We thank Professor Whelan for his thoughtful editorial discussing our randomised clinical trial evaluating a personalised modified low FODMAP diet compared with traditional dietary advice based on NICE guidelines in patients with irritable bowel syndrome (IBS) 1. As highlighted in the editorial, dietary therapy remains a central component in the management of IBS. Although the low FODMAP diet (LFD) is currently the most extensively studied dietary intervention, concerns persist regarding its restrictiveness, potential impact on dietary diversity and the gut microbiome, and the need for specialised dietetic supervision 2, 3. These limitations have prompted increasing interest in strategies that preserve the therapeutic benefits of the LFD while reducing dietary burden. Our study sought to explore whether a personalised and less restrictive approach to FODMAP reduction could achieve meaningful symptom improvement while maintaining greater dietary flexibility 4. As Professor Whelan appropriately notes, the absence of a statistically significant difference between the personalised LFD and NICE dietary advice should not be interpreted as evidence of equivalence. Our study was not designed as an equivalence or non-inferiority trial. Rather, the intention was to provide initial evidence supporting the feasibility and potential clinical relevance of individualised dietary modulation based on patient-specific symptom triggers. Importantly, the response rate observed with the personalised LFD (54.5%) is consistent with outcomes reported in several trials of the conventional LFD 5, 6. This observation raises the possibility that targeted reduction of relevant FODMAP sources may achieve comparable symptom improvement while potentially reducing unnecessary dietary restriction. We also agree that placebo and contextual effects are important considerations in dietary intervention trials in disorders of gut-brain interaction. Future studies should therefore incorporate designs that allow optimal evaluation of personalised dietary strategies, ideally including comparison with both the full LFD and appropriately designed controls. In this context, our findings should be viewed as an initial step toward refining dietary therapy for IBS. Further adequately powered trials will be essential to determine the optimal balance between dietary restriction, clinical efficacy, and long-term sustainability. E. Coss-Adame: writing – original draft, writing – review and editing. M. F. Garcia-Cedillo: writing – original draft. M. F. Huerta-de la Torre: writing – original draft. J. S. Arenas-Martinez: writing – original draft. The authors have nothing to report. This article is linked to Garcia-Cedillo et al., papers. To view these articles, visit https://doi.org/10.1111/apt.70601 and https://doi.org/10.1111/apt.70626. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Coss‐Adame et al. (Wed,) studied this question.