In Part 2 of my Low FODMAP Diet series, host Anna Mapson guides you through how to reintroduce high FODMAP foods into your diet. Whether you've just recently experienced relief from IBS symptoms during the elimination phase, or you've been avoiding FODMAPs for years, this will help!

Discover how to do this safely and systematically to create a sustainable, symptom-minimizing long-term diet.

Episode Highlights:

1. The Reintroduction Challenge: The common fear of reintroducing high FODMAP foods after eliminating them from your diet and explains why it's a crucial step in the journey toward digestive freedom.
2. The Step-by-Step Approach: Pick one FODMAP group at a time and increase your intake over three days. You need to understand which foods fall into each FODMAP category.
3. Timing and Progression: Discover the timeline for reintroduction, which may take about 6 to 10 weeks, with breaks and reset days in between challenges, ensuring a systematic approach to identify specific triggers.
4. Adapting to Change: Understand that food intolerances can evolve over time, especially for those with conditions like SIBO (Small Intestinal Bacterial Overgrowth), and learn the importance of periodically revisiting previously challenging foods.
5. Balancing Act: Anna provides insights into managing anxieties during reintroduction, employing mindful eating techniques, and staying vigilant without becoming overly anxious about symptoms.
6. Customizing Challenges: For extremely sensitive individuals, Anna suggests a slower approach by alternating reintroduction days to ease anxieties and accommodate your comfort level.
7. Revisiting Restriction: Consider a brief return to a strict low FODMAP diet for 1-2 weeks before reintroduction if you're unsure about your current triggers, to potentially identify unnecessary dietary restrictions.

Links

• Website - www.goodnessme-nutrition.com

For more personalized guidance, feel free to ask questions (info@goodnessme-nutrition.com) or tune in to Instagram live sessions (@goodnessme_nutrition) for further insights.

[Disclaimer: The information provided in this podcast is educational in nature and not a substitute for professional medical advice. Always consult with a healthcare provider or dietitian, especially when making significant dietary changes, particularly for individuals with IBS.] 🎙️🍽️

Hello, welcome to part 2

of the low FODMAP diet.

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I'm going to talk today about how to

reintroduce foods back into your diet

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after you've done the elimination diet.

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If you haven't heard the overview,

go back and listen to part 1 where I

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explain what the FODMAP diet is, who

it's for and who shouldn't use it.

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But today, we're talking about

how to bring things back in again

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if you start to feel better after

taking the foods out of your diet.

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And I'm going to talk about how

to do it bit by bit, and also what

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happens if you do get a reaction.

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What should you learn from that?

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And how can you build out your

long term diet that hopefully

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minimizes your symptoms?

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Welcome to episode 18.

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This is The Inside Knowledge

with me, Anna Mappson.

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The reintroduction phase of the

low FODMAP diet is something most

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people, I find, don't get round to.

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They eliminate foods from their diet and

then actually bringing them back in again

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feels too scary and too overwhelming.

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What happens is you either stay on

a low FODMAP diet or you don't know

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if you've got any benefit from the

diet so gradually bring things back

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in without really checking whether

they are making a difference or not.

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The aims of reintroducing the foods

is to try to get your confidence up.

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So try to make you feel more

confident about eating these foods.

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And we do it in a really slow,

measured, and careful way.

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It's about helping you identify triggers,

and ultimately getting you to the place

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where you can eat a broad range of foods

again without being so restrictive.

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So if you've done a FODMAP diet,

you're feeling better and you're

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ready to move to the next stage, this

is how you're going to get started.

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Pick one of the FODMAPs at a time

and bring them back into your

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diet, gradually increasing the

amount you eat over three days.

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Each of these challenges needs to

be chosen quite carefully so that

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you're only picking one type of FODMAP

at a time, and this is where it is

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really helpful to understand which

foods are in which FODMAP grouping.

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As I said, before.

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It's not really an intuitive

diet, so you wouldn't necessarily

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think that perhaps broad beans or

avocado might be high FODMAP foods.

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This means that if you're picking a

food that's got two types of FODMAPs,

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like apples, for example, or cashew

nuts, then You introduce those without

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testing the individual FODMAPs first.

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You won't necessarily know

which one you're reacting to.

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So this is why planning it

out, um, is really helpful.

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So the first thing to do is

to pick which of the FODMAPs

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you're going to bring back in.

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There isn't really a right or

wrong order to bring them back in.

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I do have a chat with my clients about...

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Which foods maybe that

you've missed the most?

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Like, what are you craving?

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Maybe things that would help

you expand your diet the most.

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So for people who cook for others,

sometimes it's things like pasta,

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um, and that would really help

you with family meal times.

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Other times it might be onions and

garlic because you enjoy eating out

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and it's very hard to avoid onions

and garlic when you're eating in

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restaurants or pubs or something.

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It doesn't really matter how you're

going to select the food, what matters

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is that you select one of them, and

there are lots of these to work through.

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There are 11 stages of the low FODMAP

reintroductions, and Sometimes you need

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a little bit longer in between each one.

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So three days for each FODMAP

plus one washout day at least.

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And what I mean by a washout day is

a day where you go back to the low

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FODMAP diet and just reset yourself.

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So you, you do three days of

reintroduction, increasing the amounts.

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If you feel okay, you

still have a day off.

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Go back to low FODMAP for one day.

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If you had a reaction to the food, then

you need to take a bit longer, maybe

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three or four days, to reset your gut,

to re calm yourself down, and make

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sure that you haven't got any symptoms

before you start introducing them.

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People often ask, how

long is this gonna take?

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And...

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The minimum amount of time is normally

about six to seven weeks, and that

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is because you have three days for

each FODMAP plus one extra day, which

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adds up to four days per fodmap.

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And there's 11 groups.

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So you could do 44 days.

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However, some of them you might

be a little bit more relaxed

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about, and I can explain that.

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So when you've got a category where with

two FODMAPs in, if you've sailed through

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the Galacto oligosaccharides, the Goss,

and the fructans, for example, when you

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put them together, You probably don't

need to go through the full thing to

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the full extent if you're in a rush.

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So the official line is that you

take this amount of time, which could

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take you somewhere around 10 weeks.

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So this can feel like...

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Long, long road if you've already been

struggling on the low FODMAP diet.

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Because as you're going to be expanding

your diet, which is great, you still

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may feel some level of restriction.

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So let's think about how to actually

bring the foods back in again.

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I'm going to give an example from

the FODMAP grouping of polyols

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and particularly mannitol.

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This includes things like mushrooms and

cauliflower, and large amounts of sweet

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potato, celery, that kind of thing.

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What I suggest you do is just

pick one food from a FODMAP

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group and just stick with that.

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That is the easiest way because

you're retesting the same foods.

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There is a way that you could mix it

up a bit by selecting foods out of that

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entire FODMAP grouping, and that's also

a valid approach, but it's kind of easier

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if you just stick to the same food.

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So for example, with mushrooms,

on the first day you just put

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one to two mushrooms on your

plate, which is around 10 grams.

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Then on the second day, assuming you

feel fine, you're going to increase

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that up to sort of a Three quarters of

a cup or somewhere in the right rounds

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of 40 grams and then on the final day

You want to get to 80 grams with most

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fruit and vegetables you want to aim to?

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around 80 grams of the food because

that is one portion of Or, what

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you would normally eat in a meal.

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So, for example, like with grapefruit,

they are so big and juicy that

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actually 80 grams is quite small and

quite a small piece of the fruit.

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So, often a grapefruit could

be somewhere like 200 grams.

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So, one grapefruit might be what

you would eat in one sitting.

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Therefore, you want to get up

to one fruit, not 80 grams.

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But, if you're going to vary it,

maybe you do, like on the first

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day, you do a few mushrooms.

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The second day, you might do, like,

one cup of sweet potato, which

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would be somewhere like, 180 grams,

and then you might go back on the

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third day to 80 grams of mushrooms.

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In this way, you're varying the

food between mannitol portions,

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increasing the amount of mannitol.

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within the three trial days.

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It doesn't really matter, but I

find it easier if you do stick

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to the same foods and try to keep

things a little bit consistent.

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So if that goes well, you should then be

okay with other foods in that food group.

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So assuming your mushroom challenge

goes well, then you should be able to

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eat things like cauliflower, butternut

squash, and celery, um, and fennel.

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Because those are also

high in the mannitol.

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But it is always worth being aware

that other components of food can

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be a trigger, not just FODMAPs.

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So maybe it has got a

high histamine content.

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Has it got high salicylates?

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Is there a particular protein like

casein in the milk, not lactose

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for example, that is your trigger?

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So there are other things that, not

just FODMAPs, that can be a problem.

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That's why, if you do have an issue, it's

worth testing it again with a different

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fruit or vegetable from that category.

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The sorts of symptoms that you are

looking for are things like increases

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in your bloating, changes to your bowel

habits, maybe things like headaches and

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skin rashes, like any other symptoms

that you would normally be checking

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and monitoring and thinking about.

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Those are also valid, but critically

we're thinking about the digestive

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impact of eating these foods.

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I ask my clients to check their

symptoms around eating the food.

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How do they feel when

they've just eaten it?

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3 to 4 hours later, and then 12 hours

later, and then perhaps 24 hours later.

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So I really want you to kind of

keep on top of the symptoms whilst

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you're doing this challenge to make

sure that you're just thinking about

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when the symptoms come, if they come

at all, and hopefully they won't.

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It's really important to be aware

of other confounding factors,

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like, what else is going on at the

time that you had this reaction.

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Maybe you had a super stressful day

at work, or you didn't get much sleep

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because your children were ill and you

were up through the night, or you went

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out for a meal and you had a glass

of wine that you don't normally do.

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These things can all impact

on your symptoms as well, so

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I want you to also measure.

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What confounding factors, like what

else could have influenced the results

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because this is really important.

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The other thing to be aware of is

like just picking a time to do the

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reintroduction when you're not too busy.

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So whilst I don't want anyone to put it

off for too long, like for example, two

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to four weeks on the low FODMAP diet is...

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Normally enough to know whether

you've had improvements.

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Don't put it off for ages, but at the

same time, don't also pick a time when

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you're like moving house or about to

go on holiday because it will be very

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difficult to know whether the reactions

are something to do with that or

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something to do with your food challenges.

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Now whilst I've said keep on top

of your symptoms and check them

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like every few hours, I also...

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Don't want you to be hypervigilant,

so anxiety can make things worse.

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This is where, right back in episode

2, when I talk about how to eat, and

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episode 4, where I talk about, um,

the gut brain connection and stress.

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Techniques in there about

mindful eating, chewing your

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food really well, slowing down.

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These really come into play when

you are doing a food challenge.

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It's so important to try to

keep yourself feeling calm.

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Keep yourself just feeling like

you've got this, you can do it, and

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try to calmly monitor your symptoms.

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The other final thing to be, really be

aware of is some gurgling is normal.

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It's kind of normal to have

some gas with some foods, like

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for example beans and pulses.

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So some level of reaction

is okay and tolerable.

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What you're looking out for is when the

symptoms become intolerable, like when it

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is getting to the state where you don't.

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feel happy anymore, you feel pain,

you feel, um, too much gas, like

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you're running to the bathroom,

any of those things, like that

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would be a sign to stop the trial.

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Where possible, you want to try and

get three days in so that you know

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how much of the certain food gave you

the trigger to kick your symptoms off.

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Like, what level of exposure

to that food is the point for

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you where your IBS comes back.

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That's why it's useful to

have three days worth of data.

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However, if you're feeling terrible after

day one and you just think, as soon as I

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ate that, I don't know, asparagus, I felt

terrible and I knew it was the asparagus.

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There was nothing else going

on in my life that day.

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I felt really good and as

soon as I ate that I felt bad.

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Okay, if that happens to you

and you don't want to go to day

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two, here's what you can do.

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So in my example, asparagus

is high in fructose.

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So what I would do is park the

fructose challenge for now.

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Say you're not going to eat

things that are high in fructose

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because of this reaction for now.

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And what you're going to do

is work through the others.

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Carry on going through the

other FODMAP challenges.

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Don't worry about fructose for now.

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Then you're Towards the end or in

another few weeks, we're going to

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come back to it and trial the fructose

challenge again with a different food.

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Maybe asparagus on their own

are just an issue for you.

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So what you could do is pick

something else, maybe like cherry

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tomatoes, maybe pick mango or honey.

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And again, try them in increasing

amounts on different days.

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Then make sure that you are...

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tracking your symptoms and this is

why it's helpful to write it down so

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that you can go back and see okay, how

did I feel when I had one asparagus

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spear, which is the trigger point for

high moderate FODMAPs, um, how did

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I feel when I ate that compared to

the time I ate six cherry tomatoes?

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Was it the same kind of

reaction or was it different?

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This is where you can get some data

like it's being your own detective

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and gathering as much information as

you can about the types of foods that

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you're eating and the types of symptoms

that you're getting in order to know

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whether it's a food particular trigger

or was it something else in the way

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that you ate that meal that could have

potentially triggered your reaction.

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It's also key to note that you can change

intolerances over time, and this is

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particularly for people who have SIBO,

that small intestine bacterial overgrowth.

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As you get rid of the bacteria

in your small intestine that have

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overgrown, it's normal for people to

become more tolerant to more foods.

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So things that you potentially

were intolerant to six months ago,

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you can change your reaction to.

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So sometimes our bodies just lack the

enzyme to break something down and just

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biologically don't have the capacity

to digest things particularly well.

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Sometimes it could be the case

that actually you can digest it.

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It's just that bacteria were

interfering with that process.

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And as we start to improve your digestion

overall, there is hope that you can eat

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more and more of these foods, which is why

it's good to come back and retest these

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foods again, because it won't mean that

you have to avoid asparagus for life.

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So once you've finished doing all of

your reintroductions, then make a note

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of the things that you struggled with,

that you didn't get on well with, and

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then you can come back to them maybe

in three months, six months, a year.

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It doesn't matter.

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The key thing is to keep on

testing them and not to avoid

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them for the rest of your life.

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Now, as you increase the amounts of

some foods, you will also be exposed

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to more than one type of FODMAP.

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So with my asparagus example, at a

low level, fructose is the key FODMAP.

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But as we get to more, so you might

have five spears of asparagus, then

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you are hitting the FODMAP tolerance

levels for fructose and fructan.

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So this is where it's

helpful to do the tests.

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individually first and the Monash

University FODMAP app is really helpful

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because you can look it up and see if

foods contain more than one FODMAP.

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For my clients and anyone who enters the

group gut reset or individually works

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with me, I have a handout which says

foods by FODMAP and will tell you the

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amounts that you can eat and that is

based off data from the Monash University.

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If you are super sensitive, you can do

the challenges on alternate days as well.

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So you could do day one, reintroduce,

um, you know, just one or two mushrooms.

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Then you have a day off

back to the low FODMAP diet.

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Day two, increase the

amount a little bit more.

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Have a day off.

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Day three, Then you go to the full amount.

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So if you want to do it a little bit

slower, that's also fine, particularly

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if it helps you manage anxieties about

how the symptoms may be, reacting

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or just if you find that you're

super sensitive to a certain food.

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If you have been Low FODMAP for

years or maybe, you know, over six

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months and you're just really nervous

about reintroducing the foods.

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I hope some of these tips will give

you a chance to see how it's possible

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to restart reintroducing some foods.

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Remember the goal is always to eat

as freely as possible and eat as

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broad a balanced diet as possible.

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Going through this period of restriction

was just one tool that you could use.

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This is an intervention.

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It's not a way of life.

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So if you're not quite sure whether

you're ready to reintroduce foods or

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not, what you could do is potentially

go back to a really strict low FODMAP

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diet for one to two weeks because to

try and get on top of your symptoms,

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what I find is that people say they're

on a low FODMAP diet and they're still

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getting symptoms, so it kind of means

that they're not necessarily managing it.

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Particularly well.

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Or, it's not actually a FODMAP issue.

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So, what would be really helpful is

to first of all, go super strict low

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FODMAP for one to two weeks and then

go through this reintroduction process.

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Because what you might find is you've

actually been avoiding foods for

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a long time that aren't a problem.

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And potentially it's just one or

two foods out of a whole food group.

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And you're cutting out a

lot more than you need to.

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I hope some of this has been

helpful and if you have any

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questions do drop me a line.

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I'm going to do a live on Instagram

so come over and watch that and

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I'll go through some questions that

I've had on the low FODMAP diet.

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Otherwise I'll leave it there for

this week and catch you next week.

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Bye!