Re-Feeding the Starved Horse
Nursing the starved horse back to health requires careful consideration of the type and amount of feed provided.

While it can be tempting to provide unlimited access to feed, when it comes to feeding starved horses, less truly should be the rule of thumb. iStock/Denisa

Finding yourself in the position of providing care to a starved horse can be an emotional situation for any horse enthusiast. The desire to do everything possible to return the horse to full health, including providing ample nutrition, can be the initial impulse. Sadly, the desire to feed the horse well can have catastrophic consequences resulting in a re-feeding syndrome that might result in the need for euthanasia. While it can be tempting to provide unlimited access to feed, when it comes to feeding starved horses, less truly should be the rule of thumb.

Horses rely on body stores of inert carbohydrate and fat to fuel the large number of metabolic processes within the body. These stores are constantly replenished through the diet. In a horse that is starved, these stores become depleted and so, instead, protein is utilized for energy. All protein in the body is actively contributing to important functions and is not stored for the purpose of providing energy. In this scenario, the body is not picky about what source of protein gets used for energy. Therefore, as protein is burned as a fuel source, skeletal muscle and vital organs become negatively impacted.

When a starved horse is “re-fed” and provided carbohydrates, in particular glucose, blood insulin increases. This helps move glucose from the circulation into cells and with it electrolytes. This can result in inadequate levels of key electrolytes such as phosphorus, potassium and magnesium in the circulation as well as leaving red blood cells without adequate energy. These red blood cells are then unable to adequately release oxygen to various tissues resulting in heart, kidney and respiratory organ failure and ultimately death.

Research studies have shown that a greater success rate is achieved when starved horses are rehabilitated using forages containing low non-structural carbohydrate (NSC) as this limits the insulin response. If using grass hays, they should be tested for NSC content and ideally have an NSC content of less than 10 percent. If only untested grass hay is available, feeding alfalfa might be a better choice as alfalfa has a low NSC content and also tends to provide good amounts of magnesium and phosphorus.

Very small amounts of feed should be fed that provide no more than about 50 percent of the horse’s calculated daily digestible energy (DE) requirement. Different research studies have used different feeding protocols. One fed alfalfa at 50 percent of the calculated daily DE requirement for the first three days of re-feeding, then increased the amount to 75 percent for Days 4 and 5 before increasing to a full 100 percent on Day 6. Another study fed frequent handfuls of grass hay for the first day, then provided netted hay that was hung outside the stalls so that the horses had to eat the hay through the bars. These researchers introduced 0.5 pounds of complete feed and increased this by the same amount every three days until they were being fed no more than 3 pounds at any feeding.

Re-feeding syndrome can develop as quickly as the first day of re-feeding or might not become apparent for three to four weeks. The keys to successful rehabilitation lie in starting off with very small meals that provide limited calories and utilizing forages and feeds with an NSC content at or below 10 percent. 

Sticking to these guidelines despite the natural desire to want to lavish the horse with food will provide the greatest chance of success in nursing the starved horse back to health.

The author of this article for the Equine Disease Quarterly is Clair Thunes, PhD, who can be reached at

This article was first published in the Equine Disease Quarterly (EDQ), which is produced by staff at the Gluck Equine Research Center of the University of Kentucky, and funded by Underwriters at Lloyd’s, London. 

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