The role of nutritional therapy in the treatment of equine Cushing's syndrome and laminitis.
Authors: Harman, Ward
Journal: Alternative medicine review : a journal of clinical therapeutic
Summary
# Editorial Summary: Nutritional Therapy in Equine Cushing's Syndrome and Laminitis Equine Cushing's syndrome represents a multifaceted endocrine disorder stemming from anterior pituitary hyperplasia or adenoma, characterised biochemically by elevated endogenous cortisol, insulin resistance, raised ACTH concentrations, and suppressed thyroid hormone levels—a constellation that manifests clinically through hirsutism, refractory laminitis, metabolic dysregulation, polyuria/polydipsia, immunosuppression, intestinal barrier dysfunction, and reproductive failure. Harman and Ward propose that conventional pharmaceutical management, whilst widely employed, may paradoxically exacerbate the underlying pathology; specifically, phenylbutazone—the standard NSAID analgesic—increases intestinal permeability, potentially facilitating bacterial endotoxin translocation, a recognised trigger for laminitis development and perpetuation. Their integrative approach prioritises restoration of intestinal barrier integrity through targeted nutritional intervention, combined with judicious elimination of NSAIDs, alongside adjunctive modalities including acupuncture and herbal medicine (both traditional Chinese and Western). By addressing the intestinal component of disease pathogenesis rather than treating laminitis symptomatically, this framework reports improved therapeutic responsiveness, with individualised multimodal protocols—encompassing nutrition, farriery, and complementary therapies—yielding consistently positive outcomes. For equine practitioners, this work underscores the value of investigating root causes of treatment failure in refractory laminitis, particularly the iatrogenic contribution of long-term NSAID use, and the potential clinical gains from intestinal health optimisation as foundational to managing Cushing's-associated complications.
Read the full abstract on PubMed
Practical Takeaways
- •Consider discontinuing phenylbutazone in Cushing's cases with refractory laminitis due to its adverse effects on intestinal barrier function
- •Implement nutritional and intestinal wall healing protocols alongside conventional therapies to improve laminitis management outcomes
- •Use multimodal treatment combining good farriery, nutrition, and complementary therapies rather than relying solely on NSAIDs
Key Findings
- •Equine Cushing's syndrome involves pituitary hyperplasia or adenoma with elevated cortisol, ACTH, and insulin resistance
- •Phenylbutazone (NSAID) increases intestinal wall permeability, which may worsen laminitis outcomes by facilitating bacterial exotoxin translocation
- •Removing phenylbutazone and healing the intestinal wall improves responsiveness of laminitis to treatment
- •Holistic multimodal approach combining nutritional management, hoof care, acupuncture, and herbal medicine shows positive outcomes in Cushing's syndrome treatment