FODMAP Reintroduction Plan and Challenge Phase: Your Guide and FAQ

FODMAP Reintroduction Plan and Challenge Phase- Your Guide and FAQ

[Last updated 16th October, 2017]

The FODMAP rechallenge and 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.

Additionally, it’s not healthy to just eliminate all FODMAPs in your diet for an extended period of time.

In order to rechallenge and reintroduce FODMAPs successfully, it must be approached in a systematic fashion.

This is a detailed overview and FAQ of the entire 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 (after the elimination phase), 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 typically 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.

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.

Why You Must Eventually Reintroduce FODMAPs

Many people do so well in the elimination phase of the low FODMAP diet that they never want to eat any high FODMAP foods ever again.

However, this is a big mistake.

Rechallenging and reintroducing FODMAPs into your diet is crucial for ensuring that your food intolerance doesn’t get any worse.

What’s been lost in a lot of outdated FODMAP resources is that cutting out FODMAPs for long periods of time – especially when you don’t actually have to – is causing more harm in the long run.

In other words, the longer you eliminate all FODMAPs, the further problems and symptoms can be exacerbated.

Take lactose in dairy for example, which progressively causes symptoms in those who never have it. On the other hand, those who are exposed to lactose frequently end up with a higher tolerance.

This is why it’s important to identify what FODMAPs give you symptoms, and in what quantities. Knowing how much you can tolerate allows you to continue to eat that FODMAP without getting symptoms, ensuring your intolerance does not get any worse.

Summary: Everyone must rechallenge and reintroduce high FODMAP foods at some stage after the elimination phase. Eliminating FODMAPs for months or years at a time will cause food intolerance to get worse.

How Does It Work?

There are ten FODMAP groups to be rechallenged, one at a time.

These include:

  • Lactose
  • Fructose
  • Fructans from vegetables (x2)
  • Fructans from fruit
  • Fructans from bread
  • Fructans from cereal
  • Galactooligosaccharides (GOS)
  • Sorbitol
  • Mannitol

FODMAP Groups for reintroduction phase

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; the exception polyols which has two types (sorbitol and mannitol).

This rechallenging process for each FODMAP group typically occurs 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:

FODMAP rechallenge and reintroduction plan- traditional

Want to a large version for download or printing?

Or click here to get the plan.

So if you are rechallenging for 3 days, and leaving a 3-day washout period, the rechallenge process for one group lasts almost a week. That means ten 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 rechallenge 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 ten different FODMAP groups are reintroduced to the diet, one at a time. Each group is rechallenged 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 Rechallenged 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.

Example Rechallenge and Reintroduction Schedule

Here is an example of a full schedule to follow:
FODMAP Groups and Recommended Foods for Rechallenging

It contains recommended foods and quantities based on data from both the Monash FODMAPs app and the FODMAP Friendly app.

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.

Want a large version for download or printing?

Or click here to get the plan.

If you DON’T get symptoms:

  • Increase the amount you are testing until you’ve done 3 days. After this, do the 3 washout days and then move onto the next FODMAP challenge.
  • It’s best not to eat the previously tested food often, if at all, for the remainder of the reintroduction period (even if it did not cause you symptoms). This simply minimizes potential complications during the process.

If you DO get symptoms:

  • Wait until you are symptom free, then reduce the serving size to half and rechallenge again,
  • Try another food from within the same FODMAP group to confirm the results of the first challenge.
  • Or you can assume that FODMAP is a definitely a trigger for you and move onto challenge the next FODMAP group (after waiting for symptoms to resolve of course).

This is just an example schedule, and can be too aggressive for many people. Those who are etxra sensitive will need to follow a slower, less intense schedule.

Lastly, it’s recommended that you rechallenge any problem FODMAPs again in the future (a year or so), as sensitivity to FODMAPs may change over time.

Summary: Rechallenge whichever FODMAP group you prefer first, although it’s recommended to start with a simple one like fructose. 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 rechallenge 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 4 hours, the next morning or even a full day later.

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

Here is an example diary:

food and symptom diary- reintroduction

Want a large version for download or printing?

Or click here to get the diary.

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, amine, glutamate or histamine intolerance), small intestine bacterial overgrowth (SIBO), or even inflammatory bowel disease such as Crohn’s disease.

Unfortunately, while the low FODMAP diet is highly effective, it’s not a cure-all.

Research shows it doesn’t work well for 1 in 4 patients, although often this is because they were not strict enough during the process.

However, there are some who will not improve despite doing everything correctly.

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.

After you have succesfully completed the FODMAP reintroduction phase, you then move onto a modified low FODMAP diet.

Or click here to get the plan.

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. http://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!

    • Fructose is to be avoided. Glucose isn’t, although it’s a good idea to limit sugars anyway. Broccoli can be consumed in very small amounts and the Monash app says the correct amount. If you are new to the diet I suggest you get the Monash app as it helps a lot with both knowing what foods to have and the safe amounts of them.

  5. Louise Kelley says:

    On “day 1”, I reintroduced a nutrition drink (Ensure), which contains soy protein isolate, and had no bad reaction at all that day or the next. (Consumed it midday.) The following day, 2, I consumed half as much of the drink with dinner. (Half as much just because I felt no more hunger nor thirst.) On the morning of day 3, to my astonishment, I experienced an intense bout of diarrhea (before breakfast.)
    I am doing a careful review of each thing I ate on day 1 and day 2 and will need to re-stabilize before another “test,” but is it possible that my body could tolerate having that product on a single day, but absolutely not tolerate having it 2 days in a row? Thanks!

  6. Do you have to do all the challenge groups one right after the other? 9-10 weeks straight doing low fodmap is tough for me because of my job… could i complete the first challenge group, then challenge the next group a few weeks later? (of course, after having 3 or more days with no symptoms before starting the next group)

  7. Sue Edwards says:

    What a fantastic site. Thank you for the time and effort you put into this. It is very helpful.

  8. Hello!

    I did the hydrogen breath test a few years a go and was positive for fructose malabsorption but nothing else. Should I still go through the elimination period or can I just assume I’m okay with sorbitol, mannitol, GOS and fructans? (I know i’m fine with lactose)

  9. 3-8 weeks before Introducing this elimination phase seems quite a range. As I have only had 2 episodes of diarrhoea in 3 weeks, I’m presuming that will be safe enough for me to now do the re introduction phase?

  10. Hey there! What might be an alternative to corn flakes for the cereal challenge? I’m a bit stumped here! 🙂

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