The equine gut is poorly designed for modern horse living. Stressors such as confinement living, poor quality and processed food, as well as toxins and workload all contribute to difficulties in maintaining gastrointestinal health. The challenge for integrative veterinarians is to balance treatment support with the ongoing contributors to poor health. It is no longer enough to add herbal or homeopathic therapies, or to make a simple food change. We will discuss all those treatments, but will also look at the larger picture of management and environmental factors, some of which are easier to change than others.