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Managing Gastric Health in PATH Intl. Program Horses

By Jessica Normand, Member of the PATH Intl. Equine Welfare Committee

March 2019

Gastric ulcers are common in horses for a variety of reasons. According to the American Association of Equine Practitioners’ online summary, Equine Gastric Ulcer Syndrome by Frank M. Andrews, DVM, MS, DACVIM, “Prevalence estimates have been reported to range from 25 to 50 percent in foals and 60 to 90 percent in adult horses, depending on age, performance, and evaluated populations.”

The horses that are our partners in equine-assisted activities and therapies can easily experience the risk factors of equine gastric ulcer syndrome and may also have added mental and emotional stress.

Risk Factors for Equine Gastric Ulcers

  • Stress in all forms (e.g., training, competition, shipping, injury, etc.)
  • Infrequent feeding
  • Large grain meals (feeding more than 0.5% of horse’s body weight in grain in a single meal)
  • Limited access to hay/pasture
  • Intense exercise
  • Excessive use of non-steroidal anti-inflammatory drugs (NSAIDs)

Signs of Gastric Ulcers in Horses

  • Reduced appetite/changes in eating and drinking behavior
  • Weight loss/poor body condition
  • Poor attitude (girthiness, irritability, resistance, etc.)
  • Recurrent colic
  • Dull hair coat
  • Decreased performance

If you observe signs of gastric ulcers in the horses under your care, it is imperative that you involve your veterinarian for diagnosis and proper treatment. This may include the use of prescription medications such as GastroGard® (omeprazole), currently the only FDA-approved medication for the treatment of gastric ulcers in horses.

In addition to treatment, work with your veterinarian to adjust your horses’ management program in order to reduce the risk factors for gastric ulcers. Good practices include:

  • Feed forage frequently (consider “slow feed” style hay net or bag to make hay last longer and to mimic natural grazing behavior throughout the day)
  • Allow for pasture grazing, if available/appropriate (i.e., grass may not be ideal for overweight horses and those with metabolic conditions)
  • Consider adding some alfalfa to the horse’s forage, as it has been shown to benefit gastric health
  • Limit grain, and feed in multiple, small meals
  • Manage your horse’s stress, provide down time and provide as much turnout as possible
  • Consider a daily gastric supplement to proactively support and protect stomach tissues
  • If your horse needs NSAIDs for managing pain and inflammation, work with your veterinarian to determine appropriate dosing and administration
  • Ask your vet about the use of UlcerGard® (omeprazole), the only FDA-approved medication for prevention of gastric ulcers in horses, as needed during times of added stress, such as trailering, routine and herd changes, etc.

Equine Metabolic Syndrome

By Ashley Phelps, DVM

Dr. Ashley Phelps has over 10 years of field experience as an equine veterinarian. She holds her Doctorate of Veterinarian Medicine from Mississippi State University and in her spare time enjoys doting on her horse, Ava.

Equine Metabolic syndrome (EMS) is a clinical syndrome with increased adiposity, insulin resistance, and hyperinsulinemia, affecting horses, ponies and donkeys. The underlying cause of the syndrome is unknown. Typically, it first develops in horses between 5-16 years of age. Most common breeds affected include ponies, Saddlebred, Tennesse Walking horse, Paso Fino, Morgan, Quarter Horse, and Mustang.

The signs associated with EMS in horses include obesity, increase fat deposition in the neck and tail head regions, laminitis, hyperinsulinemia with normal blood sugar levels, infertility, increased appetite, and altered ovarian activity. For diagnosis, your veterinarian will most usually perform combined glucose‐insulin test (CGIT), which requires blood to be obtained before a dextrose IV solution and insulin are given. Then blood will be obtain at certain time intervals after the injections.
Therapy is lifelong to improve the quality of life of horses diagnosed with EMS. Currently, there are no medications approved for the treatment of EMS in horses. Therapy and other management recommendations by your veterinarian may include:

1. Dietary Management: Restriction of carbohydrates is essential. Often pasture access is eliminated or highly restricted.

2. Exercise: Increasing the amount of exercise, if possible, can help with weight loss. However, if laminitis has occurred, exercise may be limited.

3. Levothyroxine sodium: It is prescribed to increase weight loss and thereby improving insulin sensitivity. It is unlikely to resolve clinical signs alone and must be paired with dietary management and exercise.

4. Laminitis management: Many horses diagnosed with EMS will also have laminits. Your veterinarian may recommend corrective shoes and trimming, pain medication, or dietary changes if laminitis is present.

5. Other Therapies: Chromium, magnesium, cinnamon, and chasteberry (Vitex agnus‐castus) may be recommended for the management of EMS. However, there is limited scientific evidence to support the use of these supplements at this time.

Management of EMS is lifelong but can be rewarding. Working with your veterinarian and farrier can provide many wonderful years with your horse.

Frank, N., Geor, R., Bailey, S., Durham, A., & Johnson, P. (2010). Equine Metabolic Syndrome. Journal of Veterinary Internal Medicine,24(3), 467-475. doi:10.1111/j.1939-1676.2010.0503.x

The PATH Intl. Equine Welfare Committee encourages positive and engaging educational exploration from our readers - we'd love to hear your feedback! Please let us know if you have any questions about our tip or have a suggestion about specific topics you would be interested in learning more about in the future. Email Dr. Ashley Phelps, PATH Intl. Equine Welfare Committee chair. Thank you!

Equine Tips: The Right Horse Initiative

By Christy Counts, PATH Intl. Equine Welfare Committee Member

In 2017, there were 873 certified PATH Intl. centers in the United States. On average, the centers utilize well over 8,000 horses in their programs. Although we do not yet know the exact average service time of horses in these centers, we believe it is approximately three to seven years. Thus, thousands of these horses are transitioned out of service annually. Each time a horse transitions out of service in a PATH Intl. center, the center is faced with two challenges. First, they have to find a new home for the horse and second, they have to find a new replacement horse. Where do all of these horses come from? What happens to them when they are finished providing service to the programs? These questions are particularly interesting to The Right Horse Initiative. 

The Right Horse Initiative (TRH) was launched 18 months ago by the The WaterShed Animal Fund. The Initiative was developed to massively increase the number of horses adopted each year in the United States while also creating more community resources to provide humane transitions for horses. Each year in the United States, 200,000 horses fall at-risk and a large majority of them have much left to give to this world. There are currently over 7 million horses in the United States, but sadly, in 2017 less than 10,000 horses were adopted from adoption facilities. The public is unaware of the vast supply of healthy, trained horses that are currently living in these adoption centers awaiting new homes and careers. An increase in market share of adoption horses will directly reduce the number of horses that fall at-risk in our country each year.
In 2018, PATH Intl joined as a partner of TRH. The partnership with PATH Intl. is a natural fit as the EAAT industry continues to grow so does its need for horses. In fact, thousands of horses are needed each year to replace horses transitioning out of service. In addition, EAAT centers all have different types of horses they are looking for with different levels of training and behavior characteristics. There is a huge opportunity to create programs with streamlined partnerships between PATH Intl. centers and TRH transition facility partners that are looking for jobs and homes for their horses. In these programs the horses are transitioned into a new EAAT career and the PATH Intl. center has a reliable, transparent source facility for their horses.

Another issue that is often reported by PATH Intl. centers is the struggle locating new homes for horses needing to transition out of a PATH Intl. center. TRH is working to create programs with transition centers that accept the return of the adopted or leased horse from the PATH Intl. center. This partnership can relieve the barn of the headache of constantly looking for placement for their retired horses. Creating this type of placement partnership can provide a win/win for both parties. The PATH Intl. centers are participating in safe and humane transitions for horses and also have a feel-good message for their supporters. Not only are they providing a valuable service to people but also to horses potentially expanding their donor base to a broader pool of funders.

When a PATH Intl. center is building out their development/fundraising plan they most often target their efforts on donors that have an affinity for humans with special needs. We all know that raising operating funds is one of the biggest challenges nonprofits face to sustain their programs. Utilizing transition horses from adoption facilities can be a fantastic way to target an entire new audience of potential donors. Suddenly, a center can attract animal welfare donors as well, if they can demonstrate the PATH Intl. program not only helps the humans but also provides homes and jobs for at-risk horses.

Surviving today in the world of nonprofits requires savvy fundraising skills. The organizations that can attract multiple bases of donors will be the winners in the end. In addition, they are directly participating in solving the horse welfare issue we are facing in this country. Programs like these could potentially provide jobs for thousands at-risk horses each year while also creating fundraising opportunities for the programs. What could be a more perfect partnership? TRH is currently working to build out the infrastructure to create efficient programs that alleviate the burden of randomly sourcing horses while also providing good, sound and trained horses in a transparent system.

The Right Horse is thrilled to welcome PATH Intl. as a partner to the Initiative and is eager to get to work building programs with PATH Intl. centers and PATH Intl. instructors. The first thing PATH Intl. members can do to get involved is spread the word about The Right Horse and its adoption partners. Sharing the adoption message and happy adoption stories goes a long way to opening horse owners mind to adoption. Furthermore, reach out to PATH Intl. if your center is interested in promoting adoption horses and wants to be partnered specifically with a Right Horse Source Shelter. The plan is to begin by piloting some regional placement programs while finetuning the system. After the regional pilot programs are completed, The Right Horse plans to expand the partnership with PATH Intl. to provide resources nationally to participating centers. For more information please contact The Right Horse at This email address is being protected from spambots. You need JavaScript enabled to view it..

Feeding and Managing the Hard Keeper

By Jessica Normand, PATH Intl. Equine Welfare Committee Member

The term “hard keeper” is often used to describe those horses that have a hard time gaining or maintaining healthy weight. Your veterinarian is the best resource for evaluating the weight – more specifically, the fat and muscle cover – of the horses in your care. He/she will likely use framework such as the Henneke Body Condition Scoring System. Using this method, your veterinarian will do a visual and tactile evaluation of 6 areas of your horse’s body (neck, ribs, withers, loin, behind the shoulder, and tailhead), giving each a score from 1 to 9, then average the results to get your horse’s overall body condition score. Regarding the scores, 1 is emaciated, 9 is obese, and 5 is considered ideal for most horses. You can and should learn this method so that you can keep tabs on your horse’s body condition in between visits from the veterinarian. And of course, it goes without saying that any sudden, dramatic changes in weight warrant a call to the vet right away.

Before we talk about typical hard keepers, it is important to note that feeding the truly malnourished horse is a very different situation and absolutely requires a veterinarian’s guidance. Horses with a body condition score of 3.5 or lower – especially those with body condition scores or 2 or even 1 (severely emaciated) are at risk for Refeeding Syndrome,1 which can be deadly. These horses cannot be fed like a normal, healthy horse. If you care for rescue horses or any horse that is malnourished, please work closely with your veterinarian to design an appropriate feeding program for recovery.

If you have or care for a horse whose body condition score tends to stay around 3.5-4.5 and you struggle to put weight on the horse, there are some important things to evaluate. First, the horse should have a full physical exam by your veterinarian to determine if any health problems are contributing to the weight challenges. These could include dental issues, digestive problems, parasites, infection, pain, metabolic conditions, and more. Your vet will also factor in your horse’s age and what that means for his dental condition and digestive efficiency.

In terms of nutrition, it’s important to think about the horse’s diet as a whole. Forage should be the foundation, and underweight horses should generally get at least 2% of their body weight in forage per day when you’re goal is for them to gain weight (for a 1,000 lb horse this is at least 20 lbs of forage daily). This means it’s important to have an accurate assessment of your horse’s weight, and it’s also important to weigh your hay. The SmartPak website provides this handy Equine Weight Calculator, and it’s easy to find an inexpensive hay scale to hang in the feed room. When you get a new load of hay, weigh a few different flakes from a few different bales, and take the average. For our example horse needing about 20 lbs of hay per day, this means 10 flakes per day if each flake weighs 2 lbs, but only 4 flakes per day if each flake weighs 5 lbs. And keep in mind that the horse’s total roughage requirement can be met by a mix of hay, pasture, and other options such as alfalfa cubes, forage pellets, chopped forage, beet pulp, and more.

Hard keepers often need some sort of concentrate, in addition to the forage component of their diet, in order to get the calories they require for gaining or maintaining weight. This could be a whole, unfortified grain such as oats, or it could be a commercial fortified grain or complete feed. Look for commercial feeds that are 10% or higher in crude fat, instead of the more traditional 2-5% fat formulas. Luckily, feed manufacturers now offer a plethora of lower starch/higher fat formulas. The reason to look for a higher fat feed is that, pound for pound, fat is the densest source of calories. This means that a pound of fat provides more calories than a pound of carbohydrate, so a higher fat feed is a more efficient way to help the horse gain weight. Because sudden feed changes are a proven risk factor for colic, always change hay and grain slowly, over the course of 1-2 weeks. It’s also important to go slowly when increasing fat in the horse’s diet, as introducing fat too quickly can cause loose manure. Other tactics for adding fat to the diet include feeding some stabilized, fortified rice bran, flax seed, healthy oils, or powdered fat supplements.

Once you’ve addressed the total calorie needs of your hard keeper, which will primarily help with fat cover on the body, you should also evaluate whether the horse needs to gain muscle. The most common place for hard keepers to lose muscle is along the topline. This may be a sign that the horse needs more protein in the diet – not necessarily more total (crude) protein, but rather more quality protein, which means providing essential amino acids. Research has shown that amino acid supplementation improved muscle mass in both senior and young horses,2 and there are some inexpensive, quality amino acid supplements available. Look for products that provide lysine, methionine, and threonine, specifically.

This discussion of diet is just skimming the surface. For a more thorough evaluation of your horse’s whole feeding program, consider the excellent online software, FeedXL (, which allows you to plug in all aspects of your horse’s current feeding program, creates a report to help you find the gaps, and shows you how making certain dietary adjustments will affect the results. In addition to evaluating vitamins, minerals, fats, and protein, this tool looks at total digestible energy, accounts for the horse’s workload, factors in his current body condition, and whether your goal is for him to maintain, gain, or lose weight.

Once your veterinarian has performed a physical exam and you’ve evaluated the horse’s diet relative to his workload, also think about his level of stress and overall living situation. Is the horse fed outside with a group of horses? If so, and he is low in the pecking order, he may not be able to consume adequate calories because other horses are moving him off of the hay or away from his feed dish. If this is the case, it may make more sense to separate him at feeding time, spread out hay across a larger area, or change up his turnout group. Also consider whether he’s stressed by other factors around mealtime, such as a noisy barn filled with students and parents, and consider if his feeding schedule can be adjusted.

Feeding and managing your hard keeper up to a healthy weight can be complex and a bit challenging, but you can do it! Work closely with your veterinarian, learn how to body condition score, evaluate the total diet (give FeedXL a try!) and reduce your horse’s stress around mealtime. Good luck!

1 Freeman, D.W., Gilliam, L. (ND) Refeeding the Poorly Conditioned Horse. Retrieved from

2 Graham-Thiers, P.M., Kronfeld, D.S. Amino acid supplementation improves muscle mass in aged and young horses. J Anim Sci. 2005 Dec;83(12):2783-8.



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