Trust Your Gut – the importance of nutrition for health, performance and longevity

Article by Dr. Richard McCormick, M.V.B., Dip. Eq.Sc., M.R.C.V.S. 

The science of equine nutrition is really quite simple – The horse is a flight animal and in the wild, needs to be able to escape from predators using a short burst of energy. Nutrition and subsequent ‘energy’ for survival is all provided by grass which has the required balance of vitamins, minerals, immune supportive nutrients and  fiber to maintain a healthy gut microbiota and keep the horse in adequate health for reproduction. Proper functioning of the gastro-intestinal tract (GIT)  in horses is dependent on a broad range of micro-organisms and more than half of the energy requirement for their survival comes from the microbial fermentation occurring in their enlarged caecum and colon (Chaucheyras-Durand et al 2022). The bacterial populations resident in the various compartments of the horses intestinal tract vary greatly (Costa et al 2015) and there is more DNA in the bacteria located in the gastro-intestinal tract  than there is in the entire body. Because of this, having a healthy gut flora is critical to having a healthy immune system.

In modern times, our demands of horses for performance for our pleasure rather than their survival has led to their need for increased energy that cannot be provided from grass alone. Because of this, the intricacies of diet (in particular the consumption of starch, fiber and fat) has come under scrutiny. Equine feed manufacturers have looked for additional sources of starch, a carbohydrate and a natural component of grass that is ‘essential  to provide energy, fiber and a sense of fullness’ (Seitz 2022). Today, most horses and rapidly growing foals are commonly fed diets with >50% of total ration by weight in the form of grain ‘concentrates’ and carbohydrates from oats, maize, soya, barley and wheat. These grain based feeds contain high concentrations of soluble, easily fermentable starches but can be deficient in certain minerals and vitamins so getting an optimally balanced feed ‘right’ is difficult.

Too much of a good thing  

With advances in scientific knowledge, we now know that when a horse is exposed to surplus starch, the hydrogen ion concentration of their gut increases promoting  the production and absorption of lactic acid, acetate and propionate through the activity of fermentation (Ralston 1994). The process is quick, with lactic acid entering the bloodstream within 3 hours of feeding and calcium subsequently being excreted in the urine.  In order to combat this nutrient loss, the horses’ hormone system triggers the release of parathyroid hormone into the bloodstream, activating the release of stored calcium (to maintain optimal blood levels) but unfortunately causing  bone demineralisation. Clinically, the horse experiences health consequences of varying degrees including digestive diseases (eg: gastric ulcers, diarrhea, colic or colitis), muscle dysfunction (eg: rhabdomyolysis (known as ‘tying up’), defective bone mineralization (expressed as increased incidence of stress fractures and developmental orthopedic diseases), systemic diseases (such as laminitis, equine metabolic syndrome and obesity (Chaucheyras-Durand et al 2022) as well as potential causes of fatigue.

The ideal equine diet 

There is little equine focused research available on the benefits of individual nutrients (due to limited numbers in trials and their subsequent evaluation) of grain ‘concentrates’. But we do know that ingredient availability and quality is regularly influenced by market pressures. 

The table (fig 1) below outlines the sugar, starch and fiber components of the various ingredients commonly found in horse feeds. The optimal grain for equine nutrition with its efficient energy source through lower starch content (relative to other grains) and its high level of soluble fiber (relative to other grains) are oats.

The healing power of omegas and short chain fatty acids 

While grass provides optimal equine nutrition in its own right, the ‘curing process’ when making hay depletes the valuable omegas 3 and 6 intrinsic in grass. These ‘healing’ nutrients naturally protect the lining of the gastro-intestinal tract by increasing mucous production and alleviating ‘auto digestion’ (via hydrochloric acid). For horses, bacterial fermentation in the hind gut also results in the production of Short Chain Fatty Acids (SCFAs), namely acetic, proprionic and butyric acids. These SCFAs ‘cross talk’ with the gut immune system providing local immunity in the gut as well as protection of the respiratory system, the brain and other tissues against disease. In human medicine, it has been repeatedly established that a dysfunctional gut microbiome is associated with respiratory problems. This is evidenced by the fact that when gut disorders such as Irritable Bowel Syndrome  (IBD) or Coeliac disease exist in humans, they are commonly associated with a higher incidence of respiratory infections and related asthmatic like conditions. Barragry (2024) explores the relationship (Fig 2) between gut microbiome and the immune system's ability to support health and combat disease in cattle. A scenario mirrored in the equine.

The stabled horse should be provided with SCFAs daily to support proper functioning gut microbiome. This critical dietary consideration should ideally be provided in the form of flaxseed which has the highest ratio of omegas 3 and 6 (in the ideal ratio 4:1) in the plant world and is most suitable for the equine herbivore.

The health benefits of flaxseed for both humans and equines has been recognized as early as 3,000 BC. Flaxseed was used for various medicinal purposes such as the treatment of gastric disorders, as a soothing balm for inflammation and as a laxative (Judd, 1995). Horsemen (who relied heavily on their equines) and trainers (who sought optimal performance from their charges through natural means) also used flaxseed as a way to supplement the diet with omega-3’s and fiber to produce high quality proteins. Now, thirteen centuries later, we have research to substantiate the knowledge of our ancestors. The renowned German researcher of ‘fats’ and pioneer in human nutrition, Dr. Joanna Budwig, as early as the 1950’s reported that “the absence of highly unsaturated fatty acids causes many vital functions to weaken". Dr. Budwig’s life’s work focused on the dietary ‘imbalance’ between omega-3 and omega-6 fatty acids in humans has been a cornerstone to the exploration of the role of inflammation and the development of many diseases of the coronary, respiratory, metabolic and immune system.

The small seed of the flax plant is also an excellent source of high-quality protein (exceeding that of soybeans and fish oils) and potassium (a mineral that’s important for cell and muscle function). But, the true power of flaxseed lies in three key components: 

Omega-3 essential fatty acids – Also known as "good" fats, omegas enhance the oxygen usage of cells and in combination with alpha-linolenic acid (ALA) are anti-inflammatory in their effect within the body.

Lignans – Flaxseed contains 750 - 800 times more lignans than other plant foods (McCann 2007, Yan 2014). Lignans are a group of compounds with antioxidant properties which also contain plant estrogen. Lignans are linked to a reduced risk of developing osteoporosis, heart disease and cancer.

Fiber - Flaxseed contains both the soluble and insoluble types of fiber essential for maintaining ‘gut’ health.

In equines, adding flaxseed to the diet has the immediate benefits of a shiny, healthy coat and fewer skin allergies. Consistent use of flaxseed has multiple long term benefits including strong hoof quality, improved joint health, reduced muscle soreness, faster healing of ulcers (Sonali et al 2008) and significantly impacts inflammation associated with chronic skin conditions (commonly known as ‘sweet itch’). In breeding stock, increased Omega-3 levels in mares’ milk leads to boosted immunity in foals with higher stallion fertility and improved conception rates in broodmares documented (Holmes, 2015).

How diet can influence performance 

It is easy to think that ‘providing more is better’ when it comes to using nutrition to support performance. But having excess levels of essential vitamins and minerals being processed by the horses’ sensitive gut has a direct impact on their behavior and willingness to perform. Today, we have greater ‘choice’ at the feed store with a broad range of commercial feeding offerings available including mixes, mashes and supplements but the discerning horse owner can be forgiven for being overwhelmed by the range of diet options for every ailment and stage of life.

In modern times, despite advances in nutrition offerings, we have seen a falloff in performance (Fig 3). During the late 1960s, the U.S. Jockey Club stats noted that racehorses averaged 12 starts per year – a far cry from today's horses racing in the U.S. where the average of 3 ‘starts’ was highlighted by leading US Trainers in 2020 (www.ownerview.com). Unfortunately, this is not just a U.S. based problem, but a phenomenon noted worldwide.

The first equine pelleted feed was formulated in the US by the Cistercian  monks in Gethsemani, Kentucky in 1957. Prior to this, all horses were fed ‘straights’ (primarily oats as their energy source and flaxseed as their protein source). My own understanding of the link between modern feeding practices and compromized performance since the 1960s has been curated off an understanding of “what was different” then, as well as a career of observations, clinical practice and scientific review. Fact is, the equine diet of the 1960s was lower in starch and high in fiber. It consisted of oats, minerals, and flaxseed as the “norm”. Hay was the preferred forage (Fig 4).

Today, soya (with one fifth of the omega 3 content of flaxseed) has practically replaced flaxseed as the protein source in equine nutrition. This small change has seen a significant drop in omega-3 and 6 (needed for prostaglandins) in the diet with consequential gastro-intestinal and joint issues. Other dietary changes include those recommended by the National Research Council (NRC) in 1978, who suggested doubling the recommended calcium levels for horses with a subsequent increase in levels of Osteochondrosis (OCD) and Osteopetrosis in the equine population (Krook and Maylin, 1989). Additional moisture in the diet too has led to excess mould formation in convenience feeds and with severe exposure causes liver damage (Buckley et al 2007). Stabled racehorses today mostly lack the nutritional protection afforded a previous generation of horses. The impact has been noted clinically in the widespread increase in equine gastric issues and as stated by J.E. Anthony “Racing fans are missing about half of what they once enjoyed in racing.”

The role of the gut bacteria in the prevention of disease

The gut microbiome begins populating and diversifying from the moment of birth. Though ‘sterile’ in utero, gut derived DNA immediately drives immune health with exposure to nutrition. Recent research suggests that the gut microbiome can be stimulated by using proven probiotics with a track record in enhancing gut health (Barragry 2024). But it is the protective power of SCFAs to allow ‘cross talk’ between the lungs and the gut microbiome that is critical to supporting horses through their life span. 

Nutrition using grain ‘concentrates’ is currently at approximately  99% saturation in today’s equine population so a return to feeding ‘straights’ is a swim against the tide of modernity. But, knowing the influence of nutrition on health, performance and longevity it falls on horse owners to be mindful of the consequential  impacts  such convenience feeds have on the gut microbiome and immune system. Random supplementation and high starch feeds are leading to dietary health issues such as gastric ulcers, hyperinsulinemia and  hyperlipaemia (obesity) as well as increased risk of laminitis . So trust your gut and keep it simple – a diet of oats, flaxseed, a multi-vitamin balancer and ad lib hay will not only meet your horses’ energy needs but will keep them happy and healthy too.

REFERENCES

Barragry. TB (2024) WEB https://www.veterinaryirelandjournal.com/focus/254-alternatives-to-antibiotics-probiotics-the-gut-microbiome-and-immunity

Buckley T, Creighton A, Fogarty (2007)  U. Analysis of Canadian and Irish forage, oats and commercially available equine concentrate feed for pathogenic fungi and mycotoxins. Ir Vet J. 2007 Apr 1;60(4):231-6. doi: 10.1186/2046-0481-60-4-231. PMID: 21851693; PMCID: PMC3113828.

Budwig, Dr. J (1903-2008) WEB https://www.budwig-stiftung.de/en/dr-johanna-budwig/her-research.html

Chaucheyras-Durand F, Sacy A, Karges K, Apper E (2022). Gastro-Intestinal Microbiota in Equines and Its Role in Health and Disease: The Black Box Opens. Microorganisms. 2022 Dec 19;10(12):2517. doi: 10.3390/microorganisms10122517. PMID: 36557769; PMCID: PMC9783266. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9783266/

Holmes, R (2015) Feeding for stallion fertility. WEB 

https://www.theirishfield.ie/feeding-for-stallion-fertility-172113/

Judd A (1995) Flax - Some historical considerations. Flaxseed and Human Nutrition, S C Cunnane, L U Thompson. AOCS Press, Champaign, IL 1995; 1–10 [Google Scholar]

Martinac, P (2018) What are the benefits of flaxseed  lignans?  WEB https://healthyeating.sfgate.com/benefits-flaxseed-lignans-8277.html

National Research Council. 1989. Nutrient Requirements of Horses. Washington D.C.: National Academy Press.

Ralston, S VMD, PhD, ACVN (1994) The effect of diet on acid-base status and mineral excretion in horses in the Journal of Equine Practice. Vol 16 No. 7. Dept of Animal Science, Rutgers University, New Brunswick, NJ 08903

Seitz, A  (2022) What to know about starch_Medically reviewed by Seitz, A - MS, RD, LDN, Nutrition — WEB https://www.medicalnewstoday.com/articles/what-is-starch#benefits

Sonali Joshi, Sagar Mandawgade, Vinam Mehta and Sadhana Sathaye (2008) Antiulcer Effect of Mammalian Lignan Precursors from Flaxseed, Pharmaceutical Biology, 46:5, 329-332, DOI: 10.1080/13880200801887732

The use of probiotics as an alternative to antibiotics to reduce resistance in the gut

Article by Kerrie Kavanagh

The leading causes of horse mortality can be attributed to gastrointestinal diseases. Therefore, maintaining the balance of the gut microbiota and avoiding a shift in microbial populations can contribute to improved health status. The gut microbiota, however, can be influenced by countless dynamic events: diet, exercise, stress, illness, helminth infections, aging, environment and notably, antimicrobial therapy (antibiotics). These events can lead to gut dysbiosis—a fluctuation or disturbance in the population of microorganisms of the gut, which can contribute to a wide range of disease. The use of antibiotics in horses is thought to have one of the most notable effects on the gut microbiota (gut dysbiosis), which can lead to diseases such as colitis, colic and laminitis.

Antibiotics, which are antimicrobial agents active against bacteria, are important to equine medicine; and bacterial infections can be resolved quite successfully using antibiotics for antimicrobial therapy, but there are consequences to their use. An antimicrobial agent can be defined as a natural or synthetic substance that kills or inhibits the growth of microorganisms such as bacteria, fungi and algae. One of the consequences of antibiotic use is that of antibiotic-associated diarrhea, which can contribute to poor performance in the horse and even mortality. In antimicrobial therapy, the target organism is not the only organism affected by the antimicrobial agent but also the commensal microbiota too (the normal flora of the equine gut). Antibiotics can promote fungal infections and resistant organisms and impede or even eliminate the more sensitive organisms; and they can have both short- and long-term consequences on the gut microbiota composition and function. 

Research has indicated that antibiotic treatment may adversely affect metabolic function in the gut by decreasing protein expression responsible for biochemical pathways such as glycolysis, iron uptake, glutamate hydrolysis and possibly even more metabolic functions. The use of antimicrobial drugs directly impacts and possibly contributes to the most notable effect on the gut microbiota of the host, leading to gut dysbiosis; and certain antibiotics can have further-reaching consequences on the microbiota than others. The type of antibiotic and mode of action (bacteriostatic versus bactericidal) will differ in their influences on the gut microbiota composition, e.g., clindamycin operates a bacteriostatic mode of action by inhibiting protein synthesis and exerts a larger impact on the gut microbiota compared to other antimicrobials. These influential consequences that are imparted by the antimicrobial agent are relatively yet to be elucidated and may result in the manifestation of illness or conditions later in life. For example, the development of asthma in humans has been linked to antibiotic treatment in early childhood as a result of bacterial infections. It may yield interesting results if researchers were to examine the gut microbiome of horses suffering from chronic obstructive pulmonary disease (COPD) and other chronic respiratory illnesses and to establish if there is indeed a link with antibiotic therapy used in horses from an early age. 

In comparison to the vast wealth of human studies conducted so far, the volume of equine studies falls disappointingly far behind, but that is changing as researchers focus their interest on developing and filling this gap of knowledge. One such study, which examined the effect of antibiotic use on the equine gastrointestinal tract, demonstrated a significant reduction in culturable cellulolytic bacteria (>99%) from equine feces during the administration period of trimethoprim sulfadiazine and ceftiofur in a study comparing responses to antibiotic challenge. That reduction was still evident at the end of the withdrawal period when compared to the control group. In other words, there was a significant reduction in the ‘normal’ bacteria of the gut. The ability of antibiotics to modulate the gut microbiota was evidenced by the proliferation of pathogenic Salmonella and Clostridia difficile (commonly associated with diarrhea in horses) in the antibiotic challenged horses. This trend of reduction in cellulolytic bacteria associated with antibiotic use was also mirrored in a relatively recent study conducted in 2019, where a short-term reduction in culturable cellulolytic bacteria was combined with a progressive increase in amylolytic bacteria. The heavy reliance on cellulolytic bacteria in the role of equine digestion (without these types of bacteria the horse cannot break down their food) may, therefore, adversely affect the dietary energy available from forage during antimicrobial therapy and may therefore impact performance.

Another study that compared the effect of penicillin, ceftiofur and trimethoprim sulfadiazine (TMS) on the gut microbiota in horses using next-generation sequencing showed that TMS had the most profound impact on the microbiota, in particular the phylum verrucomicrobia. This same study also reported a significant decrease in bacterial richness and diversity of the fecal microbiota. A reduction in bacterial diversity is certainly a trend that is commonly seen in gastrointestinal disease in horses. The restoration of the normal gut microbiota after completion of antibiotic treatment can take up to 40 days, but the organizational structure of the bacterial populations can take many years to re-establish the original structure map that was laid out in treating the pre-antibiotic gut. 

Equine studies certainly show similarities to human studies, indicating the consequences of antibiotics that can be seen across more than one species. Human studies have reported long-term consequences of antibiotic treatment on the human microbiota. One such human study investigated a seven-day clindamycin treatment and monitored the patients for two years. The impact on the human microbiota remained evident two years post-treatment, where a reduction in bacterial diversity and detection of high-resistance to clindamycin were detected. 

Interestingly, no resistant clones were detected in the control group over the two-year sampling period. Another study focusing on the effects of antibiotic treatment for Helicobacter pylori showed findings mirrored in similar studies of that field. The findings demonstrated the rapidly reducing bacterial diversity (one week) after antibiotic treatment and found that disturbances in the microbiota and high levels of macrolide resistance were evident four years post-treatment. Human studies may predict that equine studies will find similar trends with equine antimicrobial therapy. These studies highlight the impact of antibiotic use and the long-term persistence of antibiotic resistance remaining in the intestinal microbiome, which is a concern for both humans and animals. 

Antibiotics can lead to the selectivity and proliferation of resistant bacteria, which is evidenced by the long-term effects observed on the gut microbiota harboring drug-resistant encoded genes. Horizontal gene transfer (HGT) commonly occurs in the gut (can be up to 25 times more likely to occur in the gut than in other environments). HGT can be attributed to the close proximity of the microbiota in the gut, allowing the transfer of genetic material via routes such as plasmids and conjugation; in other words, the bacteria in the gut have developed a pathway to transfer antibiotic-resistant genes from one generation to another. Resistance to antibiotics is now a global issue for the treatment of many diseases. 

With the unfavorable association tied to Clostridium difficile infections (CDI) and the onset of colitis, particularly in mature horses treated with β-lactam antibiotics (commonly used for equine infections), the incidences in which antimicrobial therapy is considered should be minimized and only used if entirely necessary. The use of broad-spectrum antibiotics in recurrent presentations of symptoms of disease such as urinary tract infections in humans or diarrhea as a result of CDI in both humans and horses is promoting drug resistance. The antibiotics, by disrupting the gut microbiota (which act as a defense against the establishment and proliferation of such pathogenic bacteria) are allowing the opportunity of growth for these multi-resistant microorganisms such as C. difficile, vancomycin-resistant enterococci (VRE), and multi-resistant Staphylococcus aureus (MRSA). The organism C. difficile and its antibiotic resistance has been demonstrated in the treatment of CDI for both humans and animals. The introduction of vancomycin (a glycopeptide antibiotic) in 1959 for the control of CDI remained effective until the 1990s when a more virulent form of C. difficile emerged. This new form of C. difficile with reported broad-spectrum antibiotic resistance resulted in chronic conditions and increased human mortality. C. difficile is most noted with human hospital-acquired infections. C. difficile BI/NAP1/027 has been shown to have resistance to fluoroquinolone antibiotics, moxifloxacin and gatifloxacin, which was not seen in historical genotypes. As C. difficile infections are found to cause gastrointestinal disease in horses as well as humans, this is certainly of concern.

Alternative therapies to antibiotic therapy to restore or modulate the gut microbiome after a gut dysbiosis event could be considered in certain circumstances where antibiotics are no longer effective (e.g., CDI), if they’re not the best course (presence of extended-spectrum -β-lactamase (ESBL) producing  organisms) or if they’re not essential for example, when the diagnosis of the bacterial cause is uncertain. The rationale to using probiotic treatment along with antimicrobial treatment is that the antibiotic will target the pathogenic bacteria (e.g., C. difficile) and also the commensal microbiota of the gut, but the probiotic bacteria will help to re-establish the intestinal microbiota, and in turn, prevent the re-growth of the pathogenic bacteria in the case or residual spores of C. difficile surviving the antibiotic treatment. Alternative therapies such as fecal microbiota transplant (FMT) or probiotic solutions can reduce the risk of proliferation of antibiotic-resistant bacteria and also have fewer implications on the gut microbiome as evidenced by antibiotic use. 

Probiotics have been defined by the Food and Agricultural Organization (FAO) and the World Health Organization (WHO) as “live non-pathogenic microorganisms that, when administered in adequate amounts, confer a health benefit on the host.” The word probiotic is Greek in origin, meaning, “for life”; and the term was coined by Ferdinand Vergin in 1954. While the mechanisms of action of probiotics are complex and require a deeper knowledge of the modulations of the gastrointestinal microbiota, and the health benefits due to their use are the subject of some debate, there is no doubt that probiotics are considered by many as a vital resource to human and animal health.   

The use of probiotics in animal production, particularly in intensive swine and poultry production, has increased in recent years, primarily as an alternative to the use of antimicrobials in the prevention of disease. The problem of antibiotic resistance and antimicrobial residues in food-producing animals (the horse is considered a food-producing animal), as a result of historical antibiotic use with the corresponding reduction in antibiotic efficacy in humans, leads to having to look at more sustainable options, such as probiotic use, to combat disease. Probiotics in horses are predominantly used as a treatment modality in the gastrointestinal microbial populations to combat illnesses such as diarrhea—to prevent diarrhea (particularly in foals) or help improve digestibility.  Shifts or fluctuations in the microbial populations of the equine gastrointestinal tract have been associated with diseases such as laminitis and colic.  

Gut dysbiosis, as mentioned previously, is a fluctuation or disturbance in the population of microorganisms of the gut. It is now being recognized as a cause of a wide range of gastrointestinal diseases; and in horses, it is one of the leading causes of mortality. The ability of probiotics in conferring health benefits to the host can occur via several different mechanisms: 1) inhibiting pathogen colonization in the gut by producing antimicrobial metabolites or by competitive exclusion by adhering to the intestinal mucosa, preventing pathogenic bacteria attachment by improving the function and structure; 2) protecting or restabilizing the commensal gut microbiota; 3) protecting the intestinal epithelial barrier; 4) inducing an immune response.

It is known that there are a wealth of factors that will adversely affect the gut microbiome: antibiotics, disease, diet, stress, age and environment are some of these compounding contributors. To mirror one researcher’s words, echoing from an era where antibiotics were used as growth promoters in the animal industry, “The use of probiotic supplements seeks to repair these deficiencies. It is, therefore, not creating anything that would not be present under natural conditions, but it is merely restoring the flora to its full protective capacity.” In the case of using concurrent antibiotic and probiotic treatment, this strategic tweaking of the microbiota could be used as a tool to prevent further disease consequences and perhaps help improve performance in the horse.

The benefits of probiotic use in horses have not been investigated extensively, but as mentioned previously, they are now being focused upon by researchers in the equine field. The most common bacterial strains used in equine probiotic products are Lactobacillus, Bifidobacterium, Streptococcus, Enterococcus, Bacillus and yeast strains of Saccharomyces. Lactobacillus, Bifidobacterium and Enterococcus strains typically account for less than 1% of the microbiota’s large gastrointestinal populations. Regulation is lacking regarding labeling of probiotic products, often not displaying content with clarification and quality control (such as confirmed viability of strain[s]) not excised with over-the-counter probiotic products. There is evidence to suggest that host-adapted strains of bacteria and fungi enjoy a fitness advantage in the gut of humans and animals.  Therefore, there may be an advantage in using the individual animal’s own bacteria as potential probiotics. Probiotics and antibiotics used concurrently could be the way to minimize the introduction of antibiotic-resistant bacterial strains in the gut, and in turn, protect future antibiotic efficacy.