Cushings vs. Equine Metabolic Syndrome, Presented by Kentucky Performance Products

Can you spot the difference between PPID and EMS? Here are some tell-tale signs of each. (Remember, always involve your veterinarian if you suspect an issue with your horse so that it can be treated properly!)

As spring ramps up and we start taking a closer look at our horses as they shed out — or don’t! — many of us start wondering if our horses have a metabolic or pituitary issue. Read on for more about the differences between PPID (commonly known as Cushings) and Equine metabolic syndrome (EMS).

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Equine metabolic syndrome (EMS):

Laminitis is often the ­first indicator of the syndrome.

  • EMS has become more prevalent in the equine community.
  • It’s often found in middle-aged horses (ages 8 to 18).
  • Not all obese horses have EMS, and not all EMS horses are obese.
  • Some EMS horses go on to develop PPID, but not all.

Pituitary pars intermedia dysfunction (PPID) aka Cushing’s disease:

Muscle loss, lethargy, infertility, and secondary infections are ­first indicators of the syndrome.

  • PPID is found in older horses.
  • PPID horses can also develop signs of EMS, but not all do.

Additional symptoms of pituitary pars intermedia dysfunction (PPID) aka Cushing’s disease

  • Abnormal sweating
  • Delayed shedding
  • Hypertrichosis (long, curly hair)
  • Increased drinking and urination
  • Infertility
  • Lethargy
  • Neurological de­ficits, including blindness
  • Recurrent infections
  • Skeletal muscle atrophy

Symptoms of both EMS and PPID

  • Obesity with abnormal fat deposits in the neck, tail head, and supra-orbit (pouch above the eye)
  • Laminitis, both acute and chronic
  • Insulin resistance (aka insulin dysregulation)

Dietary recommendations for overweight horses with EMS or PPID

  • Calorie intake should be adjusted to encourage weight loss and then maintenance of a healthy weight.
  • Limit sugar and starch (nonstructural carbohydrates) intake.
  • Restrict access to pasture grass.

Dietary recommendations for hard keepers and performance horses with PPID

  • Maintaining a healthy weight is critical.
  • Calories should be derived from high fat and fi­ber concentrates.
  • Limit sugar and starch intake. Feed alfalfa with caution, as excess protein can cause issues in some metabolically challenged horses.
  • Monitor weight closely and adjust calories accordingly.


InsulinWise supports normal metabolic function in horses and ponies of all ages. It supports healthy body weight and normal fat distribution and sustains healthy laminae within the hoof.

Available only through licensed veterinarians.

Download a printable version of this infographic here.

About Kentucky Performance Products, LLC:

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