April 27, 2021 9 min read
Immubiome Ulcer Protocol
Although gastric ulcers in horses have been recognized for centuries, it was in 1999 that the term equine gastric ulcer syndrome (EGUS) was introduced to better characterize and describe lesions in the terminal esophagus, non glandular and glandular stomach, and proximal duodenum. EGUS is seen in all horse breeds and is prevalent worldwide, leading to decreased productivity and economic loss to the horse industry. EGUS is seen in foals and adult horses and the relative risk for ulceration mightincrease with age in geldings, whereas stallions seem to be at greater risk than mares and geldings. Factors that have been proposed to contribute to spontaneous development of EGUS are breakdown of mucosal defense, bacterial colonization, stress, and inflammation. Horses are continuous gastric HCl secretors, and acid exposure is thought to be the primary cause of EGUS. Prolonged exposure of the proximal stomach to a low pH environment is the likely cause of EGUS and is similar to gastro-esophageal reflux disease in humans. Several risk factors such as exercise intensity, intermittent vs. continuous feeding, stall confinement, transport stress, and high grain diets have been implicated in EGUS development.
Pain relief, healing, and prevention of secondary complications are the primary goals of anti-ulcer therapy and management recommendations in horses. The mainstay of pharmacologic treatment of EGUS is to increase stomach pH and suppress HCl acid secretion. Because of the high recurrence rate, many studies suggest that effective acid control achieved by using drug substances, such as proton pump inhibitors and antacids, should be followed by nutritional and dietary management strategies to prevent ulcer recurrence. Typical dietary management strategies include providing constant access to good quality feed to buffer gastric acidity, increasing fibre content in diet, keeping sweet feed to a minimum, and substituting grains such as oats and barley. Another complimentary approach could be to improve overall equine gut health by supporting the natural microbiota of the horse and improving immunity.
To support the dietary management of EGUS in your equine athlete, Immubiome recommends the use of two key supplements – Lean Muscle® and Gtract®. Both these products contain all-natural proprietary blends of beneficial components that have been shown to exert wellness benefits that cannot be readily attributed to classical nutrition.
The main ingredient in the Lean Muscle® supplement is bovine colostrum (BC). The G-tract® supplement also contains BC. It is the first milk produced by cows after calving and contains numerous beneficial substancesthat provide a strong nutritional base for the new-born animal. In general, BC contains less lactose and more fat, protein, peptides, non-protein nitrogen, vitamins and minerals, hormones, growth factors, cytokines and nucleotides than mature milk. Colostrumis the most potent natural immune booster known to science. It is loaded with polymorphonuclear leukocytes, macrophages, T-lymphocytes, B-lymphocytes, plasma cells, and epithelial cells which have demonstrated anti-microbial activity. Various immunoglobulins, other immune factors such as cytokines and chemokines, and antimicrobial proteins abound in BC.Helicobacter pylori infections can cause inflammation of the tissues lining the stomach and duodenum thus causing acute and chronic gastritis, duodenitis, and peptic ulcers. The immune-boosting function of BC can prove to be very beneficial for management of EGUS caused byH. pylori invasion.
BC is the only natural source of two major growth factors -transforming growth factors alpha and beta, and insulin-like growth factors 1 and 2. These growth factors, and others found in BC, have been shown to promote wound healing, promote repair and have multiple regenerative effects that extend to all structural body cells, including gastrointestinal cells. They play an important role in the repair and maintenance of integrity of the gastric epithelium. Specifically, platelet-derived growth factor, which is also secreted by macrophages present in BC, facilitates the healing of ulcers. Several studies and clinical trials carried out bothin vitro andin vivo, on humans and animals, suggest the clinical benefits of BC supplementation in gastro-intestinal diseases.
Leaky gut syndrome is the name given to a very common health disorder in which the intestinal lining is more permeable than normal. The abnormally large spaces present between the cells of the gut wall allow the entry of viruses, bacteria, fungi and other toxic material into the bloodstream. Colostrum is the best remedy known for all-around gut health. Colostrum restores leaky gut to normal permeability levels. It contains growth factors and hormones to help repair damage to the intestinal lining, including damage caused by NSAIDs and other medications, and restore gut integrity.
Prebiotics support the growth of natural microbial populations which could confer numerous benefits to the host. As BC contains relatively high levels of oligosaccharides, it can be a very good energy source and also function as a prebiotic to enhance beneficial bacterial growth in the equine gut.
The Lean muscle® formula also contains Reishi orGanoderma lucidum (mushroom mycelium, primordia, fruiting bodies and extracellular compounds) and fenugreek.Mushrooms are rich in carbohydrates, like chitin, and galactans, which make them the right choice for prebiotics. Polysaccharide peptides fromG. lucidum have been shown tomodulate gut microbiota to ameliorate microbial dysbiosis by acting as a prebiotic. G. lucidum also has specific anti-ulcer properties.
Fenugreek has been found to be a flavour preferred by horses. Fenugreek seeds are considered to possess mucilaginous, demulcent and nutritive properties, and have traditionally been used to soothe gastric ulcers and digestive upset, and during convalescence to improve eating and condition. It is a valuable digestive tonic, and helps the digestive system to make better use of the available food. In a field trial, Lucaet al. (2017) fed a herbal mixture, constituting fleawort, aloe vera, fenugreek, and licorice extracts, to the horses diagnosed with EGUS for a period of 30 days. They confirmed that the herbal mixture was effective in reducing both the number and severity of ulcerative lesions, presumably due to the beneficial effects of mucilages in protecting the mucosa from acidity apart from the anti-ulcerogenic activity of the herbs. The Gtract® supplement also contains fenugreek.
The Gtract® supplement contains a blend of the mushroomsTrametes versicolor andHericium erinaceus(mushroom mycelium, primordia, fruiting bodies and extracellular compounds). Mushrooms offer multiple benefits, including strengthening and balancing the immune system, supporting the respiratory system, calming the nervous system, increasing endurance, preventing or minimizing tumors, healing the digestive tract, and balancing the endocrine system. Turkey Tail (T. versicolor) is a mushroom which is commonly used in horse supplements. This warm and sweet mushroom builds immune function, strengthens the liver, and offers antibacterial and anti-inflammatory benefits to the digestive, urinary, and respiratory systems. Polysaccharopeptides from Turkey tail have been shown toact as a prebiotic to modulate intestinal microbiome composition.H. erinaceus (Lion’s mane) is a Chinese mushroom with nootropic properties. H. erinaceus renders changes in the composition and activity of the gastrointestinal tract microbiota that confer nutritional and health benefits to the host. Gastroprotective activity ofH. erinaceus has also been demonstrated.
The Gtract® formula also contains the yeast products,Saccharomyces cerevisiae,Saccharomyces boulardii,and yeast hydrolysate. Supplements containing mushrooms and yeast products (Saccharomyces species) are considered to confer anti-oxidative, anti-inflammatory and immune enhancing effects and improve the overall nutritional status of the horse. Gastroprotective effect ofS. boulardii in animal models of NSAID-induced gastric ulcer has been demonstrated. Yeast cultures (S. cerevisiae andS. boulardii) have been shown to provide various growth factors and pro-vitamins that help stimulate the growth of ruminal and cecal bacteria and may increase the lactic acid utilizing bacteria. A recent study showed that transportation can negatively impact the intestinal microbiota of horses triggering dysbiosis and thatSaccharomyces cerevisiae (SC) supplementation could reduce this detrimental impact of transportation by stabilizing the digestive ecosystem. Severity and duration of certain gastrointestinal tract disease is reduced in horses receivingS. boulardii. Antiulcer properties ofS. cerevisiae peptide extract have been demonstrated in animal models of gastric injury.
Hydrolyzed yeast extract is obtained by hydrolysing yeast cells with acid, enzymes or other means of hydrolysis. It is a concentrated source of vitamins, minerals and digested nucleic acids (nucleotides). There is increasing evidence that the supplementation of nucleotides in diets of monogastric animals may have beneficial effects on intestinal morphology and function, immune response, and composition of intestinal microbiota. Although the equine gastrointestinal tract is covered in mucus, the acids and enzymes nevertheless take a toll on the enterocytes (absorptive cells) lining the gut wall. Dietary nucleotides have been shown to increase the maturity and growth of normal enterocytes, which are intestinal absorptive cells responsible for nutrient uptake and pathogen defense. Nucleotides also have a beneficial effect on the intestinal microflora, stimulating the growth of beneficial bacteria and inhibiting pathogens. Thus adding nucleotides to a horse’s diet modulates immunologic mechanisms and stabilizes the digestive system.
Both the Lean Muscle® and Gtract® blends contain beneficial probiotics such asBifidobacterium bifidum,Bifidobacterium longum,Enterococcus faecium,Enterococcus thermophilus,Lactobacillus acidophilus,Lactobacillus bulgaricus,Lactobacillus casei andLactobacillus plantarum. Disruption of the normal equine gut microbiota and their environment can lead to increased incidence of gastrointestinal disorders including ulcers.Positive effects attributed to probiotics include regulation of intestinal permeability, normalization of host intestinal microflora, improvement in gut immune barrier function and equilibration of the balance between proinflammatory and anti-inflammatory cytokines. In a recent study in horses with spontaneously occurring gastric ulcers, a probiotic preparation containingLactobacillus sp facilitated healing of gastric ulcers. Once the squamous mucosa is ulcerated, resident stomach bacteria might colonize the ulcer bed and delay healing.Lactobacillus sp. were found to regulate microflora and protect the intact gastric mucosa from bacterial colonization by invasive species. A number of experimental and clinical studies support the following benefits of probiotics which play a role in effective management of gastric ulcers: i) Protection of gastric mucosal barrier; ii) upregulation of prostaglandins, mucus, growth factors and anti-inflammatory cytokines; iii) increased cell proliferation to apoptosis ratio; iv) induction of angiogenesis and v) inhibition of attachment and competitive exclusion ofH. pylori.
Based on the beneficial effects afforded by the various components of the two supplements - Lean Muscle® and Gtract® - Immubiome recommends the incorporation of the following regimen for management of EGUS: Feed the horse one scoop of Lean Muscle®, two times a day (AM and PM). After two weeks, change the PM feeding to Gtract®. A gradual increase in the feed of Gtract® is considered ideal. So, a feed of one-third scoop of Gtract® for the first week, followed by one-half scoop for the second week, should be followed by one full scoop for 12 weeks. The all-natural components in Lean Muscle® such as BC and fenugreek with their repair and healing constituents should be effective in laying the foundation for optimal growth and recovery of the intestinal epithelial cells that have been damaged due to EGUS. The restored gut lining along with the prebiotic and immunomodulatory properties of BC and mushrooms should now serve as an ideal environment for the proliferation and establishment of beneficial probiotics, yeast products and mushroom components as well as more BC that is being delivered by Gtract®. Overall, the combined repair, maintenance, protective, and regrowth properties of both these supplements should prove to be a powerful supportive therapy for relief from EGUS.
Particular attention must be paid to the diet of the equine athlete to prevent development and recurrence of gastric ulcers. Glyphosate is commonly used as a herbicide while growing hay for feeding horses and other animals. There are several reports of glyphosate exposurereducing the gut microbial diversity in animals. This can allow the growth of invasive species such asH. pylori which are a potential cause of gastric ulcers. Soaking hay for60 minutes in cool water prior to feeding is an important practice that can help remove glyphosate residue. This treatment should also get rid of other culprits that trigger EGUS, such as mold (mycotoxins), which can negatively affect the sensitive microbiome of a horse already suffering from EGUS.
Starch- and sugar-rich diets increase volatile fatty acids (VFA) production in the horse’s stomach and reduce mucosal lining integrity, leaving it susceptible to gastric acids.Soy, wheat, and molasses appear to be specific triggers. Therefore, the typical recommendation is that all grain, sweet feed, and molasses should be eliminated from the diet and replaced with high quality forages such as alfalfa hay or grass-alfalfa hay mix diets. In fact, researchers observed thathorses consuming an alfalfa hay and grain diet had fewer ulcers and lower gastric acidity than those eating bromegrass hay (a warm-season grass forage) without grain.
Reduced-grain diets should be fed to decrease the risks of ulcers. Larger grain meals (700 g/100 kg BW) resulted in slower gastric emptying compared with a smaller (300 g/ 100 kg BW) grain meal. Increased gastric retention time increases the fermentation by resident bacteria, resulting in higher VFA production and a greater potential for squamous injury. The intake of non-starch polysaccharides, and particularly grains, should therefore be restricted through the use of lower NSC (non-structural carbohydrate) complementary feeds. Based on previous studies, feeding less than 0.5 kg grain (so-called sweet feed)/ 100 kg BW (NSC = 40%) should keep the stomach VFA concentration of acetic acid below a potentially injurious threshold (20 mmol/L) and minimize the effect on squamous ulcers. Feeding less than 2 g NSC/kg BW/d or less than 1g NSC/kg BW/meal has also been recommended. This can be a challenge for trainers of high-intensity exercising horses, without an apparent (real or perceived) loss in performance. In such cases the multi-fold benefits of the soothing, restorative, protective properties of supplements such as Lean Muscle® and Gtract® become important.
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