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Laminitis VS Ulcers: Which is worse?

Imbedded in many modern management strategies is the assumption that we are trying to prevent two horrible diseases; ulcers and laminitis. We incorporate slow feed devices like hay nets and grazing muzzles, monitor body condition, do routine bloodwork, and feed low carb diets to prevent obesity and related metabolic disease which predisposes our horses to laminitis. We feed forage based diets, maximize turnout with herd mates, mix potions of supplements, and incorporate slow feed devices to increase time chewing and prevent gastric ulcers. But if we had to prioritize the prevention of one disease over the other, is there a right and wrong answer? I think that there is!


The pendulum of online horse feeding chatter has swung too far and it’s time to head on back to centerline! The centerline that I’m referring to is a theoretical position between gastric ulcers and laminitis. More specifically, the intersection is nutritional and it lies between these two terribly scary diseases. A delicate balance exists between increasing time chewing, salivating and buffering the digestive tract to prevent ulcers AND preventing your horse from being overweight which is like haltering them and leading to the cliff face that is laminitis!

This is a VERY frequent conversation in my day to day consultations. Everyone wants to prevent gastric ulcers and for good reason. Now that most equine veterinarians have an endoscope, we’re realizing that ulcers are everywhere (even the horses that rarely leave the property). They are horrifying to see, expensive to treat, and really miserable for your horse. However, the same three things can be said for laminitis, and I would argue that a severe case of laminitis is far worse than a severe case of gastric ulcers. The difficulty in formulating a diet that prevents both is that many of the strategies for ulcer prevention are counterproductive to laminitis and vice versa. Herein lies the nutritional nightmare.

In the past month, I’ve had half a dozen conversations go like this…

Me: Why are you feeding your obese horse free-choice hay? 

Owner: Because I want to prevent ulcers!

Me: You’re feeding 2.3% of it’s body weight every day in good quality forage which is far exceeding its daily caloric requirement by 150%. 

Owner: But I must prevent gastric ulcers, hind gut ulcers, and leaky gut syndrome!

Me: But you’re allowing your horse to be obese which predisposes him to laminitis. 

Owner: But don’t I need to prevent ulcers?

Me: Don’t you want to prevent laminitis more? 

The question inside this conversation is “what is worse; ulcers or laminitis”? I have a very strongly felt opinion on this matter! For me, it’s always laminitis!!! Now, I checked my bias at the door and realized that my business is skewed towards laminitis cases due to my background on low-carb forages. I frequently have long, painful discussions with horse owners that are devastated by this disease, and sometimes the nutritional changes that we make are not enough to the save the horse.

Here’s my argument.

  1. Horses get put down every day for severe cases of laminitis. 

  2. Gastric ulcers can sometimes cause severe colic that leads to death, but this is very rare.

  3. Horses can replace the lining of their stomach. Gastric ulcers are therefore reversible.

  4. Horses can not replace the laminae of their hoof. Laminitis is never reversible. 

The moral of my story = stop using ulcer prevention as an excuse for keeping overweight horses!

In order to understand my argument, you have to picture the demographic that I'm referencing. It is always an easy keeping breed with a high body condition score and increased risk of laminitis. The owner shows their love by providing the horse with loads of green yummy forage, supplements, blankets, and low stress environment. This is a recipe for disaster and why laminitis rates have never been higher. Even the American Association of Equine Practitioners suggests that we are "killing our horses with kindness" by overfeeding. *There is rarely a skinny performance horse eating >2% of its body weight that also has a high risk for laminitis. In this case, there is no problem, because the management and nutritional solutions do not conflict. The problem is when the risk for gastric ulcers is equal to the risk of laminitis. I argue quite emphatically that it’s OK to limit your horse’s total daily intake when there is risk of both. If fact, you absolutely SHOULD limit intake greatly and save your horse from such extreme pain and early death. I'm not being dramatic here!

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