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Long Term Low FODMAP | A Dietitian Explains

Feature, Gut Health & IBS | May 14, 2018

A young girl feeding her father a nutritious homemade sandwich.
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Living with gut symptoms is miserable. They are painful, embarrassing and awkward. It’s not surprising that when people find relief on the low FODMAP diet, they want to stay on it forever. BUT, this is over restrictive, in most cases totally unnecessary and even detrimental to gut health.

My name is Joanna Baker, I’m a FODMAP expert dietitian from Everyday Nutrition in Melbourne, Australia and today Andrea has kindly asked me to contribute some info on reintroducing FODMAPs back into your diet.

Living with gut symptoms is miserable. They are painful, embarrassing and awkward. It’s not surprising that when people find relief on the low FODMAP diet, they want to stay on it forever. BUT, this is over restrictive, in most cases totally unnecessary and even detrimental to gut health. Guest written by Joanna Baker, RD from Every Day Nutrition

What’s the deal with FODMAP cut offs?

You probably know by now that:

  1. We can test foods in a laboratory to see what the FODMAP content is.
  2. We also have plenty of research telling us what people with IBS will tolerate before they start loosening their jeans or running to the bathroom.

These two factors are what are used to determine the FODMAP cut offs that show if a food is low FODMAP or high FODMAP and at what serving size.

The cut offs for a food to be considered low FODMAP are at the point where 95% of people with IBS will tolerate the food or serve size. This means that if you have IBS and are following a low FODMAP diet, we can be reasonably sure your FODMAP intake will be low enough to minimise your IBS symptoms.

BUT, it also means that a large portion of people with IBS will actually tolerate a lot more FODMAPs, before they become a problem. There is a higher level of FODMAP intake that will be tolerated by 50% of people with IBS. If this is you, limiting to the cut off, is way too restrictive.

Three Phases of the Low FODMAP Diet

To find your individual level of tolerance, it is necessary to move through the 3 phases of the low FODMAP diet:

Phase 1: Reducing your FODMAP intake to the official cut off that is tolerated by 95% of people (i.e. only green rated serve sizes).

Phase 2: If this significantly reduces your symptoms, the next step is to work out which FODMAPs are a problem for you and which ones are not (this is called the challenge phase).

Phase 3: Once you have this info, you can then personalise your diet and increase your FODMAP intake over time until you find where your personal cut off is (the adapted FODMAP phase).

In my experience, (both personal and professional) most people will expand their diet significantly in at least one FODMAP group and more slowly expand in the others. Of the thousands of people I have worked with, in both group and one on one situations, I have never actually come across someone who doesn’t tolerate a higher amount of FODMAPs in at least one of the FODMAP groups.

How to Reintroduce FODMAP’s:

The first step of reintroducing is to make yourself three lists:

  1. FODMAPs you tolerated in large amounts:
  2. FODMAPs you tolerated in moderate amounts:
  3. FODMAPs you tolerated in small amounts or not at all:

Starting with the groups that you tolerated well during your challenges, begin to reintroduce a few serves per day and increase as tolerated. Because many foods contain more than one FODMAP group, this can get a bit complex! Tolerance of these ‘combination FODMAP’ foods will vary, and you will need to do some experimenting. But starting with combinations of well tolerated FODMAPs is a good place to begin.

After a few weeks, if you are feeling well, you can move on to smaller serves of the foods you tolerated in moderate amounts. This part is where you begin to play with portion size and frequency. You may find that you can have small serves fairly regularly, but more moderate serves will build up if you have too many too close together. If you find that you reach your threshold & begin to experience symptoms, just pull back a little and try again at another time. There is no right or wrong with this, and over time you will naturally find your level of variety vs tolerance.

The FODMAPs that were problematic at a small serve, you will probably avoid most of the time. If you are going out and are not going to be able to avoid them, or if you feel like splashing out occasionally, we suggest returning to the baseline low FODMAP diet for the meals prior. This will give you as much room to move as possible before reaching your threshold.

Reintroduction Tips:

  1. Keep in touch with your dietitian. Research shows that people who work through the FODMAP process with a dietitian, get more food back and have fewer symptoms long term.
  2. Reintroduction is different for everyone and can take some time, so be patient and use the results of your challenges to guide you.
  3. Remember that FODMAP thresholds are not ‘all or nothing’ – tolerance depends on the amount and the frequency of high FODMAP foods.
  4. Monitor your symptoms as you gradually reintroduce more foods.Perhaps rate your symptoms in terms of mild, moderate or severe.
  5. It is absolutely okay (and quite normal) to have some mild symptoms from day to day. We are trying to find where the tipping point is, for symptoms becoming problematic and interfering with your life.

Take Home Message

The low FODMAP diet is a journey, not a destination and tolerances will change over time, so it’s good to go back and rechallenge every now and then, you may even get pleasantly surprising results. If you are stuck, or not sure make contact with a FODMAP trained dietitian.

For more information on FODMAPs and how reintroducing them can help keep your gut healthy, check out this article that Andrea wrote for the Everyday Nutrition blog.

Andrea’s Guest Post

Andrea guest posted on taking care of your microbiome during the low FODMAP diet on my blog Everyday Nutrition – you can check it out here!

About Joanna Baker, RD

joanna Baker, Dietitian from Everyday Nutrition

Joanna is a foodie, a Dietitian and a Registered nurse, who is passionate about digestive health. She now focuses exclusively on IBS and food intolerance. In her Melbourne based private practice Everyday Nutrition, Joanna works alongside food manufacturers to develop low FODMAP products, lectures internationally on the Low FODMAP diet and works privately with patients to help them manage their IBS. In all of these roles, Joanna aims to support people to enjoy food, whilst incorporating practical everyday strategies that manage IBS, and prevent it from getting in the way of living the life they want to live.

Find Joanna on Facebook, Instagram & Twitter or join her low FODMAP Australia Facebook group.

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References

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