April 8, 2025 • 22 mins
Could your horse be vitamin E deficient without you knowing it? New research suggests this vital nutrient deficiency might be far more common than we realize, even in horses with access to fresh pasture.
Drs. Amy Johnson and Megan Palmisano join Veterinary Vertex to discuss their groundbreaking study examining vitamin E concentrations in hospitalized horses. They share a stunning revelation: approximately 17% of adult horses and 5% of foals arrived at their hospital already deficient in vitamin E, despite coming from the nutrient-rich mid-Atlantic region. Most surprising, these deficiencies occurred across different management styles, suggesting this problem transcends typical risk factors.
As Dr. Johnson explains, vitamin E deficiency has serious implications, particularly for neurological health. Her work as a neurologist revealed connections between vitamin E deficiency and devastating conditions like equine motor neuron disease, equine neuroaxonal dystrophy, and equine degenerative myeloencephalopathy. The researchers initially hypothesized that hospitalization might worsen vitamin E status by restricting access to green forage, though their findings suggest short hospital stays don't significantly impact levels.
The conversation delves into practical aspects every horse owner should know: the importance of testing individual horses rather than assuming herd status, proper handling techniques for blood samples to prevent false readings, and recommendations for seasonal testing schedules. Perhaps most critically, they emphasize that horses at the same farm eating identical diets can have dramatically different vitamin E statuses.
For veterinarians and owners alike, this episode offers vital perspective on an often-overlooked aspect of equine nutrition that could prevent serious neurological disease. Understanding your horse's vitamin E status through regular testing and appropriate supplementation when needed provides a simple but potentially life-changing intervention for their long-term health.
Listen, share, and leave us a review to help more horse owners discover this essential information about equine vitamin E requirements!
Open access JAVMA article: https://doi.org/10.2460/javma.24.09.0590
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Wellness Pet Foods (00:01):
Mealtime is more than a bowl of food.
It's the foundation for a longand healthy life.
At Wellness, dry recipes arecrafted with the highest quality
natural ingredients for a tastethat pets love and
scientifically proven throughAFCO feeding trials to ensure
that every complete and balancedmeal supports the five signs of
wellbeing.
With Wellness Pet Foods, petparents can share a life of
(00:25):
well-being together with theirpet.
Sarah Wright (00:31):
This is Veterinary Vertex, a podcast of the AVMA
Journals.
In this episode we chat aboutvitamin E concentrations in
hospitalized adult horses andfoals with our guests Megan
Palmisano and Amy Johnson.
Lisa Fortier (00:44):
Welcome to Veterinary Vertex.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Today we have Megan and Amyjoining us.
Thank you, guys, so much forbeing here on Veterinary Vertex
today and Amy for all the timesI ask you about vitamin E in my
own horse.
I appreciate you.
Amy Johnson (01:00):
Thank you both for having us today.
Megan Palmisano (01:03):
Yeah, we're very pleased to be here.
Sarah Wright (01:05):
All right, let's trot on over.
So, Amy, your JAVMA articlediscusses vitamin E
concentrations in hospitalizedadult horses and foals.
Please share with our listenersthe background on this article.
Amy Johnson (01:18):
So we know that vitamin E is a really essential
vitamin or nutrient for horses.
It provides antioxidant supportto the body, but especially to
the nervous system as well asthe muscles, and deficiencies
can adversely affect health.
We also know that horsesprimarily get their vitamin E
(01:40):
from green forage, so pastureturnout and good quality hay.
When we have horses that arehospitalized, we often don't
provide them with green pastureturnout and while we'd like to
think we provide good qualityhay in the hospital, sometimes
we intentionally hold them offfeed if they come in for an
abdominal problem or somethinglike that.
(02:00):
So, we became interested inwhether or not we were actually
creating a vitamin E deficiencyin these hospitalized horses
when we were not providing themwith pasture turnout and maybe
holding them off feed for aperiod of time during their
hospitalization.
We know that that does occur inhospitalized people that
(02:25):
they're not provided with foodsources that are rich in vitamin
E.
During hospitalization, andeven within a couple of days,
they can develop deficiencies.
The effect of this overall ontheir recovery and prognosis
isn't clear, but we wereconcerned that we might be
setting these horses up forfuture problems and if we needed
to supplement them duringhospitalization, we wanted to
know that.
Sarah Wright (02:46):
Super cool research question and really
cool study as well, so thank youfor sharing it with us.
So, Megan, what are some of theimportant take-home messages
from this JAVMA article?
Megan Palmisano (02:59):
Yeah, so I think that there's a few
important take-homes from thisarticle.
I think the first is thatvitamin E deficiency is
prevalent in horses.
So, even without thinking abouthospitalization, this study was
performed in a prettyvitamin-rich area.
We were in the mid-Atlantic,where most of our patients were
coming from, and we found thatthere is like almost 17% of
(03:20):
those adult horses thatpresented on emergency were
deficient and about 5% of thefoals that presented were
deficient.
So I think that's one of the bigtake-homes, and I think second
was that obviously the goal ofthe study was looking at how
hospitalization potentiallyimpacted the vitamin E
concentrations in these horsesand so, over that approximate
(03:40):
like week-long stay that we sawin the patient population, it
did not appear that there wasany significant decline in
vitamin E.
But I think this alsohighlights a lot that we don't
know about vitamin E, becauseobviously there are bodily
stores of vitamin E in multipledifferent organs, and so is it
something that they're doing agood job of regulating while
(04:03):
they're not provided thesesources.
It's definitely something thatwe don't necessarily know.
Lisa Fortier (04:10):
It's highly, highly under-acknowledged in the
general equine population forsure.
And Amy, I know you know for along time you've been interested
in vitamin E.
I'm interested in a couplethings.
What initiated that?
I'm going to guess it was oneperson and one disease.
And second, you said we hadthis question.
How did that question come up?
(04:31):
Like, how is this different?
What are we doing in thehospital?
Like I'm just curious.
What sparked that question?
Amy Johnson (04:37):
Sure, so I mean vitamin E in general.
I, as you know, I'm aneurologist and I learned from
Sandy De La Hanta at Cornell andTom Divers and Husni Mohamed,
and they were all veryinstrumental in discovering this
neuromuscular disease equinemotor neuron disease that is
very strongly linked to vitaminE deficiency in adult horses.
(04:59):
And the interesting thing to meabout the evolution of this is
that we saw a number of caseswhen I was up at Cornell.
I don't really want to datemyself, but we'll say I don't do
that.
Lisa Fortier (05:11):
I just said a long time I didn't date you.
Amy Johnson (05:15):
And then when I came down here to Pennsylvania
to start working, I felt like weweren't seeing a lot of vitamin
E associated disorders and Iattributed that to better
commercial diets and supplements.
And the weather down here is alittle bit more temperate than
the weather in Ithaca, so maybethe pastures are a bit better,
maybe the hay quality isdifferent, and I really, for a
(05:37):
period of time, was notdiagnosing very many diseases
associated with vitamin Edeficiency.
But then things seemed to changeand whether it was just that we
weren't looking for thedeficiency before or the
incidence has increased is alittle bit unclear to me.
But certainly as we startedlooking, we were recognizing
(05:59):
horses with neurodegenerativediseases that have a strong
association with vitamin Edeficiency.
So these are things like equineneuroaxonal dystrophy and
equine degenerativemyeloencephalopathy.
These are conditions where thebrain and the spinal cord are
(06:20):
having these neurons that aredying for slightly unclear
reasons, which is beyond thescope of probably this podcast.
But we know for those diseasesthat vitamin E is a risk factor
and we started checking moreoften horses in this area and
recognizing that, despite myperception of really excellent
(06:40):
management of these horses andpasture exposure and turnout
that we were catching, some thatwere deficient in vitamin E,
which made us measure more andmore of them, and so I'm
realizing, as time goes on, thatthis actually still is a
problem for our equinepopulation.
It's something that we need tobe concerned about, it's
something that we need toaddress, and hopefully that will
(07:02):
allow us to reduce theincidence of these
neurodegenerative diseases thatcan be so devastating for horses
and their connections.
Lisa Fortier (07:11):
And the second part of that question, Amy, was
what really made you think huh,I wonder what's happening in the
hospital.
Amy Johnson (07:18):
Really some discussions with Carrie Finnell,
actually at UC Davis, who'salso very interested in vitamin
E and has done some work invitamin E dynamics, and I
realized how quickly levels canchange in an individual animal.
They can increase very quicklywith supplementation and they
can also decrease fairly quicklyif it's not provided to horses.
(07:42):
I mean, obviously they domaintain some body stores, but
it seems like more labile than Imight have predicted before.
I started reading moreliterature about this and again,
we understand that vitamin Edeficiency is a risk factor, but
we don't necessarily know whenin the horse's life this
(08:06):
deficiency is occurring and whyit's occurring.
So sometimes we have horsesthat have a history of being
born or raised in areas wherethey didn't get pasture turnout,
and those cases are easy.
But we hypothesize that for somehorses maybe the deficiency
isn't because of the way thatthey're managed at home.
Maybe they did have somecritical illness that caused a
(08:28):
lot of oxidative stress to theirbody and so they were actually
using up all of theirantioxidant stores and they had
a higher.
You know, they might have ahigher body requirement for
vitamin E, and so in a referralhospital like where we work, we
see some of the sickest horsesthat probably have the most
critical illnesses and the mostoxidative stress, and I worry
(08:53):
that maybe we were setting thesehorses up for future problems
if we weren't addressing avitamin E deficiency while they
were in the hospital, eitherbecause they weren't getting
enough vitamin E in the dietthat we were providing to them
during hospitalization, or theywere using up their antioxidant
capacity fighting their disease.
Lisa Fortier (09:13):
Yeah, very elegant study, Megan.
Earlier, Sarah and you had alittle discussion about what
were some of the most importantfindings, and always when we do
these studies we find somethingthat really surprised us.
What are one or two things thatreally surprised you and Amy in
this article?
Megan Palmisano (09:30):
Yeah, so I think one of the things that
surprised us the most wasactually the main findings of
this study.
I think we both had anticipatedthat, even over an average
duration of hospitalization, soif we're thinking somewhere
between five and seven days thatwe would see significant
declines in vitamin E in thispopulation Because, as Amy had
(09:51):
spoken about earlier, in humansthere's actually a lot of,
there's a lot more literatureout there about vitamin E and
its importance in criticalillness.
So humans that are beingpresented to the emergency room
or are potentially onventilators, those patients are
actually found to besignificantly deficient in this
(10:12):
important micronutrient, and soI think that that was the first
surprising finding is that wedid not find this significant
decline in vitamin E.
I will say our patientpopulation.
There definitely was a lot ofhorses who were on vitamin E, so
I think some of those horseswho were in hospital for longer,
as Amy said, it's definitelybecoming a more popular finding,
(10:36):
and so I think in some of thosecases we were supplementing
horses because obviously it hasso many beneficial properties.
So, I think that thatdefinitely could have also
played into that.
And then another thing that wassort of interesting that we
don't really have a great answerfor yet was when we were
looking at the foal populationand so, looking at those foals
(10:58):
that presented, there was anumber of them that were
deficient on admission, but weactually found that there was an
inverse correlation between thevitamin E concentrations in
these foals and whether or notthey had failure of transfer, of
passive immunity, which I thinkis really really odd and
interesting, and I don't havereally a great understanding as
(11:20):
to why this is.
We had hypothesized maybe thishad to do with our really
proactive referringveterinarians in the area and
that we don't know thecomponents of plasma that's
administered.
And so if they're seeing a foalbefore referring to a hospital
and they have these concerns,maybe they provided plasma to
these foals and maybe that wassomething that influenced their
(11:42):
vitamin E status.
But I think that this isdefinitely something that just
shows there's a lot we we don'tknow about this important
nutrient.
Sarah Wright (11:51):
They definitely teed me up well for our next
question here, Megan, as far aswhat are the next steps of
future research?
Sounds like there's a lot ofhypotheses, a lot of great
research questions, so what areyou going to do next?
Megan Palmisano (12:01):
Yeah, so so.
Yeah, so I do think that there'sa lot of different avenues that
can be investigated withvitamin E.
I think one of the ones thatAmy and I have talked about is
obviously the area we performedthis study was an area that is
actually not deemed to be toodeficient in vitamin E, and so I
(12:21):
think one of the things that wewould be interested in looking
at further is investigatingvitamin E concentrations in
areas of the country that areknown to be more deficient, so
areas that have less greenpastures, more desert areas or
arid areas.
I think that's possibly one areato explore, and then I think
(12:43):
another, another big area is theimportance in these vitamin E
concentrations in the foalpopulation.
So, as you said, Carrie Finnohas done a lot of work
investigating this area, inparticular, with specific
neurologic diseases that we haveexamined in horses, but I think
(13:05):
that there's a lot we don'tknow about.
When is this critical periodand what is the insult that
ultimately might play a factorin development of these diseases
as well.
And so, and I think metabolismis a big area that needs further
investigation as well Just howthe body, how the bodily stores
of vitamin E, how horses areable to one kind of mobilize
(13:25):
those stores.
And two, whether or not actualmetabolism plays a role in any
of these horses that aredeficient.
Sarah Wright (13:33):
Well, it sounds like there's a lot of future
research that you have on yourplate, so we look forward to
hopefully receiving some moremanuscripts from you.
So, AI is definitely a very hottopic.
We're hearing about it in alldifferent sorts of avenues and
fields in the world, butspecifically for this research
topic, do you see a role for AIin this area of research Amy?
Amy Johnson (13:50):
I mean, the short answer is yes.
Am I going to lead the AIcharge?
Maybe not, but I think that AIis much better at handling
really large data sets than I am, and so, of course, we did
research during one season atone hospital in one area of the
country with a relatively smallnumber of patients compared to
(14:14):
some of the huge human studieson topics like this.
So, it would be really nice touse some kind of AI technology
I'm going to leave it loose thatcan kind of accumulate the data
.
There are several different labsin the United States that are
routinely measuring vitamin Econcentrations and probably have
the data for the signalment ofthe horse and the area of the
(14:37):
country where the sample iscoming from and to process that
information and look for trends.
So are there differencesbetween different regions of the
country?
Are there differences betweenseasons?
In the winter, when horsesdon't have access to pasture as
much, or at least the grassisn't growing, do they need
supplementation during thewinter but not during the summer
(14:58):
, and does that change dependingon where the horse is housed?
Are there certain breeds thatare much more likely to have a
low vitamin E level and shouldbe supplemented?
I think that, again, acquiringone of these kind of massive
data sets and then having acomputer look for the trends
will provide us with a lot ofinformation that would be simply
impossible for me to do with aspreadsheet on my computer.
Sarah Wright (15:22):
Yeah, I think it's a pretty common theme
throughout veterinary medicine,no matter what species you work
with.
As always, we sometimes havelow sample sizes, so definitely
be super interesting.
And for those of you justjoining us, we're discussing
vitamin E concentrations andhospitalized adult horses and
foals with our guests Megan andAmy.
Lisa Fortier (15:39):
Megan, how did your training or previous work
help you to design the study,complete it and then write this
article?
Megan Palmisano (15:53):
Yeah, so I mean , I'm still pretty early on in
my career, so I was reallyfortunate to have the mentorship
during my residency that hasreally helped me with projects
like this.
So I know I had spoken with Amyabout wanting to get involved
in this project and together wewere able to modify the study to
try and get the mostinformation out of it.
So that's where we startedadding in foals that we're
(16:13):
presenting to the hospital aswell.
So I think a big thing for meis just having the mentorship
that I had during my residency.
But any previous researchexperience that I've had
throughout my internship andthroughout my residency has all
helped a lot.
Sarah Wright (16:29):
So just exploring the literature and getting that
exposure- Now, this next set ofquestions is going to be very
important for our listeners, andthe first one is going to deal
from the veterinarian'sperspective.
So, Megan, what is one piece ofinformation the veterinarian
should know about vitamin Econcentrations in hospitalized
adult horses and foals?
Megan Palmisano (16:50):
Yeah, so I think the big one is that,
although we ultimately did notfind any significant decline in
vitamin E concentrations inthose hospitalized horses, I do
think that vitamin E can stillbe a really beneficial
supplement, especially in thesehospitalized patients that we
have concern for neurologic orneuromuscular disease or
(17:11):
potentially have any sort ofongoing oxidative damage, since
we do know it is a really potentantioxidant.
Sarah Wright (17:18):
Very well said.
And Amy on the other side ofthe relationship, what's one
thing clients should know aboutthis topic?
Amy Johnson (17:25):
To me, the most important kind of result of this
study was that 17% of theadults came in with a deficiency
, in an area where deficiency isnot thought to be that common,
and so I think it's reallyimportant for clients not to
assume that their horse has anadequate vitamin E status and
they need to test the individualhorse.
(17:45):
We haven't mentioned thisbefore, but it's not unusual
that we have multiple horses atthe same farm and some of them
have adequate status and some ofthem are low, so you can't
generalize and just test onehorse in a barn and then assume
everybody's doing okay.
It's really important to testthe individual horse and not
assume that they have adequatestatus, because, although it
(18:05):
costs money, supplementation ispretty easy and it's well
accepted by most horses, and youmay be saving yourself a lot of
heartache down the line if youcan prevent some of these
problems from developing.
Lisa Fortier (18:18):
Well, we're on the topic of testing.
Amy, how often do you recommendthat people test their horses
for vitamin E levels?
Amy Johnson (18:24):
So, I think that once a year testing if the horse
is normal is probably adequate,although I've dabbled in the
idea of whether we need to doseasonal testing and test them
once during pasture turnout inthe summer and then once again
in the winter when they'reeating more of a hay-based diet,
and certainly if the horse ison the low end of normal and not
(18:46):
being supplemented in thesummer.
You know, if they have kind ofborderline adequate status, I
would either supplement thathorse throughout the winter or I
would check again to make surethat that horse isn't dropping
into what we consider aninadequate level during the
winter months.
Assuming you're in an area thathas a summer and a winter.
Lisa Fortier (19:06):
Well, you know where I am in Ithaca.
I've started wrapping it into atwice-a-year glucose test as
well, just to get a baseline onwhere my metabolic fat horse is,
or anybody in the barn.
So, thank you for that advice.
Amy Johnson (19:22):
Yeah, that makes sense.
Lisa Fortier (19:24):
Amy there's a couple other tips and tricks for
veterinarians when they'redrawing blood on how to make
sure that it's stable and todecrease false levels of vitamin
E.
Can you remind the listeners ofthose tips and tricks that you
know about that?
We might have forgotten.
Amy Johnson (19:37):
Yeah absolutely so.
We usually collect our sampleinto a red top or a no additive
tube, and there are a couple ofimportant things about handling
the sample.
The first is to make sure thatthe blood doesn't sit on the
stopper.
So, you don't want to invertthe sample and balance it on the
stopper, because it willactually leach or bind vitamin E
(19:57):
that's in the sample and it canfalsely decrease the measured
vitamin E concentration.
The other thing is that naturallight will do the same thing,
so you wouldn't want to leave atube you know in the cup holder
of your truck in the sunlightafter pulling it.
Ideally it is kept out of lightand it's placed into a
refrigerator shortly aftercollection.
(20:19):
And if you have a severelyhemolyzed sample, you should
probably draw that one againrather than submit a hemolyzed
sample.
Lisa Fortier (20:28):
Who would store something in the cup holder in
their truck, guilty as charged?
Thank you for those remindertips.
As we start to wrap up a littlebit, we like to ask a more fun
question.
So, we'll ask Megan first, andthen Amy to follow If you could
have a superpower, what would itbe and why?
Megan Palmisano (20:46):
I think I'd go with the ability to teleport.
I think that would make myday-to-day life much easier and
also would make it reallyconvenient to just kind of go
wherever I would like to go.
Lisa Fortier (21:01):
Sure would have helped me yesterday in the
snowstorm in Ithaca.
Amy remembers those driverswell.
You're like, literally we weregoing so slow and I drive a
great big pickup truck, as youmight imagine, right, and so
we're going so slow on the roadsit doesn't even register mile
per hour on my speedometer andeverybody's driving with their
flashing lights in the daylight.
I'm like, so I could have useda teleport yesterday.
(21:22):
How about you, Amy, miss thosedays?
Amy Johnson (21:27):
Yeah, it was the snow plows spinning around and
reversing in front of me thatalways made me worried in Ithaca
.
But I'm kind of annoyed, Megan,because you stole mine.
That was the superpower that Iwas going to say is
teleportation 100%.
I have three kids and they'redoing approximately a bajillion
sports that all occur at thesame time in different locations
(21:48):
, and I could really use thosepowers at this stage of my life.
Lisa Fortier (21:53):
Yeah, that's a busy stage.
I actually took chalkboardpaint and painted an entire door
in my pantry so everybody knewwhere everybody was going, they
knew what meals were coming,because you can't do it every
day.
It just consumes way too muchtime to make that planning every
day.
So I feel you, I remember thosedays.
Sarah Wright (22:12):
So it's actually in the 50s in Chicago here today
and we're like it's like springwhat's happening.
So I'll take it while it lasts,but thank you so much, Megan
and Amy, for being here todayand for sharing information
about your article with ourlisteners.
Amy Johnson (22:26):
Thank you so much for having us.
Sarah Wright (22:29):
And to our listeners.
You can read Megan and Amy'sarticle in JAVMA.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.
Mealtime is more than a bowl of food.
It's the foundation for a longand healthy life.
At Wellness, dry recipes arecrafted with the highest quality
natural ingredients for a tastethat pets love and
scientifically proven throughAFCO feeding trials to ensure
that every complete and balancedmeal supports the five signs of
wellbeing.
With Wellness Pet Foods, petparents can share a life of
(00:25):
well-being together with theirpet.
Sarah Wright (00:31):
This is Veterinary Vertex, a podcast of the AVMA
Journals.
In this episode we chat aboutvitamin E concentrations in
hospitalized adult horses andfoals with our guests Megan
Palmisano and Amy Johnson.
Lisa Fortier (00:44):
Welcome to Veterinary Vertex.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Today we have Megan and Amyjoining us.
Thank you, guys, so much forbeing here on Veterinary Vertex
today and Amy for all the timesI ask you about vitamin E in my
own horse.
I appreciate you.
Amy Johnson (01:00):
Thank you both for having us today.
Megan Palmisano (01:03):
Yeah, we're very pleased to be here.
Sarah Wright (01:05):
All right, let's trot on over.
So, Amy, your JAVMA articlediscusses vitamin E
concentrations in hospitalizedadult horses and foals.
Please share with our listenersthe background on this article.
Amy Johnson (01:18):
So we know that vitamin E is a really essential
vitamin or nutrient for horses.
It provides antioxidant supportto the body, but especially to
the nervous system as well asthe muscles, and deficiencies
can adversely affect health.
We also know that horsesprimarily get their vitamin E
(01:40):
from green forage, so pastureturnout and good quality hay.
When we have horses that arehospitalized, we often don't
provide them with green pastureturnout and while we'd like to
think we provide good qualityhay in the hospital, sometimes
we intentionally hold them offfeed if they come in for an
abdominal problem or somethinglike that.
(02:00):
So, we became interested inwhether or not we were actually
creating a vitamin E deficiencyin these hospitalized horses
when we were not providing themwith pasture turnout and maybe
holding them off feed for aperiod of time during their
hospitalization.
We know that that does occur inhospitalized people that
(02:25):
they're not provided with foodsources that are rich in vitamin
E.
During hospitalization, andeven within a couple of days,
they can develop deficiencies.
The effect of this overall ontheir recovery and prognosis
isn't clear, but we wereconcerned that we might be
setting these horses up forfuture problems and if we needed
to supplement them duringhospitalization, we wanted to
know that.
Sarah Wright (02:46):
Super cool research question and really
cool study as well, so thank youfor sharing it with us.
So, Megan, what are some of theimportant take-home messages
from this JAVMA article?
Megan Palmisano (02:59):
Yeah, so I think that there's a few
important take-homes from thisarticle.
I think the first is thatvitamin E deficiency is
prevalent in horses.
So, even without thinking abouthospitalization, this study was
performed in a prettyvitamin-rich area.
We were in the mid-Atlantic,where most of our patients were
coming from, and we found thatthere is like almost 17% of
(03:20):
those adult horses thatpresented on emergency were
deficient and about 5% of thefoals that presented were
deficient.
So I think that's one of the bigtake-homes, and I think second
was that obviously the goal ofthe study was looking at how
hospitalization potentiallyimpacted the vitamin E
concentrations in these horsesand so, over that approximate
(03:40):
like week-long stay that we sawin the patient population, it
did not appear that there wasany significant decline in
vitamin E.
But I think this alsohighlights a lot that we don't
know about vitamin E, becauseobviously there are bodily
stores of vitamin E in multipledifferent organs, and so is it
something that they're doing agood job of regulating while
(04:03):
they're not provided thesesources.
It's definitely something thatwe don't necessarily know.
Lisa Fortier (04:10):
It's highly, highly under-acknowledged in the
general equine population forsure.
And Amy, I know you know for along time you've been interested
in vitamin E.
I'm interested in a couplethings.
What initiated that?
I'm going to guess it was oneperson and one disease.
And second, you said we hadthis question.
How did that question come up?
(04:31):
Like, how is this different?
What are we doing in thehospital?
Like I'm just curious.
What sparked that question?
Amy Johnson (04:37):
Sure, so I mean vitamin E in general.
I, as you know, I'm aneurologist and I learned from
Sandy De La Hanta at Cornell andTom Divers and Husni Mohamed,
and they were all veryinstrumental in discovering this
neuromuscular disease equinemotor neuron disease that is
very strongly linked to vitaminE deficiency in adult horses.
(04:59):
And the interesting thing to meabout the evolution of this is
that we saw a number of caseswhen I was up at Cornell.
I don't really want to datemyself, but we'll say I don't do
that.
Lisa Fortier (05:11):
I just said a long time I didn't date you.
Amy Johnson (05:15):
And then when I came down here to Pennsylvania
to start working, I felt like weweren't seeing a lot of vitamin
E associated disorders and Iattributed that to better
commercial diets and supplements.
And the weather down here is alittle bit more temperate than
the weather in Ithaca, so maybethe pastures are a bit better,
maybe the hay quality isdifferent, and I really, for a
(05:37):
period of time, was notdiagnosing very many diseases
associated with vitamin Edeficiency.
But then things seemed to changeand whether it was just that we
weren't looking for thedeficiency before or the
incidence has increased is alittle bit unclear to me.
But certainly as we startedlooking, we were recognizing
(05:59):
horses with neurodegenerativediseases that have a strong
association with vitamin Edeficiency.
So these are things like equineneuroaxonal dystrophy and
equine degenerativemyeloencephalopathy.
These are conditions where thebrain and the spinal cord are
(06:20):
having these neurons that aredying for slightly unclear
reasons, which is beyond thescope of probably this podcast.
But we know for those diseasesthat vitamin E is a risk factor
and we started checking moreoften horses in this area and
recognizing that, despite myperception of really excellent
(06:40):
management of these horses andpasture exposure and turnout
that we were catching, some thatwere deficient in vitamin E,
which made us measure more andmore of them, and so I'm
realizing, as time goes on, thatthis actually still is a
problem for our equinepopulation.
It's something that we need tobe concerned about, it's
something that we need toaddress, and hopefully that will
(07:02):
allow us to reduce theincidence of these
neurodegenerative diseases thatcan be so devastating for horses
and their connections.
Lisa Fortier (07:11):
And the second part of that question, Amy, was
what really made you think huh,I wonder what's happening in the
hospital.
Amy Johnson (07:18):
Really some discussions with Carrie Finnell,
actually at UC Davis, who'salso very interested in vitamin
E and has done some work invitamin E dynamics, and I
realized how quickly levels canchange in an individual animal.
They can increase very quicklywith supplementation and they
can also decrease fairly quicklyif it's not provided to horses.
(07:42):
I mean, obviously they domaintain some body stores, but
it seems like more labile than Imight have predicted before.
I started reading moreliterature about this and again,
we understand that vitamin Edeficiency is a risk factor, but
we don't necessarily know whenin the horse's life this
(08:06):
deficiency is occurring and whyit's occurring.
So sometimes we have horsesthat have a history of being
born or raised in areas wherethey didn't get pasture turnout,
and those cases are easy.
But we hypothesize that for somehorses maybe the deficiency
isn't because of the way thatthey're managed at home.
Maybe they did have somecritical illness that caused a
(08:28):
lot of oxidative stress to theirbody and so they were actually
using up all of theirantioxidant stores and they had
a higher.
You know, they might have ahigher body requirement for
vitamin E, and so in a referralhospital like where we work, we
see some of the sickest horsesthat probably have the most
critical illnesses and the mostoxidative stress, and I worry
(08:53):
that maybe we were setting thesehorses up for future problems
if we weren't addressing avitamin E deficiency while they
were in the hospital, eitherbecause they weren't getting
enough vitamin E in the dietthat we were providing to them
during hospitalization, or theywere using up their antioxidant
capacity fighting their disease.
Lisa Fortier (09:13):
Yeah, very elegant study, Megan.
Earlier, Sarah and you had alittle discussion about what
were some of the most importantfindings, and always when we do
these studies we find somethingthat really surprised us.
What are one or two things thatreally surprised you and Amy in
this article?
Megan Palmisano (09:30):
Yeah, so I think one of the things that
surprised us the most wasactually the main findings of
this study.
I think we both had anticipatedthat, even over an average
duration of hospitalization, soif we're thinking somewhere
between five and seven days thatwe would see significant
declines in vitamin E in thispopulation Because, as Amy had
(09:51):
spoken about earlier, in humansthere's actually a lot of,
there's a lot more literatureout there about vitamin E and
its importance in criticalillness.
So humans that are beingpresented to the emergency room
or are potentially onventilators, those patients are
actually found to besignificantly deficient in this
(10:12):
important micronutrient, and soI think that that was the first
surprising finding is that wedid not find this significant
decline in vitamin E.
I will say our patientpopulation.
There definitely was a lot ofhorses who were on vitamin E, so
I think some of those horseswho were in hospital for longer,
as Amy said, it's definitelybecoming a more popular finding,
(10:36):
and so I think in some of thosecases we were supplementing
horses because obviously it hasso many beneficial properties.
So, I think that thatdefinitely could have also
played into that.
And then another thing that wassort of interesting that we
don't really have a great answerfor yet was when we were
looking at the foal populationand so, looking at those foals
(10:58):
that presented, there was anumber of them that were
deficient on admission, but weactually found that there was an
inverse correlation between thevitamin E concentrations in
these foals and whether or notthey had failure of transfer, of
passive immunity, which I thinkis really really odd and
interesting, and I don't havereally a great understanding as
(11:20):
to why this is.
We had hypothesized maybe thishad to do with our really
proactive referringveterinarians in the area and
that we don't know thecomponents of plasma that's
administered.
And so if they're seeing a foalbefore referring to a hospital
and they have these concerns,maybe they provided plasma to
these foals and maybe that wassomething that influenced their
(11:42):
vitamin E status.
But I think that this isdefinitely something that just
shows there's a lot we we don'tknow about this important
nutrient.
Sarah Wright (11:51):
They definitely teed me up well for our next
question here, Megan, as far aswhat are the next steps of
future research?
Sounds like there's a lot ofhypotheses, a lot of great
research questions, so what areyou going to do next?
Megan Palmisano (12:01):
Yeah, so so.
Yeah, so I do think that there'sa lot of different avenues that
can be investigated withvitamin E.
I think one of the ones thatAmy and I have talked about is
obviously the area we performedthis study was an area that is
actually not deemed to be toodeficient in vitamin E, and so I
(12:21):
think one of the things that wewould be interested in looking
at further is investigatingvitamin E concentrations in
areas of the country that areknown to be more deficient, so
areas that have less greenpastures, more desert areas or
arid areas.
I think that's possibly one areato explore, and then I think
(12:43):
another, another big area is theimportance in these vitamin E
concentrations in the foalpopulation.
So, as you said, Carrie Finnohas done a lot of work
investigating this area, inparticular, with specific
neurologic diseases that we haveexamined in horses, but I think
(13:05):
that there's a lot we don'tknow about.
When is this critical periodand what is the insult that
ultimately might play a factorin development of these diseases
as well.
And so, and I think metabolismis a big area that needs further
investigation as well Just howthe body, how the bodily stores
of vitamin E, how horses areable to one kind of mobilize
(13:25):
those stores.
And two, whether or not actualmetabolism plays a role in any
of these horses that aredeficient.
Sarah Wright (13:33):
Well, it sounds like there's a lot of future
research that you have on yourplate, so we look forward to
hopefully receiving some moremanuscripts from you.
So, AI is definitely a very hottopic.
We're hearing about it in alldifferent sorts of avenues and
fields in the world, butspecifically for this research
topic, do you see a role for AIin this area of research Amy?
Amy Johnson (13:50):
I mean, the short answer is yes.
Am I going to lead the AIcharge?
Maybe not, but I think that AIis much better at handling
really large data sets than I am, and so, of course, we did
research during one season atone hospital in one area of the
country with a relatively smallnumber of patients compared to
(14:14):
some of the huge human studieson topics like this.
So, it would be really nice touse some kind of AI technology
I'm going to leave it loose thatcan kind of accumulate the data
.
There are several different labsin the United States that are
routinely measuring vitamin Econcentrations and probably have
the data for the signalment ofthe horse and the area of the
(14:37):
country where the sample iscoming from and to process that
information and look for trends.
So are there differencesbetween different regions of the
country?
Are there differences betweenseasons?
In the winter, when horsesdon't have access to pasture as
much, or at least the grassisn't growing, do they need
supplementation during thewinter but not during the summer
(14:58):
, and does that change dependingon where the horse is housed?
Are there certain breeds thatare much more likely to have a
low vitamin E level and shouldbe supplemented?
I think that, again, acquiringone of these kind of massive
data sets and then having acomputer look for the trends
will provide us with a lot ofinformation that would be simply
impossible for me to do with aspreadsheet on my computer.
Sarah Wright (15:22):
Yeah, I think it's a pretty common theme
throughout veterinary medicine,no matter what species you work
with.
As always, we sometimes havelow sample sizes, so definitely
be super interesting.
And for those of you justjoining us, we're discussing
vitamin E concentrations andhospitalized adult horses and
foals with our guests Megan andAmy.
Lisa Fortier (15:39):
Megan, how did your training or previous work
help you to design the study,complete it and then write this
article?
Megan Palmisano (15:53):
Yeah, so I mean , I'm still pretty early on in
my career, so I was reallyfortunate to have the mentorship
during my residency that hasreally helped me with projects
like this.
So I know I had spoken with Amyabout wanting to get involved
in this project and together wewere able to modify the study to
try and get the mostinformation out of it.
So that's where we startedadding in foals that we're
(16:13):
presenting to the hospital aswell.
So I think a big thing for meis just having the mentorship
that I had during my residency.
But any previous researchexperience that I've had
throughout my internship andthroughout my residency has all
helped a lot.
Sarah Wright (16:29):
So just exploring the literature and getting that
exposure- Now, this next set ofquestions is going to be very
important for our listeners, andthe first one is going to deal
from the veterinarian'sperspective.
So, Megan, what is one piece ofinformation the veterinarian
should know about vitamin Econcentrations in hospitalized
adult horses and foals?
Megan Palmisano (16:50):
Yeah, so I think the big one is that,
although we ultimately did notfind any significant decline in
vitamin E concentrations inthose hospitalized horses, I do
think that vitamin E can stillbe a really beneficial
supplement, especially in thesehospitalized patients that we
have concern for neurologic orneuromuscular disease or
(17:11):
potentially have any sort ofongoing oxidative damage, since
we do know it is a really potentantioxidant.
Sarah Wright (17:18):
Very well said.
And Amy on the other side ofthe relationship, what's one
thing clients should know aboutthis topic?
Amy Johnson (17:25):
To me, the most important kind of result of this
study was that 17% of theadults came in with a deficiency
, in an area where deficiency isnot thought to be that common,
and so I think it's reallyimportant for clients not to
assume that their horse has anadequate vitamin E status and
they need to test the individualhorse.
(17:45):
We haven't mentioned thisbefore, but it's not unusual
that we have multiple horses atthe same farm and some of them
have adequate status and some ofthem are low, so you can't
generalize and just test onehorse in a barn and then assume
everybody's doing okay.
It's really important to testthe individual horse and not
assume that they have adequatestatus, because, although it
(18:05):
costs money, supplementation ispretty easy and it's well
accepted by most horses, and youmay be saving yourself a lot of
heartache down the line if youcan prevent some of these
problems from developing.
Lisa Fortier (18:18):
Well, we're on the topic of testing.
Amy, how often do you recommendthat people test their horses
for vitamin E levels?
Amy Johnson (18:24):
So, I think that once a year testing if the horse
is normal is probably adequate,although I've dabbled in the
idea of whether we need to doseasonal testing and test them
once during pasture turnout inthe summer and then once again
in the winter when they'reeating more of a hay-based diet,
and certainly if the horse ison the low end of normal and not
(18:46):
being supplemented in thesummer.
You know, if they have kind ofborderline adequate status, I
would either supplement thathorse throughout the winter or I
would check again to make surethat that horse isn't dropping
into what we consider aninadequate level during the
winter months.
Assuming you're in an area thathas a summer and a winter.
Lisa Fortier (19:06):
Well, you know where I am in Ithaca.
I've started wrapping it into atwice-a-year glucose test as
well, just to get a baseline onwhere my metabolic fat horse is,
or anybody in the barn.
So, thank you for that advice.
Amy Johnson (19:22):
Yeah, that makes sense.
Lisa Fortier (19:24):
Amy there's a couple other tips and tricks for
veterinarians when they'redrawing blood on how to make
sure that it's stable and todecrease false levels of vitamin
E.
Can you remind the listeners ofthose tips and tricks that you
know about that?
We might have forgotten.
Amy Johnson (19:37):
Yeah absolutely so.
We usually collect our sampleinto a red top or a no additive
tube, and there are a couple ofimportant things about handling
the sample.
The first is to make sure thatthe blood doesn't sit on the
stopper.
So, you don't want to invertthe sample and balance it on the
stopper, because it willactually leach or bind vitamin E
(19:57):
that's in the sample and it canfalsely decrease the measured
vitamin E concentration.
The other thing is that naturallight will do the same thing,
so you wouldn't want to leave atube you know in the cup holder
of your truck in the sunlightafter pulling it.
Ideally it is kept out of lightand it's placed into a
refrigerator shortly aftercollection.
(20:19):
And if you have a severelyhemolyzed sample, you should
probably draw that one againrather than submit a hemolyzed
sample.
Lisa Fortier (20:28):
Who would store something in the cup holder in
their truck, guilty as charged?
Thank you for those remindertips.
As we start to wrap up a littlebit, we like to ask a more fun
question.
So, we'll ask Megan first, andthen Amy to follow If you could
have a superpower, what would itbe and why?
Megan Palmisano (20:46):
I think I'd go with the ability to teleport.
I think that would make myday-to-day life much easier and
also would make it reallyconvenient to just kind of go
wherever I would like to go.
Lisa Fortier (21:01):
Sure would have helped me yesterday in the
snowstorm in Ithaca.
Amy remembers those driverswell.
You're like, literally we weregoing so slow and I drive a
great big pickup truck, as youmight imagine, right, and so
we're going so slow on the roadsit doesn't even register mile
per hour on my speedometer andeverybody's driving with their
flashing lights in the daylight.
I'm like, so I could have useda teleport yesterday.
(21:22):
How about you, Amy, miss thosedays?
Amy Johnson (21:27):
Yeah, it was the snow plows spinning around and
reversing in front of me thatalways made me worried in Ithaca
.
But I'm kind of annoyed, Megan,because you stole mine.
That was the superpower that Iwas going to say is
teleportation 100%.
I have three kids and they'redoing approximately a bajillion
sports that all occur at thesame time in different locations
(21:48):
, and I could really use thosepowers at this stage of my life.
Lisa Fortier (21:53):
Yeah, that's a busy stage.
I actually took chalkboardpaint and painted an entire door
in my pantry so everybody knewwhere everybody was going, they
knew what meals were coming,because you can't do it every
day.
It just consumes way too muchtime to make that planning every
day.
So I feel you, I remember thosedays.
Sarah Wright (22:12):
So it's actually in the 50s in Chicago here today
and we're like it's like springwhat's happening.
So I'll take it while it lasts,but thank you so much, Megan
and Amy, for being here todayand for sharing information
about your article with ourlisteners.
Amy Johnson (22:26):
Thank you so much for having us.
Sarah Wright (22:29):
And to our listeners.
You can read Megan and Amy'sarticle in JAVMA.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.
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