The second stage of the FODMAP diet (also known as FODMAP reintroduction) doesn’t get much airtime, but it’s arguably the most important part. Here’s how to get it right.
Low FODMAP Isn’t Forever
If you’ve found your IBS symptoms have improved whilst following a low FODMAP diet, it’s time to move to stage 2 – FODMAP reintroductions.
During the reintroduction phase, you’ll gradually introduce high FODMAP foods back into your diet to work out which ones trigger your IBS symptoms, and how much of each food you can tolerate. This is important for a number of reasons. First, it’ll mean more variety and less restriction in your diet (which can be a relief) and second, it will help to increase levels of some nutrients that can be low on a low FODMAP diet – like fibre and calcium.
Although it’s understandable to be nervous about beginning reintroductions (especially if you’ve been feeling better on a low FODMAP diet) it’s really important not to put this stage off. The elimination phase of the diet (stage 1) is not designed to be followed long term due to its restrictive nature. Research also suggests the diet may reduce the numbers of beneficial microbes in the gut, which could have knock on effects on your symptoms long term.
It’s also unlikely that you’ll be sensitive to all high FODMAP foods – so there’s no need to continue with complete restriction in the long term. The only way to know which foods you’re sensitive to and which you can eat without symptoms is to carry out the reintroductions. With this in mind let’s talk five steps to successful reintroduction.
1. Get support to do it right
The reintroduction phase is arguably the most confusing part of the diet, as it involves reintroducing high FODMAP foods in different quantities systematically.
We’ve seen a lot of bogus reintroduction protocols on the internet which could easily lead to misleading results, so as always we’d encourage you to work with a dietitian to follow the correct reintroduction approach. They’ll be able to teach you how to reintroduce and in what order, and they’ll also be on hand to help you interpret your results.
If you find yourself stuck on the elimination phase for whatever reason, or you’ve completed stage one without support, don’t think this means you can’t get help now. A FODMAP trained dietitian should be able to help you at any stage.
2. Plan ahead
It’s helpful to plan ahead when doing your reintroductions so that you have the right foods available and ready to challenge. Bear in mind that the entire reintroduction process can take around 8-10 weeks to complete, so you might need to plan your reintroduction challenges around eating out or other occasions. Your dietitian can help you do this, so that it doesn’t confuse your results.
3. Keep everything but the challenge food low FODMAP
The only thing that should change in your diet during the reintroduction phase is the addition of the food you’re challenging – everything else should stay low FODMAP. So for example, if you are doing a challenge with onion, you might continue with a low FODMAP breakfast and lunch, adding the challenge portion of onion to your low FODMAP evening meal. Keeping everything else strictly low FODMAP whilst you follow the reintroduction period will help you get clear results.
Remember – even if you don’t get any symptoms during a food challenge, you will still have to keep that food out of your diet until you’ve completed all the challenges, to avoid the potential for crossover effects.
4. Keep an eye on other triggers
Remember that other dietary and lifestyle factors can affect symptoms as well as FODMAPs, so keep an eye on things like your caffeine and alcohol intake, and try to keep these at the same level as they were during the elimination phase.
Stress is another factor to consider – if you’re feeling particularly stressed, you might find you respond differently to a challenge food than if you eat it when feeling more relaxed. Try to keep a note of any stressful times during your challenges to spot patterns.
5. Keep a detailed record
Your reintroduction results will form the blueprint for stage 3 – personalisation, when you will begin to include the foods you can tolerate, whilst limiting the ones which cause symptoms.
Keeping a clear record of your challenges and symptom responses is therefore key to moving forwards to stage 3. If you find that you need help interpreting your results, your dietitian can help.
Our Food & Symptom Diary is also very handy, allowing space to track your food, medicaiton, bowel habits, other symptoms and more for everyday, plus it has a dedictaed section to help you through FODMAP reintroduction. You can purchase our Food & Symptom Diary here.
Written by Registered Dietician Laura Tilt @nutritilty, on behalf of Bay’s Kitchen.
Copyright Bay’s Kitchen. Please do not reprint without permission.
Tuck, C., & Barrett, J. (2017). Re-challenging FODMAPs: the low FODMAP diet phase two. Journal of Gastroenterology and Hepatology (Australia), 32, 11–15. https://doi.org/10.1111/jgh.13687
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