Metabolic syndrome in the horse is an ongoing problem for many owners and a focus for many researchers over the years. Despite most best efforts, metabolic related issues from foot soreness to insulin dysfunction tend to wax and wane, with most horses being chronically affected. Jiaogulan or Gynostemma pentaphyllum has gained some attention in recent years and offers benefits, however, this is just one piece of the puzzle and rarely offers true results alone. When used as a part of a larger therapy protocol, in combination with specific herbs, the results can be amplified for the equine patient with metabolic syndrome and insulin resistance.
Equine metabolic syndrome (EMS) is a complex condition and impacts a large percentage of the horse population. Most horses impacted by EMS are sedentary in nature, which heavily contributes to poor caloric burn, decreased metabolism, weight gain, and inflammatory problems. However, there are many equine competitors that demonstrate low-level EMS which is often unrecognized, contributing to foot, tendon and performance concerns.
Although there are many contributing factors to equine metabolic syndrome, which are detailed in my book ‘The Metabolic Horse‘, a high percentage of them are easily controlled by the owner. All these factors or contributors create an imbalance within the horse over time, impacting cellular function and the creation of inflammation. This inflammatory event is what then leads to all the clinical issues which are present from sore feet to insulin dysfunction. One of the main effects of inflammation is insulin dysfunction, which includes insulin resistance.
Insulin dysfunction in the equine metabolic patient is evident in two ways.
- Poor insulin receptivity at the cell surface (insulin resistance)
- Overproduction of insulin in face of a carbohydrate challenge
Both pathways can lead to an elevated insulin level and when insulin levels are above normal, insulin itself can trigger more inflammatory events in the body. This creates a viscous cycle of events. Inflammation creates the insulin problem and high insulin then creates more inflammation.
In the first scenario, insulin fails to bind to the cell receptor and allow glucose or sugar to enter the cell. This can result in higher than normal glucose levels and also deprives the cell of a much needed energy source. When this happens, cellular function is impaired on many levels contributing to poor healing, poor hoof growth, poor tendon recovery, poor circulation and the list goes on. Additionally, insulin levels will rise, given that it is not binding to the cell, and thus, inflammation goes up additionally.
In the second scenario, the pancreas produces excess insulin relative to what would be normal for a given carbohydrate meal or intake. This abnormal insulin production and secretion is likely inflammatory driven, with inflammatory proteins either impacting the pancreas itself or upsetting normal signaling pathways. In this scenario, insulin levels are high due to overproduction, which then contributes to more inflammation in the horse.
Given all this, the main focus in an equine metabolic patient should be on controlling inflammatory events and improving normal insulin function. While this may seem simple, it is not, at least for the average owner and veterinarian, mainly because there are many contributors at play. Diet, lifestyle, medications, and even supplement regimens being used can all interfere in the ability to normalize the horse. If one factor is out of whack, the whole puzzle falls apart.
Herbs and the Metabolic Horse
There are numerous herbs that have been demonstrated in research to impact insulin function and blood glucose. Amongst these are the standard herbs Curcumin and Boswellia, which we utilize very heavily as a part of our herbal formulas. In addition, there are many ‘whole foods’ which are also research supported to benefit insulin function, metabolism, and blood glucose levels which include blueberries, spirulina blue-green algae and many others.
One herb which has gained some attention in the more recent past is called Jiaogulan or more correctly, Jiao Gu Lan, which is the herb Gynostemma pentaphyllum. While there is good research to support its usage in the horse for metabolic concerns, it is quickly noted that not all see improvement or benefits, and there is a reason for this.
All herbs contain an inherent energy and target areas of benefit within the body. One easy way of looking at this would be to say that herbs and foods are either cool or warm. This inherent energy imparts some of the capabilities of the herb, as it either warms or cools the body, which then impacts various aspects of health. When you recognize these energies and utilize them properly, then benefits will come more readily. Ignore the energies and results will evade you or at worst, you could create more harm in your horse.
Gynostemma or Jiaogulan is a bitter and cold herb by nature and mainly targets the lung and heart based on Traditional Chinese (TCM) usage. Given it’s energy, Gynostemma is used to moisten the lung, dispel phlegm, clear heat and toxins, reduce inflammation, and lower blood pressures. Now, going outside of TCM, research supports that it can help to reduce inflammation and have a significant effect upon insulin function and overall metabolism. So, why doesn’t every horse with EMS benefit??
First, look at the energy of the herb. It is cold by nature, thus it cools the body. Not all EMS horses are overtly hot in nature. Those EMS horses that tend to have more problems in the heat of the summer could likely benefit more than those that have EMS related issues in the winter. One horse is more ‘hot’ in nature and the other more ‘cold’. Use a cold energy herb in a cold-natured horse, especially when used improperly, and you literally add more cold to the equation, making matters worse.
Second, another main reason may be that an improper dosage is being utilized. This is a ‘biggie’ and one main reason why many herbal regimens fail to provide benefits. Herbs must be dosed properly! Going along those lines, most herbs are never used alone but more so are used as a part of a larger herbal formula. The reason for this is to gain synergism with other herbs and also to create more balance in the blend, which benefits the horse. This is why in most cases, we never ‘hang our hat’ on just one herb, hoping to create massive benefits with just that one herb’s usage. This rarely happens in my experience.
Jiaogulan and Clinical Research in the Horse
In a recent small research trial with a handful of equine metabolic patients or those experiencing metabolic related ailments, including foot soreness, Jiaogulan (Gynostemma) was utilized as a part of a larger formula, mainly targeting insulin function and glucose metabolism. The main herbal formula utilized consisted of Gynostemma pentaphyllum, Gymnema sylvestre, and Banaba (Lagerstroemia species). All three herbs were used in extract forms, concentrating on the active components of the herb for improved efficacy and also reduced dosage. These three herbs are well known in research for improving blood sugar, insulin function and metabolism. Additionally, Gymnema has the added benefit of actually blunting the ability to taste sugars, so it reduces the sweetness drive when it comes to engorging food.
In this study of less than ten horses, close to 100% demonstrated a reduction in fasting and post-prandial blood glucose and an increase in blood ketones in both fasting and post-prandial state over a 30-day period. Now, keep in mind that most EMS horses do not technically have hyperglycemia or an elevated blood glucose, but most of them are in the higher normal range. The average healthy Thoroughbred, as an example, has a fasting glucose of around 64-75 mg/dl, while the average EMS horse is around 85-100 mg/dl. A normal range would be about 75-110 mg/dl. You can see that despite being in the normal range, the average EMS horse is higher, which is likely due to insulin dysfunction and inflammatory changes to metabolism. In our study, those EMS horses tended to shift down to around 75-80 mg/dl in their fasting glucose levels. Ketones did tend to also increase from a baseline of 0.5 mmol to around 0.8-1.2 mmol, which is a positive finding because as insulin levels decrease, ketone levels tend to increase. Ketones are also beneficial in higher levels due to impact on metabolism and cellular energy. Clinically, the horses improved additionally with positive changes noted within the first 7-10 days. They were more comfortable, less irritable, and more heat tolerant to environmental temperatures. Some were noted to have a more normal appetite, actually walking away from forage rather than engorging themselves. Insulin levels were not monitored, but based on clinical findings and ketone levels, I suspect the levels decreased and would continue to normalize over time. Overall, there was a strong positive response in the horses in the small trial.
Many equine metabolic syndrome horses also have ongoing foot soreness or pain, which is attributed to poor sole growth and overall reduce hoof health. This, of course, goes along with some demonstrating rotation of the coffin bone (laminitis) and overall poor hoof balance (long toe-low heel). The trial blend utilized did benefit some of those horses and may have benefitted them further if continued longer, but in a small percentage of the trial population, the three herb blend was combined with what is termed ‘blood movers’ or herbs that impact circulation. In our facility, we have the choice of either adding one called Arjuna (Terminalia arjuna) or another called Hawthorn leaf and berry. One is cooling by nature and the other is warming. Depending on the nature of the horse, one of the two herbs was chosen and combined with the other three. In those horses, there was a 80% reduction in digital pulses within 10 days and a marked improvement in foot soreness.
Now, keep in mind that all these herbs impact the process of inflammation additionally, but they are not the end-all-be-all when it comes to this purpose. Given this, ideally for optimal results, other herbs should be added to benefit digestion and further curb inflammation as needed. Lifestyle, diet, and other supplements and medications need to be reviewed as well, with the goal of removing other contributors and making the regimen more simplistic overall.
Clinical Research to Clinical Usage in the Horse
Where to go from here? I personally think conditions such as equine metabolic syndrome in the horse require an individualized or personalized approach. I see too many owners and veterinarians taking one approach for all patients and ending with mixed results. Even more, I see many owners adding one supplement or even medication to another, building a regimen and still failing to see improvement. Health is not cookie-cutter medicine. Every horse is different as can be every approach to improve health. There are too many factors in play and all too often, contributors are not addressed or only partially remedied. For optimal results, the individual horse is reviewed which includes their lifestyle and current regimen, then changes are implemented with targeted herbal therapies.
At this time, I have opted not to release this herbal formula as a blend which can readily be purchased, as I do have concerns about proper application. This herbal blend with or without added herbs to impact circulation will be available as a custom blend, as a part of a consultation where the horse can be reviewed in their entirety with suggestions for optimal results. I do believe, based on the research behind these specific herbs, especially in combination, that the average equine metabolic horse can be impacted positively and more so, those results could be amplified when the entire picture is addressed.
If you believe your horse could benefit from a new approach, I would be happy to assist you and review your situation. You may find a link to my consultations here.
Author: Tom Schell, D.V.M, CVCH, CHN