As those of you who have been following along know, for the past twelve weeks I’ve been on a Low FODMAP diet, after a nearly three year long chronic and often debilitating IBS-D (Irritable Bowel Syndrome – Diarrhea) diagnosis, and over a decade of lingering digestive discomfort. Affecting one in seven adults, IBS burdens many of us with gas, bloating, abdominal pain, cramping, or altered bowel movements. Finding myself consistently lethargic, bloated, swollen from my toes to my nose, and on a first name basis with my roll of toilet paper, the drastic, yet pharma-free treatment couldn’t have felt more necessary and right. A multi-week diet focused on the elimination of common symptom triggering culprits (you can read more about FODMAPs and the diet, here), specifically foods high in fermentable, poorly absorbed short-chain carbohydrates, the elimination is followed by a gradual FODMAP reintroduction phase, to gauge individual tolerance to each FODMAP and ideally pinpoint which are specifically triggering. Now thirteen weeks into the diet, and just beginning the reintroduction phase myself, I wanted to outline my FODMAP re-challenge plan, exactly how I’m pinpointing my IBS food triggers. A ten week program, this re-challenge is meant to help provide a better understanding of which, and at what portion size, particular FODMAPs affect IBS symptoms, so we can successfully self-manage in the long term without having to maintain the entire elimination. A gradual and wholly individual process, below you’ll find my ten week program and guidelines, so you get the very most out of the plan.
• There’s no ‘right’ place to start – begin by re-challenging the FODMAP you missed most.
• Note the ‘Protocol’ table in the upper right corner of the re-challenge plan: the plan begins with day 1, incorporating a small portion of your chosen FODMAP into your diet. You’ll then take a ‘washout day’ where you’ll follow a strictly Low FODMAP diet for 24 hours, followed by day 3’s incorporation of a medium portion of your chosen FODMAP. This is followed by another ‘washout day’ then day 5’s incorporation of a large portion of your chosen FODMAP. You’ll conclude with three ‘washout days’, and then will restart with your next FODMAP re-challenge.
• Note the ‘Re-Challenge’ table in the middle of the re-challenge plan: the noted portion sizes are different for each food. Each noted portion size relates to the amount of FODMAPs found in the food, rather than the typical serving size of that food. As arbitrary as this may seem, always consume the portion sizes noted.
- A small portion size indicates a moderate amount of FODMAPs. If you’re experiencing symptoms at this portion size, this FODMAP is a major trigger of your IBS symptoms and should be restricted.
- A medium portion size indicates a high amount of FODMAPs. If you’re experiencing symptoms at this portion size, you can eat this FODMAP in moderation.
- A large portion size indicates a very high amount of FODMAPs. If you’re experiencing symptoms at this portion size, generally, you can eat this FODMAP, but should avoid it in larger portions.
• Note the ‘Re-Challenge’ table in the middle of the re-challenge plan: there are three re-challenge options provided for each of the eight FODMAP subcategories (Galacato-Oligosaccharides, Vegetable Fructans, Fruit Fructans, Grain Fructans, Lactose, Fructose, Mannitol, and Sorbitol). You will only need to test one of the three options from each category, except for Vegetable Fructans and Grain Fructans – these each require two rounds of testing.
• Re-challenge food aside, you’ll be maintaining a Low FODMAP diet throughout the entirely of the re-challenge plan. For example, even if you find you can tolerate lactose after challenging, you must maintain lactose elimination until you have completed all the other re-challenges.
• If after any of the 3 re-challenges you experience mild symptoms, continue to the next re-challenge day to test the next portion size of FODMAPs. If after any of the 3 re-challenges you experience severe symptoms, stop that re-challenge and enter the ‘washout day’.