Equine metabolic syndrome (EMS) is a complex condition that involves insulin dysregulation (ID), obesity, and an increased risk of laminitis. Horses with EMS often need a multifaceted management approach to improve their quality of life and prevent serious complications. These five key management changes can help you improve your EMS horse’s metabolic status and overall well-being.

1. Optimize Diet and Forage Selection for EMS Horses

Diet plays a crucial role in managing horses with EMS. “Diets high in nonstructural carbohydrates are a risk factor for development of insulin dysregulation, a key component of EMS,” says Katie Wilson, DVM, Dipl. ACVIM-LAIM, clinical associate professor of large animal internal medicine at the Virginia-Maryland College of Veterinary Medicine, in Blacksburg, Virginia.

“One of the simplest and biggest changes owners can make is actually weighing the amount of concentrate and forage their horses are eating per day to better control caloric intake,” says Wilson. Grass hay with an NSC content of less than 10% is ideal for horses with metabolic problems, she adds. If the NSC content is unknown or higher than 10%, soaking the hay for at least 60 minutes (and discarding the soak water) before feeding can make it safer for EMS horses.

Avoid feeding your EMS horse concentrates unless absolutely necessary, Wilson says. However, forage-only diets do not provide all the vitamins and minerals (i.e., sodium, chloride, copper, zinc, Vitamin E, and selenium in areas with selenium-deficient soil) horses require, so they need a ration balancer if the diet is forage-based, she adds. “Some ration balancers are high in NSC, however, and can induce an exaggerated insulin response after feeding, so ingredients or individual horse response to feeding should be evaluated.”

2. Implement an Effective Exercise Routine

Exercise also plays a crucial role in managing EMS. An effective exercise routine can help horses safely lose weight (if needed) and improves insulin sensitivity. Always work with your veterinarian when creating an exercise plan for horses with a history of laminitis to avoid exacerbating the condition or unknowingly cause pain, says Wilson. Horses recovering from laminitis should only exercise after veterinary clearance.

After a laminitic episode and once cleared, Wilson recommends gradually introducing physical activity, such as five minutes of walking followed by 15 minutes of trotting, repeated five times per week. For EMS horses without laminitis, moderate exercise, such as trotting and cantering for at least 30 minutes, five times per week can benefit their insulin sensitivity.

3. Monitor EMS Horses’ Body Condition and Weight Regularly

Horses with EMS often display generalized or regional adiposity, but even horses with a normal body condition can have ID, says Wilson. Regularly assess your horse’s body condition to ensure he remains a healthy weight. “Assessing body condition score every two weeks can help to quantify changes that might not be noticed,” she explains. “Assessing body weight can be helpful as well, by either using an equine scale if one is accessible, or a weight tape.”

“Reducing body condition (if warranted) has been shown to improve insulin sensitivity, and weight reduction can help decrease the forces in the foot that result in sinking or rotation in horses with laminitis,” adds Wilson.

4. Adjust Turnout and Grazing Practices for EMS Horses

Unrestricted grazing can harm EMS horses because pasture often contains high levels of sugars and NSCs. “Free-choice grazing should be restricted in horses with EMS and (a history of or active) laminitis,” says Wilson. She suggests turning affected horses out in a dry lot or small paddock with little to no grass or using a grazing muzzle or strip grazing to limit pasture access.

“If horses need to be reintroduced to grazing after laminitis has resolved, it should be done slowly and blood insulin concentrations should be measured regularly to assess the horse’s insulin response to the added carbohydrate content of the grass,” says Wilson.

5. Work Closely With a Veterinarian

Equine metabolic syndrome involves many changing factors, so work closely and regularly with your veterinarian to ensure effective management. “One common mistake is assuming that a one-time change in management or feeding practices will fix the problem,” says Wilson.

Regular examinations and blood insulin monitoring can help your veterinarian tailor management strategies to the horse’s specific needs. Your vet needs to assess your horse’s insulin levels after dietary changes or modifications to his grazing schedule and at different times of year because season can impact insulin sensitivity, adds Wilson.

Equine practitioners also play a crucial role in helping horse owners navigate logistical challenges and develop practical, individualized management plans. “Veterinarians understand that there are usually many logistical limitations to implementing the ideal changes recommended for a horse with EMS and are happy to work within the owner’s restrictions to develop a plan that will work best for an individual horse,” says Wilson.

Take-Home Message

Managing a horse with EMS takes a proactive, tailored approach that fits the horse’s specific needs. By making key changes to diet, exercise, body condition monitoring, and turnout strategies—while increasing veterinary collaboration—owners can significantly improve their EMS horses’ health and well-being. Equine metabolic syndrome has no cure, but consistent monitoring and adjustments can go a long way in preventing laminitis.