Gut Microbiome

Long-term microbiome and clinical effects of a microbiome-guided personalized diet versus low-FODMAP diet in irritable bowel syndrome: A 12-month follow-up randomized controlled trial.

TL;DR

A microbiome-guided personalized diet maintained IBS symptom improvement at 6 and 12 months whereas low-FODMAP diet benefits regressed by 12 months, with personalized diet associated with sustained gut microbiome diversity gains.

Key Findings

Both diets reduced IBS symptom severity at 6 weeks, but only the personalized diet maintained this improvement through 12 months.

  • PD maintained symptom improvement at 6 and 12 months (-82.0 and -78.3 points from baseline on IBS-SSS)
  • LFD benefits regressed by 12 months (+29.3 points from baseline), indicating symptom return
  • Between-group difference at 12 months was statistically significant (p = 0.001)
  • Outcomes were assessed using linear mixed-effects models following a 6-week dietary intervention period with no further dietary intervention during follow-up
  • Participants met Rome IV criteria for IBS in a multicenter, open-label randomized controlled trial with blinded outcome assessment

At 12 months, IBS-SSS responder rates were significantly higher in the personalized diet group than the low-FODMAP diet group.

  • Responder rates were 62.5% for PD versus 34.5% for LFD at 12 months
  • Absolute risk difference was +28.0% (95% CI 4.2–47.7)
  • Between-group difference reached statistical significance (Fisher p = 0.029)
  • Responder analyses were conducted alongside linear mixed-effects models, PERMANOVA, and PERMDISP for gut microbiota

Quality of life, anxiety, and depression scores showed more favorable trajectories with the personalized diet than with the low-FODMAP diet.

  • Outcomes assessed included IBS Quality of Life (IBS-QOL), HADS-anxiety, and HADS-depression
  • PD showed more favorable trajectories on all three psychosocial measures compared to LFD over 12 months
  • No specific numeric values for IBS-QOL or HADS scores were reported in the abstract
  • Follow-up assessments occurred at 6 and 12 months after the initial 6-week intervention without further dietary guidance

The personalized diet was associated with sustained gains in gut microbiome alpha-diversity over 12 months, whereas this effect was not reported for the low-FODMAP diet.

  • Shannon alpha-diversity increased by +0.488 at 6 weeks and +0.205 at 12 months in the PD group (both p < 0.01)
  • Gut microbiota were profiled using 16S rRNA sequencing
  • Alpha-diversity gains persisted at 12 months, though the magnitude was attenuated compared to 6 weeks

A modest between-group difference in gut microbiome community composition (beta-diversity) was observed at 6 months but was not significant at 12 months.

  • Beta-diversity between-group difference at 6 months: R² = 0.035, p = 0.011
  • This between-group beta-diversity difference was not statistically significant at 12 months
  • Beta-diversity was evaluated using PERMANOVA and PERMDISP analyses
  • The authors describe the overall trial as 'hypothesis-generating,' noting that larger trials powered for long-term outcomes are warranted

What This Means

This research suggests that a diet personalized based on an individual's gut microbiome composition produces more lasting relief from irritable bowel syndrome (IBS) symptoms than the standard low-FODMAP diet (which restricts certain fermentable carbohydrates). In the study, both approaches reduced symptom severity after a 6-week active diet period, but when participants were followed for 12 months without any ongoing dietary coaching, those who had followed the personalized diet continued to experience substantial symptom relief, while those on the low-FODMAP diet largely saw their symptoms return. At 12 months, about 63% of personalized-diet participants were considered 'responders' (meaningfully improved) compared to about 35% of low-FODMAP participants. The study also found that the personalized diet was associated with sustained increases in the diversity of gut bacteria — a marker generally associated with a healthier gut — even one year after the active intervention ended. While there were some differences in overall gut microbiome community structure between the two groups at 6 months, these differences were no longer statistically significant at 12 months, suggesting the microbiome effects were partially, but not fully, maintained. Quality of life, anxiety, and depression scores also tended to be better in the personalized-diet group over time. This research suggests that tailoring a diet to a person's individual gut microbiome profile may produce more durable improvements in IBS symptoms, mental wellbeing, and gut microbial diversity compared to a standard dietary approach. However, the authors themselves caution that this was a hypothesis-generating study and that larger, longer trials are needed to confirm these findings before drawing firm conclusions.

Have a question about this study?

Citation

Tunali V, Arslan N, Dervi&#x15f; Haki&#x307;m G, G&#xfc;ndo&#x11f;du A, Ermi&#x307;&#x15f; B, Hora M, et al.. (2026). Long-term microbiome and clinical effects of a microbiome-guided personalized diet versus low-FODMAP diet in irritable bowel syndrome: A 12-month follow-up randomized controlled trial.. Gut microbes. https://doi.org/10.1080/19490976.2026.2719125