses with laminitis/EMS/PPID will usually be based on low energy, low sugar/starch high fibre forage with nutrients targeted to meet deficiencies in the forage, identified by forage analysis (or typical values).

The diet for your horse will depend primarily on whether:

- he/she needs to lose, gain or maintain weight - horses that need to gain weight need to have more energy provided by their diet, horses that need to lose weight need to have less.

- he/she has insulin dysregulation/has EMS/has had endocrine laminitis - horses that have insulin dysregulation/have EMS/have had endocrine laminitis may need to have combined sugar and starch levels kept below 10% (seeEquine Metabolic Syndrome -ACVIM Consensus Statement- Dietary Management), and ideally have any sugar/starch in the diet spread out through the day to prevent insulin peaks. Insulin levels should be monitored, either resting orOST, to assess insulin resistance/laminitis risk. The insulin results will also dictate how much, if any, grass the horse can have.

- he/she has PPID. A horse with PPID may need higher levels of nutrients, especially protein if muscle loss is an issue, and should probably be fed at least high maintenance levels (if not in work). Some experts recommend feeding good levels of anti-oxidants to horses with PPID, including vitamin E, zinc, copper and selenium.
A horse with PPID that also has insulin dysregulation/EMS will need to have good levels of nutrients whilst keeping the sugar/starch in the diet below 10%.
A horse with PPID that doesn't have insulin dysregulation/EMS may not need to have sugar/starch limited, although it is generally recommended that all horses should be fed a high fibre diet based on forage with essential nutrients supplemented as necessary.

Minimum nutrient requirements can be calculated using this programme:NRC Nutrient Requirements of Horses 2007but be aware that ratios between some minerals are important (calcium:phosphorus and copper:zinc), not just the total amounts fed.

​Forage
Hay is likely to form the bulk of the diet for an EMS/PPID/laminitic horse. Late cut, native species grass hay is likely to have lower sugar levels than early cut improved species (e.g. ryegrass) grass hay. High fibre haylage may also be suitable. Forage should ideally be analysed - NB forage analysis of simple sugar/ESC and WSC must be by wet chemistry - (ForagePlus(UK) andEqui-Analytical(USA) analyse ESC as well as WSC and starch) and contain no more than 10% total sugar and starch on a dry matter basis. If the amount of sugar/starch isn't known, it may be best to soak the hay to reduce sugars. Do not soak haylage as there may be a risk of secondary fermentation.

As a rough guide for the quantity of the total diet, feed 1.5% of bodyweight to a horse that needs to lose weight, and 2% of bodyweight to a horse that is the correct weight or needs to gain weight - the dry matter (DM) of feed is calculated. So to lose weight, a 500 kg horse might eat 7.5 kg DM, and a 250 kg pony 3.75 kg DM per day, and to maintain weight, a 500 kg horse might eat 10 kg DM, and a 250 kg pony 5 kg DM per day. NB ideally the energy content (DE) of the feed should be analysed and matched to the energy requirements of the horse.

SeeHay, Hay Soaking, Haylagefor more information.

​Energy /carrier
Horses that need to lose or not gain weight often do well with a low sugar chaff as a carrier for their minerals, e.g.Dengie HiFi Molasses FreeorTopSpec TopChop Lite.

Horses that need to gain weight often do well on unmolassed sugar beet as a carrier. Sugar beet is generally low in sugar (~ 5%) but can be soaked in lots of water, rinsed and drained to remove even more sugar. Sugar beet is mostly fermented in the large intestine to volatile fatty acids which the body can use for energy, and does not significantly increase blood sugar or insulin levels.

Both low sugar chaff and unmolassed sugar beet can be used to replace part of the hay/forage ration.

​Minerals and vitamins
Minimum (and sometimes maximum) levels of certain minerals and vitamins have been established, and these should be supplemented according to deficiencies in the rest of the diet. Horses on mostly hay or restricted diets for weight loss are likely to need more mineral and vitamin supplementation than horses eating unlimited grass.

Minerals/vitamins with an established requirement are:
macro minerals (amounts given in g): calcium, phosphorus, magnesium, sodium, chloride, potassium, sulphur.
micro/trace minerals (amounts given in mg): iron, manganese, zinc, copper, iodine, selenium, cobalt.
vitamins: A, D, E, B1 (thiamin), B2 (riboflavin).

Copper, zinc, selenium and sodium, and possibly iodine and vitamin B1 may be low in a forage diet and usually need to be supplemented.
Iron is usually high in a forage diet and rarely needs to be supplemented (insulin dysregulation may be associated with iron overload in horses - improving insulin sensitivity through weight loss, exercise if able and a low sugar/starch diet may prevent/reduce this).
The other minerals/vitamins may or may not need to be supplemented depending on levels in the forage and other factors such as whether hay is soaked (potassium, sodium and chloride and water soluble vitamins (Bs and C) are reduced by soaking, other minerals may also be slightly reduced) and how old hay is. Restricting the amount of forage fed makes the need for supplementation of these minerals and vitamins even more important. Healthy horses are generally considered to be able to synthesize their own B vitamins (other than perhaps B1 and B2) and vitamin C (although there may times when supplementing vitamin C is recommended - seeVit C and PPID).

When choosing a mineral supplement or balancer, look for one that supplies 75 - 100% of the full RDA for copper (100 mg), zinc (400 mg) and selenium (1 mg), a contribution towards B1 (30 mg), probably some iodine (~ 2 mg of the 3.5 mg RDA) and magnesium (7.5 g), possibly some calcium (20 g), phosphorus (14 g) and vitamins A (15,000 IU), D (3,300 IU) and B2 (20 mg). Potassium (25 g), sulphur (15 g) manganese (400 mg) and cobalt (0.5 mg) tend to be well supplied by a forage diet. Vitamin E and sodium and chloride will usually need to be supplemented - see below. (Figures in brackets are theNRC Nutrient Requirements of Horses 2007minimum RDAs for a 500 kg horse at average maintenance - but these are not necessarily the amounts that need to be supplemented as some minerals/vitamins will be present in the forage and other feed).

Salt usually needs to be supplemented to top up sodium levels in mineral supplements (salt is approx 40% sodium, 60% chloride). SeeNRC Nutrient Requirements of Horses 2007to calculate sodium needs for your horse's weight and status, help with calculating salt needshere-total daily salt requirements are 25 g for a 500 kg horse not in work, 12.5 g for a 250 kg pony (a tablespoon of salt weighs around 21 g) - check the salt/sodium amount in the rest of the diet and top up with salt - plain table salt can be used, or iodised salt if more iodine is needed in the diet. Hay and grass often have very low levels of sodium, therefore it is usually safe to supplement the full RDA if there is no other source of sodium in the diet.

Additional vitamin E may be a good idea for horses that don't get grass. Dr Stephanie Valberg suggests that "horses that are deprived of pasture or green, high-quality hay, and that are not supplemented with vitamin E for more than a year, are at greatest risk for EMND" and that owners of horses without pasture access should supplement horses with vitamin E at 2,000 units per day:Muscle Atrophy - where did it go and will it come back? - Stephanie Valberg 2017.Equine Applied & Clinical Nutrition recommends feeding horses prone to laminitis 150-200 IU/kg diet DM, so for a 500 kg horse eating 1.5 - 2% of his bodyweight that would be 1125-2000 IU vitamin E per day (orapprox. 300-400 IU/100 kg bodyweight - so 1500-2000 IU for a 500 kg horse, 750-1000 for a 250 kg pony). These amounts are based on natural vitamin E.
Check the amount in your mineral supplement/balancer and add more if necessary - human vitamin E capsules from supermarkets/health food shops can be added to the feed.

To supply minerals, vitamins and some protein (it is not uncommon to see hay analyses that would not provide minimum amounts of protein), The Laminitis Site recommends:
Spiller's Lite + Lean balancer

Other reasonable choices (available in the UK) for supplying minerals and vitamins include:
TopSpec AntiLam balancer
Balancers generally contain protein as well as minerals and vitamins. Although the sugar/starch content of a balancer is likely to be higher than a mineral supplement, when mixed with a low sugar/starch carrier such as a non-molassed chaff or unmolassed sugar beet, the total sugar/starch content of the bucket feed is unlikely to exceed 10%.

Thunderbrook Daily Essentials(but ensure the rest of the diet supplies adequate protein)

NB Products sold as hoof supplements are not necessary and may unbalance a correct diet. A good balancer/mineral mix (such as those recommended above) is likely to already contain good levels of the nutrients often suggested as being important for hoof growth such as biotin, zinc, copper, methionine.

Feeding for weight loss

See Diet for weight loss

NB the ECEIM Consensus Statement on EGUS (2015) suggests:
"Overweight horses and ponies at risk of EGUS should receive a minimum amount of high quality forage (1.5kg (DM)/100kg bodyweight per day) that is mature and has low energy content. If low energy forage is not available then a mixture of high quality forage and straw divided into a minimum of 4 feedings might be a suitable alternative. Straw should not be the only forage provided but can be safely included in the ration at <0.25kg (DM)/100kg BW."

Sykes BW,Hewetson M,Hepburn RJ,Luthersson N,Tamzali Y
European College of Equine Internal Medicine Consensus Statement - Equine Gastric Ulcer Syndrome in Adult Horses

Journal of Veterinary Internal MedicineVolume 29,Issue 5,pages 1288–1299,September/October 2015

Feeding for weight gain

First, be certain your horse does need to gain weight - some research has suggested that many owners are not good at recognising when horses are overweight. A horse that has had laminitis may benefit from being kept just under what may otherwise be considered a "correct" weight, particularly if insulin levels have not returned to normal and/or if rehabilitation of feet is not complete.

For weight gain, horses need to eat more energy than they use. Energy is measured in megacalories (Mcal) or megajoules (MJ), and usually listed as Digestible Energy (DE). There is no difference between energy fed for weight gain and energy fed to fuel work - whilst some feeds may make horses more "fizzy" than others, the calories fed will be used to power body functions and work, and what is left over will be stored (once short-term energy sources are replenished) as fat.

For weight gain, you can increase the quantity you are feeding, or you can increase the energy level (the DE given in MJ/kg or Mcal/kg) of the feeds, or both. If laminitis is a risk, you should increase energy levels without increasing the amount of sugar and starch in the diet.

• Ensure teeth are not causing problems (6-12 monthly dental exams), internal parasites are controlled (targeted worming and worm egg counts), PPID is well controlled (check clinical signs and blood test results) and the horse has no other illness that might cause weight loss - Investigating Weight Loss - Liphook Equine Hospital.
• Ensure the basic diet is correct, i.e. providing all essential nutrients - protein (weight loss can be a sign of protein deficiency), minerals, vitamins, essential fatty acids -as above.
• Increase fibre - feed 2 - 2.5% of the horse's bodyweight as forage (hay, haylage or grass depending on the need to restrict sugar/starch).
• Increase the DE content of the diet using rapidly fermented low sugar/starch feeds such as unmolassed sugar beet.
• Increase the DE content of the diet using oil - adding/increasingmicronised linseed may be more appropriate than adding vegetable oil, which iscalorie dense but pro-inflammatory (i.e. omega 6 levels are higher than omega 3). When adding oil to the diet, add an extra 1IU vitamin E for every 1 mlof oil added - see:Add Vitamin E to High-Fat Horse Diets - KER September 2019​.
• Feed several small meals/day rather than 1 or 2 large meals, and aim to give the horse access to forage at all times.

An example of increasing the energy supplied by the diet:
Dengie HiFi molasses free (MF) (unmolassed alfalfa/straw chaff) contains 8.5 MJ DE/kg.
Speedibeet (unmolassed sugar beet) contains 12 MJ DE/kg.
Both have sugar/starch levels of no more than 5% (according to their manufacturers), so are suitable for laminitic horses.

If a 500 kg horse is not working, he's likely to need around 70 MJ/day for maintenance requirements. Say he's getting 50 MJ/day from hay, and2 kg of HiFi MF, which supplies 17 MJ - so he's getting 67 MJ/day DE, he needs 70 MJ/day DE, and he's losing weight.

If he'll eat more, you could increase his feed - increasing his HiFi MF to2.83 kg would supply 24 MJ - an extra 7 MJ/day, bringing his daily total DE to 74 MJ.
Or to provide the same energy you could replace the HiFi MF with the higher energy Speedibeet -2 kg of Speedibeet would supply 24 MJ - that's over 40% more calories compared to the same weight of HiFi MF.

Feeding horses with PPID

Much of the above will apply to feeding a horse with PPID. It is essential to recognize whether the PPID horse has insulin dysregulation or not (i.e. a history of laminitis and/or abnormal insulin concentrations) and whether it needs to lose weight or not, and feed accordingly. Good nutrition is considered an important part of managing a PPID horse, so ensure that the diet provides above minimum levels of protein, minerals, vitamins and essential fatty acids.

Choosing a feed

There are many feeds targeted at laminitic/EMS/PPID horses. Here are some guidelines to help you choose a suitable feed for your horse:

For EMS/IR/laminitic horses, generally look for feeds with total sugar/starch no more than 10%. Some balancers contain more sugar/starch than 10% but are fed in small amounts - matched with a low sugar/starch carrier these feeds can still be suitable - e.g. a feed containing 500 g of 14% sugar/starch balancer and 500 g of 4% sugar/starch chaff will give a 1 kg feed containing 9% total sugar/starch.

Be aware that feeds claiming to be "suitable for laminitics" or carrying a "mark of approval" may contain more than 10% sugar/starch, so may be best avoided - be guided by figures, not claims.

Look for sugar/starch contents on feed bags and product descriptions and contact manufacturers if they are not available. Support companies that provide clear information and give a full analysis of their feed, including sugar and starch levels - particularly for feeds marketed at horses with laminitis, EMS, ID and PPID.

Similarly, look for an analysis of all the minerals/vitamins with an established RDA on feed bags and product descriptions, and contact manufacturers if this information is not available.

Ask for links to published research to support any claims made about feed or supplements. Support companies that carry out and publish research.

Be cautious of feeds containing herbs and substances that could have an active ingredient, unless accompanied by research showing that the feed is safe and that supports any claims made. For example, some feeds aimed at horses with PPID (which may use the old term, Cushing's disease) contain Vitex agnus castus/chastetree berry, which has been shown to reduce dopamine production in other species - this could be detrimental for horses with PPID.

Feeds that may be suitable for horses with laminitis/EMS/PPID

The list below is based on analyses provided by the manufacturers (from websites, literature or feed bags). Inclusion is based mostly on declared sugar/starch levels and does not suggest endorsem*nt of the feed by The Laminitis Site. Some feeds will be mineral/vitamin enhanced, and a full analysis of the diet should be carried out when such feeds are fed, to ensure that mineral and vitamin levels provide above minimum amounts but do not provide above upper safe limit amounts. Some of these feeds may be suitable to replace hay for horses with dental problems. The feeds are listed in order of energy content (calories), with the feeds lowest in energy and therefore best for weight loss first:

Honeychop Lite & Healthy - sugar 3.1%, starch 0.1%, DE 5.5 MJ/kg, protein 4.7%
TopSpec TopChop Lite - sugar not given, starch 1.0%, DE 7.5 MJ/kg
Rowen Barbary Soft N Soak ReadyFibre Mash- sugar <2.5%, starch 5.0%, DE 7.5 MJ/kg
Agrobs Pre Alpin Wiesencobs- sugar 7.2%, starch 1.0%, DE 7.87 MJ/kg
Allen & Page Fast Fibre- sugar 2.5%, starch 5.0 %, DE 8.0 MJ/kg
Agrobs Pre Alpin Aspero- sugar 6.3%, starch <0.01%, DE 8.38 MJ/kg
Dengie HiFi Molasses Free - sugar2.5%, starch 1.5%, DE 8.5 MJ/kg
Spillers Happy Hoof Molasses Free - sugar 1.25%, starch 1.5%, DE 8.8 MJ/kg
​TopSpec FibrePlus Cubes - sugar 2.0% or less, starch 9.0%, DE 9 MJ/kg (NB total sugar and starch may exceed the recommended 10%)
Dengie Alfa-Beet- sugar 5%, starch 2%, DE 10.5 MJ/kg
Dengie Alfa-A Molasses Free- sugar 4.5%, starch 2.0%, DE 11.5 MJ/kg
Speedi-Beet - sugar 5%, starch 0%, DE 12 MJ/kg

Straw may be suitable to form up to 30% of the diet for horses that require a very low energy diet. Harris et al. 2017 suggested that straw should be introduced into the diet very slowly to reduce the risk of impaction (although this risk should be reduced with a chopped straw), and that feeding large amounts of straw may increase the risk of gastric ulcers (EGUS) (although this risk may be reduced by adding calcium to the straw, as TopSpec have done with the TopChop Zero). Note that straw is very low in protein and minerals and vitamins, and a good balancer must be fed, and ideally the whole diet assessed to ensure minimum requirements for essential nutrients are being met, when feeding straw.
​TopSpec TopChop Zero- sugar not given (but will be low in straw), starch 1%, DE 4.0 MJ/kg
Honeychop Chopped Oat Straw - sugar 1.6%, starch 0.1%, DE 5 MJ/kg, protein 3.5%

Further information:

More information relating to diet on theTLS forum.

Articles:
Diet for weight loss
Body Condition Scoring
Who said "stop the carrots"?
Management strategies for EMS/ID

Research relating to diet

McGowan CM,Dugdale AH,Pinchbeck GL,Argo CM
Dietary restriction in combination with a nutraceutical supplement for the management of equine metabolic syndrome in horses
Vet J.2013 May;196(2):153-9 Epub 2012 Nov 8

Geor RJ
Dietary Management of Endocrine Disorders in the Older Horse
AAEP proceedings Vol 59 2013

Forages and Grazing in Horse Nutrition edited by Markku Saastamoinen EAAP 132 2012