Feeding Horses with Cushing’s Disease: A Comprehensive Guide

Last updated: January 30, 2026

By: Miles HenryFact Checked

When my friend’s horse was diagnosed with Cushing’s Disease, he was stunned. He had never heard of it before and knew nothing about the disease. The veterinarian explained that Cushing’s Disease is a metabolic disorder affecting horses’ hormone balance. One of the most critical aspects of managing the disease is proper nutrition.

Feeding a horse with Cushing’s Disease can be challenging, and my friend had a lot of questions. What should he feed his horse? How much? What should he avoid? Through trial and error and with the guidance of his veterinarian, he customized his horse’s diet, carefully monitored his response to dietary changes, and was able to manage his horse’s symptoms.

This guide focuses specifically on Cushing’s Disease (PPID) and equine nutrition. For foundational feeding principles that apply to all horses, see my complete Horse Feeding Guide. If your Cushing’s horse is also aging, also explore the Senior Horses Feeding Guide for additional strategies.

Understanding Cushing’s Disease

Cushing’s Disease is a metabolic disorder that affects horses. It happens when the pituitary gland produces excessive ACTH, which disrupts normal cortisol regulation in the body. Cortisol is essential for managing stress, but too much can cause problems.

Cushing’s Disease symptoms in horses include excessive thirst and urination, weight loss, curly coat, and potbelly. However, one of the most significant and painful issues is founder (severe laminitis), which affects their feet and can make it difficult for them to walk. Monitoring these symptoms and seeking veterinary care to manage the disease and prevent complications is crucial.

A veterinarian will do a physical exam and run blood tests to diagnose Cushing’s Disease. Diagnosis is typically made through blood testing (such as ACTH or TRH stimulation tests). Imaging of the pituitary is rarely performed in horses.

Treatment options include medications to manage the horse’s hormone levels and help them feel better. Horses with Cushing’s Disease might also need special shoeing or hoof care to manage laminitis.

Cushing’s Disease can significantly impact a horse’s overall health and well-being. If left untreated, it can lead to other health problems and make it hard for the horse to enjoy life. But with the proper care and treatment, horses with Cushing’s Disease can still live full and happy lives.

Nutrition Basics for Horses with Cushing’s Disease

Cushing’s Disease affects a horse’s hormone regulation, leading to unique dietary requirements and restrictions. They may be insulin resistant, making it harder for their body to process sugars and carbs, which increases the risk of laminitis. Horses with Cushing’s disease require a diet low in sugar and starch (target NSC under 10%), but high in fiber to manage this risk.

In addition to being insulin resistant, horses with Cushing’s Disease might also have difficulty maintaining their weight. They might lose weight due to poor absorption of nutrients or gain weight due to how their body processes food. This means they need to have a diet tailored to their specific needs to stay healthy.

Another factor to consider is that horses with Cushing’s Disease are often older and might have dental issues that make it difficult to chew and digest food properly. This means that they might need softer feeds or supplements to ensure they get the nutrients they need.

Giving horses with Cushing’s Disease a balanced diet that meets all their nutritional needs is important. This might include a combination of hay, feed, and supplements. Some horses might need special diets or supplements to help manage their symptoms.

Customizing Your Horse’s Diet

When a horse has Cushing’s Disease, their diet needs to be customized to their specific needs. This means working with a veterinarian to develop a feeding plan that works for the horse’s age, weight, and activity level.

The veterinarian will help you determine the right amount of hay, feed, and supplements for your horse. They might also recommend special diets or supplements to help manage your horse’s symptoms.

It’s essential to monitor your horse’s response to dietary changes. If you notice any changes in their weight, behavior, or overall health, inform your veterinarian immediately. They might need to adjust your horse’s diet or medications to help manage their symptoms.

In addition to adjusting feed based on your horse’s needs, you’ll also want to pay attention to the quality of the hay and feed you’re giving them. Make sure it’s fresh and mold-free, which can harm horses.

Customizing your horse’s diet is essential in managing Cushing’s Disease. By working with a veterinarian and monitoring your horse’s response to dietary changes, you can help them get the nutrition they need to stay healthy and manage their symptoms.

Ideal NSC Levels for Cushing’s Horses

• <10% safe
• 10–12% caution
• 12% high risk

I learned about Cushing’s firsthand when my friend’s mare, Stella, was diagnosed with PPID… a competitive dressage mare in her 20s… classic signs:
delayed shedding, excessive drinking, potbelly… laminitis within two months.

Plan implemented: Overhauled diet: eliminated grain, switched to tested low-NSC timothy hay (6-8% NSC), added ration balancer, strict pasture management…

Results: Within 8 weeks, her laminitis markedly improved, her energy improved, she returned to light work. Stella lived another 5 healthy years with proper diet management.

That experience showed me that Cushing’s isn’t a death sentence—it’s a management challenge solved through proper nutrition.

Recommended Feeds and Supplements

When it comes to feeding a horse with Cushing’s Disease, several recommended feeds and supplements can help manage their symptoms. First, choosing low-sugar and low-starch feeds is vital to help prevent laminitis. These feeds are often labeled as “safe” or “low-carb” and are designed specifically for horses with metabolic disorders.

High-fiber and high-fat options are also beneficial for horses with Cushing’s Disease. These feeds are easier to digest and help them maintain a healthy weight. Fiber-rich feeds like beet pulp and hay cubes are good options, as well as feeds high in healthy fats like flaxseed oil or rice bran.

Horses with Cushing’s Disease also benefit from essential vitamins, minerals, and supplements. These might include a multivitamin or mineral supplement and supplements designed to support joint health, hoof health, or digestion.

Working with a veterinarian or equine nutritionist is vital to determine the best feeds and supplements for your horse. They can help you choose the right products and ensure your horse gets all the nutrients needed to manage their symptoms and stay healthy.

Example for 1,100-pound Cushing’s horse:

6:00 AM: 3 lbs low-NSC timothy hay (<8% NSC)
6:15 AM: 2 lbs Nutrena Professional Senior + 1 oz flax oil + 1 scoop ration balancer
12:00 PM: 3 lbs timothy hay + salt block
4:00 PM: 3 lbs timothy hay
6:00 PM: 3 lbs timothy hay
6:15 PM: 2 lbs Senior feed + 1 oz flax oil + ration balancer
Post-Exercise: Soaked beet pulp + electrolytes

This keeps forage constant while keeping starch/sugar to an absolute minimum.

Here is a helpful YouTube video that explains Cushing’s Disease in horses.

Tips for Feeding Horses with Cushing’s Disease

Feeding a horse with Cushing’s Disease can be challenging, but there are some tips and best practices that can help.

• Consistent feeding schedule

One important tip is to maintain a consistent feeding schedule. Horses with Cushing’s Disease thrive on routine, so feeding them at the same time every day is essential. This can help keep their hormones and blood sugar levels stable and reduce the risk of laminitis.

• Proper dental care

Ensuring proper dental care is also essential for horses with Cushing’s. As they get older, they might have dental issues that make it difficult to chew and digest food properly. Regular dental check-ups and floating (filing down sharp edges on teeth) can help ensure they can chew their food easily and get the nutrition they need.

• Monitor your horse

Finally, monitoring horses with Cushing’s Disease for signs of laminitis and other complications is essential. Signs of laminitis might include reluctance to move, standing with their front feet stretched out in front of them, or a painful reaction when you press on their hooves. Other signs of complications might include weight loss, changes in behavior or appetite, or lethargy.

Our Louisiana climate presents unique challenges for horses with Cushing’s. Summer heat (90°F+) combined with hormonal imbalance increases metabolic stress. Cushing’s horses sweat excessively in our heat, and their insulin resistance makes them more susceptible to laminitis during spring when pasture NSC spikes.

I manage Cushing’s horses in Louisiana by: testing hay NSC before feeding (8-10% max), strictly limiting spring/early summer pasture, using grazing muzzles in spring, monitoring hooves closely during heat cycles, increasing water access significantly in summer, and adjusting electrolytes if the horse sweats excessively without hard work.

By following these tips and keeping a close eye on your horse’s health, you can help manage their symptoms and ensure they get the nutrition they need to stay healthy.

Lifestyle Changes to Support Your Horse’s Health

In addition to managing your horse’s diet, some lifestyle changes can help support their overall health and well-being when they have Cushing’s Disease.

• Regular exercise and turnout

One significant change is to provide regular exercise and turnout. Horses with Cushing’s Disease can benefit from daily exercise, even if it’s just a short walk or light ride. Turnout in a safe and secure pasture or paddock is also crucial for their mental and physical health. However, monitoring them for signs of laminitis during turnout is essential.

• Reduce stress

Stress reduction and management are also necessary for horses with Cushing’s Disease. Stress can trigger hormone imbalances and make symptoms worse. Providing a calm and consistent environment, minimizing changes to their routine, and using calming techniques like massage or aromatherapy can help reduce stress and improve their quality of life.

• Veterinary check-ups

Finally, routine veterinary check-ups and care are essential for horses with Cushing’s Disease. This might include regular blood tests, monitoring of hormone levels, and adjustments to their medications or diet as needed. Regular dental care, hoof care, and deworming are also essential to keep them healthy and happy.

By making these lifestyle changes, you can help support your horse’s health and well-being when they have Cushing’s Disease. With the proper care and management, horses with Cushing’s Disease can still enjoy a happy and active life.

Specific recommendations:

• Nutrena Professional Senior (12% protein, metabolically sensitive)
• Triple Crown Low Starch (4.7% starch, insulin-resistant)
• Buckeye Equine Senior (low-NSC option)

Important: Test hay NSC before feeding (target <10%, ideally 8%). Testing costs $20-40 but prevents $5,000+ in laminitis treatment.

Key principle: feed for the disease, not the appetite. Many Cushing’s horses will beg for grain, but they need LOW-NSC forage and minimal concentrates.

FAQs About Feeding Horses with Cushing’s Disease

Conclusion

Feeding a horse with Cushing’s Disease requires specialized knowledge, dedication, and close monitoring. As Stella’s story showed, proper nutrition can dramatically improve quality of life, prevent laminitis, and extend your horse’s healthy years.

Key principles: low sugar, low starch, high fiber, consistent schedules, and vigilant monitoring. When you get it right, horses with Cushing’s can thrive. Explore the complete horse feeding cluster below to build a full nutrition strategy.