Feeding a Cushing's Horse: A Low-NSC Diet Guide

Cushing's disease, properly called PPID (pituitary pars intermedia dysfunction), is one of the most common conditions in senior horses, and it changes how you feed. The disease itself is managed with medication from your veterinarian, but the feeding goal is to control the insulin dysregulation that so often comes with it. When a metabolic horse eats too much sugar and starch, insulin spikes, and those spikes can trigger laminitis, a painful and sometimes career-ending or life-ending hoof condition.

That makes a low-NSC, forage-first diet the cornerstone of feeding a Cushing's horse. This guide explains what NSC is, how to build a safe diet around it, and where the common traps are. None of it replaces veterinary care, including the medication and ACTH testing that keep PPID itself under control.

Low-NSC Feeds for a Cushing's Horse

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Low NSC

Triple Crown Low Starch, Low Sugar Horse Feed

$62.99 on Amazon

Fortified low-NSC feed designed for metabolic and senior horses

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Purina WellSolve Low Starch Feed

$62.49 on Amazon

Low-starch, low-sugar pellets for insulin-sensitive horses

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Triple Crown Safe Starch Fortified Forage

$47.99 on Amazon

Grain-free, low-starch chopped forage for laminitis-prone horses

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Standlee Beet Pulp Shreds

$32.99 on Amazon

Low-sugar, digestible fiber that adds safe calories without starch

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Understand NSC, the Number That Matters

NSC, or non-structural carbohydrates, is the combined sugar and starch in a feed or forage. For a horse with PPID and insulin dysregulation, NSC is the single most important figure on any feed tag or hay analysis. High NSC drives the insulin spikes that lead to laminitis, so the entire diet is built around keeping it low. A common target for the total diet is under about 10 to 12 percent NSC, though your veterinarian may set a stricter limit for a horse that has already had laminitis.

Forage First, but Test or Soak It

Forage is still the foundation, but for a metabolic horse the sugar content of that forage matters enormously. Pasture grass can swing very high in sugar, especially lush spring and fall growth, drought-stressed grass, and frosty grass, all of which are risky for an insulin-dysregulated horse. The safest forage is tested low-sugar grass hay. When you cannot have hay tested, soaking it for 30 to 60 minutes leaches out some of the water-soluble sugars, which helps, though results vary. Pour the sugary soak water away from the horse.

Pasture access often has to be limited with a grazing muzzle, a dry lot, or restricted turnout during high-risk periods. Discuss the right grazing plan with your vet based on your horse's insulin testing.

Choose a Low-NSC Feed or Balancer

Most Cushing's horses still need vitamins, minerals, and quality protein that forage alone does not fully supply. The key is to deliver them without sugar and starch. Two good paths:

• Low-NSC fortified feed: Feeds specifically labeled low starch or low NSC provide nutrients and, if needed, calories while keeping sugar and starch down. Always read the tag rather than trusting the senior label alone.
• Ration balancer: For a metabolic horse that holds weight on forage, a low-calorie ration balancer supplies vitamins, minerals, and amino acids in a small daily serving without adding NSC or calories. See our guide to the best ration balancers.

For safe calories when a Cushing's horse needs them, fat sources and unmolassed beet pulp add energy without the metabolic risk of grain.

Cut Out the Hidden Sugar

A low-NSC plan falls apart if sugar sneaks in through the back door. Eliminate sweet feed, plain grain, and molasses-coated products entirely. Watch treats closely: apples, carrots in any quantity, sugar cubes, and molasses-based horse treats all spike sugar. Switch to treats made specifically low in sugar and starch, and keep even those modest. Our guide to the best senior horse treats covers low-sugar options that fit a metabolic diet. Read every label, because many ordinary horse products are sweetened.

Feeding the Older Cushing's Horse With Bad Teeth

Many PPID horses are also senior horses with worn teeth, which means you have to satisfy two needs at once: low NSC and chewability. Soaked low-sugar hay pellets and unmolassed beet pulp do both, giving a soft, low-sugar mash that a worn mouth can manage. A low-NSC complete senior feed can replace forage when chewing fails, as long as you confirm its sugar and starch are appropriate. Build the same soaked, forage-replacement diet described in our toothless horse guide, just with low-NSC ingredients.

Diet and Medication Work Together

It is worth repeating: feeding does not replace treating PPID. The disease is managed with a prescription medication your veterinarian prescribes and monitors through ACTH testing, usually adjusted over time and around the seasonal autumn rise. The low-NSC diet controls the laminitis risk that comes from insulin dysregulation, while the medication addresses the underlying hormonal disease. Paired with regular farrier care to keep the feet healthy, this combination gives a Cushing's horse its best shot at a comfortable, sound retirement.

The Bottom Line

Feed a Cushing's horse a forage-first, low-NSC diet: tested or soaked low-sugar hay, a feed or balancer specifically labeled low starch, safe fat-based calories when needed, and strictly low-sugar treats. Eliminate sweet feed, grain, and sugary snacks, manage pasture carefully, and adapt the diet to soaked forage if teeth are failing. Keep your horse on its prescribed PPID medication with regular vet testing, and let your veterinarian and farrier guide the plan.