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Laminitis in Horses — The Root Cause Nobody Is Treating

Laminitis is one of the most feared words in a horse owner's vocabulary.

And for good reason. At its most severe, it is crippling, life-altering, and heartbreaking to witness. But what most horse owners — and many professionals — are not told clearly enough is this:

Laminitis is almost never the primary problem. It is the endpoint of a chain of events that began much much earlier.

Understanding that chain — and interrupting it — is the difference between managing laminitis forever and preventing it from happening in the first place.

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What Is Actually Happening Inside the Hoof

The hoof wall is attached to the pedal bone by an intricate system of interlocking tissues called the laminae. The sensitive laminae are living tissue — rich in blood vessels, nerve endings, and specialised cells that maintain the integrity of the hoof structure.

When laminitis occurs, these tissues become inflamed. The inflammation disrupts blood flow. The cells that hold the structure together begin to fail. In severe or prolonged cases, the pedal bone loses its suspension and rotates downward — a process called rotation that is both excruciatingly painful and potentially permanent.

This is why laminitis is a crisis. But the inflammation that triggers it didn't start in the hoof.

It started much earlier. In the metabolism.

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The Metabolic Root: Insulin, EMS and the Real Driver

The majority of laminitis cases — estimates suggest 70–90% — are associated with what is called Endocrinopathic Laminitis: laminitis driven by abnormal insulin levels.

Here is the mechanism:

When a horse with insulin dysregulation — whether from EMS or from dietary-induced insulin spikes — has chronically or acutely elevated insulin, those insulin molecules interact with receptors in the lamellar tissue of the hoof. This interaction triggers a cascade of cellular events that disrupt the normal cell division and adhesion in the sensitive laminae.

The hoof is not being attacked from outside. It is being damaged from within — by the horse's own hormonal environment.

This is why the horse that develops laminitis after spring grass is not just "eating too much." The grass — high in non-structural carbohydrates — has triggered an insulin response that the horse's already-dysregulated system cannot manage. The result lands in the hooves.

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EMS — The Silent Precursor

Equine Metabolic Syndrome (EMS) is the condition that sits upstream of most endocrinopathic laminitis cases.

The EMS horse often has:

• Abnormal fat deposits — particularly the cresty neck, the fat pads behind the shoulder, around the tailhead, and above the eye

• Insulin dysregulation — cells that are less responsive to insulin, requiring more of it to achieve the same effect

• A metabolic environment that is chronically disrupted

• A dramatically elevated risk of laminitis — particularly when exposed to high-NSC forage or feed

EMS develops gradually, over months and years of dietary mismatch. The horse that was always "a good doer" — that gained weight easily, that needed restricted grazing, that seemed sensitive to spring grass — has very often been developing EMS quietly for years before a laminitis episode makes it visible.

The tragedy is that by the time the laminitis happens, the underlying condition has already been building for a long time.

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PPID — The Older Horse's Risk

Pituitary Pars Intermedia Dysfunction (PPID) — commonly called Cushing's disease — is the other major driver of endocrinopathic laminitis, particularly in horses over 15.

PPID involves dysfunction of the pituitary gland, leading to overproduction of certain hormones that interfere with insulin regulation and create many of the same metabolic conditions as EMS — including, critically, elevated laminitis risk.

The PPID horse is often recognised by the long, curly coat that doesn't shed properly, muscle wasting along the topline, increased drinking and urinating, and a generally aged and tired appearance. But PPID can be present in relatively early stages without these classic signs — and the laminitis risk is present from the early stages.

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What Does Prevention Actually Look Like?

Prevention of endocrinopathic laminitis is, fundamentally, management of the metabolic environment that drives it.

Forage management: The foundation. Constant access to fresh, high quality hay (and by hay I mean actual hay, no haylage/silage wrapped in plastic, as the fermatation process begins the moment it is sealed airtight without oxygen, and this is one of the causes of the aforemnetioned diseases.

Feed composition: Remove or minimise grain, molasses, and high-NSC processed feeds. Choose natural feed that the body's  cells can recognize at a cellular level, allowing nutients to be absorbed and efficiently utilized throughout the body.

Gut health support: A healthy hindgut microbiome supports more stable insulin responses and lower systemic inflammation. 

Cellular support: ASEA has shown remarkable results in supporting cellular signalling in horses with EMS and laminitis history — working at the level of cellular communication to help the body restore its own regulatory capacity.

Natural anti-inflammatory support: Targeted natural supplementation to reduce the systemic inflammatory load that both drives and accompanies the metabolic picture.

Movement — but appropriate movement: Gentle, consistent movement supports insulin sensitivity. But a horse with active laminitis should not be forced to exercise. Work with your vet on return to movement.

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The Horse That Has Already Had Laminitis

If your horse has already experienced laminitis — you know the fear that comes with every change of season, every unusually green day, every glance at the hooves.

I want to tell you: the recurrence is not inevitable.

What drives recurrence is the underlying metabolic condition being unresolved. When you address the EMS or insulin dysregulation at the root — when the metabolic environment changes — the risk profile changes with it.

I have worked with horses that had multiple laminitis episodes annually, whose owners had been told to simply manage and accept the pattern. When we addressed the root cause — when the metabolic and nutritional foundation was rebuilt — the pattern stopped.

Not because of luck. Because the conditions that were creating the pattern were removed.

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Ready to Address the Root?

→ The Overweight Horse Program — the complete metabolic root-cause protocol including EMS and laminitis prevention

→ The Ultimate Feeding Plan — the nutritional foundation that creates the metabolic environment where laminitis doesn't thrive

→ Homemade Horse Treats — nourishing, low-stress additions to your horse's day
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