FODMAP Reintroduction Plan and Challenge Phase: Your Guide and FAQ

FODMAP Reintroduction Plan and Challenge Phase- Your Guide and FAQ

[Last updated 13th January 2017]

The FODMAP reintroduction plan is arguably the most important part of a low FODMAP diet .

The aim is to learn what your individual tolerance level is to different FODMAPs, and reintroduce some of your favourite foods as well.

But in order to be successful, it must be approached in a systematic fashion.

This is a detailed overview and FAQ of the reintroduction process.

What is the FODMAP Reintroduction Plan or Challenge Phase?

What is the FODMAP Reintroduction Plan or Challenge Phase?The FODMAP reintroduction plan is the second part of a low FODMAP diet, and refers to the strategic process of reintroducing FODMAPs to the diet.

This is the only scientifically proven method of treating Irritable Bowel Syndrome (1).

It’s also known as the Challenge Phase, Reintroduction Phase, or Challenge Protocol. The terms reintroduce and challenge (or re-challenge) are used interchangeably.

Following this plan enables you to discover what exact FODMAPs trigger your IBS symptoms. By the end you should have a great understanding of what foods you can and cannot tolerate, and in what quantities.

Much like the elimination phase, it’s not easy. There are many guidelines to follow and it’s strongly recommended you do this with a FODMAP-trained dietitian where possible.




Summary: The FODMAP reintroduction plan is the second phase of a low FODMAP diet. Following this protocol enables you to see what foods you do and do not tolerate.

How Does It Work?

There are 10 FODMAP groups to be reintroduced, one at a time.

This must occur over a 3-day period, with 3 washout days in between groups. That is, set days where you completely return to a low FODMAP diet in order to ‘reset’ your digestive system.

A typical schedule may look like this, although this just a generalisation. Re-challenge is used interchangeably for reintroduce:

FODMAP reintroduction plan schedule

Image Source. Click to enlarge.

So if you are re-challenging for 3 days, and leaving a 3-day washout period, the re-challenge process for one group lasts almost a week. That means 10 FODMAP groups will take 9-10 weeks total, assuming no set backs.

If you do experience symptoms, you must wait until they settle before testing the next group. Usually the 3-day washout period is enough time, but not always.

Note that you should not re-challenge any FODMAPs until you are symptom-free (or as close as you can be). It’s also important during this period that you continue to follow a low FODMAP diet the entire time.

Summary: A total of 10 different FODMAP groups are reintroduced to the diet, one at a time. Each group is re-challenged over a 3-day period, followed by a 3-day washout period. So it takes at least 9-10 weeks to do all groups.

Which Foods or Groups Should Be Challenged First?

The most appropriate foods for this phase are those that contain only one FODMAP group.

This ensures that if you do have a reaction, it’s obvious what FODMAP was the culprit. Here’s some examples from FODMAP dietitian Lee Martin:

Rechallenging FODMAPs 10 challenge foodsImage source.

There are 5 separate re-challenges for fructans because they occur in a wide variety of fruits, vegetables and grains. Fortunately there’s only one re-challenge for each of the remaining FODMAPs.

Example Reintroduction Schedule

Here is an example of a full schedule to follow from Lee Martin and A Little Bit Yummy

It contains recommended foods and quantities:

FODMAP reintroduction plan food challenge schedule

Click to enlarge.

You can start with whichever group you wish, but it may be easier to start with lactose or fructose as they are quite straight forward.

Just remember to wait until symptoms settle before testing the next group.




Summary: Reintroduce whichever FODMAP group you prefer first. Just ensure you only test with foods that contain one type of FODMAP.

How and When to Reintroduce FODMAPs

There are two main options for reintroducing FODMAPs. It should always be done at home where you are in control of the portions and ingredients.

  • Alongside: Prepare the FODMAP containing food alongside your regular meal (that you know does not cause symptoms). For example 1 teaspoon of honey with your dinner. This allows you to easily increase the portion size of the FODMAP you are testing .
  • Mixed: Mix or add the FODMAP food you are testing into your meal or snacks. For example if testing avocado you could add it as part of your favourite dip. This is more realistic to the way you would actually consume that food, but is less straightforward.

The best time of day to re-challenge depends on your personal preference and when you would typically eat that food.

But I usually recommend doing so in the early evenings when at home. There is no possibility of being ‘caught out’ when at work, and allows enough time to notice symptoms before bed.

Summary: Either reintroduce groups alongside or mixed in with the meal. Typically it’s best to test in the early evening when you are home.

Tracking IBS Symptoms With a Food Diary

Tracking IBS Symptoms With a Food DiaryA common question is when will the symptoms show after testing a food?

This varies from person to person and also depends on the severity of the reaction (if there is one). Patients report symptoms anywhere from 30 minutes, the next morning or even a couple of days later.

Just like the elimination phase, it’s critical to keep a food and symptom diary during the entire reintroduction plan. Recording what you ate, what quantity, and what symptoms resulted helps you to identify patterns you might otherwise have overlooked.

Note that for some individuals there may be FODMAP groups and foods that will always cause symptoms, regardless of the amount. If you’re highly sensitive to a particular food, you shouldn’t eat it anymore.

Summary: Symptoms from reintroducing a group can vary from 30 minutes until several days later. Keeping a food and symptom diary will help you recognise patterns.

What if You ‘Fail’ All Reintroductions?

There are numerous reasons why someone may react to every single re-challenge food, even in small quantities.

Consider the following:

  • Testing high amounts of the re-challenge FODMAP: Always start with a small amount first as that may be your threshold. If you don’t experience a strong reaction then in increase it the following day. For example start with ¼ avocado, then progress to ½.
  • Not remaining on a low FODMAP diet: During the entire reintroduction plan you must continue to follow a strict low FODMAP diet, as you were during the elimination phase. After a food has been tested do not add it back into your diet you’ve finished re-challenging the remaining groups.
  • Choosing inappropriate foods: You must re-challenge with foods that contain only one FODMAP. If testing fructose, for example, pear would be a poor choice because it contains both fructose and polyols. Honey or mango only contain fructose and are therefore a good choice.
  • Unintentionally changing your routine: Other changes and stressor can trigger digestive symptoms. Ensure you don’t increase the amount of smoking, alcohol, or caffeine you consume during the reintroduction plan. Stick to your usual eating pattern, and avoid unusually large meals or testing FODMAPs on an empty stomach.
  • Medical conditions or additional intolerances: If you are doing everything correctly, it’s possible you may have additional intolerance issues that should be investigated with your doctor. This includes a food chemical intolerance (such as salicylate or histamine intolerance), small intestine bacterial overgrowth (SIBO), or even inflammatory bowel disease such as Crohn’s disease.



FODMAP Reintroduction Protocol and Recommendations

While I’ve touched on the fundamentals, it’s much easier to carry out following a complete FODMAP reintroduction protocol.

If a FODMAP-trained dietitian is not accessible, I recommend the book Re-Challenging and Reintroducing FODMAPS: A self-help guide to the entire reintroduction phase of the low FODMAP diet (affiliate link).

It provides a full protocol to follow and is authored by FODMAP-specialist dietitian Lee Martin.

As always I also strongly recommend investing in the Monash FODMAP app for your phone or tablet.

Monash University is the home of FODMAP research, and the app provides the most up-to-date FODMAP food database and recipes available.

If You Prefer Video

New to FODMAPs and IBS? Start here.



Re-challenging FODMAPs is the only way to determine your tolerance to different groups. This is a detailed overview of the FODMAP reintroduction plan: https://www.dietvsdisease.org/fodmap-reintroduction-challenge-plan/

Comments

  1. That was very helpful! Thank you

  2. Sonia Crane says:

    A very helpful site. By the way, Crohn’s is an Inflammatory Bowel Disease, IBS is the Irritable Bowel Syndrome.

  3. I have a question…I am needing to do the challenge/reintroduction of the 2 Fructan Vegetables and I’m at a loss. I do not use raw onion in any of my cooking and haven’t for years as it’s never been GI friendly for me. I also do not use garlic very often and when I do it’s typically tiny amount in a pasta dish or something where it’s a minor ingredient. However…up until I began the fodmap diet, I have used garlic powder and rarely onion powder. So…the question is this: Can I somehow substitute garlic and/or onion powders for the challenge of the fructan vegetable or will it not be enough for true result??? Also, I don’t eat leeks, cabbage, or okra…so I’m at a loss as to how best test this group! HELP!!! Thank you 🙂 ((btw I do want to test it as I’ve been failing almost all groups thus far and I am trying to decide whether I need to look into SIBO or something else!)) THANK YOU

    • Hi Christi you can swap them in, but it’s hard for me to say the amounts, and what they are equivalent to compared to whole onion or garlic.

      Considering it’s never been GI friendly, chances are you react to it.
      If you have been following the reintroduction protocol accurately (allowing enough time in between symptoms to recover) yet continually fail all tests then i would be looking into SIBO.
      Just one round of antibiotics can really help. https://www.dietvsdisease.org/sibo-diet/

  4. I’m confused. If sugars are to be avoided, why is table sugar in some of the recipes? Also, I thought broccoli was to be avoided, yet it is in Monash and Internet FODMAP recipes also. I’ve noticed this dichotomy in several places. As a newbie, I’m very confused. Help!

Speak Your Mind

*