*All of the information I am providing is from what I have learned personally, and from what has worked for me personally. None of it is meant to supplement information or care from a professional like a Medical Doctor or dietician. Please seek experienced medical experts for individualized care and treatment*
When I first started with the Low FODMAP diet, the portion I found the least amount of information on was reintroduction. I know now that it is because it is a highly individualized process, but not once did I find someone who had outlined their reintroduction process so I knew even vaguely what to expect. For this reason, I want to share with you my reintroduction process. In part 1 i'm going to introduce how I learned what to do for reintroduction before I actually began, and for the remaining parts I will go into more detail about what foods I personally tested, in what amounts, and what my testing experience was like. I will give you tips that I found to be helpful, such as best time of day to test and test spacing (in terms of days).
If there was one element of the low FODMAP diet that confused me it was reintroduction. Even after talking to my dietician and doing as much research as I could, the process continued to feel extremely overwhelming and scary. After two months of strict elimination it was hard to come to terms with the fact that reintroduction meant I had to reintroduce the discomfort I had worked so hard to get rid of. Although I knew reintroduction was crucial for both gut health and increased freedom in my diet, it terrified me.
About a week before I began reintroducing, I franticly called my dietitian's office with a myriad of questions that kept me up the night before. I didn't understand how I'd know what portions to use for introduction for different foods. You can't just go up by half cups with every food, because not all foods are eaten in such abundance. For example, you may eat 2/3 cup of pasta as the moderate portion, but you wouldn't typically eat 2/3 cup of garlic as the moderate portion, as people are much more sensitive to a smaller amount of garlic. This confused me so so so much. I had two different examples of reintroduction plans, one from myginutrition.com, which was recommended by my dietician, and one which I had found through a registered dietician online (although now I'm not a fan of how this particular person markets IBS and weight loss and wouldn't suggest using his plans). My biggest point of contention was that neither plan outlined the portion sizes for each particular day. They only pointed out the overall amount you needed to reach. Another problem was choosing what food to test with. Both plans used different foods, and I didn't understand which foods were "best" to test.
Here are some of the questions I had, and the answers I have learned along the way.
1. Where can I find a clear example of portion sizes for testing?
The best resource for this is the Monash University FODMAP app. In the diary feature of their app, they have a reintroduction button which allows you to choose which carbohydrate group you're testing, and gives you examples of foods to test, as well as portions examples. The portion examples are in cups, tbs, and tsp, and in oz (some foods were in such small portions that the oz showed zero, for those I stuck to using the other measurement provided). I followed those portions while I was testing and found they worked very well.
2. How do I know what foods to test?
Looking at the suggestions on Monash University's app can be a great way to choose which food to test, but if you perhaps did not like any of the options, you would need to choose a food which contains only one FODMAP group. For example, if I wanted to test sorbitol, a good testing food would be avocado because the only FODMAP it contains (this can be seen on the Monash University app) is sorbitol. A bad food to choose would be apples because they contain both sorbitol AND fructose. If you were to test with apples and had symptoms, it would be very difficult to know whether those symptoms are a result of the sorbitol, the fructose, or the interaction between the two. For this reason, if you are to choose an alternate food, make sure to choose foods with only one FODMAP group.
3. How do I know when symptoms are so bad I shouldn't test the next day's portion?
Reintroduction is meant to allow more abundance of food back into your life. For this reason, when testing, you are looking for extreme discomfort, extreme symptoms, extreme signs that this food is not working for you. If mild symptoms of gas, bloating, or increased bowel movement occur, that is absolutely normal, and not a sign that you should stop testing. If you can tolerate the symptoms you are having, you are likely good to go with the next test. If, however, you experience extreme stomach cramps, very discomforting bloating or trapped gas, or bouts of diarrhea, that would be a reason to not test that next portion size (for now). The reason I say for now is that your tolerances will change over time as your gut microbiome adapts to the foods you are feeding it. If you eat those foods you don't tolerate in very small portions which you do tolerate, your gut bacteria will get more used to that food, and in turn you may tolerate more of it in the future. For this reason you will want to retest foods that previously didn't work for you a few months later.
4. How does the schedule for testing work?
This is another portion of reintroduction which is highly individualized. A typical reintroduction plan has you testing one group each week. You would test a moderate portion on day one (lets say a Monday), a high portion on day two (Tuesday), and a very high portion on day 3 (Wednesday). Then you would take Thursday-Sunday to reset your gut by eating low FODMAP and allow the FODMAPs to exit your system. You would then begin with a different test the following Monday. If, however, your gut is more sensitive and you need more recovery time, or you know your symptoms are very delayed, you may want to do a plan which has you testing a portion every other day. You would test the moderate portion Monday, then take Tuesday as a reset day, test the high portion Wednesday, and take Thursday as a reset day, and test the very high portion Friday, and take Saturday-Sunday to reset for the next test. The best way to determine what testing schedule is best for you is by working with a dietician. Personally I tested 3 days in a row, with a 4 day wash out period and that worked for me.
There are many more questions which come with reintroduction and I hope to answer most of them as I continue to outline my experience with FODMAP reintroduction. My next posts about reintroduction will include my personal experience so you can understand what reintroduction generally looks like, and hopefully be less intimidated by it.