With the low FODMAP diet being a revelation to IBS sufferers in recent years, research is being completed on different aspects of the diet regularly and advice on the low FODMAP diet is rapidly changing. This means information on the internet goes out of date fast. Most research has been done on the restriction phase meaning this information is usually more consistent and correct, however when it comes to the reintroduction phase there is a lack of information and what is available is not always accurate. Even the information I previously provided on my own blog is now out of date due to the increased knowledge we have on the FODMAP content of foods and how this relates to successfully being able to ‘re-challenge’ yourself with FODMAPs.
Reintroducing FODMAPs into the diet after completing the low FODMAP restriction diet is one of the most important elements 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 reintroducing FODMAPs
Reintroducing FODMAPs is hard and definitely a lot more complicated than following a low FODMAP diet. There have been updates over the past year, so if you are relying on the internet for information rather than seeing someone who is trained and/or qualified (preferably a registered dietitian) in providing reintroduction advice 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 and as it is open access I suggest you have a read, just follow the linkhere. 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:
In this paper the authors do not outline the protocol for reintroduction however there are several sources I found 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.
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 major mistake as 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 and it will be more likely a lot of people will get symptoms straight away. 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!’.
What you are supposed to do is 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.
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 how would 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. The tables also suggest using 200g yoghurt. Most yoghurts are 150g anyway therefore you are consuming a very large portion size of yoghurt and lactose. One whole clove of garlic is not a good test either. Even ½ a clove of garlic contains high amounts of fructans and may trigger symptoms. 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, ideally an experienced dietitian. The problem is not everyone with IBS has access to a dietitian or cannot afford to see a 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 here.
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 have teamed up with Alana from A Little but Yummy for our 5 Common Mistakes When Reintroducing FODMAPs.
This article was originally posted on www.rmdietetic.com