How HISA has affected the marketing and selling of equine supplements - What trainers need to know

Article by Ken Snyder

In 1834, Thomas Day of Day & Sons in the UK. introduced Day’s Black Drink, an elixir for horses to relieve colic, chills, “low condition” and something called “gripes.” There is no record of the ingredients, and that is probably something best left unknown.

Black Drink was the first known supplement, or product made from natural, not synthetic, substances, as this was the early 19th century. So, too, is heroin derived from a natural substance—poppies. (Created from morphine in 1874, its use on the racetrack was prevalent enough in the early 20th century to help fix races that “horse” became slang for the narcotic in recent history.)

Supplements today range from useless and quackery to many that are considered effective in horse health care by many trainers on the racetrack. In fact, the majority of  Thoroughbred trainers utilize supplements with feed.

Like therapeutic medications and illegal substances, dietary supplements are under the purview of the Horse Integrity and Safety Authority (HISA). Like their drug counterparts, HISA is instituting uniform regulations for supplements in all 50 states. The task falls specifically to the organization’s Horse Integrity and Welfare Unit (HIWU).

Good, bad, or indifferent, the intent of this organization, inarguably, is noble: to make racing safer and healthier for the horses. 

Supplements, however, are seemingly lost in the fog in the scrutiny and attention paid to perhaps the biggest problem in horse racing: medications.

There are potential hazards with supplements, however, and uniform rules across all U.S. racing jurisdictions are in place just as with medications. The key regulation that is now applicable in every HISA jurisdiction specifies that “orally administered vitamins“ and “unsupplemented isotonic electrolyte solutions by oral or intravenous administration” may be administered up to 24 hours prior to post time. This may differ from prior state regulations.

Alexa Ravit, director of communications and outreach for HIWU, outlined the objectives of this regulation and all HISA “regs” in response to an email:

“HISA’s supplements-related regulations (and in particular addressing ‘drug claims’) are intended to protect horsemen from 1) fraudulent or unproven claims of effect; 2) the unknown safety risk to horses in administering these products; and 3) products where the risk of contaminants or unknown components is high due to lack of independent quality controls.”

The task of monitoring and regulating dietary supplements is not nearly as challenging as that for medications, but it is no slam-dunk either. Also, while medications and new withdrawal times for permitted drugs might be a trainer’s focus, trainers should know that, while supplements by and large are safe, there are things to watch for with their use. 

In simplest terms, managing supplements for trainers under HISA/HIWU is following three steps: (1) reading labels (more on this below); (2) being careful in using dietary supplements in combination with approved medications; and (3) not accepting free supplements without understanding what’s on the label.

Mislabeled supplements, according to Rivet, are the major thing that can get a trainer and owner in trouble. She wrote, “If…the product’s labeling…includes a health or structure/function claim, the product is a drug, not a dietary supplement.” Also, drugs are FDA-approved and will carry that information on the label. Supplements won’t. 

In short, trainers need to look first to make sure the supplement does not say “FDA approved.” Supplement labels also should not make “structure/function” claims. HIWU lists these examples:

− Decreases or prevents exercised-induced pulmonary hemorrhaging (EIPH)

− Prevents or treats gastric ulcers
− Manages pain caused by osteoarthritis
− Controls inflammatory airway disease 

− Increases cardiac output
− Increases red blood cell production

The claims are definite, positive and apparently proven by results, warranting approval by the FDA.

Contrast these claims against what will be found for dietary supplements: 

− Sustains lung health
− Maintains gastrointestinal health
− Supports heart health
− Supports bone strength
− Promotes healthy metabolism
− Replenishes electrolytes lost through exercise and sweating

Labels on dietary supplements sound good but stop short of making a promise and, in a couple of instances, are vague at best. “Sustains lung health” and “maintains gastrointestinal health” are things you would want a horse to have after lung or gut issues are solved, and maybe skate closest to a claim like a drug. What supports heart and bone health and strength, respectively, is anybody’s guess. The same goes for promotes healthy metabolism. (Maybe the label will tell one how.) Replenishes electrolytes is a straight-up promise that evidently is achieved with dietary supplements and not drugs. (Gatorade for humans comes to mind.) 

To make another simple distinction, drugs are available only through a prescription from a veterinarian. If a trainer is getting them through another source, there’s potential trouble; but that’s for another story. Supplements are available in tack shops and/or online and do not require a veterinary prescription. 

Ravit, in response to how common it is to see supplements making drug claims contrary to regulations, only said, “It cannot be quantified.” That’s “Governmentese” for “It’s anybody’s guess.”

HISA/HIWU’s own definition of a drug, by the way, is this:

“Under the Federal Food, Drug, and Cosmetic Act, the term “drug” means a product intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease, and articles other than food intended to affect the structure or any function of the body.” That’s a mouthful to say it ought to work.; you should get results.

In case you’re wondering why supplements are not regulated by the FDA, the category name “dietary supplements” gives you the answer. The FDA defines them as a “dietary ingredient intended to supplement the diet.” Dietary supplements are not regulated for humans either.

Are they safe? You would think, given the absence of regulation, the answer would be an automatic “yes.” The FDA, however, can take action to remove supplements from the market if they are adulterated (unsafe) or misbranded (misleading). Let the buyer beware.

What a trainer can control are things to avoid, such as mixing supplements with drugs, administering too many supplements, or substituting supplements for drugs altogether. 

HIWU’s language on dietary supplements is actually a bit scary:   

“It is…the responsibility of the manufacturer to ensure the product’s safety and to market the supplement in accordance with applicable law.“

The second part of the statement should give one pause. Yes, the manufacturer is responsible for the product’s safety, but it’s the trainer or trainer’s barn help that is the last person in the literal food chain for the horse. Once a supplement is in a trainer’s hands, he or she is on their own. The safe bet is a veterinarian’s assessment of any risks and/or benefits. 

HIWU addresses this in their literature: “Supplements can interact with some medication with adverse health conditions” advising trainers to “be vigilant and discuss administration [of a supplement] with your veterinarian.”

Ravit also responded with “no comment“ to whether there have already been instances of a supplement producing a positive test for an illegal or controlled substance.

Practicing veterinarians like Dr. Rick Fischer, who has been on the racetrack for 53 years, is, as one would expect, well-versed in the difference between a drug and a supplement. He presents another issue that threatens the health and safety of horses. He and other vets are not always gatekeepers with supplements for trainers. Laymen or salesmen will approach trainers directly promoting supplements. “Worse than that, they’ll give them away: ‘Here are two gallons of this. Use it and see if you like it.’ You really don’t know what the hell you’re getting,” said Fischer.

There are other words on supplements to be mindful of. HIWU’s website warns that “’natural’ does not mean safe, nor does it mean that a product is free of Prohibited Substances.  Neither do “seals of quality assurance” that guarantee a supplement is safe and effective. In short, even practicing veterinarians recommending supplements cannot guarantee safety or effectiveness.

Fischer said there have been instances where a supplement and an approved medication have produced positive tests for banned substances. 

 HIWU’s website advises, “It is crucial to have specialized knowledge from a chemical engineer or pharmacist in order to comprehend and forecast the resulting molecules, due to the intricate interplay between the chemicals involved.” 

 Fischer expounds on the “intricate interplay” thusly: “There’s been positive tests on things that I’ve never even heard of. It’s not something that anybody in their right mind would give a horse. But the chemical breakdown when they’re in combination…who knows? 

“They’ll give you a list of all the different ingredients. Most of it is Greek to these guys and some of it is Greek to me, and I’ve been practicing for more than 50 years.”

Fischer actually parroted HIWU language in saying it would take a chemical engineer or pharmacist to be able to tell “if this molecule matches up with this molecule and what it’s going to come out as.“

Good luck to any trainer looking for a chemical engineer or pharmacist on the backside. 

Dr. Day’s Black Drink, by the way, would not pass muster as a supplement as it claimed to treat colic. As for “gripes,” there is no supplement or drug for that. 

Air Quality and Air Pollution’s Impact on Your Horse’s Lungs

Article by Dr. Janet Beeler-Marfisi

There’s nothing like hearing a horse cough to set people scurrying around the barn to identify the culprit. After all, that cough could mean choke, or a respiratory virus has found its way into the barn. It could also indicate equine asthma. Yes, even those “everyday coughs” that we sometimes dismiss as "summer cough" or "hay cough" are a wake-up call to the potential for severe equine asthma. 

Formerly known as heaves, broken wind, emphysema, chronic obstructive pulmonary disease (COPD), or recurrent airway obstruction (RAO), this respiratory condition is now called severe equine asthma (sEA). These names reflect how our scientific and medical understanding of this debilitating disease has changed over the years. We now consider heaves to be most comparable to severe asthma in people.

But what if your horse only coughs during or after exercise? This type of cough can mean that they have upper airway irritation (think throat and windpipe) or lower airway inflammation (think lungs) meaning inflammatory airway disease (IAD), which is now known as mild-to-moderate equine asthma (mEA). This airway disease is similar to childhood asthma, meaning  that it can go away on its own. However, it is still very important to call your veterinarian out to diagnose mEA. This disease causes reduced athletic performance, and there are different subtypes of mEA that benefit from specific medical therapies. In some cases, mEA progresses to sEA.

Equine Asthma and  Air Quality
What does equine asthma have to do with air quality? A lot, it turns out. Poor air quality, or air pollution, includes the barn dusts—the allergens and molds in hay and the ground-up bacteria in manure, as well as arena dusts and ammonia from urine. Also, very importantly for both people and horses, air pollution can be from gas and diesel-powered equipment. This includes equipment being driven through the barn, the truck left idling by a stall window, or the smog from even a small city that drifts nearly invisibly over the surrounding farmland. Recently, forest-fire smoke has been another serious contributor to air pollution. 

Smog causes the lung inflammation associated with mEA. Therefore, it is also likely that air pollution from engines and forest fires will also trigger asthma attacks in horses with sEA. Smog and smoke contain many harmful particulates and gases, but very importantly they also contain fine particulate matter known as PM2.5. The 2.5 refers to the diameter of the particle being 2.5 microns. That’s roughly 30 times smaller than the diameter of a human hair. Because it is so small, this fine particulate is inhaled deeply into the lungs where it crosses over into the bloodstream. So, not only does PM2.5 cause lung disease, but it also causes inflammation elsewhere in the body including the heart. Worldwide, even short-term exposure is associated with an increased risk of premature death from heart disease, stroke, and lung cancer. This PM2.5 stuff is not trivial!

In horses, we know that PM2.5 causes mEA, so it’s logical that smog and forest-fire smoke exposure could exacerbate asthma in horses, but we don’t know about heart disease or risk of premature death.

Symptoms, Diagnostic Tests and Treatments

Equine asthma manifests with a spectrum of symptoms that vary in severity and the degree of debilitation they cause. Just like in people with asthma, the airways of horses with mEA and sEA are “hyperreactive.” This means that the asthmatic horse’s airways are extra sensitive to barn dusts that another horse’s lungs would just “ignore.” The asthmatic horse’s airways constrict, or become narrower, in response to these dusts. This narrowing makes it harder to get air in and out of the lungs. Think about drinking through a straw. You can drink faster with a wider straw than a skinnier one. It’s the same with air and the airways. In horses with mEA, the narrowing is mild. In horses with sEA, the constriction is extreme and is the reason why they develop the “heaves line”; they have to use their abdominal muscles to help squeeze their lungs to force the air back out of their narrow airways. They also develop flaring of their nostrils at rest to make their upper airway wider to get more air in. Horses with mEA do not develop a heaves line, but the airway narrowing and inflammation do cause reduced athletic ability.

The major signs of mEA are coughing during or just after exercise that has been going on for at least a month and decreased athletic performance. In some cases, there may also be white or watery nasal discharge particularly after exercise. Often, the signs of mEA are subtle and require a very astute owner, trainer, groom, or rider to recognize them.

Another very obvious feature of horses with sEA is their persistent hacking cough, which worsens in dusty conditions. “Hello dusty hay, arena, and track!” The cough develops because of airway hyperreactivity and because of inflammation and excess mucus in the airways. Mucus is the normal response of the lung to the presence of inhaled tiny particles or other irritants. Mucus traps these noxious substances so they can be coughed out, which protects the lung. But if an asthma-prone horse is constantly exposed to a dusty environment, it leads to chronic inflammation and mucus accumulation, and the development or worsening of asthma along with that characteristic cough.

Accurately Diagnosing Equine Asthma

Veterinarians use a combination of the information you tell them, their observation of the horse and the barn, and a careful physical and respiratory examination that often involves “rebreathing.” This is a technique where a bag is briefly placed over the horse’s nose, causing them to breathe more frequently and more deeply to make their lungs sound louder. This helps your veterinarian hear subtle changes in air movement through the lungs and amplifies the wheezes and crackles that characterize a horse experiencing a severe asthma attack. Wheezes indicate air “whistling” through constricted airways, and crackles mean airway fluid buildup. The fluid accumulation is caused by airway inflammation and contributes to the challenge of getting air into the lung. 

Other tests your veterinarian might use are endoscopy, bronchoalveolar lavage, and in the specialist setting, pulmonary function testing. They will also perform a complete blood count and biochemical profile assay to help rule out the presence of an infectious disease. 

Endoscopy allows your veterinarian to see the mucus in the trachea and large airways of the lung. It also lets them see whether there are physical changes to the shape of the airways, which can be seen in horses with sEA. 

Bronchoalveolar lavage, or “lung wash” is how your veterinarian assesses whether there is an accumulation of mucus and inflammatory cells in the smallest airways that are too deep in the lung to be seen using the endoscope. Examining lung wash fluid is a very important way to differentiate between the different types of mEA, between sEA in remission and an active asthma attack, and conditions like pneumonia or a viral lung infection. 

Finally, if your veterinarian is from a specialty practice or a veterinary teaching hospital, they might also perform pulmonary function testing. This allows your veterinarian to determine if your horse’s lungs have hyperreactive airways (the hallmark of asthma), lung stiffening, and a reduced ability to breathe properly. 

Results from these tests are crucial to understanding the severity and prognosis of the condition. As noted earlier, mEA can go away on its own; but medical intervention may speed healing and the return to athletic performance. With sEA, remission from an asthmatic flare is the best we can achieve.  As the disease gets worse over time, eventually the affected horse may need to be euthanized.

Management, Treatment and Most Importantly—Prevention
Successful treatment of mEA and sEA flares, as well as long-term management, requires a multi-pronged approach and strict adherence to your veterinarian’s recommendations.

Rest is important because forcing your horse to exercise when they are in an asthma attack further damages the lung and impedes healing.  To help avoid lung damage when smog or forest-fire smoke is high, a very useful tool is your local, online, air quality index (just search on the name of your closest city or town and “AQI”).  Available worldwide, the AQI gives advice on how much activity is appropriate for people with lung and heart conditions, which are easily applied to your horse. For example, if your horse has sEA and if the AQI guidelines say that asthmatic people should limit their activity, then do the same for your horse. If the AQI says that the air quality is bad enough that even healthy people should avoid physical activity, then do the same for you AND your horse. During times of poor air quality, it is recommended to monitor the AQI forecast and plan to bring horses into the barn when the AQI is high and to turn them out once the AQI has improved.

Prevent dusty air. Think of running your finger along your tack box – whatever comes away on your finger is what your horse is breathing in. Reducing dust is critical to preventing the development of mEA and sEA, and for managing the horse in an asthmatic flare. 

Logical daily practices to help reduce dust exposure:

• Turn out all horses before stall cleaning

• Wet down the aisle prior to sweeping

• Never sweep debris into your horse’s stall

• Use low-dust bedding like wood shavings or dust-extracted straw products, which should also be dampened down with water

• Reduce arena, paddock, and track dust with watering and maintenance

• Consider low-dust materials when selecting a footing substrate

• Steam (per the machine’s instructions) or soaking hay (15–30 minutes and then draining, but never store steamed or soaked hay!) 

• Feed hay from the ground

• Feed other low-dust feeds

• Avoid hay feeding systems that allow the horse to put their nose into the middle of dry hay—this creates a “nosebag” of dust

Other critical factors include ensuring that the temperature, humidity and ventilation of your barn are seasonally optimized. Horses prefer a temperature between 10–24 ºC (50–75 ºF), ideal barn humidity is between 60–70%. Optimal air exchange in summer is 142 L/s (300 cubic feet/minute). For those regions that experience winter, air exchange of 12–19 L/s (25–40 cubic feet/minute) is ideal. In winter, needing to strip down to a single layer to do chores implies that your barn is not adequately ventilated for your horse’s optimal health. Comfortable for people is often too hot and too musty for your horse! 

Medical interventions for controlling asthma are numerous. If your veterinarian chooses to perform a lung wash, they will tailor the drug therapy of your asthmatic horse to the results of the wash fluid examination. Most veterinarians will prescribe bronchodilators to alleviate airway constriction. They will also recommend aerosolized, nebulized or systemic drugs (usually a corticosteroid, an immunomodulatory drug like interferon-α, or a mast cell stabilizer like cromolyn sodium) to manage the underlying inflammation. They may also suggest nebulizing with sterile saline to help loosen airway mucus and may suggest feed additives like omega 3 fatty acids, which may have beneficial effects on airway inflammation. 

New Research and Future Directions

Ongoing research is paramount to expanding our knowledge of what causes equine asthma and exploring innovative medical solutions. Scientists are actively investigating the effects of smog and barn dusts on the lungs of horses. They are also working to identify new targeted therapies, immunotherapies and other treatment modalities to improve outcomes for affected horses.

Conclusion

Both mild and severe equine asthma are caused and triggered by the same air pollutants, highlighting the need for careful barn management. The alarming rise in air pollution levels poses an additional threat to equine respiratory health. Recognizing everyday coughs as potential warning signs and implementing proper diagnostic tests, day-to-day management practices and medical therapies are crucial in combating equine asthma. By prioritizing the protection of our horse’s respiratory health and staying informed about the latest research, we can ensure the well-being of our equine companions for years to come.

Highlights

1. Work to prevent dust and optimize barn air exchange.

2. Avoid idling farm equipment and trucks around horses.

3. Don’t ignore a cough—call your veterinarian.

4. Monitor your local air quality index—it’s a free and simple way to help prevent lung damage!