The Equine Cushings and Insulin Resistance (ECIR) Group was started in 2000. It is the largest field
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The Equine Cushings and Insulin Resistance (ECIR) Group was started in 1999 for disseminating information and sharing of experiences among owners and professionals dealing with Equine Cushing's Disease. In ensuing years, each horse and each member has contributed to the learning and the success of the ECIR group and to the health and longevity of many more horses. Robin Siskel founded the ECIR Gro
up for her mare, Night Flight (Tina) with the goal of keeping information firmly based in science. Noted veterinarian Eleanor Kellon, VMD, joined the EC and IR Group in 2001 and became Co-Owner with Robin. Because Insulin Resistance/ Equine Metabolic Syndrome was and still is often mistaken for Cushing's Disease, the ECIR Group developed as a resource for both Cushing's Disease and Insulin Resistance/Equine Metabolic Syndrome. With thousands of international members, the ECIR groups.io outreach group is arguably the largest field trial in the world and provides the latest research, medication information & 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 and can now receive tax deductible contributions and grants to support ongoing research, education and awareness of Equine Cushing's Disease and Insulin Resistance/Equine Metabolic Syndrome.
If your equine lives in acorn county, now is the time to figure out a way to keep your horse. pony, donkey, or mule away from oak trees. Acorns can be toxic for horses, and present the additional risk of laminitis for horses with EMS. Read more in Dr. Kellon's blog here: https://drkhorsesense.wordpress.com/2021/10/27/acorn-toxicity-in-horses/
https://drkhorsesense.wordpress.com/2019/08/04/the-seasonal-acth-rise/
ACTH, adrenocorticotropic hormone, is produced by the pituitary gland. It’s function is to trigger cortisol release from the adrenal gland. Every year in the fall there is a temporary increa…
Find the answer here: https://bit.ly/2zXFwkE
Find out how the Seasonal Rise (which peaks in just over a week for equines in the northern hemisphere) affects diagnosis of PPID:
The ecirhorse.org website is complimentary to the Equine Cushing's and Insulin Resistance outreach group..
Laminitis is not a primary disease; it is always the secondary outcome of some event, ranging from sepsis, supporting limb laminitis, black walnut shavings, or endocrine disorders -- the latter accounting for the majority of reported cases. The causal agent of endocrinopathic or “insulin-induced” laminitis is insulin. Dietary sugar and starch, obesity, lack of exercise are factors that play a role in insulin regulation but are not the cause. Iron overload disorder (hyperferritinemia) from excessive dietary iron can be associated with insulin resistance and diabetes in humans and many animal species including equines but does not cause insulin resistance or laminitis. *(PMID: 32042647). Genetic makeup is likely the greatest contributor to the development of EMS and PPID. *(PMID: 32534851).
Exercise is by far the best way to maintain normal glucose and insulin dynamics in all animals. In cases where insulin is abnormally high (hyperinsulinemia), controlling the amount of simple sugars and starch (carbohydrates that stimulate glucose and insulin release) in the diet will help to lower insulin and reduce the risk of laminitis. Hyperinsulinemia can be transient. For example, a healthy horse with normal insulin can graze spring grass or eat a grain meal and can have high serum insulin concentrations that respond normally to the amount of simple sugars and starch in the meal. Within hours, insulin values return to normal. In contrast, an equine with EMS has an even higher insulin response to all meals, even meals with low sugar/starch, and fasting insulin is higher.
There are plenty of sedentary, overweight, grain-fed equines that don’t have EMS. Likewise, there are many older horses that don’t develop PPID. There are many horses with excessive iron in their diets that don’t develop iron overload disorder (IOD; hyperferritinemia). Yes, lack of exercise can lead to increased risk of obesity. Obesity can lead to increased risk of insulin resistance and inflammation of adipose tissue (fat) *(PMID: 36244309), but insulin-induced laminitis is not caused by adipose tissue or systemic inflammation. Dietary sugar will stimulate more glucose/insulin release. Hyperferritinemia is a confounding variable that can have a negative effect on many metabolic pathways and overall health, including EMS and PPID. What is the best predictor of insulin-induced laminitis? Insulin! *(PMID: 35263471).
This is not a matter of semantics – it’s basic physiology. In order for treatments or management to be effective, we must understand the direct cause. In a recent publication, the authors stress “It is crucial to continue to emphasize the importance of testing for insulin dysregulation in communication about endocrinopathic laminitis, whether in scientific publications, disease awareness initiatives, or continuing education events.” *(PMID: 34958881).
Of course, we shouldn’t ignore the other factors that play important roles in the management of EMS or the treatment of PPID. If able, introduce exercise to encourage weight loss and stimulate glucose uptake, reducing the demand to secrete more insulin. Limit simple sugars and starch in the diet. Analyze forage to identify mineral deficiencies and excesses. Feed a mineral balanced diet to assure a solid nutritional foundation to work from. Keep the focus on insulin as the central cause of endocrinopathic laminitis.
* Those interested in the preceding references can go to https://pubmed.ncbi.nlm.nih.gov and enter the numbers in the above parentheses into the search box.
**For more information, download Dr. Kellon’s proceedings “Protein, Iron and Insulin” from the 2021 NO Laminitis! Conference here: https://www.e-junkie.com/i/11jjd. and https://www.ecirhorse.org/proceedings-2013.php
Kathleen M. Gustafson, PhD
Director and Research Advisor, ECIR Group Inc
The classical signs of Cushing’s Disease in horses (pituitary pars intermedia dysfunction/PPID) of poor topline, sagging belly and long curly coat that fails to shed are only evident fairly late in…
View the short films Getting the Correct Diagnosis, Diet and Drugs, and Who We Are. What We Do here: https://bit.ly/3SlSIHN
Learn more about effectively relieving laminitis pain here: https://bit.ly/2Rru8Ub. To get help with your horse, pony, donkey, or mule with PPID and/or EMS, join our free outreach group: https://bit.ly/2DzMqzw
Important words from Dr. Kellon regarding managing a PPID and/or IR/EMS equine:
"Don't fall into the trap of settling for 'improvement.' You want to always strive for control. If you don't, you can be guaranteed the time will come when the horse is no longer improved, much worse, and very hard to control."
PPID originates from loss of dopaminergic neurons in the hypothalamus. Some functions of the hypothalamus are also affected and cause the increased thirst/urination, altered shedding and poor temperature control. In winter, horses may show abnormal sweating or unusual sensitivity to cold. Watch your horse carefully and clip or blanket as needed.
Laboratory reference ranges are not the same thing as normal, especially for things like insulin. Levels vary widely and depend on the testing conditions. https://www.ecirhorse.org/FastingInsulin-LabRefRanges.php
Chromium can be an effective supplement for people with type II diabetes mellitus, but it doesn’t help most horses with metabolic syndrome: https://drkhorsesense.wordpress.com/2021/10/28/chromium-and-insulin/
Find out how the Seasonal Rise (which is happening now for equines in the northern hemisphere) affects diagnosis of PPID: https://bit.ly/2zXFwkE
Learn more about the importance of balancing minerals to hay here: https://bit.ly/2HV5Gqs
For more information on appropriate diet for equines with PPID and/or EMS, go here: https://bit.ly/3Cmh50L. For an in-depth review, download the Proceedings from Dr. Kathleen Gustafson’s lectures from the 2021 ECIR Group – NO Laminitis! Conference: https://www.e-junkie.com/i/11b2s. Downloads are free.
Looking for answers to questions about PPID and EMS? Check our FAQs here: https://bit.ly/2JH6MLy
Dr. Treiber's 2006 study was the first to look at laminitis in a pasture setting. The onset of cases in horses at risk (high insulin) coincided with a flush of clover growth. Learn more in Dr. Kellon's proceedings from the 2021 NO Laminitis! Conference. Downloads are free. https://www.e-junkie.com/i/11jjb
This is directed to owners, veterinarians or other caretakers giving horses in their care one of the -flozin drugs - canagliflozin, empagliflozin, dapagliflozin. As you probably know, hypertriglyceridemia and in some cases elevated liver enzymes are an issue with these drugs. This survey is an attempt to identify aspects of the individual horse's signalment, comorbidities and/or diet that contribute to or help prevent this issue. The survey can be found here https://www.surveymonkey.com/r/YM5JD9G . If there are any questions you can contact Dr. Kellon "at" gmail.com. One survey per horse.
The classic coat changes associated with PPID are actually an ADVANCED symptom. Besides laminitis in the fall, there are other early signs that are often missed. Learn what to watch out for here: http://bit.ly/2XyUkyJ
We know that a lot of you have equines dealing with acute or chronic laminitis. for extremely helpful information check out two great lecture proceedings from Dr. Kellon to help guide you, your vet and hoof pros through what we know is a stressful period.
The first goes through the ECIR approach step by step. The second deals with what to do for acute care. They are both free to download here: https://www.ecirhorse.org/proceedings-2017.php
Tiered Management Approach to EMS and PPID
Eleanor M. Kellon, VMD
Successful prevention or rehabilitation of laminitis takes finding the correct Diagnosis, establishing a supportive Diet—and Drugs if needed—maintaining the correct physiological Trim and, when the horse is able, an appropriate Exercise program (DDT+E). This lecture shows how a tiered-management approach maximizes the chances of successfully maintaining or rehabilitating a Pituitary Pars Intermedia Dysfunction and/or Equine Metabolic Syndrome equine, and bringing them into optimal health.
Acute Care for Endocrinopathic Laminitis
Eleanor M. Kellon, VMD
Because of the unique pathophysiology of endocrinopathic laminitis, usual acute care measures may be ineffective or even potentially harmful. This lecture explores approaches to acute care that provide targeted and more effective pain control, focusing on the underlying pathology.
Two additional lectures that others have found helpful deal with Inflammation in Equine Metabolic Syndrome (EMS) and Endocrinopathic Laminitis: How is it Different?
All four of these and much more can be found at the link above.
To get individual help for your horse, pony, donkey, or mule, join our free outreach group: https://ecir.groups.io/g/main. For more information, please also visit our website: https://bit.ly/2nppyc9
Exercise vastly improves insulin sensitivity, but the acutely laminitic horse cannot tolerate exercise. However, with recovery, exercise is to be encouraged as long as the horse tolerates it. As the horse's condition improves, the level of exercise should increase. The importance of adequate exercise in the EMS-prone equine cannot be understated. Additional important details here: http://bit.ly/34xa60X
Unfortunately, by the time many owners find us, their equines have already experienced laminitis. Since 80-90% of all laminitis cases are a result of the horse, donkey, or mule having uncontrolled EMS (Equine Metabolic Syndrome) and/or PPID (Equine Cushing's Disease), our goal is to help owners and equine professionals get the correct diagnosis and initiate treatment BEFORE a laminitic event. Here's what you need to know: https://bit.ly/2A36ERq
For more details, click here to view our short film: Getting the Correct Diagnosis: https://bit.ly/2BSdEhK
Details about the Virginia Polytechnic proxies: https://pubmed.ncbi.nlm.nih.gov/16677122/
Learn more on our website here: https://www.ecirhorse.org/DDT+E-trim.php
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