Tips For Reintroductions on the low-FODMAP Diet
If you’ve been around the SIBO or gut health world for any time now, you’ve probably at least heard of the low-FODMAP diet, if not tried it yourself.
The premise around this diet is that avoiding certain foods that contain short-chain carbohydrates will reduce your symptoms of IBS. Symptoms including bloating, gas, abdominal pain, and constipation/diarrhea.
These short-chain carbs are known as prebiotics, and are what feeds our gut bacteria. But, when you have an overgrowth or imbalance of bacteria in your gut (known as dysbiosis) eating foods that feed bacteria often results in unpleasant symptoms.
For a better idea of what FODMAPs are, I suggest you visit Monash University’s FODMAP website, or download their app – both are a wealth of FODMAP information! I’ve also pulled a graphic from Monash’s website that explains the categories of FODMAP foods, if you just want a quick reference point.
Image from Monash University (www.monashfodmap.com)
There have been many studies linking the presence of SIBO to those with IBS symptoms, and I’ve seen study results showing as high as 54% of patients with IBS test positive for SIBO.
So, it’s no wonder why a diet meant to reduce the symptoms of IBS would be so popular among SIBO patients!
As a SIBO sufferer myself, I used the low-FODMAP diet to successfully reduce the severity of my symptoms, which gave me some breathing room to work on healing my gut and getting rid of my SIBO.
The Low-FODMAP Diet for SIBO Symptoms
The low-FODMAP diet does a great job of restricting the foods that your overgrown bacteria feed off of, but that also means the good bacteria in your large intestine are getting starved as well.
This restrictive of a diet shouldn’t be followed forever, and it isn’t actually meant to treat your SIBO, only to control your symptoms while you use other methods to heal your gut and get rid of those misguided bacteria.
In fact, even after just four weeks on a low-FODMAP diet, researchers have found that there can be a reduction of the proportion and concentration of bifidobacteria (a helpful type of friendly bacteria normally found in healthy guts) as compared to patients that weren’t restricting these carbohydrates.
So, that means eating these prebiotic carbs are actually beneficial to our gut bacteria and therefore our overall health (read more about why our gut bacteria are critical to our health).
But, many people (myself included) end up getting stuck on this restrictive diet because they’re unable to reintroduce foods for a number of reasons.
Whether it’s out of fear of making the overgrowth worse (that was me!), or because you find that you still can’t tolerate a lot of FODMAP foods (that was me too), or just because you don’t know how to begin reintroductions, the low-FODMAP diet can become a way of life for way too long, potentially reducing your overall gut bacteria count and diversity.
I know from personal experience how trapped you can feel on this type of diet - your symptoms feel so much better when you eat this way, but you’re also so limited in your food choices that going out to eat or having variety in your diet seems nearly impossible.
And I don’t want what I’m saying about the low-FODMAP diet reducing good bacteria in your gut to be a stressor. I just want to make the point that this diet isn’t meant to be forever, and that although it can feel good to get some symptom relief, the only way to truly heal and get back to 100% health is to get to the root of what is causing you to need to be on this diet in the first place.
Low-FODMAP Isn’t Forever
Just because you have SIBO or IBS doesn’t mean that you’re doomed to live a life of restricted diets for the foreseeable future, even after you’ve eradicated the overgrowth.
What I’m trying to implore with these facts is that true healing is possible, and once you get there you won’t need a severely restricted diet to stay healthy and symptom free!
With that being said, I want to share a few tips and tricks for anyone who’s been on the low-FODMAP train for a while and wants to try to begin reintroducing some higher FODMAP foods.
However, I’ve found that FODMAP reintroductions are usually only successful after some significant gut healing and overgrowth removing has taken place.
If you attempt to introduce some FODMAPs and find that you’re still having symptoms it might just not be your time yet - and that’s totally okay. I needed to do some significant gut healing before I could even attempt to start adding some of these restricted foods back into my life.
And again, if you’ve been on this diet for some time, don’t worry - just focus on building up your gut health and slowly but surely, you’ll be able to tolerate more, I’ve seen it in myself and I know the same is possible for you. (If you want to try some of my gut healing tips you can sign up for my newsletter, here, and get my free eBook - My Top 5 Keys to Gut Healing!)
Also, I’m not a medical professional, just someone who has been through what you’re going through now. When making decisions about your diet, always trust your best judgement and the guidance of your healthcare practitioner (not some article you read on the internet).
But okay, let’s get to those tips!
Tip #1: Find out if there’s a category of FODMAPs you’re not sensitive to and reintroduce those first.
Like the image above illustrated, there are several categories of FODMAP containing foods, each one grouping foods by the type of short-chain carbohydrates they contain.
So, for example, asparagus is listed as being a high FODMAP food. But it’s only high in oligos and fructose when you consume five spears or more. Asparagus doesn’t contain polyols or lactose, the other two types of FODMAPs.
And a serving of four brussels sprouts is only high in oligos, and low in the other three categories of FODMAPs.
(Again, Monash University’s FODMAP resources really help explain this way better than I ever could, so if you’re lost, check them out! And I’m totally not getting paid to tell you this, I’m just that passionate about how useful their resources are.)
If you’re able to determine that you’re sensitive to certain FODMAPs, you can essentially work on introducing foods in those groups that you’re not sensitive to.
This will definitely take some trial and error and listening to your body - it won’t happen overnight and it won’t necessarily be easy.
But, if you’re able to identify the specific FODMAPs that you’re having reactions to or that flare your symptoms, you’ll know to avoid those FODMAP categories and stick to the others.
There’s no sense in restricting all of the FODMAPs if you only react to some of them. The broader the diet you can create for yourself, the more success you’ll have on it and the better you’ll feel.
When I first started trying to reintroduce some high FODMAP foods I noticed that I reacted badly to apples (which are high in fructose and polyols) - I would get bloated almost immediately, and I would feel so tired after eating them. So, I was pretty certain that fructose and/or polyols were FODMAPs that I could not handle.
But, I noticed that I was able to eat a small serving of mushrooms (high in polyols) with no issues.
So, with just these two food observations I was able to determine that, because I reacted to apples (fructose and polyols), but not mushrooms (polyols), I needed to avoid FODMAPs that contained fructose, but could start introducing some foods that were high in polyols.
If you’re just starting out on this reintroduction journey it will be helpful to write down the foods you’re attempting, what FODMAPs they contain, and how they make you feel after.
That way you’ll be able to see patterns and similarities easier than just trying to go by memory.
And again, this will be a process - but being able to expand your diet and eat more freely will be so worth it!
Tip #2: Start reintroductions using small portion sizes only.
If you’re using the Monash FODMAP app (friend, it’s so helpful - I still have it on my phone and I don’t eat low-FODMAP anymore!) you’ll see that they use a traffic light system (red, yellow, or green) for rating the amount of FODMAPs that are contained in certain servings of each food.
Red means that a food at that serving size has a high dose of FODMAPs, yellow means a moderate dose, and green a low dose or no FODMAPs.
This system can be a little confusing at first, but it’s super helpful when trying to start reintroductions.
Here’s an example of the stop light system at work, and then I’ll go into more detail about how you can use it.
Asparagus is considered a high FODMAP food (high in oligos and fructose) when you eat a serving size of five spears or more. (As shown in the image from the FODMAP app, below)
Image from Monash University FODMAP app
However, when you only eat one spear of asparagus (it may seem a little silly to only eat one spear, I know, but you have to start somewhere), it’s only moderately high in fructose.
Image from Monash University FODMAP app
So, as you can see, the FODMAP content changes with the portion sizes of the foods you’re eating.
If you work on reintroducing only small portion sizes at a time you’ll likely have a much better chance of tolerating something than if you ate a large portion of it.
This can definitely get a little tedious, but it’s so worth the effort if you’re able to broaden your diet - even if it’s just by one spear of asparagus!
Tip #3: Support your digestion during the process.
Making any change to what you’re eating is going to take some getting used to, but this is especially true for these short-chain carbs that aren’t as easy to digest in the first place.
The reason your gut bacteria can feed off of FODMAP containing foods is because they’re not as easily digestible by our actual guts, leaving more time and space for our bacteria to get to them.
So, during FODMAP reintroductions it’s important to ensure that your digestion is working as well as it can be so that you don’t leave any opportunity for your gut bacteria to ferment the food and cause symptoms.
There are so many things you can use to support your digestion, it will (like everything else I’m mentioning) take some trial and error to figure out what works best for your body and your specific health situation.
I’ve found a lot of success using a product called Iberogast. It’s a solution of a bunch of bitter herbs that help to stimulate digestive juices and get your system ready to handle the digestion process.
Digestive enzymes, HCL with pepsin, apple cider vinegar, celery juice, or lemon water are also great tools to help increase stomach acid, and in turn help you break down your food before your gut bacteria get to it.
And like anything, always check with your trusted healthcare professional before adding any supplements to your routine.
I’m only mentioning these because I’ve had success using them to help my gut when it needed the digestive support.
Tip #4: Having reactions to new foods doesn’t necessarily mean that you can’t tolerate that food and should continue to avoid it.
If you’re trying a new exercise at the gym, you’re going to be super sore the next day.
If you’re learning a new subject in school, you’re going to have to study it over and over until you master it.
It’s the same concept with our guts and introducing foods you haven’t eaten in a while, it’s going to get a little worse before it gets a whole lot better.
And I totally get it, if you’re trying to introduce these high-FODMAP foods back into your diet and you experience unfavorable symptoms again, your first reaction would be that you’re not ready to start expanding your diet.
But, what actually happens when you haven’t eaten a food, or a group of foods, in a while is that your body stops producing the enzymes needed to digest those foods.
The best example of this is when vegetarians or vegans try to start eating meat again and they have a really hard time. It’s because their body has stopped producing the enzymes and digestive acids to digest meat - because it just didn’t need to for so long.
So, just because you’re experiencing symptoms like bloating and gas when you first attempt a FODMAP reintroduction doesn’t mean that you still can’t tolerate that food.
When I was trying to reintroduce broccoli, I would get super bloated and tired after eating it the first few times. But, I stuck with it and over time, as I continued to introduce this food to my gut, the bloating and other symptoms lessened and eventually went away completely.
You have to give your body time to adjust to these foods that you’ve been restricting for so long. So, don’t get discouraged if you don’t feel 100% perfect your first few tries - keep at it, and if your body is ready your symptoms will subside.
I do understand that it may be difficult to distinguish between a symptom that you just need to push through, and a symptom of a reintroduction that you’re not quite ready for.
And I would just have to implore you to listen to your body. If you feel significantly worse after eating a small amount of a food, then it’s probably not right for you. But if you only have minor symptoms that aren’t causing you pain or distress, it might be okay to try again.
But, only you know your gut best, and you can’t let anyone else (including me) tell you what to reintroduce and when. If you can get in tune with the signs your body is giving you, you’ll be golden!
The Bottom Line
The low-FODMAP diet isn’t meant to be a life sentence. Nor is it designed to treat SIBO or any other digestive condition. It’s merely a tool to use to control your symptoms so that you can work on figuring out and treating the root cause of your digestive issues.
And I know that trying to reintroduce foods that once caused terrible symptoms is so much easier said than done, I’ve been there too.
But, using these tips as a guideline and a stepping off point can help you to get over the initial hurdle and start expanding your diet.
However, if you find that your FODMAP reintroductions aren’t going well and you’re feeling significantly worse, don’t get discouraged. That just means the diet is doing its job and reducing your symptoms, but you still have some gut healing to do.
It took me a long time, and many failed reintroductions, to get to the place where I could start expanding my diet.
So, don’t stress if you’re not quite there yet. Keep up the gut healing, work on reducing your stress, and team up with a great practitioner to help you remove any overgrowths that may be keeping you from expanding your diet. It’s hard work, but your body will heal, and you will be able to eat more foods - promise!
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