Introduction to Low FODMAP Elimination and Reintroduction by

Introduction to Low
Elimination &
This booklet is a brief introduction to the low FODMAP diet elimination and challenge
(reintroduction) phases, produced by Casa de Sante, Inc. At Casa de Sante we make and sell
all natural low FODMAP Certified Developed by a physician scientist, Casa de Sante quality
low FODMAP products are all natural, vegan, gluten and diary free with no additives,
preservatives or fillers. Casa de Sante products are lab tested and certified FODMAP
friendly, so customers with IBS can eat with confidence. We offer delicious spice mixes,
salad dressings, stock, granolas, drinks, sauces, salsa and more.
Learn more or order at
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What to eat
Daily Guides
meal plans to
reviewed once
Challenge phase is
Before you start
What are FODMAPs
FODMAP Challenenge
Whats out
Gluten & FODMAPs
Symptoms time frame
Non FODMAP food
Dairy & FODMAPs
Manageing symptoms
Whats in
Challenege schedules
What to Eat
What’s in:
The following foods are low in FODMAPs. Consuming these will help you minimise the
FODMAPs in your diet. The meal plans and recipes in the free Casa de Sante app are lowFODMAP, but may include a few medium FODMAP foods that can be enjoyed in small
serve sizes (pay attention to serving limits) and watch for sensitivities as individual
tolerance can vary. If you are going to modify or change the meal plans or recipes, make
sure to select from these foods to stay on the low FODMAP diet.
Low FODMAP vegetables: alfalfa, bean sprouts, bamboo shoots, Asian greens (bok choy,
choy sum, gai lan, wombok), beetroot (up to 4 slices), broccoli, brussel sprouts (2- 4),
cabbage (chinese, red & green), capsicum/bell pepper/pepper – red, green, yellow,
carrot, celeriac & celery, chilli –red, green, choko (½ cup), corn (up to ½ cob), cucumber,
edamame, eggplant/aubergine, fennel – bulb & leaves, galangal & ginger, green beans,
kale, lettuce – all types, leek (green only), mushrooms: black fungi, shimeji, oyster,
canned champignon, okra, potato, parsnip, pumpkin (kent, japanese, kabocha squash),
radish, sauerkraut – red (3 tbsn.), white (1 tbsn.), seaweed (nori), silverbeet, snow Peas
( 5 pods), Spring onion/shallot (green only), squash, spinach, sweet potato (up to ½
cup), taro (up to ½ cup), tomatoes, turnip, water chestnut, yam, zucchini/courgette
Low FODMAP fruits: avocado (1-2 tbsp.), banana (firm), blueberries, carambola (dragon
fruit), clementine, coconut (up to 1 cup fresh, 4 tbsp. desiccated), cumquats, dates –
dried & fresh (limit 1-2), figs (limit to 1-2), grapefruit (up to ½), grapes (red &, green),
guava, honeydew melon (up to ½ cup), jackfruit, kiwifruit, lemon, lime, mandarin,
orange, passion fruit, pineapple, pomegranate, prickly pear, rambutan (1-2), raspberries,
rhubarb, rock melon/cantaloupe (up to ½ cup), star fruit, strawberries, tamarind
Low FODMAP nuts, seeds & legumes: all nuts and seeds, excluding pistachios and
cashews. Almonds and hazelnuts need to be limited to 10 or less per serve, canned chick
peas (¼ cup drained), canned butter beans (¼ cup drained), canned lentils (½ cup
drained), firm tofu
Gluten free grains: quinoa, all rice, buckwheat, teff, millet, rice based pasta, buckwheat
noodles, rolled oats (½ cup/60g serve), polenta
Gluten containing foods: soy sauce (2 tbsp per serve), 1 slice wheat bread, ½ cup wheat
pasta, 2 slices spelt or wheat sourdough bread, 2 dry crackers
Meat, poultry & fish: fresh cuts of meat, poultry and fish are low FODMAP. Be sure to
check seasonings or marinades for high FODMAP ingredients e.g. onion, garlic
Eggs: all eggs are low FODMAP
Dairy and dairy alternatives: Lactose free milk, yoghurt and ice cream (check for added
high FODMAP ingredients e.g. fruit flavours, inulin), traditional Greek yoghurt, all set or
firm cheese (cheddar, American, brie, blue, camembert), coconut milk (1/3 cup), pea
milk, almond milk, rice milk, quinoa milk, hemp milk
Oils & vinegars: apple cider vinegar, white, wine, red wine, balsamic vinegar, all oils are
Herbs and spices: all herbs and spices are low FODMAP, avoid blends that include onion
or garlic
Sweeteners: pure maple syrup, table sugar, stevia, glucose syrup, dextrose, invert sugar,
rice malt syrup
Alcohol: red and white wine in small serves (avoid sticky or sweet wine), beer in small
serves, spirits in small serves note: alcohol is a gut irritant in large serves
Non-alcoholic drinks: Casa de Sante LemonAID, water, tea, coffee (in small serves),
small serves of orange or cranberry juice ( ½ cup/4 oz)
What’s out:
Alcohol: rum, sticky or sweet wines, note: alcohol is a gut irritant in large serves
Drinks: soft drinks, large serves of coffee & tea, most fruit juice, kombucha
High FODMAP grains: Barley, rye, large serves of wheat bread, flour and pasta,
cereals with high FODMAP ingredients e.g. dried fruit, honey, kamut, bran, farina,
couscous, wheat flour
Processed and packaged foods: Most contain high FODMAP ingredients. Unless a
product is certified low FODMAP, you will need to check the ingredients list
High FODMAP vegetables: asparagus, artichoke – globe, Jerusalem, bitter melon,
blackberries, cauliflower, garlic, karela, leek - white part, onion – shallots, brown,
red, white, peas (frozen), mushrooms, spring onion – white part, yucca root
High FODMAP fruit: Apple, apricot (fresh and dried), banana – ripe, blackberries &
boysenberries, cherries, custard apple, feijoa, mango, nectarine, peach, pear,
persimmon, sugar banana, tamarillo, watermelon
Nuts, seeds & legumes: Cashews & pistachio nuts, baked beans, black beans, borlotti
beans, broad beans, cannellini beans, fava beans, four bean mix, garbanzo beans,
haricot beans, navy beans, soy beans, silken tofu
Dairy & alternatives: cows, sheep & goat milk, soy milk made form soy beans, large serves
of oat or coconut milk, kefir
Sweeteners: high fructose corn syrup, agave, erythritol (e968), fruit juice concentrate,
honey – all types, isomalt (e953), mannitol (e421), maltilol (e965), sorbitol (e420),
treacle, xylitol (e967)
Processed, packaged foods, sweet, candy, chocolate: many contain high FODMAP
ingredients. Unless low FODMAP certified, Ingredients list will need to be assessed
on an individual basis.
Non-FODMAP trigger foods
Even though they are low FODMAP, certain foods and drinks can be gut irritants. If
you have IBS, it is best to limit these to small serves and eat/drink them slowly and
Non-FODMAP food triggers include:
 Alcohol
 Caffeine
Spicy food
Rich & fatty foods
Large amounts of overly sweet foods
Carbonated soft drinks
Too much fibre, too little fibre or the wrong types of fibre
Other Non- FODMAP triggers include:
 Stress & anxiety
 Eating too fast
 Certain medications or supplements
Daily Guides
To assess meal plans and recipes as soon as Challenge section is completed
Before you Start
1. What are FODMAPs?
FODMAP is an acronym for groups of short chain carbohydrate or
“sugar” molecules that may be poorly digested in the small intestine.
They continue their path along the digestive tract to the large intestine,
or colon, where they become fast food for the healthy bacteria that live
As FODMAP pass through the digestive tract, two events occur which
may cause IBS type symptoms such as gas, bloating, abdominal pain or
alter bowel habits (constipation and/or diarrhoea).
1. FODMAPs are osmotic – they attract water and draw water into
the digestive tract. This extra fluid causes matter to move more
quickly along the digestive tract and may also cause watery stool
or diarrhoea
2. FODMAPs are fermented in the Large intestine by the healthy
bacteria that live there. When these healthy bacteria consume
FODMAPs, they create gas as a side effect. This results in gas
which swells the large intestine creating a feeling of bloating and
irritating the nerve endings around the bowel.
Carbohydrate molecules that are fermented in the
bowel creating gas as a side effect
Short chains of sugar molecules found commonly in
wheat, asparagus, barley, rye, onion, garlic, some nuts
and legumes, watermelon, artichoke
The double sugar - Lactose in milk and milk products
Fructose in excess of glucose found in honey, apples,
pears, agave, mango, high fructose corn syrup
Sugar alcohols, sorbitol and mannitol, found in
mushrooms, cauliflower, stone fruit, artificially
sweetened gums and nutrition bars
The low FODMAP diet is not a forever diet. It is instead designed to be used as a tool to
identify the sorts of foods that trigger IBS symptoms in each individual. These trigger
foods will vary from person to person, to know your individual triggers it is necessary to
move though the three phases of the low FODMAP diet:
 Phase 1: The low FODMAP phase. All high FODMAP foods are removed from
your diet for a period of 2-6 weeks. The aim of this phase is to determine if
removing FODMAPs makes a consistent improvement in your IBS symptoms.
 Phase 2: The Re-Challenge (reintroduction phase). Each FODMAP group is
challenge is a structured and systematic way to determine if it is problematic or
not and what amount of the FODMAP can be tolerated at any one time.
 Phase 3: Adapted low FODMAP diet. This phase of the low FODMAP diet is
where you use the information gathered during the Re-Challenge phase to
expand your diet as much as possible while still keeping IBS symptoms well
2. Gluten and FODMAPs
Gluten is the protein in found in wheat, barley and rye. FODMAPs are the
carbohydrate found in wheat, barley, rye, milk, sweeteners, certain fruits and
vegetables, nuts and legumes. These are different molecules that are commonly
found in the same foods.
Celiac Disease, when they eat gluten containing foods an abnormal response occurs
which results in damage to the lining of the small bowel. This has serious
consequences and may result in serious long term health problems. People with
celiac disease may have similar symptoms to those with IBS or no symptoms at all.
Currently the only treatment for celiac disease is a strict gluten free diet for life
including care with cross contamination.
IBS does not cause damage to the bowel, although it can cause rather “unfriendly”
symptoms that impact on a person’s quality of life. Since the bowel remains healthy,
the treatment for IBS to avoid trigger foods only to the level necessary to keep
symptoms settled at a tolerable level. In the case of IBS, it is most likely the
FODMAPs (or carbohydrate) in wheat products that are the culprit.
Not all gluten containing products are high FODMAP and some gluten is allowed on
the low FODMAP diet.
Similarly, not all gluten free products are low FODMAP and when choosing gluten
free foods you will also need to check for the presence of high FODMAP ingredients.
Low FODMAP foods that contain gluten:
 1 slice serve of wheat bread
 ½ cup serve of wheat pasta
 2 slice serve of wheat or spelt sourdough bread
 2 tablespoon serve of soy sauce
Gluten free foods that are high FODMAP:
 Besan/chick pea flour, coconut flour, lupin flour, soy flour
 Inulin/chicory root
 Certain fruits and vegetables including onion, garlic, apple
 Certain nuts and legumes
 Honey, agave
 Dried fruit
3. Dairy and FODMAPs
Lactose is a di-saccharide” and the “D” in the FODMAP equation. It is a double sugar
molecule made of glucose and galactose, found naturally in milk and milk products.
When the glucose and the galactose are bound together, they form lactose. To
digest lactose, the glucose and galactose must be separated to single sugar
molecules by an enzyme, called Lactase, that lives in the lining of the digestive tract.
Once they are separated, they are easily digested and absorbed. If an individual has
got low numbers of the Lactose enzyme, they will not be able to separate the
lactose, and it will remain in the digestive tract undigested. Like all FODMAPs, as
lactose moves through the digestive tract it can cause IBS type symptoms such as
pain, bloating, wind and altered bowel habits (constipation and/or diarrhoea)
Lactase enzyme can be added to milk and milk products prior to eating or drinking
(e.g. lactose free milk or ice cream). This can be done during manufacturer (i.e. in
lactose free milk) or purchased from a drug store in tablet form and taken with a
food that contains lactose. This is very effective, but be sure to check the
ingredients, some lactase tablets can contain other high FODMAP ingredients e.g.
Dairy foods that are allowed on the low FODMAP diet include:
 Some dairy products e.g. cheese do not naturally contain lactose and can be
consumed as normal on a low FODMAP diet. This includes all hard or set
cheeses i.e. Cheddar, parmesan, harvati, swiss, tasty, edam, camembert, brie,
all blue cheese, red leister, mozzarella, fetta, bocconcini
 Wet or fresh cheeses still contain small amounts of lactose and can be eaten
in small serves i.e. ricotta, cottage cheese, cream cheese, haloumi
 Milk and white chocolate also contain some lactose, and is best limited to
small serves on a low FODMAP diet.
 Greek yoghurt that has been made in the traditional way, is strained and
most of the lactose is discarded. This means Greek yoghurt can be enjoyed in
small amounts on a low FODMAP diet.
 Lactose free milk, sour cream custard, yoghurt, ice cream.
Nb: be sure to check lactose free products such as yoghurts, ice creams,
flavoured milks, for high FODMAP flavours or thickeners. These may include
high FODMAP sweeteners (fruit juices, honey, polyols), high FODMAP fruit
flavours (mango, pear) or high FODMAP thickeners (inulin, chicory root).
 Butter
Lactase containing products that require the addition of lactase include:
 All mammalian milks e.g. cow, sheep, goat
 Regular yoghurt
 Regular ice cream
 Regular sour cream
 Regular custard
 Whey powder/whey concentrate
 Kefir
 Evaporated and condensed milk
There are many alternative and plant based milks available in stores today. While
these are lactose free, they may be high FODMAP for other reasons. If you choose to
switch to a plant based milk, it is important to choose one that is nutritionally similar
to cow’s milk so as to ensure you meet calcium and protein requirements. We
suggest looking for an option with about 120mg/100ml or 30-35% calcium.
Low FODMAP plant based milks include:
 Soy milk made with soy protein
 Almond milk
 Pea milk
 Rice milk
 Hemp milk
 Other nut milks
High FODMAP plant based milks include:
 Coconut milk over ½ cup (4oz)
Oat milk or over ½ cup (4oz)
Soy milk made with soy beans
Plant milk with high FODMAP ingredients e.g. high FODMAP fruit flavours,
inulin, added fructose
Lactose and medications:
Lactose can sometimes be added as a filler in medications. This is only used in small
amounts and well below the cut off for lactose, so not considered a concern on a low
FODMAP diet.
Challenging (Reintroduction)
1. FODMAP Rechallenge Phase
Phase 2 of the low FODMAP diet involves Re-Challenging each FODMAP group to
assess for personal tolerance. This will provide you with the information you need to
Reintroduce FODMAPs into your diet into your diet and allow as much variety as
possible while still maintaining good symptoms management.
Similar to the elimination phase, you will continue to consume low FODMAP foods;
however, each week you will “Re-Challenge” a different FODMAP group in increasing
portion sizes to assess how your body responds. The portion size you tolerate, can
then be used to guide your reintroduction.
The following points are designed to help guide you through this phase:
 This process is meant to be done slowly and systematically. You will try a
new FODMAP group each week, Re-Challenging a food item specific to a
particular FODMAP group in increasing amounts (per tolerance).
 This phase is about testing your tolerance to each FODMAP group, so that
you can use this information and apply it to a variety of different foods.
Foods need to be chosen carefully to only include one FODMAP group.
 You can do challenges in any order, choosing one of the following to start
with: Oligosaccharides (Fructans and GOS), Disaccharides (lactose),
Monosaccharides (excess fructose), Polyols (sorbitol and mannitol)
 A key point to remember is that you want to only try one FODMAP type at a
time. For example, if you are Challenging dairy (lactose), then you will want
to try plain milk, not a milk product that contains other added FODMAP e.g.
high-fructose corn syrup.
 Begin with a small portion and advance each day if you experience mild
symptoms or no symptoms at all.
 Be sure to document which foods you have tried, how much, and associated
symptoms (if any).
 If the symptoms you experience are severe, then wait until your symptoms
resolve and try a different food item from the same FODMAP group or wait
until the end of the washout period to try a different FODMAP group.
 If you experience symptoms, return to the baseline low FODMAP diet. You
can also use other strategies that help to manage symptoms at this time,
such as peppermint tablets, hot packs relaxation techniques and so on.
Remember that you will want to continue to eat low FODMAP foods as you were
doing in the elimination phase, and not try anything new at this time.
2. IBS Symptom time frame
High FODMAP foods often cause symptoms in those with IBS within 6-24 hours. This
is the amount of time it takes for food you’ve eaten to reach the large intestines
where fermentation occurs. Symptoms occurring outside of this time frame may
indicate a different mode of action and we suggest talking to a specialist registered
Common symptoms associated with high FODMAP food/beverage intake include:
abdominal pain, distention, bloating, flatulence, cramping, diarrhea, and
constipation. The length of time symptoms persist is variable. Some individuals
experience resolution of symptoms within hours, some within 1-2 days.
3. Managing Symptoms
At some point during the challenge phase, it’s likely that you will experience some
sort of gut symptoms. There will also be times in the future that you overindulge or
come into contact with one of your bigger FODMAP triggers. This is not something to
feel bad about (no one can be strict all the time) and reactions to food can also be
inconsistent. Having a plan to manage this makes it less daunting and helps
symptoms to pass more quickly.
Revert to the low FODMAP Elimination diet
Stick with simple low FODMAP foods that you know are well tolerated.
Avoid high fat foods, rich or spicy foods, coffee, soft drinks and alcohol
Use behavioural techniques
Rest, meditation and mindfulness are all great ways to help realign the gutbrain axis
Fresh air & gentle exercise can help you feel better
Hot packs, hot baths or a gentle tummy massage are great for bloating
Treat your symptoms
Your healthcare professional may recommend suitable counter medications
like laxatives, anti-diarrhoea medications or anti-spasmodic
Casa de Sante LemonAID is great for calming the gut
Peppermint oil, peppermint tea & ginger may help with bloating and a queasy
Soluble fibre supplements (e.g. Metamucil® or Regular Girl® (PHGG) can
improve stool form
Stay hydrated by drinking plenty of water
4. Challenge Schedules
Foods suitable for Challenging FODMAPs
The food listed in the table below only contain one FODMAP group and are suitable to use
for Challenging. Using these foods will tell you how you tolerate each FODMAP group and
the information can be applied to other foods which contain multiple FODMAP groups
Foods for Challenging Lactose
Cow’s milk
Evaporated milk, canned
Goat milk
Sheep milk
Ice cream
Regular yoghurt (no high FODMAP
ingredients e.g. fruit, honey, inulin)
Foods for Challenging Excess Fructose
Artichoke hearts
Sugar Snap peas
Foods for Challenging Fructans (4
challenges needed)
 Wheat bread
 Pasta
 Bran
 Couscous
Fructan fruit:
 Leek (white part)
 Globe artichoke
 Grapefruit
 Persimmon
Foods for Challenging GOS
Foods for Challenging Mannitol
Foods for Challenging Sorbitol
Butter Beans
Chick Peas
Black beans
Soy bean milk
Mushrooms (Portobello, shitake, enoki
or porcini)
Yellow Nectarine
Sugar free mints
Green beans
It is recommended that you follow the proceeding schedule when challenging a
particular FODMAP group. Remember: You will only test ONE FODMAP group per
week, followed by a three day washout. If you experience moderate/severe symptoms
at any time you can discontinue Challenge and wait for your symptoms to resolve.
When you feel well again you can challenge a different food from the same group or
complete the washout period by returning to the Elimination diet prior to moving on
to the next challenge.
Day 1
Day 2
Re-Challenge Schedule
Challenge Day #1 Symptoms are mild or no symptoms present: Proceed
to day #2
Symptoms are moderate/severe: Do not advance to
proceeding day.
When symptoms resolve, try a different food from
the same FODMAP group or commence the four day
washout before moving on to the next FODMAP
Challenge Day #2 Symptoms are mild or no symptoms present: Proceed
Medium FODMAP to day #2
Symptoms are moderate/severe: Do not advance to
proceeding day.
When symptoms resolve, try a different food from
the same FODMAP group or commence the four day
washout before moving on to the next FODMAP
Day 3
Challenge Day #3
Day 4
Washout Period
Day 5
Washout Period
Day 6
Washout Period
Day 7
Symptoms are mild or no symptoms present: Proceed
to day #2
Symptoms are moderate/severe: Do not advance to
proceeding day.
When symptoms resolve, try a different food from
the same FODMAP group or commence the four day
washout before moving on to the next FODMAP
Remove the challenge food and maintain low
FODMAP intake for the duration of the washout
period even if a FODMAP group was successfully
Remove the challenge food and maintain low
FODMAP intake for the duration of the washout
period even if a FODMAP group was successfully
Remove the challenge food and maintain low
FODMAP intake for the duration of the washout
period even if a FODMAP group was successfully
Maintain low FODMAP diet in preparation for the
next Challenge. Do not introduce high FODMAP foods
even if they were successfully challenged previously.
It is recommended that you Re-Challenge the following food items which represent a
specific FODMAP group. You will also find various portion sizes that correspond to
days 1-3. Day #1 of reintroduction will always be a small portion to assess overall
tolerance of the FODMAP group being reintroduced. If Day #1 is tolerated well (mild
or no symptoms), you are encouraged to proceed to day #2 (medium portion) and, if
day #2 doesn’t cause moderate/severe symptoms, eventually to Day #3 (large
If you experience symptoms: You can stop the challenge at any time
that you experience moderate or severe symptoms. Remove the test
food from your diet and wait until the symptoms go away.
If you do not experience symptoms:
If you complete the full challenge
without experiencing symptoms, congratulations! You still need to
remove the test food form your diet and complete the washout phase
prior to commencing the next challenge.
Recommended FODMAP Foods to Challenge
Day (#)
Portion Size
Food Item
Day #1
125 mL
Oligos - Wheat
Oligos - Onion
Oligos - Garlic
Oligos - fruit
Polyols - Sorbitol
Polyols - Mannitol
Day #2
Day #3
Day #1
Day #2
Day #3
Day #1
Day #2
Day #3
Day #1
Day #2
Day #3
Day #1
Day #2
Day #3
Day #1
Day #2
Day #3
Day #1
Day #2
Day #3
Day #1
Day #2
Day #3
Day #1
Day #2
Day #3
250 mL
375 mL
1 Tsp
1 Tbsp
2 Tbsp
1 Slice
2 Slices
3 Slices
1 tablespoon
2 tablespoons
3 tablespoons
½ teaspoon
1 teaspoon
1½ teaspoons
1 tablespoon
2 tablespoons
3 tablespoons
15 Pieces
20 Pieces
30 Pieces
5 pieces
10 pieces
15 pieces
¼ cup
½ cup
1 cup
By taking your time to determine which FODMAP groups induce symptoms, and
which do not, will enhance the variety of your diet tremendously. However,
individual responses to FODMAP reintroductions vary widely. There are few that
may be able to reintroduce all FODMAP groups in large serves, and there are some
who may only tolerate small serves of most FODMAP groups. If you find that you do
not tolerate any of the FODMAP groups upon Re-Challenging, consult with your
healthcare professional to discuss other possible underlying causes for your
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