ECEIM Consensus Statement On Equine Metabolic Syndrome

The European College of Equine Internal Medicine (ECEIM) issued a consensus statement on a problem affecting a lot of horses called in general, Equine Metabolic Syndrome or EMS. I want to summarize here some of the key points and then add my 2 cents.


The following points were made about EMS some of which I found shocking. Obesity was defined as increased body fat that has a negative effect on the health of the horse. Most horses with EMS, but not all, are obese.

• EMS is more common in sedentary horses.

• EMS is most common in Shetland ponies, donkeys and miniature horses.

• Insulin levels were higher in older horses and ponies.

• Obesity ranges from 21% to 45% in the United Kingdom.

• Obesity is in 10% of Icelandic horses in Denmark.

• Obesity is in 8% to 29% of horses in Canada.

• Obesity is in 24.5% of Australian pleasure horses and ponies.

• Obesity is in 51% of mature light breed horses in the US.

• Thoroughbreds were the least likely to be obese compared to draft-type, cob-type, Welsh, Shetland, Rocky Mountain, Tennessee Walker, Quarter Horses, Warmblood and mixed breed horses.

Isn’t it interesting that over half the mature light breed horses in America are considered obese? This is more than any other country. I have also noted that the number of horses I see today that are ill or lame is greater than compared to 30 to 40 years ago. A coincidence?

Oh Gosh Everybody – Here I Go Again!

During the last year I have taken away the illusion of complexity that surrounds feeding horses. It has been more difficult than I thought. One reason for this is the excellent marketing of misinformation. The second reason is that most of the horse owners I see say, “I will do anything for my horses.” Unfortunately doing “anything” has become “everything” with the vultures praying on these individuals with feed and supplements that at best do nothing for their horses. At worst it makes them fat. And fat means inflammation and inefficiencies in the body systems.

Last week I introduced the liver and its important role in filtering the blood. Blood from 70% of the gut, with all the sugars, fats and proteins, goes through the liver before it goes into any other part of the body. I introduced the phrase of “liver overflow.” In essence, there is too much fuel entering the liver and its capacity to use it is overwhelmed. It is like a sink with a limiting drain being filled with a fire hose. Eventually the water overflows the sink. In the liver, all parts become saturated which leads to inefficiency in fueling the body as well as distributing protein needed to make the horse operate. This leads to illness and dysfunction of systems.

The fire hose in the horse is owners feeding every day too much food. Forage, grains and supplements are abundant, hand delivered to our barn and stacked neatly with just a simple phone call. It is ruining our horses. In the wild all horses and in fact all animals have a season when food is not as abundant. They are supposed to use the body fat for energy. They eat “poor” pasture which is actually a high fat diet. Remember that fat has 20 to 28 times more energy than sugar so they don’t need to eat as much. When the summer grass returns the horses gain body fat because….. winter is coming.

Missing From The Report

I was very disappointed in the ECEIM consensus report because only a few sentences were devoted to protein. They said, “Ensuring adequate protein, vitamins and minerals is important via a ration balancer supplement.” Yikes! I wrote about a national ration balancer in my blog “Betrayal!” Worse, the report never mentioned how much protein a horse should be getting (read “Chronic Protein Deficiency In Horses“). Studies in horses and humans both show the importance of adding protein to reduce fatty liver and fat in the blood (hyperlipemia). Guess what is found in all horses with EMS? They have hyperlipemia.

In essence the report suggests to starve the horse by removing all grain (yea!), muzzling, restricting hay and pasture, soaking the hay in water (with caution) and increasing exercise. If I were a horse then just shoot me rather than starve me! There is nothing worse than starving a horse. Yet in my experience, horses with an adequate protein intake decrease their appetite and they naturally lose weight. They also add top line, flatten their hay belly, improve their hair coat, skin and hooves and have a generally more improved outlook on life.

I cannot understand why chronic protein deficiency is not being addressed at professional meetings. It is the missing link and was missing in this lengthy report on EMS.

What was clear in the report was that there are a lot of fat horses out there. And half of the horses in the USA are considered obese. Can you say epidemic?

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Comments 35

  1. As always, excellent article. I have a horse with cushings (Friesian 18 years) and a Q-horse (0ver 28) boarder with the same. Both do not have EMS. Both are 4-5 on a 9 BCS, no crest, and have a bit of trouble shedding out. No real symptoms at all. But these are the factors that have kept me up to date with EMS info. I know of one EMS morgan gelding and the owner has found certain hay cubes to help. You are right though, nothing on protein. There is a graph available for these horses that might interest you. As I am not a nutritionist, which of these listed items would provide the protein? My herd eat hay and in the winter, alfalfa hay cubes soaked. The cushings horses of course get pergolide.

    1. Post

      Chris – I sit far outside what all my colleagues say about EMS, IR, ID, PPID and others. I dig deeper than the “how to treat” aspect and look at the better question – why did this happen?

      It is common for these horses with excessive fat to be hungry all the time. Why? Because they are looking for something they are not getting and for my thinking, the missing thing is protein. Research shows that higher protein intake along with resistant starch is recommended in humans, horses, dogs and cats with high fat levels in the blood and for non alcoholic fatty liver disease. This actually curbs the appetite which allows the people / animals to clear the liver and reduce body fat.

      Horses willing to go on the no grain diet and then supplement with soy bean meal after the gut inflammation subsides find that the bellies disappear, the top line fills in, hunger is satisfied, hair and hooves improve, disposition improves, pergolide is reduced or eliminated, non-sweating horses sweat again, and more.

      There is no down side to adding protein until the amino acid levels are restored in the body (6 to 24 months depending on the age and severity).

      The ECIR website, as you say, doesn’t mention additional protein. I have read somewhere that the protein content of soaked hay may be lowered as well as the sugar. These horses on the restricted and soaked hay diets are unhappy. Additionally, hay is a processed feed and soaking it is an additional processing step taking it another step away from natural grass.

      Wouldn’t it be nice to replace our fear of sugar in fat horses with actually fixing the underlying problem? Better yet, let’s prevent the problems in the first place and reduce the obesity epidemic in our horses.

      1. One question I have, is the topline going to fill in on an older horse who is not not being exercised as much anymore?

        1. Post

          With every step the top line is exercised. But if the materials aren’t there to build the muscle or if the muscle continues to be converted into fuel to survive then the top line will never return even if the exercise is increased.

          All the horses who have eliminated gut inflammation and have added protein experience improved top line and a reduction in the Hoyt belly (increased abdominal muscle tone) WITHOUT added exercise.

      2. Way back when, last fall maybe, you wrote about the no grain diet and I wrote you about my boarder (who has the cushings). I went no grain and all the problems with his gut went away. It came back though, and now he gets a supplement which has helped again. He gets a leaky gut in the winter on hay, but is great on grass. Here in Southern Ontario that means hay until June at least.
        Either way, the question is what can we give horses that is a protein? In humans, meat, beans etc can get the protein. What supplement should a horse have to get protein in their diet while on a no grain, hay only feeding schedule?
        I agree that soaking the hay can get rid of the protein and I always do a hay analysis. In the past years it has not been great for protein. This was the latest report Protein % (N x 6.25) 11.49 ..10.27. So not wonderful for here, although in 2013 it was Protein % (N x 6.25) 9.55 8.41.
        All thoughts are appreciated.

        1. Post

          I have several blogs on protein for horses. Here is the best one:

          Please read all the protein blogs on my site. My clear choice is soy bean meal (SBM), Soy beans are a legume and not a grain. They give all of the amino acids a horse needs to consume and 80% of what they eat is absorbed.

          I have heard about some horses who get diarrhea on hay. Remember that hay is a man made substance that is really processed summer grass. any hays are now sprayed with glyphosate to help dry it for mold prevention. You could try to find organic hay with no preservatives. You could also try to purchase better quality hay from a different hay dealer of from a known local hay maker. You could also try feeding reduced hay plus added hay cubes or bagged chopped hay from someone like Standlee (Google for a dealer).

          You should also consider using Succeed during the hay giving months. This product I wholly endorse for leaky gut and hind gut ulcers. Use as directed.

          But adding SBM is really the first step in bringing back the horse to a more normal state. For reasons stated in my blogs I believe a chronic protein deficiency is at the root of most disease and soundness problems we see today in horses.

          And there is nothing like a field of wild grass – the elixir of life for horses.

          1. my pasture is primarily fescue grass and the baled hay we feed is fescue . I limit summer pasture for my POA pony, mini Horse and mini donkey. I feed soaked Timothy pellets am/pm to add herbs for Adrenal/pituitary support. I have problems with big bellies in the mini Horse and donkey, laminitis in the pony and big belly on my horse an Arabian. Any advice.

          2. Post

            Add soy bean meal as a protein source. This will eliminate the big belly and will decrease their appetite so they are no longer hungry all the time. Most people report that the big hay belly is gone in about 1 to 2 months.

            Adding protein will also help strengthen the hooves which should help with laminitis hooves.

            Please read all the nutrition blogs on my site here: It is a lot to go through but if you take the time you will get the results you are looking for.

            Thanks for commenting and reading this blog.

          3. Are you giving your horses that have Cushings and laminitis Prescend or only herbs? Just giving them herbs is not going to get the problem under control and the Cushings will progress.

          4. Post

            I don’t practice that part anymore. I just do teeth. However I suggest to my clients with horses diagnosed with Cushing’s to understand that it is a neurodegenerative disease. Pergolide is a dopamine agonist. Then I ask them WHY does their horse have a degeneration of the nervous system and then I ask if they realize that they are treating with a neurotransmitter. And neurotransmitters are PROTEINS.

            Sever horses that stop the gut inflammation and add protein are telling me, with the help of their veterinarian, that they retest their horses and get them off pergolide. More research needs to be done here but I was very glad this year at the AAEP conference when they called PPID a neurodegenerative disease.

          5. Thank you again. I have read the article and will be purchasing the SBM from our local feed supplier today. I checked with my nutritionist who likes this product, plus my farrier who uses this on his barrel horses. 🙂

            I presume you know, or know of Don Kapper. He has done a lot of work on protein in horses and totally supports your points on protein and topline.

            As the weeks/months unfold I will continue to keep tabs and report back.

            Many thanks again, hope the weather where you are is warming up, we are at 1C today and up to 15C on Wed. That is a lovely way to melt all the darn snow!!

          6. Post
          1. Post

            The best place to start is on this blog: The picture of the manure on the wall tells it all.

            Another would be .

            All the other blogs at will fill in the missing pieces. I also have the University course on feeding horses which walks you through all the parts involved in Micronesia dysbiosis and leaky gut –

  2. This coincides with all the obese people in this country now. Most people’s dogs are obese too. There is an epidemic of obesity in this country.

    1. Post

      There is an epidemic of carbohydrate overload. Just look at any convenience store. All sugar and little good quality protein.

  3. I am still grain free, forage only diet for my horses since Sept. We are all happy. Thanks, Doc.

    1. Post
      1. Do you or anyone have any information on getting nonGMO soybean meal. Also, what is the best form of Vit amin E to give your horse?

        1. Post

          We googled non-GM SBM and found a bulk dealer in the US. Others in the NW have found local sources after hunting for it. My thoughts on GM SBM use have been described in other blogs here. If you look at the problems evident in horses from chronic protein deficiency as something that needs a “treatment” then the use of any SBM for 1 to 2 years becomes acceptable. In other words there are much more severe and present dangers of many of the medicines we use in horses (bute, antibiotics, ulcer meds) but the cost to benefit ratio leans towards their use in many situations. 3 months of antibiotic use in my son plus 1 anesthesia saved his life but he paid a toll for over a year. There are no outward signs of glyphosate problems or GM problems in horses but there is mounting evidence that including SBM for a year or two has huge rewards.

          The vitamin E supplement should use the “D” form and not the “DL” form.

          Both of your questions were asked and answered on the blog “A Question About Soybeans.”

      2. Finally got a feed store to order SBM for me. I feed a total of 1 cup /day/horse along with alfalfa pellets & Cool Stance.

        1. Post

          The dose I recommend is 1 pound SBM per day for horses weighing 1000 to 1400 pounds. Adjust for the horse’s weight if different. Also young horses may not need as much while very old horses with severe top lone loss may need 2 or Morse pounds per day for a while.

          Adding SBM is temporary at this dose. Your horses may need 1 to 2 years of supplementation. When the urine starts to smell of ammonia you will need to reduce the amount.

          I like the diet you are feeding but Coolstance is an added non-inflammatory fat and protein source. You probably don’t need to feed the Coolstance in the summer if there is good pasture available or if your horses gain too much fat. Also the SBM provides all the essential amino acids so the amino acids in the Coolstance will be redundant.

          Reducing the amount of SBM plus continuing Coolstance is also an option but keep an eye on their body fat and adjust according to that.

          1. Can feeding coolstance plus vit/mineral without sbm be enough? Of course , plus forage. My guy is fat but doesn’t do soy.

          2. Post

            Coolstance is a great way to add or keep fat on a horse. It also has amino acids. But historically soy bean meal works the best.

            I’m not sure what you mean when you say he doesn’t do soy. Whole;e soy is not soy bean meal. Almost every horse loves to eat it and I have had zero adverse reactions to it in horses. There are a few who turn up their nose. For these just give a handful mixed into some dry or moistened hay pellets. It is cheap. Continue to offer this small amount until he changes his mind. The few who have said no to SBM in about 2 weeks love it. Let us all here know if that works.

          3. Hi Dr. T,
            So since soy has lectins, are horses sensitive to lectins like people can be? Since it looks like lectins can be a culprit in leaky gut in people. Thanks for your work!

          4. Post

            I agree that all plants have lectins. But horses seem OK with legumes as a class of plant. In addition, lectins are found in the outer areas of seeds and beans. In SBM, the outer layers have been removed.

            I have not seen any gut inflammation in horses caused from SBM as far as outward appearances. Only a postmortem exam with histopathology of the gut wall would tell us for sure.

  4. My only concern is what about cortisol??? Studies are showing that severely restricting forage causes spike in cortisol. Horses hang on to the weight we are seeking to decrease. All of the vets talk about starving these horses. Thoughts?

    1. Post

      Hi Beth! I agree. Starving any animal would lead to increased stress and therefore cortisol including humans. By adding the protein you would be satiating via natural hormone feedback (ghrelin and leptin). The horses stoop eating on their own because they are no longer looking for “something” that can’t be found in a starvation diet. This, along with removing all grains, causes the horse to remove body fat, liver fat and maintain muscle and other proteins no longer belong converted into fuel.

      The addition of protein is documented in Dr Diver’s AAEP talk on the liver 2 years ago and is also echoed in human medicine. Yet who is listening?? You are and so are the others reading this blog. Time to share! And thank you so much for commenting here. I hope winter is being kind to all at the farm.

  5. Hello Dr T,

    I am officially 4 weeks of zero grain. This approach made sense to me, I am generally a less is more, but had begun to slide down the scoop of this, that, and the other rabbit hole.
    The information on the Calcium Carbonate, and elevated calcium in feeds, which blocks the absorption of protein and magnesium was enlightening. (100 wat light bulb moment)
    After reviewing every label in my feed room, then making contributions to the garbage can, I spent the last few weeks browsing ingredient lists of the different feeds available, along with supplements, and treats.
    Also, reading about the other/better calcium supplements the feed manufactures could use instead of calcium carbonate, and have concluded, it is about price and saving money.
    In addition, the use of Zinc Oxide as an additive. Zinc Oxides is great if you don’t want a sunburn, but taken orally, isn’t bio-available. A quick search will give you an idea of the 7 different Zinc supplements, which are more or less bio-available, big surprise Zinc Oxide is also the cheapest to purchase. (all these years I naively trusted the feed industry)

    I will be honest, I didn’t expect to see much difference in my 3 horses, mainly because I didn’t feed much grain due to owning easy keepers.
    We are at 30 days no grain, no sugars, and on 1pound SMB and 1pound Alfalfa and Timothy pellets. Using, Alfalfa/Timothy Cubes broken into smaller pieces for “good boy” treats.

    The 3 horses run 12 acres with Coastal pasture, have access to a 40X60 3 sided barn with 6-8 inches of shavings, and I keep a Round Bale in the Barn, a convince, it is protected from the weather, sometimes it rains 8 days straight, the horses have the option to stay dry, and still eat.
    They are only locked in 3 hours a day while I ride. Having an open and airy shelter, I have, at times been surprised of the urine smell. Around 15 days of no grain, basically no smell. Wowza!!!!!!

    1st- 12 yr old Swedish WB mare 16.2 h 1325 pounds of Queen-Bee attitude, Eventing is our game. Received 1-1/2 pounds of 14% (low starch) 2 times a day. She is a very sensitive, hot, chestnut (red head) with many opinions, and believes there is a” boogie man” behind every blade of grass, jump judges sitting in the shade have proven more of an obstacle than you can imagine. Still bold over fences…go figure.

    15 days into the no grain life. I can say, many of the” boogie men” have vacated, and now, when something startles her, I can feel her thinking it through, and deciding not to react. Huge!!!! insert, slow clap.

    2nd- 7 yr old Half Andalusian/Friesian gelding 15.3h 1350pound easy keeper, and basically all Unicorn, super easy to train, tries hard to please. Received 1/2 pound 14% (low starch) 2 times a day. Sadly he foundered, I actually believe from protein deficiency. Emaciated when I purchased him at 14 months old.(there is a story here, not sure sharing is needed)

    30 days no grain, plus SMB etc. He has visibly lost tummy. This is also Huge!!!! and of course he is not being worked, moving around the 12 acres is his only exercise, currently busy growing a new hoof.

    3rd- 6 yr old Dutch/Friesian cross gelding 17h 1450 pound easy keeper, with PSSM, one of the…no, the hardest horse I have every started or ridden, super athletic, with a buck that launches me into aerospace, doesn’t have much try, not wanting to go forward. Learns fast in hand though. Received 1/2 pound 14% (low starch) 2 times a day. To be fair, he had surgery as a foal, I am going to assume his Gut Flora has never been good. I suspect he needs more than 30 days, to develop a health hind gut.

    30 days no grain, etc. Lets be honest, 1/2 pound 2 times a day isn’t much for a horse this size, it was more of a way to deliver electrolytes, the mare needed her 3 pounds to keep her curves, and they are all fed in a group, giving 1 grain and not the other 2 would be a little hard. As I said, I think he needs longer to repair his hind gut, that being said, I feel a little more “Try” under saddle, and over all, generally seems a bit more…content. Hoping to see more improvement over the next few months. If he becomes a stand up citizen, Dr. T you will be the first to know!

    None of the horses have lost topline during this change, I do supplement with a pure Amino Acid, the 10 EAA plus Glutamine for muscle building and recovery. I do hope my founder boy will continue to lose fat.

    I see these changes as significant, for a couple of reasons.
    a) Not feeding much grain to begin with. This seemingly small adjustment, that delivered results should not be dismissed. I can only imagine what people observe who had been feeding larger quantities of grain.
    b) Also found hidden sugars and wheat middling’s, in many things that are now no longer in my feed room. (kind of grieving for not studying sooner, I am so careful about my own diet, why did I trust a feed manufacture)
    c) The lack of ammonia smell is such a wake up moment, and major bonus.

    Of course I am excited about learning more, and have shared this with others. As expected, couple of friends have been interested. Now for the “intrigue” the response from a few people, who for a moment, considered not feeding grain for 14 whole days, I am pretty sure I saw a panic and horror flash behind their eyes. As you said in this article, marketing has done an excellent job!

    I can’t thank you enough for sharing knowledge, much gratitude! Looking forward to how they develop in the next 6 months.

    Save travels,

    1. Post

      Thank you Rebecca for trusting and trying and then sharing not just with your friends but with everyone reading this comment here. I am the one who is grateful – and so are your horses.

      I often ask, “How much gluten do you feed a person with celiac (gluten intolerance).” The answer is none! So it’s not how much grain you feed a horse but for many, it is ANY grain.

      Isn’t it nice not to see the fever in them at feeding time?

      There is no test to find out if the horse is getting enough protein. You just need to look at the horse in several different ways I have discussed elsewhere. You say you are supplementing with an amino acid mix. While they say there are all 10 essential amino acids, are you feeding enough? Reading the label and then multiplying the amino acid concentration times the amount of the supplement you are giving will tell you how much of each EAA is being consumed. However it does not tell you how much is being absorbed. Additionally there are no minimum values for EAA requirements. This is why I recommend the time tested feeding of soy bean meal (see the several blogs on this). It is 80% bioavailable and 1 pound a day for a 1000 to 1400 pound horse seems to work well. It is basically feed to effect which is about 1 to 2 years.

      Thank you again for this report and sharing it with others. We all look forward to future reports. I also hope your friends will try it. It costs nothing and it’s just 14 days.

  6. I have a friend with a shellfish allergy. Though she was initially very sceptical that removing grain could have the impact it has on my horse (was dangerously explosive, went no grain six months ago and have not had a single explosive incident in those six months), she said something that has stuck with me and has helped me explain the impact of grain to others, and helped me commit 💯 % to no grain and no added sugars:

    If you are allergic to shellfish, it doesn’t matter if you have a pound of shrimp or one single shrimp, you still get sick!

    I think that explains the changes Rebecca has seen with her horses. They weren’t getting much grain, but even a little was still upsetting their system. Removing it ALL got the results!

    1. Post

      I often ask how much wheat can a person with celiac disease eat? The answer is none.

      As you say here, it’s not “just a little,” it’s “any” that can cause inflammation. It is also why the overlay of genetic individuality that determines why some horses are more sensitive to the same food – why there are easy and hard keepers. The bottom line is if what you are feeding isn’t working, keep removing until it does. Don’t keep adding things hoping to find something that works.

      Thanks for your comment!

  7. My crew has been grain free for several months now after doing the 2 week no grain challenge and then adding in the soybean meal. Both of my mates look great and I’m liking the changes I’ve seen in one of their work ethic. She still has a way to go, but we’ll take progress over perfection. Now that the grass in full bloom, one if my mares that has a tendency to get very fat and have fat pockets is headed that direction again. In the past I have kept her on animed remission to try and assist with this issue even though she has never been laminitic. We did blood work last year and thyroid levels were in normal ranges. My mates stay out 24/7 for the most part, but I’d sure love if she wouldnt get so fat with the fat pockets on sides and tail head. She gets a good bit of exercise 5 days a week either ridden or lunged at least 15 minutes, mostly at a lope, jogging to warm up and cool down. Any advice other than dry lotting her with plenty of hay to assist this? She currently gets no supplements or anything other than the soybean meal and grass. Thank you for all you do! Always enjoy reading the blogs.

    1. Post

      Some horses live on air, so it seems. The important thing is to keep up the protein so the liver fat becomes mobilized. Many ravenous horses become satiated after being on the SBM for about 1 to 2 months. You may find her resting more and consuming food less.

      Is there a way to increase her exercise? For humans the best exercise they say is High Intensity Intermittent training (HIITS) where the heart rate elevates for short periods of time. This also rejuvenates the mitochondria. Maybe 15 minutes of loping isn’t enough for her. Maybe a short burst of riding up a hill to really get the heart rate up will trigger the use of the body fat.

      The hay may have less sugar than the grass until autumn starts to turn the grass to a more dormant state. Hay plus dry lot may be the most reasonable approach until her metabolism adjusts to the no grain plus SBM. For some horses it takes longer – up to 6 months and more. It’s like they need to go through a year’s cycle before everything resets. We have more to learn but the most important point to remember is that every horse is an individual and requires a unique approach to resolving this metabolic syndrome.

      Thanks for this update. Come back and let us all know how she does this summer.

      1. Thank you so much for your reply. She is a barrel horse, so she makes runs pretty regularly. Last year I did try to do interval work with her and would jog the short sides of the pasture, gallop one long side, and sprint the other long side, but my long sides are only about 300 yards, so can be trying to get pulled up and a good speed work in. In my region, we’re pretty flat, so no opportunity for hill work, unfortunately. We will continue to try to increase work load and add some interval work back in as well. Thank you for your input. I’m loving this program and so is my wallet. My horses look great, feel great, are bright and shiny. Nice not to have to spend $25 for a bag of feed or supplement 10 different things! I will keep you posted as things progress, and hopefully as we continue this program, she will level out. Thank you for your blogs. I’ve sure enjoyed reading and learning!

Your thoughts are important for all to hear and may help others to learn from your experiences. Take the time to add to the discussion. However due to time limitations I will probably not answer direct questions to me. Thanks, Doc T

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