In this podcast, Dr. Meg Miller Turpin and Liz Ehrlich from Equine Elixirs discuss the common causes of equine ulcers and all natural ways to address them.

Transcript

HOST: Welcome to the podcast, Dr. Miller, and welcome back to the podcast, Liz Ehrlich.

Liz Ehrlich: Thank you.

HOST: So, anytime pretty much anyone posts anything on Facebook these days about their horse, one of the early comments is always to check for ulcers. And it seems like because most things, most behaviors horses can have, can really have an underlying stomach condition. I feel like we’re learning more about this almost daily, it seems, in our industry. I think about how we fed horses when I was a kid growing up and cringe a little bit. Dr. Miller, can you tell us about the signs of ulcers that we see in horses?

DR. MILLER: Yeah, I mean, the most classic traditional signs are not wanting to eat, or eating their grain and then immediately getting uncomfortable, acting a little crampy, weight loss, and gastrointestinal disturbances. Sometimes they get diarrhea, sometimes they just don’t pass enough manure, but usually those are the common symptoms. Other symptoms we’re seeing more now, or learning more about in sport horses, is your horse may be suddenly spooky or not want to go forward or not get a lead. And you think that more commonly, you want to do an orthopedic workup, but often they will find nothing. Some people just choose to go straight to the stomach because it’s often a sound horse that suddenly starts doing these things. And we are finding more horses that have ulcers showing this symptom.

HOST: The behavioral side of these issues is really interesting because, obviously, no matter how good you are, you can't train away physical pain or discomfort, right?

DR. MILLER: Yeah, exactly. For instance, some horses are just girthy and they’ll be that way all their life. But if it’s a new thing, or if they try to bite you when you’re grooming their side, or show any sort of behavior change or irritability, if you can pinpoint it to a source of pain and they get better from treatment, then you know that was a true medical problem. We have a bunch of different options for treating ulcers. But can we talk a little about the different types of ulcers? I think, as we learn more, we kind of use general terms that describe more conditions. There are two different parts of the horse's stomach. From the esophagus to the top part of the stomach is the squamous mucosa, which is just the type of cells that line that part of the stomach. The bottom half of the stomach is glandular, and this is where the acid sits. It’s made from the glands in the glandular part of the stomach.

The acid touches all parts of the stomach, but there are different causes of ulcers depending on whether it’s in the glandular part (the bottom half) or the squamous part (the top half). The glandular part is more used to living in acid, so it’s not as sensitive. The squamous part, where food first hits the stomach, is the more sensitive area.

When you get ulcers in the pylorus (the exit of the stomach), which is also glandular, you treat them differently from ulcers in the squamous part. Squamous ulcers are most commonly treated with gastroprotectants like omeprazole or antacids. Glandular ulcers are different, but you wouldn’t know that unless you scope the stomach.

Some people think their horse is getting better with traditional ulcer treatment, but actually, they may have pyloric ulcers.

LIZ: That's actually the interesting thing that we did with the case studies with the Ulceraser and the Sea Buckthorn, which was for horses that had persistent glandular and pyloric ulcers that had not really responded 100% or as well to the traditional gastro protective therapies. We introduced the Ulceraser and the Sea Buckthorn at a double dose for a six-week period and actually had really incredible results in the glandular and pyloric region combining those two. So Piper, I don't know if you know that, but Meg actually did those scopes for us and helped us with those case studies.

HOST: Dr. Miller, tell us what scoping is, what the procedure is like, and how these case studies, what you had to do to kind of analyze this.

DR. MILLER: ​​So using the scope is fairly simple. Some people don't like to do it. They think it's invasive.

It's really not. It takes minimal light sedation, usually less than what you're using to inject a joint. So it's just enough to get a little tube passed and then pass the scope into the stomach.

The horse needs to be fasted. I usually do it for 14 hours before. So because if you scope the stomach, it's full of food, you're not going to see the lining.

So it's a waste of time. So basically it's the fasting, light sedation. If this horse is very good and the stomach is pretty empty, it might only take actually 10 minutes for the procedure, 10 to 15 minutes.

You basically look at the top line, then you dive down to the bottom and look at the pylorus, and you can go into the duodenum, which is the first part of the small intestine. So when Liz approached me and a couple other products I've tried as well, I said I'd try some products because there's not a lot known still about why horses get these pyloric ulcers and what are the best treatments. And I have a bunch of horses where I've used the traditional antacids, gastroprotectants, and they just fail to get better. So that's why I'm always looking for something else that might help. So we chose to try the Ulceraser, at least. It's very high in Omega 3s. That can help with mucosal healing and any inflammatory effects. So that's what we chose to try. I told her I would try it on horses that weren't getting better with traditional therapy, either as an add-on or just to try it by itself and do a, you know, scope it four to six weeks later, depending on where the lesions were.

In general, horses with the squamous ulcers tend to heal quicker, they tend to be easier to heal, and they don't take as long as the glandular ulcers. They almost always take six to eight weeks or more. So like I said, they can be very challenging to figure out what's going to help them heal. It depends on why they got the ulcers in the first place. So that's why a lot of the non-traditional treatments, I think the homeopathic, things like this will help them because it's not related to drugs that cause the ulcers.

LIZ: I think that actually sort of leads into the importance of diet and how diet can impact the issue of recurring ulcers. Do you feel that that's something that we're learning more about now in terms of diet?

DR. Miller: Piper laughed when she talked about how she used to feed her horses, how we always think, oh, you know, straight sweet feed. Oh, corn, the best corn. We're finding that feed with higher sugar, higher protein, causes more of an acid rebound. The stomach will produce more acid to try to digest those. And it's too much all at once. So they're more likely to cause ulcers. Certain brees are different.

That's definitely lower starch, higher fiber. It seems to be better in general feeding more frequent small meals and trying to keep hay or roughage in their stomach as much as possible. That in itself helps absorb the acid.

But then the added fat is a big component. Omega-3 fish oil, they've done a study on that really. Oh, that was one study that was actually done to prove that

LIZ: Well, it's the EPA and the DHA from the fish oil. So if you get EPA and DHA from an alternate source, like say from algae, it will still have the anti inflammatory effect with the benefit of it being a vegan source for the horse.

Dr. Miller: Yeah. And maybe more palatable. It's difficult to get horses to eat fish oil alone. So you need to add some things to make it palatable.

HOST: What is it about horses' lifestyles right now that make them have high risk factors for ulcers?

Dr. Miller: I mean, definitely the athlete, the one that's showing and moving in and out of the showground, changing its environment, but not always as consistent as just staying at home on the farm, living in a stable, not getting... Horses are naturally used to 24-hour turnout and grazing all the time. So we've changed that and that's most of the ways that we take care of them. So I think that's an added stressor. And then it depends on what your program is or what your level of competition is. A lot of horses, to keep them moving well and sound, they need to get non-steroidal. They end up being abused with injections of steroids and those obviously have side effects. They can be harmful.

They can be a primary cause of the ulcers. And then I like to say every horse is an individual. I've had a few horses where I said, stop showing them and give them time off.

And two horses I know got worse with that environment. They actually needed exercise, needed constant activity... they needed a job. So it's not, it can't be... It’s not a one-size-fits-all.

And feeding them consistently is important, and most people now know this, they keep hay nets in the stall, they're feeding at night checks. Most of this area does that, but I often need to just tweak it a little bit depending on the individual horse.

Liz: I feel like people are starting to appreciate more of the importance of a forage-based diet and the importance of low sugar and low starch, which is obviously how farm programs are designed in order to gear it toward them having a successful career and not any gastric issues.

HOST: Dr. Miller, you did 12 months of case studies with Ulceraser. Can you talk about the results and pace of the resolution of ulcers? If your horse does have ulcers, what’s the timeframe for healing?

DR. MILLER:  The general take-home was that many of these that I would say were actually better in six weeks. And we don't say six weeks is a cutoff, we just, maybe they're healed in four weeks.

We just can't say, we will scope your horse every week so I can look at its stomach and see if it's better. No one is going to put the horse through that or pay that amount of money to do it weekly. It would be nice, but we can't do that. So, we try to take the average for a squamous stomach which would be 30 days, if it's not really severe, it should be the majority of it better. And my lower ones are more like six weeks, but sometimes three months, four months, and that's why that's too long. And I will say once we added the Ulceraser and the sea buckthorn, we added the two together.

LIZ: I remember when Lisa had shown some images on a particular horse, she said she could see the orange residue of the sea buckthorn actually acting as a little coating agent over what looked like some ulcerative tissue that was healing.

HOST: Liz, tell us about the tummy gummies and what they're designed to counteract.
 
LIZ: So the tummy gummies are designed to buffer gastric acid on contact. So they work immediately and they last for about 40 minutes at a time. So when horses are away from their stall and they're not able to eat and forage constantly, they have a constant influx of gastric acid that isn't then being buffered by the continuous influx of food.

So the acid can start to make their stomachs uncomfortable. And if you can give them four gummies at a time, that will increase the pH so that they don't have the discomfort of the gastric acid. So the gummies are a combination of calcium carbonate, and magnesium oxide.

So it's a gummy form of tums. And you can take them with you. You can give them before you ride.

You can give them when you're standing at the show ring. And it's a way to buffer acid immediately and for short periods of time. And then the other benefit being that you do want them to have some acid in their stomach that they can properly digest food.

You're not looking to eliminate it, but just to buffer it during times when they might be more at risk for some discomfort. 

DR. MILLER: And then we tell people the reason that horses are more likely, they've shown that horses are more likely to get ulcers with stress with performance. And part of it is just the exercise.

But with horses, part of it is the acid spilling around back and forth. So if you're riding the horse on an empty stomach or partially empty stomach, there's nothing to buffer the acid. So that's exactly the perfect time to do it.

Like Liz said, feed the gummies right before you're going to ride or 15 minutes before. Buffer the acid before that acid is moving around in like a balloon. So the bottom part of the stomach can handle the acid.

The glandular part, like I explained before, it's not as sensitive or fragile. But when the acid starts filling up higher on that squamous part, that's when you start to get ulcers. Unless you have a bunch of hay, something that stomach's full.

But if it's not, it's better to have the buffer. Keep the acid level low, so the pH higher, then it's not going to be burning as much. Instead of drinking Coke on an empty stomach.

LIZ: Yeah, absolutely. Some people can't even drink coffee on an empty stomach.

HOST: Liz, can you talk about hindgut issues and how symbiotic fits into this part of the process?

DR. MILLER: So hindgut is one thing I wanted on my pet peeves that clients ask me.

90% of the time when I'm scoping, they'll say, well, does it have hindgut ulcers or foregut? And I think people, I think we should change the way we, the terminology. Because when a lot of people are saying hindgut, they're talking about the pylorus and the squamous, the bottom of the stomach. But then other people are talking about colon ulcers. The hindgut should be the colon, but a lot of people think of it as the pylorus.

So I like to say stomach or colon ulcers. Okay. 

LIZ: So hindgut is really colon for people who might be confused.

Interestingly, Ulceraser actually does benefit the colon because the forage nature of it helps encourage digestion in the foregut where it belongs rather than in the colon. Because if you have a lot of sugar and starch that goes undigested in the stomach, and then starts to break down in the colon, the release of volatile fatty acids can cause the beneficial bacteria to die off, which can cause the pH to plummet and is one of the potential causes of colon ulcers.

DR. MILLER: Yeah, I agree with that. And I think the omega-3 content of your product also helps the colon and the inflammation. Right.

LIZ: And the inflammation in the stomach as well as the colon. That's Ulceraser. Symbiotic is a probiotic that's designed to survive and bypass the stomach environment in order to make it into the colon to both help populate beneficial bacteria, but then to also serve as a food source for the beneficial bacteria in the colon.

Read more about the Ulceraser case studies referenced in the podcast: https://www.equineelixirs.com/newspost/ulceraser-case-studies.html