Chronic fatigue syndrome in horses – treatment with acemannan

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					Chronic fatigue syndrome in horses – treatment with acemannan

Lack of appetite, weight loss, dull coat, tiring easily after exercise and poor performance are

all signs of chronic fatigue syndrome in horses. This condition was first described in the UK

in 1992 and shares many similarities with chronic fatigue syndrome in humans; it can be as

equally debilitating as its human counterpart and as difficult and troublesome to treat.

       The exact cause of equine chronic fatigue syndrome is not known. It is widely

believed to be associated with viral infection – and hence commonly called post-viral fatigue

syndrome – and there is some scientific support for this. Antibodies to so-called

enteroviruses are found in approximately 80% of affected horses and it has been suggested

that equine herpes viruses may also be responsible in some cases. These viruses appear to

weaken or suppress the immune system in certain horses, resulting in chronic fatigue


       While the symptoms of equine chronic fatigue syndrome range in severity, from a

horse being simply ‘off colour’ to severe illness, it is the persistence of these signs over a

long period of time, in some cases over a year, that is characteristic of the condition. In

addition to the typical signs of a poor or variable appetite, weight loss, tiredness and poor

performance, other symptoms include fever, dry faeces, muscle tremors, and a dry or dull hair

coat. Some horses appear drowsy and apathetic, standing with their head and neck lowered,

eyes closed and taking no interest in their environment. Skin and respiratory infections, as

well as conjunctivitis, can also accompany the condition.

       Blood samples taken from affected animals typically demonstrate a reduction in the

numbers of white blood cells (leucopaenia), and specifically of one subset of white cells

called lymphocytes. Many cases are also anaemic, with lower than normal values for red
blood cells and haemoglobin concentrations. The symptoms of equine chronic fatigue

syndrome are related to anaemia together with weakening of the immune system as a result of

the viral infection. Some viruses, particularly the herpes viruses, may also cause muscle

inflammation and pain that contribute to the illness.

       Diagnosis of equine chronic fatigue syndrome is usually made on the basis of the

clinical signs shown in conjunction with the results of blood tests. Examination of the upper

airways using an endoscope may reveal the presence of secondary bacterial infections and

differentiate the condition from recurrent airway obstruction. The presence of recurrent skin

infections, which respond to antibiotic treatment but simply recur once this has finished, is

also suggestive of suppression of the immune system.

       Treatments for equine chronic fatigue syndrome include rest and vitamin and mineral

supplements to help correct the anaemia. The most important goal of therapy is, however, to

support the repair of the immune system and the regeneration of white blood cells and

lymphocytes in particular. Vets in the UK will typically use the medicines levamisole and

gamma-interferon in an attempt to stimulate the immune system and these help in some but

not all cases. Bacterial products (e.g. EqStim and Equimmune) have been shown to

strengthen the immune system in clinical trials and are available in the USA, but there is as

yet no data on their efficacy in equine chronic fatigue syndrome.

       Arguably the most promising immunostimulant is the plant extract acemannan. This

is a potent anti-viral agent that also has the ability to enhance the immune system and

particularly the function of lymphocytes. It is extracted from the pulp of the meaty leaves of

Aloe Vera plants and in its injectable form is used for the treatment of certain cancers of dogs

and cats. There are a number of user reports of the use of Aloe Vera products in equine

chronic fatigue syndrome, with the authors finding that oral supplementation with Aloe Vera

Gel resulted in significant improvements in health and blood counts.
       ‘Vinnie’ was a 12 year-old gelding, competing at Intermediate level eventing, that

suddenly went off his food, developed a nasal discharge and cough, and had a fever. Blood

samples showed a markedly reduced white blood cell count, almost total depletion of

lymphocytes, and low haematocrit which is a measure of the red blood cells and indicator of

anaemia (Table 1). Initial treatment with antibiotics and a bronchodilator improved Vinnie’s

respiratory condition and subsequent endoscopic examination revealed no significant

abnormalities. A second blood sample taken 4 weeks later showed that the white blood cell

and lymphocyte counts were increased and so Vinnie returned to work.

       Some 3 months later the owner became concerned that Vinnie was not able to cope

with his competition programme and was tiring easily. He performed badly in the cross

country phases of several one day events, with an unusual number of jumping penalties and

retiring afterwards at one event and then on the course in another. Further blood tests on

28/05/07 revealed a lowering of the white blood cell and lymphocyte counts, although he was

now no longer anaemic. These parameters remained low despite treatment with a dietary

copper supplement, levamisole and inteferon over the ensuing 2 months. Vinnie was then

turned out to grass for 3 months, with no ridden exercise.

       Prolonged rest did not improve the blood picture, with the white blood cell count in

particular remaining low, and this did not improve with further rest over the winter months.

In the spring of 2008 the owner Laura Swinnerton and her vet, Dr Tim Watson of the Equine

Veterinary Clinic in Renfrewshire, came across an article on the usefulness of acemannan in

post-viral lethargy syndromes and Vinnie was started on a 6-week treatment with Aloe Vera


       Laura soon noticed an improvement in Vinnie’s demeanour and general condition.

Blood samples taken towards the end of the treatment period on 20/06/08 showed a

substantial improvements in white blood cell and lymphocyte counts, which had more than
doubled during the course of treatment and were now well within the normal range, as well as

the haematocrit. This was accompanied by a transformation in his work, with him being

much more responsive, not tiring and making fewer jumping errors. Vinnie returned to

competitive activities soon after and has continued to perform well.

       Vinnie’s story is typical of many horses with equine chronic fatigue syndrome and

serves to illustrate the frustration that it can cause owners, particularly of competition horses.

Symptoms can persist for a long period of time – in Vinnie’s instance well over 12 months –

and treatment, including prolonged rest, can be ineffective.

       His case also highlights the lack of efficacy of traditional veterinary treatments,

including immunostimulants, but fortunately shows the very positive benefit of acemannan in

the form of Aloe Vera Gel. The 6 week course cost £180 from Karen Lodge, Independent

Distributor of Forever Living Products (please see contact details below) and was backed by

a 60 day money back guarantee that promised a full refund if there was no improvement.

       It is testament to the benefits of acemannan that Laura continues to give Vinnie Aloe

Vera at a maintenance dose and that her vet, Dr Tim Watson, has adopted the treatment as his

principle therapy for horses with equine chronic fatigue syndrome.

For more information on Forever Living Products Aloe Vera Gel, and indeed any of their

products, or if you would like to order product please contact Karen Lodge direct on either

01505 872219/07973 930285 or email at


   1. Aloe Vera plant

   2. Vinnie back to health on the cross country course.
Table 1. White blood cell, lymphocyte and haematocrit parameters in Vinnie over the course
of his illness and treatment.

                         White blood cell      Lymphocyte count         Haematocrit (%)
                         count (x109/L)        (x109/L)

Normal Range             5.4 – 14.3            1.5 – 7.7                32 - 53

18/01/2007 – onset of    3.7                   0.7                      29

13/02/2007 – prior to    4.9                   1.6                      31
return to work

28/05/2007 –             3.6                   1.1                      32
performing badly

22/06/2007 – after       4.5                   1.1                      35
treatment with
levamisole and

07/11/2007 – after       3.3                   1.7                      32
being turned out for 3

25/03/2008 – after       3.1                   1.2                      31
winter off work

20/06/2008 – after       6.8                   2.8                      38
Aloe Vera Gel

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