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Key takeaways:
- In a 2026 survey of 261 people with IBS, 70% found low FODMAP restriction hard to follow.¹
- 59% of respondents stayed in the restriction phase for more than 8 weeks.¹
- In our survey of 118 US adults with IBS, 60% were satisfied with gut-brain therapy vs 42% with diet.²
- Gut-directed hypnotherapy matched the low FODMAP diet for IBS symptom relief in a Monash University randomized trial.³
The low FODMAP diet is hard to follow for 70% of people with IBS who try it, even though 71% said it helped, a new study in Frontiers in Gastroenterology shows.¹ The question shifts from whether the diet works to how to support patients through it, with dietitian care and gut-brain therapy.
That support often runs out between visits. You recommend the diet, and months later the same patient is still eating a handful of “safe” foods. The diet itself isn’t the problem: low FODMAP remains the best-evidenced diet for IBS, and the American Gastroenterological Association (AGA) recommends it in three phases: restriction, reintroduction, and personalization.⁴
The new data shows where patients stall between those phases, and where that support can step in.
What the new low FODMAP diet survey found about adherence in IBS
Low FODMAP adherence broke down at every phase in the survey: 70% found restriction hard, 59% stayed in it beyond 8 weeks, only 30% had a dietitian’s help, and 83% said they’d be interested in a simpler version of the diet.¹ The researchers, including William Chey, Sarah Ballou, and Prashant Singh, recruited respondents through the International Foundation for Gastrointestinal Disorders (IFFGD), a US patient nonprofit.¹
| FINDING | RESULT |
|---|---|
| Found restriction somewhat or extremely difficult | 70% |
| Reported symptom improvement during restriction | 71% |
| Continued restriction beyond 8 weeks | 59% |
| Took more than a month to complete reintroduction | About two-thirds |
| Found reintroduction difficult | 41% |
| Had a dietitian’s help during restriction | 30% |
| Had a dietitian’s help during reintroduction | 25% |
| Interested in a simpler version of the diet | 83% |
The diet worked for most of those who tried it. The trouble came after restriction, when patients needed to move on and add foods back.
Of 387 respondents, 261 had clinician-diagnosed IBS and had tried the diet, and two small focus groups added 8 more voices.¹ IFFGD members are likely more motivated and health-literate than the average patient, and answers relied on recall, so treat these figures as signals rather than population estimates.
The focus groups help explain why so many patients stall.
Why IBS patients get stuck in the low FODMAP restriction phase
Fear of symptoms returning keeps IBS patients in low FODMAP restriction, according to the study’s focus groups.¹ Participants described being afraid of food, and some hadn’t retested foods because they were too anxious to try. Eating out was hard too, and some felt the people around them thought they were overdoing it.¹
“What I’ve seen for a lot of people is that we started to get a lot of food fear around things. I will get people who come in who have been on a low FODMAP diet for years and they have a huge amount of anxiety around trigger foods.”
– Dr. Kim Bretz, Naturopathic Doctor, Faculty at University of Waterloo School of Pharmacy
Applying this in practice
Plan reintroduction at the same visit you recommend restriction. At follow-up, ask which phase the patient is in and what they’ve added back. For patients who aren’t good candidates for restrictive diets, the AGA advises screening for disordered eating with a full dietary history first.⁴
A dietitian can carry much of that load.
How dietitian support changes low FODMAP diet outcomes for IBS
Dietitian support was linked to better low FODMAP follow-through, with 62% of supported patients completing all three phases, compared with 46% without.¹ Only 39 people had a dietitian, though, so the difference wasn’t statistically significant.¹ The AGA recommends referring willing patients to a registered dietitian nutritionist.⁴
“And if we do a good job at this, the goal is that we can have patients start to liberalize their diet more and not have so much fear and anxiety around eating these foods.”
– Morgan Binder, Physician Assistant and Registered Dietitian, Arizona Digestive Health
Applying this in practice
Bring a GI dietitian in when you first recommend the diet, so reintroduction is planned from the start rather than left to the patient. If you’re the dietitian, agree on a set time frame for restriction at the first appointment, as the AGA advises, so moving to reintroduction is the expected next step.⁴
Watch for restriction driven by fear rather than symptoms, such as avoiding foods a patient has never reacted to, or putting off reintroduction. At that point, gut-brain therapy is a non-dietary option to consider alongside dietary care, rather than tightening the diet further.
It’s also worth asking patients how they feel about the diet itself, because being satisfied with an approach isn’t the same as it working.
Diet vs gut-brain therapy: how satisfied are US IBS patients?
US adults with IBS were more satisfied with gut-brain therapy than with diet change in our September 2026 survey: 60% vs 42%.² It’s an indicative online survey of 118 people, measuring satisfaction rather than efficacy.
The trial evidence backs offering both. In a Monash University randomized trial, gut-directed hypnotherapy improved IBS symptoms about as well as the low FODMAP diet, with benefits lasting to 6 months.³ And in our analysis of 26,008 users presented at Australian Gastroenterology Week 2026, people who named food as their main trigger improved as much as those who named stress (23.0% vs 23.4%).⁵
Where gut-brain therapy fits alongside the low FODMAP diet
Gut-brain therapy complements dietitian-led care, giving patients a non-dietary option so symptom management doesn’t rely on ongoing restriction. The American College of Gastroenterology (ACG) guideline suggests gut-directed psychotherapy for global IBS symptoms.⁶
It’s especially useful for patients who:
are still restricting after 8 weeks
have stalled in reintroduction because of fear of symptoms
aren’t good candidates for restriction.
Nerva is a digital gut-brain therapy program patients access via a phone app. It combines gut-directed hypnotherapy with CBT-informed education and breathing exercises, and asks for no dietary changes.
In a randomized controlled trial of 244 adults with IBS, 81% of Nerva participants achieved a clinically meaningful improvement on the IBS Symptom Severity Scale, compared with 63% on an active control.⁷
You can refer patients through the clinician form or simply recommend Nerva.
Frequently asked questions
How long should the low FODMAP elimination phase last?
The low FODMAP elimination phase is designed to last 2–6 weeks, according to Monash University, which developed the diet.⁸ If there’s no clinical benefit by then, the AGA advises stopping and trying another option.⁴
Can a low FODMAP diet make IBS worse?
A low FODMAP diet can cause problems when strict restriction runs long, lowering fecal bifidobacteria and raising the risk of nutritional inadequacy and disordered eating.⁹ Reintroducing foods according to tolerance helps limit those risks.⁹
Can you combine gut-directed hypnotherapy with the low FODMAP diet?
Gut-directed hypnotherapy and the low FODMAP diet can be used together, and they complement each other: diet manages food triggers, while gut-brain therapy targets the visceral hypersensitivity that amplifies symptoms. In the Monash trial, patients who combined them improved as much as those using either approach alone.³ Nerva is low risk and asks for no dietary changes, so it won’t disrupt a patient’s diet plan.
How do you refer a patient to a digital gut-brain therapy program?
A referral to Nerva can be made through the clinician form or by recommending the program in a consult. Referrals don’t expire, so patients can start when they feel ready.
References
Fehlman J, Peng W, Pfenning C, et al. Irritable bowel syndrome in the community: a cross-sectional study looking at patient experiences and challenges with the low FODMAP diet. Front Gastroenterol. 2026;5:1930300. doi:10.3389/fgstr.2026.1930300
Mindset Health. Conjointly survey of US adults with IBS (n=118). September 2026. Unpublished data.
Peters SL, Yao CK, Philpott H, Yelland GW, Muir JG, Gibson PR. Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2016;44(5):447-459.
Chey WD, Hashash JG, Manning L, Chang L. AGA clinical practice update on the role of diet in irritable bowel syndrome: expert review. Gastroenterology. 2022;162(6):1737-1745.e5. doi:10.1053/j.gastro.2021.12.248
Dabash O, Hall C, Peters SL, Raik-Allen S. No difference in adherence or clinical response to a digital brain-gut behavioural therapy program among 26,008 users reporting food-related or stress-related primary symptom triggers. Abstract presented at: Australian Gastroenterology Week 2026; August 28–31, 2026; Perth, Australia.
Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036
Anderson EJ, Peters SL, Gibson PR, Halmos EP. Comparison of digitally delivered gut-directed hypnotherapy program with an active control for irritable bowel syndrome. Am J Gastroenterol. 2025;120(2):440-448. doi:10.14309/ajg.0000000000002921
Monash FODMAP. Just 2-6 weeks, not a STRICT diet for life. Published June 8, 2015. Accessed November 12, 2026. https://monashfodmap.com/blog/just-2-6-weeks-it-is-not-diet-for-life_8/
Hill P, Muir JG, Gibson PR. Controversies and recent developments of the low-FODMAP diet. Gastroenterol Hepatol (N Y). 2017;13(1):36-45.
