Dietary management makes sense in patients with irritable bowel syndrome, because food is a major inducer of symptoms, and dietary manipulation empowers patients to influence the outcome of their disorder. It is not surprising, therefore, that the arrival of the low FODMAP diet, which is based on sound scientific evidence,1 has led to its enthusiastic adoption in clinical practice across the world. However, the diet has been criticized in 4 main areas: (1) the strength of the efficacy data, mainly owing to perceived bias in clinical trial design and the lack of real-world placebo-controlled trials2,3; (2) the complexity and difficulty of teaching the diet; (3) safety, especially on the structure of gut microbiota4; and (4) longer term efficacy and safety.