Beyond the Magic Bullet

If your horse has suffered from gastric ulcers, you have probably wished for a fast, simple, affordable fix. While there is no magic diet or supplement, we know that dietary changes play a role in reducing risk. A combination of thoughtful feeding, careful management, and veterinary support has been proven to decrease the occurrence of gastric ulcers.

Forage First

Many nutritional experts agree on, and research supports, the importance of forage-first diets. Any forage that requires chewing can be beneficial since saliva naturally buffers stomach acid. As little as one pound of forage can help buffer stomach acid but ideally provide at least 1.5-2% of your horse’s body weight in pasture or hay each day (Nutrient Requirements of Horses, 2007).

The longer the stem, the more chewing is required and the more saliva produced. Alfalfa, which is high in calcium, is a particularly good buffer.

Break the Fast

Since feed helps buffer stomach acid, it is important to avoid long fasting periods. The equine stomach empties approximately every six hours. Ideally, fresh forage should be available at least that often.

Slow feed hay nets, hay balls, and other receptacles can increase a horse’s time foraging and chewing (Hart et al., 2024). However, hay nets and other devices can cause frustration, and even pain in horses with back or neck issues, which can increase the risk of gastric ulcers. The type of hay net, height from the ground, and other factors may need to be adjusted based on individual horses’ preferences (Hodgson et al., 2022; Ellis et al., 2015).

Consider feeding your horse a small hay meal before each ride. Acid can splash up into the squamous area of the stomach during exercise and a layer of feed helps prevent this.

Similarly, avoid trailering horses on an empty stomach, and provide hay during transport.

Grain, Starch, and Sugar

Non-structural carbohydrates (NSCs), simple sugars and starches, are easily digested and absorbed by the small intestine, providing readily available sources of energy from forage and feed. It is important to consider NSC levels in the diet along with factors such as age and performance requirements, to properly support equine health.

Beneficial bacteria that naturally colonize equine stomachs and play important roles in digestion also ferment NSCs. This creates volatile fatty acids that can increase acidity and irritate the stomach lining. To reduce risk, avoid feeding higher starch feeds to horses prone to gastric ulcers.

Current recommendations suggest limiting starch and sugar intake to less than 2 grams per kilogram of body weight per day (Luthersson et al. 2009).

While high-starch diets are a known risk factor for squamous ulcers, low starch diets appear to have a limited effect on prevention (Vokes et al. 2023).

Feed smaller grain/concentrate meals three to four times throughout the day to avoid increased stomach acidity following a large grain meal. Grain does not require as much chewing, so not much saliva is produced to buffer stomach acid.

Supplements

The equine supplement industry is booming, but not every product delivers on its advertised promises. Note that products can only make general “structure-function” claims, such as “supports gastric health”. They cannot legally claim to treat or cure gastric ulcers without FDA approval. 

Scientific evidence for supplement claims is often limited, and studies frequently yield mixed or inconclusive results due, in part, to inconsistent research methods, small sample sizes, and confounding management variables such as feeding schedules and environmental stressors. 

Studies have examined a wide range of ingredients, individually and in combination with mixed results. Certain ingredients may support gastric health in some horses when used in combination with proper management:

• Neutralize/buffer acid - Calcium carbonate (Andrews et al. 2017), magnesium hydroxide (Clark et al. 1996), licorice root extract (Ahmadnejad et al. 2022) and other ingredients may provide some relief by reducing acidity in the stomach for a few hours. These are best used before a ride, when trailering, and at competitions.
• Coat the stomach - Slippery elm and marshmallow root (Reed et al. 2020) may line the stomach and form a protective physical barrier against acid.
• Support healing - Pectin-lecithin complexes (Ferrucci et al. 2003), beta glucans, collagen, L-glutamine, and zinc methionine (Sharir et al. 2010) may help initiate immune responses to facilitate healing of the stomach lining.
• Support overall gut health – Omega-3 fatty acids (flaxseed oil, fish oil, etc.) may have roles in regulating inflammation. One cup of corn or canola oil daily can be an effective part of routine management and prevention of gastric ulcers.

Further research is needed to determine the effectiveness of these ingredients. Always consult your veterinarian before adding supplements to your horse’s diet to address gastric ulcer concerns. Nutritional interventions, including the use of supplements, are not a substitute for FDA-approved treatment.

Proper feeding and management are the most reliable tools to battle equine gastric ulcers. Certain supplements may play a supporting role, but there is no magic bullet. Prioritize providing adequate forage, avoiding long fasting periods, and working closely with your veterinarian to build a tailored ulcer management plan that addresses your horse’s individual needs.

References

Ahmandnejad M, Jalilzadeh-Amin G, Sykes BW. Prophylactic effects of Glycyrrhiza glabra root extract on phenylbutazone-induced Equine Glandular Gastric Disease (EGGD). J Eq Vet Sci 2022;118:104088.

Andrews FM, Larson C, Harris P. Nutritional management of gastric ulceration. Equine Vet Ed 2017;29(1):45-55.

Clark CK, Merritt AM, Burrow JA, Steible CK. Effect of aluminum hydroxide/magnesium hydroxide antacid and bismuth subsalicylate on gastric pH in horses. J Am Vet Med Assoc 1996;208(10):1687-91.

Committee on Nutrient Requirements of Horses, Board on Agriculture and Natural Resources, Division on Earth and Life Studies, National Research Council of the National Academies. Nutrient Requirements of Horses. Washington, D.C.: National Academies Press, 2007.

Hart R, Bailey A, Farmer J, Duberstein. Chewing analysis of horses consuming bermudagrass hay in different styles of slow feeders as compared to loose hay. J Eq Vet Sci 2024;140:105133.

Hodgson S, Bennett-Skinner P, Lancaster B, Upton S, Harris P, Ellis AD. Posture and Pull Pressure by Horses When Eating Hay or Haylage from a Hay Net Hung at Various Positions. Animals 2022;12:2999.

Ellis AD, Redgate S, Zinchenko S, Owen H, Barfoot C, Harris P. The effect of presenting forage in multi-layered haynets and at multiple sites on night time budgets of stabled horses. Applied Animal Behavior Science 2015;171:108-116.

Ferrucci F, Zucca E, Croci C, Di Fabio V, Ferro E. Treatment of gastric ulceration in 10 standardbred racehorses with a pectin-lecithin complex. Vet Rec 2003;152(22):679–681.

Luthersson N, Nielsen KH, Harris P, Parkin TDH. Risk factors associated with equine gastric ulceration syndrome (EGUS) in 201 horses in Denmark. Equine Vet J 2009;41:625–630.

Reed L, MacNicol JL, Charchoglyan A, Brewer D, Murrant C, Pearson W. A Botanical-Based Equine Nutraceutical Reduces Gastric Smooth Muscle Contractile Force In Vitro. J Eq Vet Sci 2020;84:102836.

Sharir, H., Zinger, A., Nevo, A., Sekler, I. and Hershfinkel, M. Zinc released from injured cells is acting via the Zn2+ sensing receptor, ZnR, to trigger signaling leading to epithelial repair. J Biol Chem 2010;285:26097-26105.

Vokes J, Lovett A, Sykes B. Equine Gastric Ulcer Syndrome: An Update on Current Knowledge. Animals (Basel) 2023;13(7):1261.