Vet’s 2025 Guide to Equine Metabolic Syndrome – by Dr Duncan Houston
In this article
📉 Vet’s 2025 Guide to Equine Metabolic Syndrome (EMS)
By Dr Duncan Houston BVSc
1. What Is EMS?
Equine Metabolic Syndrome (EMS) is an endocrinopathy defined by three key elements: obesity or fat deposits (such as cresty neck, tailhead, supraorbital fat), chronic insulin dysregulation, and a high risk of laminitis :contentReference[oaicite:3]{index=3}. It often affects “easy‑keeper” breeds like ponies, Morgans, Arabians, Warmbloods, and Quarter Horses :contentReference[oaicite:4]{index=4}.
2. Why It Matters
- Insulin dysregulation leads to laminitis—painful hoof inflammation that can cause chronic lameness or founder :contentReference[oaicite:5]{index=5}.
- Obesity adds strain on joints and increases risk of metabolic and reproductive issues.
- EMS overlaps with PPID but occurs in younger horses (5–15 yrs) :contentReference[oaicite:6]{index=6}.
3. Signs & Diagnosis
- Widespread fat deposits, especially crest, tailhead, shoulders, eyes :contentReference[oaicite:7]{index=7}.
- History of laminitis, hoof rings.
- Diagnostic tests: fasting insulin, oral sugar test, or combined glucose/insulin tests for insulin dysregulation :contentReference[oaicite:8]{index=8}.
- Rule out PPID with ACTH testing if >15 yrs old :contentReference[oaicite:9]{index=9}.
4. Treatment Goals
EMS isn't curable—but with disciplined management many horses thrive. Focus on:
- Safe weight loss (1–2% bodyweight/week).
- Eliminating spikes in sugar/starch.
- Increasing insulin sensitivity through exercise.
- Using medication only when diet/exercise are insufficient :contentReference[oaicite:10]{index=10}.
5. Diet & Pasture Management
- Feed 1–1.5% ideal bodyweight in low-NSC hay (<10% NSC), soaking for 30–60 min when needed :contentReference[oaicite:11]{index=11}.
- Avoid grain/concentrates; use ration balancers for nutrients.
- Restrict pasture—grazing muzzle up to 12 h/day or limit to early morning :contentReference[oaicite:12]{index=12}.
- Weigh hay daily; adjust ration monthly based on body condition.
6. Exercise & Turnout
- Daily turnout with room to move is critical :contentReference[oaicite:13]{index=13}.
- Formal exercise 20–30 min, 2–4 times/week, gradually increasing intensity :contentReference[oaicite:14]{index=14}.
- Track systems/habit trails can promote movement and metabolic improvement :contentReference[oaicite:15]{index=15}.
7. Medication When Needed
Consider medications if weight and insulin remain elevated:
- Levothyroxine: short-term weight loss boost while feeding/exercise optimized :contentReference[oaicite:16]{index=16}.
- Metformin: may reduce post-meal glucose spikes; limited insulin-sensitivity benefits :contentReference[oaicite:17]{index=17}.
8. Hoof & Laminitis Care
- Maintain barefoot or corrective shoeing; engage a farrier experienced in metabolic laminitis.
- Monitor hoof rings, heat, digital pulses.
- Address acute or chronic laminitis promptly with veterinary guidance.
9. Monitoring & Follow-up
- Track body condition monthly using Henneke scale :contentReference[oaicite:18]{index=18}.
- Blood tests (insulin, glucose, ACTH if >15 yrs) every 3–6 months until stable.
- Adjust diet and exercise based on condition and test results.
10. Prevention Strategies
- Foals from easy-keeper lines: test insulin early and practice weight control.
- Limit seasonally lush pasture, especially in spring or after frost :contentReference[oaicite:19]{index=19}.
- Weigh hay, avoid treats high in sugar and starch.
- Support body condition score around 4–6 to minimize risk :contentReference[oaicite:20]{index=20}.
11. Ask A Vet Support 🩺
With Ask A Vet you get:
- Food plan reviews and NSC hay testing recommendations.
- Personalized exercise scheduling and lifestyle design.
- Guidance on grazing muzzle use and pasture management.
- Medication planning and monitoring (levothyroxine, metformin).
- Hoof-health oversight and laminitis risk monitoring.
Download the Ask A Vet app for smart EMS management, metabolic coaching, and hoof care support through 2025! ❤️
12. Quick Reference Table
| Aspect | Guideline |
|---|---|
| Hay intake | 1–1.5% bodyweight, low NSC, soaked if needed |
| Exercise | 20–30 min, 2–4×/week + turnout |
| Grazing | Restrict, use muzzle ≤12 h/day |
| Medications | Levothyroxine/metformin if needed |
| Monitoring | BCS monthly, insulin/glucose every 3–6 mo |
| Hoof care | Track rings, engage metabolic-savvy farrier |
13. Final Thoughts
EMS requires long-term lifestyle change—not a quick fix. Through weight control, dietary discipline, consistent movement, and proactive veterinary oversight, most horses maintain comfort and function. Ask A Vet offers tailored plans, metabolic coaching, and laminitis prevention support to guide you every step of the way in 2025 and beyond. Together, we can turn metabolic risk into metabolic resilience. ❤️
