Here are my Top 20 tips when starting the elimination phase of the Low FODMAP diet (2-6 weeks). My tips are from the book the Low-FODMAP diet Step by Step by Kate Scarlata and Dede Wilson, the Monash University app and now I can say…personal experience.
1. Watch for garlic and onion/powder in pre made sauces; you can get a garlic infused olive oil to still have garlic flavoring in your food.
2. Soy is tricky: soy milk must be from soy protein isolate and not from whole soybeans; soy sauce and edamame are ok. Firm tofu is fine but silken tofu is high in FODMAPs
3. Read food labels very carefully and be wary of commercially prepared products. Avoid those that contain high fructose corn syrup, fruit juice, agave, honey, dried fruit, sorbitol, mannitol, xylitol, isomalt, erythritol, etc.
4. Check amounts to see how much of a low or moderate FODMAP food is allowed, to still be considered low in FODMAPs
5. Certain vegetable parts are ok; for example: broccoli heads and the green parts of scallions are allowed
6. Berries: strawberries and blueberries made the cut, but blackberries did not
7. Plan your meals and snacks...or you will fail; menu planning is key! Bring your own food to social events or eat before going out.
8. You can use a grocery delivery app (such as Whole Foods through Amazon prime) to save time getting the proper low FODMAP groceries without wasting time searching for obscure items at the store.
9. Different resources may seem to contradict each other; if there is a discrepancy, I would use the Monash University app because it is periodically updated
10. Look out for food additives such as chicory root (was in the protein powder that I normally use) and inulin
11. Chickpeas and lentils that are canned (not dry) can be consumed as some of the FODMAPs are released from the food in the canning process, making them allowable.
12. When eating out...just ask. Ask what ingredients are in your dish and if alterations can be made.
13. Don’t start this diet during a time when it will be difficult to adhere to (for example, while traveling and possibly during the holidays). You have to be fully committed and it’s indeed a learning process.
14. You will have the most success if you are involved in cooking your own meals or can provide the cook in the house with low FODMAP recipes
15. The Monash University app has several resources about companies that make low FODMAP foods such as the FODY Food Co which has an online store.
16. If using the Monash University app, make sure you go through the tutorial (press start the diet) to understand how to use the app and go to the booklet section to look at specific topics (there is a good read on how to do the diet if you are vegan or vegetarian).
17. You may need to see a dietician if this is too cumbersome to follow on your own. However, using the app and a book also help. We do have a dietician in our office.
18. You may need to be ruled out for other conditions before you try this diet such as Inflammatory Bowel Disease, pancreatic insufficiency, microscopic colitis, defecatory disorders, small intestinal bacterial overgrowth, etc. Breath tests can possibly aid in figuring out if you have fructose or lactose malabsorption. However, there is some question regarding how accurate and reproducible they are.
19. This diet works best in combination with other therapies for IBS, such as cognitive behavioral therapy and when needed, medications.
20. Have fun! Being on this diet may seem restrictive but it has forced me to expand my horizons and try out new recipes and vegetables.
Top 10 tips during the Challenge phase: 6-8 weeks
1. Start with the food subtypes you think you are not sensitive to
2. Use a challenge food that is high in only one subtype of FODMAP
3. Incorporate the test food three times in 1 week, once per day. Increase the amount on each consecutive day, as recommended per the Monash University app (this is found in the diary section--> + icon --> apple icon) or the guideline below. However, for Day 3, you can maintain the amount used in Day 2 if you normally would not consume the amount suggested below for Day 3.
4. Challenge food amounts suggested below are mostly in the raw form (not cooked) unless specified
5. If your IBS flares on a test food, then allow your symptoms to resolve for 3 days prior to testing a new food group
6. Keep a record of your symptoms during the challenge phase with each food group
7. If you feel like you passed the test for a subtype, do not start incorporating it into your diet until the complete challenge phase for all of the subtypes has been completed
8. You may need to repeat a challenge if you are not sure if it is a trigger for you. Triggers can cause abdominal discomfort/pain, distension, bloating, etc.
9. Stress may be a trigger and can interfere with interpretation during the challenge phase (try to avoid doing a challenge on a stressful day).
10. Keep at least 1 day in between completing a challenge and starting a new challenge
The above chart is summarized from (Low FODMAP Diet Step by Step) with full reference below.
Top 5 tips for Personalization/Reintegration
1. Incorporate the foods in serving sizes that you tolerated during the challenge phase
2. If using the Monash University app, you can select, enable filtering, to select your triggers and then this will further filter the diet based on You!
3. Your triggers may vary over time
4. If you are avoiding certain food groups such as dairy: notify your physician as you may need to make sure that you are getting enough vitamin D and calcium in the diet. This diet can be also be low in pre-biotics and fiber. We still recommend getting at least 25 gm of fiber per day in the diet for women and 35 g/day for men.
5. The initial phase of the elimination diet is not a diet that should be continued for longer than necessary. It can be overly restrictive. If there are several other restrictions on your diet, the low FODMAP diet may not be right for you and you need to discuss this with your physician before starting it.
The most important tip: Use all of your resources! The Monash University app also has lists of several food companies that make low FODMAP food items/supplements, cookbooks (the Low FODMAP diet Step by Step had great recipes that I tried and really liked), your gastroenterologist, a dietician, and your friends and family for moral support. And with that…I wish you not luck but success.
References:
Monash University (2019). Monash University FODMAP Diet (3.0.4) [Mobile application software].
Scarlata, Kate and Dede Wilson. The Low – FODMAP Diet Step by Step. Da Capo Press, 2017.