The Role of the Hind Gut in Laminitis

Eleanor M. Kellon, VMD

A lot of attention has been directed to bacterial endotoxins, MMP enzyme activators, and fructan or starch fermentation as factors in laminitis, but how much are they really involved?

With laminitis, it is usually hormones, not the hind gut.

In the “horse broke into the feed bin” scenario, too much starch reaches the hind gut where it is fermented to lactate. A significant acidosis develops, which weakens the lining, and allows bacteria, bacterial endoxins, and other factors to enter the circulation.

The same lining damage and bacterial invasion happen with experimental fructan overload, colic/colic surgery, intestinal infections like Potomac Horse Fever or Salmonella, colitis, and uterine infections from retained placenta. These horses have SIR – systemic inflammatory response. They are obviously very ill with dehydration, fever, elevated white count and, usually, diarrhea. In fact, most of these horses are in hospitals.

When laminitis occurs without the horse being seriously ill, and with no overconsumption of grain, there is at least a 90% chance the cause is high insulin from equine metabolic syndrome (EMS), pituitary pars intermedia dysfunction (PPID), or late pregnancy.

Why is this important? The focus in treating endocrinopathic laminitis should be on lowering insulin, not the hind gut, but many supplement sites to this day talk about hind gut factors – and, of course, sell stuff for that. There is even dangerous advice, like suggestions to feed alfalfa because it does not contain fructan when alfalfa is a laminitis trigger for many horses.

The bottom line here is that unless the horse is obviously also ill, you should be focusing on insulin, not the hind gut. For more in-depth information go to, especially the 2017 NO Laminitis! Conference proceedings, specifically: Tiered Management Approach to EMS and PPID, Endocrinopathic Laminitis: How is it Different? and Acute Care for Endocrinopathic Laminitis, as well as, Inflammation in Equine Metabolic Syndrome (EMS).

About ECIR Group Inc.
Started in 1999, the ECIR Group is the largest field-trial database for PPID and EMS in the world and provides the latest research, diagnosis, and treatment information, in addition to dietary recommendations for horses with these conditions. Even universities do not and cannot compile and follow long term as many in-depth case histories of PPID/EMS  horses as the ECIR Group.

In 2013 the Equine Cushing’s and Insulin Resistance Group Inc., an Arizona nonprofit corporation, was approved as a 501(c)3 public charity. Tax deductible contributions and grants support ongoing research, education, and awareness of Equine Cushing’s Disease/PPID and EMS.

THE MISSION of the ECIR Group Inc. is to improve the welfare of equines with metabolic disorders via a unique interface between basic research and real-life clinical experience. Prevention of laminitis is the ultimate goal. The ECIR Group serves the scientific community, practicing clinicians, and owners by focusing on investigations most likely to quickly, immediately, and significantly benefit the welfare of the horse.

Contact:  Nancy Collins

Stock photo available