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Supplement for Cushing’s Horse

My 23 yr old QH mare was diagnosed today with Cushing’s. I am starting her on Pergolide ASAP. Can you please advise me about the diet I should provide? Rice bran pellets (Vitabran) and alfalfa was my plan. I had also just put her on glucosamine as a preventative measure. Should I hold off on that until we stabilize the Cushing’s? Or do you recommend Cetyl-M for horses as a daily joint supplement? Karen

Dear Karen,

Managing a horse with Cushing’s Disease (Pituitary Pars Intermedia Dysfunction or PPID) can be challenging because some horses need to lose weight, some need to gain weight, and some are just right. So step one in developing the correct diet for her is assessing her body condition score and deciding if she is heavy and needs less calories, thin and needs more calories or just right and should stay on the same diet.

Step two is finding out if insulin resistance (failure of the body to respond properly to insulin) is a secondary component of her condition since that will affect her diet also. Experts generally recommend that horses with Cushing’s Disease avoid feedstuffs high in non-structural carbohydrates (sugars or starches) and this is especially true if they also have Insulin Resistance.

Foods high in sugars and starches are grains, treats, grass pasture especially at the end of the day, and some grass hay. Alfalfa hay generally doesn’t have as much sugar and starch as grass hay but some horses prone to laminitis (horses with Cushing’s and Insulin Resistance) are sensitive to it so add it to your horse’s diet slowly, especially if she hasn’t had alfalfa before.

You may be just fine with a low-sugar/starch hay that you either sent off for analysis and found to be less than about 10 or 12% NSC or that you soak in water to remove sugars. Rice bran—as long as it’s fortified with calcium to offset its naturally high phosphorus content—is a good choice for adding calories back to the diet through fat. I personally like molasses-free beet pulp as a feed source, because it has a nutritional profile similar to hay, doesn’t cause a spike in blood sugar and therefore insulin, and provides energy from bacterial fermentation of fiber.

Since fortified grain is probably not a good idea, make sure she is still receiving a complete and balanced diet by adding in a multi-vitamin/mineral supplement or ration balancer. And because Cushing’s is thought to be caused in part by oxidative stress on aging brain tissues, add in antioxidants like Vitamin E, Vitamin C (beneficial for most older horses), Selenium if your area is low in it, and others.

Lydia F. Gray, DVM, MA SmartPak Staff Veterinarian and Medical Director Dr. Lydia Gray has earned a Bachelor of Science in agriculture, a Doctor of Veterinary Medicine (DVM), and a Master of Arts focusing on interpersonal and organizational communication. After “retiring” from private practice, she put her experience and education to work as the American Association of Equine Practitioner’s first-ever Director of Owner Education. Dr. Gray continues to provide health and nutrition information to horse owners through her position at SmartPak, through publication in more than a dozen general and trade publications, and through presentations around the country. She is the very proud owner of a Trakehner named Newman that she actively competes with in dressage and combined driving. In addition to memberships in the USDF and USEF, Dr. Gray is also a member of the Illinois Dressage and Combined Training Association (IDCTA). She is a USDF “L” Program Graduate and is currently working on her Bronze Medal. Find Dr. Gray on Google+

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27 comments on “Supplement for Cushing’s Horse
  1. Victoria says:

    Omega Horseshine is also a good supplement to add. It has a low NSC and can help replace some of the omega 3 fatty acids lost because your mare isn’t grazing anymore.

  2. Amy says:

    One part of the question didn’t get answered though, that I’m also interested in knowing. What about a joint supplement? Is it ok for them to be on products containing Chondroitin & Glucosamine?

    • e stevenson says:

      I was told not to give my Cushing’s mare a glucosamine supplement because glucosamine is a sugar. I suspect she is also insulin resistant.

  3. Heather says:

    My 30yr old QH has been living with Cushings for 5 yrs now shes been on pergolide and One AC in the summer has helped her stay sound and happy 😀 I get my pergolide through Smartpak because its worth the convenience of it always being shipped every 28 days so you don’t run out. I had bought it through my vet which was slightly cheaper but its used for alot of horses and they sometimes run out which can leave you stranded if you hit the inbetween time. Hope it works out well for you and her 😀

    • Dee Holcomb says:

      My 22yr old Missourie Fox Trotter has been on pergolide for about a year now. She is doing wonderfully on it. Please can you tell me what One AC is? The one big prjoblem I have with Sky, is her sweating. When I ride, and only at a walk, she is dripping and covered with lather. She even sweats when just standing in the pasture. Does the One AC help this? Any help I can get with the Cushings problem would be greatly appreciated.

      • cindy McKellar says:

        Hi Dee,
        Your mare may not be on enough Pergolide. I have a 22 yo TB mare who is on 1 mg/day of pergolide. She had the same symptoms as your mare and the sweating stopped after she was on the Pergolide for about 2 weeks. I would talk to your vet about possibly increasing the dose.

      • stephanie says:

        Did you mean A1C?…If so,that is a diabetic term.
        It measures the average blood glucose control for three months.
        This can help if your diabetes plan is working or changes are needed.It is also called HbA1c.
        I’m not sure how it pertains to horses considered to be IR(insulin resistant).I would ask your vet to explain it for you.

      • Anna says:

        As strange as this sounds; I have heard from Dr. Ron Hoffman “Drinking Sage Tea can cure night sweats…”

        I do not know if this applies to Equine; also; there are hundreds of type of Sage so choose the safe Sage!

  4. Gail Kopp says:

    Hi Karen: For continued support for your Cushing’s horse, check out the Cushing’s and Insulin Resistance site on Yahoo:

    I got all of my information plus one-on-one support from the veterinary moderator. My 32 year old Cushing’s horse is alive today because of the help I found there. Good luck.

  5. My miniature donkey, female age 15 years, has recently been diagnosed with Cushings. Her # with the most recent blood test was 62 and her insulin is within normal parameters. She balks at the pergolide intake through her feed and I am looking for another way to get her to take the pergolide. Pill pockets were suggested but I am unaware of how to find them. Any suggestions? Thanks.
    Ellen Lindsay

    • Mary says:

      We use a dosing syringe of 50cc to give our Cushings horse oil and Pergolide mixed with the oil from vit E capsules. It’s not difficult to do and the reusable plastic syringes are easy to find online. Best of luck!

    • Susan says:

      Another option is liquid flavored pergolide from a reputable compounding pharmacy. Several flavor options exist–my horse thinks it is the only treat he ever gets since treats are no-go with Cushings. The concentration can be prescribed at almost any number of milligrams per mililiter, so that you can have a very low volume or a rather high volume per dose, but can easily adjust the dose by changing the volume as directed by your vet. Only drawback with liquid pergolide is that it must be stored in something like a refrigerator–light and warmth make it ineffective within a day or a week or so, depending on which pharmacist you ask.
      Best wishes.

    • Barb says:

      I have used Pergolide in capsule form for about 5 years now. I just slice a very thin piece of apple and slide it into the apple. He never knows what he’s getting. been working so far as well as Quiescense thru Smart Pak.

    • Anna says:

      I would concentrate on her diet as opposed to the Pergolide…Pergolide is from the Ergot Fungus and some Equine have a bad reaction to…my advice to you

      Get her on a low starch feed from Smart Pak; avoid all sugary feeds and treats; pure hay is best; you might add some nice Rice Bran Pellets for the B-Vits.

      summary: do not force the med. on the donkey; find another safer more natural alternative route; I would actually suggest for your Donkey…

      A Good Multi Vitamin supplemental pellets for Donkey; give this for about 6 mos and see she better!

  6. Karlan says:

    My 30 yr old Arabian gelding is still showing and winning with the addition of Pergolide, He was started in harness last year at age 29 and was Regional reserve champion carriage driving horse at out Arabian Regional (4 states) championship show! The pergolide has to be reported to USEF and has to be held for 24 hrs before he shows. We give it again as soon as he finishes for a 24 hr period.

  7. Tricia says:

    Hi, I was just reading through here and want to add my .2 cents. My horse foundered because of Cushing’s and is on a very strict diet, but I have found a place that makes low sugar/low starch horse cookies and treats. Your horse will be able to have a treat once a day with No, I don’t work for them or anything, but I do love their horse treats. They are beautiful, smell wonderful and are just like small pieces of art.

  8. Judy says:

    My 30 something Cushings horse is doing marvelous on flavored pharmacy compounded pergolide (about 2 years now). I recently tried Smartpak’s Cool Calories to sdd weight when he couldn’t chew hay any longer due to tooth loss. He gets soaked alfalfa cubes with Cool Calories and has regained body condition this winter.The Smartpak Cool Calories has done him a world of good–I would recommend trying that if your vet agrees.

  9. Blondie says:

    I have a 31 year-old standardbred that was diagnosed with Cushings 4 yrs ago. Started him on liquid apple flavored compounded Pergolide but found it hard to give with syringe, even with a little help of Pepto Bismol; he would sometime spit it out and it was wasted. It was only available out of state, 100cc at a time and had to be refrigerated. I found a compounding pharmacy out of state that makes it in powdered/flavored form which is how I order it now. I mix 1cc/scoop per day with his grain. He went off his grain due to ulcers so wasn’t getting his meds which also included prednisolone and bute. Gastroguard fixed that problem. I am now waiting for my order of ranitide and aspirin from SmartPak to help with the ulcers and wean him off the bute. My vet said to feed 1 flake alfalfa (good for cushings horses) and 1-2 flakes hay BEFORE feeding grain. 1st cut timothy is better than 2nd cutting and it’s best to find hay with little to no clover, legumes and treefoil. I feed Tribute Essential K w/glucosamine & chondroitin. My vet didn’t see a problem with my horse getting these 2 added supplements. I also give him a weight gain supplement and have him blanketed during the cold Ohio weather.

  10. Jean says:

    I had a Tennessee Walker that had Cushings for probably 15-16 years. She was on compounded Pergolide and Cyproheptadine every day from the day I found out she had it. I could never find much information about the disease and what to feed her and not feed her back then and I tried many websites. I wish I had found this one, it would have been very helpful. She did well on the Cypro and the Pergolide for many years but in reading all the comments about the sugar, I know now she never should have had all the carrots I gave her but I didn’t know. My vet never told me. One morning she just wouldn’t get up so I had to call a vet, a different one from the original and he tried and tried to make her get up but she just couldn’t. He was going to give her an injection but by the time he came back from the truck, she started having seizures, her eyes rolling back and shaking, he said her quality of life would be very limited so I had to put her to sleep. She lived to be 33 years old and I believe a good life for the most part, considering, but I just think about things that I may have been able to do for her had I found more information about the disease at the time. I still miss her. She was just such a sweet girl, not a mean bone in her body.

    • Anna says:

      thanks for your testimony; exactly my point; just Pergolide alone will not alleviate all symptoms; and Pergolide certainly does not cure the disease…this is why I recommend a better diet and supplements to the regieme…Sugar depletes Insulin; so stop sugars!
      and anyhow other people learn from your experiences !

  11. Louise says:

    I have a 29 year old Palomino Paint QH who was diagnosed with Cushing’s 4 years ago. She did well on Cyproheptadine for the first three years but now she is on Pergolide. I buy the Pergolide in a liquid compounded form from Prescription Specialties. She started out on 1.0 daily but stopped eating after one week. The Vet cut her down to .5 ML and that has been her dose for the past year. She also takes 1 Bute daily for Arthritis. She stopped eating again before Christmas so I purchased some PRO CMC from SmartPak and it has really helped her stomach. She also eats Carb Guard Grain. I have soaked Plain Beet Pulp to help keep her weight on in the past. You can definately keep your horse going indefinately after a Cushing’s diagnosis. Just remember, carrots have a tremendous amount of sugar as do many treats!

    • JAMIE says:


  12. Nadine says:

    I have found exceptional results with chaste tree berries and Antioxidant concentrate from Vita Key. Along with a diet of no sugar/no starch pelleted feed and limited grazing in the summer months. I’ve installed a misting system for the hot Florida summer months to ease his misery in the heat. I know at 21 his days are numbered but he can go from being down and completely lame to cantering up to me 2 weeks later, I’ll continue doing whatever I can to make his days good ones. I’ve also added a scoop of flax and his coat is blowing out nicely.

  13. alexa says:

    Perriwinkle(28 yr old welsh) has been on pergolide for 5 years. If we run out we have about 4 days until she starts to founder. As soon as we resume pergolide she is well again. She gets local grass hay, soaked alfalfa cubes, rice bran and a little beet pulp. She tends to be on the thin side but has teeth issues so I don’t know which problem is the cause. I do err on the side of caution when changing her feed. I haven’t the heart to cut off all grazing so I let her have a few hours a day. It helps the mental altitude of a little old pony. She likes to trot out to the pasture and is much happier to go for her little riders. I believe that quality of life is very important as a full time boxstall life is not what ponies dream of.

  14. kathy says:

    my 25 yr old trakhener gelding has been on pergolide 3-4 yrs now. he eats triple crown low starch feed(6 lbs) which is recommended portion split in 2 feedings, Heiro supplement, lots of hay,no treats.I took him off glucosamine as per vet and put on HA. he doesnt like powder so smart pak just told me of vetra ha in pellet form.i give daily wormer and tape wormer 2x year. my constant thing to watch for is that he doesnt get scratches on hind pasterns because last july it gavehim bacterial infection with leg swelling tremendously and him having 106.something temperatureand me almost losing him.great vetting, my research and lots of helpful friends to hose and walk him saved his life. anytime he gets swelling starting or hotter hooves he gets bute and antibiotic (2x this past year). this stops it before it goes too far. thank god he looks great,rides great, and is ok.he needs to be shaved twice once in november and again in march/april to keep him comfy since he sweats easily. we had cold,snowy brooklyn winter and he only wore 100 gram blanket or medium weight.never used heavy winter blanket even shaved.teeth and feet are also a priority which goes to say it is a lot of diligent work on my part but he is so woth it good luck to all of us and our beloved horses!

  15. Kenya Glen says:

    A friend of mine) gave my daughter her retired gaming horse that is now 18 yrs old. We got him last March 2012 and was fine nonthing.g out of the normal. A couple months ago he went off his feed no drinking water and just didn’t feel good. Vet drew blood checked him out couldn’t figure out what was wrong. Put.him on penicillin oh he had no temp either and we gave him a couple grams a bute soaked his hay. After about week he came back around this was I April . So this.king it was just he just wasn’t feeling good we went on normal stuff. I forgot mention my daughter games in 4- h. She’s not a big time gamer but does ok. Its mow middle of June and he hasn’t sneezed out. He doesn’t have a full on winter curly hair type coat but he has a a decent thick coat. Barely shedding. The shoer mentioned he might have cushings. We haves shaved him since she’s riding. I don’t see Amy other signs but maybe a big sheath but if I remember it was like that when we got him. So I will have tested nut I’m pretty sure he has it. What sortof joint supplements can I feed him as we still game him and gets stiff and is getting arthritis. Any help is greatly appreciated
    I am very educated horse person but have never felt with any problems with horses like this.

    • SmartPak SmartPak says:

      Hi Kenya, thanks for your question! It’s fantastic that you’re working with your veterinarian to address some of the concerns your farrier raised, and it sounds like clipping him was a good idea! Where he is in his upper teens and still doing some gaming, it’s very smart of you to start considering joint support. One of our absolute favorites is a supplement called SmartFlex Senior: It has key ingredients like glucosamine, chondroitin, and hyaluronic acid to support healthy joints, as well as ingredients like Devil’s Claw and MSM to help manage discomfort. Your horse would also be getting some digestive support and antioxidants, which are great to have on board for senior horses. SmartFlex Senior comes in a tasty pellet that most horses love! – SmartPaker Casey

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