NSC and ACTH - Double Trouble in the Fall

Horse showing typical stance of a horse with laminitis
Horse showing typical stance of a horse with laminitis Pooring Studio

Horses are more likely to suffer from laminitis in the fall than any other time of year. Two reasons – high NSC (non-structural carbohydrates) from cooler nighttime temperatures and increased blood ACTH (adrenocorticotropic hormone) secretion from the pituitary gland. Both of these lead to elevated insulin.

Protecting horses from laminitis

Protecting horses from laminitis

Horses are more likely to suffer from laminitis in the fall than any other time of year for two reasons - high non-structural carbohydrates from cooler nighttime temperatures and increased blood ACTH secretion from the pituitary gland.

Insulin rise = laminitis

Simple sugars (denoted as ethanol soluble carbohydrates – ESC, on your hay analysis report) along with starch are digested down to glucose. Once glucose enters the bloodstream, it signals the pancreas to produce insulin. Elevated insulin is the most common cause of laminitis. It stimulates the production of “insulin-like growth factors” within the hoof’s laminae, resulting in proliferation of the epidermal layer.

The laminae have two intermeshed layers, the epidermal and the dermal layers. When the epidermal layer lengthens and stretches with uncontrolled growth, it can weaken the laminae. This can lead to a structural failure by compromising the connection of the coffin bone to the hoof wall, creating a gap between the wall and the sole. You may see some hemorrhaging under your horse’s foot - an indication of laminitis.

Insulin also rises due to the normal hormonal cascade initiated by stress. Stress can take many forms. Intense exercise, mental discomfort, pain, or an empty stomach (there should always be a steady flow of forage through the digestive tract) cause the pituitary gland to release ACTH.

ACTH signals the adrenal gland to produce the stress hormones cortisol and epinephrine, both of which are needed to release glucose, for energy, out of glycogen stores in the liver and muscle. Glucose from liver glycogen stimulates the pancreas to secrete insulin. The healthy body has a homeostatic mechanism to maintain these hormones within a normal range.

However, all horses, regardless of health status, experience a rise in ACTH between August and November (in the northern hemisphere). This seasonal rise can negatively impact the already insulin-resistant horse by further increasing inflammatory insulin, potentially leading to a laminitis attack.

NSC or ESC+Starch?

Both! Any condition that is influenced by elevated insulin (such as Metabolic Syndrome or equine Cushing’s disease) needs to be managed by feeding a forage source that has a low level of ESC (simple sugars) plus starch. It is best for this sum to be less than 10 - 11% on a dry matter basis[i].

However, there is another cause of laminitis that is not endocrine-related, requiring us to look at NSC. NSC equals the sum of WSC (water soluble carbohydrates) and starch. WSC includes ESC as well as an indigestible polysaccharide known as fructan.

Systemic sepsis can occur from too much fructan in the hay or pasture. The horse does not produce the digestive enzymes needed for fructan digestion in the small intestine (foregut); therefore fructan ends up in the hind gut (cecum and large colon) where it can be fermented to lactic acid by the microbial population. The resulting decline in pH can lead to cecal acidosis and the destruction of beneficial bacteria, causing endotoxins to enter the blood stream.

When these endotoxins reach the hoof, they themselves don’t really cause the problem; what happens instead is that they cause an over activity of specific enzymes called matrix metalloproteinases (or MMP for short). These enzymes are important for normal tissue growth and repair, but when they become overactive, they are destructive, potentially causing laminitis.

Consequently, it is important for the grass to have a low NSC (less than 12 to 13% on a dry matter basis[ii]) to avoid both endocrine-related and sepsis-related forms of laminitis.

NSC can vary with stress

Stress not only affects your horse; it also influences forages. NSC can vary according to temperature, rainfall, and other stressors. However, not all grasses are the same in the way they accumulate NSC. This is summarized in the table below:

Stressors that Affect NSC Level in Grasses and Legumes[iii]


C3 – Cool Season

(Timothy, fescue, orchardgrass, brome, perennial rye, Kentucky bluegrass)

C4 – Warm Season Grasses and Legumes

(Bermuda, Bahia grass, crabgrass, prairie grass, Teff, Tifton, alfalfa, clover, perennial peanut grass)

Cold temperatures (below 41° F; 5° C)

High NSC (mainly as fructan) until stem base is no longer green


Low NSC (virtually no fructan); Dormant

Warm temperatures

Lower in NSC


High NSC (mainly as starch) in hot weather.

Light intensity

NSC is lowest in early morning if night was warm enough (above 41° F, 5° C) to allow for the plant to utilize sugars produced the day before. NSC will be highest in the late afternoon on a sunny day. Cloudy conditions or grass grown in the shade reduces NSC accumulation.



Lack of water for more than 5 days will increase NSC. NSC of new shoots will be high after it rains following a period of drought.


Excessive grazing or mowing

Accumulate NSC. Mow only low enough to remove seed heads.

Safety guidelines:

  • When the nighttime temperature remains below 41° F (5° C) for 2 to 3 weeks, cool season grasses are high in NSC, even in the daytime. Wait until the base of the stems are no longer green. If they remain green throughout the winter, consider testing your pasture. Please see article, Testing Your Pasture for Peace of Mind:  http://gettyequinenutrition.biz/library/testingyourpastureforpeaceofmind.htm
  • Warm season grasses go dormant and do not accumulate NSC once cool weather sets in.
  • If the nighttime temperature remains above 41° F (5° C), the NSC will be lowest in early morning until approximately 10:00 am and then again at night, starting a few hours after the sun sets.
  • During times when the horse is not on pasture, allow the horse to graze free-choice on appropriately low-NSC hay. Slow feeders work very well for these situations.

Bottom line

Insulin resistant (IR) horses should be removed from pasture in climates where the nighttime temperatures start to get cold. Furthermore, ACTH increases during the early fall, increasing the risk for laminitis especially in IR and cushingoid horses. Test your hay for suitability and feed it free-choice to avoid stress during those times when pasture must be restricted.

Note by EquiMed Editor: This is a reposting of Dr. Getty's article posted Wed October 04, 2017

Juliet M. Getty, Ph.D. is an internationally respected, independent equine nutritionist who believes that optimizing horse health comes from understanding how the horse’s physiology and instincts determine the correct feeding and nutrition practices.

Dr. Getty’s comprehensive resource book, Feed Your Horse Like a Horse, is available at Dr. Getty’s website, www.gettyequinenutrition.com, as well as from Amazon (www.Amazon.com) and other online book retailers. The seven separate volumes in Dr. Getty’s topic-centered “Spotlight on Equine Nutrition” series are also available at her website, where Dr. Getty offers special package pricing, and from Amazon (in print and Kindle versions) and from other online retailers.

Dr. Getty’s website, www.gettyequinenutrition.com, offers a generous stock of free, useful information for the horseperson. Sign up for her monthly newsletter, Forage for Thought; browse her library of reference articles; search her nutrition forum; and purchase recordings of her educational teleseminars. Plus, for the growing community of horse owners and managers who allow their horses free choice forage feeding, Dr. Getty has set up a special forum as a place for support, celebrations, congratulations, and idea sharing. Share your experiences at jmgetty.blogspot.com. Reach Dr. Getty directly at gettyequinenutrition@gmail.com.

by Juliet M. Getty, Ph.D.

[i] I prefer to look at the as-sampled column since this is what the horse is actually eating. ESC+Starch should be less than 10% on an as-sample basis, but for the typical hay with 93% dry matter, this equates to 11% ESC+Starch on a dry matter basis. NSC should be less than 12% on an as-sampled basis, equating to 13% NSC on a dry matter basis. For pasture, it is best to either look at the dry matter column, or multiply it by 93% to make it comparable to hay with 93% dry matter.

[ii] See note above.

[iii] Adapted from two sources by Watts, Kathryn A.: (1) 2010, Pasture Management to Minimize the Risk of Equine Laminitis, Veterinary Clinics Equine, 26, 361-369; (2) 2004, Forage and Pasture Management for Laminitis Horses. Clinical Techniques in Equine Practices, 31(1), 88-95.

About the Author

Juliet M. Getty, Ph.D.

Author picture

Juliet M. Getty, Ph.D. is a specialist in equine nutrition whose philosophy is founded on feeding a horse in sync with his natural needs and instincts. Dr. Getty is the author of the comprehensive resource, Feed Your Horse Like A Horse, and her articles and interviews often appear in national and international publications.