In August 2023, a diet evaluation was requested for a 46 year old Welsh/Quarter Horse gelding weighing 700 lb (320 kg) in Ontario, Canada. Reported health concerns included acute weight lossfree fecal water syndrome, dentition issues, Cushing’s Disease and a history of laminitis.

Over the previous month, the gelding experienced significant weight loss, prompting the owner to seek dietary consultation from Mad Barn’s equine nutritionists.

Clinical Presentation

The gelding was assessed and found to have a body condition score of 3.5 out of 9 on the on the Henneke Scale and presented with the following clinical signs:

  • Acute weight loss
  • Presence of liquid fecal water
  • Age-related dentition issues
  • Poor coat health

Horse History

The gelding had been housed at the same stable for 20 years without prior chronic weight issues. His weight loss coincided with a change in herd dynamics upon the introduction of a new horse to the herd.

Within a month of this change, his body condition fell to an underweight score of 3.5 out of 9.

While the gelding received routine dental care, he exhibited loss of chewing capacity (dysmastication) due to age-related dental wear.

In addition to the clinical signs noted above, the horse had a history of several health issues:

1) Cushing’s Disease

Pituitary pars intermedia dysfunction (PPID), also known as Cushing’s disease, is characterized by dysfunction of the pituitary gland resulting in overproduction of adrenocorticotropic hormone (ACTH).

This hormonal imbalance is often associated with the development of insulin resistance, making these horses particularly sensitive to levels of hydrolyzable carbohydrates (sugar and starch) in their diet. [1]

In this case, the gelding exhibited many common symptoms of PPID such as poor coat condition and recurrent episodes of laminitis.

After the veterinarian diagnosed the horse with PPID, initial treatment involved Prascend® (pergolide). However, due to the gelding experiencing adverse side effects, the veterinarian opted to manage the condition without Prascend®.

2) Free Fecal Water Syndrome

Free fecal water syndrome (FFWS) is characterized by the presence of liquid fecal water that is released before, after or during the defecation. [2]

The gelding presented with FFWS that initially began one year prior to the nutrition consultation. However, no contributing factors were identified as coinciding with its onset.

3) Previous Laminitis Episodes

The gelding had previously experienced two episode of acute laminitis, a painful and potentially debilitating condition in horses where the sensitive laminae within the hoof become inflamed. Laminitis can result in lameness and structural damage to the foot.

Both episodes of laminitis occurred during cold winters, which suggests the gelding is sensitive to winter laminitis.

Initial Diet

At the time of the nutrition consultation, the horse’s daily ration consisted of:

  • Rationed Hay (unspecified amount)
  • Hoffman’s Mineral (according to the label directions)
  • 1 lb Flax Appeal
  • Salt (unspecified amount)
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As part of the consultation, an updated diet plan was formulated to address the specific concerns of the horse. The primary goals of dietary intervention were:

  • Promote Weight Gain: Increase caloric intake by incorporating nutrient-dense feeds while avoiding those high in hydrolyzable carbohydrates to mitigate the risk of metabolic disturbances and insulin resistance.
  • Support Digestive Health: Introduce forage in a suitable format for a senior horse with dental wear, ensuring optimal fiber intake to support gut health.
  • Optimize Nutrient Balance: Provide a diet enriched with essential vitamins and minerals to support the horse’s coat, hoof, and immune health.

To accommodate age-related dental wear, easily chewable forage sources were incorporated to provide increased fiber and calorie intake. Specifically, this consisted of soaking 5 to 7 pounds of timothy/alfalfa cubes, making them easier to consume while maintaining their nutritional value.

An oil supplement was added to further increase the calorie density of meals. Oils offer a source of cool energy, delivering essential fatty acids in a digestible format that is also free of starches and sugars.

Due to the horse’s pre-existing metabolic condition, grains high in hydrolyzable carbohydrates were largely avoided. However, a small amount of commercial grain was kept in the diet to support palatability.

Preserved forages such as long-stem hay and hay cubes are a good source of fiber and protein, but they do not fully meet a horse’s requirements for nutrients including copper, zinc and vitamin E. To balance the diet, Mad Barn’s Omneity Pellets were added as a concentrated source of vitamins and minerals.

Gut Health

To support hindugt health, forage fermentation, and reduce risk of FFWS, Mad Barn’s Optimum Digestive Health was added for digestive support.

In horses with dental issues, inadequate mastication (chewing) results in larger forage particles reaching the hindgut. This can impair fiber breakdown, reduce nutrient absorption and cause irritation in the digestive system. Consequently, these particles may pass through the gastrointestinal tract and appear in the horse’s fecal matter. [5] In the case of this gelding, dental issues also likely contributed to poor appetite and further exacerbated weight loss.

To address this, soaked timothy/alfalfa cubes were added to the diet as an easy-to-chew fiber source. Forage cubes are made of chopped hay and have a smaller particle size with increased surface area, which makes them more digestible and less abrasive in the hindgut. Increasing the intake of smaller forage particles helps support a healthy gut microbiome, which may have contributed to easing FFWS symptoms.

Feeding Mad Barn’s Optimum Digestive Health also helped to support the gelding’s hindgut function. Optimum Digestive Health provides a source of probiotics, yeast, prebiotics, digestive enzymes and immune nucleotides to maintain a healthy gut microbiome, improve feed efficiency and support nutrient absorption.

Optimum Digestive Health

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  • Prebiotics, probiotics & enzymes
  • Support hindgut development
  • Combats harmful toxins in feed
  • Complete GI tract coverage

Updated Diet

Following consultation, the horse’s updated diet consisted of:


  • Within five days of implementing the dietary changes, symptoms of free fecal water syndrome ceased
  • After a month on the updated diet, the horse experienced healthy weight gain and improved body condition
  • An improvement in the horse’s energy level, mood and coat quality were also observed following the dietary changes


A significant number of aging horses have PPID/Cushing’s disease, affecting between 15% and 30% of horses aged 15 years and older [3][4]. Given the advanced age of the horse in this case study, the presence of Cushing’s disease is not unusual.

Unplanned weight changes, such as the weight loss observed in this gelding, are common in horses with PPID. In this case, the weight loss likely resulted from multiple factors: metabolic changes caused by the disease, shifts in herd dynamics that led to stress and competition for resources, and reduced chewing capacity due to age-related dental issues.

Since the horse was underweight, increasing caloric intake was a priority for the updated feeding program. However, due to the horse’s metabolic issues, history of laminitis and on-going FFWS, it was important to minimize the use of commercial grains in the diet. Instead, calories were provided from forage sources and a fat supplement (W-3 Oil).

This decision was based on the following considerations: [2]

  • Increasing Fiber: Most commercial grains have lower neutral detergent fiber (NDF) and higher starch and sugar content compared to forages. A diet with low NDF and high starch and sugar is associated with a higher risk of hindgut health issues like FFWS.
  • Reducing HC: Horses with a history of metabolic conditions should be fed a diet containing less than 10% hydrolysable carbohydrates (HC), sometimes referred to as non-structural carbohydrates (NSC).
  • Feeding Processed Forages: We suspected that low forage intake due to dental wear and changing social dynamics were the main causes of weight loss for this horse. Forage intake was increased with easy-to-chew soaked forage cubes to effectively address this issues.

Weigh gain was also supported by adding a fat supplement to the diet in the form of Mad Barn’s W-3 Oil, a source of natural vitamin E as well as DHA – an omega-3 fatty acid. In addition to providing a concentrated source of calories, feeding w-3 Oil supports immune function, antioxidant defenses, and normal homeostatic regulation of inflammation.

Adding processed forages and fat to the diet led to noticeable weight gain and improved body condition within one month of introducing the updated feeding plan.

w-3 Oil

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  • Promotes joint comfort
  • Helps to fight inflammation
  • Skin & coat condition
  • Palatable source of Omega-3's

Balancing the Diet

While the primary focus was on increasing the gelding’s forage and caloric intake, it was equally essential to ensure that his diet remained well-balanced with adequate vitamins and minerals to support immune function and overall health.

Mad Barn’s Omneity Pellets were added to the diet to ensure the gelding’s vitamin and mineral requirements were met. Feeding Omneity also supports hoof health, skin and coat quality, energy metabolism and muscle health.

Omneity P – Pellets

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  • 100% organic trace minerals
  • Complete B-vitamin fortification
  • Optimal nutrition balance
  • Our best-selling equine vitamin

Overall, the dietary adjustments led to significant improvements: the gelding gained weight, developed a healthier, shinier coat, exhibited improved energy levels, and experienced resolution of free fecal water syndrome.

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