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Managing Cushings in the Real World

Updated: Feb 28

A lot of people have a fantasy of putting their beloved old horse in a lush pasture to live out its days in bucolic bliss. This is not the reality. Most of our pastures have only a limited number of species, meaning that an unsupplemented horse - whilst maintaining a satisfactory weight, or indeed being overweight, may still be deficient in many important vitamins and minerals.

Many horses who have a propensity towards being overweight anyway suffer complications from this lifestyle. The most extreme example of this is Cushings Disease, or Pituitary Pars Intermediary Syndrome. This is very common, and probably one in five of the horses that I consult for would be somewhere along this insulin resistant - Cushings spectrum. Particularly ponies, quarter horses and other 'thrifty' or 'good doers'.

There is lots of good information out there about Cushings Disease. Probably the best one is

This post is about managing it - or not.

Here are three horses with Cushings syndrome - all at about the same stage in the disease, and roughly the same age, who's condition is being managed to various degrees.


The first is Twigs. Twigs is an aged quarter horse mare. She has some other issues that affect her lameness, including two bowed flexor tendons on her front legs. Twigs has unrestricted access to about twenty acres of improved pasture. She is not fed daily (although she is fed weekly), and so she is not being daily medicated or given any other nutriceuticals (by this I mean non-prescription dietary supplements that have anti-inflammatory or hormone-regulating properties). Twigs owner does not live on the property where Twigs is kept, so her symptoms are not being managed in any way. She has the typical curly coat, odd fat deposits (above the eyes, at the withers and tail head), cresty neck. She has some level of laminitis at all times. She is on a very regular trim cycle which helps to manage her laminitis.

This is what Cushings looks like without any intervention.


The next example is Chum. This welsh pony is, again, aged. Chum has chronic laminitis most of the time, but also suffers from bouts of acute laminitis which render him immobile. Like Twigs, Chum has other injuries. He has a calcification of his near-side fetlock, and compromised ligament attachments of the offside hind knee. He also has the curly coat typical of a Cushings horse, fat deposits above the eyes, on the wither and tail head.

Chum is in a small unimproved paddock. He has 24/7 access to pasture, but it also fed low sugar grass hay and an evening meal of speedibeet with minerals and nutriceutical anti-inflammatories (MSM and glucosamine), but he is not on any medication to regulate his insulin. He is on a 8 to 10 week trim cycle, which is not ideal. He is also quite challenging to trim because he finds it very difficult to stand on three legs.

This is what we call the 'box stance' (the horse looks like it is standing on a small box). It indicates a horse with long-term, chronic, fairly intense pain over their whole body. When they are sore in one hoof they will typically point, when they are sore on both fronts they generally stand over at the knee, or high medial, low lateral, when they are sore in the hinds they will frequently stand base-wide (like a Boxer dog), or with their hinds underneath them (like a German Shepherd).

The line under the belly shows that he is literally holding his breath. All of these stances use a lot of energy, and will end up with uneven muscle development and wastage.

This is what Cushings looks like with moderate intervention.


Allie is the same age as Twigs and is the same size and breed as Chum. She is on a four week trim cycle. She is on 3 daily Sound Advice Supplements - Trace Mix, Calm Mix and Relief Mix.

She is on the vet prescribed Pergolide to manage to her Cushing symptoms. Most importantly she is on NO PASTURE. She lives in a suburban backyard and is handwalked and/or ridden every day. She competes regularly at pony club and sporting events.

This is what Cushings looks like with complete intervention.

All of these horses above would improve with veterinary medication for this condition. However, many horses in the earlier stages often improve with Vitex Agnus Castus (chaste tree berry), which is available from our store, as part of a holistic approach to managing this condition.

Most people would imagine life would be better and more comfortable for a horse on 20 acres of lush pasture, than on a dirt block in a backyard, but as you can see, that is not necessarily the case.

The idea of our older horses standing knee-deep in lush pastures, with little human intervention in their twilight days sounds like a lovely gift we can offer to our old friends, but the reality is quite different. Many horses do not prosper at all in this scenario. Imagine taking your Nanna and Pop and locking them in McDonalds.

Horses need a simple diet low in sugars and high in fibre. They need regular exercise and appropriate hoofcare, irrespective of their age, or the owner's personal or financial circumstances.

If you need help, we have over ten years experience supporting horse owners with challenging nutritional needs. Please contact us for a nutrition consult. This can also be done by email.


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