F
Fat/Oil - feeding (for fat horses see Obesity)
Fenugreek
Foot support (frog support)
Forage analysis
FOS - Fructo-Oligosaccharides
Founderguard
France - information relating to
Fructans
Fructosamine
Fructose
FSIGT (Frequently Sampled Intravenous Glucose Tolerance Test)
Fenugreek
Foot support (frog support)
Forage analysis
FOS - Fructo-Oligosaccharides
Founderguard
France - information relating to
Fructans
Fructosamine
Fructose
FSIGT (Frequently Sampled Intravenous Glucose Tolerance Test)
Fat/Oil - feeding
Effects of feeding fat on EMS and PPID horses. For fat horse see Obesity
Research has found differing effects of feeding high fat/oil diets on insulin sensitivity and glucose tolerance, and has tended to compare feeding fat to feeding sugar/starch, rather than assessing the effects of adding oil to a high fibre diet. According to Equine Applied and Clinical Nutrition 2013 p 149, there is currently no evidence that supplying around 10-20% of a horse's energy requirements as unsaturated fatty acids causes insulin resistance, and whilst the effects of fat v no fat diets do not appear to have been studied in EMS/PPID horses to date, unsaturated fatty acids are considered a suitable energy source for underweight insulin resistant horses. However, feeding fat/oil should be avoided for horses that are overweight as it is likely to promote weight gain and possibly increase the risk of diseases linked with obesity, such as insulin resistance.
Pagan et al., Proc. Australasian Equine Sc. Symp. Vol 4, 2012 (p 37)
Fish oil supplementation attenuates abnormal glucose clearance caused by high dietary fat intake in aged thoroughbred geldings
Pagan et al., Proc. Australasian Equine Sc. Symp. Vol 4, 2012 (p 20)
Moderate dietary carbohydrate improves and high dietary fat impairs glucose clearance in aged thoroughbred geldings
Feeding a high fat diet (30% of DE, 500 g/day oil per 500 kg horse) to non-obese aged horses impaired glucose clearance.
Bamford NJ, Potter SJ, Harris PA, Bailey SR, Proc. Australasian Equine Sc. Symp., Vol 4, 2012 (p 19)
Effect of increasing adiposity, induced by a high fat low glycaemic diet or similar diet with once daily glucose, on insulin sensitivity in horses and ponies
Feeding granulated vegetable fat and canola oil (up to 200g/100kg BW) to induce weight gain did not significantly change insulin sensitivity. However, horses fed an isocaloric diet with 1.5 g/kg bw glucose (plus some vegetable fat to equal the energy content of the fat fed group) showed significant improvements in insulin sensitivity.
J Anim Sci. 2005 Nov;83(11):2509-18 (full paper available free as pdf)
Effects of rice bran oil on plasma lipid concentrations, lipoprotein composition, and glucose dynamics in mares
Frank N, Andrews FM, Elliott SB, Lew J, Boston RC
Hoffman RM, Boston RC, Stefanovski D, Kronfeld DS, Harris PA
Obesity and diet affect glucose dynamics and insulin sensitivity in Thoroughbred geldingsJ Anim Sci. 2003 Sep;81(9):2333-42 (PubMed) (Full paper)
Effects of diet were likely confounded by body condition, but horses had lower Si (P = 0.066) when fed SS (sugar/starch) compared with FF (fat/fibre), especially when nonobese.
Journal of Veterinary Medicine Series A, 48: 39–49 (2001)
Effects of Fat Feeding and Energy Level on Plasma Metabolites and Hormones in Shetland Ponies
Schmidt O, Deegen E, Furhmann H, Dühlmeier R, Sallmann H-P
8 Shetland ponies fed a high fat diet for 5 weeks had a greater plasma GIP concentration that ponies eating a sugar and starch diet - the increased GIP could be a stimulus for insulin hypersecretion and insulin resistance.
"Feeding the fat-enriched diet, independently of its energy content, led to a significant decrease in plasma triglycerides, associated with a mean 50% increase of plasma lipoprotein lipase activity. After oral glucose load the ponies on fat-enriched diets showed higher plasma glucose concentrations. Oral glucose administration after feeding the hypercaloric fat-enriched diet led to a 25-fold increase of plasma insulin levels. Glucose-dependent insulinotropic polypeptide plasma levels were increased in the animals on the fat-enriched diets. The results of this study suggest that fat feeding improves triglyceride clearance. However, the fat supplementation of the diet also led to impaired glucose tolerance."
Research has found differing effects of feeding high fat/oil diets on insulin sensitivity and glucose tolerance, and has tended to compare feeding fat to feeding sugar/starch, rather than assessing the effects of adding oil to a high fibre diet. According to Equine Applied and Clinical Nutrition 2013 p 149, there is currently no evidence that supplying around 10-20% of a horse's energy requirements as unsaturated fatty acids causes insulin resistance, and whilst the effects of fat v no fat diets do not appear to have been studied in EMS/PPID horses to date, unsaturated fatty acids are considered a suitable energy source for underweight insulin resistant horses. However, feeding fat/oil should be avoided for horses that are overweight as it is likely to promote weight gain and possibly increase the risk of diseases linked with obesity, such as insulin resistance.
Pagan et al., Proc. Australasian Equine Sc. Symp. Vol 4, 2012 (p 37)
Fish oil supplementation attenuates abnormal glucose clearance caused by high dietary fat intake in aged thoroughbred geldings
Pagan et al., Proc. Australasian Equine Sc. Symp. Vol 4, 2012 (p 20)
Moderate dietary carbohydrate improves and high dietary fat impairs glucose clearance in aged thoroughbred geldings
Feeding a high fat diet (30% of DE, 500 g/day oil per 500 kg horse) to non-obese aged horses impaired glucose clearance.
Bamford NJ, Potter SJ, Harris PA, Bailey SR, Proc. Australasian Equine Sc. Symp., Vol 4, 2012 (p 19)
Effect of increasing adiposity, induced by a high fat low glycaemic diet or similar diet with once daily glucose, on insulin sensitivity in horses and ponies
Feeding granulated vegetable fat and canola oil (up to 200g/100kg BW) to induce weight gain did not significantly change insulin sensitivity. However, horses fed an isocaloric diet with 1.5 g/kg bw glucose (plus some vegetable fat to equal the energy content of the fat fed group) showed significant improvements in insulin sensitivity.
J Anim Sci. 2005 Nov;83(11):2509-18 (full paper available free as pdf)
Effects of rice bran oil on plasma lipid concentrations, lipoprotein composition, and glucose dynamics in mares
Frank N, Andrews FM, Elliott SB, Lew J, Boston RC
Hoffman RM, Boston RC, Stefanovski D, Kronfeld DS, Harris PA
Obesity and diet affect glucose dynamics and insulin sensitivity in Thoroughbred geldingsJ Anim Sci. 2003 Sep;81(9):2333-42 (PubMed) (Full paper)
Effects of diet were likely confounded by body condition, but horses had lower Si (P = 0.066) when fed SS (sugar/starch) compared with FF (fat/fibre), especially when nonobese.
Journal of Veterinary Medicine Series A, 48: 39–49 (2001)
Effects of Fat Feeding and Energy Level on Plasma Metabolites and Hormones in Shetland Ponies
Schmidt O, Deegen E, Furhmann H, Dühlmeier R, Sallmann H-P
8 Shetland ponies fed a high fat diet for 5 weeks had a greater plasma GIP concentration that ponies eating a sugar and starch diet - the increased GIP could be a stimulus for insulin hypersecretion and insulin resistance.
"Feeding the fat-enriched diet, independently of its energy content, led to a significant decrease in plasma triglycerides, associated with a mean 50% increase of plasma lipoprotein lipase activity. After oral glucose load the ponies on fat-enriched diets showed higher plasma glucose concentrations. Oral glucose administration after feeding the hypercaloric fat-enriched diet led to a 25-fold increase of plasma insulin levels. Glucose-dependent insulinotropic polypeptide plasma levels were increased in the animals on the fat-enriched diets. The results of this study suggest that fat feeding improves triglyceride clearance. However, the fat supplementation of the diet also led to impaired glucose tolerance."
Fenugreek
Fenugreek analysis - nutritiondata.self
In taste trials, horses chose flavours in the order fenugreek, banana, cherry, rosemary, cumin, carrot, peppermint and oregano. Both fenugreek and banana encouraged horses to eat unpalatable mineral pellets:
Goodwin D, Davidson HPB, Harris P
Selection and acceptance of flavours in concentrate diets for stabled horses
Applied Animal Behaviour Science 95 (2005) 223–232
‘Unusual’ feeds for performance horses - P.A. Harris & H. W. Gee - EAAP
In taste trials, horses chose flavours in the order fenugreek, banana, cherry, rosemary, cumin, carrot, peppermint and oregano. Both fenugreek and banana encouraged horses to eat unpalatable mineral pellets:
Goodwin D, Davidson HPB, Harris P
Selection and acceptance of flavours in concentrate diets for stabled horses
Applied Animal Behaviour Science 95 (2005) 223–232
‘Unusual’ feeds for performance horses - P.A. Harris & H. W. Gee - EAAP
Foot support (frog support)
Deep supportive bedding/surfaces such as sand, pea gravel or peat allow the horse to bear weight on the back of the foot and relieve pressure at the toe/under the tip of P3. Shavings are not as supportive, and straw is not at all supportive.
Artificial support is often required during acute laminitis to relieve pressure on the hoof wall and move weight bearing to the back of the foot so that the bars, frog and palmar/plantar sole becomes load sharing/weight bearing. This can be achieved with high-density foam e.g. styrofoam, deformable impression material, or boots with pads. Horses with solar pain can have pads fitted with holes cut out under the painful area. Experimentation is often required to optimise comfort - the horse should always be more comfortable when support/padding has been fitted - if not then the padding/support needs to be removed and/or changed.
Where heels are so high that the frog is not weightbearing, palmar support should be fitted so that the frog shares weightbearing until the heel can be trimmed sufficiently for the frog to be weightbearing.
"Whatever method is chosen, it should encompass all the structures in the palmar/plantar section of the foot instead of relying on the frog alone. Excess pressure placed solely on the frog or on weak structures in the heel area of the hoof capsule over time may further and negatively alter these structures and thus reduce mass." Stephen O'Grady and Andrew Parks - Farriery Options for Acute and Chronic Laminitis
Foot support should be used in conjunction with x-rays and correct trimming to prevent/realign rotation/sinking.
Some boot and pad systems suitable for use during laminitis:
Easyboot Rx
Soft-Ride Equine Comfort Boots
Some foam/impression materials:
Equisoft System
Stable Support System
Styrofoam Support System
Impression material
Some homemade foam/impression materials that owners have found useful:
EVA foam pads - see TLS guide for making pads from EVA gym mats
Play mats for children - usually foam/rubber interlocking tiles
Gardener's kneeling pads
Hoof Rehabilitation Protocol - Debra Taylor, Ivy Ramey, Pete Ramey
Key points:
- during acute laminitis/lamellar separation, reducing weight bearing by the hoof wall (other than the heel buttress) can immediately stabilize the foot and prevent additional rotation/sinking.
- solar protection methods include hoof boots/casts with foam pads/dental impression material or pea gravel/sand.
- for solar penetration or thin sole under the tip of P3, relief can be given by hollowing an area in the pad/impression material under the tip of P3.
How to Treat Severe Laminitis in an Ambulatory Setting - Stephen E. O'Grady
Chris Pollitt - Therapeutic Shoeing
Jennifer Schleining evaluated the effects of applying polystyrene foam insulation pads to non-lame horses and concluded that the use of foam sole supports could be an effective, economical and immediate treatment for acute laminitis:
JA Schleining, SR McClure, TR Derrick, C Wang
Effects of industrial polystyrene foam insulation pads on the center of pressure and load distribution in the forefeet of clinically normal horses.
Am J Vet Res. 2011 May ;72 (5):628-33
The effect of a reverse shoe and polystyrene padding on the biomechanics of the front hoof of the horse
Henning J Mostert - MSc dissertation 2009
Artificial support is often required during acute laminitis to relieve pressure on the hoof wall and move weight bearing to the back of the foot so that the bars, frog and palmar/plantar sole becomes load sharing/weight bearing. This can be achieved with high-density foam e.g. styrofoam, deformable impression material, or boots with pads. Horses with solar pain can have pads fitted with holes cut out under the painful area. Experimentation is often required to optimise comfort - the horse should always be more comfortable when support/padding has been fitted - if not then the padding/support needs to be removed and/or changed.
Where heels are so high that the frog is not weightbearing, palmar support should be fitted so that the frog shares weightbearing until the heel can be trimmed sufficiently for the frog to be weightbearing.
"Whatever method is chosen, it should encompass all the structures in the palmar/plantar section of the foot instead of relying on the frog alone. Excess pressure placed solely on the frog or on weak structures in the heel area of the hoof capsule over time may further and negatively alter these structures and thus reduce mass." Stephen O'Grady and Andrew Parks - Farriery Options for Acute and Chronic Laminitis
Foot support should be used in conjunction with x-rays and correct trimming to prevent/realign rotation/sinking.
Some boot and pad systems suitable for use during laminitis:
Easyboot Rx
Soft-Ride Equine Comfort Boots
Some foam/impression materials:
Equisoft System
Stable Support System
Styrofoam Support System
Impression material
Some homemade foam/impression materials that owners have found useful:
EVA foam pads - see TLS guide for making pads from EVA gym mats
Play mats for children - usually foam/rubber interlocking tiles
Gardener's kneeling pads
Hoof Rehabilitation Protocol - Debra Taylor, Ivy Ramey, Pete Ramey
Key points:
- during acute laminitis/lamellar separation, reducing weight bearing by the hoof wall (other than the heel buttress) can immediately stabilize the foot and prevent additional rotation/sinking.
- solar protection methods include hoof boots/casts with foam pads/dental impression material or pea gravel/sand.
- for solar penetration or thin sole under the tip of P3, relief can be given by hollowing an area in the pad/impression material under the tip of P3.
How to Treat Severe Laminitis in an Ambulatory Setting - Stephen E. O'Grady
Chris Pollitt - Therapeutic Shoeing
Jennifer Schleining evaluated the effects of applying polystyrene foam insulation pads to non-lame horses and concluded that the use of foam sole supports could be an effective, economical and immediate treatment for acute laminitis:
JA Schleining, SR McClure, TR Derrick, C Wang
Effects of industrial polystyrene foam insulation pads on the center of pressure and load distribution in the forefeet of clinically normal horses.
Am J Vet Res. 2011 May ;72 (5):628-33
The effect of a reverse shoe and polystyrene padding on the biomechanics of the front hoof of the horse
Henning J Mostert - MSc dissertation 2009
Forage analysis
See also Hay analysis.
Pelletier S, Tremblay GF, Betrand A, Belanger G, Castonguay Y, Michaud R
Drying Procedures affect Non-structural Carbohydrates and Other Nutritive Value Attributes in Forage Samples
Animal Feed Science and Technology Feb 2010 157(3-4), 139-150 (Full)
See also Hay analysis.
Pelletier S, Tremblay GF, Betrand A, Belanger G, Castonguay Y, Michaud R
Drying Procedures affect Non-structural Carbohydrates and Other Nutritive Value Attributes in Forage Samples
Animal Feed Science and Technology Feb 2010 157(3-4), 139-150 (Full)
FOS - Fructo-Oligosaccharides
Respondek F, Myers K, Smith TL, Wagner A, Geor RJ
Dietary supplementation with short-chain fructo-oligosaccharides improves insulin sensitivity in obese horses
J Anim Sci. 2011 Jan;89(1):77-83. doi: 10.2527/jas.2010-3108. Epub 2010 Sep 24
Respondek F, Myers K, Smith TL, Wagner A, Geor RJ
Dietary supplementation with short-chain fructo-oligosaccharides improves insulin sensitivity in obese horses
J Anim Sci. 2011 Jan;89(1):77-83. doi: 10.2527/jas.2010-3108. Epub 2010 Sep 24
Founderguard
The importation of Founderguard is to be phased out in the UK, and will be completely banned from 30 September 2014 - see TheHorse.com article 17 July 2012.
There is no reason to believe that Founderguard can help with pasture-associated laminitis, which has an endocrine basis, and other treatments such as icing (cryotherapy) have proven to be useful for SIRS laminitis.
Rowe JB, Lees MJ, Pethick DW
Prevention of Acidosis and Laminitis Associated with Grain Feeding in Horses
J. Nutr. 124: 2742S-2744S, 1994
There is no reason to believe that Founderguard can help with pasture-associated laminitis, which has an endocrine basis, and other treatments such as icing (cryotherapy) have proven to be useful for SIRS laminitis.
Rowe JB, Lees MJ, Pethick DW
Prevention of Acidosis and Laminitis Associated with Grain Feeding in Horses
J. Nutr. 124: 2742S-2744S, 1994
France - information relating to
Information in French
28ème Journée d'étude de la Belgian Equine Practitioners Society - 2011, Leuven, Belgique
Mise à jour sur le diagnostic et de traitement de la maladie de Cushing chez le cheval
A. Durham
The ECIR Group "New Member Primer - How to Get a Correct Diagnosis" file has been translated into French (with thanks to Dr Eleanor Kellon for permission to use this information and Aurelie for the translation) (this file is available in English from the ECIR Yahoo Group):
La Maladie de Cushing chez les Équins (Dysfonctionnement de la partie centrale de l'hypophyse (PPID)) et l'insulino-résistance Équine
If you can help translate information on this website into French, please contact us.
Endocrine testing in France
Lyon
Free ACTH testing in France!
Boehringer Ingelheim are offering free ACTH testing for horses in France through VetAgro, the vet school at Lyon. The free test is offered for horses over the age of 10, that have presented with laminitis with no obvious cause. Given that probably over 90% of laminitis cases are endocrine, which will be EMS and/or PPID, this will be most first time cases of laminitis. Horses under 10 can get PPID too, so it's a shame that the free test excludes younger horses. The protocol calls for blood to be collected into EDTA (purple topped tube), centrifuged within 2 hours, chilled until despatch to the lab or frozen before despatch. As ACTH levels decline in unchilled blood, we recommend freezing the samples before despatch (but the blood must be separated by centrifuge, not by gravity, before the plasma is frozen, otherwise falsely high ACTH results are likely to be seen).
More information:
Dysfonction Par Intermedia (maladie de Cushing) Cheval
http://www.vetagro-sup.fr/node/754
Protocol
http://www.vetagro-sup.fr/sites/default/files/Maladie%20de%20Cushing%20Cheval.pdf
http://www.vetagro-sup.fr/sites/default/files/Campagne%20de%20depistage.pdf
NB insulin should also be tested in all horses with endocrine laminitis. ACTH is diagnostic for PPID, but insulin is suggestive of laminitis risk.
Frank Duncombe Laboratory in Normandy (France) is now testing ACTH (EDTA) and insulin (serum), presumably using a similar protocol to Liphook Equine Hospital. Prices we've been told (Feb 2013) are
ACTH: 37,36€ TTC
Insulin: 19,48 € TTC
Laboratoire Frank Duncombe, 1 Route de Rosel, Saint Contest, 14053 Caen
T: 02 31 47 19 50
email: lfd-sante@calvados.fr
Idexx-Alfort Paris
ACTH can be tested at Laboratoire Idexx Alfort. On the large animal submission form they request that blood for ACTH testing is collected into EDTA and the plasma frozen, which is the protocol we recommend. They also test insulin (serum) and glucose (sodium fluoride). Laboratoire Idexx Alfort submission sheet
Nantes
LDHvet at Nantes offers insulin and ACTH testing:
Lab submission sheet
The test offered by Nantes (as at April 2012) for PPID involves testing insulin, cortisol and prolactin in 2 blood samples taken at least an hour apart. Insulin is useful to indicate insulin resistance/hyperinsulinaemia, but is not diagnostic of PPID. Cortisol is not diagnostic of PPID (see PPID Working Group Diagnostic Testing for PPID p6 "Not useful: Resting cortisol concentration, Diurnal cortisol rhythm"). Prolactin concentrations could potentially be affected in some horses with PPID, as prolactin is also controlled by dopamine, but prolactin is not produced in the pars intermedia and is not considered a test for PPID by the PPID Working Group.
The protocol used by Nantes for ACTH (blood collected into dry tube or heparin, separated and sent unfrozen) is not the protocol followed by the PPID Working Group and most of the laboratories publishing research into PPID (blood collected into EDTA, separated and sent chilled/frozen). The Laminitis Site recommends following the protocol as set out by the PPID Working Group - Liphook Equine Hospital follows this protocol and will accept blood for testing from France - see Laboratories.
Prices as at April 2012
Insulin Nantes 41 euros; Liphook £17.90 plus VAT
PPID Nantes 65 euros for insulin, cortisol & prolactin, 95 euros plus ACTH; Liphook ACTH £18.50 plus VAT
Nantes appears to test ACTH twice a month and will only test samples received within 24 hours.
Liphook aims to test all samples on the day of receipt, Mon - Sat, with results sent out the same day, and will provide a chiller pack for postage of ACTH samples.
Treatment and Medication in France
LDHvet treatment advice for EMS and PPID
Pergolide became unavailable in France in May 2011 but could be obtained from Germany via Boehringer Ingelheim France (as Prascend) with a demande d'autorisation temporaire d'utilisation du Prascend.
Prascend was authorised for use in France on 22 May 2012 - Index des Médicaments vétérinaires autorisés en France - Résumé des caractéristiques du produit - Prascend 1 mg comprimes pour chevaux
Pergolide (Prascend) can be obtained from the UK with a French veterinary prescription - Viovet is one company that will supply Prascend against a French prescription (price £1.03/1 mg tablet plus delivery as at April 2012). The usual starting dose for Pergolide is 0.5 mg for a pony (approx. 250 kg) or 1.0 mg for a horse (approx. 500 kg) as suggested by Nantes.
Metformin (Metformine/Glucophage) is available from pharmacies in France. The dose suggested by Nantes (1.5 g/100 kg bodyweight (or 7.5 g per 500 kg horse) - can be doubled) is lower than the dose currently being found effective by Liphook (30 mg/kg bodyweight) 2 x day (or 15 g per 500 kg horse twice a day).
Hay analysis in France
The only French hay analysis we have seen to date cost 45 euros and gave no indication of sugar or NSC levels. If anyone knows of a laboratory in France that will analyse hay and report a reliable ESC/WSC/NSC figure, we'd love to hear from you (please contact us). In the meantime we suggest sending hay samples to the UK or USA for analysis (see hay testing).
Feed and supplement suppliers in France
France/Europe feed and supplement suppliers
Cheval Naturel www.cheval-naturel.com
28ème Journée d'étude de la Belgian Equine Practitioners Society - 2011, Leuven, Belgique
Mise à jour sur le diagnostic et de traitement de la maladie de Cushing chez le cheval
A. Durham
The ECIR Group "New Member Primer - How to Get a Correct Diagnosis" file has been translated into French (with thanks to Dr Eleanor Kellon for permission to use this information and Aurelie for the translation) (this file is available in English from the ECIR Yahoo Group):
La Maladie de Cushing chez les Équins (Dysfonctionnement de la partie centrale de l'hypophyse (PPID)) et l'insulino-résistance Équine
If you can help translate information on this website into French, please contact us.
Endocrine testing in France
Lyon
Free ACTH testing in France!
Boehringer Ingelheim are offering free ACTH testing for horses in France through VetAgro, the vet school at Lyon. The free test is offered for horses over the age of 10, that have presented with laminitis with no obvious cause. Given that probably over 90% of laminitis cases are endocrine, which will be EMS and/or PPID, this will be most first time cases of laminitis. Horses under 10 can get PPID too, so it's a shame that the free test excludes younger horses. The protocol calls for blood to be collected into EDTA (purple topped tube), centrifuged within 2 hours, chilled until despatch to the lab or frozen before despatch. As ACTH levels decline in unchilled blood, we recommend freezing the samples before despatch (but the blood must be separated by centrifuge, not by gravity, before the plasma is frozen, otherwise falsely high ACTH results are likely to be seen).
More information:
Dysfonction Par Intermedia (maladie de Cushing) Cheval
http://www.vetagro-sup.fr/node/754
Protocol
http://www.vetagro-sup.fr/sites/default/files/Maladie%20de%20Cushing%20Cheval.pdf
http://www.vetagro-sup.fr/sites/default/files/Campagne%20de%20depistage.pdf
NB insulin should also be tested in all horses with endocrine laminitis. ACTH is diagnostic for PPID, but insulin is suggestive of laminitis risk.
Frank Duncombe Laboratory in Normandy (France) is now testing ACTH (EDTA) and insulin (serum), presumably using a similar protocol to Liphook Equine Hospital. Prices we've been told (Feb 2013) are
ACTH: 37,36€ TTC
Insulin: 19,48 € TTC
Laboratoire Frank Duncombe, 1 Route de Rosel, Saint Contest, 14053 Caen
T: 02 31 47 19 50
email: lfd-sante@calvados.fr
Idexx-Alfort Paris
ACTH can be tested at Laboratoire Idexx Alfort. On the large animal submission form they request that blood for ACTH testing is collected into EDTA and the plasma frozen, which is the protocol we recommend. They also test insulin (serum) and glucose (sodium fluoride). Laboratoire Idexx Alfort submission sheet
Nantes
LDHvet at Nantes offers insulin and ACTH testing:
Lab submission sheet
The test offered by Nantes (as at April 2012) for PPID involves testing insulin, cortisol and prolactin in 2 blood samples taken at least an hour apart. Insulin is useful to indicate insulin resistance/hyperinsulinaemia, but is not diagnostic of PPID. Cortisol is not diagnostic of PPID (see PPID Working Group Diagnostic Testing for PPID p6 "Not useful: Resting cortisol concentration, Diurnal cortisol rhythm"). Prolactin concentrations could potentially be affected in some horses with PPID, as prolactin is also controlled by dopamine, but prolactin is not produced in the pars intermedia and is not considered a test for PPID by the PPID Working Group.
The protocol used by Nantes for ACTH (blood collected into dry tube or heparin, separated and sent unfrozen) is not the protocol followed by the PPID Working Group and most of the laboratories publishing research into PPID (blood collected into EDTA, separated and sent chilled/frozen). The Laminitis Site recommends following the protocol as set out by the PPID Working Group - Liphook Equine Hospital follows this protocol and will accept blood for testing from France - see Laboratories.
Prices as at April 2012
Insulin Nantes 41 euros; Liphook £17.90 plus VAT
PPID Nantes 65 euros for insulin, cortisol & prolactin, 95 euros plus ACTH; Liphook ACTH £18.50 plus VAT
Nantes appears to test ACTH twice a month and will only test samples received within 24 hours.
Liphook aims to test all samples on the day of receipt, Mon - Sat, with results sent out the same day, and will provide a chiller pack for postage of ACTH samples.
Treatment and Medication in France
LDHvet treatment advice for EMS and PPID
Pergolide became unavailable in France in May 2011 but could be obtained from Germany via Boehringer Ingelheim France (as Prascend) with a demande d'autorisation temporaire d'utilisation du Prascend.
Prascend was authorised for use in France on 22 May 2012 - Index des Médicaments vétérinaires autorisés en France - Résumé des caractéristiques du produit - Prascend 1 mg comprimes pour chevaux
Pergolide (Prascend) can be obtained from the UK with a French veterinary prescription - Viovet is one company that will supply Prascend against a French prescription (price £1.03/1 mg tablet plus delivery as at April 2012). The usual starting dose for Pergolide is 0.5 mg for a pony (approx. 250 kg) or 1.0 mg for a horse (approx. 500 kg) as suggested by Nantes.
Metformin (Metformine/Glucophage) is available from pharmacies in France. The dose suggested by Nantes (1.5 g/100 kg bodyweight (or 7.5 g per 500 kg horse) - can be doubled) is lower than the dose currently being found effective by Liphook (30 mg/kg bodyweight) 2 x day (or 15 g per 500 kg horse twice a day).
Hay analysis in France
The only French hay analysis we have seen to date cost 45 euros and gave no indication of sugar or NSC levels. If anyone knows of a laboratory in France that will analyse hay and report a reliable ESC/WSC/NSC figure, we'd love to hear from you (please contact us). In the meantime we suggest sending hay samples to the UK or USA for analysis (see hay testing).
Feed and supplement suppliers in France
France/Europe feed and supplement suppliers
Cheval Naturel www.cheval-naturel.com
Fructans
See Do Fructans Cause Laminitis for more details.
What are fructans?
During photosynthesis, grass fixes atmospheric carbon dioxide in the presence of sunlight to produce simple sugars. When more sugar is produced than is used for growth, the excess sugars are converted to storage carbohydrates. In cool season (C3) grasses these storage carbohydrates are fructans and are stored in the leaf and stem (starch is only stored in the seed in C3 grasses). Tropical (C4) grasses and legumes store carbohydrates as starch, not fructans, in the leaf and stem.
There are 2 types of fructans - the grass-type levan with beta 2-6 linkage, and the inulin type with beta 2-1 linkage. Grass levans are soluble in water (inulin is less soluble), but solubility in alcohol/water mixtures decreases as chain length increases.. Fructans in grasses are predominantly linear molecules with varying degrees of polymerization. Fructan content increases with low temperatures and perennial ryegrass in the UK has been found to have 30% fructan. (Source: Nutritional Ecology of the Ruminant - Peter J Van Soest 1994).
Johnson RJ, Rivard C, Lanaspa MA, Otabachian-Smith S, Ishimoto T, Cicerchi C, Cheeke PR, McIntosh B, Hess T
Fructokinase, Fructans, Intestinal Permeability, and Metabolic Syndrome: An Equine Connection?
Journal of Equine Veterinary Science published online 18 June 2012
Italian Journal of Animal Science 2010; 9:e66
Hydrolyzable and fermentable carbohydrates in North Italian pastures for horses
Paola Superchi, Alberto Sabbioni, Valentino Beretti, Ilaria Vecchi, Franca Vaccari Simonini
The Impact of Nutrition on the Health and Welfare of Horses - EAAP Publication No. 128 see p 19
J Nutr. 2006 Jul;136(7 Suppl):2099S-2102S. (PubMed) Full Text
Pasture nonstructural carbohydrates and equine laminitis.
Longland AC, Byrd BM.
There IS sugar in grass and hay - Katy Watts www.safergrass.org
Kagan IA, Kirch BH, Thatcher CD, Strickland JR, Teutsch CD, Elvinger F, Pleasant RS
Seasonal and Diurnal Variation in Simple Sugar and Fructan Composition of Orchardgrass Pasture and Hay in the Piedmont Region of the United States
Journal of Equine Veterinary Science, Volume 31, Issue 8, August 2011, Pages 488-497
Deepdyve
Kagan IA, Kirch BH, Thatcher CD, Teutsch CD, Pleasant RS
Chromatographic profiles of nonstructural carbohydrates contributing to the colorimetrically determined fructan, ethanol-solube, and water-soluble carbohydrate contents of five grasses
Animal Feed Science and Technology , Volume 188 , 53 - 63
Do fructans cause laminitis or affect blood glucose/insulin?
It is now widely accepted that fructans in grass do not cause laminitis via the SIRS route (carbohydrate overload upsetting hind gut bacteria leading to acidosis and GI mucosal barrier dysfunction), and that pasture-associated laminitis has an endocrinopathic cause.
But does fructan intake contribute to insulin resistance and/or hyperinsulinaemia, or should we only be concerned with simple sugars? Should we be looking at NSC contents of grass and hay (WSC (of which ESC is a sub-set) plus starch), or ignoring the fructan content and just looking at ESC plus starch?
Glatter M, Bochnia M, Goetz F, Gottschalk J, Koeller G, Mielenz N, Hillegeist D, Greef JM, Einspanier A, Zeyner A
Glycaemic and insulinaemic responses of adult healthy warm-blooded mares following feeding with Jerusalem artichoke meal
J Anim Physiol Anim Nutr (Berl). 2017 Jun;101 Suppl 1:69-78. doi: 10.1111/jpn.12669
Rosenmeier JG, Strathe AB, Andersen PH
Evaluation of coronary band temperatures in healthy horses
Am J Vet Res. 2012 May;73(5):719-23. doi: 10.2460/ajvr.73.5.719
6 healthy horses were fed 3 diets (treatment 1, 1 g of fructan/kg fed daily in the morning; treatment 2, 1 g of fructan/kg fed daily in the afternoon; and treatment 3, a low-carbohydrate [7.2%] diet) in a 3 × 3 Latin square study design.
Nutritional Ecology of the Ruminant - Peter J Van Soest 1994
p 159 grass fructans are listed in a table of common dietary carbohydrates digested by animal enzymes - simple sugar components: fructose; digestion: gastric acid; digestibility: high; digestive products: fructose; linkage beta 2-6. Does this relate to horses? The NRC Nutrient Requirements of Horses 2007 p 38 says "it is also possible that fructan can be hydrolyzed to some extent by gastric acid (Van Soest 1994) or fermented in the stomach."
J Anim Sci. 2007 Nov;85(11):2949-58. Epub 2007 Jun 25.
Dietary fructan carbohydrate increases amine production in the equine large intestine: implications for pasture-associated laminitis.
Crawford C, Sepulveda MF, Elliott J, Harris PA, Bailey SR.
3 g/kg BW inulin was fed mixed with Readigrass, a 15% protein high sugar freeze-dried grass
J. Nutr. 136: 2108S–2110S, 2006 (PubMed) Full Text
Fermentative Gases in Breath Indicate that Inulin and Starch Start to Be Degraded by Microbial Fermentation in the Stomach and Small Intestine of the Horse in Contrast to Pectin and Cellulose
Coenen M, Moßeler A, Vervuert I
"The results obtained suggest that inulin and starch are rapidly fermented prececally in healthy horses."
"Acute laminitis has been shown to result from a single dose of fructan fed at 7.5 g/kg M, and, as a result, many studies have been performed to try to establish the exact role of fructan in this disease. Dysbiosis following carbohydrate overload in the hindgut is suggested to play a major role in the onset of this disease. The results of the current study show that the microbial community in the prececal part of the gastrointestinal tract must be involved in some way, perhaps by modifying prececal fermentation patterns. Until now, work has been focused on the fermentative processes and microbial changes in the hindgut of horses with laminitis, but perhaps now, microbial changes in the foregut of horses should be elucidated."
Short chain v long chain fructans
Harlow BE, Lawrence LM, Kagan IA, Flythe MD
Effect of inulin chain length on fermentation by equine fecal bacteria and Streptococcus bovis in vitro
JEVS May 2015 Volume 35, Issue 5, Page 425
Deepdyve
The abstract states that grass fructans can be fermented by Gram-positive bacteria (e.g. Streptococcus bovis) in the horse's hindgut, causing increased production of lactic acid and decreasing pH (reference?). Micro-organisms from the dung of 3 horses were mixed with short chain inulin (DP 10 or less) or long chain inulin (DP 23 or more) and incubated. Results: pH was lower in short-chain fermentations. Conclusion: short chain inulin may be more available for fermentation than long chain inulin by equine fecal bacteria, and Streptococcus bovis specifically.
Fructan analysis
J Sci Food Agric. 2012 Feb 1. doi: 10.1002/jsfa.5555. [Epub ahead of print] (PubMed)
Comparison of a colorimetric and a high-performance liquid chromatography method for the determination of fructan in pasture grasses for horses.
Longland AC, Dhanoa MS, Harris PA.
"RESULTS: Pasture grasses (Phleum pretense, Festuca rubra, Dactylis glomerata, Lolium perenne) managed for grazing (sampled from April to November) and a further set managed for conservation (sampled in July) were analysed for fructan content by HPLC and the colorimetric technique. HPLC values ranged from 83 to 299 g fructan kg(-1) DM (mean 154); corresponding colorimetric values were 5-238 g fructan kg(-1) DM (mean 82). Discrepancies in values between the two methods varied with time of sampling and plant species. Comparison of selected samples before and after incubation with the fructan hydrolases used in the colorimetric method revealed incomplete fructan hydrolysis from the pasture grasses, resulting in underestimates of their fructan content."
Horses were fed 3 diets (treatment 1, 1 g of fructan/kg fed daily in the morning; treatment 2, 1 g of fructan/kg fed daily in the afternoon; and treatment 3, a low-carbohydrate [7.2%] diet) in a 3 × 3 Latin square study design.
What are fructans?
During photosynthesis, grass fixes atmospheric carbon dioxide in the presence of sunlight to produce simple sugars. When more sugar is produced than is used for growth, the excess sugars are converted to storage carbohydrates. In cool season (C3) grasses these storage carbohydrates are fructans and are stored in the leaf and stem (starch is only stored in the seed in C3 grasses). Tropical (C4) grasses and legumes store carbohydrates as starch, not fructans, in the leaf and stem.
There are 2 types of fructans - the grass-type levan with beta 2-6 linkage, and the inulin type with beta 2-1 linkage. Grass levans are soluble in water (inulin is less soluble), but solubility in alcohol/water mixtures decreases as chain length increases.. Fructans in grasses are predominantly linear molecules with varying degrees of polymerization. Fructan content increases with low temperatures and perennial ryegrass in the UK has been found to have 30% fructan. (Source: Nutritional Ecology of the Ruminant - Peter J Van Soest 1994).
Johnson RJ, Rivard C, Lanaspa MA, Otabachian-Smith S, Ishimoto T, Cicerchi C, Cheeke PR, McIntosh B, Hess T
Fructokinase, Fructans, Intestinal Permeability, and Metabolic Syndrome: An Equine Connection?
Journal of Equine Veterinary Science published online 18 June 2012
Italian Journal of Animal Science 2010; 9:e66
Hydrolyzable and fermentable carbohydrates in North Italian pastures for horses
Paola Superchi, Alberto Sabbioni, Valentino Beretti, Ilaria Vecchi, Franca Vaccari Simonini
The Impact of Nutrition on the Health and Welfare of Horses - EAAP Publication No. 128 see p 19
J Nutr. 2006 Jul;136(7 Suppl):2099S-2102S. (PubMed) Full Text
Pasture nonstructural carbohydrates and equine laminitis.
Longland AC, Byrd BM.
There IS sugar in grass and hay - Katy Watts www.safergrass.org
Kagan IA, Kirch BH, Thatcher CD, Strickland JR, Teutsch CD, Elvinger F, Pleasant RS
Seasonal and Diurnal Variation in Simple Sugar and Fructan Composition of Orchardgrass Pasture and Hay in the Piedmont Region of the United States
Journal of Equine Veterinary Science, Volume 31, Issue 8, August 2011, Pages 488-497
Deepdyve
Kagan IA, Kirch BH, Thatcher CD, Teutsch CD, Pleasant RS
Chromatographic profiles of nonstructural carbohydrates contributing to the colorimetrically determined fructan, ethanol-solube, and water-soluble carbohydrate contents of five grasses
Animal Feed Science and Technology , Volume 188 , 53 - 63
Do fructans cause laminitis or affect blood glucose/insulin?
It is now widely accepted that fructans in grass do not cause laminitis via the SIRS route (carbohydrate overload upsetting hind gut bacteria leading to acidosis and GI mucosal barrier dysfunction), and that pasture-associated laminitis has an endocrinopathic cause.
But does fructan intake contribute to insulin resistance and/or hyperinsulinaemia, or should we only be concerned with simple sugars? Should we be looking at NSC contents of grass and hay (WSC (of which ESC is a sub-set) plus starch), or ignoring the fructan content and just looking at ESC plus starch?
Glatter M, Bochnia M, Goetz F, Gottschalk J, Koeller G, Mielenz N, Hillegeist D, Greef JM, Einspanier A, Zeyner A
Glycaemic and insulinaemic responses of adult healthy warm-blooded mares following feeding with Jerusalem artichoke meal
J Anim Physiol Anim Nutr (Berl). 2017 Jun;101 Suppl 1:69-78. doi: 10.1111/jpn.12669
Rosenmeier JG, Strathe AB, Andersen PH
Evaluation of coronary band temperatures in healthy horses
Am J Vet Res. 2012 May;73(5):719-23. doi: 10.2460/ajvr.73.5.719
6 healthy horses were fed 3 diets (treatment 1, 1 g of fructan/kg fed daily in the morning; treatment 2, 1 g of fructan/kg fed daily in the afternoon; and treatment 3, a low-carbohydrate [7.2%] diet) in a 3 × 3 Latin square study design.
Nutritional Ecology of the Ruminant - Peter J Van Soest 1994
p 159 grass fructans are listed in a table of common dietary carbohydrates digested by animal enzymes - simple sugar components: fructose; digestion: gastric acid; digestibility: high; digestive products: fructose; linkage beta 2-6. Does this relate to horses? The NRC Nutrient Requirements of Horses 2007 p 38 says "it is also possible that fructan can be hydrolyzed to some extent by gastric acid (Van Soest 1994) or fermented in the stomach."
J Anim Sci. 2007 Nov;85(11):2949-58. Epub 2007 Jun 25.
Dietary fructan carbohydrate increases amine production in the equine large intestine: implications for pasture-associated laminitis.
Crawford C, Sepulveda MF, Elliott J, Harris PA, Bailey SR.
3 g/kg BW inulin was fed mixed with Readigrass, a 15% protein high sugar freeze-dried grass
J. Nutr. 136: 2108S–2110S, 2006 (PubMed) Full Text
Fermentative Gases in Breath Indicate that Inulin and Starch Start to Be Degraded by Microbial Fermentation in the Stomach and Small Intestine of the Horse in Contrast to Pectin and Cellulose
Coenen M, Moßeler A, Vervuert I
"The results obtained suggest that inulin and starch are rapidly fermented prececally in healthy horses."
"Acute laminitis has been shown to result from a single dose of fructan fed at 7.5 g/kg M, and, as a result, many studies have been performed to try to establish the exact role of fructan in this disease. Dysbiosis following carbohydrate overload in the hindgut is suggested to play a major role in the onset of this disease. The results of the current study show that the microbial community in the prececal part of the gastrointestinal tract must be involved in some way, perhaps by modifying prececal fermentation patterns. Until now, work has been focused on the fermentative processes and microbial changes in the hindgut of horses with laminitis, but perhaps now, microbial changes in the foregut of horses should be elucidated."
Short chain v long chain fructans
Harlow BE, Lawrence LM, Kagan IA, Flythe MD
Effect of inulin chain length on fermentation by equine fecal bacteria and Streptococcus bovis in vitro
JEVS May 2015 Volume 35, Issue 5, Page 425
Deepdyve
The abstract states that grass fructans can be fermented by Gram-positive bacteria (e.g. Streptococcus bovis) in the horse's hindgut, causing increased production of lactic acid and decreasing pH (reference?). Micro-organisms from the dung of 3 horses were mixed with short chain inulin (DP 10 or less) or long chain inulin (DP 23 or more) and incubated. Results: pH was lower in short-chain fermentations. Conclusion: short chain inulin may be more available for fermentation than long chain inulin by equine fecal bacteria, and Streptococcus bovis specifically.
Fructan analysis
J Sci Food Agric. 2012 Feb 1. doi: 10.1002/jsfa.5555. [Epub ahead of print] (PubMed)
Comparison of a colorimetric and a high-performance liquid chromatography method for the determination of fructan in pasture grasses for horses.
Longland AC, Dhanoa MS, Harris PA.
"RESULTS: Pasture grasses (Phleum pretense, Festuca rubra, Dactylis glomerata, Lolium perenne) managed for grazing (sampled from April to November) and a further set managed for conservation (sampled in July) were analysed for fructan content by HPLC and the colorimetric technique. HPLC values ranged from 83 to 299 g fructan kg(-1) DM (mean 154); corresponding colorimetric values were 5-238 g fructan kg(-1) DM (mean 82). Discrepancies in values between the two methods varied with time of sampling and plant species. Comparison of selected samples before and after incubation with the fructan hydrolases used in the colorimetric method revealed incomplete fructan hydrolysis from the pasture grasses, resulting in underestimates of their fructan content."
Horses were fed 3 diets (treatment 1, 1 g of fructan/kg fed daily in the morning; treatment 2, 1 g of fructan/kg fed daily in the afternoon; and treatment 3, a low-carbohydrate [7.2%] diet) in a 3 × 3 Latin square study design.
Fructosamine
Knowles EJ, Menzies-Gow NJ, Mair TS
Plasma fructosamine concentrations in horses with pituitary pars intermedia dysfunction with and without laminitis
Equine Veterinary Journal Volume 46, Issue 2, pages 249–251, March 2014 (Published online 04 July 2013)
Knowles EJ, Withers JM, Mair TS
Increased plasma fructosamine concentrations in laminitic horses
Equine Vet J. 2012 Mar;44(2):226-9 Epub 2011 Jun 23
Knowles EJ, Menzies-Gow NJ, Mair TS
Plasma fructosamine concentrations in horses with pituitary pars intermedia dysfunction with and without laminitis
Equine Veterinary Journal Volume 46, Issue 2, pages 249–251, March 2014 (Published online 04 July 2013)
Knowles EJ, Withers JM, Mair TS
Increased plasma fructosamine concentrations in laminitic horses
Equine Vet J. 2012 Mar;44(2):226-9 Epub 2011 Jun 23
Fructose
Does fructose contribute to insulin resistance and laminitis? Does it have a significant effect on insulin levels?
Can fructans be digested to fructose in the horse?
So what do we know about fructose?
Fructose is a monosaccharide, present in grass.
Sucrose, a disaccharide present in grass, is made up of one molecule of glucose and one molecule of fructose.
Molasses is roughly half glucose, half fructose (some as sucrose, some as monosaccharides), whereas honey is slightly higher in fructose than glucose.
Starch is digested totally to glucose - no fructose comes from starch.
Apples and pears are particularly high in fructose with fructose:glucose ratios of 2 or above - see Wikipedia fructose
Fructose is well absorbed by horses.
Fructose is transported from the GI lumen into the enterocytes of the GI by the sodium independent facilitative transporter GLUT5.
Merediz EF, Dyer J, Salmon KS, Shirazi-Beechey SP
Molecular characterisation of fructose transport in equine small intestine
Equine Vet J. 2004 Sep;36(6):532-8 (PubMed)
"RESULTS: eGLUT5 is expressed in the villus enterocytes with highest levels in duodenum>jejunum and lowest in the ileum. Kinetic studies indicate eGLUT5 is a low affinity, high capacity transporter.
CONCLUSIONS: Equine small intestine has the capacity to absorb fructose."
Johnson RJ, Rivard C, Lanaspa MA, Otabachian-Smith S, Ishimoto T, Cicerchi C, Cheeke PR, McIntosh B, Hess T
Fructokinase, Fructans, Intestinal Permeability, and Metabolic Syndrome: An Equine Connection?
J Equine Vet Sci. 2013 Feb;33(2):120-126 ( published online 18 June 2012)
J ANIM SCI May 14, 2012 jas.2012-4236
Effect of feeding glucose, fructose, and inulin on blood glucose and insulin concentrations in normal ponies and those predisposed to laminitis
Borer KE, Bailey SR, Menzies-Gow NJ, Harris PA, Elliot J
Insulin AUC was greater in previously laminitic ponies than in ponies that hadn't had laminitis after feeding both glucose and fructose, but changes in both glucose and insulin were lower after feeding fructose than after feeding glucose (differences between previously laminitic and non-laminitic ponies were seen).
Comment..
Bailey S, Habershon-Butcher J, Ransom K, Elliott J, Menzies-Gow N
Hypertension and insulin resistance in a mixed-breed population of ponies predisposed to laminitis
Am J Vet Res 2008 Jan;69(1):122-9
Fructose is suggested to play a role in human metabolic syndrome, and metabolic syndrome has been induced in other species by feeding high fructose diets. Plasma uric acid levels increased in laminitis-prone ponies when grazing summer pasture. Can fructans be digested to fructose in the horse?
Vervuert I, Coenen M, Bichmann M
Comparison of the effects of fructose and glucose supplementation on metabolic responses in resting and exercising horses
J Vet Med A Physiol Pathol Clin Med. 2004 May;51(4):171-7
Young horses were fed 600 g of either grass nuts (control), grass nuts with 50% glucose or grass nuts with 50% fructose. Control horses ate approximately 81 g protein, 63 g starch and 37 g sugar taking 14 minutes; fructose horses ate approximately 44 g protein, 29 g starch and 331 g fructose taking 8 minutes; glucose horses ate approximately 44 g protein, 39 g starch and 319 g glucose taking 8 minutes, after a 12 hour fast. Blood was collected 30 minutes before and until 5 hours after feeding. Peak and AUC glucose were significantly higher for glucose supplementation, no significant difference between control and fructose supplementation. Insulin increased after feeding all supplements, with peak and AUC insulin significantly higher for glucose supplementation, and a moderate increase in insulin for fructose supplementation. Peak insulin occurred 2.5 hours after feeding for glucose and fructose supplementation, less than 1 hour after feeding for control. Fructose is converted into glucose in the liver before being used by the body, and at rest may be mostly stored as liver glycogen with a small amount of glucose being released into the blood. In this study, the increase in plasma glucose in the fructose supplemented horses might have been the result of conversion of fructose into glucose, and the lack of difference in time to peak plasma glucose between glucose and fructose supplemented horses suggests that the absorption rate from the gut lumen is similar. As expected, in resting horses fructose supplementation caused only moderate plasma glucose and insulin increases. When the horses were exercised, fructose supplementation caused a lower glycaemic response than glucose supplementation.
2000 American Society for Nutritional Sciences (Full)
Carbohydrate Supplementation of Horses During Endurance Exercise: Comparison of Fructose and Glucose
Bullimore SR, Pagan JD, Harris PA, Hoekstra KE, Roose KA, Gardner SC, Geor RJ
This paper suggests that fructose is well absorbed in horses and may be rapidly converted to glucose. No explanation is given of a possible means by which fructose may be converted to glucose. Horses were given either glucose, fructose or 50:50 glucose:fructose, and plasma glucose concentrations were similar regardless of the treatment. A control was not used. Horses given 300 g of fructose in 1.5 litres of water did not show adverse GI effects. Horses given fructose appeared to have a higher plasma lactate concentration, the paper suggests further investigation is required to determine whether fructose is converted to lactate by horses, and if so, how. Insulin results were lower following fructose administration than glucose.
Fructose in human Metabolic Syndrome:
Jang C, Hui S, Lu W, Cowan AJ, Morscher RJ, Lee G, Liu W, Tesz GJ, Birnbaum MJ, Rabinowitz JD
The Small Intestine Converts Dietary Fructose into Glucose and Organic Acids
Cell Metabolism , Volume 27, Issue 2, p351–361.e3, 6 February 2018
Song M, Schuschke DA, Zhou Z, Chen T, Pierce WM Jr, Wang R, Johnson WT, McClain CJ
High fructose feeding induces copper deficiency in Sprague-Dawley rats: a novel mechanism for obesity related fatty liverJ Hepatol. 2012 Feb;56(2):433-40
Sugar: The Bitter Truth - Robert H Lustig MD, Professor of Paediatrics, Division of Endocrinology, University of California (UCTV)
Dr Lustig presents evidence that fructose is a toxin and a major contributor to Metabolic Syndrome in humans.
Is any, most or all of his evidence valid with horses?
Are we missing the point by looking at glucose levels because they have a direct influence on insulin levels - should we instead be considering that ingested fructose can be causing the insulin resistance that leads to increased insulin levels when glucose is eaten?
Nutr Metab (Lond). 2012 Jul 24;9(1):68.
Consumption of fructose- but not glucose-sweetened beverages for 10 weeks increases circulating concentrations of uric acid, retinol binding protein-4, and gamma-glutamyl transferase activity in overweight/obese humans
Cox CL, Stanhope KL, Schwarz JM, Graham JL, Hatcher B, Griffen SC, Bremer AA, Berglund L, McGahan JP, Keim NL, Havel PJ
Isocaloric, weight-maintaining diets providing 25% energy as either fructose or glucose found that prolonged fructose consumption increased uric acid, GGT and RBP-4, increased visceral adipose tissue and reduced insulin sensitivity and glucose tolerance.
Nutr Metab (Lond). 2005 Feb 21;2(1):5 (PubMed) (Full paper)
Fructose, insulin resistance, and metabolic dyslipidemia
Basciano H, Federico L, Adeli K
"A high flux of fructose to the liver, the main organ capable of metabolizing this simple carbohydrate, perturbs glucose metabolism and glucose uptake pathways, and leads to a significantly enhanced rate of de novo lipogenesis and triglyceride (TG) synthesis, driven by the high flux of glycerol and acyl portions of TG molecules from fructose catabolism. These metabolic disturbances appear to underlie the induction of insulin resistance commonly observed with high fructose feeding in both humans and animal models. Fructose-induced insulin resistant states are commonly characterized by a profound metabolic dyslipidemia, which appears to result from hepatic and intestinal overproduction of atherogenic lipoprotein particles. Thus, emerging evidence from recent epidemiological and biochemical studies clearly suggests that the high dietary intake of fructose has rapidly become an important causative factor in the development of the metabolic syndrome."
Can fructans be digested to fructose in the horse?
So what do we know about fructose?
Fructose is a monosaccharide, present in grass.
Sucrose, a disaccharide present in grass, is made up of one molecule of glucose and one molecule of fructose.
Molasses is roughly half glucose, half fructose (some as sucrose, some as monosaccharides), whereas honey is slightly higher in fructose than glucose.
Starch is digested totally to glucose - no fructose comes from starch.
Apples and pears are particularly high in fructose with fructose:glucose ratios of 2 or above - see Wikipedia fructose
Fructose is well absorbed by horses.
Fructose is transported from the GI lumen into the enterocytes of the GI by the sodium independent facilitative transporter GLUT5.
Merediz EF, Dyer J, Salmon KS, Shirazi-Beechey SP
Molecular characterisation of fructose transport in equine small intestine
Equine Vet J. 2004 Sep;36(6):532-8 (PubMed)
"RESULTS: eGLUT5 is expressed in the villus enterocytes with highest levels in duodenum>jejunum and lowest in the ileum. Kinetic studies indicate eGLUT5 is a low affinity, high capacity transporter.
CONCLUSIONS: Equine small intestine has the capacity to absorb fructose."
Johnson RJ, Rivard C, Lanaspa MA, Otabachian-Smith S, Ishimoto T, Cicerchi C, Cheeke PR, McIntosh B, Hess T
Fructokinase, Fructans, Intestinal Permeability, and Metabolic Syndrome: An Equine Connection?
J Equine Vet Sci. 2013 Feb;33(2):120-126 ( published online 18 June 2012)
J ANIM SCI May 14, 2012 jas.2012-4236
Effect of feeding glucose, fructose, and inulin on blood glucose and insulin concentrations in normal ponies and those predisposed to laminitis
Borer KE, Bailey SR, Menzies-Gow NJ, Harris PA, Elliot J
Insulin AUC was greater in previously laminitic ponies than in ponies that hadn't had laminitis after feeding both glucose and fructose, but changes in both glucose and insulin were lower after feeding fructose than after feeding glucose (differences between previously laminitic and non-laminitic ponies were seen).
Comment..
Bailey S, Habershon-Butcher J, Ransom K, Elliott J, Menzies-Gow N
Hypertension and insulin resistance in a mixed-breed population of ponies predisposed to laminitis
Am J Vet Res 2008 Jan;69(1):122-9
Fructose is suggested to play a role in human metabolic syndrome, and metabolic syndrome has been induced in other species by feeding high fructose diets. Plasma uric acid levels increased in laminitis-prone ponies when grazing summer pasture. Can fructans be digested to fructose in the horse?
Vervuert I, Coenen M, Bichmann M
Comparison of the effects of fructose and glucose supplementation on metabolic responses in resting and exercising horses
J Vet Med A Physiol Pathol Clin Med. 2004 May;51(4):171-7
Young horses were fed 600 g of either grass nuts (control), grass nuts with 50% glucose or grass nuts with 50% fructose. Control horses ate approximately 81 g protein, 63 g starch and 37 g sugar taking 14 minutes; fructose horses ate approximately 44 g protein, 29 g starch and 331 g fructose taking 8 minutes; glucose horses ate approximately 44 g protein, 39 g starch and 319 g glucose taking 8 minutes, after a 12 hour fast. Blood was collected 30 minutes before and until 5 hours after feeding. Peak and AUC glucose were significantly higher for glucose supplementation, no significant difference between control and fructose supplementation. Insulin increased after feeding all supplements, with peak and AUC insulin significantly higher for glucose supplementation, and a moderate increase in insulin for fructose supplementation. Peak insulin occurred 2.5 hours after feeding for glucose and fructose supplementation, less than 1 hour after feeding for control. Fructose is converted into glucose in the liver before being used by the body, and at rest may be mostly stored as liver glycogen with a small amount of glucose being released into the blood. In this study, the increase in plasma glucose in the fructose supplemented horses might have been the result of conversion of fructose into glucose, and the lack of difference in time to peak plasma glucose between glucose and fructose supplemented horses suggests that the absorption rate from the gut lumen is similar. As expected, in resting horses fructose supplementation caused only moderate plasma glucose and insulin increases. When the horses were exercised, fructose supplementation caused a lower glycaemic response than glucose supplementation.
2000 American Society for Nutritional Sciences (Full)
Carbohydrate Supplementation of Horses During Endurance Exercise: Comparison of Fructose and Glucose
Bullimore SR, Pagan JD, Harris PA, Hoekstra KE, Roose KA, Gardner SC, Geor RJ
This paper suggests that fructose is well absorbed in horses and may be rapidly converted to glucose. No explanation is given of a possible means by which fructose may be converted to glucose. Horses were given either glucose, fructose or 50:50 glucose:fructose, and plasma glucose concentrations were similar regardless of the treatment. A control was not used. Horses given 300 g of fructose in 1.5 litres of water did not show adverse GI effects. Horses given fructose appeared to have a higher plasma lactate concentration, the paper suggests further investigation is required to determine whether fructose is converted to lactate by horses, and if so, how. Insulin results were lower following fructose administration than glucose.
Fructose in human Metabolic Syndrome:
Jang C, Hui S, Lu W, Cowan AJ, Morscher RJ, Lee G, Liu W, Tesz GJ, Birnbaum MJ, Rabinowitz JD
The Small Intestine Converts Dietary Fructose into Glucose and Organic Acids
Cell Metabolism , Volume 27, Issue 2, p351–361.e3, 6 February 2018
Song M, Schuschke DA, Zhou Z, Chen T, Pierce WM Jr, Wang R, Johnson WT, McClain CJ
High fructose feeding induces copper deficiency in Sprague-Dawley rats: a novel mechanism for obesity related fatty liverJ Hepatol. 2012 Feb;56(2):433-40
Sugar: The Bitter Truth - Robert H Lustig MD, Professor of Paediatrics, Division of Endocrinology, University of California (UCTV)
Dr Lustig presents evidence that fructose is a toxin and a major contributor to Metabolic Syndrome in humans.
Is any, most or all of his evidence valid with horses?
Are we missing the point by looking at glucose levels because they have a direct influence on insulin levels - should we instead be considering that ingested fructose can be causing the insulin resistance that leads to increased insulin levels when glucose is eaten?
Nutr Metab (Lond). 2012 Jul 24;9(1):68.
Consumption of fructose- but not glucose-sweetened beverages for 10 weeks increases circulating concentrations of uric acid, retinol binding protein-4, and gamma-glutamyl transferase activity in overweight/obese humans
Cox CL, Stanhope KL, Schwarz JM, Graham JL, Hatcher B, Griffen SC, Bremer AA, Berglund L, McGahan JP, Keim NL, Havel PJ
Isocaloric, weight-maintaining diets providing 25% energy as either fructose or glucose found that prolonged fructose consumption increased uric acid, GGT and RBP-4, increased visceral adipose tissue and reduced insulin sensitivity and glucose tolerance.
Nutr Metab (Lond). 2005 Feb 21;2(1):5 (PubMed) (Full paper)
Fructose, insulin resistance, and metabolic dyslipidemia
Basciano H, Federico L, Adeli K
"A high flux of fructose to the liver, the main organ capable of metabolizing this simple carbohydrate, perturbs glucose metabolism and glucose uptake pathways, and leads to a significantly enhanced rate of de novo lipogenesis and triglyceride (TG) synthesis, driven by the high flux of glycerol and acyl portions of TG molecules from fructose catabolism. These metabolic disturbances appear to underlie the induction of insulin resistance commonly observed with high fructose feeding in both humans and animal models. Fructose-induced insulin resistant states are commonly characterized by a profound metabolic dyslipidemia, which appears to result from hepatic and intestinal overproduction of atherogenic lipoprotein particles. Thus, emerging evidence from recent epidemiological and biochemical studies clearly suggests that the high dietary intake of fructose has rapidly become an important causative factor in the development of the metabolic syndrome."
FSIGT
The Frequently Sampled Intravenous Glucose Tolerance Test (FSIGTT) evaluates glucose and insulin dynamics.
The procedure for the FSIGTT first described by Hoffman et al. and modified by Toth et al.:
A catheter is inserted into the jugular vein (usually the day before the test is performed). 100 mg glucose/kg bodyweight is infused as a bolus within 1 minute as 50% weight/volume dextrose solution followed by 20 ml heparinised saline, and blood samples collected at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, 14, 16 and 19 minutes after the dextrose infusion. At 20 minutes insulin is administered at 20 mU/kg bodyweight, followed by 20 ml heparinised saline, and further blood samples collected at 22, 23, 24, 25, 27, 30, 35, 40, 50, 60, 70, 80, 90, 100, 120, 150 and 180 minutes after the initial dextrose infusion. At each time point 3 ml of blood is withdrawn from the infusion line and discarded, then blood collected for glucose and insulin testing.
Tóth F, Frank N, Elliott SB, Perdue K, Geor RJ, Boston RC
Optimisation of the frequently sampled intravenous glucose tolerance test to reduce urinary glucose spilling in horses
Equine Vet J. 2009 Dec;41(9):844-51
"CONCLUSIONS: Results indicate that the dextrose dosage of 300 mg/kg bwt used in the established FSIGTT is too high. UGS can be reduced by lowering the dextrose dosage to 100 mg/kg bwt.
POTENTIAL RELEVANCE:A new FSIGTT involving the administration of 100 mg/kg bwt dextrose followed by 20 mu/kg bwt insulin 20 min later is recommended for use in horses because this test provides adequate data for minimal model analysis while minimising UGS."
Research using the FSIGT test:Tinworth KD, Boston RC, Harris PA, Sillence MN, Raidal SL, Noble GK
The effect of oral metformin on insulin sensitivity in insulin-resistant ponies
Vet J. 2012 Jan;191(1):79-84. Epub 2011 Feb 23
Kalck KA, Frank N, Elliott SB, Boston RC
Effects of low-dose oligofructose treatment administered via nasogastric intubation on induction of laminitis and associated alterations in glucose and insulin dynamics in horses
Am J Vet Res. 2009 May;70(5):624-32
Pratt SE, Geor RJ, LJ McCutcheon
Repeatability of 2 Methods for Assessment of Insulin Sensitivity and Glucose Dynamics in Horses
Journal of Veterinary Internal Medicine, 19: 883–888 (2005). doi:10.1111/j.1939-1676.20
The procedure for the FSIGTT first described by Hoffman et al. and modified by Toth et al.:
A catheter is inserted into the jugular vein (usually the day before the test is performed). 100 mg glucose/kg bodyweight is infused as a bolus within 1 minute as 50% weight/volume dextrose solution followed by 20 ml heparinised saline, and blood samples collected at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, 14, 16 and 19 minutes after the dextrose infusion. At 20 minutes insulin is administered at 20 mU/kg bodyweight, followed by 20 ml heparinised saline, and further blood samples collected at 22, 23, 24, 25, 27, 30, 35, 40, 50, 60, 70, 80, 90, 100, 120, 150 and 180 minutes after the initial dextrose infusion. At each time point 3 ml of blood is withdrawn from the infusion line and discarded, then blood collected for glucose and insulin testing.
Tóth F, Frank N, Elliott SB, Perdue K, Geor RJ, Boston RC
Optimisation of the frequently sampled intravenous glucose tolerance test to reduce urinary glucose spilling in horses
Equine Vet J. 2009 Dec;41(9):844-51
"CONCLUSIONS: Results indicate that the dextrose dosage of 300 mg/kg bwt used in the established FSIGTT is too high. UGS can be reduced by lowering the dextrose dosage to 100 mg/kg bwt.
POTENTIAL RELEVANCE:A new FSIGTT involving the administration of 100 mg/kg bwt dextrose followed by 20 mu/kg bwt insulin 20 min later is recommended for use in horses because this test provides adequate data for minimal model analysis while minimising UGS."
Research using the FSIGT test:Tinworth KD, Boston RC, Harris PA, Sillence MN, Raidal SL, Noble GK
The effect of oral metformin on insulin sensitivity in insulin-resistant ponies
Vet J. 2012 Jan;191(1):79-84. Epub 2011 Feb 23
Kalck KA, Frank N, Elliott SB, Boston RC
Effects of low-dose oligofructose treatment administered via nasogastric intubation on induction of laminitis and associated alterations in glucose and insulin dynamics in horses
Am J Vet Res. 2009 May;70(5):624-32
Pratt SE, Geor RJ, LJ McCutcheon
Repeatability of 2 Methods for Assessment of Insulin Sensitivity and Glucose Dynamics in Horses
Journal of Veterinary Internal Medicine, 19: 883–888 (2005). doi:10.1111/j.1939-1676.20