Heart of Phoenix’s Re Feeding protocol for Starved Horses

Horses that arrive at a Body Score of 1-3 (or so) are in danger of developing re-feeding syndrome. They are also in danger of colic. Re-feeding Syndrome is a serious, potentially fatal, complication of nutritional restoration. A major cause can include low phosphorus blood levels following intake of foods high in calories or glucose. Phosphorus depletion causes abnormalities in the cardio-respiratory system. Symptoms also develop in response to changes in potassium and magnesium levels. Rapid changes in nutritional intake can place excessive strain on the impaired heart which is then unable to maintain adequate circulation. The liver and the central nervous system are almost always affected also.

Not only is there a risk of this serious metabolic issue that can lead to death, but we believe the risks of losing the horse due to severe starvation increase when re-feeding is done at too slow a rate, because the rescuer is afraid of overfeeding.

This is a very fine line.

One often referred to article on re-feeding comes from UC Davis.

Dr. Stull, PhD, of UC Davis states in ‘Nutrition for Rehabilitating the Starved Horse’ that “when a horse loses more than 50% of its body weight,” so a body score of 1, being the lowest experts recognize on the scale, “the prognosis for survival is extremely poor,”

However, here at HOP, we have been very fortunate that we have lost only 2 very large, senior horses who were body score 1 or less due to the inability of the animals to recover from starvation that was very long term, and these horses arrived in possible organ failure.

This is extraordinary because many, if not most, of our cases have been body scores of 1 (we feel some have truly been .5 having lost not only all body fat, but most muscle, as well).

Our feeding process is very simple, and while different than the recommendations found in some articles, a sizable number of emaciated horses rehabbed successfully prove that, for our horses, it works.

We feel time is short to stabilize a horse coming in at a body score of 1 when you start to “re-feed.” You cannot make mistakes.


The MOST important aspect: We make sure they have  a loose quality mineral and salt (not mixed) from the moment they arrive, even before being offered water (block of salt AND a block of mineral will work if that is all you can offer, but it isn’t recommended by HOP). If these are not there from the beginning, the horse has a much lower chance of survival if she is a body score of 1. We have used CMPK for cattle in critical cases a few times, which is a calcium, phosphorus, magnesium and potassium supplement in the proper absorbable ratios. THIS IS CRITICAL TO UNDERSTAND.

Without quick access to minerals and salt, especially before unlimited water, you can run into serious problems as the horse who is already very deficient in these will flush out the tiny bit they have with all the water they are drinking. This is likely the main reason people lose the starving horse. Calcium, Magnesium, Phosphorus, Potassium and Sodium. Get these into the horse fast in unlimited amounts based on how much they want. We find they always prefer minerals to water during the first hour.

Do not add the salt and minerals to the feed. Leave it separate and free choice.  A horse’s body tells them how much they need to consume when a mineral is lacking. Just as too little mineral can damage a body, too much of certain ones can be detrimental also.

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Obviously, clean water. You wouldn’t believe how denied these horses can be of this basic need which is why they are apt to drink copious amounts of water. Minerals BEFORE or at the same time as WATER.

Then we offer free choice, good quality, grass hay. We personally do not limit hay here at all. We do not do small feedings of hay. Others suggest this, but it has never been how we rehab. Access to grass in our region has proven very safe, as well, even from the start of rehab.

We start almost all of our horses out within the first few days of intake with a dental float. No matter the weight of the horse, the teeth are done right away. We do a fecal, and by 10-14 days, we have begun a safe de-worming process.

We use probios paste or the probiotic powder for probiotic in the gut daily.

Depending on condition, overall brightness and vet check, we will begin to introduce a no molasses / no corn type of low starch feed, something low grain in base, high in forage, a handful twice a day, in 7-14 days. If we feel grain is still too much, we will do soaked alfalfa pellets instead. Soaked alfalfa is safe, in our experience, from day one.

We do not usually use weight gain products. We almost never see any need. No need to rush the gain with supplements behind solid nutrition.

The best thing for a horse to achieve optimal weight, after teeth are addressed, is free choice forage/hay (seniors or those with dental issues or other health conditions are exceptions). We want a slower, steady weight gain.

Forage is the foundation of rehab and equine nutrition as time goes on.

Grain selection is based on the age of the horse and health factors like whether the horse would be a hard or easier keeper, whether we are dealing with ulcers, etc.

For feeds, we generally like pellets without high molasses content(and this is what a horse Should be fed), but that said, grain choices for stable horses well into rehab vary foster location to foster location.

Generally, think of grain or concentrate as a small part of the diet of the rehabbing horse.