In my previous post, I talked about the important reasons why you shouldn't stay low FODMAP forever. In some cases, people may find they can't tolerate any quantity of any FODMAP groups when they try reintroducing them. If this happens to you, first please ensure you did the FODMAP reintroduction process properly. It's fairly common that patients come to me out of frustration when they feel they've failed all challenges, but in many cases it turns out they didn't quite get the process right in the first place.
If you did do reintroductions properly, consider checking with your doctor to ensure that you don't have Small Intestinal Bacterial Overgrowth (SIBO) or another underlying condition that's affecting your ability to tolerate FODMAPs. If you feel like you react to every FODMAP group in any portion or you have excess bloating very soon after eating, SIBO is a possibility and should be ruled out.
If you've done these things already, then check out these tips that may help improve your intestinal bacterial diversity and your nutritional status to keep you feeling your best!
Try to eat a wide variety of low FODMAP, high fiber foods including fruits, vegetables, whole grains, nuts and seeds. If tolerated, be sure to include low FODMAP amounts of canned legumes like chickpeas and lentils into your diet to receive the prebiotic benefits. Gradually increase high fiber foods if you aren't used to eating them because it will likely worsen symptoms if you drastically increase your fiber intake suddenly.
There is some evidence that lactose intolerance can be improved by eating small amounts of lactose at a time spread out throughout the day rather than eating large amounts at once. So it may be worth your while to try this and see if you can build up your tolerance.
Keep challenging high FODMAP foods every 3 months or so because tolerances can change over time. Just because you can't tolerate certain FODMAPs now doesn't mean you won't ever again so don't give up!
Small amounts of FODMAPs in your diet (especially those in the Oligosaccharides category) may be better for your health than none. So if you found during the reintroduction phase that you tolerated only a ¼ clove of garlic, by all means incorporate that small amount into your regular diet if you enjoy it.
Consider adding a prebiotic fiber supplement, such as partially hydrolyzed guar gum (PHGG) or acacia gum. There is some promising research on the role of PHGG on the management of IBS symptoms. As with any fiber supplement, I would recommend starting with a very small dose and working your way up slowly.
Discuss with your dietitian or doctor if adding a probiotic may be helpful to you and what brand he or she would recommend, if so.
Heal your relationship with food. Though it may sound silly, it's important to recognize that food isn't evil and that it's meant to be nourishing to our bodies and our souls. Many people with chronic digestive problems end up over-restricting so many foods for long periods of time, and as a result, they feel unwell, run down, and/or depressed because they can't enjoy any social activities related to food. If you're only eating a few of the same foods every day and feel afraid to eat, please know you aren't alone. But please also know how important it is that you get help from either a trained dietitian or a therapist. Be brave and seek out the support you need! You're worth it!