Are you tired of leaving out FODMAPs?
Ready to learn more about how to expand your diet and add them back?
How long have you been following the Low FODMAP diet? Perhaps it’s been a few weeks, maybe a few months, or a few years. Often the Low FODMAP diet is recommended by your doctor or you hear about it online and there are not a lot of guidelines or follow-ups. You’re left to sort it out on your own. Maybe that’s why you’re here… and I’m happy you are. It is my pleasure to help!
The thing is, perhaps the idea of this elimination diet seemed like a short-term thing, or perhaps you weren’t told it was just supposed to be followed strictly for 2-6 weeks (according to Monash University researchers). And once you’ve completed the elimination and symptoms have improved, you may be wondering NOW WHAT?
Before I get into the next steps, let’s back it up and talk about FODMAPs. Perhaps you stumbled across this article and have jus heard of the Low FODMAP diet or maybe you’re just in the middle of it and still experiencing symptoms.
The Low FODMAP diet is a complicated diet developed by researchers at Monash University to help those with Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (Crohn’s and Colitis) reduce symptoms like gas, bloating, abdominal discomfort, pain, diarrhea and/or constipation.
FODMAPs are poorly digested, small, short-chained sugars that are contained in some types of food. These sugars are not broken down in the digestive system and can trigger digestive issues through fermentation.
Don’t worry, it’s not ALL sugar, just some specific types. By removing foods that are high in FODMAPs from your diet for a period of time, many people can actually find incredible symptom relief.
The Low FODMAP diet is ultimately the best diet for IBS and the best diet for Crohn’s and Colitis to date.
The Low FODMAP diet, is an evidence-based diet, actually the only diet for digestive issues that has real research demonstrating significant improvement in 75% of those that follow it.
However, the diet has two phases. So it’s important to understand this process if you decide to follow this diet or if you are in the middle of it.
I was diagnosed with IBS in 2007, when the recommendations from my doctor included eating more fibre and drinking more water… and that was it. Really. Not much help at that time.
It took me years of struggling and symptoms, cutting out this food and that food, to finally find a solution to improve my symptoms and feel better. This is really the first goal – improve symptoms!
I’m not exaggerating when I say that the Low FODMAP diet changed my life. I went from daily symptoms to a whole lot better! It was the start to gut healing and a healthier, happier, symptom-free life.
SIDE BAR: I do recommend more than the Low FODMAP diet to help improve your symptoms with additional strategies, but that’s a topic for another day. If you want to learn more about the whole plan, take a look at what we are doing in the CLAIRITY Program.
Not everyone finds 100% symptom improvement with the diet. Actually studies show about 25% of people do not respond with symptom improvement to the diet.
No Symptom Improvement with the Low FODMAP Diet
If you are not experiencing improvement, let me suggest next steps:
Book a visit with your doctor to discuss the diet you’ve followed and current symptoms. You may need further tests or treatment.
Consider Small Intestine Bacteria Overgrowth (SIBO). You can read more about it here. Symptoms of SIBO can overlap with symptoms of IBS, so we want to make sure this is ruled out. And if you do have SIBO, it must be treated before you experience symptom improvement.
Work with an expert dietitian, seriously. A dietitian recommending a dietitian. You got it! This diet is complicated and so is gut health. Reach out to me to join the CLAIRITY Program or to get connected to a dietitian in your area to work with one-to-one. A FODMAP expert dietitian can help support you and help problem solve.
Take some time to sit in stillness and listen within. Could there be hidden stress, anxiety or previous trauma that is preventing your body from healing? You may need to spend some time working on you. Improving the mind gut connection to improve symptoms.
Back to the two phases of the Low FODMAP diet…
Phase One: FODMAP Elimination – avoid all foods high in FODMAPs
Phase Two: FODMAP Reintroduction – bring high FODMAP foods back into your diet
When it comest to expanding your diet and bringing FODMAPs back into your life, there are a couple options to do so, which we will get into later in this article. For now you may be wondering why you have to bring FODMAPs back.
Why Reintroduce FODMAPs?
There is a growing body of scientific literature that demonstrates excluding high FODMAP foods for a few weeks may change the bacteria that live in our gut, known as the microbiotica. This includes health strains we need for good digestion.
According to a study published in 2016 in the Clinical and Translational Gastroenterology journal, reducing FODMAPs in the diet of study participants was associated with a change in the gut bacteria.
Another study published in the Journal of Nutrition in 2012, discusses the issue that fructans and galacto-oligosaccharides (GOS) are prebiotic fibres, which are needed for the healthy growth of gut bacteria beneficial for the digestion process.
By excluding the FODMAP foods, food for the bacteria, even for just a few weeks (4 weeks in the research) there were lower concentrations and proportions of specific bacteria needed by the body for good digestion.
What can we take away from this?
One of your goals is to reduce digestive symptoms and another is probably to have good digestion, so that you can effectively break down the food you eat, which in turn will help minimize symptoms.
This means you should follow the FODMAP diet with two phases, adhering to the elimination phase of the Low FODMAP diet for a short period of time. Monash University, where the diet was developed, recommends between 2 to 6 weeks on the strict elimination phase.
After this elimination phase, you can gradually increase the high FODMAP foods in your diet. Even just a small amount will bring these prebiotic foods in your diet to help nourish the bacteria in your gut and keep you healthy.
When do you add FODMAPs back into your diet?
When you’ve followed the diet for a few weeks or a few months.
When you’ve started to experience symptom improvement so that as you add FODMAPs back you can clearly identify if that food is a trigger for you. This usually means symptom improvement of at least 50%.
You haven’t experienced any symptom improvement and it’s time you look at other tests and treatments.
When you are being treated for SIBO… more on this in another post.
I know this can feel overwhelming and even scary – you don’t want symptoms to come back! I get it. I too suffered with terrible and embarrassing digestive symptoms that I NEVER want to return.
I personally feel 99% symptom-free and have for years. I know what my triggers are, how to eat day-to-day and I do enjoy a modified Low FODMAP diet and eat well for digestion. I believe this is possible for you too.
I added foods back into my diet, slowly and gradually. There was no direction on Challenge Phase back then. So I believe you have a choice on how to bring FODMAPs back into your diet.
There is no one right way or gold standard for how you bring FODMAP foods back into your diet. The researchers at Monash University who developed this diet, do not mention any specific challenge phase instructions, did not test different reintroduction strategies and actually themselves recommend gradually increasing FODMAPs back into your diet. This can mean so many things, so let’s talk about your options.
The FODMAP Challenge Plan
I believe there are two approaches to expanding your diet and bringing FODMAPs back. One is the FODMAP challenge and the other is with a slow and gradual FODMAP Re-Introduction. Let’s talk about the Challenge Phase of the Low FODMAP diet first.
There are 5 different categories of FODMAPs, which include:
2. Galacto-oligosaccharides (GOS)
3. Sugar Polyols
The goal of the challenge phase is to identify your personal tolerance level. During the challenge you may find that you can tolerate one or more of these FODMAP groups without any symptoms. Or you may find that you can tolerate a certain amount and no more than that.
How do you Challenge FODMAPs?
Step one: Choose a FODMAP group to challenge. I recommend starting with GOS and fructans as they have the most prebiotic fibres to help your gut bacteria, according to Monash University.
Step two: Choose a specific food in that FODMAP group to challenge. Use the Monash University App for the most up-to-date list of FODMAP foods and to find an appropriate serving size.
Step three: Try ta small serving of the FODMAP food, while eating “safe” Low FODMAP foods.
Step four: Give your body 48 hours to process this FODMAP trial food. Food can affect your digestive system for 48 hours, more or less, so I recommend giving your body a break before adding another FODMAP food in to see if any symptoms occur.
Step five: If no symptoms occur, then you can try a larger serving.
NOTE: IT’S RECOMMENDED TO GO THROUGH THE LOW FODMAP DIET, ESPECIALLY THE CHALLENGE AND REINTRODUCTION PHASE WITH A QUALIFIED REGISTERED DIETITIAN.
Challenge is not the only way to do this, but if you need more help with this and step-by-step instructions on how to bring foods back, the CLAIRITY Program has everything you need.
When it comes to a strict challenge phase can be helpful, to get you clear on personal tolerance and intolerance levels. However, there are definitely a few reasons why this isn’t a good idea.
When to Avoid the FODMAP Challenge:
- If you are feeling stress and overwhelmed by the FODMAP challenge, avoid it. Try this next approach instead.
- If you are putting off bringing FODMAPs back into your diet because you don’t have time to figure out the FODMAP challenge.
- When you want to bring FODMAPs back in a more casual, gradual way without adhering to strict guidelines.
The FODMAP Reintroduction Plan
As an alternative to the strict Challenge Phase of the diet, you can choose a more slow, gradual reintroduction. In this process, you bring foods back a little at a time and then increase sizes and options as time goes on.
What FODMAP foods to bring back first:
- Food you miss the most
- Foods you thought you could tolerate well before the diet
- Small servings of different foods high in just one FODMAP group
- Other foods you excluded that are not high in FODMAPs like caffeine, alcohol, pulses, sulphurous vegetable, etc.
After a few weeks or months of slowly expanding your diet, you may want to expand and try more advanced FODMAP foods and combinations.
FODMAP foods to bring in later on:
- Foods with multiple FODMAPs in them
- Larger servings of FODMAP foods
- Multiple FODMAP foods in a day
- Multiple FODMAP foods in a meal
Remember, food can affect you for up to 48 hours. And for those with slower moving bowels, perhaps even longer. So as you are reintroducing foods keep record with a food & symptom journal or other tracking worksheet. And if you need more instruction or support with this process, please consider working with an expert dietitian or join us in the CLAIRITY Program.
You can challenge and/or re-introduce FODMAP foods while continuing to manage digestive symptoms. I know this is a BIG goal of yours and I know you can do it. You will be identifying food triggers, but you can minimize symptoms so they aren’t really awful.
How to Minimize Digestive Symptoms During FODMAP Challenge and Re-Introduction
- Include other strategies for good digestion. This is my favourite class in the CLAIRITY Program and a huge recommendation of mine for the past 5+ years with my clients. It really can help you improve symptoms and keep them under control. There are quite a few things you can do to improve digestion including avoiding other potential dietary triggers like caffeine, alcohol and sulphurous vegetables. And avoiding triggers like stress. Also, including a practice of yoga or mediation or exercise can keep your body working well.
- Add FODMAPs back slowly. Whether you work through a step-by-step Challenge Phase or you use the more gradual Reintroduction process, doing this slowly, one food at a time can really help. And of course, keep a food & symptom journal along the way to track your progress and even use a special tracking sheet as you add back.
- Work with a registered dietitian. This diet in all it’s phases, is complicated and confusing. It’s a lot for someone without nutrition expertise to navigate. Plus it takes so much time to sort through. The trickiest parts is the challenge and re-introduction and problem solving through this phase. By working with an expert dietitian who really understands digestive health nutrition and the Low FODMAP diet, you can be as successful as possible and really minimize symptoms as you expend your diet.
Looking for help along the way? Learn more about the CLAIRITY Program where I offer my step-by-step system to help you achieve symptom relief and support members with classes, guides, resources, recipes and much more in order to help them achieve their wellness goals.
PLUS in the membership we have classes to help you in the process including the Challenge class and the Relaxed Reintroduction class. If you’re looking for help walking through the exact process of FODMAP challenge or the more casual reintroduction process these classes are so helpful. All while getting support, coaching and recipes in the CLAIRITY Program.
If you are still experiencing symptoms, connect with a dietitian to help you improve symptoms first and guide you through the next steps.
If you’re ready, you can start this challenge or reintroduction on your own. If you do experience symptoms as you add foods back, keep that food out for now, but know that your tolerance can change over time and you can add this food or FODMAP group in the future.
At this time, the Monash University App has the up-to-date information on foods that are high and low in FODMAPs that you need. I recommend using this app to support you in the diet and to identify foods that are high and low in FODMAPs. I make no commission on this recommendation.
One final thought my friend. I know that this diet and this reintroduction process can feel overwhelming. I know it can feel damn frightening to think about adding foods back that caused you pain.
It actually makes me a little nauseated right now to think about going back to what I was experiencing in 2007. And it makes me ill to think about you suffering… that is NOT what I want for you. Trust me. I only want wellness, happiness and health for you. It’s why I do what I do every day.
I’ve been there right where you are. It’s a tough place to be in. But I know you can do it. I know you can take the steps needed to improve your life and your health. It may be a teensy step, a tiny step, an itty-bitty bite of high FODMAP food… but move along in this direction and you’ll get there.
And if you need any support along the way, please let me know. I’ve got your best interests at heart. I’ve got your back.
Wishing you much health, happiness & wellness,
Stephanie and the Team