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There is a new term starting to emerge in relation to the low FODMAP diet and this is the modified low FODMAP diet.

Put simply this is the long term diet the majority of people follow after completing the reintroduction phase of the low FODMAP diet.

People with IBS who have been fortunate enough to see a dietitian will understand that there are actually 3 phases to a low FODMAP diet. Those who could not get access to a dietitian or have chosen to try the low FODMAP diet themselves may probably not have realised the low FODMAP diet has 3 phases. Certainly if you obtain most of your information from the internet the reintroduction phase and the long term maintenance phase are rarely mentioned. I have to admit the research into FODMAPs and IBS is pretty slim on these important phases too! The figure shows these 3 phases and is explained below.

So what are the 3 phases of the low FODMAP diet?

1. The first phase is the low FODMAP restriction (or elimination) diet. This is what most people know as the low FODMAP diet but this phase of the diet should only be followed for 2-6 weeks.

2. The second phase of the diet is the reintroduction phase. This involves both re-challenging and reintroducing FODMAPs to test your tolerance levels to FODMAPs and understand your FODMAP threshold. This phase takes about 10 weeks to complete. In a way it continues indefinitely as your tolerance to FODMAPs can change over time and you continue to re-challenge and reintroduce FODMAPs. More on reintroducing FODMAPs here.

3. The final phase is termed a modified low FODMAP diet. Once you have completed the reintroduction phase and reintroduced FODMAPs back into your diet most people will still restrict some high FODMAP foods. This combination of eating high FODMAP and low FODMAP foods to personal tolerance results in a modified low FODMAP diet.

The final terminology for these 3 phases has yet to be agreed or published but will be similar to what is discussed above. There is limited research available on what people do once they have completed the 2-6 week low FODMAP diet. Earlier this year I presented an abstract while working at King’s College London at the Digestive Diseases Federation conference which looked at the long term effects of the low FODMAP diet in the UK and answered some very interesting questions.

1. Do people reintroduce FODMAPs after starting a low FODMAP diet?

YES!

In fact 97 out of 103 people completed the reintroduction phase.

2. What sort of diet do people follow in the long term after completing the low FODMAP restriction diet and the reintroduction phase?

Out of the 103 participants when followed up one year later:
78 of them continued to follow an adapted low FODMAP diet. Meaning they had reintroduced FODMAPs to their own tolerance levels.
19 followed a normal diet. Meaning they had reintroduced FODMAPs and no longer followed any FODMAP restrictions.
6 continued to follow a low FODMAP restriction diet in the long term (a year later).

Therefore the vast majority of people do reintroduce FODMAPs but continue to follow a modified low FODMAP diet as their normal diet.

3. After you have reintroduced FODMAPs do you still have relief of your IBS symptoms in the long term?

YES!

There are two statistical points here. First of all 61% of people found relief of their IBS after following a low FODMAP restriction diet. This is similar to other studies looking at the effectiveness of the restriction phase of the low FODMAP diet. Importantly in those 61% of people 70% of them continued to have relief of their symptoms a year later.

This shows that in the vast majority of people who find the low FODMAP restriction diet effective, even once they have reintroduced FODMAPs they still have relief of their IBS symptoms in the long term.

The abstract is available here.

The full programme from the event is available here.

It is great that these questions are starting to be answered as it helps the low FODMAP diet become a long term treatment option for IBS symptoms. It also means that the full information about the low FODMAP diet will become known to more people. Hopefully this will result in more support for those who are following only phase one of the low FODMAP diet and unnecessarily restricting their diet.

The study also looked at quality of life, the long term nutritional adequacy and acceptability of the diet with some really interesting findings which I will discuss in a later post.

Want more information on the low FODMAP diet and IBS? Click here for the latest changes and important updates.

We are currently travelling around the world and plan to bring you‘Around The World In 80 Low FODMAP Dishes’ – a collection of the best low FODMAP foods and recipes as we travel the globe. See more on our low FODMAP diet travel section.

Good news! The first ever book dedicated to reintroducing FODMAPs is now available to purchase on Amazon Kindle. The book is titled ‘Re-challenging and Reintroducing FODMAPs – A self-help guide to the entire reintroduction phase of the low FODMAP diet’. Click on the logo for more details.

More information on Reintroducing FODMAPs here.

Low FODMAP recipes here.

We are offering very reduced rates for Skype consultations while we are travelling the world. For more information and for contacting R&MDietetics you can enquire here or email info@rmdietetic.com

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Well now that we are at the end of the first week of following the low FODMAP diet I can see why some people find it very difficult to follow strictly. If you’re the sort of person who eats everything outside of the home the diet is really hard, there just isn’t enough non-wheat options always available (especially for a short lunch break!); let alone also then trying to find suitable low FODMAP foods from the small selection presented to you. We have had a busy week, meaning we have had plenty of opportunities to test out the difficulties of the diet – including a sunny bank holiday weekend involving lots of eating with friends. Here are some of the things we found out this week:

Eating Out

I had to grab some lunch in Pret a Manger last week and was limited to two choices of Salad, which when you are really hungry sometimes isn’t what you always fancy – and especially hard if you want to eat on the move (luckily I did have time to sit down). I fancied a soup but all the soups had onion or some other high fodmap veggie so I opted for the chicken salad, and only had to remove the pistachio nuts. It was actually really tasty and not having any carbs wasn’t a problem (if you did want these you were probably limited to a packet of crisps or popcorn). We relied on taking lunches into work, usually leftovers from the night before – which is probably the way forward when following this diet. I also ate out on 2 more occasions, one at restaurant with a very small selection of food and so opted for…yet again…a chicken salad – this one a little dry and boring so left feeling quite unsatisfied. Our usual Saturday morning trip for brunch was again a little difficult with limited wheat free options, however Fego’s ( www.fegocaffe.co.uk) did give us some amazing tasty steak and chicken salads which really hit the spot. Sharing a portion of chips also meant we could still be a bit more indulgent on the weekend.

Snacks

Nuts and suitable dried fruit have become my mainstay for snacking at the moment. I also tried the original 9bar (http://www.9bar.com/products/) which was great but at 222kcals per 40g it might put people off if they are trying to watch their weight. Having said that most of the calories are from seeds so definitely not wasted calories and it did seem to fill me up for a while. Eat natural bars are also wheat free and so long as you avoid the problem fruits…are a good snack on the go and available everywhere. Otherwise I have been snacking on fruit through the day such as grapes and strawberries.

Breakfast

This will be a blog post on its own soon, but this week we have been making our own cereal using oats, oatmeal, seeds, nuts, dried fruit, banana chips etc. We have also been making our porridge the night before, and having it cold in the morning mixed with fruit and soya yogurt. We have been trying a variety of gluten free breads, some of which are really great and perfect for weekend eggs on toast.

Mistakes

Yes even a dietitian screws up sometimes! We bought a grape juice fizzy drink in Pret which had a large percentage of apple juice…showing us reading labels for ALL new foods is so important. As far as trying new products go… It was probably a mistake trying Waitrose Love Life free from gluten bread which was really sweet and not particularly nice especially with eggs. We have been trying lots of gluten free breads and products already which definitely require their own blog post. Some are really great and make following the low FODMAP diet so much easier.

Main tip for the week

One of the best foods discovered this week was garlic infused oil which really does give a good flavour of garlic which we made a pesto with for our gluten free pasta, and was perfect (recipe to follow!)

Symptoms

We have both noticed a general reduction of symptoms, with more settled stomach in general after just one week. With having a break for one day, the return of these symptoms was noticeable that day and the next – shows sticking to it is worth it.

We are definitely getting used to the restrictions already and have found great products to replace with and so for the moment it is not feeling difficult. It feels that preparation is the key, and the difficulties are buying lunch or dinner on the go and eating at other peoples houses! We have got some really good low FODMAP recipes already which we will be sharing. Here goes week 2!

Want more information on the low FODMAP diet and IBS? Click here for the latest changes and important updates.

Good news! The first ever book dedicated to reintroducing FODMAPs is now available to purchase on Amazon Kindle. The book is titled ‘Re-challenging and Reintroducing FODMAPs – A self-help guide to the entire reintroduction phase of the low FODMAP diet’. Click on the logo for more details.