Reintroducing Fodmaps – Why, When, and How

Embarking on a journey towards better digestive health often involves careful consideration of food and non-food triggers. The low FODMAP diet’s initial phase identifies problematic foods. However, the often-overlooked FODMAP reintroduction phase holds the key to long-term success.

In this guide, we explain the reintroduction process, providing insights that will help you build a sustainable, diverse diet, customized to your unique needs. Let’s move beyond restriction and embrace a life where food can be enjoyed without fear!

Understanding FODMAPs

FODMAPs include five categories of short-chain carbohydrates that are poorly absorbed by the human body. Some of these carbohydrates remain undigested because our bodies lack the necessary enzymes. Others, despite us having the enzymes, are not fully broken down and absorbed.

Ok, so you may be asking yourself, “If FODMAPs are poorly digested, should everyone avoid them”? The answer is a resounding “NO!”.

To be clear, FODMAPs are not unhealthy. In fact, they are often highly nutritious foods. And in most people, they do not cause any problems whatsoever. But, in some people (especially those with IBS) they can contribute to uncomfortable symptoms such as bloating, distention, abdominal pain, diarrhea, or constipation.

Decorative Image - woman with abdominal pain

To make things even more confusing, not everyone with IBS is sensitive to FODMAPs. And those who are, usually do not react to all categories of FODMAPs. FODMAP elimination and reintroduction can help you figure out which categories you are sensitive to – if any.

If you are just learning about the FODMAP diet and have not started the elimination phase yet, be sure to check out this article – The FODMAP Elimination Diet: What to Consider Before You Start.

The Importance of Identifying Your Triggers

IBS can be debilitating. And unfortunately, it is a condition that medical providers often give little attention to. Patients are often left with insufficient treatment and support. But it doesn’t have to be that way.

By learning how to identify your IBS triggers, you can take back control of your life. You can learn to love food again and gain trust in your body.

Most people have both food- and non-food triggers. FODMAPs are some of the more common food triggers. Others include caffeine, alcohol, fatty foods, and large amounts insoluble fiber.

Non-food triggers can include stress or anxiety, a sedentary lifestyle, inadequate sleep, your menstrual cycle or hormone changes, and poor eating habits like skipping meals or overeating.

IBS Triggers include food triggers like FODMAPs, fatty foods, alcohol, caffeine, and insoluble fiber; and non-food trigers like stress, anxiety, poor sleep, hormones, skipping meals, overeating

Once you discover your triggers, it becomes easier to formulate a plan on how to avoid them or cope with them.

Often, there are multiple triggers present at the same time. A Registered Dietitian with specific training in the low FODMAP process can help sort through the noise to figure out which triggers are contributing to your discomfort.

That dietitian can also help ensure that your diet is adequate to meet your nutrition needs as you proceed through FODMAP elimination and reintroduction.

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Why Reintroduction of FODMAPs is Necessary

Maybe you’ve gone through the elimination phase of the diet, and you feel better. Hooray!

But now you are wondering, “If I feel better, can’t I just continue a low FODMAP diet?”. Perhaps you are afraid your symptoms will come back. And you would rather live with a limited diet than go back to the discomfort you were feeling before.

Those concerns are valid! But FODMAP reintroduction really is necessary. The low FODMAP diet was never intended to be long-term.

Following a low FODMAP diet for too long may lead to nutrient deficiencies, damage to your gut microbiome, a complicated relationship with food or your body, and a decrease in your overall quality of life.

When to Start the FODMAP Challenge Phase

Suppose you’re are currently in the elimination phase of the diet and have had a satisfactory reduction in symptoms. In that case, you may proceed with FODMAP reintroduction, challenging one FODMAP category at a time.

Most people are ready to move forward with reintroduction after 2-4 weeks, but in some cases, it can take up to 6 weeks to get there.

If you have not had any improvement in symptoms in the first 2-4 weeks, FODMAPs are likely not your main trigger. In this case, you may abandon the FOMDAP process altogether. But don’t consider this a failure – in many cases, it reveals other factors that may be contributing to symptoms, like stress, lack of sleep, or other dietary triggers.

How to Reintroduce FODMAPs

It’s time to get ready to reintroduce! Keeping a food and symptom diary will help you gain clarity through this process. Record what you eat, any symptoms experienced along with the time of day, and any other factors that might impact your symptoms – stress, poor sleep, your menstrual cycle, travel, etc.

Step One – Pick Your Starting Point

Step one in the reintroduction process is to decide which FODMAP to start with. Many people choose to start with a FODMAP that you think you will tolerate. This can help you ease into the reintroduction process with less fear.

Step Two – Choose a Food

Pick your challenge food. You can work together with your dietitian to decide what this food will be. Usually, it is a food that contains only one type of FODMAP. Save foods with multiple FODMAPs for later.

Step Three – Determine Your Challenge Portions

Determine your portion sizes. For each challenge, you will start with a small portion on day one. Using the Monash app, this may be a green serve or slightly more. If it is a food that you are fearful of, you might start with a very small amount.

If you handle the first challenge well, slightly increase the portion for the second one. If that goes well too, increase it once more for your third challenge.

If you have symptoms at any stage of the challenge, stop and take note. This may mean you are intolerant of that FODMAP. But before you write off that FODMAP for good, reflect on any other possible triggers that may have skewed your results (like stress). You can always come back to this challenge later if the results are unclear.

It can be helpful to wait a day in between challenges. Sometimes the symptoms are a bit delayed, especially if you are more prone to constipation than diarrhea.

Usually, a FODMAP challenge looks something like this — Day 1: Small serve, Day 2: Break, Day 3: Moderate Serve, Day 4: Break, Day 5: Large Serve.

FODMAP Reintroduction, sample challenge using wheat. Day 1: 1 Slice, Day 2: Break, Day 3: 1 1/2 slices, Day 4: Break, Day 5 2 Slices

Step Four – Pause and Reset

Return to a low FODMAP diet between challenges – usually for about three days. Give it more time if you still have symptoms. You should be comfortable before moving on to the next challenge.  

Even if you tolerated your challenge food, it is important to go back to that baseline low FODMAP diet in between challenges. If you fail to do so, it can make the results of subsequent challenges harder to interpret. This is due to the potential for FODMAP stacking.

FODMAP stacking occurs when you have multiple foods containing FODMAPs in one meal. Sometimes these foods do not cause symptoms in isolation, but when consumed together, have an additive effect that can send you running for the bathroom.

FODMAP Stacking - picture of a stack of FODMAP foods: asparagus, onions, tomatoes, blackberries, pear.

Step Five – Repeat

Repeat the process for the other categories of FODMAPs.

Of note, more than one challenge can be done for certain FODMAP categories. For example, there are usually three separate challenges for fructans – one using wheat, one using onions, and one using garlic. In some cases, someone might tolerate wheat but be sensitive to onions and/or garlic – or the other way around…

Another example is with polyols. Some people are sensitive to mannitol, but not sorbitol. So, we challenge these separately.

Once you have determined which FODMAPs you are sensitive to, you can challenge foods with multiple FODMAPs. Examples include apples (sorbitol + fructose), and cashews (fructans + GOS).

Common Challenges During Reintroduction

One of the biggest challenges of FODMAP reintroduction is the time it takes to get through each challenge. You’ve already been on a restrictive diet for at least 2-4 weeks, so the thought of dedicating more time can be daunting. That’s why it is so important to know what you are getting into ahead of time.

Try to start the low FODMAP diet when you know there won’t be a lot of interruptions. However, we know that life happens, and you may have situations come up that make staying on the diet more difficult. This might include travel for work, social events, family emergencies, vacations, etc.

You might also experience feelings of frustration, isolation, or anxiety as you move through the phases of the diet. This is normal. But with the right approach and support, these obstacles are usually manageable.

However, if your stress becomes overwhelming, it may interfere with the low FODMAP process. After all, stress can trigger symptoms independent of diet. In this case, other treatment options should be explored.

Here are some tips to get you through FODMAP reintroduction:

  1. Remember where you started. If you are in the reintroduction phase of the FODMAP process, that probably means you have had some symptom improvement. Reflecting on what life was like before you started this journey can help keep you going.
  2. Learn from your mistakes. If you eat something you shouldn’t during the elimination or reintroduction phase, that doesn’t mean you have screwed up the whole process. Take note of any symptoms and keep on going. Sometimes we can learn from these mistakes.
  3. Keep your eye on the prize. The goal of FODMAP reintroduction is to get you on the least restrictive diet without exacerbating symptoms. You are so close to figuring this out!
  4. Be patient. Patience is key during the reintroduction phase. Stay committed to the process and avoid rushing through the challenges.
  5. Seek support. Don’t hesitate to reach out to a registered dietitian for guidance and support during the reintroduction phase. They can offer personalized advice, help you interpret your symptoms, and adjust your diet as needed.
  6. Take a break. Sometimes you need to take a break from the process. By now you hopefully have some idea of your triggers and can plan accordingly. Taking a break from reintroduction might mean loosening some of your restrictions for a period of time. If you experience symptoms, you can go back to a low FODMAP diet and resume the reintroduction process. But please! make sure you don’t get stuck on a restrictive diet long-term.

Interpreting FODMAP Reintroduction Results

If you have kept a food and symptom journal, it can help you analyze the results of your FODMAP challenges. Again, make sure to track non-food factors that may contribute to symptoms, like stress, poor sleep, your menstrual cycle, travel, etc.

A Food and Symptom Journal can help you analyze the results of the FODMAP reintroduction process.

Keep in mind that FODMAPs produce symptoms in our intestines, not our stomach – usually our large intestine. It takes time for the food we eat to get there. If you notice symptoms 10 minutes after eating a food, it may not be what you just ate, but rather what you ate several hours ago.

If you experience symptoms during reintroduction, ask yourself…

  • Was it the challenge food, or something else? Consider your stress level, sleep, or interruptions to your usual routine. For women, could it have been related to the time of month? Was there a non-FODMAP food trigger in your diet, like fried food, too much coffee, or alcohol?
  • Were small portions tolerated? If you tolerated the first and maybe even the second challenge, but not the third, you may be able to include small portions of this FODMAP in your diet. You can play around more with your threshold of tolerance in the Personalization phase of the diet.
  • How severe were the symptoms? If symptoms were mild, could you add this food back in? Is it worth having some symptoms to be able to have a more varied and exciting diet?

If the results of your challenge are not clear… for example, if you had non-food triggers that may have impacted your results, you can always circle back and try that challenge again.

It is also important to note that your tolerance to FODMAPs can change over time. So, just because you didn’t tolerate a food today, doesn’t mean that you should never try it again. You might consider rechallenging your problem FODMAPs a few months down the road.

Building a Personalized FODMAP Approach

Once you have completed your FODMAP challenges, it is time for the fun part – putting together your new personalized diet.

You may start by adding more foods in the FODMAP categories that you tolerated.

But, keep in mind the concept of FODMAP stacking. Having multiple FODMAP foods at once may cause you symptoms, even if those foods were tolerated on their own.

Don’t be afraid to try stacking. In fact, having multiple serves of the foods you “passed” during the challenge phase is a good way to test how liberal you can be with these foods. But choose a day that you can be in the comfort of your own home. Note any symptoms and how many FODMAP foods you had at that meal.

Next, you may try adding small portions of the foods that caused non-severe symptoms. Work on gradually increasing the portions of these foods to establish your threshold for tolerance.

If your symptoms are well controlled, you may also consider going back to any challenges with unclear results. Maybe you even decide to go back to a challenge that was poorly tolerated and experiment with smaller portions.

If you are interested in adding foods that have not been tested for FODMAPs, use a similar approach to determine tolerance – starting with a small amount and working your way up to your usual portion.

Throughout the process, try to maintain an overall balanced diet that includes protein, fruit, vegetables, whole grains, nuts or nut butter, and beans, as tolerated.

Balancing your plate: Aim for 1/2 a plate of fruits and vegetables, 1/4 plate grains or starch, and 1/4 lean protein.

Long-Term Considerations for Building a Resilient Gut

Aside from figuring out your personal food triggers, there are some things we can all do to achieve better gut health.

We’ll start with the basics:

  • Chew your food well.
  • Slow down – set your fork down between bites if it helps.
  • Stay well hydrated.
  • Put away the distractions at mealtime.
  • Try to eat in a calm environment.
  • Take a few relaxing breaths before starting your meal.

Next is variety. Variety is key! A healthy gut microbiome loves a diverse diet. Especially one rich in plant-based foods. Plants contain fibers and phytonutrients that help your gut bugs flourish.

Why is this important? It is thought that the gut microbiome plays a role in the development of IBS. Building a resilient microbiome can help you establish a more resilient gut. So be sure to include as many of those FODMAP foods in your diet as you can tolerate.

However, eating a plant-rich high-fiber diet can be challenging with IBS. Consider focusing on soluble fiber more than insoluble. For some people, this might mean limiting tough skins or seeds.

Or consider modifying the texture of your food to get more plants in. For example, some people have trouble digesting raw vegetables but tolerate them once they are cooked. Others can’t eat whole nuts but do just fine with nut butter.

And finally, limit alcohol, which happens to be a common trigger in IBS. Heavy alcohol use is associated with dysbiosis, or an imbalance of healthy versus unhealthy microbes in your gut. Heavy drinking can also increase gut permeability, sometimes referred to as “leaky gut”.

The amount that causes damage is unknown. Most of the studies available on alcohol and the gut microbiome have been conducted in adults with alcohol dependence.

Keep moderation in mind. If you tolerate alcohol, stick to one drink per day for women and two drinks per day for men. And ideally give yourself a day or two without alcohol every week.

A Recap on The Importance of FODMAP Reintroduction

The FODMAP elimination diet can be a helpful tool for managing the uncomfortable symptoms of IBS. However, the reintroduction phase of the diet is crucial for long-term success.

Most FODMAP-sensitive individuals are not sensitive to all FODMAPs. Staying on the full elimination is unnecessary and potentially harmful. Reintroducing FODMAPs helps liberalize the diet, allowing a greater variety of foods and nutrients that can be helpful both physically and mentally.

Skipping this important step can lead to nutrient deficiencies, poor gut health, and a decrease in quality of life. A registered dietitian can help you through the nuances of the FODMAP elimination and reintroduction process, increasing your chance of success.

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Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

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