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How to complete a 3-phased FODMAP protocol
You’ve read us mentioning the 3 phases of the low FODMAP diet a few times already in these articles of this IBS series. Without further ado, here are the 3 phases of the FODMAP protocol to start and follow a FODMAP diet: Elimination, Reintroduction and Personalization.
Phase 1 – Elimination
The first step consists of eliminating all High FODMAP foods from the diet until the symptoms get better or fully disappear. It may take up to 6 weeks to feel better, even if a strict low FODMAP diet is being followed.
As previously seen, there are a lot of foods containing FODMAPs such as produce grains and cereals, nuts, legumes, lentils, dairy products and a variety of processed foods. This often makes things tricky to:
- Stick to the diet. Eating low FODMAP may seem blend and repetitive. However, there are many tips, resources and products that can be used to diversify your eating and flavor up the food.
- Have balanced meals. Sometimes it seems just easier to avoid eating completely a food group and to substitute by another one. Our advise: Keep your meals balanced. Lacking a food group may have negative impact on your digestion, as explained in our previously published article https://www.healthstandnutrition.com/soluble-vs-insoluble-fibre/ , causing more diarrhea or constipation, and then delay the relief of your symptoms AKA being on the low FODMAP diet for a longer period of time.
If there is a relief in the symptoms, you can now move onto the second phase. If after 6 weeks there are no changes in the symptoms, it is important to work with your dietitian to identify the causes and see what to do from there.
Phase 2 – Reintroduction
This step is essential to identify which one of the FODMAPs triggers symptoms and how much can be tolerated. By reintroducing methodically 1 food item at a time, the symptoms will be monitored closely and the food triggers may be identified. During this phase, that is typically completed in 6-8 weeks, it is important to remain on the low FODMAP diet except for the only food item being reintroduced.
To test the different categories, the Monash FODMAP App is a very useful tool, since it has pre established food items with amounts per families. You simply have to pick 1 food you want to reintroduce, start with the small amount (day 1) normally recommended at your 1st or 2nd meal and monitor your symptoms for the rest of the day. If you have no change in your symptoms you can increase to a medium amount (day 2) and so on. Keeping a journal of your symptoms, stress level and food eaten is important during the 2nd phase in order to catch potential false negative readings.
It may feel scary to move into the phase 2 because you have been feeling great since being on the first phase. However, it is important to consider that being on a strict low FODMAP diet is unsafe, because it increases the risk of several nutrient deficiencies, and restricts food categories that have no reason to be restricted since they don’t trigger symptoms. It just happens that you don’t know what triggers your symptoms yet.
Phase 3 – Personalization
This step consists in building the new lifestyle from what has been discovered in the second phase. A regular balanced diet can now be followed except the FODMAP category(ies) that have been identified to increase the digestive symptoms.
The intolerance to the trigger(s) identified is typically for life. However, IBS is a condition that evolves over time, which means that your tolerance may be better or worse over time. For this reason, it is recommended to test your intolerance about every 6 months.
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