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Turns Out, Milkshaking May Not Do Much For Performance After All

Despite its use by trainers looking for an edge since the 1980s, a new study has suggested that the process of “milkshaking” a horse may in fact do nothing to enhance performance. A study published in September in the Journal of Equine Science rounded up previous research trials looking at the use of sodium bicarbonate in Thoroughbred and Standardbred racehorses.

The research team looked at seven randomized and controlled trials that spanned 74 horses and had been published in peer-reviewed journals. Horses were given sodium bicarbonate between two and a half and five hours ahead of exercise and had their results compared to control horses who did not get sodium bicarbonate. Exercise took different forms in different trials; sometimes the two groups of horses were put on a treadmill while in others they worked over the track. Both the time to exhaustion and performance were measured, and researchers could not find that the administration of the “milkshake” improved either factor in a statistically significant way. In fact, for treadmill exercises where time to exhaustion was measured, milkshaked horses actually performed slightly worse than their controls.

Sodium bicarbonate, usually given in the form of baking soda mixed with some sort of liquid, is typically given through nasogastric tube within hours of race time. It has long been believed by horsemen that the baking soda acts as a neutralizer of lactic acid, which is responsible for the feeling of achey or tired muscles during exertion.

For lead author Dr. Joshua Denham, lecturer in exercise science at RMIT University, the findings were not a surprise.

“Some recent reviews on the influence of sodium bicarbonate on endurance performance in humans have emphasized equivocal findings,” said Denham. “Given we know humans are prone to placebos, I was always skeptical about its utility as an ergogenic aid.”

Milkshaking has been banned within 24 hours of a race by most racing authorities, but the study suggests it “remains an issue in modern horse racing.” TCO2 tests, designed to pick up on the administration of sodium bicarbonate, are part of the standard pre-race testing procedures in most states, though not all horses in all races are tested in some places.

Besides being an uncomfortable and apparently unnecessary procedure, milkshaking can be dangerous if it goes wrong. In addition to potential gastric upset and possible injury to the nose and throat that can happen during tubing, an inexperienced practitioner can also send the tube down the trachea rather than the esophagus, sending the sludgy solution into the horse's lungs instead of the stomach.

It's not totally clear why people first began milkshaking horses, except that sodium bicarbonate ingestion was at one time thought to improve human athletic performance. The study authors note however that previous research shows this improvement at exercise periods of around four minutes in people, while flat races are significantly shorter. Of course, it's also possible human test subjects may have been influenced by a placebo effect.

“Although it's certainly not my area of expertise, I'm tempted to speculate that early positive findings in humans prompted trials in racehorses,” said Denham. “Some positive results may have occurred by chance or because the trials were always going to show positive results – whether it was on purpose or not. It reminds me of the church bell fallacy: Although one church bell rings at noon and another a block over rings one minute later, the first bell ringing did not cause the second one to chime. Once someone believes in something, it can be easy for them to pass on that information – whether it is accurate or not.”

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Can A Horse That Has Had EPM Have A Relapse?

Equine protozoal myeloencephalitis (EPM) is a potentially devastating disease caused by a protozoa that horses ingest. Once the horse has been infected, the organisms can migrate to the central nervous system, causing inflammation and tissue damage to the spinal cord and brain.

A horse that has EPM can be incoordinated, lame or weak. Treatment involves the use of antiprotozoal or antiparasitic medication like diclazuril, ponazuril or sulfadiazine and pyrimethamine. These can reduce or eliminate the signs of EPM. Most cases of EPM respond to treatment, but horses may need more than one round of treatment weeks or months after their initial treatment.

EPM-causing protozoa are good at evading the immune response and surviving immune attacks, which makes them hard to eradicate. Additionally, a horse's immune response in the central nervous system is not as strong, additionally complicating treatment. Because of this, horses that have had EPM can relapse, though it is unclear how often this happens. One study showed a relapse in about 8 percent of horses within 90 days after the initial EPM treatment concluded. Evidence of relapses after longer periods of time also occur.

Multiple factors are involved in an EPM relapse, including the dose and type of drug used, as well as the variability of the individual horse to clear the organisms. A veterinarian caring for a horse that has another episode of EPM should investigate lengthening the duration of treatment.

Abdominal Surgery Poses Greatest Risk Of Surgical Site Infection

As with human surgery, there is always a potential for infection during equine surgery, Drs. Kelmer, Paz, Tatz, Dahan, Bdolah-abram and Oreff reviewed 198 post-operative complications related to surgery procedures on 167 horses at the Koret School of Veterinary Medicine in Israel over a 15-month period.

The study reviewed 40 percent abdominal surgeries, 30 percent orthopedic surgery and the rest were general surgeries that had a 9 to 20 percent chance of developing a surgical site infection. The incidence of infection was 16.7 percent during the study period.

The study team noted that post-operative surgical site infections created difficulties with recovery, increased the length of stay in the hospital, increased client coats sand delayed return to work. It addition, surgical site infections caused an increase in equine morbidity and mortality.

Of all the surgeries performed, abdominal procedures had the highest risk of infection with 28 percent. This may be because of the length of the incision or the weight of the intestines on the incisions.

The scientists identified the following as factors that increase the risk for a surgical site infection:

Type of surgery.
Having a repeat surgery in less than 6 months in the same area or in an area near the original incision. Abdominal procedures are particularly at risk.
Weight of the horse. Heavier horses have more weight resting on the incision line in their abdomen.
Gender. In the study, only 2.3 percent of stallions developed infections, compared to 16.1 percent of geldings and 24.3 percent of mares; 50 percent of pregnant mares had surgical site complications.
Recovery from anesthesia. A horse that has a hard time recovering from anesthesia may increase his risk of infection development by four times.

Abdominal procedure infection rate ranges from 7 to 37 percent; arthroscopic surgery infection rate was less than 1 percent. Overall infection frequency in orthopedic procedures was around 10 percent.

The team found that other factors may amplify infection risk. These include time of day and season when the surgery takes place; the surgeon; and a horse's breed and age. They also note that as this study looked at cases between 2011 and 2013, surgical techniques, bacterial resistance and bacterial populations have changes, so additional studies are needed.

Brain Waves And Equine Welfare

While not the most widely available diagnostic option, measuring the brain waves of horses shows promise as an objective tool for assessing stress and welfare in horses. Often equine welfare is assessed by how people feel when they find animals in particular situations, rather than on scientific findings, Drs. Nora de Camp, Mechthild Ladwig-Wiegard, Carola Geitner, Jürgen Bergeler and Christa Thöne-Reineke note.

The study team created a pilot study to see if an electroencephalogram (EEG) could be used to objectively measure animal welfare and associated physiological states. An EEG detects electrical activity in the brain. The researchers used three adult horses for the study. The horses were recorded for 30 minutes a day for six days. On each day, they were either resting or placed in stocks for a veterinary treatment, which is stressful to horses.

EEG readings were taken throughout and the videos were assessed on the science-based Horse Grimace Scale. The researchers reported that they were able to see differences in EEG activity between the rest and stress phases of the study, which corresponded with significant changes in the Horse Grimace Scale scores.

They conclude that EEGs may be used as a tool to objectively asses animal welfare and well-being. They note that a crossover into human medicine is also a possibility; EEGs could be used as a tool to help determine the comfort level of people who are unable to actively communicate.

Read the full study here.