Phase 2: FODMAP Reintroduction
Ok so you’ve been eating low-FODMAP for awhile now (read 2-6 weeks) AND you’ve felt either a reduction in the amount or intensity of symptoms, or both! This means that it is time to start reintroducing FODMAP groups one by one.
Do I still have to eat low-FODMAP?
The short answer is, yes. It’s kind of like feeding a toddler, we really don’t want to change anything else about your diet right now except for the reintroductions, meaning that we should keep it low-FOD until phase 2 is completed to minimize any background symptoms. This is definitely a conversation between you and your GI Dietitian, because I have definitely made exceptions based on unique circumstances.
Okay, so what do we reintroduce?
Your questions are fire! We need to pick a rep food aka a food to represent each FODMAP group. Here are some suggestions:
| Fructose | Sorbitol | Fructose + Sorbitol |
|---|---|---|
| Honey Mango Asparagus | Avocado Blackberries Apricot | Red apple Pear Cherries |
| Mannitol | Fructans (veg) | Fructans (grains) |
|---|---|---|
| Mushrooms Cauliflower Sweet potato | Onion Garlic Dates | Pasta Cous cous Bread |
| Lactose | GOS |
|---|---|
| Milk Ice cream Ricotta | Chickpeas Green peas Pistachios |
Let’s move on to the how-to.
You can reintroduce FODMAP groups in any order. Often, I suggest reintroducing foods or flavourings that you are truly missing from your diet first, and leaving any probable food triggers until the end. Over three days, we are going to increase the rep food from a small portion (about 1/3 what you would normally eat), to moderate (approximately 1/2 of a usual serving for you), and finally to a large or regular serving of the food. If your symptoms are usually delayed, 12+ hours after eating, you may want to space out reintroductions to every other day (i.e. reintroduce on days 1, 3, and 5 vs. 1, 2, and 3). If you start to experience symptoms that are unacceptable to you, STOP. Do not continue reintroducing that food, and always wait 3 symptom-free days before reintroducing another group. See two sample reintroductions below.
| FODMAP Group | Rep Food | Day 1 | Day 2 | Day 3 |
|---|---|---|---|---|
| Fructose | Honey | 1 tsp | 2 tsp | 1 Tbsp |
| Sorbitol | Avocado | 1/4 avocado | 1/2 avocado | 3/4 avocado |
| Fructose + Sorbitol | Red apple | 1/4 apple | 1/2 apple | 1 whole apple |
| Mannitol | Mushrooms | 1/2 button mushroom | 2 button mushrooms | 4 button mushrooms |
| Fructans (veg) | Garlic | 1/4 clove | 1/2 clove | 1 whole clove |
| Fructans (grain) | Wheat pasta | 1/2 cup cooked | 1 cup cooked | 1 1/2 cup cooked |
| Lactose | Regular milk | 1/4 cup | 1/2 cup | 1 cup |
| GOS | Canned chickpeas | 1/2 cup | 3/4 cup | 1 cup |
| FODMAP Group | Rep Food | Day 1 | Day 3 | Day 5 |
|---|---|---|---|---|
| Fructose | Mango | 1/4 mango | 1/2 mango | 1 mango |
| Sorbitol | Blackberries | 2 berries | 5 berries | 10 berries |
| Fructose + Sorbitol | Pear | 1/4 pear | 1/2 pear | 1 pear |
| Mannitol | Cauliflower | 2 florets | 4 florets | 8 florets |
| Fructans (veg) | Onion | 1/8 onion | 1/4 onion | 1/2 onion |
| Fructans (grains) | Cous cous | 1/4 cup cooked | 1/2 cup cooked | 1 cup cooked |
| Lactose | Vanilla ice cream | 1/4 cup | 1/2 cup | 1 cup |
| GOS | Green peas (from frozen) | 2 Tbsp cooked | 1/4 cup cooked | 1/2 cup cooked |
What are my IBS symptoms telling me?
Since our rep food represents the whole FODMAP group, the intensity of your symptoms will suggest how much of the foods in that group you can tolerate and what your symptom threshold is. Think of a traffic light. If you make it to the largest serving on day 3, with little or no symptoms, you are free to eat moderate (yellow) and high (red) servings of that group in phase 3 and beyond. If you stop at day 2, a medium sized portion, you may be able to tolerate small (green) and some moderate (yellow) servings of that FODMAP group. If you have symptoms following the smallest serving on day 1, stick to low (green) serves of those foods or avoid completely going forward. In phase 3 we will tailor a long-term diet for you that significantly reduces symptoms, but still has variety, gives you enjoyment, and is well-rounded nutritionally.
How long does FODMAP reintroduction take?
This is the longest phase, and when done following the steps above, can take 8 weeks on average. I get it. This is a long time to continue eating low-FODMAP, and it does take some planning in order to have these foods on hand when you need them. It is also important to consider timing. Some of my clients have chosen to reintroduce their rep foods on or close to the weekend so that their symptom response doesn’t interfere with work. Because, embarrassing and painful, but I don’t have to tell you that. It may also be helpful to think about any holidays or vacation time you have coming up, and how that may interfere with this process. You can start and stop the reintroductions any time, just ensure you have 3 symptom-free days prior to reintroducing.
There IS a way to challenge the reintroduction phase, which can cut down reintroduction time by half. However, there are pros and cons to this, and we’ll get into both next week!
- 10 Ways to get Enough Fibre on the Low-FODMAP Diet
- Challenging FODMAP Reintroduction
- Phase 2: FODMAP Reintroduction
- The Low-FODMAP Diet Made Simple
- Phase 1: FODMAP Elimination
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