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The FODMAP reintroduction plan is the only way to learn what your individual tolerance level is to different FODMAPs, and the only way to safely reintroduce some of your favourite foods as well.
But in order to be successful, it must be approached in a systematic fashion.
That's what I'm looking at in this video.
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Title: FODMAP Reintroduction Plan and Challenge Phase
Reintroducing FODMAPs is the second part of a low FODMAP diet, after the elimination phase.
It’s also known as the Challenge Phase, Reintroduction Phase, or Challenge Protocol. The terms reintroduce and challenge [or re-challenge] are used interchangeably.
Following this plan enables you to discover what FODMAPs trigger your IBS symptoms. By the end you should have a great understanding of what foods you can and cannot tolerate, and in what quantities.
Okay so how does it actually work. Well there are 10 FODMAP groups to be reintroduced, one at a time.
This must occur over a 3-day period, with 3 washout days in between groups. That is, set days where you completely return to a low FODMAP diet in order to ‘reset’ your digestive system.
A typical schedule may look like this, although this just a generalisation. And in this case re-challenge is used interchangeably for reintroduce.
So if you are re-challenging for 3 days, and leaving a 3-day washout period, the re-challenge process for one group lasts almost a week. That means 10 FODMAP groups will take 9-10 weeks total, assuming no set backs.
If you do experience symptoms, you must wait until they settle before testing the next group. Usually the 3-day washout period is enough time, but not always.
Note that you should not re-challenge any FODMAPs until you are symptom-free (or as close as you can be). It’s also important during this period that you continue to follow a low FODMAP diet the entire time.
The most appropriate foods to reintroduce for each group are those that contain only one FODMAP group. This ensures that if you do have a reaction, it’s obvious what FODMAP was the culprit.
There are 5 separate re-challenges for fructans because they occur in a wide variety of fruits, vegetables and grains. Fortunately there’s only one re-challenge for each of the remaining FODMAPs.
So here is an example of a full schedule to follow from FODMAP-trained dietitian Lee Martin which is on the website A Little Bit Yummy.com
It contains recommended foods and quantities. So you can see Re-challenge 1 is fructose, so in this example you would gradually reintroduce honey for 3 days and record if you get symptoms. Then you would have 3-days washout period - no honey and continuing low FODMAP diet - before moving to re-challenge 2.
You can can start with whichever group you wish, but it may be easier to start with lactose or fructose as they are quite straight forward. Additionally I usually recommend re-challenging in the early evenings when at home. There is no possibility of being ‘caught out’ when at work, and allows enough time to notice symptoms before bed.
Now a common question is when will the symptoms show after re-challenging a food?
This varies from person to person and also depends on the severity of the reaction (if there is one). Patients report symptoms anywhere from 30 minutes, the next morning or even a couple of days later.
While I’ve touched on the fundamentals, it’s much easier to do all this following a complete reintroduction protocol. So if a FODMAP-trained dietitian is not accessible to you I recommend the book by Lee Martin, which I'll link to in the video description. Alternatively you can visit my reintroduction guide on DietvsDisease which I'll link in the description as well.
Dietitian: Joe Leech (MSc Nutrition)