FODMAP FIRST STEPS

[Djste]

Can anyone recommend what I should try to re-introduce after sticking to a FODMAP diet for 4 to 6 weeks successfully?

Any how long should I try each item or group of items?

[Luisa22]

When you say your low Fodmap trial was successful, do you mean your symptoms stopped or lessened?

Did you also eliminate anything with gluten? If you did, then maybe you could try with small amount of gluten (something like a small piece of bread or toast) Watch your symptoms, and if you don't get any then wait about 3 days. If there are still no symptoms, then try a slightly larger amount, and do the same. If after 3 days you get no worse symptoms, you can safely say that gluten is OK for you.

Then bit by bit try it with other high Fodmap foods which you like. Start with small amounts of one particular food, and aim eventually over the next week or so for 1 portion a day, but keep a couple of days in between. Keep watch and see what happens...etc.

You could also try this with lactose (though I don't know if you had dairy products in your Low Fodmap trial.)

It's complicated, and a bit long winded and you could really do with a dietician on board, but those are not always available. I do know. I did the trial and re-introduction myself though we are strongly advised not to.

It's a work in progress. Two years on, I am still re-introducing foods, and not always succeeding, and sometimes find I can eat very tiny amounts of some things, but no more, and not too often (re: brussels sprouts, which I happen to like!) I don't do very well with fruit yet.

[SueCats]

The principles of what Luisa22 says are correct, but bread contains wheat. I can eat gluten, but not wheat. Gluten is present in other foods, such as barley and rye. The best way to check if you are gluten intolerant is a coeliac test.

[swarthy in reply to SueCats]

A coeliac test is only viable if you've continued to eat gluten - once you stop - the antibodies disappear. I stopped gluten on my own after being ill for three months - I was refused a formal diagnosis until I'd started eating gluten for at lest 6 to 8 weeks, then had a positive blood-test (needless to say I refused, and have been gluten free now for some 15 years)

[Luisa22 in reply to swarthy]

Yes, I think if you stop eating gluten and do definitely improve, then try it again and slide back, then get better when you stop it again that's a red flag for at least 'gluten sensitivity' if not full blown coeliac.

But yes, wheat also contains fructans, so things can get mixed up, true. It might be fructan sensitivity if someone reacts to bread, not gluten sensitivity.

[swarthy in reply to Luisa22]

I would NEVER return to eating gluten, I was horrifically ill, lost three stone with my skin peeling off due to my eczema after a lifetime of the "experts" telling me that my condition wasn't related to my diet .

I was accidentally glutened a fair bit when I first changed my diet - and have zero desire to return - I would rather starve than risk being glutened my experience was that bad (and it had been facing me for years - I just never made the connection)

[ClareLou]

you need to reintroduce one FODMAP at a time. So for example if you try cows milk first on day one you have one portion, if you have no symptoms on day two you have 2 portions, if again you have no symptoms you can have 3 portions on day 3. If after day 3 with no symptoms you can think of this food as a safe food for you. If you have symptoms after day 1 or 2 you stop and remove the food as you know this is one of your FODMAP triggers.

After day 3 with no symptoms you remove that food so in this example cows milk and try another FODMAP. You have to do one food at a time, it is long winded but this gives you the data you need to work out what foods trigger you and also the amounts.

Remember you only need to experiment with one food from each of the FODMAP groups as your testing which of the FODMAPS you’re more sensitive to.

I hope this helps and you find your trigger foods. Good luck

[Luisa22 in reply to ClareLou]

Yes, amounts matter too. I tested lettuce (not iceberg, little gem) and was fine on it, and have been since. But yesterday I ate a huge portion, about 3 times what I usually have, and had a very bad tummy this morning. So the conclusion is that lettuce is ok, but portion sizes matter.

[Flyonawall]

Try expanding your diet within the fodmap range first,it is generally broader than most people's regular diet.Correct,one potential trigger food at a time.Go slowly with this.

We do not need cows milk as adults. Try low lactose items like aged cheese rather than fresh types.

I can tolerate gluten free bread in small quantities, there's a good local Baker for that where I am.

Oats have always been ok for me.

We're all different.

[xjrs]

I was issued with very specific instructions when I was taken through this with a NHS dietitian - they had standard booklets for it. I've had a look online and tried to find something similar for you and found this:

gloshospitals.nhs.uk/media/...

Are you able to get a dietitian referral through your GP?

[Trenholm]

Try a small slice of bread a day and build up gradually. You might only tolerate small amounts.

[tryfan004]

Hi Djste, you really should go to a state registered dieticien. They will at least give you the correct researched booklets that you should follow closely. These booklets come from the two universities in this counrty who have researched FODMAPS over years. Some of the stuff on line is wrong or misleading and can become very confusing. Get your GP to refer you to a dieticien. They will then guide you through the process. Do not take no for an answer as if they have dismissed every other thing it could be they are duty bound to refer you. Good luck.

[Icanchangethislater]

I just finished the food re-introduction phase and used the Monash LOW FODMAP app. for instruction. The app was invaluable! If you have the app., on the main menu select Diary, then click on the plus sign on upper right. Then select the apple with the circular arrow. This takes you to a page where you select the food component (sorbitol, fructan, etc) and then gives you an option to choose which food and how much to re-introduce for the three days. As far as which food to choose first, I don’t think it matters. I started with honey. For the different fructans you might want to wait a day between each re-introduction amount.

[Bralorne in reply to Icanchangethislater]

you should really follow the low Fodmap diet under the guidance of a dietician. The Monash University reintroduction booklet provides very clear instructions for reintroducing all the foods you eliminated in the first 6week elimination phase.

[Icanchangethislater in reply to Bralorne]

To be honest, I did just as well as any dietician. I explicitly followed the instructions of booklets and videos by Monash University. I didn’t vary one bit. Throughout the entire elimination phase I did not have one episode of diarrhea. Not one. It took almost three months to get through the elimination and re-challenge, so it wasn’t easy. Every bit of food I ate was Monash University approved. It was challenging, and expensive, but I did it and I did it well.

[Bralorne in reply to Icanchangethislater]

hi yes I was the same, if you stick to it it really works. I was fortunate my consultant organised a dietician to work with me and she was a great source of useful hints. I know a few people who have tried to go it alone and sadly didn’t have much success. I agree you really need to get your head round it and stick with it. Hope you continue to keep we...

[Icanchangethislater in reply to Bralorne]

What was strange is I didn’t have symptoms during food re-challenge, other than minor bloating and being a tad bit gassy. And those symptoms occurred two days after the final third challenge day. The nurse practitioner and I think it’s because prior to going on the low FODMAP diet, I was consistently eating lots of FODMAPS. I mean 1/2 avocado, cashews, and pea protein powder pretty much every day. Talk about FODMAP stacking! I guess that’s why I was having severe episodes of diarrhea.

[Bralorne]

hi I had very limited success during the reintroduction stage and find I really have to follow a fairly strict diet. Like you I love all the problem food, like avocados, lentils etc but now can’t have. However anything is better than the pain, nausea, wind and having to stay near a toilet. I’ve since been told my IBS is on pretty bad but life goes on and I certainly feel better now than before.

[Chris61]

I managed to get referred to a dietician through my gp and to be honest I was disappointed. All they did was to send me a low fodmap list that I was already aware of.

I then found a private one from the BDA website and what a difference. First the down side you have to keep a very detailed diary of everything that goes in your mouth ,your toilet visits, your feelings, sleep etc. I did that for a number of weeks, then she spent a lot of time going through it.At the end I was given quite a bit of advice which was very helpful. This cost me £82.

Whats good is she is at the end of the phone if I need advice and so far she hasn't charged me any more.

If you decide to go down this route do your research off the BDA site, the dietician I chose was very experienced and highly qualified, they don't need to be local it can all be done remotely.