If you’ve been living with IBS for a while, chances are you’ve come across the low FODMAP diet. Your GP may have mentioned it. A dietitian might have recommended it. At the very least, the internet has probably suggested it approximately four hundred times.
And if you tried it, it might even have helped – for a while.
But here you are, still reading about IBS. So let’s talk honestly about what both approaches actually do, how they compare, and how to figure out which one makes sense for where you are right now.
First, what is the low FODMAP diet?
FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. They are a group of carbohydrates found in foods like wheat, dairy, onions, garlic, and certain fruits. In the gut of someone with IBS, these foods can ferment in the colon, attracting extra water and producing gas. Because the nerves in an IBS gut are already hypersensitive, that extra pressure from gas and water is enough to trigger a cascade of symptoms – things like pain, bloating, urgency, unpredictable bowel movements.
The low FODMAP diet, developed by researchers at Monash University, works by eliminating all high-FODMAP foods for several weeks, then systematically reintroducing them to identify your personal triggers. It’s always recommended to go through this process alongside a qualified dietician.
It’s evidence-based, it’s widely recommended, and for some people it does make a meaningful difference – at least in the short term.
So what’s the problem with it?
The issue isn’t really whether the low FODMAP diet really works. The issue is what it doesn’t do, and what the experience of following it is actually like for many people.
First, it’s genuinely hard to sustain. It’s restrictive, time-consuming, and requires a level of vigilance around food that quickly becomes exhausting. Eating out becomes a negotiation. Social meals become stressful. Over time, that constant scrutiny of everything you eat can actually increase anxiety – which, in IBS, makes symptoms worse, not better.
Second, the relief is often partial. Physical symptoms might ease a little, but the anxiety around flare-ups, the food fear, the mental load of constant planning — that tends to stay exactly where it was. Sometimes it gets worse, because the diet reinforces the idea that food is the enemy and your gut is something to be managed and controlled rather than trusted.
And third, and this is the most important point, the low FODMAP diet treats IBS as a food problem. But IBS isn’t primarily a food problem. It’s a disorder of the gut-brain interaction. Food is one trigger among many others, and eliminating triggers doesn’t address the underlying reason the gut is so reactive in the first place.
What does gut-directed hypnotherapy do differently?
Rather than targeting what you eat, gut-directed hypnotherapy works on the gut-brain connection itself.
In IBS, the communication between the brain and the gut becomes disrupted. The nerves in the gut become hypersensitive – interpreting normal digestive sensations as pain, reacting disproportionately to stress, and getting caught in a cycle that’s very difficult to break through dietary changes alone.
Gut-directed hypnotherapy works by calming that communication. In a deeply relaxed, receptive state, using guided imagery and suggestion, it helps the gut become less reactive and less sensitive. It supports the nervous system in spending more time in a rest-and-digest state, rather than constantly on high alert.
And because I combine it with CBT, we also address the anxiety, anticipatory worry, and negative thought patterns that keep the cycle going; the toilet-scanning, the food fear, the dread that builds before social situations or long journeys.
What does the research say?
A randomised clinical trial (Peters et al., 2016) directly compared gut-directed hypnotherapy with the low FODMAP diet across three groups of IBS patients. The findings were striking: all three groups saw similar improvements in gut symptoms; around 70% of participants in each group responded positively.
But here’s the difference. The hypnotherapy group showed significantly greater improvements in psychological measures, including anxiety and depression, than those who followed the diet alone. In other words, hypnotherapy matched the low FODMAP diet for physical symptom relief, and went considerably further in terms of overall wellbeing and quality of life.
Gut-directed hypnotherapy is also recommended by NICE and endorsed by the American College of Gastroenterology as an effective treatment for IBS — endorsements that require a substantial body of evidence. And the improvements tend to last: the longest follow-up study shows benefits still present five years after treatment ended, without any further sessions needed.
Do you have to choose one or the other?
Not necessarily. The two approaches aren’t mutually exclusive, and if you’ve found that avoiding certain foods genuinely helps you feel better, there’s no need to abandon that.
But if you’ve tried the low FODMAP diet and found it unsustainable, only partially effective, or if you’re still struggling with anxiety around food and symptoms even when you’re eating carefully, that’s an important signal. It means something else needs to be addressed.
Because the truth is, you can eat “perfectly” and still have a significant flare-up if your nervous system is in a heightened state. Food is one input into a much more complex system. Hypnotherapy works on the system itself.
How to decide what’s right for you
A few questions worth sitting with:
Is your relationship with food becoming increasingly restricted or anxious? If mealtimes feel like minefields and your safe food list keeps shrinking, the low FODMAP approach may be reinforcing the problem rather than solving it.
Have you tried dietary changes and still have significant symptoms? This is probably the most common reason people come to me; they’ve done everything “right” by dietary standards and are still struggling. That’s a sign the gut-brain axis needs attention.
Are stress, anxiety, or anticipatory worry a significant part of your experience? If the mental load of IBS is as exhausting as the physical symptoms — and for many people it is — then an approach that addresses both simultaneously is worth considering.
Neither hypnotherapy nor the low FODMAP diet is a quick fix. Both require commitment and consistency. But they ask very different things of you, and they offer very different outcomes.
If you’re curious about whether gut-directed hypnotherapy could be the right fit, I offer a free 30-minute discovery call. No pressure, no commitment — just a conversation about where you are and whether this approach makes sense for you.
