Train, Race, Recover and Repeat – How targeted nutrition can support the recovery process to optimise performance

Article by Dr Andy Richardson BVSc CertAVP(ESM) MRCVS

Introduction

Horses evolved as herd-living herbivores with a digestive tract designed to cope with a near continuous dietary input of forage in the form of a wide range of plant species. A large hindgut acts as a fermentation vessel where gut microbiota (predominantly a mix of bacteria, protozoa and fungi) exist in harmony with the horse in order to digest the fibre rich plant material.

Fibre is important to the horse for several reasons. The digestion of fibre releases energy and other key nutrients to the horse. Fibre also acts to provide bulk in the digestive tract, thus helping maintain the passage of faecal material through the system. Fibre also acts like a sponge to absorb water in the gut for release when required.

As horses became domesticated and used for work or sporting purposes, more energy-dense feeds in the form of cereal grains were introduced to their diet, as simple forage did not provide for all the caloric requirements. Cereal grains are rich in starch, which is an energy-dense form of nutrition. However, too much starch can cause problems to a digestive tract that remains designed for a pasture-based diet. The issues that can be caused by the trend away from a solely pasture-based diet can be digestive, behavioural or clinical.

Nonetheless, the combination of forage and cereal-based concentrates remains the mainstay approach for the majority of horses in training today, in order to maximise performance. A great deal of research and expertise are utilised by the major feed companies to ensure that modern racehorse concentrate feeds provide adequate provision of the major nutrients required and minimise unwanted effects of starch in the diet.

This article aims to discuss some scenarios where targeted or supplemented nutrition can act to help overcome some of the nutritional challenges faced by the modern horse in training, as they “Train, Race, Recover and Repeat.”

Equine Gastric Ulceration Syndrome (EGUS)

EGUS occurrence in racehorses is well documented, with prevalence shown to be over 80% in horses in training (Vatistas 1999). With a volume of approximately 2–4 gallons (7.53–15 litres), the stomach in horses is relatively small compared to their overall size due to its functional role in accommodating trickle feeding that occurs during their natural grazing behaviour. 

As a horse chews, it produces saliva, which is a natural buffer for stomach acid. When the horse goes for a period of time without chewing, the production of saliva ceases, and stomach acid is not as effectively neutralised. The lower half of the stomach is better protected from acid due to its more resistant glandular surface. The upper, or squamous, region does not have such good protection, however, and this can be a problem during exercise when acid will physically splash upwards, potentially leading to gastric ulceration.

In practice, this can presentrepresent a challenge for horses in training. Typically, they will be fed a concentrate-based feed in the early morning that stimulates a large influx of acid in order to help digest the starch. This may be followed by a period without ad-lib access to hay, thus reducing the amount of saliva subsequently produced to act as a buffer. When the horse is subsequently worked, there is a risk of acid damaging the upper squamous region of the stomach. There is some evidence to suggest that the provision of hay in advance of exercise may act like a sponge for the acid, as well as helping form a fibrous matt to minimise upward splash.

Gastric ulceration can go undetected in horses in training and may not lead to any obvious clinical signs. In other horses, it can lead to colic, poor appetite, dull coat and behavioural changes. In both scenarios, it is likely that the ulceration will have an impact on their performance, with decreased stride length, reduced stamina and inability to relax at speed all being possible consequences (Nieto 2009). Gastric ulceration can therefore have a significant impact on the ability of a horse to perform optimally day in day out in a training environment. This is exacerbated when ulceration leads to a reduction in appetite, with the obvious downside of a reduction in calorie intake leading to condition loss and further drop in performance.

This is an area where targeted nutrition has been clinically proven to play an important role. Ingredients such as pectin, lecithin, magnesium hydroxide, live yeast, calcium carbonate, zinc and liquorice have all been studied as having beneficial effects on gastric ulceration (Berger 2002, Loftin 2012, Sykes 2013). It is likely that a combination of the active ingredients will be most efficacious, with benefits noted when the supplement is added to the feed ration to help neutralise acid and form a gel-like protective coating on the stomach surface.

The daily administration of a targeted gastric supplement can be an important part of daily nutrition of the horse in training, alongside the use of pharmaceuticals such as omeprazole or esomeprazole when required.

Sweat loss

Horses have one of the highest rates of sweat loss of any animal, with sweat being comprised of both water and electrolyte ions such as sodium, potassium, chloride, magnesium and calcium. Therefore, it is not surprising that horses in training are at risk of unwanted issues should sweat loss not be replaced.

It is also worth noting that transportation can also lead to excessive sweat loss, with studies showing sweat rates of 5 litres per hour of travel on a warm day (van den berg 1998).

If the electrolytes lost in sweat are not adequately replaced, a drop in performance can result, as well as clinical issues such as thumps, dehydration and colic.

Electrolytes play key roles in the contraction of muscle fibres and transmission of nerve impulses. Horses without adequate electrolyte levels are at risk of early onset fatigue that may result in reduced stamina. It is also worth noting that horses that train on furosemide will have higher levels of key electrolyte losses, so will require targeted support to help maintain performance levels (Pagan 2014).

There is also evidence to suggest that pre-loading of electrolytes may be beneficial (Waller 2022). For horses in daily work, the addition of electrolytes to the evening feed will not only replace losses but also help optimise levels for the following day’s travel or race. The benefit of providing electrolytes with feed is that it will minimise the risk of the electrolyte salts irritating the stomach lining, which can occur if given immediately after exercise on an empty stomach. Feeding electrolytes when the horse is relaxed back in the stable will also allow them to drink freely, with the added benefit that electrolytes will stimulate the thirst reflex when they are relaxed, ensuring they are adequately hydrated for the following day.

Products should be chosen on the basis of adequate key electrolyte provision as not all products will provide meaningful levels of all the key electrolyte ions.

Muscle soreness

The process of muscle breakdown and repair is a normal adaptive response to training. This process can lead to inflammation and soreness or stiffness after exercise. In humans, there is a well-recognised condition called Delayed Onset Muscle Soreness (DOMS).

Further research is required to fully understand the impact of DOMS in horses. DOMS is the muscular pain that develops 24–72 hours after a period of intense exercise. There is no pain felt by the muscles at the time of exercise, in contrast to a ‘torn muscle’ or ‘tying-up’ for example.

In humans, DOMS is thought to be the result of tiny microscopic fractures in muscle cells. This happens when doing an activity that the muscles are not used to doing or have done it in a more strenuous way than they are used to.

The muscles quickly adapt to being able to handle new activities, thus avoiding further damage in the future; this is known as the “repeated-bout effect”. When this happens, the micro-fractures will not typically develop unless the activity has changed in some substantial way. As a general rule, as long as the change to the exercise is under what is normally done, DOMS are not experienced as a result of the activity.

In practice, avoiding any post-exercise muscle soreness in a training programme may be unavoidable, as exercise intensity and duration increases. Horses are far from being machines, so there is a fine balance between a programme that gets a horse fit for purpose without some post-exercise muscle discomfort. Physiotherapy, swimming and turnout will all likely benefit horses experiencing muscle discomfort. Whilst non-steroidal anti-inflammatories will always have their place for horses in training, one area of advancement is the use of plant-based phytochemicals to support the anti-inflammatory response (Pekacar 2021). These may have the benefit of not leading to unwanted gastrointestinal side effects and not having prolonged withdrawal times, although this should always be checked with any supplement particularly with the recent update regarding MSM on the BHA prohibited substance list.

Exercise will also lead to a process of muscle cell damage caused by oxidative stress. This is an inflammatory process and recovery from oxidative stress is key to allow for muscle cell repair and growth. Antioxidants are compounds that help recovery and repair of muscle cells following periods of intense exercise. The process of oxidative stress in muscle cells can lead to muscle fatigue and inflammation if left unsupported. Antioxidant supplementation in the form of Vitamin E or plant-based compounds can help protect against excessive oxidative stress and support muscle repair after exercise (Siciliano 1997).

Conclusion

Nutritional management of horses in training is a complex topic, not least as every horse is an individual and so often needs feeding accordingly. Whilst there is a lot of science available on the subject, the ‘art of feeding’ a racehorse—something that trainers and their staff often have in-depth knowledge of— remains an incredibly important aspect. Targeted nutritional supplements undoubtedly have their place, as discussed in, but not limited to, the scenarios above. 

Veterinarians, physiotherapists, other paraprofessionals and nutritionists all play a role in minimising health issues and maximising performance. In the quest for optimal performance on the track, nutritional support is one of the cornerstones of the ‘marginal gains’ theory that has long been adopted in elite human athletes. There is no doubt that racehorses themselves are supreme athletes that live by the mantra of Train, Race, Recover, and Repeat.

References

Berger, S. et al (2002). The effect of acid protection in therapy of peptic ulcer in trotting horses in active training. Pferdeheilkunde 27 (1), 26-30,

Loftin, P. et al (2012). Evaluating replacement of supplemental inorganic minerals with Zinpro Performance Minerals on prevention of gastric ulcers in horses. J.Vet. Int. Med. 26, 737-738

McCutcheon, L.J. and geor R.J. (1996). Sweat fluid and ion losses in horses during training and competition in cool vs. hot ambient conditions: implications for ion supplementation. Equine Veterinary Journal 28, Issue S22.

Nieto, J.E. et al (2009). Effect of gastric ulceration on physiologic responses to exercise in horses. Am. J. Vet. Res.70, 787-795.

Pagan, J.D. et al (2014). Furosemide administration affects mineral excretion in exercised Thoroughbreds. In: Proc. International Conference on Equine Exercise Physiology S46:4.

Pekacar, S. et al (2021). Anti-Inflammatory and Analgesic Effects of Rosehip in Inflammatory Musculoskeletal Disorders and Its Active Molecules. Curr Mol Pharmacol. 14(5), 731-745.

Rivero, J.-L.L. et al (2007). ‘Effects of intensity and duration of exercise on muscular responses to training of thoroughbred racehorses’. Journal of Applied Physiology 102(5), 1871–1882.

Siciliano, P.D. et al (1997). Effect of dietary vitamin E supplementation on the integrity of skeletal muscle in exercised horses. J Anim Sci.75(6), 1553-60.

Sykes, B. et al (2013). Efficacy of a combination of a unique, pectin-lecithin complex, live yeast, and magnesium hydroxide in the prevention of EGUS and faecal acidosis in thoroughbred racehorses: A randomised, blinded, placebo-controlled clinical trial. Equine Veterinary Journal, 45, 16.

van den Berg, J. et al (1998). Water and electrolyte intake and output in conditioned Thoroughbred horses transported by road. Equine Vet J. 30(4), 316-23.

Vatistas, N.J. et al (1999) Cross-sectional study of gastric ulcers of the squamous mucosa in thoroughbred racehorses. Equine Vet J Suppl. 29, 34–39.

Waller, A.P., and M.I. Lindinger. (2022). Tracing acid-base variables in exercising horses: Effects of pre-loading oral electrolytes. Animals (Basel) 13(1), 73.

Probiotics as an alternative to antibiotics to reduce resistance in the gut

Article by Kerrie Kavanagh

The leading causes of horse mortality can be attributed to gastrointestinal diseases. Therefore, maintaining the balance of the gut microbiota and avoiding a shift in microbial populations can contribute to improved health status. The gut microbiota, however, can be influenced by countless dynamic events: diet, exercise, stress, illness, helminth infections, aging, environment and notably, antimicrobial therapy (antibiotics). These events can lead to gut dysbiosis—a fluctuation or disturbance in the population of microorganisms of the gut, which can contribute to a wide range of disease. The use of antibiotics in horses is thought to have one of the most notable effects on the gut microbiota (gut dysbiosis), which can lead to diseases such as colitis, colic and laminitis.

Antibiotics, which are antimicrobial agents active against bacteria, are important to equine medicine; and bacterial infections can be resolved quite successfully using antibiotics for antimicrobial therapy, but there are consequences to their use. An antimicrobial agent can be defined as a natural or synthetic substance that kills or inhibits the growth of microorganisms such as bacteria, fungi and algae. One of the consequences of antibiotic use is that of antibiotic-associated diarrhoea, which can contribute to poor performance in the horse and even mortality. In antimicrobial therapy, the target organism is not the only organism affected by the antimicrobial agent but also the commensal microbiota too (the normal flora of the equine gut). Antibiotics can promote fungal infections and resistant organisms and impede or even eliminate the more sensitive organisms; and they can have both short and long-term consequences on the gut microbiota composition and function. 

Research has indicated that antibiotic treatment may adversely affect metabolic function in the gut by decreasing protein expression responsible for biochemical pathways such as glycolysis, iron uptake, glutamate hydrolysis and possibly even more metabolic functions. The use of antimicrobial drugs directly impacts and possibly contributes to the most notable effect on the gut microbiota of the host, leading to gut dysbiosis; and certain antibiotics can have further-reaching consequences on the microbiota than others. The type of antibiotic and mode of action (bacteriostatic versus bactericidal) will differ in their influences on the gut microbiota composition, e.g., clindamycin operates a bacteriostatic mode of action by inhibiting protein synthesis and exerts a larger impact on the gut microbiota compared to other antimicrobials. These influential consequences that are imparted by the antimicrobial agent are relatively yet to be elucidated and may result in the manifestation of illness or conditions later in life. For example, the development of asthma in humans has been linked to antibiotic treatment in early childhood as a result of bacterial infections. It may yield interesting results if researchers were to examine the gut microbiome of horses suffering from chronic obstructive pulmonary disease (COPD) and other chronic respiratory illnesses and to establish if there is indeed a link with antibiotic therapy used in horses from an early age. 

In comparison to the vast wealth of human studies conducted so far, the volume of equine studies falls disappointingly far behind, but that is changing as researchers focus their interest on developing and filling this gap of knowledge. One such study which examined the effect of antibiotic use on the equine gastrointestinal tract, demonstrated a significant reduction in culturable cellulolytic bacteria (>99%) from equine faeces during the administration period of trimethoprim sulfadiazine and ceftiofur in a study comparing responses to antibiotic challenge. That reduction was still evident at the end of the withdrawal period when compared to the control group. In other words, there was a significant reduction in the ‘normal’ bacteria of the gut. The ability of antibiotics to modulate the gut microbiota was evidenced by the proliferation of pathogenic Salmonella and Clostridia difficile (commonly associated with diarrhoea in horses) in the antibiotic challenged horses. This trend of reduction in cellulolytic bacteria associated with antibiotic use was also mirrored in a relatively recent study conducted in 2019, where a short-term reduction in culturable cellulolytic bacteria was combined with a progressive increase in amylolytic bacteria. The heavy reliance on cellulolytic bacteria in the role of equine digestion (without these types of bacteria the horse cannot break down their food) may, therefore, adversely affect the dietary energy available from forage during antimicrobial therapy and may therefore impact performance.

Another study that compared the effect of penicillin, ceftiofur and trimethoprim sulfadiazine (TMS) on the gut microbiota in horses using next-generation sequencing showed that TMS had the most profound impact on the microbiota, in particular the phylum Verrucomicrobia. This same study also reported a significant decrease in bacterial richness and diversity of the faecal microbiota. A reduction in bacterial diversity is certainly a trend that is commonly seen in gastrointestinal disease in horses. The restoration of the normal gut microbiota after completion of antibiotic treatment can take up to 40 days, but the organisational structure of the bacterial populations can take many years to re-establish the original structure map that was laid out in the gut pre-antibiotic treatment. 

The equine studies certainly show similarities to the human studies, indicating the consequences of antibiotics that can be seen across more than one species. Human studies have reported long-term consequences of antibiotic treatment on the human microbiota. One such human study investigated a 7-day clindamycin treatment and monitored the patients for two years. The impact on the human microbiota remained evident two years post-treatment, where a reduction in bacterial diversity and detection of high-resistance to clindamycin were detected. 

Interestingly, no resistant clones were detected in the control group over the two-year sampling period. Another study focusing on the effects of antibiotic treatment for Helicobacter pylori showed findings mirrored in similar studies of that field. The findings demonstrated the rapidly reducing bacterial diversity (one week) after antibiotic treatment and found that disturbances in the microbiota and high levels of macrolide resistance were evident four years post-treatment. Human studies may predict that equine studies will find similar trends with equine antimicrobial therapy. These studies highlight the impact of antibiotic use and the long-term persistence of antibiotic resistance remaining in the intestinal microbiome, which is a concern for both humans and animals. 

Antibiotics can lead to the selectivity and proliferation of resistant bacteria, which is evidenced by the long-term effects observed on the gut microbiota harbouring drug-resistant encoded genes. Horizontal gene transfer (HGT) commonly occurs in the gut (can be up to 25 times more likely to occur in the gut than in other environments). HGT can be attributed to the close proximity of the microbiota in the gut, allowing the transfer of genetic material via routes such as plasmids and conjugation; in other words, the bacteria in the gut have developed a pathway to transfer antibiotic resistant genes from one generation to another. Resistance to antibiotics is now a global issue for the treatment of many diseases. 

With the unfavourable association tied to Clostridium difficile infections (CDI) and the onset of colitis particularly in mature horses treated with β-lactam antibiotics (commonly used for equine infections), the incidences in which antimicrobial therapy is considered should be minimised and only used if entirely necessary. The use of broad-spectrum antibiotics in recurrent presentations of symptoms of disease such as urinary tract infections in humans or diarrhoea as a result of CDI in both humans and horses is promoting drug resistance.

The antibiotics, by disrupting the gut microbiota (which act as a defence against the establishment and proliferation of such pathogenic bacteria) are allowing the opportunity of growth for these multi-resistant microorganisms such as C. difficile, vancomycin-resistant enterococci (VRE), and multi-resistant Staphylococcus aureus (MRSA). The organism C. difficile and its antibiotic resistance has been demonstrated in the treatment of CDI for both humans and animals. The introduction of vancomycin (a glycopeptide antibiotic) in 1959 for the control of CDI remained effective until the 1990s when a more virulent form of C. difficile emerged. This new form of C. difficile with reported broad-spectrum antibiotic resistance resulted in chronic conditions and increased human mortality. C. difficile is most noted with human hospital-acquired infections. C. difficile BI/NAP1/027 has been shown to have resistance to fluoroquinolone antibiotics, moxifloxacin and gatifloxacin, which was not seen in historical genotypes. As C. difficile infections are found to cause gastrointestinal disease in horses as well as humans, this is certainly of concern.

Alternative therapies to antibiotic therapy to restore or modulate the gut microbiome after a gut dysbiosis event could be considered in certain circumstances where antibiotics are no longer effective (e.g., CDI), nor may they not be the best course (presence of Extended-spectrum -β-lactamase producing (ESBL) organisms) nor essential for example, when the diagnosis of the bacterial cause is uncertain. The rationale to using probiotic treatment along with antimicrobial treatment is that the antibiotic will target the pathogenic bacteria (e.g., C. difficile) and also the commensal microbiota of the gut, but the probiotic bacteria will help to re-establish the intestinal microbiota and in-turn prevent the re-growth of the pathogenic bacteria in the case or residual spores of C. difficile surviving the antibiotic treatment. Alternative therapies such as faecal microbiome transplant (FMT) or probiotic solutions can reduce the risk of proliferation of antibiotic-resistant bacteria and also have fewer implications on the gut microbiome as evidenced by antibiotic use. 

Probiotics have been defined by the Food and Agricultural Organisation (FAO) and the World Health Organisation (WHO) as “live non-pathogenic microorganisms that, when administered in adequate amounts, confer a health benefit on the host”. The word ‘probiotic’ is Greek in origin, meaning, ‘for life’; and the term was coined by Ferdinand Vergin in 1954. While the mechanisms of action of probiotics are complex and require a deeper knowledge of the modulations of the gastrointestinal microbiota, and the health benefits due to their use are the subject of some debate, there is no doubt that probiotics are considered by many as a vital resource to human and animal health.   

The use of probiotics in animal production, particularly in intensive swine and poultry production, has increased in recent years, primarily as an alternative to the use of antimicrobials in the prevention of disease. The problem of antibiotic-resistance and antimicrobial residues in food-producing animals (the horse is considered a food-producing animal), as a result of historical antibiotic use with the corresponding reduction in antibiotic efficacy in humans, leads to having to look at more sustainable options such as probiotic use to combat disease. Probiotics in horses are predominantly used as a treatment modality in the gastrointestinal microbial populations to combat illnesses such as diarrhoea—to prevent diarrhoea (particularly in foals) or help improve digestibility.  Shifts or fluctuations in the microbial populations of the equine gastrointestinal tract have been associated with diseases such as laminitis and colic.  

Gut dysbiosis, as mentioned previously is, a fluctuation or disturbance in the population of microorganisms of the gut is now being recognised as a cause of a wide range of gastrointestinal diseases; and in horses, it is one of the leading causes of mortality. The ability of probiotics in conferring health benefits to the host can occur via several different mechanisms: 1) inhibiting pathogen colonisation in the gut by producing antimicrobial metabolites or by competitive exclusion by adhering to the intestinal mucosa preventing pathogenic bacteria attachment by improving the function and structure; 2) protecting or restabilising the commensal gut microbiota; 3) protecting the intestinal epithelial barrier; 4) by inducing an immune response.

It is known that there is a wealth of factors that will adversely affect the gut microbiome, antibiotics, disease, diet, stress, age and environment are some of these compounding contributors. To mirror one researcher’s words echoing from an era where antibiotics were used as growth promoters in the animal industry, “The use of probiotic supplements seeks to repair these deficiencies. It is, therefore, not creating anything that would not be present under natural conditions, but it is merely restoring the flora to its full protective capacity”. In the case of using concurrent antibiotic and probiotic treatment, this strategic tweaking of the microbiota could be used as a tool to prevent further disease consequence and perhaps help improve performance in the horse.

The benefits of probiotic use in horses have not been investigated extensively but as mentioned previously, they are now being focused upon by researchers in the equine field. The most common bacterial strains used in equine probiotic products are Lactobacillus, Bifidobacterium, Streptococcus, Enterococcus, Bacillus and yeast strains of Saccharomyces. Lactobacillus, Bifidobacterium and Enterococcus strains typically account for less than 1% of the microbiota large gastrointestinal populations.

Regulation is lacking regarding labelling of probiotic products, often not displaying content with clarification and quality control (such as confirmed viability of strain[s]) not excised with over-the-counter probiotic products. There is evidence to suggest that host-adapted strains of bacteria and fungi enjoy a fitness advantage in the gut of humans and animals.  Therefore, there may be an advantage in using the individual animal’s own bacteria as potential probiotics. Probiotics and antibiotics used concurrently could be the way to minimise the introduction of antibiotic-resistant bacterial strains in the gut, and in turn, protect future antibiotic efficacy.