How Long Should You Stay on the Low FODMAP Diet

Low FODMAP results: how long does it take?

Hi, this is Dr. Ruscio, DC.

• How long do you need to stay on the low FODMAP diet?
• Do you need to be on it forever? No.
• Can you realize all of the improvements from the low FODMAP diet and just a couple of weeks? Probably not.

Low-FODMAP is an elimination diet that removes high FODMAP foods that trigger abdominal pain, bloating, diarrhea and constipation, and other digestive symptoms from irritable bowel syndrome (IBS), SIBO, and other digestive complaints. During the FODMAP elimination phase, you remove high FODMAP foods for 4-6 weeks. Once your digestive symptoms subside, you add high FODMAP foods back into your diet during the FODMAP reintroduction phase.

Low-FODMAP Results: How Long Does it Take?

Here’s what I would recommend. At the two to three week mark, you should be able to tell, yes or no, the low FODMAP diet is helping. Maybe all your digestive symptoms haven’t been resolved, but they’re clearly inching you in the right direction.

The next step is what tends to elude many people: how long should they stay on the low FODMAP diet. What you should really aim for is to stay on the low FODMAP diet until you’ve seen a peak level of improvement. Then wait—at least in my opinion—one-to-two months before you undergo a robust FODMAP reintroduction. People will vary slightly within how quickly they can successfully reintroduce foods.

Low-FODMAP Diet Before and After: Mona’s Story with Chronic Acid Reflux

Let me share Mona’s story about her FODMAP experience, which is one of the recent case studies we recently published. Mona had chronic acid reflux. She had seen a number of doctors and no one was really able to help her until she came into the clinic. We used a couple simple supports: A low FODMAP diet paired with probiotics. This led to a strong response with her reflux. She didn’t know she had a FODMAP intolerance.

There’s a detail here that’s really important. She went from chronic, daily, multiple-times-per-day bouts of reflux to what appeared to be only one or two bouts per week which were only induced by FODMAP foods. She was very happy with that response. However, once she became acclimated to that improvement, she got frustrated and she said, “I feel like this isn’t working.” People very quickly—and rightfully so—get acclimated to their new level of improvements. And if they’re not perfect, they complain that they’re not yet perfect, which again, is totally understandable. But the point that you don’t want to miss is to mistake not being perfect with things not working.

What Mona noticed is she had to maintain the low FODMAP diet (which was a little bit annoying to her admittedly, because there’s many foods that one has to cut out) and her probiotics for a couple months until she could successfully do FODMAP reintroduction. During those couple of months, she expressed frustration that she couldn’t have garlic or avocado, or other high FODMAP foods, without flaring her acid reflux. I kept telling her, “You’re much better than you were. Let’s give your body time, and we should see your ability to tolerate high FODMAP foods increase in the future.” What do you know? At about the second or third month, she was very happy that she was able to have a lot of “bad” food over the holidays. She specifically noted eating a full avocado and she had no acid reflux.

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Low FODMAP Transformation: Give it Time to Work

It’s very important that if something is working, you maintain that plan and you give it ample time. On the other side of the coin, we don’t want to be doing things for eight months, 12 months, or two years without any additional benefit. That’s being too patient. But it’s not abnormal to see a fairly large jump in digestive symptom improvements during the first four-to-six weeks. Then the rate of improvement slows, or even plateaus. This happens because—especially with things like the low FODMAP diet and probiotics—you’re modulating some of the bacterial colonies in your gut, which can take time.

Further yet still—this is a bit more of a presumption, but there’s some preliminary evidence to support this—that the bacteria impacts the way your immune system functions and reacts. We’ve seen this with leaky gut studies and inflammatory cytokine studies that do show these interventions impact these mechanisms which are immune mediated. This response may take longer to be attenuated and calmed down. You want to see initial improvements, yes, but then give your body some time on your plan before you try to do a FODMAP reintroduction. That increases the probability that you’ll be able to undergo the FODMAP reintroduction successfully. So remember, if you’re making dietary changes, you will likely see some pronounced improvements at the start and then a slowing in terms of the rate of response. Don’t let that fool you into changing what you’re doing, jumping ship or complicating matters. If something that you’re doing is working, give it time. Realize that for some of these finer points to correct, especially if they are immune or inflammatory in nature, it may take some time, a couple months, for them to be subdued. Once you get over that transitional hump, then you’re in a good position to try your FODMAP reintroductions.

How Long to Use the Low-FODMAP Diet: Summary

I share this to help protect you from rushing off to other stuff if you have a plan that seems to be working. In Mona’s case with chronic acid reflux, she saw some very pronounced improvements within the first four-to-six weeks. Then she needed to maintain that plan for two-to-three months before she could successfully do FODMAP reintroductions. She did need to do additional therapies, which is the key point here I’m hoping that you don’t miss.

So be a little bit patient, but don’t be a lot patient. Don’t expect it to take years, but DO give your body some time, a few months in this case, before you try FODMAP reintroductions. If it works, fantastic. If it doesn’t work, look to Healthy Gut, Healthy You, which lays out a litany of steps to help you on your gut health journey. This is Dr. Ruscio, DC, and I hope this helps you get healthy and get back to your life.