So you have conquered the low Fodmap elimination diet and want to know what to do now. Well, it’s time for the reintroduction phase. My video will tell you how to go about this and what order to introduce foods back into your diet.
Transcript of the Video – The Reintroduction Stage of the Diet
How does the reintroduction stage of the diet work?
Welcome to this video. Today I want to talk about the reintroduction phase of the low FODMAP diet. Let’s imagine you’ve completely finished the elimination stage and you are symptom-free. I would definitely wait until you are symptom-free before trying the reintroduction phase; otherwise it’ll be difficult to work out whether the food you are testing is causing you the problems, or something that’s already in the diet from before. Once you are symptom-free, and you are ready psychologically to do this – because there could be some symptoms coming back, which is not exactly what you are going to be looking forward to – this is the time – symptom-free – when you test some foods.
There is an order and a kind of a regime to how you do this so that you are really clear about whether you can tolerate a food, and if so, at what level you can tolerate that food. I suggest you start testing foods with small amounts first, and then test at a larger amount if you have no symptoms at the smaller amount. You’re going to have less trouble if you’re testing a small amount – and it goes wrong – than if you are testing a higher amount.
The Polyols
For example, the first thing that you should really test, and it’s recommended by the Monash University, are the polyols. I get my clients to test, first, a little avocado – just a quarter of an avocado – and see if they tolerate that. The Monash University app is saying that we should be able to eat an eighth of an avocado, but test that. Then the next day, if that’s fine, go to a quarter. And if that’s fine, go to a half. Very frequently would we eat any more than that at a sitting, anyway. But if you get symptoms, you stop, and you work out at what level you were able to eat the tested food. It is possible that you weren’t able even an eighth of an avocado. So you note that down, or you probably will remember it, because you’ll remember the symptoms you got from testing the avocado. If there are no symptoms, you go on to the higher amount. If there are symptoms, you stop. Then you have to wait until you are symptom-free again before testing any other food.
After the avocado, test a little cauliflower with exactly the same system – increase the amount until you know exactly where you are with that food. It’s possible you can’t eat any. It’s possible you can eat as much as you like of it. But maybe you can only tolerate a half a cup. So you’ll take a note of that and include that in your diet, because the wider you can get your diet, the better it is for you, so that you’re absorbing more nutrients.
After the cauliflower, you can test mushrooms in exactly the same way again. Then after you’ve done the polyols, you could test some other foods within the polyols as well, but those are the three main ones that I test.
Lactose
Then you pass on to the lactose. With the lactose, I would try just half a cup of normal cow’s milk and see how that goes. See if you can increase it to a full cup or a full glass because of the body’s calcium needs – we need a couple of glasses of milk a day or the equivalent in other dairy products. You can get some calcium from other foods, but the best form is from diary, although, of course, you could have rice milk which is calcium enriched. So test half a cup of the milk and then see how you go with that. Same system – if there are no symptoms, you can move straight on to the next test. If there are symptoms, you have to wait until they completely ease off.
Fructose
Next, test fructose. You can test that with a teaspoon of honey or with some mango. Both of those are high in fructose. 45% of people with a FODMAP malabsorption problem malabsorb fructose. So there is almost a 50-50 chance that you will have an issue with that.
Fructans
Your next test is fructans. Just start with one slice of white wheat bread. You’re likely to get less of a reaction with the white bread than a bread that’s got lots of nuts, seeds and fibre in it, because you might be muddying the waters with the fibre, because we know we can only tolerate a certain amount of fibre if we have IBS. So just test one slice of white bread and see how you go. Many people will be able to tolerate that. If that goes fine, test a couple of slices. Make a nice sandwich with low FODMAP vegetables, a couple of slices of meat, and see if you’re able to tolerate that. You could also, instead of the bread, test pasta. Try half a cup of pasta, then a cup of pasta, and the same system.
Legumes and Pulses
You can test the galacto-oligosaccharides with 1 cup of lentils. We can tolerate half a cup of canned lentils or a quarter of a cup of boiled lentils. The other thing you could test is baked beans. Have maybe half a cup and see how you go with that. Most people do have a bit of an issue with the galacto-oligosaccharides. So we leave that for the last test.
Once you’ve done that – you’ve tested them all – hopefully you’ve been able to widen your diet further than just the elimination diet. I recommend that you eat as widely as possible within the foods that you are able to tolerate without having symptoms, so that you are absorbing as many different nutrients as possible.
Good luck with the reintroduction diet. It is a bit of a time of ups and downs, a bit of a roller coaster ride, as your symptoms can return. But it’s well worth doing so that you can widen that diet. Well, thank you for listening and goodbye.
Stuffed Meat Pockets
Another delicious recipe straight out of my little green book. I have always loved this sort of cream based sauce so I am very glad I am not lactose intolerant. For those who are lactose intolerant, they could get a tasty effect with coconut cream but it is pretty rich and we can't have large amounts of coconut so they would have to go easy on the sauce. This really is a simple recipe for a rather sophisticated looking finished dish. It would be an impressive one to prepare for guests.
- 4 thin slices of beef
- 4 slices of hard cheese
- 2 slices ham
- Salt & pepper
- 1 heaped tbsp white rice flour
- 1 tbsp oil
- 1 tbsp butter
- ½ cup of cream/coconut cream
- 1 tsp paprika
- Season one side of the slices of meat.
- Cut the ham in half and place each piece on one half of the meat.
- Place a slice of cheese on the top.
- Fold over the meat and secure with toothpicks.
- Season the outside of the meat.
- Coat the pockets in flour.
- Heat the butter and oil in a large frying pan.
- Cook the pockets on one side for 5 minutes.
- Turn them over and cook 5 minutes on the other side.
- Add the cream to the pan and sprinkle over the paprika and mix it in.
- Put a lid on and cook five minutes then take the lid off and cook 5 more minutes to thicken the sauce.
- Serve hot with the sauce spooned over the top.
I love the look of your meat pockets. They look very tasty and like a lovely family meal. I’m pleased to hear you’re not lactose intolerant. My naturopath has told me to limit the amount of dairy in my diet but I’m finding it’s one big weakness xx
I am very pleased that I am not lactose intolerant. A life without ice cream and cream would be very sad. Dairy is also a great source of calcium and that is so important especially as we get older.
Hi, i have just finished the elimination phase but are confused about the process of the reintroduction phase. If i follow the guidelines given above and for instance have no bad reaktion from the honey or mango when testing fructose does that mean i can eat and drik all fructose food. Same question regarding the other fodmap groups.
Vkr jonas
You only have to test one food for both the fructose and lactose groups and that tells you the answer for the whole group, but that isn’t true for the Fructans and Polyols. More individual testing is required. You may be okay with the fructans in wheat but not in onions for example.
I am also following the autoimmune protocol of the paleo diet. I have had fair improvement in symptoms (loose stool and frequency of bm’s). Is re-introduction of FODMAPs the same if I am not currently eating gluten, grains, and dairy? Would I just skip the lactose? Are there any alternative fructans I can try? Do I just skip legumes altogether? Thanks, I really appreciate your blog. It’s a great resource.
There is no point in doing the reintroduction phase until you are completely symptom-free or you won’t know what is causing symptoms when you test a food. But, when you get to that stage, test only foods that you know you want to have in your diet. There is not point in testing lactose if you are philosophically opposed to dairy. The same with legumes. Test only what is relevant to you. The fructan-containing foods have to be tested individually on the whole anyway since testing one food doesn’t give you the answer for the whole group,
I am glad you are finding my blog useful.
Thank you. And do you recommend veggies be cooked or raw, ie mushrooms, cauliflower, broccoli, etc.?
That depends on how well you digest raw foods. Some people need to cook all vegetables but most people can eat them raw. I would cook the broccoli though.
I am symptom free for the first time since I can remember on the Paleo version of the FODMAP diet. I am the reintroduction phase. Once a food or category of foods has proven not to cause symptoms, is that now reentered into the diet, or is there need to wait until all testing is done to eat the new foods? Similarly, if I reintroduce a food or category and have no issue, is there an amount of time I must wait to introduce the next food or category? Thank you for your help!
Glad to hear it. Wait until all groups and foods have been tested because many of them contain more than one group and so you need to test both. You could take a pause after testing lactose, fructose and the polyols and introduce the foods from the groups you passed and then do the oligosaccharides later since they need to be done one by one.
Is it safe to take something like citrucel or an antacid while in the reintroduction phase?
It is preferable if you can control your reflux with diet. See this video: https://www.youtube.com/watch?v=oXCRvtKFtoE&t=14s