There are two popular schedules for completing your reintroduction challenges. Your dietitian is the best person to advise you on how to space out your FODMAP challenges. Based on your symptoms, reactions and circumstances they can further tailor the schedule to suit you. [1] Your timescale for rechallenging should take into account several factors including:
- typical severity of your symptoms during a flare-up
- typical timing of your flare-ups after eating
- lifestyle and work schedule
- level of anxiety over reintroducing FODMAPs
- past experience of how a certain FODMAP affects you
- personal preference
3-day reintroduction schedule
The general reintroduction schedule for most people is to challenge over 3 consecutive days. Each day the portion size of the challenge food increases as you go. Based on your reactions you decide whether or not to proceed to the next day's challenge.
The benefits of 3-day reintroduction
The benefits of this approach are that you can potentially work through your challenges faster in a hyper-focused way. This may be the best choice for those with milder symptoms. It's more suited to anyone struggling to eat a restricted low FODMAP diet. It's also beneficial for those with a dietary need to reintroduce certain food groups as soon as possible. This category could include vegans, vegetarians and diabetics. [2]
The negatives of 3-day reintroduction
The downside to this schedule is that if you do trigger symptoms it may be more difficult to accurately detect which portion size caused the flare-up. This is because some foods (such as GOS and fructans) and some people, take longer to react than others. This may result in you avoiding FODMAPs when in fact you may be able to tolerate them in smaller amounts. You might also be more suited to eating certain FODMAPs over non-consecutive days.
Alternate day reintroduction schedule
An alternative reintroduction schedule is to challenge every other day, leaving a rest day in between.
Some dietitians actually recommend this every other day approach to everyone for the GOS and fructan challenges. This is because these FODMAPs generally move slower through our digestive systems. As a result of this, it can take longer to feel their effects. [3]
The benefits of alternate day reintroduction
It's possible that allowing the rest day in between challenges makes it a bit easier to spot and limit potential flare-ups. This schedule may be best suited to those that experience severe flare-ups to most of the FODMAPs. It may also benefit people that find the idea of reintroduction very stressful. Those with slower digestion such as anyone suffering from chronic IBS-C often benefit from a slower pace.
The negatives of alternate day reintroduction
This is a slower approach which potentially lengthens the amount of time spent in the reintroduction phase. This can come with its own issues such as the increased possibility of losing focus or compliance. The longer we spend limiting FODMAPs in our diet the more likely we are to disrupt the balance of our gut microbiome. A longer reintroduction phase also means we're more likely to encounter more reasons to postpone or abandon the diet. There's more opportunity and FOMO in favour of socialising, holidays, takeaways and meals out.
FODMAP challenge basics
However you decide to space out your FODMAP challenges there are a few basic principles that remain consistent. You need to try to eat your challenge food at the same time each day. This helps to keep the FODMAP load spread evenly across all 3 challenge days.
It's also important to leave at least 3 days between ending one challenge and beginning another. This should always be done, even if the challenge was successful. This break in between is known as a washout period. It allows time for the FODMAPs to leave your digestive system, which reduces the likelihood of FODMAP stacking.
Challenging different FODMAPs back to back increases the risk of skewing the results of the next challenge. This can happen due to a delayed FODMAP reaction or FODMAP stacking [4]. The idea is that your symptoms return to your low FODMAP baseline during the washout period. For accuracy, this should happen before you progress onto the next challenge.
Depending on your reactions it may be that for some challenges you need to take longer than a 3-day break. If you reacted badly then you need to get your symptoms back under control before moving on [5]. This is fine but you need to be mindful of getting back on track with your challenges as soon as you feel better.
Which reintroduction schedule were you advised to use? Let us know in the comments if you think this was the right choice for you.
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