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Equine Syndrome X: What You Need to Know About This Growing Epidemic

Horses Eating

Equine Metabolic Syndrome (EMS) is a condition in horses that features abnormal fat distribution and elevated insulin levels.

Horses with EMS typically show some or all of the following symptoms:

Insulin regulates sugar and energy metabolism in the body. High fasting levels of the hormone indicate a condition of insulin resistance in which the body is not responding to the insulin being produced. This leads to metabolic issues, which leads to diabetes in humans. In horses, elevated insulin levels seem to create inflammatory and circulatory disorders.

Equine veterinarians are seeing an ever-increasing number of horses with EMS, similar to the epidemic of obesity and diabetes in humans.

According to Richard Tully, DVM, writing for Veterinary Practice News:

“Without a doubt, exercise and diet modification play a central role in the management of EMS. I use this treatment wherever possible. Unfortunately, this practice doesn’t fit many situations.

Whether due to lameness, a challenging barn environment, inactivity due to cold weather or something else, diet and exercise are often not enough. With more and more animals being diagnosed with EMS, finding other management tools is becoming a priority for the veterinarian, trainer and owner alike.”

Dr. Becker's Comments:

Dr. Tully is an allopathic veterinarian who was open-minded enough a few years back to investigate a food-based nutritional supplement developed to treat animals with Equine Metabolic Syndrome.

The doctor openly admits his skepticism of non-traditional remedies when he states, “I didn’t have much confidence in supplements and didn’t have much experience using them until I had the opportunity to participate in a clinical evaluation of a supplement now on the market.”

Equine Metabolic Syndrome Symptoms

EMS, also called ‘equine syndrome X,’ is not as clearly defined in veterinary medicine as metabolic syndrome is in human medicine. The disorder has become increasingly important to understand due to its connection to laminitis, the second most common cause of death in horses.

Your horse is at risk for EMS if he’s obese or an easy keeper (he maintains or gains weight on a minimum amount of food), and is between eight and 18 years of age. A horse doesn’t have to be overweight to develop the condition, however.

EMS horses generally have abnormal fat deposits on the neck, above the eyes, on the shoulders, the loins and the tailhead. Some animals appear pot-bellied and drink and urinate more than normal. Mild but recurrent laminitis is also common.


Equine metabolic syndrome has very similar characteristics to two other common conditions: Cushing’s syndrome and hypothyroidism.

Unfortunately, diagnosing insulin resistance in your horse is not a straightforward process, as there are a number of factors that can impact test results. Many equine veterinarians consider the euglycemic insulin clamp test to be the most accurate tool available, but it’s a lengthy, complex, and costly test to perform and interpret.

Another test is the CGIT (glucoseinsulin tolerance) test, but it also requires several hours to conduct and like the euglycemic insulin clamp test, requires that your animal be transported to a large animal hospital or similar facility.

Due to the inconvenience, cost and stress on the animal incurred by the above two tests, many vets opt to leave the horse on the farm and take a blood sample to measure blood glucose and insulin levels. Unfortunately, glucose to insulin ratios are not considered particularly useful in establishing insulin resistance or equine metabolic syndrome.

Treatment Options

The primary treatment if your horse has EMS is through changes to diet and increased exercise.

Many horse owners unintentionally overfeed their animals. If your horse is older or less active, he quite likely can be fed forage only to maintain a good body weight. Animals with EMS should have very limited access to pasture, if any.

Horses with EMS should be exercised daily, if possible. If your horse is suffering from laminitis at the time of diagnosis, it’s important to wait for the condition to resolve before starting or resuming an exercise schedule.

Equine metabolic syndrome can’t be cured, but the degree and severity of laminitis at the time the disorder is diagnosed is the most accurate gauge of how well your horse will do long-term, even with appropriate dietary and exercise adjustments.

Standard Process Equine Metabolic Support

It’s obvious from Dr. Tully’s article he was impressed with the nutritional supplement he tested. In fact, he considered it “an apparently safe product with significant possibility of therapeutic benefit.”

Dr. Tully went on to participate in a larger scale evaluation sponsored by the manufacturer of the supplement, Standard Process. His practice ultimately studied a total of 29 horses that were given the product for four months. Of the 29, 20 had decreased fasting insulin levels and three had increased circulating insulin levels. The remaining animals had varying responses to the supplement.

Physical changes noted in the study participants were improvements in ‘cresty neck,’ obesity, laminitis, activity level and overall quality of life.

During the course of his investigation, the doctor developed anecdotal evidence of his own in horses that improved tremendously on the supplement, as well as animals that were taken off it, regressed, were put back on it and improved.

The ingredient in the supplement Dr. Tully was especially interested in was buckwheat flour for its reported ability both to slow the absorption of sugar and also maintain capillary health, which could benefit EMS horses with laminitis.

Other ingredients in Equine Metabolic Support include:

  • Licorice root
  • Cinnamon
  • Chili powder
  • Green tea extract
  • Chromium
  • Vanadium

All of these ingredients have the potential to decrease a horse’s metabolic stress.

Preventing EMS in Your Horse

Whenever possible, it’s always better to prevent disease than to treat it after the fact.

Since equine metabolic syndrome is linked to obesity, the most important thing you can do for your horse is maintain her at a healthy weight by feeding a forage-based diet and exercising her consistently.

If you’re unsure what your horse’s body condition is or should be, ask your vet for help.

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