HEALTH + NUTRITION CPD – FEBRUARY 2026

Laminitis: managing risk from the inside out

By Caroline Loos, PhD – Nutritionist and Head of research for the CAVALOR brand

Laminitis is one of the most painful and feared conditions in equine health. While often associated with lush spring grass, it’s now clear that laminitis isn’t just a seasonal condition, it’s a complex, metabolic issue that deserves year-round attention.

Recent scientific insights, including those from studies on the nutraceuticals, are reshaping how we approach prevention and management. This article explores the metabolic mechanisms behind laminitis, how to manage underlying endocrine dysfunction and present novel insights on what we can do - from the inside out - to reduce risk for development of this debilitating condition.

What Is Laminitis and Why Does It Happen?

Laminitis is the inflammation of the laminae, the soft connective tissues that secure the hoof wall to the bone inside. Inflammation or damage to this area can cause intense pain, lameness, and in some cases, rotation or sinking of the pedal bone.

Laminitis can be triggered by several factors including mechanical overload, systemic infection and sudden dietary changes, however, 90% of laminitic cases seen in clinical practice are related to underlying hormonal dysfunction. This type of laminitis is called endocrinopathic laminitis and will be the focus of this article. 

Laminitis: As Prevalent As Colic

A large-scale study¹ conducted by the Royal Veterinary College (CARE Study) followed over 1,000 horses and ponies across the UK. The results were striking:

• 1 in 10 horses or ponies developed laminitis every year
• Laminitis was found to be as common as colic
• Over 50% of cases were not diagnosed by a vet, suggesting significant underreporting

The majority of affected horses showed signs including:

• Lameness at walk (70%)
• Short, stilted gait (72%)
• Difficulty turning (78%)
• Increased hoof temperature (58%)
• Shifting weight or reluctance to walk (51%)

The Role of Insulin Dysregulation

As the name implies, endocrinopathic laminitis is caused by underlying hormonal dysfunction. Because hormones are central regulators of many physiological processes, endocrine disorders disrupt normal metabolism throughout the body. For this reason, laminitis is classified as a “metabolic disease”. Among various hormones involved, insulin plays a particularly important role in the development of endocrinopathic laminitis.

Insulin is a key anabolic hormone that regulates multiple metabolic processes including: 

• Regulating blood glucose levels 
• Facilitating energy storage within tissues
• Stimulating protein synthesis 
• Control of lipid metabolism 

When normal insulin regulation is disrupted, the consequences affect virtually all tissues. Insulin dysregulation (ID), the term used to describe this condition, is characterised by transient or persistent elevations in circulating insulin, often driven by tissue-level insulin resistance. Although the exact pathways by which ID leads to laminitis are not yet fully elucidated, research consistently demonstrates that hyperinsulinaemia compromises the structural integrity of the lamellar tissues. Proposed mechanisms include insulin-mediated disturbances in intracellular signalling and the activation of metabolic, cytomorphologic, and vascular pathways, collectively initiating the cascade that culminates in a laminitic episode.

Why do horses develop insulin dysregulation?

ID typically represents the end-stage expression of multiple contributing factors, including genetic predisposition, nutritional overload and reduced activity levels. Age-related hormonal changes and concurrent endocrine disorders such as PPID can further exacerbate the condition. 

Most commonly, ID develops in horses that are naturally “easy keepers”, animals that maintain or gain weight readily, even when feed intake is restricted. Many pony breeds, draft breeds, and certain warmbloods fall within this category. However, lean phenotypes of ID, though uncommon, have also been described.

In genetically predisposed horses, consumption of calorie-dense feeds, particularly those high in non-structural carbohydrates (NSC), or access to lush pasture can rapidly overwhelm metabolic and hormonal regulatory systems.

Clinical manifestations include exaggerated and prolonged post-prandial insulin responses and increased generalised or regional adiposity. Over time, these disturbances contribute to cellular stress and impairments in insulin signaling, ultimately promoting tissue-level insulin resistance.

Recent research has also highlighted alterations in intestinal glucose handling and enhanced incretin responses, such as elevated GLP-1 secretion, which further perpetuate a chronic hyperinsulinaemic state.

ID is frequently an underlying component of several metabolic conditions, including:

• Equine Metabolic Syndrome (EMS)
• Pituitary Pars Intermedia Dysfunction (PPID)
• Obesity or regional fat storage
• Chronic low-grade inflammation

Seasonal Triggers: Why Spring and Autumn Are High-Risk

While laminitis is a year-round welfare concern, spring and autumn pastures present a particularly heightened risk. Grasses store sugars primarily in the form of fructans. Under normal conditions, fructan concentrations rise during sunny periods, peaking in the late afternoon and evening, and then decline overnight as the plant uses these sugars for growth. This pattern is why morning turnout is generally considered safest.

The risk increases markedly when warm, sunny days are followed by cold nights. Low overnight temperatures inhibit plant growth, preventing the normal depletion of stored sugars. As a result, fructans accumulate to high levels. Horses with underlying metabolic dysfunction that graze these pastures can exhibit extremely high insulin spikes. Such episodes of hyperinsulinaemia can rapidly induce acute laminitis if not promptly addressed. For these reasons, pasture access is best restricted or avoided entirely during these high-risk seasonal conditions for horses with ID. 

Managing ID horses

The first step in management is obtaining an accurate diagnosis. Because ID is especially common in easy keepers, horses with excessive body condition, particularly those with a cresty neck or localised adipose deposits (e.g., behind the shoulders or along the tailhead), should be closely monitored and screened regularly.

Although a single baseline blood sample may identify severe cases, many horses only show hyperinsulinaemia following stimulation by glucose. For this reason, dynamic testing, assessing the insulin response to an oral glucose load, is recommended. Evaluating the insulin response to the horse’s regular meal can also be a practical tool for monitoring affected horses and for assessing the effectiveness of dietary interventions.

While certain pharmaceutical options can assist in acute episodes of endocrinopathic laminitis, long-term metabolic health and laminitis prevention depend on restoring normal insulin metabolism. However, working against an inherently thrifty metabolic phenotype is challenging and requires strict diet control, careful prevention of nutrient imbalances, and consistent weight management. Even with optimal care, genetically predisposed horses with a history of ID or laminitis may continue to experience metabolic issues throughout their lives.

These challenges have prompted researchers and the equine industry to explore therapeutic strategies that support hormonal balance. This has led to growing interest in natural bioactive plant compounds (e.g., resveratrol, quercetin, select plant extracts), some of which have shown promising beneficial effects in specific cases of ID.

Essential Oils: A New Perspective on Prevention

Plant-derived compounds such as essential oils have also gained attention in medical and veterinary research as potential therapeutic agents. Their bioactive constituents exert effects through multiple complementary mechanisms, such as anti-inflammatory activity, antioxidant action, and modulation of key metabolic enzymes.

Unlike single-target pharmaceuticals, essential oils can influence several interconnected pathways simultaneously, among them insulin signaling, lipid metabolism, and cellular oxidative-stress responses. This multi-target profile makes them particularly relevant for managing the complex, multifactorial nature of metabolic disease. 

Numerous studies in human and rodent models have demonstrated beneficial effects of specific essential oils on glucose regulation and broader metabolic function. When administered orally, essential oils also interact with the gut microbiota, which plays an integral role in regulating host metabolic homeostasis.

A recent study in horses², showed that specific essential oil combinations improved insulin sensitivity and lower the insulin response to an oral sugar test in a subset of horses with severe ID. Supplementation with these EO also shifted specific blood metabolites associated with amino acid and energy metabolism, primary bile acid metabolism and inflammatory processes.

These findings introduce an innovative, valuable tool to our laminitis-prevention toolbox, one that aims of addressing the underlying root cause of the problem, not just its symptoms.

Prevention Starts from Within

Once laminitis develops, the prognosis is often guarded and long-term complications are common. Prevention remains the most effective strategy, and it many cases, it is entirely achievable. Success depends on consistent, informed management:

1. Know Your Horse

• Understand the breed and its metabolic predispositions.
• Monitor body weight and condition regularly.
• When ID is suspected, assess insulin status, ideally with a dynamic oral challenge.
• Even if baseline insulin is normal, continue periodic monitoring in at-risk horses.

3. Feed Smart

For predisposed but otherwise healthy horses:

• Monitor sugar levels in the forage; test hay if needed, as sugar levels vary widely.
• Limit feeds high in NSC (preferably <15% NSC); feed small, frequent meals.
• Use caution with high-protein feeds or supplements, as amino acids can also stimulate insulin release.

For horses with ID or laminitis:

• Use low-sugar forage (<10% WSC) confirmed by hay analysis.
• Choose low-NSC (<10%), high-fibre concentrates; avoid grains and feed small meals.
  • < 0.1 g of NSC/kg BW per meal
• Add a vitamin–mineral balancer if feeding forage-only to avoid nutrient deficiencies.
• Discuss metabolic supplements with your veterinarian, especially when combined with medications.

4. Manage Turnout

• Avoid turnout after cold spring/autumn nights 
• Use grazing muzzles to reduce grass intake and feed hay before turnout 
• For horses with diagnosed ID or laminitis, avoid turnout on grass and use a dry lot

5. Encourage Daily Movement

• Regular, light exercise improves insulin sensitivity and helps weight control
• Turnout alone may not be enough - consider in-hand work, lunging or riding
• Tailor activity to comfort level and hoof health

6. Support internal Metabolic Balance

• These metabolic improvements may help reduce the internal pressures that contribute to laminitis risk.
• Research shows that specific essential-oil blends can support healthier metabolic regulation in horses with ID.
• Six weeks of oral supplementation has been associated with improved insulin sensitivity.
• Supplementation produced favourable shifts in pathways related to fat, amino-acid, and energy metabolism.

Key Takeaway 

Laminitis isn’t just a hoof problem. It’s a metabolic warning sign that reflects deeper dysfunction inside the horse, most often driven by insulin dysregulation.

As a trusted advisor, you can play a vital role in prevention by helping owners:

• Recognise early signs of metabolic imbalance and laminitis risk.
• Monitor insulin levels, ideally with dynamic testing when indicated.
• Understand how genetics, diet, and activity contribute to insulin dysregulation.
• Implement evidence-based management: low-sugar forage, controlled NSC intake, weight management, and consistent exercise.
• Make informed decisions about pasture access, especially during high-risk seasons.
• Consider research-supported supplements, including essential-oil blends shown to support insulin sensitivity.

With a root-cause approach focused on metabolic health, laminitis risk becomes manageable, and for many horses, preventable.