The low FODMAP diet is a beneficial therapeutic approach for irritable bowel syndrome (IBS) patients. However, its mechanisms are not fully understood. These include luminal distension from gas and water, visceral hypersensitivity, increased intestinal permeability, microbiota changes, short-chain fatty acid (SCFA) production, and metabolomics. While most evidence is of low quality, recent trials confirm its effectiveness, particularly in reducing bloating and pain. This review examines the pathophysiological mechanisms and evidence for the diet's effectiveness across IBS subtypes. Key considerations include the need for professional guidance, individual variability, microbiota concerns, nutritional deficiencies, constipation risk, and the necessity of excluding eating disorders before starting the diet. Despite its efficacy, limitations such as long-term data scarcity and practical challenges must be acknowledged. The diet is implemented through top-down or bottom-up approaches, with the top-down method being more supported. The low FODMAP diet has shown efficacy in symptom management, particularly in IBS-D, with improvements in abdominal pain and quality of life. It is compared to other diets and treatments, with the low FODMAP diet showing greater effectiveness in reducing symptoms. However, it is more expensive and complex to follow. Personalization is crucial, and response markers such as breath tests and microbiota analyses are being explored. Despite its benefits, the diet has social, lifestyle, and nutritional challenges, requiring professional guidance and careful implementation. The review highlights the importance of addressing these limitations to ensure the diet's effective and safe use in IBS management.The low FODMAP diet is a beneficial therapeutic approach for irritable bowel syndrome (IBS) patients. However, its mechanisms are not fully understood. These include luminal distension from gas and water, visceral hypersensitivity, increased intestinal permeability, microbiota changes, short-chain fatty acid (SCFA) production, and metabolomics. While most evidence is of low quality, recent trials confirm its effectiveness, particularly in reducing bloating and pain. This review examines the pathophysiological mechanisms and evidence for the diet's effectiveness across IBS subtypes. Key considerations include the need for professional guidance, individual variability, microbiota concerns, nutritional deficiencies, constipation risk, and the necessity of excluding eating disorders before starting the diet. Despite its efficacy, limitations such as long-term data scarcity and practical challenges must be acknowledged. The diet is implemented through top-down or bottom-up approaches, with the top-down method being more supported. The low FODMAP diet has shown efficacy in symptom management, particularly in IBS-D, with improvements in abdominal pain and quality of life. It is compared to other diets and treatments, with the low FODMAP diet showing greater effectiveness in reducing symptoms. However, it is more expensive and complex to follow. Personalization is crucial, and response markers such as breath tests and microbiota analyses are being explored. Despite its benefits, the diet has social, lifestyle, and nutritional challenges, requiring professional guidance and careful implementation. The review highlights the importance of addressing these limitations to ensure the diet's effective and safe use in IBS management.