Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jun;34(3):373-385.
doi: 10.6133/apjcn.202506_34(3).0012.

Predicting response to the low FODMAP diet in irritable bowel syndrome: Current evidence and clinical considerations

Lauren P Manning  1 , Caroline J Tuck  2 , Jessica R Biesiekierski  3
Affiliations
Review

Predicting response to the low FODMAP diet in irritable bowel syndrome: Current evidence and clinical considerations

Lauren P Manning et al. Asia Pac J Clin Nutr. 2025 Jun.

Abstract

Background and objectives: The low fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) diet is an effective dietary intervention for irritable bowel syndrome (IBS), yet up to 50% of patients fail to re-spond adequately. Identifying reliable predictors of response could optimize treatment selection and improve treatment outcomes while avoiding unnecessary dietary restrictions. This narrative review examines current evidence for predictors of response to the low FODMAP diet and highlights gaps in knowledge that must be addressed to develop clinically useful indicators for routine practice.

Methods and study design: We re-viewed the literature on the low FODMAP diet, and studies investigating factors that may predict treatment response, including clinical, diagnostic, biological, biochemical, and microbial markers.

Results: Several po-tential predictors to the low FODMAP diet have emerged, including baseline symptom severity, psychological factors (particularly depression), hydrogen breath test results, volatile organic compounds in fecal samples, and specific gut microbiota profiles. Clinical and psychological measures show the most immediate potential for implementation due to accessibility and established measurement tools. Biological markers, including breath testing, metabolomics, and microbiome analysis, show promise but require further validation in larger, diverse populations and standardization of methodologies.

Conclusions: Despite promising research, signifi-cant gaps remain in developing reliable, accessible predictors of response to the low FODMAP diet. Future research should focus on validating simple clinical tools that combine symptom profiles with psychological assessment to guide treatment decisions. A personalized approach to dietary management of IBS based on reliable response predictors would optimize clinical outcomes while minimizing unnecessary dietary restriction and healthcare resource utilization.

Keywords: predictive markers; treatment response; FODMAP; diet therapy; irritable bowel syndrome.

PubMed Disclaimer

Conflict of interest statement

All authors declare nil conflicts of interest.

Figures

None
Graphical abstract.
See this image and copyright information in PMC

References

    1. Lacy BE, Pimentel M, Brenner DM, Chey WD, Keefer LA, Long MD, Moshiree, B. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021;116:17–44. doi: 10.14309/ajg.0000000000001036. - DOI - PubMed
    1. Black CJ, Staudacher HM, Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut. 2022;71:1117–26. doi: 10.1136/gutjnl-2021-325214. - DOI - PubMed
    1. Wu J, Masuy I, Biesiekierski JR, Fitzke HE, Parikh C, Schofield L, et al. Gut‐brain axis dysfunction underlies FODMAP‐induced symptom generation in irritable bowel syndrome. Aliment Pharmacol Ther. 2022;55:670–82. doi: 10.1111/apt.16812. - DOI - PubMed
    1. Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021;160:99.e3–114.e3. doi: 10.1053/j.gastro.2020.04.014. - DOI - PubMed
    1. Sperber AD. Review article: epidemiology of IBS and other bowel disorders of gut–brain interaction (DGBI) Aliment Pharmacol Ther. 2021;54:S1–S11. doi: 10.1111/apt.16582. - DOI - PubMed

LinkOut - more resources