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Tuesday, April 03, 2012

Grass Laminitis: What You Don’t Know Can Hurt You (and Your Horse) and Surprise the Researchers

New ad promo and publicity from Boehringer-Ingelheim Vetmedica perhaps oversimplifies grass laminitis. But it might get the attention of horse owners.
When it comes to laminitis, I feel like a whirling dervish: what’s going on in Australia, what’s going on in Europe? what’s going on here in the USA? (whirl)

Mevlane - Whirling Dervishes
Whirling Dervishes
But geography doesn’t tell the whole story, since laminitis is now divided into research on the molecular biology level; research on the genetic level; research on the use of regenerative medicine; research on grass metabolism; research on exercise, diet and obesity; research on support limb laminitis; research on the mechanisms of insulin resistance in horses...and every once in a while, there’s even some research on the horse’s foot. (whirl, whirl)

So recent research published in the United Kingdom passed before my laminitis-loaded eyes and might have kept on going except that I thought that what Boehringer-Ingelheim is doing there to promote their newly-patented formulation of pergolide, marketed as Prascend, should be of interest to Hoof Blog readers. Prascend has also been introduced in the United States.

And what's interesting is not what the researchers are telling the horseowners--it's what the horseowners are telling the researchers. In a sense, they told them quite clearly that they don't have the latest information.

Whenever there’s a survey of horse owners about laminitis, my ears are up. And they’re up today.

The survey by Boehringer Ingelheim Vetmedica revealed that over three-quarters of horse owners in Great Britain believe that laminitis in the spring is most commonly caused by access to lush pasture, especially if the horse or pony is overweight. The survey was answered by 222 horse owners.

This is what we think of as a "Cushings horse". The high prevalence of positive tests for Cushings syndrome (also known as PPID) is revealing that many horses with positive tests do not show the typical signs. (photo by Dr Christian A. Bingold, used with permission)
Only 10% of owners questioned for the research correctly identified that access to lush pasture on its own is unlikely to cause laminitis, without the presence of an underlying endocrinopathy.

In response to these findings, Boehringer launched a 'Talk About Laminitis' initiative to help raise horse owner awareness of endocrinopathic laminitis, and identify the 90% of laminitis cases that are--according to Boehringer Ingelheim Vetmedica's information--the result of an underlying endocrinopathic condition--namely Pituitary Pars Intermedia Dysfunction (PPID) or Equine Metabolic Syndrome (EMS).

In other words, evidence now suggests that 9 out of 10 horses and ponies with laminitis have an endocrine disease at the root of the problem. The grass, of course, triggers the laminitis but the endocrine levels are the deciding factor.

Last fall, nearly 1,000 horses and ponies were tested for PPID, approximately 75% of which were found to be suffering from the disease.

According to Boehringer-Ingelheim, in the past, research into the cause of laminitis focused on the role of simple sugars (fructans) in lush grass. It was proposed that eating excessive amounts of fructans could disrupt fermentation in the hindgut, resulting in laminitis.

However recent research evaluating grass intake in grazing horses and ponies has shed doubt on this theory. The average daily consumption of fructans in grazing horses and ponies is considerably lower than the levels required to cause laminitis experimentally, according to Boehringer-Ingelheim.

(The reference for this statement was linked to an article by Dodson and Horrell nutritionist Teresa Hollands, "Obesity and laminitis: minimising the impact of nutrition", published in the Laminitis Awareness 2010 Proceedings.)

Instead, when horses and ponies with an underlying hormonal disease graze and ingest soluble carbohydrates such as fructans, the result is abnormally high levels of the hormone insulin.

Insulin, of course, is the hormone responsible for moving carbohydrates from the blood into the tissues. There is very good evidence that high levels of circulating insulin results in laminitis in horses and ponies with PPID and/or EMS. In normal horses (without an underlying hormonal disease), grazing pasture is unlikely to cause laminitis.

Horse owners surveyed thought that
the spring grass caused laminitis.
During the public awareness campaign, which runs throughout April and May, Boehringer is teaming up with the Liphook Equine Hospital laboratory to provide free laboratory fees for ACTH blood tests to detect PPID in British horses. To participate in the scheme, veterinarians can download a voucher from They will then simply attach that voucher to the ACTH sample submission form, and the ACTH laboratory fees will be free of charge.

"If you are not checking for PPID and EMS in horses and ponies with laminitis, you are not getting to the real cause of the problem," says Andy Durham of the Liphook Equine Hospital.

The launch of the Talk About Laminitis initiative in Britain follows the enormous success of Prascend's Talk about Cushing's last autumn, which saw nearly 1,000 horses and ponies being tested for PPID, approximately 75% of which were found to be suffering from the disease.

For further information on Talk About Laminitis or Prascend®, the first licensed product for the treatment of PPID, please visit

Note: Prascend is sold by Boehringer-Ingelheim in the United States as well as in Europe. However, the programs and survey described in this article are relevant only for horse owners in Great Britain.

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Anonymous said...

The post states that 1,000 horses were tested, and 75% were positive for EMS. So, was this a random sampling of horses, or were these horses with symptoms? If it is a random sampling, and 75% of horses were positive, it can hardly be considered a disease, as the occurence is more prevalent than the lack thereof.

Anonymous said...

More information, please. What test was used to determine that the horses and ponies had the diseases? How reliable is the test (i.e., what is the rate of false positives and false negatives)? Was the testing performed by the drug manufacturer or an independent study by researchers who have absolutely no ties to the drug manufacturer?

After all, it was "studies" that led to spring grass being implicated as the major contributor to laminitis. Now we're being told that is not correct. Hmm......

Joni Solis said...

I also would like the answers to the same questions left by "Anonymous" below. Why are so many horses showing positive for EMS? What is the percentage of wild horse that show positive for this disease? Could we be causing EMS by how we feed or care for the horse? I don't trust drug company studies when they want to sell more drugs. So who paid for this study?