If you own a horse, especially one that is competing, I don’t have to tell you that there are ‘gut’ problems in the industry. Gut health seems to be a topic on many owner’s minds. It seems as if almost every horse is on an ulcer medication in some shape or form. Gastrogard® and Ulcergard® tubes seem to be almost a staple in every tack box. We have a problem, but are we addressing it correctly? What are the causes of the GI distress and is there something more we can do to assist our equine companions to adjust? Or are we destined to just continue the expensive dance of anti-ulcer medications? Let’s take a different look at the problem and see if we can produce some answers.
We’ve already established that stomach ulcers are a problem in the equine performance horse. This is evident by the high dispensal rate of ulcer medications in the veterinary industry. It has been estimated that as much as 90% of the performance equine population is impacted by ulcers. In the recent past few years, we have also noted a rise in hindgut conditions ranging from acidosis to ulcers to irritable bowel syndrome. There is a problem and any veterinarian or competitive horse owner can tell you this. We’d love to reduce the use of these medications as they are not only expensive, but do carry some inherent risk in regards to health. We see them in one light, in regards to helping to reduce acid secretion which may encourage healing of ulcers, but on the other side, their continued use has concerns. If we truly want to get off of these medications, reduce cost and improve our equine companion’s health and performance, we must understand the causes and realize there are better ways to address the problem.
Gastric ulcers in human are generally associated with increased stress levels. It is true that some foods can encourage the problem and in some instances, there is a connection with a certain bacteria, Helicobacter pylori…but the underlying condition is often stress with secondary increased acid secretion in the stomach.
Now, we have stress and increased acid secretion, but in the normal situation, the stomach lining should be able to endure. The stomach is generally divided into two regions; glandular and non-glandular. The glandular portion of the stomach is responsible for acid section but also is protected through bicarbonate and mucous secretion. The non-glandular portion is generally the upper portion of the stomach and does not produce acid. It is also more susceptible to irritation by the acid and thus, generally, ulcers develop within this region.
In the average horse on pasture, food or roughage is taken in consistently throughout the day along with a continuous flow of acid by the stomach. Despite the continuous production, the acid is often ‘neutralized’ to an extent by the constant presence of foodstuff in the stomach. In a horse that is stalled and fed twice daily, the acid secretion is still present but there is less buffering due to inconsistent foodstuff present in the stomach. Thus, there is often more acid present in the stomach relative to the foodstuff and irritation can and does occur. When you combine this with increased stress levels in a stalled horse or horse in training/competition, the acid secretion can be even higher. Cortisol may also be elevated in these patients, which may actually contribute to the breakdown of protective mechanisms against ulcer development. So, essentially, we have a myriad of problems which are often ‘man-made’.
Stomach Ulcer Contributors:
- Restricted feeding/no pasture turnout
- Stall confinement
- High reliance on grains
Stomach ulcers are a major problem, but what about hindgut concerns?
In the past decade, hindgut problems have become more prevalent. It is not uncommon to have a diagnosis of hindgut acidosis, hindgut ulcers or even irritable bowel disease contributing to recurrent colics, gas production, loose stools, weight loss, poor performance and even diarrhea. Sometimes these diagnoses can be challenging to make and often require extensive fecal examiantion, colonoscopy and biopsy.
- Ulcer medications
- Gastric protectants
- Specilized diets
Despite these treatment approaches, it is rare to find a patient that thrives and fully recovers without suffering still with the problem on some level, often requiring expensive medications on a daily basis. We seem to have all sorts of expensive equipment to make these diagnoses and get some really neat images on our computer, but in reality, this technology has not assisted us in improving the treatment or prognosis.
Specialized diets and a daily dose of ulcer medications is not the answer, for if it was, we would not be continually evaluating these patients and horse owners would not be constantly looking for more viable options.
New Approaches & New Ideas:
Again, in order to fix the problem we need to understand it better. First, we do need to realize that the majority of the ulcer and hindgut problems are man-made. Given this, it is up to us as ‘man’ to fix the problems we have created. We need to step back and take a good look at what we have done or maybe what we have not done, which has contributed to the problem development.
First, stress and stall confinement need to be minimized. A horse needs to be turned out and even better, allowed to socialize with other horses. They are social by nature and when we deprive them of this, stress builds as do behavioral problems. They are also designed to continuously eat and again, problems will develop when we deprive them of this inherent characteristic. By confining a horse to a stall day in and day out with little turnout, it is no wonder why we have so many problems.
I do realize that many are fearful of turnout, especially with a top level competition horse, but often this fear is unwarranted. We are afraid of injury or worse, but in reality, injuries will and do happen no matter what we do. A horse on pasture is actually less accident prone from my perspective than one that is confined and restricted. A horse on pasture, even for short periods, actually has lower stress levels and overall better health as well.
Stress can be managed and if the daily regimen cannot be changed, then we need to look at ways of reducing the impact on health, which also impacts performance and soundness. A horse under stress has higher cortisol levels, which impacts health and even predisposes tissues to injury. Cortisol is a catabolic steroid, inferring that it contributes to the breakdown of tissue. How can we reduce the impact of stress on the body? Ulcer medications are not the answer. We need to look to food, specifically herbs, to reduce the impact. A certain group of herbs termed adaptogens are especially beneficial. One in particular that we use often is Ashwaghanda in a concentrated, low dose extract. This herb has been shown to reduce cortisol levels, reduce anxiety and even support healthy nerve function. Ashwaghanda also provides potent antioxidant properties, which supports healthy cellular function. A particular product that we use is called Cur-OST® EQ Adapt & Calm. It is a low dose formula of a concentrated Ashwaghanda. In most cases, we see general improvement within 7-10 days on a once daily dosing regimen. Well accepted by most horses and quite effective.
Despite the use of adaptogenic herbs, we do need to realize that the stress response impacts cellular function and contributing to inflammation. This then can impact other areas of the body, aside from just the ‘gut’, but also negatively impacting immune and even joint function. Given this, it is not uncommon to use other Cur-OST® formulas to help curb or balance that inflammatory response and improve overall cellular health.
Second, we need to realize that the daily use of prescription ulcer medications is not a good thing. Even with the human medications, it is advised that the products be used for short term relief of acute problems. There is a reason for this. First, the use of these medications may cover up a more severe underlying problem. Second, chronic use of ulcer medications is associated with reduced absorption of certain nutrients including magnesium. Third, in some cases, overuse of ulcer medications is also associated with overgrowth of potentially harmful bacteria in the gastrointestinal tract. It is not a wonder in some cases that we also have behavioral problem that may be related to low magnesium levels. Instead of seeing the big picture, we are more inclined to continue the medications and just supplement with magnesium. There is also concern over other nutrients being poorly absorbed due to lowered acid secretion, which may actually contribute to poor cellular performance, poor haircoats, weak hooves and even weakened tendons.
Third, we need to realize the importance of the gastrointestinal tract and how overall health is connected. Many of us may view the ‘gut’ as just being an organ that digests food and absorbs nutrients, which is true, but there is more to this story. The gut is ‘home base’ for the immune response. What happens there, in regards to immune response, is often then reflected througout the body. Horses with various health conditions ranging from allergies to laminitis have recently been explored with an ever increasing connection with gut health and normal function. In research, it has been noted than in certain health conditions in humans there is an evident shift in bacteria within the gut. This holds true for horses as well. The gut has a normal balance of bacteria, which is essential for optimal digestion, nutrient absorption and immune function. In metabolic horses with laminitis, research has indicated that these horses demonstrate an overgrowth of a potentially harmful group of bacteria referred to as lactic acid producers. This same bacterial shift is common in horses with ulcers and hindgut concerns. In some instances of persistent diarrhea and colic, some horses have demonstrated higher levels of not only this group of bacteria, but potentially more harmful ones including Clostridia and even Salmonella. This shift or overgrowth is not something they contracted from food or the environment, but is more so a natural shift as a result of extrinsic factors such as stress, medications, processed foods and low quality food sources. In humans, there is a strong association with processed foods, so in horses the concept should be no different.
The concern with this bacterial shift is that it may not only be reflective in poor digestion and nutrient absorption, but it may also manifest throughout the body as an increased level of inflammation. This constant low level of inflammation then may contribute to metabolic disorders including insulin resistance, laminitis, allergies, immune related problems such as Lyme or EPM and on a basic level, poor nutrient absorption and weakened tendons, hooves and hair coat.
Our instant response to this problem is probiotics, which is natural due to the mass marketing that we are exposed to. In reality, the jury is out on probiotics. Many of them simply provide lactic acid producers such as lactobacillus. Lactic acid bacteria are normally present in the GI tract of the horse, but in very low levels. It doesn’t make sense to supplement or increase the levels of something that is normally low. Some horses may benefit, while in other situations it could prove detrimental.
Looking at the big picture, stress and the stress response is one of the main culprits. This stress response can be systemic or localized, impacting the gut in many of the cases. We can manage the response and its impact on the body with a variety of herbs and formulas, including Cur-OST EQ Total Support, EQ Adapt and the EQ Stomach blend. These are by far the most common three that we use in our personal horses and patients.
Overall, the gut in the horse is more than just a digestive vat for food. It’s normal function can make or break a horse in regards to health and performance. It is a complicated system, but one thing is for sure, we should listen to our horses and see the problems on a whole new level instead of just covering up the symptoms with medications. Each symptom is essentially a call for help, a warning sign. It is up to us to recognize them and seek guidance for the best possible outcome. I do promise you that if the condition is remedied correctly, not only will your veterinary costs be reduced, but your horse will perform on a whole new level.
All my best,
Tom Schell, D.V.M.