Equine metabolic syndrome (EMS) is a collection of factors and events within the horse affected by food, stress, and sleep. This podcast focuses on the fact that behind the top three causes of medical deaths in humans (atherosclerosis/cardiovascular disease, cancer, cognitive disorders) is a metabolic system not functioning to its full potential. Could a poor metabolic system also be causing health issues in horses? I believe it does. In the last podcast (Part One), I overviewed the basics of the ingested materials (air, water, minerals, fats, sugars, and proteins) and what they do within the body. It covered the role of insulin, insulin resistance, and its relationship to metabolic syndrome. I also discussed the secondary diseases of EMS, including laminitis, muscle loss, and others. In this podcast (Part Two), I narrow the discussion to fat storage and its' role in inflammation, mitochondrial flexibility to partition the fuels used in power production, the role of exercise in glucose uptake, and balancing the amount of calories in with calories used. Correct metabolic functioning depends on balancing food consumed (as calories in) with using that food (as calories used). When this balance is heavy on the food eaten, metabolic syndrome follows with its associated illnesses, breakdowns, and early death. But if the balance goes the other way (excess work, stress, poor sleep, or absence of food), death will occur, too. Healthspan and longevity come from a perfect balance between the two.