The low FODMAP diet has helped SO…many of my clients with IBS! Teaching the low FODMAP diet and seeing so many patient’s lives turn around has been SO rewarding!
I love my job!
But, it is important to know… the low FODMAP diet is a learning diet NOT a life long diet.
Although it is awesome to feel a sense of calm in your otherwise tumultuous belly…it really is important to undergo the challenge (or re-introduction) phase of the low FODMAP diet and attempt to re-introduce FODMAPs to identify your personal triggers. If you have tried to re-introduce foods without good success, consider the following:
- Are you doing the re-introduction correctly? Choose challenge foods that only contain one FODMAP. An apple would not be a suitable first line challenge food as it contains multiple FODMAPs. Honey or mango are good fructose challenge food choices as they only contains excess fructose NOT other FODMAPs.
- Do remember to stick with your low FODMAP diet while attempting your FODMAP challenges. If you are dining out, drinking a few cocktails and attempting to add back FODMAPs…your results might be a bit skewed!
- If you failed ALL challenges despite being guided by a FODMAP knowledgable dietitian, consider the possibility of an overlapping issue such as: small intestinal bacterial overgrowth, dumping syndrome, food chemical intolerance (histamine, salicylate), or gluten sensitivity, to name a few.
- Try ‘gentle’ food challenges! When challenging garlic (fructans), don’t add several cloves of garlic to your meal to really identify if garlic puts your belly in a tail spin. Try adding small amounts such as a 1/2 of a clove at first and up to 1 clove per meal.
The low FODMAP diet has beens shown to reduce beneficial gut bacteria {Study here}. Since our gut bacteria play an important role in health and disease, scientists don’t know the implication of following a low FODMAP diet long term. As a dietitian, one of my goals for you is to enjoy what you are eating and to have as varied a diet as your tummy will allow.
So.. don’t forget to re-introduce some FODMAPs after the elimination phase of the diet.
Don’t be afraid to try to reintroduce foods. Tolerance to food will change overtime as your gut bacteria likely get back in balance. Go slow. Get help from a knowledgeable registered dietitian. And…listen to your body!
Ellen
Your advice is so sensible. I had my large bowel removed after it ruptured and my gastroenterologist suggested I see a dietician about the FODMAP diet. We did the elimination and reintroduction phases and identified my issues – lactose and sorbitol. If I avoid these life is good, though sometimes they pop into things and upset me. Recently we visited Canada from Australia and in the absence of lactose free milk on cafes I had soy milk. Big mistake. Something in the soy upset my gut that isn’t in Aussie soy. Worked it out. Changed temporarily to almond or one real milk coffee a day – cos a day without one coffee is very grumpy for everyone – and moved on. Since bring home my gut has settled and all is good. Can’t seem to lose those 2kg from my holiday though!
Liz Almond
I started tbe Challenge with a bagel and it was obvious that it caused Diarrhea and pains. Waited a couple days and tried one piece of Sourdough toast – yes! No reaction! Tiday it’s on to spaghetti sauce with onions! Thanks for the advice!
katescarlata
Liz, your bagel example is a perfect example! Bagels often weigh the amount of 4 slices of bread. So challenging fructans with a bagel will most certainly cause GI symptoms. Sourdough bread–tends to have less fructans as the yeast in the sourdough culture reduce the fructans! So sourdough bread can make a great option for fructan challenge –Just be sure there are no other added FODMAP ingredients such as high fructose corn syrup!!
Phyllis Strickland
Great article! I have been trying to re-introduce FODMAPs with limited success. This has been so helpful because it confirms what I have been suspecting – there just might be an overlapping problem. I live in a somewhat rural area so have not found a dietitian with experience in this area. They are willing to learn about it, but this has been such an issue for me for so long, and it takes so little for me to get out of sync, that I think I need someone with experience. I just don’t know how to find that person. Any suggestions?
Linda dc
I have been doing fodmap diet for 4 months now and my symptoms have mostly disappeared though I still have the odd day with a little bit of upset, so have been scared to try new things, but after reading this I may give it a go, like you said good to try the “one” fodmap foods first, and small amounts too, that is good advice. Be great to have a list to go by, but I will try to look it all up and see what I can try first. I think I might have problems with beans no matter how much I soak them and cook them, even sprouted ones. Still not sure about the green beans.
Kelsi
Each time I try getting off the low fodmap diet and try reintroducing a high fodmap item my symptoms return. What’s the harm of sticking to a low fodmap diet long term if it eases symptoms and pain? Plus, who needs all that artificial sweeteners and so much fructose?
katescarlata
Kelsi, It’s not about the artificial sweeteners and excess fructose but rather including foods with fructans–such as small amounts of garlics which feed healthy bifido bacteria. OR… incorporating a wider variety of fruits and vegetables…which confer so many health benefits. I agree…the goal would NOT be to have pain or debilitating symptoms–but rather enjoy more healthy foods to your personal tolerance.
Laura
“Don’t be afraid to try to reintroduce foods” – unfortunately easier said than done. 🙂
Leslie
Hi Kate. The thought of potentially inducing symptoms, especially when they last for days as they do in my case, is not all that appealing, but I understand the need to vary the diet as much as possible and not overly restrict foods. This will only come from challenging FODMAPs. So I have this question. If I challenge honey, for example, and I fail the challenge, should I conclude that I do not tolerate fructose or would I need to test each high fructose food independently? As always, thank you for your knowledge and guidance.
katescarlata
The challenge phase of the diet has not been fully researched but I can share what I do in my practice. If a patient fails adding back small amounts of honey 1-2 teaspoons–then I would say they failed the fructose challenge and they would continue to modify excess fructose foods from their diet…then we would try again in 3 months. Also, be sure that you have evaluated other causes of your prolonged symptoms –such as small intestinal bacterial overgrowth.
Kate
I have been on this diet for years. No one ever told me to reintroduce until a year ago, when I got pregnant. I challenged some things while pregnant with success. However, I now have a colicky baby, and after crossing off issues like reflux, allergy, I was pointed toward to research showing that a low fodmap diet can help with colic. Any experience with this? I’m wondering of I need to go back to elimination.
katescarlata
Hi Kate, There is one small pilot showing a positive impact of the low FODMAP diet used in breastfeeding moms with colicky children. Here is the link: http://www.emobilise.com.au/files/programs/26/abstracts/7213.pdf Might be worth a trial!
Terri
Hi Kate! Thank you for all of you great advice. I have SIBO. I continually fight this bacterial over growth! What diet would you recommend? I suffer with a lot of gas and bloating after most everything I eat! Taken many rounds of the antibiotic Xzfaxan. Very discouraged!
Thank you I would appreciate any advice.
Terri
katescarlata
When diagnosed with small intestinal bacterial overgrowth–it is most important to realize that it is a symptom vs.and end point diagnosis. You and your doctor need to work toward identifying the cause of your recurrent sibo. Did you get sibo due to a motility disorder? Do you have an underlying autoimmune condition that is impacting your symptoms? Do you have low stomach acid? Do you have adequate digestive enzyme production? SIBO is not the end of the road–it’s the beginning. Identifying the cause is important particularly w/ recurrent episodes–or it will continue to come back. Most of my patients do very well on low FODMAP, with 3-4 hour meal spacing for SIBO. Some need low dose erythromycin at night to help with cleansing waves. Very rare do I have a patient that can’t tolerate resistant starch–but in this case, I wonder if its more of a colonic dysbiosis vs. small intestinal overgrowth scenario. So much to learn in this area.
Sharon
I have been diagnosed with SIBO and I have just started the reintroduction phase. I have not heard about the 3-4 hour meal spacing, please can you explain this.
katescarlata
Sharon, in the small intestine the MMC, migrating motor complex, initiates a cleansing wave removing bacteria, food & debris from the small intestine. This cleansing wave occurs in the fasting state–after about 90 minutes to 4 hours of fasting. The timing varies person to person–those with IBS have less MMC, cleansing waves. So spacing meals out is a good way to help these cleansing or housekeeper waves occur. Meal spacing is particularly impt for those with SIBO as bacteria tend to remain in the small intestine leading to GI symptoms.
sandra schwartz
I have been following a FODMAPs diet for 3 years and have no IBS symptoms as long as I stick to my limited foods list. During this time I have had treatment for a parasite,digestive enzymes, probiotics for my low lacto and bifido bacteria in colon, herbal antimicrobials for SIBO and recently Betaine HCl to see if i needed help with stomach acid. I continue to be supersensitive to minute amounts of some of the lowFODMAPs foods. I am just worried that I will never be able to eat more vegetables and fruits- don’t care much for the legumes, breads etcs Any ideas for me, PLEASE!
katescarlata
Sandra, Wonder if you still have SIBO. Not sure how effective the herbal antibiotics are for SIBO. Have you been re-tested? I would start there. If you still have bacteria in your small intestine it will be difficult to add back FODMAPs without symptoms. Can you work with a dietitian knowledgeable in the re-introduction of FODMAPs. It is difficult and not appropriate to provide individual advice in a blog setting.
suzanne
Hi Kate,
Thank you for this interesting post. After being on FODMAPS for over a year i have begun trying to re introduce. During that year I discovered I had SIBO and was treated for it, I then set about taking the best probiotics on the market religiously taking them on a daily basis at a high dose. Like you say its important to add back the Fructans as they help the good bacteria to repopulate, so that is what i am trying first. I have found that I’m ok with one clove of garlic in my cooking ( a curry) and I’m happy with that, today i actually added red onion so we will see how that goes 🙂 I have found Brussel sprouts are ok too in small quantities, they are high in Vit C too.Also, after not eating sugar for a very long time ( over a year) i find i no longer crave it, By sugar I mean maple syrup as well. i think that along with cutting out all flours including Gluten free flours has helped to keep the SIBO away, bacteria thrive on carbs! In fact they party on them ! The SCD way of eating is a healthy and delicious way to eat.
I would recommend people read ‘Breaking The Vicious Cycle’ by Elaine Gottschall, Kate I’m sure you are familiar with this book and diet. Regards Suzanne.
Mary
Thank you for this reminder, Kate. I am one of those who’s so happy with reduced gut symptoms on the low-FODMAP that I’m wary of doing the challenges … I keep waiting for the ‘right time’ to possibly feel uncomfortable or worse. I was off dairy and gluten for a few years before trying the low-FODMAP diet — so I’m particularly reluctant to try those again. If I have an adverse reaction to a FODMAP challenge is that going to leave me feeling unwell, or sensitive for more than a day or two?
Thank you so much for your encouragement to do the challenges.
katescarlata
GI symptoms post food challenges are quite variable person to person. Some feel miserable for that evening and fine the next day–others feel poorly for a few days….and many people pass the challenges without a major hitch. If you don’t care about adding gluten back–then don’t add it back. But consider trying other challenges such as onion, garlic for the fructan challenge.
R
How do you actually do the reintroduction? How do you know what quantity to start with? If there are no symptoms after a day or two, do you try a bigger quantity? I have tried small reintroductions and they have gone all right. I am having trouble pinpointing how much my body is OK with. So when I have a bad day, it’s difficult for me to figure out what the problem was. A particular food, too much in one serving, or just too many FODMAPs in the course of the day?
Sylvia Ossorio
I’ve been 100% on the low FODMAP diet and have added the probiotic Healthy Trinity. Would the probiotic help regain some of the beneficial bacteria you lose in the low FODMAP diet?
Thank you,
Sylvia
katescarlata
Sylvia–in theory probiotics should be helpful–but the evidence is mixed for probiotics and IBS –and more research is needed.
Wendy
I have been using the 21 Day Tummy book and Cookbook for the past couple of months. I’ve added in some polyols. I thought I’d be safe with the veggies, and I was. So mushrooms and cauliflower…Yay! I tried some garlic, but perhaps too much at one time. It did not do too well. I’ve tried onion…NO! Was wondering, how about trying some leeks, or shallots, would they have less fructans than onions so possibly I could get some fructans but not the horrible reaction?
I love how at the end of the 21 Day Tummy book there is a section telling how to test food to introduce back into your diet.
I originally tried to just follow the low FODMAPs diet list and I was always having trouble. There seems to be somethings on there I just can’t eat, or I can’t eat in the quantities listed. So that is also something I have to try to challenge. the 21 Day Tummy diet has really saved me. Thank you so much for it!
oh…and I’ve lost 32 lbs since June 1st. Had my physical in July and my blood work is better than it has EVER been, even when I was much thinner! thank you so much for the book. It has been a great elimination diet, now I’m adding things in and finding out all kinds of things. But it is scary. I don’t want to blow up and feel horrible.
thank you for all you do!
katescarlata
So glad you like my latest book, 21 Day Tummy. The book includes sound nutritional principles: the low FODMAP diet to ease GI symptoms, calorie controlled plan to aid weight loss, healthy fats &magnesium rich for anti-inflammation, and overall well balanced with real foods! In regard to your question, you may find leeks a bit easier to tolerate due to the size of the fructans. Onions are made with very small chain fructans so may cause a bit more distress than leeks. Also, you might want to try a smaller serving of the garlic to establish if you can tolerate some. Take your time with the elimination phase. Congrats to you!
Wendy
Thanks so much Kate! I have recommended this book to so many people!
I am going to try less garlic to see if I can handle it. And I think I’ll try leeks sometime in the not too distant future.
You’re the best!
Laura
Kate, Is there a chart or guide showing which foods we can try to incorporate back into our diet slowly? You say apples aren’t good (multiple fructans) but garlic may be okay. I am wondering what other foods would be worth trying after the elimination diet.
katescarlata
Laura, It is best to work with a dietitian to guide you with the re-challenge phase of the diet. FODMAPs challenges are done with each FODMAP group. Choosing a test food is important. The test food should ONLY contain the FODMAP you are testing–not other FODMAP groups. Fructose is challenged in my practice with mango or honey typically–as they only contain excess fructose as their FODMAP source.
Healthy Food
If you have persistent gastrointestinal symptoms, a low-FODMAP diet may help. Great post! Very helpful! Thank you for sharing! I bookmarked your blog! 🙂
Dana
Hi Kate, first off..I love your blog!!! The layout and photos are beautiful and so much fantastic information on it. I’m fairly new here, I’ve been reading for a bit but this is my first time commenting. I started following FODMAP as I’ve always had bad heartburn and gas issues and noticed a big difference when I cut back on some high fodmap foods. I used to get bad heartburn after eating cauliflower and didn’t realize why. I found I was getting a bit better when I started the Paleo diet (and I used to be vegetarian for over a decade, so grains and soy were my staples). I need to print out your fodmap list as I’d thought celery was ok, but it’s celery root that’s low fodmap! I made a celery soup the other day and my symptoms came back (first time since started fodmap last year), and I realized celery should be in moderation! Oops 🙂 Also, I found yogurt really bad, I thought I was having gallbladder issues but when I stopped eating my daily yogurt my symptoms were almost gone. Would that be a dairy allergy, do you think? I don’t seem to have the normal symptoms for dairy issues (diarrhea, stomach problems etc). I have added a bit of cream, cheese etc back and seem fine on them. Thanks again for your wonderful blog and all the information. I have added it to my bookmarks! Cheers 🙂
katescarlata
Dana could be other components in the yogurt–the probiotics can trigger symptoms. If you have not had small intestinal bacterial overgrowth tested I think this is a good idea.
Jean
Hi Kate,
Can you please comment on Histamine? I have been trying really hard on this FODMAP diet for well over a month with limited success. The other day I decided to “fix” my gut flora for good and ate a 6 oz. container lactose free yogurt and Kombucha (just about 1/4 of the bottle). I don’t usually eat yogurt (ever) because I just was a little afraid. My non-IBS related symptoms were really off the charts.. I was itchy all over, had a massive headache, was boiling (I’m usually cold all the time) and my heart palpitations were really bad. It felt like there was acid in my stomach burning away.
I have been diagnosed with GERD (7 years) and IBS (for about 14 years) and heart palpitations (for about 3). My SIBO test just came back negative.
I also have hashimotos and severe allergies to weeds, trees, dust, dust mites, animals. I am 55, I am 5’6″ and weight 135. And otherwise perfectly healthy!!! I have seen a dietician and I am watching Patsy’s “Bold” items.
Is Histamine Intolerance really a thing? Is there a reliable test? My doctors just think I am nuts. (it’s very sad). Thanks for your help. I was just getting ready to go completely without fruit since I seem to have the bloating every night even following fodmap pretty closely.
katescarlata
Yes, Jean, I believe histamine intolerance is a very real thing. Food chemical such as amines, salicylates, glutamate are all naturally occurring food chemicals that can trigger GI symptoms and other systemic symptoms such as headaches. As a general rule of thumb–the stronger the flavor of the food the more likely there are more food chemicals in it. Some additives such as benzoates, nitrates, sorbates can cause adverse reactions in the body. In one large time dose or over days –food chemicals can build up and then cause reaction in those sensitive. I do believe histamine intolerance is under diagnosed. But I don’t think there is a good diagnostic test to determine histamine intolerance. An attempt at a low histamine diet is usually trialled. Royal Prince Alfred Hospital in Sydney, Australia is a good resource {www.allergy.net.au} There are others too which I can’t get a hold on at the moment. This would really be a good blog post–so I am glad you brought it up. I just wish there was a little more time in the day.
Liz Almond
I’m still slowly going through the Challenge phase of Fodmaps. My question is – If I don’t have a bad reaction to a group – for me, Fructose – does that mean I can eat as much of that group as I want, or should I still be limiting the amount of all foods with Fodmaps?
Thanks!
Jean
Thank you so much!
katescarlata
Hi Liz, Not really. If you pass the fructose challenge than you should be able to tolerate foods with ONLY excess fructose–mango, honey, small amounts of asparagus. Some foods that have excess fructose such as apples, pears, watermelon have other FODMAPs such as polyols–so after all of the major FODMAP group challenges—you can try to introduce foods with multiple FODMAPs. And remember while undergoing the challenges–always follow a your low FODMAP diet. In other words, if you pass excess fructose challenge–you don’t add back the mango and honey during the challenge phase –as this could skew the challenges a bit. Do challenges with the background of a low FODMAP diet. Some of my clients will do a couple of the challenges—and then stay there for a month or two–and then undergo other challenges later.
Liz Almond
Thanks for the quick response!
So, if I go through challenging all the groups and pretty much know which groups I can eat and which are giving me trouble, will I then be able to eat as much of the ones that don’t give me trouble as I want?
Liz Almond
Kate ,
Do you know of any anti-gas meds that do not contain magnesium? Magnesium gives me “D”.
laura
Hello. I’m new to the FODMAP diet and wondering how does one determine the amount of FODMAPs in any one food? You mention apples contain multiple FODMAPs but how would the average person know that and where might I look up other foods to know their FODMAP values exactly?
katescarlata
Hi Laura–there are a few published papers in the research from the Monash University scientists that provide accurate and up to date info on FODMAP content. Overall, there is a lack of research at this time to make calculating FODMAP intake very feasible. Instead, we tend to modify the high foods during the elimination phase. Working w/ a dietitian helps balance out the diet so that it is healthy and low FODMAP.