Navigating Next Steps: FODMAP Reintroduction

You've now been diligently following a low FODMAP diet for 6 weeks, and your gut is finally giving you a break - kudos to you!  

However, a low FODMAP diet is not meant to be a lifelong diet, so now it’s time for the next steps.  

Why a Fodmap Diet Is Not a Long-Term Diet

We understand that it’s tempting to continue with a low FODMAP if it has improved your IBS symptoms.  However, the low FODMAP diet is not a long-term solution for managing IBS.

There are a few reasons why:  

• a low FODMAP diet is restrictive, and can be low in important nutrients, like calcium and fibre. 
• It's more difficult to shop, cook and eat out on a low FODMAP diet  
• many high FODMAP foods contain fibres that nourish the beneficial bacteria in your gut. A prolonged low FODMAP diet can inadvertently starve these beneficial microbes 

Research also shows that a strict low FODMAP diet is not necessary to maintain relief from symptoms. This is why reintroduction is vital. It will help you identify which FODMAP groups your gut is sensitive to, allowing you to return to a more varied diet while maintaining symptom control. 

How the Reintroduction Phase Works: 

The reintroduction phase will help you pinpoint which FODMAPs contribute to your gut symptoms.  

Using a reintroduction guide, you’ll introduce one type of FODMAP back into your diet at a time, in different portion sizes, for a set period (usually 3 days).

During the test period, the rest of your diet will stay low FODMAP, and you’ll record any changes in your symptoms. You’ll repeat this process until you've tested each group. 

At the end of the reintroduction period, you’ll know which FODMAP foods trigger your symptoms, and which you can eat comfortably and in what portion size.  

You’ll then move onto stage three; personalization, where you return to a normal and varied diet, only avoiding the FODMAP foods that triggered symptoms during reintroduction.  

How to Get Started with Reintroduction: 

We’re currently in the process of building our reintroduction programme, with a plan to launch in Spring 2024. In the meantime, here are our recommendations for getting started with FODMAP reintroduction.

1. Consult With a Dietitian: A registered dietitian who specialises in the low FODMAP diet can guide you through the reintroduction phase. You may already be working with a FODMAP dietitian, but if not, you can find a list of FODMAP certified dietitians here

2. Use the Monash App Reintroduction Guide: The ‘reintroduction’ setting in the diary function of the Monash FODMAP app can guide you through the process of reintroduction. Have a read of this blog from Monash which explains how it works on the app.

You might also find it help to watch this 15-minute webinar of the reintroduction process, written and delivered by NHS dietitians. Scroll down the page to find webinar 4 - Low FODMAP Reintroduction Process. 

How long will it take?  

Reintroduction can take 6-10 weeks, depending on how many food challenges you decide to do, and how your gut responds.  

This can feel daunting, but the step-by step approach used in reintroductions the best way to accurately identify your triggers. You can also take breaks between challenges if needed.  

There are no strict rules around the number of foods to be challenged during FODMAP reintroduction, but typically around 10 challenges are recommended. This ensures you’ve tested at least one food from each FODMAP group, and a few from the fructan group.  

I’m worried about symptoms!

Recent research shows that more than half of the foods challenged are tolerated – so often, your symptoms will not increase during a challenge.  

Each challenge also starts with a small portion of the high FODMAP food, which is less likely to trigger a big exacerbation of symptoms.

If you get symptoms on day one, you’ll stop the challenge and leave a few days for these to settle before going on to your next challenge. This means you shouldn’t experience too much discomfort during the reintroduction process.  

A final reminder

In conclusion, the low FODMAP journey doesn't end with symptom improvement – it evolves into the reintroduction phase.  

This next important step will help you identify your triggers, reintroduce foods, and enjoy a well-balanced diet with ongoing symptom relief.