Equine metabolic syndrome (EMS) can occur in horses and ponies of all ages, breeds and types. It isnt a disease itself, but the name given to a collection of risk factors that increases a horse or ponys likelihood of developing laminitis, which poses a serious threat to horse health.We now know that over 90% of cases of laminitis occur secondary to underlying hormonal (endocrine) disease, namely EMS, Cushings disease, or both. Risk factors include insulin dysregulation in the form of high blood insulin levels or abnormal blood insulin responses, or both, plus obesity, or abnormal fat deposition.Signs of equine metabolic syndromeMost horses with equine metabolic syndrome are obese andhave regions of abnormal fat deposition.Such fat deposits are generally on thecrest of the neck, over the shoulders, overthe back musculature and in the rumparea.It is important to remember thatsome lean horses may also have EMS.These equines tend to have regions of abnormalfat deposition despite their ribs beingvisible or easily palpable.It is also worth remembering that not all overweight horses have equine metabolic syndrome, and this highlights the importance of confirming abnormal blood insulin levels by performing the relevant blood tests.Equine metabolic syndrome: risk factorsEMS was alluded to as early as the 1980s in veterinary literature, but only in recent years has there been an increase in knowledge and awareness of the issue.An abnormal blood insulin level is integral to the development of laminitis. Some horses with EMS will have persistently high blood insulin levels, whereas in others it may only be evident following a sugar challenge, such as a period of time at grass.Experts currently dont know exactly how abnormal blood insulin levels cause laminitis, but we do know that high blood insulin is associated with episodes of laminitis. Research is ongoing to determine the exact reason why.Other risk factors for the development of abnormal blood insulin levels include inactivity and ageing.Which horses are most at risk?Although any equine can have EMS, we know that there appears to be a higher incidence of it in British native ponies, Shetlands, minis and donkeys.A scientific study* published in the Equine Veterinary Journal identified the high prevalence of equine metabolic syndrome in UK native ponies and cobs along with a set of risk factors.The research, which was undertaken in 2020, included 354 horses at 64 properties in the northwest of England and north Wales, including studs, livery yards and riding schools.Diagnosing equine metabolic syndromeIn an ideal world, a proactiveapproach would be undertaken toidentify horses with EMS, managethe condition and, in turn, preventthe development of laminitis.Sadly,a diagnosis of EMS is frequentlymade when a horse or pony hasalready come down with laminitis.Therefore, if your equine is agood-doer, struggles to lose weight,or has areas of abnormal fatdeposition, then you should discuss equine metabolic syndromewith your vet andbe pro-active rather than reactive.EMS is often suspected based ona horses history, appearance andclinical examination findings.However, blood work is requiredto confirm abnormal blood insulinlevels.A number of tests and testingprotocols are available, and your vetwill be able to discuss the mostappropriate one for your horse.How to manage equine metabolic syndrome1 DietThe affected horses diet should be closelyexamined and the necessary tweaksmade. Grazing should cease until normalblood insulin results have been obtainedand the affected patient has lost weight.Hay should be fed at a rate of 1.5% of body weight in kilograms per day, and should be weighed dry prior to soaking for 8-12 hours in clean, fresh water in a shaded area. Your horses daily requirement should then be fed at regular intervals throughout the day.Try being inventive in making the hayration last for as long as possible. Thereare many ways of achieving this, fromdouble netting or using trickle nets, toplacing some of the daily ration in a treatball and feeding forage cafeteria style in order to mimic the natural roaming horses do in the wild.If the horses previous daily hay intake vastly exceeded the new calculated amount, then reduce gradually to this lower recommended quantity.If feeding soaked hay, in order to meetthe horses vitamin and mineralrequirements, a low-calorie balancershould also be fed, or, alternatively, avitamin and mineral powder. Othersuitable feeds include light, unmolassedchaff or unmolassed sugar beet pulp.2 ExerciseExercise has been proven to improvecellular insulin sensitivity. However, ifyour horse or pony is actively laminitic,exercise cant commence until they havebeen given the all-clear by your vet.Yourhorse should then begin an exerciseprogramme that is increased onlygradually in intensity in line with their fitness level.In horses diagnosed with EMS butwho dont actively or havent recentlyhad laminitis, then the aim should bethat they do at least 20 minutes ofcontinual trot or canter work at least fivetimes per week.Once visible weight loss has occurred,bloods can be repeated to ascertain thehorses response to the managementchanges.3 Medication for EMSA number of drug therapies are available for managing equine metabolic syndrome. Metformin, levothyroxine andertugliflozin are all used, but in the UKtheir use is currently off-licence.Drugtherapy doesnt replace diet and exercise,but it can help in severe and non-respondingcases, and it can beparticularly useful when laminitis occursbut exercise isnt permitted or possible.He lost a whopping 99kgWhen one of my clients nine-year-old Welsh gelding developed laminitis in December 2021, blood work confirmed equine metabolic syndrome.Kyes restingblood insulin level was 63.9mIU/L(normal being less than 32 mIU/L). Overthe years, Kyes weight had crept up and,at the point of diagnosis, he weighed602kg. Kyes owner knew thatdrastic action was required.Kye required six weeks box rest to allowthe laminar inflammation to settle. Duringthis time, he was taken off haylage andplaced on a diet of 9kg of hay per dayweighed dry and soaked for 8-12 hoursbefore feeding, divided into four small-holednets. A balancer was also provided.His owner felt that she was starving Kye, but her determination paid off and six weeks after the diagnosis, a hand-walking exercise programme could begin.Ten weeks later, a weigh-in showed that Kye had lost 53kg. At this point, swimming rehabilitation at a local centre was introduced.Using a combination of diet, controlled walking exercise and swimming, Kye lost a whopping 99kg. He was now ready for a further increase in work, including ridden work.Quality of lifeGiven Kyes weight loss and to assist with ongoing loss, his daily forage requirement was reduced to 7.5kg per day of dry hay soaked.At this point, Kye was being hand grazed, but he began to be turned out in April. Eventually, 45 minutes of loose grazing was permitted with a muzzle in place, but unfortunately Kye suffered a mild laminitic flare-up.Luckily, this settled following a short period of box rest and a course of oral anti-inflammatory drug therapy.As a result, Kyewas soon able to restart a hand walkingexercise programme. Equine metabolic syndrome bloods wererepeated, revealing a normal blood insulinresult Kyes level was now 16.9 mIU/L.As quality of life is hugely important, Kye restarted hand grazing. This increased to 25 minutes of grazing per dayand he was turned out in thefield with his pony pal Neville for the first timein several months.Soon after that, Kyes owner began riding him again.Prevention is better than cureManaging a horse with equine metabolic syndrome requires time, patience and dedication from the owner. Diet and exercise form the cornerstones of management and it is possible to restore a horse or pony to good health.However, prevention is better than cure and lowering the risk by keeping their weight at a healthy level will go a long way to keeping your horse healthy.Research links*Equine metabolic syndrome in UK native ponies and cobs is highly prevalent with modifiable risk factorsRelated contentEverything you need to know about laminitisHay vs haylage: which is best?Soaking hay: how to do it correctlyWhat does fat really do to your horses body?Why metabolism is important for horse health and four ways to support itAll about cafeteria-style feeding and its huge health benefits for horses *VIDEO*The post Equine metabolic syndrome explained: why every horse is at risk appeared first on Your Horse.