Letter: Lost in Translation—Replicating a Modifying FODMAP Diet in Patients With IBS. Authors' Reply

We thank Professors Halmos and Gibson for their thoughtful comments regarding our recently published randomised clinical trial evaluating a personalised modified FODMAP diet in patients with irritable bowel syndrome (IBS) [1, 2]. We are particularly grateful for their perspective, given their seminal contributions to the development and implementation of the low‐FODMAP diet.

The authors raise three important questions regarding the effectiveness, practicality, and long‐term applicability of our approach. We agree that these issues are central when considering the role of dietary interventions in IBS management.

Regarding efficacy, we acknowledge that the response rate observed in our study may appear modest when compared with some reports of the conventional low‐FODMAP diet. However, our objective was not to reproduce the established three‐phase low‐FODMAP protocol nor to demonstrate superiority over it. Rather, we sought to determine whether a less restrictive, individualised strategy based on patient‐specific symptom triggers could achieve clinically meaningful symptom improvement while reducing dietary burden. Importantly, both intervention groups experienced symptomatic benefit, supporting the concept that dietary modification remains a valuable therapeutic option in IBS [2].

With respect to implementation, our modified strategy was deliberately designed to reflect real‐world clinical practice. We fully recognise that the conventional low‐FODMAP diet is supported by a substantial evidence base and remains an important therapeutic option. Nevertheless, successful implementation of the three‐phase diet requires detailed dietary assessment, structured reintroduction, repeated follow‐up visits, and significant expertise from healthcare professionals trained in gastrointestinal nutrition and FODMAP methodology [3]. Sultan et al. emphasised that implementation can be challenging even within specialised settings, owing to issues of adherence, dietary complexity, nutritional adequacy, cultural adaptation, and limited access to appropriately trained dietitians [3]. Furthermore, they highlighted that additional training is required when dietary interventions are delivered by gastroenterologists, nurses, or other healthcare professionals rather than specialist dietitians [3].

These considerations may be particularly relevant in Latin American populations. Most evidence supporting the low‐FODMAP diet has been generated in predominantly Caucasian populations from Australia, Europe, and North America [3]. Whether identical dietary algorithms should be universally applied across populations with substantially different dietary habits, staple foods, culinary traditions, and cultural eating behaviours remains uncertain. Our study was therefore designed to explore a pragmatic and culturally adapted approach within a Mexican population, where dietary patterns differ considerably from those represented in most published low‐FODMAP studies.

Finally, we agree that patient empowerment is a key objective of dietary therapy. Our approach was intended as an initial framework for personalised dietary modification rather than a replacement for the structured reintroduction and self‐management principles that underpin contemporary FODMAP practice. Future studies should specifically evaluate long‐term adherence, patient understanding of symptom triggers, and whether simplified dietary strategies can promote sustainable self‐management while maintaining clinical efficacy.

Ultimately, we do not view our findings as a challenge to the conventional low‐FODMAP diet. Rather, we believe they contribute to the ongoing discussion regarding how best to individualise dietary therapy and how to adapt evidence‐based interventions to diverse populations and healthcare environments. We thank the authors for helping place our findings within this broader clinical and scientific context.

Author Contributions

Enrique Coss‐Adame: writing – original draft, writing – review and editing, conceptualization. María Fernanda Huerta‐de la Torre: writing – review and editing. Josealberto Sebastiano Arenas‐Martinez: writing – review and editing. María Fernanda Garcia‐Cedillo: writing – review and editing.

Funding

The authors have nothing to report.

Linked Articles

This article is linked to Garcia‐Cedillo et al. papers. To view these articles, visit https://doi.org/10.1111/apt.70802 and https://doi.org/10.1111/apt.70601.

Garcia‐Cedillo M. F., la Torre M. F. H., Arenas‐Martinez J. S., and Coss‐Adame E., “Letter: Lost in Translation—Replicating a Modifying FODMAP Diet in Patients With IBS. Authors' Reply,” Alimentary Pharmacology & Therapeutics 64, no. 5 (2026): 707–708, 10.1111/apt.70818.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.