If your horse has a cresty neck that won’t go away, seems to gain weight easily, or has had an unexplained bout of laminitis, Equine Metabolic Syndrome (EMS) may be the underlying cause. EMS can be misunderstood and understanding what it is and how to manage it, is the first step toward keeping your horse sound, comfortable, and healthy for years to come.
What is EMS?
Equine Metabolic Syndrome (EMS) is a group of related problems that can often show themselves as:
- Obesity or abnormal fatty deposits (e.g. cresty neck, fat pads around the top of the tail)
- Insulin dysregulation
- Laminitis
EMS can affect horses of all types, although some breeds and individuals may be predisposed. Why some horses develop EMS while others don’t is still not completely understood.
What happens in an EMS horse?
At the centre of EMS is insulin dysregulation (ID). Insulin dysregulation is when the body isn’t able to produce or respond normally to insulin. This leads to elevated insulin levels and decreased sensitivity to insulin in tissues such as muscle, fat and liver. This can contribute to signs including general obesity, cresty necks and abnormal fatty deposits, as well as an increased risk of laminitis.
For a closer look at exactly how insulin dysregulation develops and how it drives laminitis risk, see our article.
EMS vs PPID/Cushing’s vs ID
Often when EMS is mentioned, it can be confusing to understand the differences between Equine Metabolic Syndrome, Pituitary Pars Intermedia Dysfunction (PPID; Cushing’s disease) and insulin dysregulation. Often the terms are used interchangeably, and clinical signs and management strategies can overlap, but they aren’t the same thing.
- EMS is a broader metabolic syndrome. It’s a combination of insulin issues, fat metabolism changes, and elevated laminitis risk.
- PPID is a distinct hormonal disorder caused by dysfunction in the pituitary gland, typically appearing in older horses. Typical symptoms can include long coat, abnormal sweating patterns, excessive water intake and urination.
- Insulin dysregulation is the specific breakdown in insulin and glucose regulation that can occur as part of either EMS or PPID. It’s the mechanism, not a standalone disease.
Insulin dysregulation is the common thread connecting EMS and PPID, and it’s the piece most directly responsible for laminitis risk in both conditions. When a horse has both EMS and PPID at once, it can greatly increase their laminitis risk. Each diagnosis calls for a different management approach, which is exactly why veterinary intervention matters more than guessing based on appearance.
Horses at risk
EMS can affect all types of horses, but there are some horses that are more at risk.
- Breed: Ponies, Spanish breeds, Morgans, Miniatures, Warmbloods
- Age: Commonly middle-aged horses
- Body condition: easy doers, overweight ponies and horses
Signs and symptoms
Not all EMS horses will show the below signs and symptoms. It is important to contact your veterinarian to help with an EMS diagnosis.
- Increased and abnormal fat deposits
- Cresty neck. For a closer look at the impact of cresty necks and stubborn fat pads, see our article.
- Fat deposits above the tail head and shoulders
- Difficulty losing weight
- Laminitis
Why EMS Increases Laminitis RiskÂ
For most owners, laminitis is the outcome everyone is trying to prevent.
It is a major part of EMS, and is the crippling condition caused by weakening of the tissues (laminae) anchoring the hoof wall to the bone. Laminitis can be life threatening.
Laminitis can be:
- Low grade or severe
- Intermittent or sudden
- Triggered by diet management
Read our full breakdown into laminitis and how it impacts your horse, see our article.
How is it diagnosed?
EMS can’t be diagnosed from appearance alone. Diagnosis requires veterinary intervention.
Your vet might evaluate insulin levels, glucose levels, body condition, history, and diet, exercise and management plans.
Your vet might also test for other conditions like PPID, to help with their diagnosis and recommended treatment plan.
Managing a horse with EMS
There is no cure for EMS however daily management strategies can significantly help the health of your horse. These management strategies often include diet, exercise, medications, supplements and environmental changes.
With the help of your vet and a qualified equine nutritionist, the overall dietary goal for EMS horses is to reduce daily non-structural carbohydrate (NSC) intake. This can be through choosing low NSC feeds and also monitoring pasture access.
Feeding an EMS horse can be complicated. For this reason, we have developed a guide on how to feed a metabolically challenged or laminitis prone horse.
To help with body condition and insulin sensitivity, frequent exercise is a key management strategy, especially for horses that are easy doers. An exercise program should be tailored to the horse’s current health and body condition, particularly following a recent laminitis flare-up, as the appropriate starting level may differ from that of a healthy, sound horse. To assess progress, regular body condition scoring can help identify positive or negative changes over time.
In some cases, particularly when diet and exercise alone aren’t enough, your vet may recommend medication to help manage the health of your horse. This medication program might be short or long term, depending on your horse’s condition.
Targeted nutritional support in the form of a supplement designed for metabolically challenged horses can help support and enhance current EMS management plans. PROTEKMDTM has been formulated to support healthy metabolic function by addressing the key drivers of metabolic health. PROTEKMDTM is designed to be part of your horse’s broader EMS management plan.
Find out how PROTEKMDTM can support your metabolically challenged horse.
Small changes to your horse’s environment can meaningfully help. These changes might include the introduction of a grazing muzzle under veterinary guidance, the use of slow feeder hay nets, allowing pasture access during low NSC periods or using tracking systems to control forage intake.
Long term outlook
EMS is common, manageable and often misunderstood. With consistent management strategies, an EMS horse can live a sound, active life. Understanding the connection between insulin dysregulation, fat metabolism, and laminitis risk gives you the tools to catch warning signs early and make informed decisions with your vet.
Photo credit: Blue Cross.
