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How to Safely Refeed the Malnourished Horse
'It's insane to have won all those things'

Horse owners are familiar with the tragic pictures shared on social media of the emaciated horse rescued by the authorities, or the one that could not be saved due to its poor condition. Malnourished horses are a reality even in our affluent Western world. Sometimes these horses are the result of well-intentioned people trying to “save” unwanted horses, only to find they are unable to do so because of cost or scarcity of feed. Sometimes the malnutrition is the result of poor teeth, advanced age, parasites, or any disease condition that affects the horse’s ability to eat or metabolize feed effectively. Can a Severely Malnourished Horse Recover?

Henneke Body Condition Scoring Chart The prognosis for the malnourished horse varies with the severity of the body weight loss and the length of time the horse has been subjected to insufficient nutrient intake. Starved horses quickly run out of body fat reserves to mobilize, and then they begin to use muscle mass for energy. This can include skeletal muscle as well as protein from the breakdown of essential organs such as the heart, liver, and kidneys. When starvation goes on for too long, the damage to muscles and body organs can become catastrophic. Horses that are allowed to lose weight sufficient to drop them down to a body condition score of two or less on the Henneke scale of 9 are far less likely to ever return to health. In addition to acute body condition loss, starvation in the horse causes a multitude of symptoms including weakness, heart arrhythmia, and electrolyte irregularities. Starvation will exacerbate existing conditions such as arthritis or joint issues, and will reduce immune function. Horses that are thin but also plagued with parasites, such as ticks or lice, will have a more difficult time regaining health once on a suitable feeding regime. Horses that are senior or suffering from debilitating health conditions, such as lameness or poor teeth, can be even more difficult to refeed to health. Bringing a Malnourished Horse Back to Health The most effective way to refeed a malnourished horse is to first establish a plan that includes your veterinarian. Horses that have been subjected to prolonged nutrient deprivations could have potential physical damage to body tissues and your veterinarian will need to assess the animal before a refeeding program is initiated. An assessment of current body weight and desired body weight is necessary, as is an estimation of current body condition. A weight scale for this kind of workup is the best, but a weight tape can also be used. Equine weight tapes are available at most stores that supply equine feed. When weight taping an emaciated horse, don’t be surprised if the tape suggests that the horse is heavier than expected. Weight tapes are best used for horses that are in “average” body condition and are not always accurate for the emaciated horse. Despite that, the use of one as part of your initial plan can be helpful in giving you a “baseline” weight measurement to use going forward. Pictures taken at the initiation of the refeeding program and at regular intervals during the course of treatment can be invaluable when assessing the progress of the horse.

Do not undertake deworming or dental work on the horse at this point. Ask your veterinarian when it is safe to subject the horse to these kinds of stresses. Your goal must be to determine how badly the horse has been affected by starvation and how best to reintroduce food. As always with any horse, healthy or not, small meals fed often is the maxim for good horse health, and is of critical importance in refeeding the malnourished horse. Often starved horses are dehydrated and will need prompt attention to water intake. If the horse is clearly dehydrated but will not readily drink adequate water, discuss options for rehydration with your veterinarian. What is Refeeding Syndrome? Refeeding syndrome is the term used to describe a metabolic condition affecting horses that are reintroduced to high-nutrient feeds too quickly after enduring starvation for extended periods of time. Starved horses that have lost in excess of 50 percent of their normal body weight are in acute danger of suffering from refeeding syndrome if they are not re-introduced to feed very slowly and carefully. Offering a starving horse unlimited quantities of high quality feed is tempting but not advisable. When a starving horse is offered large amounts of feed, the digestible carbohydrates are readily broken down to glucose in the stomach and small intestine. When absorbed into the blood stream, glucose initiates a cascade of metabolic responses that the starved horse is unable to adequately regulate. The outcome is frequently a severe disturbance in the electrolyte balance of the horse, resulting in loss of muscle function and strength, erratic heart rate, shock, and frequently, death. Starved horses can also have disrupted populations of hind gut microbial populations. Introducing large amounts of readily fermentable carbohydrates into this compromised environment can also have catastrophic health effects for the starved horse. What Should the Horse be Fed? The safest and most effective way to initiate the safe refeeding of the malnourished horse is to offer it multiple small feeds per day of a good quality alfalfa or grass-alfalfa mix hay. Alfalfa hay delivers a safe source of protein and hind gut-friendly fibre for energy. The goal should be to offer meals of about one to one-and-a-half pounds of hay at intervals of three to four hours for the first few days. Avoid concentrates like grain initially. Starved horses often have compromised endocrine function and so may not cope well with the blood glucose and insulin swings generated by starch and sugar. Don’t worry about including mineral supplements until after at least the first ten days of refeeding the horse. A salt block can be offered free choice along with free-choice water. It is advisable to offer water in a bucket rather than automatic waterers initially to allow intake to be monitored.

If starvation continues for too long, the damage to muscles and essential organs will be catastrophic. Photo: Flickr When the horse is progressing satisfactorily on this regime for three to five days, then it is safe to increase meal size and reduce the number of meals being fed. Horses that successfully make it to ten days on a feeding regime like this are at much less risk of developing refeeding syndrome. After ten days, it is safe to introduce small amounts of low non-structural carbohydrate (NSC) complete feeds, again keeping the meal sizes very small. Any manufactured feeds introduced should complement the hay intake of the horse, not replace it. Most horses who have been in a refeeding program for at least ten days can safely eat about one-half a pound of commercial complete feed, fed twice a day. This can be increased gradually as needed. Once you get the horse past the risk of refeeding syndrome, it may be advisable to consult with your veterinarian or an equine nutritionist about a more targeted plan for safe weight gain. If the malnourished horse is destined for performance or breeding, you may want to have a better estimation as to how long the progression back to healthy body weight might take, and the nutritional plan needed to achieve it. Should the Horse Have Pasture? The safe use of pasture for the malnourished horse will depend on the condition of the horse to begin with. Horses that are severely malnourished should be kept on stall rest with a feeding program of hay as already described. Horses who are not as severely malnourished can be allowed short periods of grazing under good weather conditions after they have demonstrated that they can handle walking around and foraging for themselves.

If this emaciated horse survives initial refeeding, it may take up to a year before he returns to a healthy body weight. Photo: iStock/Arghman Pasture can vary widely in quality and so be cautious in expecting a horse recovering from starvation to fend for himself in a pasture situation. Grazing should allow the horse to consume sufficient digestible energy from forage to assist in body weight gain. If he has to walk for three hours in order to find a small amount of grass, you will have done him no favour by pasturing. The malnourished horse should not be put out in a group situation until he is strong enough to fend for himself against other possibly more aggressive horses. Limit grazing for the malnourished horse to two or three hours at the most initially, and as with any horse, be very careful of grazing when spring pastures are at their most productive.