The only supplement with the goal of getting your horse back out on pasture.

Heiro gives you and your veterinarian black and white test numbers to show it works.

HEIRO™

Please see the FAQ Section for the Ingredients in HEIRO™.

 

 

Table #1 - Why use HEIRO™?

	USDA Certified Organic Herbs	University Lab Tested For Content	Commercial Lab Tested For Content	Tested Safe for Sugar & Starch	* * * Before & After Lab Tests Showing Heiro Works.	Super-concentrated Vitamin E, over 2,600 IU	Goal: Pasture Turnout
HEIRO™	YES	YES	YES	YES	YES	YES	YES
Other	No	No	No	No	No	No	No

Table #2 - What to expect - before and after sample results from usage of HEIRO™?

Horse	Breed	Date Tested Insulin Results prior to HEIRO™	Dated Tested Insulin Results while on HEIRO™	Status
“A”	Morgan	5/22/07 334.8	7/14/07 33.8 - Normal	On pasture/ Moves well
“B”	Connamara	2/6/07 173.9	3/7/07 47.1 - Normal	On pasture/ Moves well
“C”	Welsh Pony	9/08 162	12/08 20.54	On pasture/ Moves well
“D”	Quarter Horse	10/31/07 171.7	2/17/08 11.4 - Normal	On pasture/ Moves well
“E”	Tennessee Walking Horse	8/24/06 126.9	10/26/06 28.5 - Normal	On pasture/ Moves well

 

 

*Note the Dramatic Drops*
*Insulin Resistance horses have normal Glucose/high Insulin
*Normal post feeding levels are under 60 u/U/ml for Insulin
***If over 60 u/U/ml, your horse is Insulin Resistant.***

Testing Labs used in Study:
Antech Diagnostic Lab - largest commercial veterinary testing lab in the USA
Cornell University Veterinary School Diagnostic Testing Lab
Michigan State University Veterinary School Diagnostic Lab

    

 

1. What is Insulin?
2. Insulin Resistance Defined.
3. Exercise: Why it is important
4. Chromium, Magnesium, Pergolide, and Thyroid powder
5. Metformin: Why is it not helping?
6. Diet: Best Hay, Grain, and Amounts
7. Pasture Turnout and the Best Muzzle.
8. Good and Bad Snacks, Horse Treats
9. Avoiding Glucosamine, Good joint products
10. Feeding Flax
11. Lyme Disease
12. How to test for Insulin Resistance correctly
13. Glucose-Insulin Ratio (why not the best test)
14. Diagnostic results for Insulin Resistance
15. Farrier: Why important for success/Trim Schedule/Best Boots/Best Glue ons
16. Vaccines: Best Management
17. Scout Radiographs
18. Pasture Management for Insulin Resistant Horses
19. Winter Foot Pain: How to stop it, Why is it happening?
20. Bibliography

 

 

What Heiro™ Does That Other Products Do Not
27 Ways!

		Heiro™	Others	Winner
1.	Only product designed to get horses back on Pasture	Yes	No	Heiro™
2.	Only product designed to help with winter foot pain	Yes	No	Heiro™
3.	Free consults for owners with an Equine Veterinarian	Yes	No	Heiro™
4.	Free consults with the owner’s Farrier and doctor with an Equine Veterinarian	Yes	No	Heiro™
5.	Free web site on best diet/snacks and test protocols	Yes	No	Heiro™
6.	Economical price, money-back guarantee	Yes	No	Heiro™
7.	Helps Cushing horses with Insulin problems	Yes	No	Heiro™
8.	Before and after tests showing it works	Yes	No	Heiro™
9.	Highest concentration of Vitamin E.  Natural, Water Soluble	Yes	No	Heiro™
10.	Natural – No fillers, No artificial color/preservatives	Yes	No	Heiro™
11.	Highest concentration of Magnesium	Yes	No	Heiro™
12.	Only product using pharmaceutical-grade Magnesium	Yes	No	Heiro™
13.	NRC top-rated form of Magnesium	Yes	No	Heiro™
14.	Freshness dated for top performance	Yes	No	Heiro™
15.	Smells Great	Yes	No	Heiro™
16.	Tastes Great	Yes	No	Heiro™
17.	Only One Tablespoon Daily	Yes	No	Heiro™
18.	Safe:  USDA Certified Organic Herbs	Yes	No	Heiro™
19.	Safe: Certified Melamine Free	Yes	No	Heiro™
20.	Safe: Certified Lead Free	Yes	No	Heiro™
21.	Safe: Certified Drug Free	Yes	No	Heiro™
22.	Safe: Certified Pesticide Free	Yes	No	Heiro™
23.	Safe: Certified Low Sugar	Yes	No	Heiro™
24.	Safe: Certified Low Starch	Yes	No	Heiro™
25.	Safe: Certified Low Fructan	Yes	No	Heiro™
26.	Safe: Certified Low Iron	Yes	No	Heiro™
27.	60 Day Money Back Guarantee	Yes	No	Heiro™

 

I.  What is Insulin?

A.     Insulin is a hormone produced by an organ in the abdomen called the Pancreas.  Using a Quarter Horse for reference, the Pancreas is about two feet behind the girth of the saddle on the right side and weighs approximately ¾ of a pound.

  

Striker, of Peirson, Florida, licks his lips for Heiro™.

About 98% of the Pancreas produces enzymes to break down food in the gut and only 2% make hormones such as Insulin.  Hormones are chemicals produced by one type of tissue that are transported to target tissues that have special receptors for the hormone; once the hormone and the receptor connect, the hormone will facilitate reactions inside the target cell.

B.      Insulin has many jobs and many targets.  Insulin has direct action on all cells in the body (except the brain), and helps in carbohydrate, protein, and fat breakdown products entering the cells.

 Insulin’s main job involves carbohydrate metabolism.  Insulin release from the Pancreas is triggered by rising levels of carbohydrate in the bloodstream.  The carbohydrate that causes this Insulin outflow is called Glucose.  As Glucose levels rise, Insulin levels will rise and when Glucose levels go down, less Insulin is released from the Pancreas and hence Insulin levels go down.

 There are several ways for Glucose levels to go up, but by far, the biggest rise comes after your horse eats.  In hay and grass, carbohydrates are the main type of nutrient, with protein second, and fat the third type.  In magazines, carbohydrates are often referred to as “sugars” or “starches”. 

Starches are actually long chains of thousands of Glucose molecules linked together.  As your horse chews, he is starting the process of breaking down starch to release the simple sugar unit of Glucose.  Saliva enzymes, stomach acid, and small intestine enzymes further breakdown starch into individual Glucose molecules.  Once these Glucose units get into the small intestine, they are absorbed out of the digestive tract and into the bloodstream.  After a meal, large quantities of Glucose pour into the bloodstream.  Blood Glucose levels are now rising.  In literature, blood Glucose is often referred to as the “blood sugar”.  This high level of Glucose circulates to the Pancreas and will trigger the Pancreas to release Insulin into the bloodstream.  Now we understand Insulin’s source and what causes it to go up and down, which leads us to what it does.

C.  Equine Insulin Resistance in horses is the correct term to use when they get pathologically high levels of Insulin.  There are many other terms that have been used in the past that are inaccurate or confusing such as:

• Metabolic Syndrome – this requires high resting Glucose levels which most horses do not get and requires central obesity which horses do not get.
• Pseudo Cushings and Peripheral Cushings – horses get Insulin Resistance by itself with no Cushings at all in many cases, so trying to attach Cushings to this syndrome is not accurate.  Many Cushings horses can develop Insulin Resistance but not all of them do.
• Diabetes – most horses do not have elevated blood Glucose levels in Insulin Resistance.
• Hyperinsulinemia – this is inaccurate because horses and people elevate Insulin levels many times a day after a meal which is normal.  The correct term, developed by Dr. Reilly, is Equine Pathological Hyperinsulinemia with Insulin Resistance being one of the causes.

D.  Insulin is crucial in promoting Glucose in the bloodstream to move into cells.  Glucose is the major fuel used by cells for energy.  Again, Insulin has many target tissues but the most important are muscle, fatty tissue, and the liver.  How Insulin gets Glucose into cells is much like a lock and key.  On the muscle cell, for example, are thousands of receptors waiting for Insulin to arrive.  The receptor is the lock and Insulin is the key.  When the key fits the lock, it allows Glucose to enter the cell.  As Glucose goes from the bloodstream into the cell, the blood Glucose level will drop and hence the output of Insulin from the Pancreas will drop.

Glucose transport into muscle and fatty tissue goes up 5-20 times in the presence of Insulin.  This fact highlights how important Insulin’s action is in obtaining energy for the cell.

E.   Regarding fatty tissue which is another target tissue for Insulin:

1.   Insulin promotes Glucose into fat cells which help in fat synthesis.
2.   Simultaneously, Insulin promotes enzymes that help increase fat synthesis.
3.   At the same time, Insulin inhibits another type of enzyme that normally breaks down fat.

This is a “triple-barrel shotgun effect” — all of which promote fat. This action by Insulin is normal in your horse but you can already hear warning bells if things go wrong.  Too much Insulin means too much fat and that puts weight on your horse.

#1 Common Problem of Owners with Insulin Resistant Horses:"It breaks my heart to pen my horse in a small dirt lot and watch him look over the fence at his buddies grazing and playing in the field next door."

II.  Insulin Resistance

A.     Defined

Inability to respond to and use Insulin the body produces because Insulin is not functioning properly; higher Insulin levels are needed to achieve the same effect.

 

There is an abnormally high amount of Insulin circulating for long periods of time that leads to diseases such as Laminitis.  Normally, we know the usual level of Insulin throughout the day and know that after a grain meal, the Insulin level will go up 3-4 times the regular level due to Insulin responding to Glucose pouring into the bloodstream.  The short-term high level of Insulin is normal Hyperinsulinemia and lasts only a few hours.

 In Insulin Resistance, the base level of Insulin is about 3 times higher, so there is a constant elevation during the day.  When an Insulin Resistance horse has a grain meal, there is a pathological Hyperinsulinemia that sees the level of Insulin go up 30, 40, 50, and over 100 times usual levels, and can remain elevated much longer than normal.

This stark fact highlights the reason behind the need to control insulin!

According to the American Diabetes Association, people with insulin resistance and diabetes have a 7-12 year decreased life span. In a horse, that translates to losing 2.5 to 4.5 years of life.

Basically, the key and lock system is broken.  There are several ways this occurs and they can occur separately, or combine to do multiple damage.

Ways to cause Pathological Hyperinsulinemia:

1. The receptor (the lock) on the target cell is directly damaged.  Insulin comes along (the key) and can not make a connection.  With no connection, Glucose can not enter the cell and is essentially shut out.  Blood Glucose levels do not drop and are now artificially elevated, so the Pancreas pours out more and more Insulin to correct the problem.  There are lots of keys with not enough working locks.  Result: higher than normal levels of Insulin.
2. The number of receptors on the cell is lower than normal.  Again, the same result as above: higher than normal levels of Insulin.  The receptors work, but there is just not enough to get Glucose quickly into the cells.
3. Insulin’s normal action is directly inhibited.  The keys do not work right even in target cells that are normal.  Again, this means Glucose is not getting into the cells and the Pancreas keeps pouring out more and more Insulin in an attempt to overcome the problem.

The final result that the target cells are resisting to work normally with Insulin (hence the name Insulin Resistance) which causes the Pancreas to try to overcome the resistance by pouring out more and more Insulin.  In Insulin resistance, this higher and higher level of pathological Hyperinsulinemia is able to still push Glucose into the cells and maintain normal blood Glucose (blood sugar) levels.

Rarely in horses, the higher Insulin levels can not overcome all the problems and the blood Glucose levels can not be maintained and start to stay elevated— this is called Early Stage Type II Diabetes.  In these rare cases, the horse has sky-high Insulin and sky-high blood Glucose.  To get to Type II Diabetes, you first have to be very Insulin resistant to the point you can not maintain Glucose levels.

Often, Insulin Resistance is mistakenly called Diabetes or Type II Diabetes in the horse.  The reason for this is because in people, Type II Diabetes is the most expensive disease process in humans, the fastest-growing disease process in humans, and now the #1 cause of blindness in humans.  Your horse probably has Insulin Resistance because they can still maintain normal blood Glucose levels.

C.   What conditions are breaking the lock and key system in my horse?

1.   Toxins from fat cells.

1. If your horse is overweight at an early age, they can have 3 times the number of fat cells as a regular horse.  Some fat cells release toxins that interfere with Insulin’s action at the target cell.
2. If your horse is overweight:
   Fat, itself, is increased with high levels of Insulin and it turns around to interfere with Insulin which leads to more Insulin.  This leads to a vicious merry-go-round.
3. Most Insulin Resistance horses are over weight.  A recent University of Virginia/Maryland report estimates 50% of the horse population is over weight  and 20% are obese (Obese is over 20% beyond ideal weight).  In addition, if a horse is obese, about 1/3rd of them will have Insulin Resistance.

2.   Insulin

Insulin at very high levels starts to interfere with other Insulin’s ability to get to receptors.  The keys are breaking each other.  This is “negative cooperatively”.
*A recent study from Australia showed that injecting high Insulin into a normal horse caused Laminitis within 2 days.  High Insulin and Laminitis are cause and effect.

3.   Cushings Disease

Can lead to Insulin Resistance in several different ways.  The horse can have Cushings and Insulin Resistance at the same time.  Why?

1. High ACTH levels in Cushings can directly interfere with Insulin’s action.  ACTH is damaging the keys.
2. High ACTH levels lead to Cortisol abnormalities.  Cortisol is responsible for increasing blood Glucose levels by causing stored sugars in muscle/liver to be released.  The higher levels of Glucose trigger more and more Insulin.
3. Cortisol, like ACTH, can directly interfere with Insulin’s action.  More keys are damaged.
   This is why it is smart to test the ACTH level and the Insulin level of a Cushings horse on a regular basis.  Your Cushings horse could have normal Insulin and later become an Insulin Resistance horse on top of Cushings in a large number of cases.  You are treating it with Pergolide but not treating the Insulin Resistance and wonder why they have Laminitis still— now you know why!

4.  Stress

Mental/Physical— surgery, infections, shipping...

1. Increased Epinephrine causes increased ACTH, increased Cortisol, leading to more Insulin Resistance.
2. Increased Cortisol will interfere with sleep, so more stress.
3. Increased Cortisol will depress immune system leading to more infections that lead to higher Insulin levels.
4. Increased Cortisol breaks down muscle which results in muscle weakness— often see in Cushings horses
   — skinny with fat pads.
5. Increased Cortisol decreases muscle synthesis.

High Insulin is like a small hammer banging your horse's foot. No shoe, no amount of Bute will help unless you first stop the hammer.

5.   New study via Dr. Reilly – “Insulin Resistance – New Triggers”.  More research results pending.

 

Genetic lock- diet/exercise is not controlling insulin. Owners have tried multiple management techniques but the horse is still foot sore, has repeat laminitis, can't be turned out on grass, and stays big on little food. Also the horse is a candidate for future problems and the owner would like to avoid a problem instead of waiting for the problem to occur. These are the horses the Heiro program can help.

 

A.   Magnesium

At times, you will see ads for products with lots of Magnesium to help with cresty necks/fat deposits.  Know that the new Insulin Resistance diet your horse along with the Heiro™ already has increased your levels of Magnesium to the right level. Do not waste money on supplementing more Magnesium.

1. Heiro has the highest concentration of magnesium of any equine supplement on the market. We are also lab tested safe.
2. Of the many types of magnesium, Heiro uses the natural form yielding the highest amount of the mineral. National Research Council 2007.
3. Heiro uses only the natural form of magnesium. Other products use forms that have been artificially produced in a lab. We use the form seen in human multivitamins like products from GNC, Twin Labs and Sunshine vitamins seen in your grocery store or pharmacy.
4. The Heiro Insulin Resistant program also aids in providing magnesium to the diet like no other plan can:
   1. High protein of the grain mixes we list help increase magnesium absorption from the intestine. Oregon State University Pauling Institute.
   2. Peanuts as a snack is one of the top 10 sources of magnesium, providing 48mg in just one ounce.
   3. Alfalfa increases magnesium digestibility in the diet to increase absorption. National Research Council 2007.
   4. Beet pulp has twice the level of magnesium needed for maintenance, which is an added bonus.
   5. *** Heiro is the only supplement with a goal to get your horse on pasture and maintain it there. Magnesium is part of chlorophyll, the green pigment of plants, so the fresh grass is a high magnesium source. Solid evidence why horses can still get laminitis on dirt paddocks. They need green leafy material.
5. Magnesium can help increase the blood flow, improve insulin levels and assist in gastric ulcer repair. With this in mind you want the tested safe, highest concentration of magnesium you can get, which is Heiro.
6. Heiro's concentration of magnesium means you only feed 1/2 an ounce once a day.
   This small amount is 2, 3 or 4 times less volume then other supplements, and does not require feeding twice a day.

As you can see, you are covered on Magnesium with the new Insulin Resistance diet and Heiro™ supplement.

Heiro™ is unique because it is the only product using the top-rated form of Magnesium and is using a pharmaceutical grade of Magnesium and NOT a feed grade. Your horse deserves the best.

 

B.   Chromium

At times, you will see ads in magazines to use this to lose weight. You already will have a horse losing fat on the Insulin Resistance diet, but here are the facts:

1. No study in veterinary or human medicine has cured Insulin Resistance with Chromium.
2. No study in veterinary or human medicine has shown low Chromium levels in Insulin Resistance horses/people.
3. John Hopkins University’s Diabetes Center sees no value in using it in Insulin Resistance/Diabetes.
4. Latest study on its use in horses by LSU’s Veterinary School showed, “No effects on Glucose or Insulin concentrations”. (L. Gentry, JEVS, 19 (4) 1999)
5. Harvard Medical Center Director of Diabetes, Dr. Nathan, does not list chromium as a helpful supplement in his latest book, Beating Diabetes (2005).
6. *** "No evidence has ever been found of a chromium deficiency in horses." National Research Council, Nutritional Requirements of Horses, 2007.
7. "In humans, routine use of chromium supplement is not warranted based on current data." Dr. Porter 1999, Arch. Family Med.
8. "Chromium did not alleviate elevations in plasma leptin or insulin or alter glucose dynamics and insulin sensitivity in horses." Dr. Cartmill 2005 Equine Sci Proc.
9. Chromium supplemented horses when exercised had higher heart rates and higher lactic acid levels that "suggested exercise capacity of chromium supplemented horses was compromised." Dr Ververt 2005 Journal of An Physio.
10. Regarding chromium Dr. Divers says, "Limited scientific support for this in horses" and "I do not routinely recommended". Dr Divers, Cornell University School of Vet. Med. J. of Equine Science. 2008

Chromium supplements are available at the grocery store and in many horse products but appear to have little/no benefit.

C.   Pergolide

Studies have shown it will not help in Insulin Resistance cases.  If your overweight horse is being given Pergolide and does not have Cushings Disease, you are getting the wrong medicine.  Pergolide is not cheap and has side effects.  It is excellent in treating Cushings Disease but has no place in the treatment of a horse with Insulin Resistance alone. Many horses have Cushings and Insulin Resistance together. These horses that are on Pergolide but continue to get laminitis need Heiro™ to help support the body and maintain insulin control. If you are on Pergolide and are lame or on a dirt lot, you need to add Heiro™ to get back on pasture and avoid lameness

.

Note: Pergolide in cookies is not the best option.  The cookies are made of oats and molasses which are Insulin Resistance triggers. Many Pergolide syrups have high sugar. Ask for methylcellulose or carboxymethylcellulose in the syrup instead of sugar based compounding syrup. Many Pergolide powders have pure sugar bases. Ask for 100% Pergolide with no sugar or instead, have them substitute alfalfa powder flavoring. Do not get Pergolide made with any oil such as almond or peanut oil. These oil-based products are a problem in two different ways. 1. They are high fat and can trigger Laminitic episodes. 2. They are very difficult in keeping a consistent amount of medication throughout the bottle. The medicine settles to the bottom, so you are under and over dosing without knowing it. Again, the University of Kentucky study clearly proved high fat causes Insulin surges in horses.  If your horse has both Cushings and Insulin Resistance, and you do not know yet about the Insulin Resistance, it is a problem.  Many Cushings horses will go on to Insulin Resistance and that is why you need to test yearly for Insulin Resistance if you have a Cushing Horse.

D.      Thyroid Powder

1. Studies show that if you remove the entire Thyroid Gland, this did not lead to Insulin Resistance.  Low thyroid levels are not the cause.
2. If thyroid levels are low or at the low end of normal range (.6, .8, 1.0) you need to supplement with thyroid powder and retest in 10-14 days. Thyroid powder does help with increasing sensitivity to Insulin. (N. Franks, AJVR 66 (6) 2005, U. of  TN) - brilliant study.

a. What should be the level? 2-3 uG/dl. The normal range on blood tests is between .5 and 4.0. We want a mid to high normal level between 2 and 3.
b. How much powder to feed? Start with 1 level scoop (is in Thyro-L container) once a day in the morning feed. Retest after 10-14 days. If still not there, go to 2 scoops once a day in the morning.
c. Do I stay on it? Yes. We want quality thyroid levels at all times. 1 container lasts 2 months so it is not expensive to stay on.

3.   Some advocate causing purposeful thyroid hormone overdoses in order to lose weight.  I do not agree with this, even if it is temporary.   HEIRO™ and the Insulin Resistance diet will do this for you in a healthy way without creating a hormone imbalance to try to cure a hormone imbalance.
4.   Just so you know what happens in overdosing thyroid hormone (Guyton's Medical Physiology):

a.   Increases appetite – how is this going to help?  It will lead to stress since you are controlling intake.
b.   Decreased bodyweight due to break down of protein in muscle— can lead to muscle weakness.
c.   Protein break down in bone is increased – can lead to bone weakness.
d.   Vitamin needs increased— can lead to vitamin deficiency.
e.   Increased body temperature — intolerant of heat can lead to heat exhaustion.
f.   Clients find the horse over excited and "edgy".

E.     Metformin (Glucophage) in Equine Insulin Resistance

   You should AVOID this drug in horses for several reasons:

1. Severe side effects seen in people on this drug that you need to be aware of according to the Mayo Clinic – 2008:
   1.  Lactic Acidosis (known as “Tie-up” in a horse).  “Severe muscle pain and cramping.”
   2. Gastrointestinal Upset (known as “Colic” in a horse) “Need to take with food to reduce stomach and intestinal side effects.”  “Vomit, stomach ache, passing gas, heart burn.”
   3. Thyroid Condition- Drug can interfere with Thyroid medicines.  Some horses need Thyroid supplement.
2. Can suddenly not work any more.  “At some point this medicine may stop working and your blood glucose will increase.” Mayo Clinic, 2008.
3. Emergency Kit recommended.  “Carry an Emergency ID Card and Glucagon Emergency Kit for emergencies” due to hypoglycemic reactions.  Mosby’s Drug Guide.  Not practical with horses.
4. $2,300.00 a year to give to horses.  One study in England dosed it in horses at 15 mg/kg – a 1,000 pound horse (454 kg) at $470.00 a bottle costs a lot to even try this drug(pricing: CVS Pharmacy 11/17/08).  The study also said some horses “May need to be on it for life.”  Not an economic reality. Need to dose twice a day every single day.
5. Requires constant/multiple blood testing to monitor.  More expense.
6. No FDA approval for use in horses – creates liability issues.
7. No study of long-term effects on horses.  Your horse is not a guinea pig.
8. This drug is used for Type 2 Diabetes in people.  Most horses don’t have this.  They have Insulin Resistance.
   
9. “Metformin is not an effective long-term mono therapy for increasing Insulin sensitivity in horses.”  M. Vick, University of Kentucky Dept. of Vet. Sci, Reprod. 2006.
10. On package insert inside box of Metformin."If lactic acidosis does occur, it can be fatal in up to half the people who develop it."
11. Can cause severe respiratory problems. "Respiratory alkalosis may be an early adverse event induced by Metformin prior to developement of lactic acidosis." Am J. of Therapeutics, 2004 .
12. Dr. Pratt, Professor at North Carolina State Universtiy, College of Vet. Med., stated, "Human drugs like Metformin have not proven to be effective in horses." Morris Animal Foundation.
    
13. Oregon State Veterinary Research Team in May, 2009 - In horses, only 4-7% of Metformin given orally is absorbed. Concluded that Metformin is "insufficient to achieve plasma concentration of drug comparable to the therapeutic range achieved in humans." AJVR, 2009. Horses even at megadoses do not absorb enough of the drug.
    

OUR GOAL

 

The key is to control carbohydrate metabolism by eating the right foods in the proper amounts. The HEIRO™ program will greatly assist your horse in this project by helping to manage Insulin.

Your horse ideally will get: some fresh grass, some hay, some grain, and some snacks.  Often the scenario is the horse gets too much of one item and it causes a Laminitis trigger.

We will go over several items:  Grass intake management, hay to feed, fats/oils, good and bad snacks, hay testing.

Goal:  Practical, straight forward, understandable items to stop Laminitis and help your horse live a good life.

In the past, (2006, 2005, ...) you would see the term NSC standing for non-structural carbohydrates. This term is still used by feed companies to categorize low carbohydrate feeds of about 10-15% NSC. When you test your hay or fresh grass you will not see this NSC listed any more due to recent changes in the way sugars are categorized. The new category for sugar content of hay/fresh grass is called ESC because it contains sugars and a partial amount of fructans.

The starch category is the same as always.

This new category can not be compared to your past analysis. Know that NSC is not ESC and that past sugar tests can not compare to ESC.

A.    Hay - Goal - slow, sustained release of nutrients all day long with no long periods of fasting.

1. Hay is essential in helping prevent Laminitis.  Your horse can not be on grass all day and can not get grass in the winter/bad weather.  Hay provides fiber to steady Glucose levels.  Hay provides eating activity for your horse (they eat 70-80% of the day).  Hay decreases stress which can steady stress hormones.  Hay stimulates the gut tone and motility. Steady hay eating avoids a problem. If the horse has fasted several hours and then is fed, can get Insulin surge beyond the normal which can be harmful. We want a slow, constant, low level of hay moving through.
2. Spread the hay — make horses walk to multiple small piles in the field to increase exercise.
3. Soaking hay— this can lower Carbohydrate levels and as a bonus has been shown to decrease allergens in “heave” horse reactions.  At times this is not practical in cold weather — you get a “hay sickle” in the bucket — the water freezes into ice.  This is a great time to test hay in fall when you are stocking up to feed it in the winter.  If it has low ESC/sugar/starch you will not need to soak it.  Also, test your horse’s Insulin level after a few days on the new hay.  This will let you know if all is Ok.  Most Laminitis is via fresh grass and not hay.  Pasture associated Laminitis accounts for 54% of equine Laminitis. (USDA Lameness and Laminitis National Health System 2000) Dr. Watt’s work on grass/hay sugar levels has been very helpful.
4.   What hay to feed and what levels do I look for if tested?
   1. Timothy Grass Hay – Good choice, easy to get.  If tested, want 8-12% protein, low end of normal range of ESC (Simple Sugars) that is 4.7-10.9%, and low end of normal range of starch that is 1.5-4%. Example: If 15% ESC and 6% starch, do not buy it - probable Laminitis trigger. If it is 5.7% ESC and 1.8% starch is Ok to buy and no need to soak
   2. Alfalfa Hay - Can mix with Timothy up to a 50:50 ratio. It has a slightly lower ESC, starch, and sugar than Timothy Hay. The Equi-Analytical web site has a print out showing its safety. If someone tells you Alfalfa is a problem in Insulin Resistant horses, they do not have the facts. ESC is 4.2-8.2% Starch is 0.8-3.2%. I usually will not go above a 50:50 ratio because higher amounts of Alfalfa seems to cause more gas and runny manure.
   3. Orchard Grass Hay - Very similar to Timothy Grass Hay. A good choice.
   4. Teff Grass - Tests we have run show it to be safe on sugar and starch, so, again, it is a good choice, When you test, you want similar values as Timothy. Can have mixes of Teff with Orchard or Timothy.
   5. Bermuda or "Coastal" Hay - These have double the starch of Orchard or Timothy, so you would need to soak these overnight and during the day prior to feed. 6% starch average, range 3.1-9.0. Since most Bermuda Hay is fed in the south, freezing "hay sickles" will not factor in. Timothy, Orchard, Timothy/Alfalfa, Orchard/Alfalfa are better choices.
   6. Avoid Totally: Wheat hay, Oat hay, Barley hay - all very bad. Huge starch.

      

5. Your horse, if not getting any fresh grass, will need 2% of body weight in hay daily.  In most Insulin Resistance horses, we want to reduce weight, so will feed less hay.  A normal 1,000 pound horse needs 20 pounds of hay.  To assist your horse in weight loss, instead of feeding the normal horse 2%, feed 1.8% or 18 pounds of hay.  To slow him down on eating, we covered the ways of putting in a field alone, blocking their view if in a stall.  A new way is to put the hay in a hay net.  The net will slow their ability to get big mouthfuls of hay.  At times, a horse may still go through his hay too fast even with a hay net and hence get stressed, get Insulin surges due to fasting.  Put the net into another net.  This is your plan B, because it will really slow the rate of eating down.  Perhaps do a double net in the night and a single during the day — your horse will talk to you.  To weigh hay, now is the time to get the bathroom scale to weigh a bale.
6. Avoid feeding Blue Seal's Hay Stretcher - it has molasses and a NSC of 22%. It comes in a large pellet.
7. Often, the horse grazes during the day and is in at night. They eat the hay given to them between the 6:00 PM feeding and 9:00 PM, the horse is out of food, and goes with no food for 10 hours until the 7:00 AM feeding. When they are refed, they get a huge Insulin surge that can be 700% higher than normal. Essentially, the horse is being given a high-dose shot of Insulin every morning. No wonder they put on lots of fat and get Laminitic. The fresh grass intake is monitored but its the "in the stall with hay that doesn't last" scenario that can be the real health danger. Ten pounds of hay that they eat throughout the night will cause less weight gain and protect the feet better than feeding five pounds of hay with almost half a day (or night) with no food.

B.     Fat/Oil Supplements

1. Do NOT use in Insulin Resistance horses. 
   A study by the University of Kentucky's Dept. of Veterinary Science in 2002 by Dr. Fitzgerald showed that an infusion of fat actually induced Insulin Resistance in horses in less than 2 hours time. This can lead to a Laminitis trigger. High fat diets can cause a crisis.
2.  High Insulin levels already are promoting fat which in turn release toxins to further cause more and more Insulin. This cycle is not helped by promoting more fat with a high fat diet.
3.  What to avoid:
• NO OILS - No corn oil, no rice bran oil, no wheat germ oil.
• NO RICE BRAN - two big reasons
  1. According to a USDA study by Dr. Marshal in his 1994 Rice Science Study (465 page report), it is approximately 16% fat. This is going to promote fat on your horse, add weight, and cause problems.
  2. Rice bran is loaded with starch. Dr. Marshal has it at 16% and Equi-Analytical Labs at almost a 20% average. This is 5 to 7 times more than timothy/orchard hay or beet pulp. Rice bran has an NSC level of about 25 which is extremely high.
  3. Rice bran's NSC is very close to that of Wheat bran (30). Both need to be strongly avoided in these horses.

4. High/increased fat is great in tying up horses, EPSSM, horses needing weight, but not in Insulin Resistance.
5. On the bag of ingredients of many low carbo, low fat feeds you may see rice bran. DO NOT panic. They put in an extremely small amount for flavor. These products have low NSC values (10%) and low fat values (3-5%). The main point is not to add more of rice bran or wheat bran to the diet.

C.     Grain

Yes, you will feed grain to an over weight Insulin Resistance horse. Why?

1. An all-hay diet will lead to problems due to vitamin/micro nutrient deficiency.  If you hear that the solution to Laminitis in an Insulin Resistance horse is feeding it just  hay and keeping it on a dirt lot, you are getting inadequate and incorrect information.
Again, our goal: some grass, some hay, some grain, some snacks.

     In the winter, grass options are lost, so grain is even more important at this time.
2. What type to feed my horse?

   1. You want a low NSC pellet feed which will provide vitamins/micro nutrients and a high amount of protein.  These special feeds are very concentrated so you will only feed a small amount to your horse each day.  Normal horses can get up to 1% of body weight in grain a day for maintenance — that is 10 pounds of grain in a 1,000 pound horse.  With a low NSC concentrated feed, that same horse gets only 1 pounds a day.  You will mix the HEIRO™ in with the morning feed.  With Insulin Resistance horses, we want to reduce weight, so we will feed grain only once a day in the morning — your horse’s natural circadian rhythm has Insulin highest in the morning and we want HEIRO™ working then to control Insulin all day.
   2. There are many low NSC/low carb pellet feeds on the market but they are not all good for an Insulin Resistant horse because they may also have high fat. We want a low carbohydrate (low NSC), high protein, and low fat diet. To compare, sweet feeds have a NSC of 40% due to the sugars/starch of lots of corn, oats, and molasses and some feeds have 12-30% fat.

   Good Choices:
   

Name of Feed	Company	NSC %	Protein %	Fat %	Approx. Cost of 50 lb. Bag
Enrich 32	Purina Mills	10	32	5	$28.00
Gro'n Win*	Buckeye Feed	10	32	5	$28.00
Triple Crown 30	Triple Crown	13	30	3	$28.00
M-30	McCauley Feeds	10	30	5	$28.00
Equi-Pro MVP	Poulin Feed	10.5	24	3	$28.00
Moormans Gro Strong Mintrate	Alliance Nutrition	12	33	2	$28.00
Empower Balance Grass Formula	Nutrena	10	30	5	$28.00
Winning Touch Sunshine Plus	Blue Seal	18	30	3	$28.00
ProAdvantage Grass Formula	Progressive	10	30	5.5	$28.00
Equine Choice 32	Kent Feeds	14	32	5	$28.00
Essential K	Tribute Feed	14	28	6	$28.00
AllPhase	Pennfield Feeds	15	26	3	$28.00
* Avoid Gro'n Win GC which contains Glucosamine

 

Canadians Purina (Enrich 32 is called Optimal), Triple Crown, Nutrena, and Blue Seal all sell in Canada.

 

1. Why These?
   

   Low Carb/ High Protein	Low Carb/ 12-14% Protein
   1 Pound once a day.	2-2.5 pounds twice a day for a total of 5 pounds.
   High protein means increased muscle. Muscle is the biggest user of insulin, and this helps lower blood glucose.	X
   High protein helps increase magnesium absorption which helps lower insulin.	X
   High protein diets lower glucose uptake in the intestine decreasing insulin surges.	X
   Cost: about $360 a year per 1000 lb. horse. Save over $700 per horse.	About $1080 a year per 1000 lb. horse.

   
   
   
2. Which low carbo feeds to avoid? Ones with extra fat such as Purina Ultium, Ker Re-Leve, and Blue Seal Carb-Guard. These are great options in tie up, PSSM, and Cushings horses with no Insulin Resistance.
   
   Summary: Not all "lite" feeds are best for Insulin Resistant horses. You will feed a very small amount of one of these four in the morning along with HEIRO™, beet pulp, and a handful of alfalfa pellets.
   
   
3. An example of one of these feeds - Purina's Enrich 32.

1,000 pound horse gets1 pound feed once a day in the morning
Large pony gets ¾ pound feed once a day in the morning
Small pony gets ½ pound feed once a day in the morning.

1 cup of “Enrich 32” weighs 0.38 pounds
¼ cup of “Enrich 32” weighs 0.1 pound

1,000 pound horse – Feed 3 cups in the morning
Large pony – Feed 2 cups in the morning
Small pony – Feed 1 ¼ cups in the morning

What cup to use:  a kitchen measuring cup from the grocery store.  Not a scoop, not a coffee can, not your Snoopy coffee cup.

Imagine low carbo feeds as breakfast cereal. The one with high protein has you eating one bowl each morning, while the 12-14% protein type has you eating 5 bowls. Both cereals are good, but the high protein type is the winner.

 

Many owners notice that low carbo, 12% protein feeds want you to feed four to five pounds of it a day and a majority of the owners will not do it. Instead, some will only feed a handful of it which is not good. The horse is not getting its micro nutrient requirements. To help your horse, feed the low carbo, high protein feed that gets all the nutrients needed in only a couple of baking cups. Easier to give, 1/5th the cost and better for your horse.

 

Do I need another supplement for horses on hay diets? No. The low carbo/high protein grain has you covered completely and it costs less than $0.40 a day. Also, products to "supplement" hay don't tell you the sugar, the starch, the iron level - - why gamble with your horse's health on unknown items.  Take the money you will save and go out to dinner.

 

D.   Ways to help us monitor the right food needed:

There are 2 methods to choose the right foods and to monitor what is in the food.  The best way is to use both systems to plan the diet.  The systems to monitor are called the “Glycemic Index” and the “Carbohydrate Level test”.

1. Glycemic Index of food
   This compares food’s effects after eating to that of a similar amount of pure Glucose.  Glucose has a rating of 100 and the closer to 100 (higher the Glycemic Index) the faster that food delivers its Glucose into the blood stream.  We want low Glycemic Index foods to avoid Glucose surges which trigger Insulin surges.  Example:  A carrot has a high Glycemic Index number of 71, while peanuts have a low Glycemic Index number of 14.  Conclusion: avoid carrots, feed roasted peanuts in the shell as a nutritious snack to your horse.
2. Carbohydrate Level Test
   When you get grass or hay tested to see if it is safe, there are two items to look at to see Carbohydrate levels.  They are sugar and starches. 

   The main nutrient of hay/grass is Carbohydrate.  As we went over earlier, sugar and broken down starch will enter the blood stream as Glucose.  We want to avoid high sugar/starch forage or, if we see it, monitor and manage the intake.
   

   Grass will change during the season and if you have a concern, test the grass and test the horse’s Insulin together.  If the grass is high in sugar but your turn out time with a muzzle shows a good Insulin level, then all is well.  Just because the grass is high in sugar, does not mean you lock the horse in the stall; you just manage the horse differently.

Grass pasture — normal levels of:
ESC (Simple Sugars)   5-15%
Starch                         .5-6%

Timothy grass hay - normal levels of:
ESC (Simple Sugars)    4.7-10.9%
Starch                          .9-3.7%

Side note on fiber:
Fiber is also a Carbohydrate but it requires the bacteria of the large intestine to break it down.  The sugar/starch Carbohydrates go into the bloodstream at the small intestine.  Fiber rolls past the small intestine and goes down the tract. 

There are two types of fiber:
1.   Soluble fiber – bacteria break it down, nutrients absorbed
2.   Insoluble fiber – cellulose seen in stems, seed hulls

Is fiber important? Yes.

1.   It creates a sensation of fullness because it is not digested at the small intestine level, so your horse eats less due to not being as hungry.
2.   Assists in slow, steady delivery of Glucose to the small intestine due to its bulk — slows release out of stomach of sugars.
3.   Soluble fiber can account for 50% of the energy needs of your horse.
4.   Hay and beet pulp have excellent amounts of fiber.  Hay has about 30% and beet pulp about 20%.  For comparison, corn has only 2% fiber which means it is mainly sugar/starch— that is why corn is avoided in Insulin Resistance horses.

The Heiro™ Program is like no other -- correct way to test, best diet and snacks, a testable supplement, and free veterinary consults. Other products are "here's a powder, good luck to you".

E.   Pasture Turnout in Equine Insulin Resistance

1. Your horse is meant to graze and play in a grass pasture. Too often, you will see statements that grass must be "severely curtailed or totally eliminated". This is NOT TRUE!
   By being on Heiro, along with proper diet and snacks, you horse can get back to where they belong. We've helped hundreds of horses get off dirt lots and get back to grass. Lab tests show that Insulin can be controlled if on the right program.
2. Dr. Divers, at Cornell's College of Veterinary Medicine, put it best in that grazing "may even have advantages over totally dry lot confinement by supplying essential nutrients and antioxidants that may not be available in commercial feeds and stored hay." J. of Equine Science, 2008.

3. Get Your Horse Out of Jail

   In human studies, diet and exercise were able to help diabetics control blood sugar, in 60% of the cases. This means 40% were still in trouble. The same goes for horses. Many Equine Insulin Resistant patients "have such thrifty genes that high body scores are maintained in spite of consistent exercise and nutritional programs". Dr Divers, J. of Equine Science, 2008.
   These are the horses that people have tried everything but the horse still gets foot sore and stays in jail. These are the horses needing Heiro the most. Your Veterinarian will do testing to see how the Insulin levels are and how well Heiro works after 60 days. Once the numbers improve, a controlled pasture turnout program can be started. Many horses are back to 8 hours a day within two months of starting on grass.
4. Muzzles in Equine Insulin Resistance.- Yes, you'll need a muzzle to slow down the horse in order to have a continuous, slow and steady feed intake.
   1. Get a muzzle that clips to the halter - avoid the muzzles that have the built in halter. This type is easier for the horse to rub off or for other horses to pull off.
   2. The velcro clip design is good but needs help. Go to a hardware store like Home Depot or Loews and get Gorilla tape. Split the tape and wrap it around each velcro strip where the muzzle is attached to the halter. This stops other horses from ripping the muzzle off the halter.
   3. Keep the muzzle right against the nose- do not leave a 2-3 inch gap from the nose to the muzzle. That is so loose that they will slip it off. You do not need to smash it against the nose but it should touch.
   4. Do not panic if it comes off.
      We had many calls from new Heiro users very worried that their horse had the muzzle off when they came home. A single episode resulted in no laminitic cases in all of 2008. The key is not to let them pig out for multiple days in a row. So if they continue to take it off you need to figure out a way to stop them.
   5. Make sure the muzzle is still working- look at this picture (to the right) of one that basically was worn out to the point of not restricting food intake. Get a new one every 12-18 months.
      

F.   Snacks: Horse Treats in Equine Insulin Resistance

Yes, your horse can still get many types of snacks.  You love to give them and your horse loves to have them.  It is one of the best parts of having a horse.  The important thing is to know what can and can not be eaten.

Good Snacks — Low Glycemic Index, Low Carbohydrate.

1. Beet Pulp with no molasses added.

1. There are two types of beet pulp. You want the type with no molasses.
2. Beet pulp is a great way to provide fiber to your horse's diet - added fiber lowers Insulin levels and it gives your horse a feeling of being full which cuts appetite and hence intake. Grass hay and beet pulp have similar fiber.
3. The sugar part of sugar beets has been mostly removed as it was processed. What is left over is beet pulp which is 97% "sugar free" which is very good. Wet beet pulp is only a 3% ESC simple sugar. Studies have proven that it will not raise Insulin levels and, in fact, is a good product to feed horses. Do not get beet pulp mixed up with bran mash. Bran mash is extremely high in sugar and can not be given to these horses/ponies.
4. Beet pulp has about the same protein level as grass hay (9-10%).
5. You do not need to buy "designer" beet pulp. It only costs over twice as much as regular beet pulp and that is without added shipping costs on top. Your local feed store has non-molasses beet pulp at about $15.00 per 40 pound bag.

You can feed a 1,000 pound horse beet pulp 1-2 times a day. Soak 2 cups in 4 cups of water for 4 hours.
You can add HEIRO™ to the morning beet pulp along with the low NSC grain.     

I can't find plain beet pulp! Now what?

If you prepare beet pulp with molasses you can feed this safely – it actually has less sugar than soaked, plain beet pulp.  We were surprised at this fact. This is probably due to our soaking and rinsing process.

                                                                                             Starch              Simple Sugar
Data Base – Equi-Analytical Soaked Plain Beet Pulp               1.8                       2.4
Prepped soaked/rinsed Beet Pulp with molasses
   Also run at Equi-Analytical Labs (9/25/08)                           0.1                       0.1

            Steps to Feed Beet Pulp with Molasses to Horses  (How we prepped):

1. 1 cup of beet pulp into a bowl with 4 cups of water.  Soak this for 24 hours – This is just what you will do in the real world for making it up in the morning to use the next day.
2. Next, we poured it into a colander (K-Mart $6.00) and hand pushed it down for 5 seconds to squeeze out water.
3. Then, we rinsed it in cold water for 30 seconds and squeezed it out again for 5 seconds.
4. All done – ready to feed.  Easy, quick, inexpensive.

  Conclusion:  Prepped Beet Pulp is a safe product for the Insulin Resistant horse.

Also, you should soak plain beet pulp because dry, plain beet pulp has a simple sugar of 9.2 which drops to 2.4 if soaked.  Go to the Equi-Analytical site to see this additionally surprising fact!

2. Strawberries, cherries with out the pits, and roasted peanuts in the shell.  Peanuts in the shell can be bought in bulk at BJs.  If you feed the horse peanuts in the shell, it will increase the fiber content which is good.  Also, pumpkin seeds are low Carbohydrate, high fiber. Another snack clients have told me their horses love is celery sticks. Cut them up into sticks or let the horse bite off a piece. Celery has an extremely low glycemic of 1 (lowest level) and is only 1% total carbs with very high fiber.
3. Special Candy.  Where to get?  In supermarkets, they now all have special aisles of senior adult/diabetic foods and this is where to go.  Get sugar-free candy for diabetics.  The candy only has 6 calories.  Great peppermint, grape, cherry, and watermelon flavors.  The ones we have used that horses like:  Estee Sugar Free Peppermint Swirl hard candy and Sorbee Sugar Free Lite hard candy with Cherry, Grape, Orange, Strawberry flavors.  Often, diabetic foods are near the energy bar section— do not feed any energy bars to your horse.  They are loaded in corn syrup/oats and molasses (even the so called diet types).

A client asked:
Are the sugar substitutes in the diabetic candy OK to give to my horse?

Yes, if it has Splenda or Nutrasweet. We checked with:

1. The ASPCA Toxicology's National Poison Control Animal Center. Sept 2008.
2. Dr. Val Beasley, Board Certified Veterinary Toxicologist, Head of Toxicology at University of Illinois College of Veterinary Medicine, and author of articles and books on veterinary toxicology. Sept 2008.
3. Dr. Dirikolu, Veterinary Pharmacologist, University of Illinois College of Veterinary Medicine. Sept 2008.
4. Head of Toxicology, University of Pennsylvania's College of Veterinary Medicine at New Bolton Center. Sept 2008.
   
The Splenda or Nutrasweet in these products have never caused any cases of problems in horses.The sugar substitute that has caused problems in dogs and cats is called Xylitol. It is found most often in sugar free gum, so skip the gum and go for the sugar free peppermints. Both Splenda and Nutrasweet are FDA approved.


4. Hay cubes —   Why hay cubes under snacks and not under hay?
1. Horses eat cubes 25% faster than hay which means there will be extended periods of fasting with no forage. Fasting causes Insulin to surge way beyond normal when the horse is fed again. This is exactly what we do not want. The goal is steady release of nutrients all day long and not eat - starve - eat - starve.
   
2. Expense.  Cubes are much more expensive than hay per pound of feed. A 1,000 pound horse will go through a bag in 2-3 days and if you compare that to the cost of hay (even $6-$7 a bale), cubes will run about $1,000.00, per year per horse more.
3. Hay cubes are finely chopped so they leave the stomach faster - regular hay slows the process down.
4. Hay cubes are a good snack to give in the afternoon. You can slice them up into 4 pieces per cube and give 2-3 cubes (8-12 pieces). Either alfalfa or timothy cubes are fine to use. One bag will last 3-4 months - that is about $0.12 a day for this snack.
5. Alfalfa Pellets – a handful in the morning feed or as an occasional snack is fine.  Good fiber, low glycemic index.  Again, only as a snack because as the main forage it is too expensive, leads to fasting like cubes.  Alfalfa pellets have an added bonus of helping to prevent stomach ulcers due to its buffering ability. (The Horse, February 2008)
6. Chopped Low NSC Hay – These are GOOD snacks but are NOT a primary forage due to three reasons:

1. Studies show that horses eat these too fast. Most horses will blow through 5-10 pounds in less than 1 hour. If it is the only forage, horses will go 11-15 hours with no food.
2. Finely chopped means it will go out of the stomach quickly, so the horse gets an empty stomach quickly. This is not our goal.
3. These feeds have the advantage of you knowing they are low in sugar/starch, so they are safe to add to the high protein/low carb grain. Add 1-2 pounds per feeding. Horses seem eager to eat these products and owners often comment their horses enjoy this forage.

SAFE CHOICES (2)

Note: Not all chopped hay is safe for an Insulin Resistant horse - other types add molasses which we don't want.

Bad Snacks — High Glycemic Index or High Carbohydrates or both.

1. Cookies – loaded in corn, oats, sugar, and molasses.  The cookies at the tack shop need to also be avoided.
2. Candy – only use special candy (see good snacks).
3. Bran mash – lots of Carbohydrates.  Higher Glycemic Index than many grains. Wheat bran and rice bran should be avoided. Rice bran has 8 times more starch than alfalfa cubes and over 10 times more than beet pulp.
4. Certain grains – corn, oat, wheat – even a handful is a bad choice.

According to Equi-analytical, Oats have a starch of 44.2 and an NSC of 48.7 making it:

15 times the starch and 4 times the NSC of alfalfa.

 4 times the NSC of low carb/high protein feeds.

13 times the starch of fresh grass pasture.

22 times the starch of wet beet pulp and 9 times the NSC.

5. Certain fruit/vegetables – apples, carrot, applesauce (3 times worse than apples), watermelon
6. Other items we have seen fed that need to be avoided – jelly beans, yogurt, pretzels, chips, lawn clippings, and frosted mini-wheats.

G.  Glucosamine Products in Equine Insulin Resistance.

Both oral glucosamine and injectable (N-acetyl glucosamine) from compounding pharmacies should be AVOIDED.

Why?
Many studies are showing glucosamine can do the following:

1.  "Induce peripheral Insulin Resistance". Diabetes Journal 1996

2.  "Induce Insulin Resistance" J. Clinical Investigations 1995.

3.  "...demonstrate that induction of Insulin Resistance by glucosamine results in reduction of the blood flow rate as well as the uptake of glucose..." Diabetes Journal 2000.

4.  "Probably a good idea to avoid glucosamine if you have diabetes" Mayo Clinic 2007.

5.  "Diabetics should be alert to potential blood sugar changes" Harvard Medical School 2007.

To be fair and make you aware, there are a few studies that say it may not effect glucose:

1.  J. Clin. Endocrin. Metab. 2001

2.  Arch Intern Med 2003.

What to look for to not accidently feed Glucosamine:

A. Many joint products have it – look very carefully on label and at products with “Flex”, “Joint”, “Gluco”, or “Glyco”.
B.   Many products to treat Laminitis have Glucosamine.  That is really surprising.

What can I use in place of Glucosamine:

A. Oral Chondroitin- Many types are available in catalogs. Double check it is not a Chondroitin/ Glucosamine combination. You want plain Chondroitin.

 

 

B. Adequan- Has PSGAG and contains no Glucosamine

          C. MSM Oral - Safe, effective product to help stiff horses. One (1) Tablespoon in the morning and one (1) Tablespoon in the evening. Costs less than a nickel a day.

H.  Flax Seed in Equine Insulin Resistance.

1. You can feed flax seed to these horses, if prepared the correct way and fed in the right amount.
2.  Flax seed is an excellent source of fiber (40%), a natural antioxidant, high in protein (26%), and high in essential fatty acids - Omega 3 and Omega 6. One tablespoon is only 36 calories.
3. We are feeding the seed and not pouring cups of flax seed oil into the diet. The fat portion is small if you feed 1/4 cup (4 tablespoons) a day to a 1000 pound horse.
4. According to the Flax Council of Canada (Canada is the largest producer and exporter of flax in the world):
   1. Brown flax seed has the same nutritional make up as yellow flax seed.
   2. Whole flax seed can be kept at room temperature for up to a year.
   3. Once ground, flax see should be kept in an airtight, opaque container and refrigerated. "Ground flax seed kept this way will keep for up to 90 days." "Best to grind whole flax seed as you need it.".
5. To prepare:
   

1. Buy whole flax seed in a health food store. Don't buy pre-ground flax, because you don't know when it was ground and it is usually not refrigerated.
2. Grind the seeds in an electric small coffee grinder ($15) - available at KMart and WalMart.
3. The seeds must be ground. Whole seeds can not be digested and will pass through the horse, coming out as they went in. It is very simple to grind up a month's supply of seeds then refrigerate. After each use clean out the grinder to prevent residue that may become rancid. Fresh seeds should go into a clean grinder.
   

6. Before you buy horse flax products:
   1. Many have oats and sugars added. You have no idea of the NSC, sugar content.
   2. Many are already ground up, so they are over 90 days old and of questionable value. The Flax Council is in the business of selling flax and if they say it is only good 90 days after grinding, it is wise to listen.
   3. They are ground but not in an airtight container and, again, are over 90 days. Mayo Clinic also recommends airtight containers.
   4. They are in huge bags that would take months to get through and if already ground are even more likely to be of questionable value.
7. Evidence in studies show that the Omega 3 and Omega 6 in flax can help decrease inflammatory responses and the need for medications in horses. National Research Council 2007.

VI. Lyme Disease in Equine Insulin Resistance/Lyme Laminitis

1. Several studies in human and animal medicine show that bacterial components can trigger Insulin Resistance temporarily in normal individuals.  Most horses exposed to Lyme/showing disease/being treated do not get Laminitis because most are not already Insulin Resistant before infection.  Normal (non Insulin Resistant) horses get an Insulin surge from bacteria but the level is not enough to trigger Laminitis.
2. Another reason horses being treated for Lyme usually avoid Laminitis is due to Tetracycline antibiotics (Doxycycline tabs, Oxytetracycline IV) have an anti-inflammatory effect on top of their antibiotic effect.  This two-for-one bonus helps avoid problems.
3. The Big Problem:  Horses with already in place Insulin Resistance being exposed to the Lyme bacteria causing a horse with already high Insulin to go sky high and trigger Laminitis.  The double teaming of bacteria and the Insulin surge take a horse already on the edge and push them off the cliff.
4. If you have an Insulin Resistance horse or a probable one (body type, Laminitis history), it is a good idea to test Insulin level if diagnosed with Lyme.
5. What can I do?  This disease highlights the important concept of needing to control Insulin now in order to help avoid a problem later.

Simply, by moving your horse away from the edge to a safer Insulin level, it gives the horse a buffer zone so that if a surge occurs (Lyme, colic, trauma, surgery…) it is not enough to go over the edge into Laminitis.  I call it my “Grand Canyon Concept”.  If we are not near the edge, we can’t be pushed off the cliff.

VII.  Winter Foot Pain In Equine Insulin Resistance

A. Many reasons why this occurs:

1. Cold Stress - Almost all of these cases of foot pain occur where it is cold. These cases appear to be slightly different from warm weather Laminitis flares in that they require a longer period of time (usually three weeks) to resolve but have less severe radiographic changes - we are investigating why this occurs.

a. We see most cases between Thanksgiving and Christmas: November 24 - December 25.
b. Hard ground/frozen mud/rocks protruding up encased in icy ground contribute to this problem - possible Allodynia of past Laminitis (makes overly sensitive feet) plays a role because its not all horses. These horses walk on rocky areas as if it is broken glass, while others are having no problems.
c. Cold causes stress, so Cortisol increases. Cortisol interferes with Insulin causing Insulin levels to surge to overcome it.
d. Less grazing - less continuous eating so there is more changes of Insulin rebounds on re feeding. Fasting times between meals increase, so as re fed, Insulin levels surge way beyond usual amount. Its like giving a shot of Insulin and the high level leads to Laminitis.

2. ACTH Seasonal Surge - in horses, as daylight shortens between September and December, ACTH hormone goes up. ACTH interferes with Insulin so Insulin levels surge trying to overcome it. Insulin Resistant horses are already on the brink and the added Insulin puts them over the cliff.

a. Cushing's horses with already high ACTH get a surge of ACTH on top if it and, again, over the cliff. Whether Pergolide can control seasonal surges is unknown. Many clients will up the Pergolide during this time to try to avoid a problem.
b. On horses we test, the ACTH has been normal! When we see them, the seasonal ACTH surge is over. Our theory: The cumulative ACTH surge of three months leads to problems, but when we test, the surge is over by then. We are working on trying to resolve the true cause. We can not rule out ACTH as a problem, but we can not say its the ultimate cause.
c. Combo Cause - The cold stress plus ACTH surge plus underlying Equine Insulin Resistance gang up to make the problem. I'd bet on this.

B.  What to do?

1. Go on Heiro™ twice a day for ten days, then once a day in usual schedule.

2. What we have had luck with:

a. Stall confine seven days - even if ok in three, keep in seven days.
b. Protect feet - packing with impression material, Soft Ride boots....
c. 1000 pound horse: One (1) Bute Tab in the morning and one (1) Bute Tab in the evening for three weeks in a row.
At the same time, one (1) Equioxx full tube in the morning and one (1) in the evening for seven days, then one (1) in the morning for the next fourteen days.
d. Avoid Black Hole - we have had a lot of improvement in ten days, and then I pulled off medications and two days later they got lame again and it took a long time to bring them back. Avoid this problem I had.
e. Radiograph front feet on day 1.
f. Farrier consult on radiographs, medications. Get their opinion of foot condition and their past experience with the horse - day 1.
g. These winter foot pain cases take a longer period of time to put out the fire, but thank goodness seem to go on and do well after.

Owners often ask about using Previcox Tablets (57 mg) in place of Equioxx Paste. Owners point out it is the same strength of Firocoxib, and is made by the same company but is more economical than the Equioxx. We recommend owners talk openly and directly to their Veterinarian.

VIII.  How to Test for Insulin Resistance:

1. To diagnose Insulin Resistance, your doctor will need to test several items in order to get a complete picture of your horse’s condition.  This is a key point in the HEIRO™ Laminitis prevention program.  Another key point is that most doctors and labs are unaware of special handling procedures in testing for Insulin Resistance.  We have consulted with numerous labs, supply companies of blood tubes, and universities such as Harvard, John Hopkins, Stanford and the Mayo Clinic.  We have run hundreds of tests to see which tubes give the best results and we enthusiastically share this information with owners in order to help their horses.

The two main items of Insulin Resistance to test for are Insulin and Glucose, but also test the Thyroid levels and the ACTH.

* If you suspect Cushings, run Insulin Resistance tests.  If you suspect Insulin Resistance, run Cushings blood tests.

Each test needs specific tubes, handled specific ways both in the barn, and later, in the lab or car in order to get accurate results.  Poor handling in any of these steps will yield false information which can lead to your horse not getting the correct therapy.

2. What can I do as the owner to make testing more accurate?
   1. The goal is to keep the routine and peace prior to blood testing.  You, as the owner, know the best way to do that.  Insulin and ACTH levels will go up if the horse is excited — if it is a rodeo to catch the horse, we will get a false elevation.  If you usually turn out after grain, and they are easy to catch/sweethearts in the field, then pull blood in the field.  If the horse is tough to catch in the field, keep them in with other horses.  Provide hay as you usually do after giving grain.  If you turn out, put a muzzle on if you usually do, or if you do not, and then just turn out.
   2. Tell the doctor if the horse is sick.  Besides excitement, sickness, high stress of recent show/shipping or current laminitis is enough stress to elevate Insulin/ACTH which makes testing difficult.  If we test these horses and get high levels of Insulin/ACTH, we struggle to tell if it is from stress or stress and Insulin Resistance/Cushings together.  If Insulin/ACTH levels are sky high, it is probably stress and disease.  Owners need to be aware of this limitation of tests in certain situations— if you know and we know, we will be a better team.
   3. Tell the doctor if the horse is on medications.  Certain items like Bute and Banamine will lower thyroid blood levels causing false low results.



Test Insulin in the morning.

3. Test #1:  Insulin and Glucose
   1. When to test?
      1. In the morning, approximately 2 hours after feeding some sweet feed. Example:  Feed at 8:00 AM, test at 10:00 AM. This is a "soft" challenge and will not cause a problem. 
      2. If you have already tested Insulin, by feeding hay or low carb grain and hay, and the result is over 60, you do not need a "soft" sweet feed challenge. You are a confirmed Insulin Resistance horse already. You need to get on a program quickly to get the number down quickly.
   Why the two hour wait?
   In a 2008 study, Insulin peaks at 2-2.5 hours after feeding, even when feeding low carbo/low starch diets. If you wait 3 hours, the Insulin drops 10% and you get a false low number. If you test in the afternoon, the number can be 40-50% lower then the peak. If you test in the afternoon, you may think your horses is ok, but actually it may be in trouble. Dr Gordon, J. Equine Veterinary Science, 2008.
   2. What to feed prior to the test?
      1. Hay/Fresh Grass – feed normal amount of hay you usually give in the morning.  Turn out normally onto grass after you give the sweet feed.  Put muzzle on if usually muzzle or leave off if usually you do not put on.  We will test 2 hours later.
      2. Sweet Feed - If you feed little/no grain or a low carbohydrate grain, today you will feed a very small amount of sweet feed (like Omelene 200) to see how your horse’s Insulin level reacts.  This test means you will not have to have your horse tubed down with a dextrose sugar solution and have blood drawn 12 times – that is stressful and expensive.  Our studies have found it only takes a very small amount of sweet feed to find true Insulin Resistance horses – for example about 2-3 handfuls to a pony.

   1000 pound horse       - Feed 3cups
   Large Pony                 - Feed 2 cups
   Small Pony                  - Feed 1 cup

   The goal is to find the horse's true Insulin status and a very small amount of grain will show this. Fasting or testing while only on hay gives inferior information.

Cup to use is a kitchen measuring cup used in baking.  Not a scoop, not a coffee can, not a Snoopy coffee cup.

Why Sweet Feed?

1. Dr. Frank's 2006 AAEP article mentioned that fasting Insulin level tests will miss true Insulin cases at times. The fasting created a false low result.
2. Dr. Bailey's 2007 study showed that if they only feed hay to Insulin Resistance horses, their Insulin levels are the same as the normal control horses - again, a false negative. When they gave these horses a feed challenge, their Insulin tripled over the normal horses. Summary: Testing while only on hay will miss cases. For a horse to have a high Insulin while on just hay is not common.
3. It is only a soft challenge - Dr. Bailey's study gave much more sugar with NO HORSES GETTING LAMINITIS.
4. It is easy, inexpensive, and will pick up true Insulin Resistant horses needing help.

Use any one of these tubes:
10ml plain red top serum tube with additive made of plastic with conventional stopper. To order tubes: Fisher Scientific: fisherhealthcare.com or 800-640-0670. Brand: BD Vaccutainer - MFG #366441, Catalog number: 02-683-60.
10ml plain red top serum tube with no additive made of glass with conventional stopper. To order tubes: Fisher Scientific: fisherhealthcare.com or 800-640-0670. Brand: BD Vaccutainer - MFG #367820, Catalog number: 02-685-112.

All of these provide serum.

Do NOT use these tubes:
Tiger top SST tubes (have gel at bottom) cause false elevations
Green, gray, and blue tops.

You will be pulling only 2 tubes to run 4 tests, but need to first use the red top tube and after that, use a purple top tube for the ACTH.  Red is first.  The tubes must be filled fully— blood will pour into the tube and at the end drip drops of blood— after drips stop, it is full.  Now, gently roll tube 8 times— required by blood tube manufacturing company.

2. Next, you will place tubes in a refrigerator pack to cool down for 30 minutes and coagulate.  Start stop watch function on your wrist watch after blood is drawn.  Keep tubes upright in refrigerator and not on side.
3. Next, centrifuge blood at about 3,000 rpm/5 minutes— slower rates will also work, but this is what we use in our practice.  The centrifuge is in the car— an adapter to your car’s cell phone charger part will allow plenty of power for the centrifuge.

Spinning needs to be at 30 minutes— doing it 4-6 hours later at the lab is no good and not the standard used in endocrine labs or for diabetes screening because it causes false low results.  If done correctly, Glucose levels will be over 80 mg/dl to about 100 in most horses.  If you have Glucose levels of 65, 52, 47…, then the blood was not handled properly  Glucose was eaten by red cells in the tube which will also throw off Insulin levels.  If we want accurate information and treatment, it does not start with a Glucose of 52— if we are going to test, we need to do it correctly.

4. The serum is harvested after centrifugation into a hard plastic tube using a sterile plastic pipette.  The hard plastic tube will have a screw on top or snap-on top of hard plastic.  Why this?  The rubber top of blood tubes used to pull blood will alter results— this is why we do not harvest and put serum into another blood collection tube.  Also, the activator of the original blood collection tube can alter results if serum is exposed a second time to activator.  We learned this the hard way— it turns serum into a hard Jell-0 and, again, alters results.  You only need 2cc of serum.  Next, store the serum in the refrigerator until ready to ship to lab.
5. WARNING —  Never give your horse a shot of Insulin to see how he responds.  This is called an Insulin Challenge Test and can lead to severe laminitis or death.  If this is ever mentioned as a way to diagnose Insulin Resistance, run for the hills.

Therapeutic Diagnosis - For a variety of reasons, some owners can not get the Insulin blood level of their horse. In these cases, clients will try Heiro™ for sixty (60) days to see how it helps their horse. The owner is able to diagnose the problem of Insulin Resistance by gauging how the horse responds to Heiro™.

 

 

 

D.        Test #2 – Thyroid Hormone Levels

The red top tube and serum collected for Insulin and Glucose is enough to also test the thyroid level.  This one blood tube yields 3 results: Insulin, Glucose, and Thyroid.  Consult your doctor to see if they want to use TRH or TSH stimulation tests for thyroid levels.

E.         Test #3 – ACTH

1. After you draw the 10cc red top, next draw blood into a 10cc purple EDTA tube to test for ACTH.
   Tube to Use: 10 ml Purple Top Tube with EDTA (K3) Additive made of glass with conventional stopper. These can be ordered from Butler Animal Health, 1-800-551-3861. Manufacturer: Kendall Monoject, MFG # 8881-3117743.
2. Like Insulin, ACTH peaks in the morning, so you need to test then. (Same time as Insulin).
3. Like with the Insulin red top, fully fill a current-dated tube, spin at 30 minutes, harvest, put in a separate hard-plastic tube, and refrigerate.  This tube must be frozen within 2 hours of sampling and will be sent to the lab with the serum of Insulin/Glucose/Thyroid test in a refrigerator pack.  Like the previous test, only need 2cc of fluid (plasma).
4. Cortisol testing is of no value in testing for Cushings.

   Why?.

   In multiple references this test is described as: "Not Definitive", "Too variable", and the test has a "lack of consistency".
   Equine Internal Medicine- 2004
   Equine Medicine and Surgery volume 2. 5TH Edition- 1995
   Journal of Vet. Internal Medicine - 1996

5.  Do not test ACTH from August through December - is a seasonal elevation in all horses and it will cause a false reading. Spring is a good time to test.
6. You do not need a Dexamethasone stimulation test to diagnose Cushings.

Big Point of View:  When pulling blood from horse, first pull red top, second pull purple top.  The refrigerator pack will have 2 tubes sent to the lab, one of which is frozen.

7. Recent university project showed that all horses over 13 years old in their study had Pituitary Gland Hyperplasia, with many having high ACTH levels but no signs (laminitis, lots of hair…) yet.  This study is important because these sub-clinical “hidden” cases will also hide Insulin Resistance cases in those with both diseases.  Again, if high Insulin, test ACTH, and if high ACTH, test Insulin.

F.      Results:

1.   Insulin and Glucose. Once get to lab, Glucose results in 1 day, Insulin results in 2 days.

1. Normally after a meal, Insulin levels of baseline 5-20 u/U/ml will go up about 40-50.  When levels are above 60, this is abnormal.  We have had several over 400 which is slam dunk Insulin Resistance.  If over 60, you are Insulin Resistant. Some labs use pmol/L for Insulin - if so, divide this number by 7.175 to get to u/U/ml.
2. Glucose – Normally and in most Insulin Resistance horses, 80-100 mg/dl.  In very rare cases of early-stage Type II Diabetes, over 200.  If your lab uses mmol/L as Glucose unit, divide this number by .055 to get to mg/dl.
3. Glucose/Insulin ratios are of little value because Insulin Resistance Horses have normal Glucose ranges. High Glucose is very rare and low Glucose from improper testing procedures throw off this ratio. Do not count on this too heavily as a diagnostic tool.
   Dr Divers, Cornell University, 2008 J. of Equine Veterinary Science. "Because most horses with EMS maintain glucose within the normal range when fed only low NSC forage, the change in Insulin is the primary determinant of any ration change".
   

   Here is an example of why it is not helpful.
   Glucose levels are considered normal between 80 and 120.

   Horse A- glucose of 80, insulin of 40 has a 2:1 ratio.
   Horse B- glucose of 120 and an insulin of 30 has a 4:1 ratio.

   Both horses are normal but ratios are double on Horse B.

Conclusion:

Ratios are not going to find a problem. You know if the Insulin is over 60 there is a problem of Insulin Resistance and you know if the glucose is 40 the sample was handled poorly. Also you will know that if the glucose is sky high, your horse is Early Stage Type II Diabetic and quickly needs help. It is straight forward to diagnose and monitor progress.

Insulin Test Result Chart:

uIU/ml	pmol/L
5-40	<287	Fasting Normal
40-60	287-430	Peak Insulin 2 Hr after breakfast in a normal horse.
80	574	Abnormal- Insulin Resistance Confirmed If blood was taken without a grain challenge and you are in this range you are severely insulin resistant.
120	861
180	1,291
250	1,794
400	2,870
600	4,305

• To convert from uIU/ml to pmol/L, multiply by 7.175.
• To convert from pmol/L to uIU/ml, divide by 7.175.
• If your lab says you are greater then 200uIU/ml, ask them to titrate it out to a real number. This does not cost any extra. If your horse is at 550, and it drops to 210 with management, that is great progress, and you will miss it.
• Cornell and Antech use uIU/ml.
• Michigan State and Idexx use pmol/L.

2.   Thyroid – consult doctor.  Once at lab, results in 1 day.

3.   ACTH – once at lab, results in 2 days.  Normally, most horses are under 35 pg/ml.

1. In the fall, normal horses have elevated levels in our findings of about 75-100, but studies say it can get up to 200.
2. In the fall, you are looking for extreme ACTH elevations to diagnose Cushings of over 300.
3. During the rest of the year, horses over 60 are suspects and usually are retested in 30 days, while horses over 100 are treated with Pergo. Our highest level: 565.  Some labs have seen levels over 1000.

G.        Retest

1.   Insulin/Glucose

1. After 60 days on HEIRO™ Supplement and following the Insulin Resistance/Laminitis Prevention Program, retest your horse's blood. This time, you will feed the Heiro™ the same amount of sweet feed and hay and test two (2) hours later. If you were turning out to graze after breakfast on the first test, turn out again to keep the same routine, and we will pull blood two (2) hours later in the field.

   The American Assoc. of Clinical Endocrinologists recommends a challenge to find Insulin Resistance cases in order to avoid missing cases.

2. If you are ever concerned about the amount of grass your horse is getting, even with the muzzle, you can retest the Insulin to make sure the levels are good. For example, in April/May when starch levels double, you can turn out less (with the muzzle still on) and in June when increase turn out, you have the option of retesting. The same goes when cold weather of October comes in and stress grass sugar goes up - you can test the horse in October.
   
3. Retest Insulin once a year - can do at Coggins/Vaccine time Retest at same time each year -- for example, every March.

2.   Thyroid – 2 weeks after on thyroid medicine if tested low. Adjust amount after.  Retest yearly.

3.   ACTH – 30 days after on Pergo or if monitoring to see if level is rising.  Adjust amount after.  Retest yearly.

Your Farrier is often the first line of defense against Insulin Resistance Laminitis. They see the hoof regularly and will pick up changes or notice a lameness on visits. They are a major part of the team and will be consulted regularly on blood tests and radiographs. Your Farrier has important experience with the hoof which is vital in knowing what has or has not worked in the past.

They will notice signs of possible Insulin Resistance such as:

• Overly sensitive response as they put nails in - the horse flinches more than in the past.
• Laminitis with no known cause.
• Sore-footed more in the Winter.

They will help protect the feet in several ways:

• Trim on a regular and more frequent (4 weeks ideal) basis.
• They may put shoes on a usually barefoot horse or add thin sole pads/protectants because of increased sensitivity of the foot. The horse is not Laminitic but moves short. Seen in people with neuropathic foot pain - the phenomenon of "allodynia": pain-related behavior in response to normally innocuous stimuli. For example, going sore on frozen/hard ground in the Winter that usually is no problem to other horses at the barn.
• The use of glue on shoes in the face of a Laminitis attack. Nails should be avoided in the acute phase, but glue on shoes can go on quickly to lift up and protect the sole. Often needs only one or two sets of glue ons and then can go back to usual routine.
• Your Farrier may request radiographs in order to know how much toe to remove or to improve balance or see improvement with glue ons/bar shoes.

If your horse is sore after routine trims, you do not need a new farrier, you need to get the horse tested.

 

Radiographs also give your Farrier the proper toe length to maintain your horse in future trimmings. This information gives them the "safe zone" -- how much can I trim without being close to the coffin bone and what is a good guideline so I can measure out a consistent toe length each visit.

For example, a certain small pony named Brandy, with past Laminitis episodes, is moving well now and radiographs show an ideal toe length of 2 3/4 inches from coronet to toe on the dorsal aspect. This number allows the owner to help the team monitor the length and give the Farrier information. If the schedule is every six weeks but the toe length is 4 inches at five weeks, the owner can set up more frequent Farrier visits. This number avoids feet being sore from being too long or sore from a dramatic trimming needed to "catch up".

***Remember, x-rays will not show hoof quality and dynamics -- the ideal toe length is only a safety guide. Your farrier may see things requiring less trimming that visit. The foot talks to the Farrier. They trim a foot not a radiograph.

Best Glue-On Shoe:
We have seen this shoe turn very painful horses around in 10 minutes or 1-2 days.  The shoe puts NO GLUE on the bottom of the foot, so there is no instability in putting the foot down after applying.  (Smearing/shifting as weight is put on it.)  This shoe once applied sets up in less than 1 minute, so you are not wrestling to keep it up if the opposite foot is sore.

How to get it:  www.soundhorse.com or 1-800-801-2654.  Company:  Sound Horse Technology.  Get the size of the foot to order from your Farrier.  Order the Series I Fabric Cuffed Morrison Roller Action Shoe.  The entire kit is only $70.00, for front feet shoes.

A fabric cuff goes over the outside of the hoof wall.  A shock absorbing urethane pad is bonded to the shoe for further help.  The shoe slips on like a slipper and quickly and strongly bonds.  Most universities use this shoe now in Laminitis.  Most Farriers when they use it once will use no other glue-on shoe.

A.     Scenario: Client with a horse on HEIRO™ that has been doing great all of a sudden is foot tender. Why?
These horses taught us a big lesson - most were overdue for a hoof trim. Insulin Resistant horses need a rigid 4-6 week trim schedule - never go over 6 weeks. Get with your Farrier on a schedule such as "every 2nd Tuesday of the month". Even one week overdue can be a problem. Also, clients tell us the horse on Heiro™ grows foot faster than other horses at the farm. Good quality, strong feet help keep your horse sound.

B.     Scenario - What can I do as an owner to help my Farrier?

1. Paint the bottom of the sole 2-3 times a week with Venice of Turpentine to toughen it up and decrease bruising - also it is an antiseptic so any little wounds are tended. Simple and easy. Really helps.

2. If your horse is a thin soled/stingy footed type, feed six (6) Zinc tablets (50 mg per tab) once a day, every day. Your horse will eat them up "as is" when fed in the morning. Get Zinc tablets at any grocery store or in the pharmacy in the vitamin section. It costs very little.

3. If your horse has shelly, poor quality feet - Isoxsuprine Tablets cause a burst in hoof growth. We have found them of little help in navicular disease but even a low dose, once a day, will help grow the foot. One bottle will last about 2 months if fed 15-20 once a day. Again, inexpensive.

Often, you can avoid a problem by giving a horse a low dose of Bute the morning of a trim, some more that night, and some the next morning. Several clients from around the country told me they do this and it makes sense to avoid the problem and keep the horse comfortable. Most horses do not need it, but some really do need a little help to avoid discomfort.

4. Foot Protection - For clients wanting to avoid shoes or needing a bridge before putting on shoes:

1. Many clients have seen improvement in alleviating foot pain using the Soft-Ride Boots. You can size them on the site. Order the Turquoise (blue) colored standard insert. You need to take them off for 30 minutes a day to let the foot dry out or as the horse improves, use them when outside and take them off when in the stall. www.soft-ride.com.

2. Clients will also use them in early Laminitis and when the horse's foot improves, go on to use glue-on or other types of Laminitis shoes.

Soft-Ride Shoe

 

Gel Toe Bumper

No matter how talented the farrier or impressive a job they do putting on a variety of Laminitis shoes - it will not work if underlying Insulin damage continues. The house is on fire and putting on an addition won't help. Give the farrier the ability to succeed by testing and controlling Insulin.

 

5. Biotin (Vitamin H)

I.  Several Studies have shown it is of benefit and is a great product to add to your horse’s diet.

1. Recent study by the University of Tennessee College of Veterinary Medicine showed it is of benefit.
2. A Cornell study (Eq. Practice, 1987) and a separate university study (Vet Record 1984) showed feeding 15 mg of Biotin a day after a five-month period showed “marked improvement” to hoof quality and improved all 55 horses in the study.
3. A study of Lipizzaner Stallions after six months on Biotin showed increased white line condition and hoof tensile strength. (Proc. Eq. Nutrition, 1993).

II. Here are two sources of Biotin that are easy to administer and horses will enjoy.  Biotin is not stored in the body, so a daily supplement is a good idea.

1. Brewers Yeast – 1 teaspoon once a day.
2. Biotin-100 in a five pound bag.  It is made by Vetamix and can be obtained in most catalogs – inexpensive.  We had it analyzed at Equi-Analytical and it has only a .5 ESC and a .4 starch – these are extremely low and this product does not contain methionine which may have an inflammatory component.  This product is fed:
   1. 4 tablespoons once a day to a draft.  (30 mg)
   2. 2 tablespoons once a day to a 1000 lb. horse. (15 mg)
   3. 1 tablespoon once a day to a pony. (7.5 mg)

III. Biotin, like many vitamins, will not maintain stability forever.  At twelve months old, it has only 58% of the initial activity under normal storage (it has 76% at six months), so throw it out if it gets one year old.

IV. Biotin has “not shown to be detrimental if fed in excess”, so if you feed your horse 3 tablespoons instead of 2, you are ok.

V. You don’t need Biotin that has a bunch of vitamins and minerals thrown in.  You just need plain Biotin.

X.   Vaccines

After the Laminitis Conference in 2007, I spoke to several owners and veterinarians about Insulin Resistance and vaccine precautions needed for these horses. The exact mechanism is unknown, but these horses seem to be more prone to adverse vaccine reactions than the general population. I advise, and I will bet your doctor would agree, that splitting up vaccines into 2 or 3 sessions seems to avoid the problem and to consider a low dose of Banamine at each session (5cc per 1000 pounds). Do not give any Azium or Dexamethasone - they can cancel the vaccine. If needed, can also give an IV antihistamine.

* If your horse is the one in the barn that gets big hives, large swellings, or colic/sick year after year on vaccines, get tested for Insulin Resistance.

Avoid combo vaccines with 3, 4, or 5 items in one shot. These seem to provoke more problems in these horses. Try for just Tetanus, just Flu/Rhino, just West Nile Virus... and put them in different sites. Avoid putting Flu/Rhino and Rabies in the neck - go for the gluteal or chest on these vaccines.

XI.    Scout Radiographs (X-Rays)

At both the AAEP and Laminitis conferences, it is highly recommended to have a lateral view with a lead marker on the hoof wall to allow precise (to the millimeter) measurements and to see if there is rotation. These films also assist your Farrier regarding toe length, shoe placement, and progress of improvement.

XII. Future Applications of Heiro™

            Insulin Resistance in horses and humans (through independent studies) has shown to occur within 24 hours of endotoxin administration.  This toxin of bacteria is a common occurrence in certain types of colic and post-colic surgery. 

            In other species, it is already shown to occur that in profound trauma (surgery/wounds) and immune challenges, Insulin Resistance occurs in normal individuals.  These “stress-induced Insulin Resistant” cases can, again, possibly be a source of Laminitis, even in horses with no pre-existing metabolic problems.

 Summary:

In horses already with Insulin Resistance, trauma/colic/infections/surgery can push them over the edge if their Insulin is already high.  If normal individuals can get Insulin Resistance, then it highlights how important it is to get your Insulin Resistant horse back in action in the field to get the Insulin down.

XIII. Pasture Management for Insulin Resistant Horses

A. Identification of Common Weeds

 

   

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