Truth or ConsequencesHow equine GI health may be

putting your practice at risk…

and what to do about it.

By Freedom Health, LLC

Published November 2018

All rights reserved

IntroductionPracticing veterinarians too easily overlook

digestive health in their equine patients.

Important issues in the performance practice,

like joints and other musculoskeletal issues,

often take priority. But the fact remains: gut

health IS vital to the horse’s overall health and

performance potential. A healthy gut provides

optimal digestion and energy utilization, while

an unhealthy gut can lead to welfare issues and

performance-limiting disease processes.

At the same time, many horse owners and

trainers are starting to pay attention to diges-

tive health in their horses. This has given rise to

a multi-million dollar digestive category with-

in the supplement industry—an industry that

thrives on people’s lack of understanding.

With the wide array of digestive products

available, combined with the accessibility of

information on the internet (often inaccurate or

misleading), you will likely find that your clients

are making decisions every day about their

horses’ health, often without consulting you as

their veterinarian. That leaves them susceptible

to poor choices that do not address the core issues

or that may do more harm than good. This in itself

raises the need for you to pay more attention to

GI health in your practice.

It is increasingly clear, too, that gastric ulcers,

diagnostic measures like gastroscopy, and typical

treatments represent only the tip of the iceberg

when it comes to digestive disease in horses.

Issues in the hindgut, especially among perfor-

mance horses, are common and significant. Also,

traditional therapy protocols don’t solve the root

issues from which gastric ulcers arise, and they

don’t address the hindgut.

When you aren’t proactively identifying and

managing the widespread digestive issues among

your clients’ horses, your practice is at risk.

This paper reveals current issues in equine

digestive health management and the resulting

consequences for horses, owners, and your

veterinary practice if you neglect to make a change.

Learn the problems and pitfalls . . . and what you

can do to avoid them.

When you aren’t proactively identifying and managing the widespread digestive issues among your clients’ horses, your practice is at risk.

2

Digestive Health is a Significant Issue

• The importance of the hindgut

• The role played by bacteria

• Hindgut issues are widespread

• The benefits of early detection

Why GI Health Matters

• To the Horse

• To the Owner

• To the Veterinarian

The Need for Effective Diagnostics

• Reliance on Symptoms

• Treatment/Response

• More Sophisticated Diagnostic Methods

A Better Diagnostic Approach – The SUCCEED FBT

• Reliability Illustrated

• Evaluated in the Real-World

• Limitations of the FBT

• Applications of the FBT

Current Treatments

• Gastric ulcers – the silver bullet

• How to address the hindgut

SUCCEED Veterinary Formula

• Oat oil rich in polar lipids

• Oat flour rich in beta glucan

• Amino acids

• Nucleotides

• Yeast products

The SUCCEED Healthy Gut Commitment

• Conclusion

• References

Page 4

Page 10

Page 13

Page 16

Page 22

Page 25

Page 29

Table of Contents

3

Digestive Health is a Significant Issue The biggest single issue affecting the health of a given horse’s

digestive system, and which is often overlooked by the owner,

is the role the owner and other human caregivers play in the

process. Performance horses may be most prone to digestive

health problems simply because of the way they are cared for.

The modern performance horse is fed a carbohydrate-rich diet

on an intermittent basis, i.e., two or three times a day (Richards

et al., 2006). This is especially true in the racing operation. The

horses are stabled much of the time without the ability to move

or forage (Luthersson et al., 2009). Then, they undergo travel and

the nearly continuous stress of training and performance

(McClure et al., 2005). All of these factors increase the demands

on the horse’s digestive tract, metabolism, and immune system.

The lifestyle of equine athletes makes them particularly suscep-

tible to digestive health issues (Dionne et al., 2003). As such,

poor digestive health may be an occupational hazard for

performance horse patients. Combine this susceptibility with the

fact that treatments are too often aimed at mitigating clinical

signs and not the underlying disease processes. The result may

well be a perfect storm for declining health and performance.

4

The importance of the hindgut

When considering equine digestive health,

practitioners are inclined to think first of the

portion of the gut they can visualize with a

three-meter endoscope—that is, the stomach.

The prevalence of stomach ulcer treatments also

serve to keep the stomach in the forefront when

discussing GI health with colleagues and clients.

But it is important to remember what may be the

most important part of the horse’s GI tract: the

hindgut.

The hindgut is significant for a number of practical

reasons. First, it is physically large. Second, the

whole of equine digestion depends on a healthy

hindgut. That means the horse’s ability to digest

food and absorb nutrients requires the hindgut to

function properly. And the horse’s ability to per-

form and its general health and wellbeing are, in

turn, dependent on the availability of nutrients and

energy that result from efficient digestion. This

alone should give the hindgut some status, such

that it warrants more attention and the best

efforts of all caretakers to keep it healthy.

The hindgut is also the source of many health

conditions that, when they arise, require interven-

tion. One example, and perhaps most obviously,

is equine colic. Colic is the number one health

threat to horses (Traub-Dargatz et al., 1999) and

a constant source of worry for owners. While the

technical definition of colic is abdominal pain,

most vets in practice recognize colic as a condi-

tion primarily of the intestinal tract, including the

small intestine and the colon.

That upwards of 10 percent of all horses suffer a

colic episode each year (Uhlinger, 1992) means

the horse owner is constantly on high alert for the

tell-tale signs. The simple fact that a horse has

a 1-in-10 chance of a colic episode in its life, and

the hindgut of the animal is significantly involved,

means the hindgut warrants attention. Beyond

colic, the hindgut is also important because

horses suffer from colonic lesions and other

inflammatory conditions there.

Finally, the hindgut is important because it serves

as home to literally trillions of microbes, includ-

ing a wide range of bacteria, which are only just

beginning to be understood. This bacterial popula-

tion, known collectively as the “microbiota,” plays a

significant role in the horse’s digestive process, as

well as overall health and well-being.

5

The role played by bacteria

A horse derives much of its energy from grass

and other sources of fiber in its diet. In fact,

horses were designed to graze on grasses most

of the day. The digestive system of the horse

(like humans) isn’t able to digest the high fiber

content of a grazing-heavy diet. That’s the job of

the microbes that live in the cecum and colon of

a horse (Al jassim et al., 2009). Each horse has

a particular mix of various types of microbes, in

various proportions, representing its own unique

microbiota (Martin et al., 2017). Thus, a “normal”

microbiota is not a specific collection of certain

bacterial strains and species common to all

horses, but a particular mix that is right for the

given horse.

Within the larger context of digestion, it is the

role of the microbiota to act, by way of fermenta-

tion, on the incoming fiber from the horse’s diet.

It is this bacterial action of fermentation that pro-

duces essential volatile fatty acids (VFAs) that

then serve as the primary energy source of

a horse. In addition to energy, microbes also

produce essential B vitamins and vitamin K.

The aforementioned fermentation process

involves a highly connected network of microbes

that must cooperate for optimal nutrient absorp-

tion. Poor fermentation results in malnutrition,

reduced appetite, laminitis, improper immune

function, and even behavioral problems (Costa

& Weese, 2018). A healthy microbiota provides

resistance to infectious agents, enhancing

overall health.

Hindgut issues are widespread

If nothing else, hindgut issues are important simply because they are widespread—likely more

common than generally understood. This can have repercussions not only for the horse, but for the

owner and for you, the veterinarian.

While incidence rates of gastric ulcers in horses have been reported for decades, hindgut ulceration

and related disease processes represent relatively recent subjects of research. At Freedom Health,

scientists and veterinarians have been working together to investigate these issue first-hand.

In 2003, Dr. Franklin Pellegrini, later Vice President of Veterinary Medicine for Freedom Health, con-

ducted the first large-scale necropsy study of gastric and colonic ulcers at an abattoir in Texas. That

study, published in 2005, showed an incidence of colonic ulceration of 63 percent (Pellegrini, 2005).

Figure 1: Post-mortem incidence rates of colonic and gastric lesions in horses, 2003.

7

In subsequent necropsy studies conducted between 2007 and 2011, significant

incidences of both gastric and colonic ulcers were reported. Over the course of four

separate studies, the prevalence of ulceration in the colon increased, to the point that

almost all of 178 horses in 2011 were found to have lesions in their colons. While

these results reflect abattoir horses, which cannot therefore be applied to the horse

population at large, the findings do suggest colonic ulcers are a very real issue.

Figure 2: Post-mortem incidence rates of colonic and gastric lesions in horses, 2007–11.

2007

# HorsesSampled 86

60%

87%

111

43%

85%

188

48%

74%

178

79%

94%

GastricUlcers

ColonicUlcers

2008 2009 2011

8

The post-mortem analysis of gastric and colonic tissue at necropsy revealed a wide range of lesions

and inflammation, including disseminated and focal ecchymoses, purpura, petechiation, hyperemia,

and, at least in terms of visual characteristics, traditional ulceration of both the stomach and colon.

In the colon, these issues were observed in all quadrants.

Figures 3-5: Examples of colonic lesions and inflammation observed in equine subjects, 2008 and 2011.

The benefits of early detection

Common clinical signs associated with GI dysfunction include intermittent diarrhea, anorexia, and/

or colic episodes. But as these issues arise and diagnosis is more obvious, the options for treating

them effectively diminish. This leaves practitioners with options that are more costly, more risky,

more invasive, and/or less effective. It is therefore beneficial to the horse and its caretakers to

identify an issue sooner rather than later.

As it is, if clients were better educated on recognizing outward signs that may be indicative of GI

tract distress, earlier intervention may be possible. Unfortunately, such signs may not be predictive

of specific disease conditions, particularly because they are often indicative of multiple underlying

conditions.

Also, some effects of GI health issues bear on the horse’s external behavior or other physical

manifestations, including poor performance. These effects are often attributed to external causes

unrelated to GI health. In such cases, owners and trainers are likely to blame the horse’s training, or

even the horse itself. As such, your clients are unlikely to raise such issues with you.

9

Why GI Health Matters The extent to which pathological conditions of the equine GI tract represent

an array of viable disease conditions facing the horse does not, in and of

itself, reflect the need for action. Truth be told, for many equestrians pursu-

ing specific goals with their horses, the importance of any issue must be

assessed by balancing the burden of addressing it against the risk and

consequences of doing nothing. But GI health conditions do negatively

affect everyone involved: the owner, the horse, and the veterinarian.

10

To the Horse

Overall health implications of GI tract wellness are perhaps most significant for the

horse and this, in turn, elevates the importance of gut health for the owner. Common

pathological conditions of the GI tract, even if apparently minor at first blush, may

reflect a more significant underlying condition, either at present or in the near future.

Colic is the health condition of the equine gut that certainly commands the most

attention, although it is not a disease condition per se. The risk of death from colic,

combined with the seemingly unpredictable nature of its appearance, puts both vets

and their clients on notice. Ulcers, too, are not a disease, but are a common and

disruptive condition of the equine digestive system that can cause horses discom-

fort, or worse.

To the Owner

Of course, digestive health issues are not without costs for the horse’s owner and/

or its trainer. This includes direct costs in the form of medical-related expenses, and

indirect ones, by way of lost earnings or loss of productivity or performance.

Poor GI health has long been associated with poor performance (Mitchell, 2001).

This may manifest in a lack of consistent, progressive training, as well as in poor

results in competition. For the typical recreational competitor, this may amount to

fewer ribbons or fewer bragging rights in the barn. But for professionals or otherwise

serious competitors, a reduction or loss of training and performance productivity can

impact their livelihood.

A healthy digestive tract for the horse benefits the owner in other ways, including

a healthy coat, overall appearance and condition, and the attitude and behavior of

the animal. While these issues may, on the surface, appear to be secondary in

importance, they also may affect the horse’s willingness and ability to perform or

impact the horse’s presentation in the show setting.

11

To the Veterinarian

Digestive health has implications for you as well. Colic is notorious for always

seeming to arise in the middle of the night. And when colic episodes turn serious,

and a referral is in order, or especially when death results, you may find it difficult

to collect on the bill.

Even something as ubiquitous as gastric ulcers can affect you. First, the only

FDA-approved treatment is typically effective but generally expensive for many

clients. This leaves you with second-tier treatment options with less successful

outcomes. Further, the potential for recurrence of ulcers or other gut conditions is

high, especially when the underlying conditions that give rise to the disease state

are still in place. This can affect the vet/client relationship which, in turn, can

eventually impact your very reputation.

12

The Need for Effective Diagnostics The potential implications of gastrointestinal disease and related conditions for

the horse, the owner, and the veterinarian all demonstrate the need for effective

diagnostic methods. For GI health in particular, effectiveness means more than simply

“helpfulness” or “reliability.” It also means:

1. An ability to differentiate conditions of the foregut from those in the hindgut, and

2. Providing early detection of conditions, thus allowing for early intervention.

Research shows that ruling in gastric ulcers does not rule out colonic ulcers or other

serious issues of the hindgut. Further, treatment approaches for stomach ulcers or

other foregut issues are generally likely to be different from those for the hindgut. Thus,

the ability to truly differentiate foregut and hindgut pathology is important.

And, of course, doing this earlier in the disease process allows for earlier interven-

tion, which often allows for less invasive procedures and which increases the odds of

successful outcomes. To this point, Professor Derek Knottenbelt of the University of

Glasgow vet school, wrote:

Early detection of large colon diseases and their definitive diagnosis will bring

significant welfare benefits [to horses]. Clearly, subclinical colonic disease

does exist and it is naïve to assume that it invariably has no clinical significance.

Unfortunately for the veterinarian in practice, diagnostic options for detecting and

managing GI tract conditions have proven to be limited in a number of ways. A look at

each helps illustrate the problem more fully.

13

Reliance on Clinical Signs

At least until recently, diagnostic modalities have generally proven to reflect

reactive rather than proactive care. That is, they are best, and most frequently,

used after a GI tract issue is already suspected.

Vets are often inclined to look at the equine patient’s prior history and observed

clinical signs (either directly, or indirectly by way of the owner or other

caregiver). While certainly not a true “diagnostic method,” the high cost and/or

lack of availability of other, more sophisticated diagnostic approaches makes

this a common practice in the field.

The first limitation of basing a preliminary diagnosis on clinical signs is that

such signs may arise later in the disease process, limiting the viable treatment

options available to the vet. Moreover, clinical signs often prove to be imprecise

as a diagnostic indicator. This is particularly true in cases where common

symptoms may, in fact, reflect any number of potential disease states, as

described above.

Treatment/Response

A second approach commonly used for diagnosis of GI tract conditions is the

horse’s response (or lack of response) to treatment. This is most often the

diagnostic approach used in situations where the client is unable or unwilling

to pay for a more rigorous diagnostic method.

The most significant problem with a treatment/response approach to diagnosis

is the risk of administering an inappropriate treatment approach. This means

time lost going down the proverbial wrong road, thus delaying an appropriate

treatment. It also results in unnecessary expense for the client. In worst-case

scenarios, inappropriate treatments may prove risky to the health of the patient.

14

More Sophisticated Diagnostic Methods

Vets in practice do have access to more substan-

tial and proven tools to aid in diagnosis of GI tract

conditions. These, however, also have limitations.

Scoping entails visual observation of GI tract

tissue via gastric endoscope. This is a common

diagnostic procedure, but is limited to the equine

stomach. Even then, research has shown that

practitioners can readily miss lesions in the bot-

tom of the stomach, especially along the antrum

and pylorus (Murray et al., 2001). Though gastros-

copy techniques have improved over the years,

limitations remain (Martinez et al., 2014).

Gastroscopy is also a moderately invasive

procedure in that it requires a period of fasting

and sedation. Further, gastroscopy requires a

three-meter endoscope, which many veterinarians

in practice do not possess. This leaves veterinari-

ans to refer the horse, and requires the additional

step of trailering the horse to the secondary

location. All of this puts stress on the horse and

the owner, and can ultimately prove to be an

expensive proposition.

Ultrasound to assess gut wall thickness is also

available to clinics with the appropriate equip-

ment. However, ultrasonography is limited to only

a certain depth of the abdomen (depending on the

quality of the equipment), and the results are not

always conclusive to GI disease.

Rectal palpation is available to virtually every

practitioner. Such an approach is, of course, crude,

and the distance of evaluation is quite literally

limited to the length of the vet’s arm.

This lack of reliability and efficacy in common

diagnostic modalities puts your practice at risk.

Given the high incidence of gastrointestinal

disease, the impact such disease has on equine

performance and well-being, and the relative

inability to practically and reasonably diagnose

the condition, it’s highly likely that you have horses

in your care with underlying conditions you aren’t

aware of. And further, it’s likely you won’t be aware

of it until more aggressive remediation is

necessary.

You and your clients need a diagnostic method for

GI tract disease that is more effective and more

accessible. Such a diagnostic approach would:

• Allow for earlier detection, thus enabling earlier

diagnosis, and earlier intervention.

• Provide a more accurate diagnostic result,

including differentiation of foregut from

hindgut conditions such that a more targeted

treatment approach may be administered.

• Be less invasive, reducing both stress on the

animal and downtime following the procedure.

• Prove more affordable, such that most or all

clients are able and willing to afford it.

• Be available for all vets, reducing the need for

referrals.

The sooner you can identify the issue, the sooner

you can administer the appropriate treatment,

enhancing the chances of a successful outcome.

15

A Better Diagnostic Approach—

The SUCCEED FBT The SUCCEED® Equine Fecal Blood Test™ , from Freedom Health, LLC, provides

veterinarians with an easy, affordable, and reliable tool to support your diagnosis of

GI tract conditions in your equine patients (Pellegrini, 2009). The SUCCEED FBT

detects occult blood proteins in a fecal sample to serve as a point-of-care screening

test for GI tract disorders. The FBT:

• Differentiates foregut and hindgut issues.

• Is simple to use right in the barn.

• Provides results in 15 minutes or less.

• Requires only a fresh fecal sample and clean water.

The test utilizes equine-specific antibodies, one for hemoglobin and one for

albumin. Due to the nature of these two blood proteins, they can be used together

to determine whether their source is the foregut or the hindgut of the horse.

Hemoglobin in the feces is indicative of injury anywhere along the GI tract. Albumin

is a weaker molecule and, thus, destroyed by the acids and enzymes introduced into

the small intestine by way of the common bile duct. Therefore, the presence of

albumin in the feces indicates a source caudal to the common bile duct, most

commonly in the hindgut.

16

Reliability Illustrated

The FBT was developed after a theoretical threshold was established for both fecal

hemoglobin and albumin, followed by careful titration in an abattoir setting, most

recently in 2011. Horses in an abattoir likely reflected a higher prevalence of GI

lesions compared to the general population, which provided a high number of true

positives to use as test models.

In the 2011 study, the following incidence levels of ulceration were recorded using

visual observation of the stomachs and colons of 178 subjects post mortem:

October, 2011 N = 178

Colonic Ulcers

Gastric Ulcers

Either

Both

93.8%

79.2%

98.3%

74.7%

17

Fecal Blood Tests were run using fecal samples from these same 178 subjects, and

the results were later analyzed against the observations of ulceration recorded

separately. Results were as follows:

This shows a high positive predictive value, meaning that a positive test result is

highly correlated to a true condition. The test is less predictive in the face of a true

negative, but the results of the statistical analysis shown above were certainly

influenced by the relative lack of true negatives against which to test.

It is up to you, the veterinarian, to use FBT results, along with other subjective and

objective information, to formulate a differential diagnosis. This is why the SUCCEED

FBT is marketed and sold only to veterinarians.

Albumin(predictive for colonic ulcers)

Hemoglobin(predictive for gastric or colonic ulcers)

95.4%

96.9%

75.0%

57.9%

0.04

0.03

Positivepredictive value

Negativepredictive value

p-value

18

Evaluated in the Real World

An informal trial to evaluate the FBT in a clinical setting was conduct-

ed in 2012. (See figure 6 below.) Here, FBT results were gathered from

equine patients at multiple practices, including both larger referral

centers (group 1) and smaller clinics (group 2). The tests were specifi-

cally run on horses that did not present for GI tract conditions in order

to determine prevalence of GI disease in the horse population at large.

19

Group 1: major referral centers, TX and CA (performance horses)

Group 2: smaller practices (primarily non-performance horses)

AIb - 47.6% 8.4% 56.0%

AIb + 25.3% 18.7% 44.0%

Total 72.9% 27.1% 100.0%

N=42 Hb - Hb + Total

N=166 Hb - Hb + Total

AIb - 78.6% 2.4% 81.0%

AIb + 14.3% 4.8% 19.0%

Total 92.9% 7.1% 100.0%

Figure 6: Fecal blood test results from equine patients at two groups of clinics—group 1 representing primarily performance horses at major referral centers, and group 2 representing primarily non-performance horses at smaller clinics. Subject horses in all cases were presenting with issues not related to GI health.

The critical finding in these circumstances was that just over half of the group 1 horses in the

major clinics produced results indicative of some sort of digestive tract condition that produces

whole blood or albumin—that is, a condition somewhere along the GI tract. Perhaps more surpris-

ing is that 8.4 percent of the horses produced a positive He with a negative Al. This indicates that

1 in 12 of the horses presented for non GI tract health conditions produced test results consistent

with a bleeding gastric lesion.

In the smaller practices serving a higher proportion of leisure or companion horses (i.e., horses

not used in performance), the prevalence of FBT positive results was predictably much lower.

This reinforces the value of the SUCCEED FBT as a diagnostic tool for performance horses in

particular.

Limitations of the FBT

While the FBT is an excellent screening tool, it is important to address its limitations.

First, the SUCCEED FBT only detects a loss of two specific blood components—Albumin and

Hemoglobin. As a result, if a horse has a non-bleeding, or intermittently bleeding, lesion, a

negative test result is likely.

Second, because the FBT detects any type of bleeding lesion, it is important for practitioners

using it to consider as part of a differential diagnosis any type of pathological condition

associated with blood loss. This includes heavy parasitism, recent dental work, recent rectal

palpation and neoplasia, as these can all yield a positive test result.

It is also important to note that the SUCCEED FBT is not a reliable diagnostic for gastric ulcers.

This is because of the nature of how the test works. Because it relies on the presence of fecal

blood or blood protein, non-bleeding gastric ulcers will not produce a positive test result. However,

the FBT may be used in conjunction with scoping. For example, in the face of a horse presenting

with clinical signs consistent with gastric ulceration, but also producing a double-negative FBT

result, scoping of the horse may help to confirm a gastric ulceration diagnosis.

Finally, the FBT does not provide a specific diagnosis. The role of the SUCCEED FBT is akin to that

of a thermometer: it will indicate that a problem exists, but it is up to you to use that result in

conjunction with clinical signs and other modalities to develop the definitive diagnosis.

20

Applications of the FBT

The SUCCEED FBT provides you with a useful tool in a number of situations:

• To assess any horse suspected of GI health pathology (to validate your

preliminary diagnosis with additional objective data).

• As part of a basic work-up and wellness program.

• As preventive medicine—to diagnose and treat conditions before they

express as clinical problems.

• To gross screen a large group of horses to identify candidates for further

investigation.

• As part of a pre-purchase exam.

The SUCCEED FBT is a valuable tool for the equine veterinarian, especially

those whose practices serve performance horses. The FBT is a quick, easy

and affordable diagnostic tool that provides a reliable starting point for the

diagnosis of GI tract conditions. This allows for an earlier, more accurate

diagnosis, affording more targeted and earlier treatments.

Current Treatments Once a horse is diagnosed with gastrointestinal disease, treatment

approaches must be considered. Here, your situation gets

challenging. Unless you know the precise disease condition, its

etiology, and where the horses is currently in the disease process,

the most appropriate course of action is often uncertain. Add to

this the practical realities of the patient: the owner likely seeks to

get their horse back in optimal condition for the next race or other

event, but seeks to spend as little money as possible. This can all

leave you in an untenable position.

22

Gastric ulcers—the silver bullet

For gastric ulcers, treatment with proton pump inhibitors, especially omeprazole,

is the remedy of choice. It has been proven effective in multiple studies

(McClure et al., 2005; Andrews et al., 1999), and the commercial form of omepra-

zole, Gastrogard®, is FDA-approved for this application in the U.S. But again, this

is all dependent on the client’s ability and willingness to pay.

Treatment with omeprazole or other acid inhibitors has its downside. First, by

virtue of how this class of products works—by shutting off acid produced by the

parietal cells of the lower stomach—acid inhibitors have no benefit for intestinal

or colonic disease. In fact, by modifying a natural physiological component of

digestion, their long-term and consistent use may be giving rise to more issues,

perhaps farther along the GI tract. For an animal that is fed something other than

its natural, intended diet—that is, higher proportions of non-structural carbohy-

drate fed intermittently—the risk is greatest.

Additionally, recent research has shown that gastric ulceration is, in fact, two

distinct syndromes, distinguishing between those in the upper, squamous

portion of the stomach (Equine Squamous Gastric Disease, or ESGD) and those

in the lower, glandular portion (Equine Glandular Gastric Disease, or EGGD)

(Sykes et al., 2015). Here, the efficacy of omeprazole has been distinguished

as well. While consistently shown to be effective for treatment of squamous

ulceration, omeprazole has been shown to be less efficacious in glandular

ulceration applications (Sykes et al., 2014, 2015).

How to address the hindgut

It is often the case that you don’t know a patient’s true underlying condition,

at least not entirely. Even if you can definitively diagnose stomach ulcers via

gastroscopy, unless you also rule out hindgut conditions, it’s possible the

horse has more than one thing going on. Further, hindgut conditions don’t

have a similar “silver bullet” treatment—FDA-approved, proven effective, and

widely available and accepted.

Recurrence is a significant issue as well. Whatever treatment method you

employ, and regardless of how effective it is in ameliorating the issue and

getting the horse back in the show ring or on the race track, horses are

likely to face the issue again . . . and again. This is almost certainly because

the underlying causes are inherent in the horse’s very lifestyle and environ-

ment. Thus, horses, their owners, and their veterinarians are too often caught

in an endless “diagnose-treat-repeat” cycle.

Taking the horse out of performance, and allowing it to rehabilitate in a

low-stress, pastoral setting is the ideal treatment for the horse. But this is, of

course, largely impractical for the owner or trainer.

Given this, an alternative approach may be appropriate. Such an approach

may involve dietary methods of supplementing the nutrients utilized by the

horse’s digestive anatomy and physiology such that the animal is itself better

able to manage the effects of its diet, stress, and performance.

24

One nutritional supplement approach to man-

aging the ongoing health of the equine digestive

system is found in a product called SUCCEED®

Digestive Conditioning Program®. A specific

version sold exclusively through veterinarians is

available, called SUCCEED® Veterinary Formula

(VF). This product was created to give veterinari-

ans and their clients a viable alternative to

pharmaceutical treatment.

SUCCEED VF provides a natural, daily program

designed to manage the health of the equine

GI tract. The product provides a variety of nutri-

ents that are generally used by the body to

maintain the integrity of the gut wall, support

efficient nutrient absorption, and maintain

immune function, without interfering with natural

digestive processes.

Unlike proton pump inhibitors, SUCCEED VF

works on the entire digestive tract to promote

optimal digestion in both the foregut and hindgut.

Because the ingredients are natural, the product

can be used up to and through the day of

competition.

SUCCEED VF has been proven effective in

clinical settings and real-world applications.

This includes multiple word-wide patents,

numerous internal clinical trials conducted by

Freedom Health, and independent studies. This

includes a trial conducted by researchers at the

University of Glasgow, Scotland, published in

2016. This study showed that SUCCEED was

equally effective to omeprazole in the treatment

of squamous gastric ulceration at 90 days

(Kerbyson et al., 2016).

The SUCCEED Veterinary Formula (or VF) is

effective for you and your clients because it

addresses root causes, without modifying

natural digestive processes. It can be used in

conjunction with other treatments, including

acid inhibitors, if needed. SUCCEED VF contains

all natural ingredients in a palatable daily-use

formulation.

SUCCEED Veterinary Formula

25

A summary of SUCCEED VF ingredients

Oat oil rich in polar lipids

Polar lipids are fat molecules important in forming the tight junctions be-

tween the epithelial cells lining the gut. Adding polar lipids to the diet has

been shown to support the intestinal mucosa (Martin et al., 1981; Kiviluoto

et al., 1991; McNeil & Ito, 1989). Oats are also rich in trienols and tocopher-

ols. Polar lipids are versatile emulsifiers, stabilizing oil-water mixtures. They

provide an ideal nutrient delivery vehicle, capable of ferrying both fat and

water-soluble molecules into the tissues (Kreitler, 2003).

Oat flour rich in beta glucan

The oat flour in SUCCEED VF is produced from oat bran rich in beta glucan.

Beta glucan is a soluble fiber of oats, has been shown to reduce LDL and raise

HDL cholesterol in the blood (Davidson et al., 1991; Bell et al., 1999). More

significantly for a performance horse, it moderates the release of sugars

from the digestive system, helping to prevent the sugar highs and lows that

animals fed twice daily on an energy-rich high-carbohydrate diet often face

(Braaten et al., 1994).

Beta glucan also creates a gel with digesta, slowing its transit through the

horse’s gut and allowing starches to be digested in the small intestine, as they

should (Bohm & Kuhlicke, 1999; Wursch & Sunyer, 1997). This reduces the

opportunity for undigested starch to reach the hindgut where it can adversely

affect the delicate microbiota there.

26

Amino Acids

SUCCEED VF includes glutamine, threonine, proline, serine, leucine, isoleucine, and lysine.

Glutamine is a muscle fuel that also supplies nitrogen to the immune cells of the

intestinal mucosa. Under normal conditions, an animal can create as much glutamine

as is needed. However, large amounts of glutamine are consumed when the animal is

stressed, and supplements may help maintain a healthy supply (Rotting et al., 2004;

Duckworth & Madison, 1992; Vasquez et al., 1996; Brosnan, 2003).

Threonine, proline and serine are the three most important amino acids in the mucopro-

teins that, along with sugars, make up mucus. Together, they account for over 40 percent

of the total amino acids found in mucus. A specific mix of threonine, proline, and serine,

like that found in SUCCEED VF, has been shown to be beneficial in studies where dextran

sulfate sodium was used to induce a model of ulcerative colitis.

Further, threonine is an important component of the mucin distributed throughout the

intestinal tract. By assisting metabolism and nutrient absorption, threonine supports a

smoothly functioning GI tract. A deficiency of threonine slows the regeneration of the gut

wall and depresses the production of mucus (Bertolo et al., 1998; Ball et al., 1999; Cuaron

et al., 1984).

Leucine increases the post-feeding insulin response in horses. Both before and after

exercise, leucine augments the rate of muscle glycogen synthesis (Urschel et al., 2010).

Glycogen is always observed in the stratified epithelium of mucous membranes (Fallin,

1961).

Isoleucine is a component of peptide histidine isoleucine (PHI), which is found through-

out the digestive system, but particularly in the colon (Yiangou et al., 1985). PHI plays a

role in the regulation of the immune system through its interplay with prolactin (Kulick et

al., 2005).

Lysine is an essential amino acid that has a major role in building muscle protein and in

recovery from injury. It is also important to the growth of horses, especially yearlings

(Ott et al., 1981; Graham et al., 1994). Lysine and proline are important to GI healing and

the formation of collagen (Thornton & Barbul, 1997).

27

Nucleotides

The cells lining the gut wall are constantly dividing, replacing the intestinal lining about

every three days. This continuous cell division requires the replication of millions of DNA

molecules every second.

Each DNA molecule is made up of several billion nucleotides, representing an impressive

amount of energy-intensive chemical synthesis. Maintaining an adequate level of

nucleotides is important for a healthy digestive system, especially for horses used in

performance. Under these conditions, nucleotide supplements from yeast in the diet have

been shown to be beneficial (Bueno et al., 1994; Uauy et al., 1990; Marshman et al., 2002;

Hales, 2001; Lin, 1995).

Yeast products

SUCCEED contains a beta glucan extracted from the inner cell wall of the yeast

Saccharomyces cerevisiae. It is a highly efficient mycotoxin adsorbent that helps prevent,

decontaminate, and minimize the toxicity of mycotoxins produced from fungi, and molds

horses commonly encounter, typically through contaminated grain, forage, and feeds.

(Ip & Lau, 2004; Swanson et al., 2002).

SUCCEED VF also includes Mannan Oligosaccharide (MOS) extracted from the outer cell

wall of Saccharomyces cerevisiae. The primary role of MOS is the competitive blocking of

bacterial lectins, binding pathogenic bacteria that, in turn, helps to block colonization of

pathogenic bacteria organisms such as Clostridium, E.coli, and salmonella by adsorbing

and safely removing them (Bland et al., 2004; Newman, 1994).

29

The SUCCEED Healthy Gut CommitmentOne other feature that makes the SUCCEED Veterinary

Formula so attractive for the veterinarian is that is

includes a special program, the SUCCEED Healthy Gut

Commitment. The program provides financial support

for colic treatment, for horses fed SUCCEED VF

continuously for at least 90 days. If a horse experienc-

es a GI-health related colic episode while on SUCCEED

Veterinary Formula, the company will reimburse the

veterinarian up to $800 for veterinary services in treat-

ing that colic. In case of a qualified surgical colic, the

company will also reimburse the veterinary hospital up

to $15,000 to cover the associated costs. In both

cases, payments are made directly to the practitioner.

29

SUCCEED® HEALTHY GUTCOMMITMENT

Gastrointestinal health issues among performance horses represent both a widespread

issue for the industry and a costly problem for the individual horse, owner, and veterinarian.

The problem is exacerbated by the relative inability for practitioners to easily identify the

problem, made more difficult by the limitations of current diagnostic methods. Even when

diagnosis is possible, available treatment options are limited by scope or practicality.

The SUCCEED Equine Fecal Blood Test represents a simple, affordable, and reliable screen

test for GI tract conditions that helps you differentiate foregut from hindgut conditions.

SUCCEED Veterinary Formula provides you and your clients with a viable approach to

managing GI health, minimizing the adverse effects (and cost) of pharmaceutical remedies.

Conclusion

30

Manufacturers of

The Equine Digestive Health Experts

ReferencesAndrews F.M., Sifferman R.L., Bernard W., et al. (1999) Efficacy of omeprazole paste in the treatment and prevention of gastric ulcers in horses. Equine Vet J, 29(1), pp. 81–86.

Al Jassim R. A., Andrews F. M. (2009) The bacterial community of the horse gastrointestinal tract and its relation to fermentative acidosis, laminitis, colic, and stomach ulcers. Vet Clin Equine, 25, pp. 199–215.

Ball R.O., Law G., Bertolo R.F.P., Pencharz P.B. (1999) Adequate oral threonine is critical for mucin production and mucosal growth by neonatal piglet gut. Proceedings of the VIIIth International Symposium on Protein Metabolism and Nutrition, EEAP.

Bell S., Goldman V.M., Bistrian B.R., et al. (1999) Effect of beta glucan from oats and yeast on serum lipids. Crit Rev Food Sci Nutr, 39, pp. 189–202 [review].

Bertolo R.F., Chen C.Z., Law G., et al. (1998) Threonine requirement of neonatal piglets receiving total parenteral nutrition is considerably lower than that of piglets receiving an identical diet intragastrically. J Nutr, 128(10), pp. 1752–1759.

Bland E.J., Keshavarz T., Bucke C. (2004) The influence of small oligosaccharides on the immune system. Carbohydrate Research, 339(10).

Bohm N, Kulicke W. (1999) Rheological studies of barley (1-3)(1-4) beta glucan in concentrated solution. Carbohydrate Research, 315, pp. 293–301.

Braaten J.T., Scott F.W., Wood P.J., et al. (1994) High beta glucan oat bran and oat gum reduce postprandial blood glucose and insulin in subjects with and without type 2 diabetes. Diabet Med, 11, pp. 312–318.

Bueno J., Torres A., Almendros A., et al. (1994) Effect of dietary nucleotides on small intestinal repair after diarrhea. Histological and ultrastructural changes. Gut, 35, pp. 926–933.

Costa M.C., Weese J.S. (2018) Understanding the intestinal microbiome in health and disease. Veterinary Clinics of North America: Equine Practice, 34, pp. 1–12.

Cuaron J.A., Chapple R.P., Easter R.A. (1984) Effect of lysine and threonine supplementation of sorghum in gestation diets on nitrogen balance and plasma constituents in first litter gilts. J. Anim. Sci., 58, pp. 631–637.

Davidson M.H., Dugan L.D., Burns J.H., et al. (1991) The hypocholesterolemic effects of beta glucan in oatmeal and oat bran. A dose-controlled study. JAMA, 265, pp. 1833–1839.

Dionne R.M., Vrins A., Doucet M.Y., Paré J. (2003) Gastric ulcers in standardbred racehorses: prevalence, lesion description, and risk factors. J Vet Intern Med.

31

Duckworth D.H., Madison J.B., et al. (1992) Arteriovenous differences for glutamine in the equine gastrointestinal tract. Am J Vet Res, 53(10), pp. 1864–1867.

Falin, L.I. (1961) Glycogen in the epithelium of mucous membranes and skin and its significance. Cells Tissues Organs, 46(3), pp. 244–276.

Graham P.M., Ott E.A., Brendemuhl J.H., TenBroeck S.H. (1994) The effect of supplemental lysine and threonine on growth and development of yearling horses. J Animal Science, 72(2), pp. 380–386.

Hales N. (2001) Diet supplement may help boost immune system. American Society for Parenteral and Enteral Nutrition 25th Clinical Congress, Chicago.

Ip W.K., Lau Y.L. (2004) Role of mannose-binding lectin in the innate defense against Candida albicans: enhancement of complement activation, but lack of opsonic function, in phagocytosis by human dendritic cells. J Infect Dis, 190(3), pp. 632–640.

Kerbyson N.C., Knottenbelt D.K., Carslake H.B., et al. (2016) A comparison between omeprazole and a dietary supplement for the management of squamous gastric ulceration in horses. J Equine Vet Sci, 40, pp. 94–101.

Kiviluoto T., Paimela H., Mustonen H., Kivilaakso E. (1991) Exogenous surface-active phospholipid protects Necturus gastric mucosa against luminal acid and barrier-breaking agents. Gastroenterology, 100(1), pp. 38–46.

Kreitler B. (2003) Feed and nutrition: fat: the next nutraceutical? Thoroughbred Times.

Kulick R., Chaiseha Y., Kang S., et al. (2005) The relative importance of vasoactive intestinal peptide and peptide histidine isoleucine as physiological regulators of prolactin in the domestic turkey. Gen Comp Endocrinol, 142(3), pp. 267–273.

Lin C. (1995) Effect of dietary nucleotide supplementation on in vivo and in vitro immune function in protein-malnourished mice. University of Florida. PhD. Dissertation.

Luthersson N., Nielsen K.H., Harris P., Parkin T.D.H. (2009) Risk factors associated with equine gastric ulceration syndrome (EGUS) in 201 horses in Denmark. Equine Vet J, 41, pp. 625–630.

Marshman E., Booth C., Potten C.S. (2002) The intestinal epithelial stem cell. Bioessays, 24(1), pp. 91–98.

Martin E.J., Reed K.J., Kunz I.G.Z., et al. (2017) Normal variation and changes over time in the equine intestinal microbiome. Abstract. J Equine Vet Sci, 52, p. 60.

Martin G.P., Marriott C., Kellaway I.W. (1981) The interaction of progesterone with mucus glycoproteins. Pharm Acta Helv., 56 (1), pp. 5–8.

Martinez Aranzalez J.R., Silveira Alves G.E. (2014) Equine gastric ulcer syndrome: risk factors and therapeutic aspects. Rev Colomb Cienc Pecu., 27(3), pp. 157–169.

32 33

McClure S.R., Carithers D.S., Gross S.J., Murray M.J. (2005) Gastric ulcer development in horses in a simulated show or training environment. J Am Vet Med Assoc., 227(5), pp. 775–777.

McClure S.R., White G.W., Sifferman R.L., et al. (2005c) Efficacy of omeprazole paste for prevention of gastric ulcers in horses in race training. J. Am. Vet. Med. Ass. 226, pp. 1681–1684.

McNeil P.L., Ito S. (1989) Gastrointestinal cell plasma membrane wounding and resealing in vivo. Gastroenterology, 96(5), pp. 1238–1248.

Mitchell R.D. (2001) Prevalence of gastric ulcers in hunter/jumper and dressage horses evaluated for poor performance. Assoc. Equine Sports Med.

Murray M.J., Nout Y., Ward D. (2001) Endoscopic findings of the gastric antrum and pylorus in horses: 162 cases (1996–2000). J Vet Intern Med., 15(4), pp. 401–406.

Newman K. (1994) Mannan-oligosaccharides: natural polymers with significant impact on the gastrointestinal microflora and the immune system. Biotechnology in the Feed Industry, Nottingham University Press, Nottingham, UK, pp. 167–174.

Ott, E.A., Asquith, R.L., Feaster, J.P. (1981) Lysine supplementation of diets for yearling horses. Journal of Animal Science, 53(6), pp. 1496–1503.

Pellegrini F.L. (2005) Results of a large-scale necroscopic study of equine colonic ulcers. J Equine Vet Sci, 25 (3), pp. 113–117.

Pellegrini F.L. (2009) A novel antibody test can help to differentiate gastric from colonic ulcers in horses. In: proceedings 11th International Congress of World Equine Veterinary Association. Sao Paulo, Brazil.

Richards N., Hinch G.N., Rowe J.B. (2006) The effect of current grain feeding practices on hindgut starch fermentation and acidosis in the Australian racing Thoroughbred. Aust Vet J. 84, pp. 402–407.

Rotting A.K., Freeman D.E., Constable P.D., et al. (2004) Resistance of HOCl-injured mucosa recovered partially during the incubation period, and glutamine improved recovery. Am J Vet Res, 65(11), pp. 1589–1595.

Swanson K.S., Grieshop C.M., Flickinger E.A., et al. (2002) Effects of supplemental fructooligosaccharides plus mannanoligosaccharides on immune function and ileal and fecal microbial populations in adult dogs. Arch Tierernahr, 56(4), pp. 309–318.

Sykes B.W., Hewetson M., Hepburn R.J., et al. (2015) European college of equine internal medicine consensus statement—equine gastric ulcer syndrome in adult horses. J. Vet. Intern. Med., 29, pp. 1288–1299.

Sykes B.W., Sykes K.M., Hallowell G.D. (2014) A comparison between pre‐ and post-exercise administration of omeprazole in the treatment of EGUS: a randomised, blinded clinical trial. Equine Vet J, 46, pp. 422–426.

33

34

Sykes B.W., Sykes K.M., Hallowell G.D. (2015) A comparison of three doses of omeprazole in the treatment of gastric ulceration in the horse: a randomised, blinded clinical trial. Equine Vet J, 47, pp. 285–290.

Thornton F.J., Barbul A. (1997) Healing in the gastrointestinal tract. Surg Clin North Am., 77(3), pp. 549–573.

Traub-Dargatz J.L., Kopral C.A., Seitzinger A.H., et al. (2001) Estimate of the national incidence of and operation-level risk factors for colic among horses in the United States, spring 1998 to spring 1999. J Am Vet Med Assoc., 219(1), pp. 67–71.

Uauy R., Stringel G. Thomas R., Quan R. (1990) Effect of dietary nucleotides on growth and maturation of the developing gut in the rat. J. Pediatr. Gastroenteral. Nutr., 10, pp. 497–503.

Uhlinger C., (1992) Investigations into the incidence of field colic. Equine Vet J., 24 (13), pp. 16–18.

Urschel K.L., Geor R.J., Waterfall H.L., et al. (2010) Effects of leucine or whey protein addition to an oral glucose solution on serum insulin, plasma glucose and plasma amino acid responses in horses at rest and following exercise. Equine Vet J Suppl., 38, pp. 347–354.

Vazquez P., Gomez de Segura I.A., Cos A., et al. (1996) Response of the intestinal mucosa to different enteral diets in situations of surgical stress and malnutrition. Nutr Hosp, 11(6), pp. 321–327.

Wursch P., Sunyer F.X. (1997) The role of viscous soluble fiber in the metabolic control of diabetes. A review with special emphasis on cereals rich in beta glucan. Diabetes Care, 20(11), pp. 1774–1780.

Yiangou Y., Christofides N.D., Blank M.S., et al. (1985) Molecular forms of peptide histidine isoleucine-like immunoreactivity in the gastrointestinal tract. Nonequimolar levels of peptide histidine isoleucine and vasoactive intestinal peptide in the stomach explained by the presence of a big peptide histidine isoleucine-like molecule. Gastroenterology, 89(3), pp. 516–524.

C701 Rev Ai 11/19

SUCCEED® is a registered trademark of Freedom Health LLC. © 2018. All Rights Reserved