Nutrition Focus: Laminitis Nutrition

Lorna Edgar – specialist equine nutritionist

Laminitis Nutrition

Looking at feeding management

After reading the October article on a method of treatment for laminitis, I was inspired to continue the subject and talk about feeding management for the laminitic; an area I don’t think I have covered before, but something I have come across in polo ponies.

Generally, we would not associate polo ponies with laminitis – it is a disease found in ‘fat natives’ after all – how wrong we are! With the high cereal/starch rations that polo ponies receive, rapid changes in diet, possible steroid injections and exercising or playing on hard ground they could still be at risk, but how do we manage and avoid it?

What is Laminitis?

Laminitis is an acute vascular disease of the hoof causing disruption to the blood supply to the laminae within the hoof, resulting in decreased oxygen delivery to the laminae and reduced removal of metabolic waste. Laminae are the ‘scaffold’ that hold the pedal bone to the hoof wall and work to transfer the load onto the hoof walls so that the sole does not bear weight. This process is hard work for the laminae so they require a large blood supply to bring oxygen and nutrients and to remove waste.

Decreased blood supply to the laminae results in their death, which can occur within hours and causes considerable pain. Laminae death decreases the strength of the attachment of the pedal bone to the wall of the hoof which can result in movement of the bone because of the weight on it and the pull of the deep digital flexor tendon. Limited laminae death will cause rotation, but extensive death causes the bone to sink.

The Cause

Laminitis manifests itself in one or more of the horse’s hooves but nearly always arises as the result of a metabolic upset. Severe illness, mainly from gut disorders, like colic, colitis or salmonella poisoning, result in the release of endotoxins (harmful substances), from the cell walls of dead gut bacteria, which get into the bloodstream and have potent effects on circulation. Retention of the placenta after foaling or the long-term use of drugs, like corticosteroids, can lead to similar results.

Excessive trauma to the hoof can however also lead to an onset of laminitis, as a result of over working on hard surfaces, poor hoof balance or severe lameness which overloads an unaffected hoof or hooves. By far the most common causes of laminitis seems to be nutrition related and include fructan overload from pasture, which causes the release of amines that disrupt the circulation in the hoof, or starch overload from cereals which reaches the hind gut, upsetting the bacterial population and resulting in the release of endotoxins.

Nutritional Causes Fructan Overload – Too Much Grass

The component in grass thought to be responsible for laminitis is fructan which is a water-soluble carbohydrate; the fibre element of grass is insoluble carbohydrate and it is this which is fermented slowly in the hind gut to produce energy. The horse is unable to digest fructan in the stomach and small intestine so it passes into the hind gut which can cope with small amounts of it also being fermented by bacteria. Fermentation results in the production of lactic acid but, if levels of fructan are excessive, the gut becomes more acidic resulting in the death of some of the beneficial gut bacteria. As these bacteria die, they produce the endotoxins, as previously mentioned and are able to pass into the bloodstream more easily, as a result of damage to the gut wall caused by the excessively acidic conditions. Grass needs light to make sugars, which it uses as an energy source to grow, and needs a temperature of 5°C or above to grow. If it’s not warm enough to grow but bright enough to make sugars, the grass stores the extra sugar that it makes as fructan. Cold bright conditions therefore see an increase in the fructan content of the grass which is why laminitis can occur in December and is now not just considered a spring problem. The reason laminitis occurs commonly in the spring and autumn is the volume of the grass available as the warm damp conditions mean there is simply plenty of grass for the horse to eat. Levels of fructans tend to rise during the day, peaking in the afternoon to early evening, but decline in the early hours of the morning.

Photograph by Polo Times Autumnal & spring grass has a higher fructan content

Starch Overload – Too Much Cereal

Just as grass stores sugar as fructans so the grains of cereal plants store it as another soluble carbohydrate, starch. This concentrated source of energy is ideally absorbed in the small intestine but if too much is consumed at one time, it passes on to the hind gut where it can disrupt the bacterial population in a similar way to excess fructan. Undesirable bacteria start to digest the excess starch producing stronger acids than would normally exist in the hind gut. The more acidic environment kills off the beneficial, fibre-digesting bacteria resulting in the release of endotoxins, that enter the circulation through the acid damaged gut wall, and these trigger other chemicals in the

Photography by Lorna Edgar

Products including less starch, such as Ease & Excel Cubes or Mix are beneficial

body, including hormones, that disrupt blood flow to the hoof.

Other Causes

Overweight individuals are more susceptible, due possibly to the increased load placed on hooves (trauma) but also, through research, we now know that obesity can decrease the body’s ability to utilise glucose (sugar) in the bloodstream, known as Equine Metabolic Syndrome (EMS) which occurs when the horse’s cells don’t respond appropriately to signals from insulin (a hormone that instructs cell’s to take and store glucose circulating in the bloodstream), leading to high blood glucose and insulin levels. Diseases such as Cushing’s (now known as Pituitary Pars Intermedia Dysfunction or PPID), which affects the pituitary gland of, generally, older horses, also causes a reduction in the uptake of glucose by the laminae making sufferers more prone to laminitic attacks.

In Case of an Attack

If you suspect your horse has even a hint of laminitis you should call your vet immediately; all the serious changes associated with the disease occur within 72 hours. Although the condition results in a disruption (reduction) of the blood supply to the feet, it is thought to be followed by a rush of blood returning (reperfusion) which is why the hooves feel warm to the touch and we may feel a pounding digital pulse.

Any potential cause should be removed from the diet eg. grass and cereals/

compound feed, and only clean forage with a low nutritional value provided in the early stages. Your vet will recommend how

Outshine increases calorie intake without introducing starch

best to proceed but a source of vitamins and minerals, like a balancer, should be reintroduced as soon as possible to assist recovery – I would strongly recommend calling a feed company Helpline for both short and long term advice.

Management and Prevention

In many instances this is simply a case of applying the “Rules of Feeding” to the letter to avoid overloading the horse’s system with either starch or fructan. The finger is often turned point blank on cereals and compound feeds but they are not a cause per se, it is more their misuse which is to blame. “Feeding little and often” means ensuring that where compounds are fed, meals are kept small; as a guide, horses at approx. 15.2hh should have no more than 2kg (about 1½ “Stubbs scoops of mix or 1 of cubes) per meal. Most modern manufacturers also cook the cereal content of their feeds to increase the digestibility of the starch content and maximise the chances of it being digested where it should be, in the small intestine.

A Balanced Diet

Feeding a token gesture of hard feed is going to leave them short of essential nutrients, proteins, vitamins and minerals. Feeding a balancer, which is formulated for good doers, provides all nutrients a horse needs for health and well-being but without the calories. Quality protein is essential for muscle and tissue development and repair and it, along with vitamins and minerals, is not only vital for the healthy horse but also for helping any sick or injured horse, including the laminitic, recover successfully. Balancers should also contain good levels of nutrients, like biotin, zinc and methionine, which are all important for healthy hoof growth so is useful for the longer term maintenance of good, strong hooves as well as to help support recovery from a bout of laminitis.

Anti-Oxidant Support

Increased workload, injury or illness, like laminitis, results in an increased requirement by the horse’s body for antioxidants to help eliminate harmful free radicals. A balancer will often supply these anti-oxidants, as will specially developed supplements marketed to the laminitis prone.

Photography by Lorna Edgar

Meals should be kept small, no more than 2kg/ 1½ Stubbs scoop

None should be seen as a cure, however and strict weight control and meticulous general management remain the best way to avoid an attack.

Fructan Control

Not only should starch intake and weight control be part of your preventative regime, but steps will also be necessary to limit the susceptible horse’s exposure to grass and fructans. Strip grazing will help to limit the horse’s total grass intake, as will periods of turnout with a grazing muzzle. It may be that simply only allowing very limited time at grass, whilst turning out when the fructan content of the grass is low will also help avoid an overload. Since fructan levels are more likely to be high at certain times of the day, it is recommended that horses are turned out either very late at night or very early in the morning and are brought in by mid morning. Restricting access to grazing should not compromise the horse’s fibre intake which must be maintained to ensure healthy gut function.

Promoting “Safe” Weight Gain

When we have the dilemma of a horse or pony who is susceptible to laminitis but needs condition we need to avoid starch based feeds and focusing on digestible fibres and oils. Looking for a product containing less than 10% starch is beneficial, such as Ease & Excel Cubes or Mix. Adding additional oil supplements such as Outshine will also increase the calorie intake without introducing starch, I wouldn’t however use straight oil without the addition of anti-oxidants; and focusing on digestible fibres such as Speedibeet, will also increase calories but safely.

Bacterial Support

Since most attacks of laminitis involve a disruption of the microbial population in the horse’s gut, it can be beneficial to feed a digestive enhancer to help restore the balance. Probiotics contain live bacteria and can be useful to enhance the beneficial species in the gut, whilst prebiotics encourage the proliferation of existing useful bacteria. Digestive enhancers may be of particular

KEY POINTS for DIET

• Remove starch • Maintain a balanced diet – preferably using a balancer • Be mindful of turning out on grass – how much and what time of day? • DO NOT STARVE! • Calories from low starch feeds, digestible fibres and oils • Pre and probiotics • Think about your hay and haylage – analysing for Water Soluble

Carbohydrates? • Make changes to the diet GRADUAL (10-14 days!) • Always contact nutritionist or feed helpline for further advice

benefit to the underweight laminitic since they help to promote gut efficiency to help ensure they make the most of every mouthful.

Contact Lorna Edgar of Baileys Horse Feeds on lorna@baileyshorsefeeds.co.uk

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