Laminitis; looking more like diabetes all the time
W/Dr Joseph Thomas, PhD
5-14-06
Lisa-Welcome back to another informational If Your Horse Could Talk show. I’m your host Lisa Ross-Williams and today I’ll be chatting with Dr Joseph Thomas about laminitis and how it’s starting to look more like diabetes. And how Chinese herbalism can play a major role in healing. Welcome Dr Thomas, thanks so much for being with us today.
Joseph-Thanks, Lisa. It’s always such a pleasure and I’m excited to bring this information-it’s very valuable for people to understand what’s going on with their horse. Laminitis is so terrifying.
Lisa-It’s so true and I know you are always researching and learning new things so every time we chat, you have even more information and pieces of the puzzle to this horrible condition. Before we jump into the nitty-gritty, why don’t you tell us a bit about your background and how you got involved with helping horses with laminitis.
Joseph-I think it’s important that people understand my background so I’d like to start there. I am presenting a model that is more western in nature but my treatment is always Chinese herbs. I was a MIT research scientist in the department of brain science and was doing medical research which should give people an idea why I can talk about research so fully. Ethics started entering my world and I realized that I was doing what I considered unethical behavior with the animals we were using. But all things lead to your destiny and I found my first teacher of Chinese medicine; for the next 20 plus years, I taught, consulted and practiced, specializing in internal medicine for the most serious of illnesses.
I have always loved horses. My wife, Crystal and I have five horses and two of them came down with laminitis. Although I had been practicing medicine on humans, I never thought of using it on horses but it was so frustrating because no one could help our babies. Here I am after 11 years, I’ve reached this point in Chinese medicine with horses. The research part of me never stops-I research quite literally every day. It’s so nice now to be in a profession where I’m helping these lovely creatures and helping I’m doing!
Lisa-I need to tell everybody how much you have helped our horses; a couple who had deeper issues that although I’m pretty good at dealing with some stuff, I knew I needed your knowledge and help with them. This included Rebel, my gray Arab who had some tumors as well as Riley with his metabolic disorder. By the way, he has lost about 100 pounds already and is like a new horse. He’s just six and way too young to have to deal with this. Thanks to me paying attention to the signs and you helping, he’s on his way. I can’t stress enough that when I’m in need of help I turn to Joseph.
So, would you like to start talking about laminitis or the metabolic issues that contribute to it?
Joseph-Crystal, the general manager and Editor in Chief of For Love of the Horse, is my interpreter to the world and she really stressed that I need to start in the beginning. I am presenting a model of laminitis and diabetes which is where my research has taken me.
Laminitis; what’s in a name?
Joseph-I realized that part of the problem of laminitis is the name—to have “itis” attached to anything means inflammation. So we have laminae inflamed. But language is so powerful that everyone starts thinking about laminitis in terms of the hoof so that’s where the focus normally is. Certainly for any of you out there who have a laminitic horse or have gone through that experience, all you can think about is the hoof. Because your horse is standing there in all that pain and can’t walk, the natural assumption is that the problem is in the hoof.
Lisa-I think part of that comes from the conventional veterinary approach that focuses just on the hoof. The good veterinarians may suggest a diet change but from my experience, corrective shoeing, anti-inflammatory and pain meds, stick them in a stall and don’t let them move. We know, of course, that’s wrong because as you’re saying, this is a whole body problem that happens to be most apparent in the hoof.
Joseph-It is and the horse’s end result of the disease is laminitis. Let me call into play the definition of diabetes, taken out of a clinical diagnosis. It’s a disease in which the glucose levels in the blood are elevated because of deficient insulin or abnormal insulin action.
Diabetes, not just a human condition
I want people to just understand that diabetes means high glucose in the blood; elevated levels and the Insulin Resistant model which I understand not everyone is familiar with. This metabolic model has been around for some time when describing laminitis and its sibling Cushings and is identified by high glucose levels in the blood. Now, if it’s in the blood that means it’s not getting into the cells. Glucose is a form of sugar whose job it is to give nurturing and sustaining life energy to all the cells in the body and this also means laminae cells. We now know through the work of Christopher Pollitt in Australia that if the lamina cells are deprived of glucose, you get separating, stretching and often coffin bone rotation under the weight of the horse. So here we are--We’ve got the beginning stage of the similarity between laminitis and diabetes.
Lisa-So is this like in human diabetes where the people must be very careful with their feet because I’m assuming it’s the same thing-glucose not getting to the feet and therefore are more prone to infection? Is this the same type of thing we deal with in horses?
Joseph-Well…..no. Along with glucose derivation another thing prominent in laminitis and diabetic blood profiles is a much weakened immune system. Particularly the lymphocytes which are part of a white blood cell that is most instrumental in fighting off infections. So here’s the part of the diabetic; wounds are very hard to heal. But the foot aspect in the diabetic is different; it’s more a neural response rather than laminae separating.
If you have excess glucose in the blood, which we do in diabetics and laminitic horses, it’s not getting into the cells. If it’s not getting into the cells, they themselves do not have the energy for life sustenance. So, they don’t have the ability to perform all their functions like laminae cells maintaining its binding quality. That’s the beginning…
Glucose is hanging around the blood because insulin which is secreted by the pancreas is not functioning properly; Insulin’s job is to push glucose into the cells. If I may, as this is coming out of my research that in the very early stages of laminitis and diabetes we find that insulin is incredibly high in a blood test which equals an excess concentration of it in the blood, but we have low glucose.
Here is the birth of laminitis and diabetes noted from this profile. Keep in mind this is before any horse owner or any veterinarian notices anything. You though, Lisa my dear, noticed something because that’s where Riley was when you contacted me. He had very high insulin and his glucose was perfectly normal. By definition, he is not laminitic, not diabetic and yet this is where it begins.
What we have in an Insulin Resistant model is we have high insulin-high glucose. As the disease progresses, you have all the insulin being secreted by the pancreas by a Beta cell, but glucose is low and remember, insulin pushes glucose into the cells. We have this inordinate amount of insulin hanging around in the blood and pushing glucose into cells and everything looks fine. Except what happens is the pancreas, the Beta cells, get overused and start dying off. As they die off, insulin starts becoming deficient.
Progressing along the continuum
What we’re seeing in this genetic disease, and I’ll repeat that, genetic disease is that the Beta cells start dying off and glucose starts to increase. We then see the classic definition of diabetes--high glucose and deficient insulin or abnormal insulin action. Now the disease is progressing to low insulin and high glucose.
We now have the conditions set-up for a laminitic episode. In the beginning stages where Riley was, high insulin and normal glucose, you don’t have to worry about him having an episode. What we do have to worry about is that he is a horse that is going to be a laminitic candidate. Nothing is going to stop that unless you have someone like me. This is a disease of metabolism.
Now the disease has progressed to here. We have all these conditions set-up; all the glucose in the blood, pancreas is getting tired and Beta cells are no longer able to secrete enough insulin to push the glucose into the cells. The wonderful thing about bodies is they are always trying to correct to a healing state but that doesn’t mean they are capable of doing that.
Moving into laminitis
Joseph-How do we come up with a lame horse with these conditions? We know if glucose is not pushed into the cells that the laminae cells no longer have the life energy to be able to withstand the weight of the horse, the give out and we get separation. Keep in mind, another definition of diabetes is that they have difficulty in metabolizing carbohydrates. But, a common example—A horse out in a lovely green pasture, eating all those carbohydrates and sugar.
Here’s the process that happens then—we know by definition this horse has a metabolic disease and can’t metabolize the fructans; the sugar content of carbohydrates. So it’s moved down the digestive system into the small intestine. The current understanding is that the small intestine does not have the appropriate bacteria to digest fructans so it gets moved along the digestive path to the rest of the intestinal system where it gets quickly fermented in the large intestine. In that quick fermentation process the lining of the intestine gets damaged, making the intestinal system acidic. By that acidic process, toxins are released. Since we have this amazing circulatory system which wants to feed the body everything that is processed, the toxins are now being moved through the body and quickly find its way to the hoof.
Now, this is controversial but I believe this notion--there is a vassal dilation which means the blood vessels open allowing the toxins freedom to move very quickly into the hoof. When the toxins reach the hoof, a floodgate of an enzyme called MMP is released and along with the deprivation of glucose, separates the laminae. The important thing is the fermenting process that people need to understand.
The process of the separation happens because of the metabolic issue. In this metabolic issue, they can’t metabolize the carbohydrates in grass, grains, etc. The quick fermenting and acid environment damages the lining and then we have an episode. It’s the acidic environment that does it.
The liver’s role
Now as the disease progresses, we have high glucose, low insulin and no one ever talks about the liver which has important value. The most reliable test of liver function is bilirubin. What I consistently find is that the total bilirubin is low and the direct bilirubin is high which means there is interference in bile secretion from the liver. One of bile’s most important functions is to keep the small intestine alkaline, not acidic. Interestingly, horsed don’t have a gall bladder which deals with bile and because there isn’t a gall bladder, the liver bile ducts connect right into the small intestine. This is an evolutionary genius of the horse because the environment must be alkaline. One of the things that nature has done is made horses foragers who eat all the time. To do that they have a stomach filled with hydrochloric acid and they must eat all the time to absorb it.
Blood work shows interference. With this process, laminitic horses have a problem with bile secretion and bile’s most important job is to keep the intestine alkaline, not acidic. But because there is this problem with bile secretion, laminitic horses already have an acidic intestinal track. This is a new piece of information on the metabolic syndrome. They already have an acidic environment in their intestines so that when they eat grass or carbohydrates, the amount of damage and potency of a trigger is dependent on his bilirubin level. This is a diabetic process. Not every laminitic horse has the same number of low to high because each horse is somewhere along the continuum. That’s why some horses who are laminitic can eat a little grass and not have an episode while others can’t.
People need to understand this is a disease and that it has very quantifiable ways to look at it so we can understand. Diet is very important because we want to keep the carbohydrates, grasses, and sugars down because they are already living in an environment that is set to move into an episode.
Easy keepers; it’s genetics
Lisa-So lets cover “easy keepers” and please stress this is a genetic condition. For Riley, we were so very careful with him; he was just a couple weeks old, an orphan who had a great diet from the get go. Because he is a pony breed, I had an idea he might be prone to an insulin resistance issue. But even this great care was not enough because of the genetics—a great diet can’t change genes.
Joseph-That’s why I want people to understand this is diabetes. Let’s break diabetes into two types—one is the Type 1 where you have to have insulin and this comes on very early in life. The model that is identical to laminitic horses is Type 2 which comes on later in life because of the process I talked about. A person is born with a gene, called a thrifty gene; a laminitic horse is born with that predisposition just as Type 2 diabetic is born with a predisposition.