Why Bute Doesn’t Work with Endocrine-Related Laminitis

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Laminitis caused by high insulin is different from other types

Laminitis caused by high insulin is different from other types of laminitis. Both you and your veterinarian are anxious to relieve your horse’s pain when there is laminitis. The first thing reached for is usually phenylbutazone or another NSAID drug like Banamine or Equioxx. Unfortunately, they often have little effect.

Types of Laminitis

There are many different types of lamintis, including:

  • Mechanical: A horse is overloading one leg because another is injured, stretched laminae and dropped coffin bone from a long toe and/or shoes.
  • Inflammatory: Grain overload, experimental fructan overload, retained placenta, Strangles, colic, Salmonella, Lyme, Potomac Horse Fever.
  • Endocrinopathic – EMS or PPID.


Anti-inflammatory drugs like the NSAIDs (nonsteroidal anti-inflammatory drugs) are most effective with the inflammatory types of laminitis which involve destruction of the basement membrane of the laminae, which does not occur in endocrinopathic laminitis.

The FDA-approved instructions on the product inserts for these drugs clearly limits their use to 5 to 14 days only (depending on the drug). This is because of the significant risk of damage to the stomach, colon, or kidneys with long-term use. Despite these mandated precautions, many horses end up in a cycle of long-term pain and NSAID use because the real cause of their pain is not being addressed.


Research has clearly shown that approximately 90% of laminitis cases are endocrinopathic.

Endocrinopathic refers to a problem with the endocrine system, the hormones. In this case it is insulin in horses with Equine Metabolic Syndrome – EMS or PPID – Pituitary Pars Intermedia Dysfunction. High insulin levels cause the laminitis.

NSAIDs do nothing to lower insulin. The white blood cell invasion and basement membrane destruction does not happen with this type of laminitis. The NSAIDs are reasonable for a few days because any damaged or destroyed tissue will trigger an inflammatory reaction, but the real focus needs to be on insulin and the effects of insulin.

What Works

Insulin is lowered by a low-sugar and -starch diet. Feed only grass hay soaked for 30 minutes until a hay analysis can be done. No grain, including those called “safe”, and soaked beet pulp only as a carrier for supplements. For more details see the files at https://ecir.groups.io/g/main. Those that fail to respond can be started on metformin. It’s also important to do a physiologically correct realigning trim as soon as possible.

Finally, the only clearly documented effect of high insulin is to increase levels of endothelin-1, which causes blood vessels to spasm. The Chinese herb Jiaogulan can counteract this by increasing activity of the eNOS, endothelial nitric oxide synthase, an enzyme which produces nitric oxide inside blood vessels to dilate them. Arginine supports this production.

Endocrinopathic laminitis is different but if you approach it with the goal of controlling the cause – insulin – results are good. For more information see www.ecirhorse.org

RELATED: Fat Horses – A talk about Equine Metabolic Syndrome and Laminitis

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3 thoughts on “Why Bute Doesn’t Work with Endocrine-Related Laminitis”

  1. My horse has a lot of inflammation where the hairline meets the hoof. Would a blood test show whether or not this is coming from high insulin or something else? She has good body condition; is about 12 years old and this problem is only on one foot, but causing extreme discomfort. She has been pulled off of three fields and is only fed Timothy Hay (soaked) and Timothy pellets as well as a forage called safe starch.

  2. Thanks for this article! I didn’t realize about this type of laminitis. I have had several horses with laminitis and one may have had high insulin levels. Glad to learn this.


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