(Updated 2017) by Lee Martin MSc RD
The world of FODMAPs is changing and information on the low FODMAP diet available on the internet goes out of date fast. The information you can now find on the restriction phase of the low FODMAP diet is more consistent and correct these days however when it comes to the reintroduction phase there is still a lack of information and what is available is not always accurate. Even the article I previously wrote on my this blog ‘Reintroducing FODMAPs‘ is now out of date due to the increased knowledge we have on the FODMAP content of foods and how this relates to successfully being able to ‘re-challenge’ yourself with FODMAPs. To avoid the pitfalls of reintroducing FODMAPs using wrong or outdated information this article will give you some important points to look out for.
Reintroducing FODMAPs into the diet after completing the restriction phase of low FODMAP diet is the most important element of this dietary approach to treating symptoms of IBS. This is probably why my previous post on Reintroducing FODMAPs has been the most viewed post on the blog, on average, over the last couple of years.
Inaccurate information on how to test tolerance levels when reintroducing FODMAPs
Reintroducing FODMAPs can be hard and is a lot more complicated than following a list of foods to eat either high or low in FODMAPs. Plus there is lots of misleading information on the reintroduction phase so if you are relying on the internet for information rather than seeing someone who is trained and/or qualified (preferably a registered dietitian) then it can get even more confusing. Let me use an example to show this.
Through searching the internet (using Google) the most common information provided on reintroducing FODMAPs is from blogs or websites. The majority have loosely based their information on the paper below by Monash University from 2012. This is a really useful and interesting paper by the way and as it is open access I suggest you have a read, just follow the link here.
In a flow chart describing a ‘patients journey’ from diagnosis to low FODMAP treatment the Monash authors discuss the reintroduction phase. For re-challenging FODMAPs they recommended the following foods and portion sizes to test tolerance levels to each individual FODMAP:
In this paper the authors do not outline the protocol for reintroduction however there are several sources I found on the internet which using the information above have created the following table as a FODMAP reintroduction plan:
The problem with this is it is incorrect. The people who have created this table do not fully understand the reintroduction process and they have made some mistakes in translating the research.
How are you supposed to test tolerance levels to FODMAPs if you are only eating the same portion size every time?
First of all they have suggested using the same portion size (taken from the Monash 2012 paper) of FODMAPs each time you test that FODMAP. This is a mistake and begs the question: ‘how are you supposed to test tolerance levels to FODMAPs if you are only eating the same portion size every time?’
In fact the portion sizes they suggest you start with are going to be way too high in FODMAPs in the first place. It will be likely a lot of people will get symptoms straight away if they eat this portion size. This may have negative consequences as people may think ‘oh well, I have tested all these FODMAPs and I can’t eat any of them I had better stick to a low FODMAP diet for ever!’.
A better and more accurate approach is to start with a smaller portion size of FODMAP and gradually increase the portion over three consecutive or non-consecutive days. That way you know the amount of FODMAP you can tolerate and when the portion size is too large and starts to trigger symptoms.
Testing tolerance levels foods that contain more than one type of FODMAP is more likely to cause symptoms than help test tolerance levels!
Another mistake made is the foods chosen above actually contain more than one type of FODMAP. For example mushrooms contain significant levels of both fructans and mannitol so when testing symptom reactions it would be difficult to know if it’s the fructans or the mannitol triggering your symptoms. The Monash University low FODMAP app states 4 apricots are high in both sorbitol and fructans meaning you are once again confusing two FODMAPs and also starting at a portion size far too high to start with. This is more likely to cause symptoms than help test tolerance levels.
More problems with too large portions of high FODMAPs…
The tables also suggest using 200g yoghurt. Most yoghurts are 150g anyway therefore you are consuming a very large portion size of yoghurt and therefore lactose – meaning you are likely to experience symptoms. One whole clove of garlic is not a good starting portion size to test tolerance levels either. Even ½ a clove of garlic contains high amounts of fructans and may trigger symptoms. It is better to start with a smaller amount of garlic and gradually increase the portion size for the test to have some degree of accuracy.
When it comes to reintroduction you really should seek information from someone who knows what they are talking about
Much of the information available via the internet on reintroducing FODMAPs is out of date although you wouldn’t be aware of this without having extensive knowledge on the subject. When it comes to reintroduction you really should seek information from someone who knows what they are talking about.
Ideally you should go and see a dietitian. The problem is not everyone with IBS has access to a dietitian or cannot afford to see a private dietitian, while others would rather do it themselves. In fact if everyone in the world with IBS actually wanted to see a dietitian then there would probably need to be a dietetic clinic on every other street corner. For those who do not have access to a dietitian but still want accurate dietetic information I have written the first ever book dedicated to the reintroduction phase of the low FODMAP diet.
The book discusses the best way to ‘Re-challenge and Reintroduce FODMAPs’. This cannot replace the individualised advice you can get from a dietitian appointment but it will provide you with a protocol for reintroducing, tell you what foods to re-challenge and at what portion sizes and give you two methods of reintroducing to choose from so you can self-manage the reintroduction process. You can read more about the book on the website www.reintroducingfodmaps.com
Thankfully there is also some useful information available on the internet. Alana who runs A Little bit Yummy has researched several sources of reintroduction information to provide a more balanced overview of the reintroduction process. Her excellent blog provides loads of fact based and practical low FODMAP information. You can read her blog post on reintroducing here: ‘Testing FODMAPs: How does the re-introduction phase work?’
To help people find more accurate information available on the internet for the reintroduction phase of the low FODMAP diet I am going to team up with Alana from A Little but Yummy. So watch out for our Top 5 Tips on Reintroducing FODMAPs coming soon…. (update – this article is now available here)
Further articles on how to challenge FODMAPs and navigating the Reintroduction Phase of the low FODMAP diet
We recently travelled around the world and blogged about following a modified low FODMAP diet. See more on our FODMAP travel section.
Good news! The first ever book dedicated to reintroducing FODMAPs is now available to purchase on Amazon. The book is titled ‘Re-challenging and Reintroducing FODMAPs – A self-help guide to the entire reintroduction phase of the low FODMAP diet’. Click on the logo for more details.