One of the most difficult problems in equine nutrition research is often the lack of objective and clinically relevant end points. Nevertheless, this article attempts to present the best evidence (or lack thereof) for some of the most common clinical questions pertaining to such topics as the evaluation of glucose and insulin tolerance and factors that may confound results, dietary management of horses prone to laminitis and rhabdomyolysis, nutritional prevention of gastric ulcers and developmental orthopedic disease, the efficacy of commonly used herbal products, and feeding geriatric horses.