Graded Food Exposure Tip Sheet

What is graded food exposure?

• Your doctor or dietitian may have suggested graded food exposure to help you improve your diet and food tolerance.
• This method involves reintroducing foods slowly and in very small amounts, especially if you have had severe gut symptoms or have concerns about trying certain foods.
• Graded food exposure is a well-used and researched technique that we have found useful with many patients.
• There are two main goals that focus on balancing your nutrition needs with a ‘food first’ approach;

1. Improve both the variety and quantity of foods you can enjoy, and
2. Help your gut and brain relearn that food may not always cause symptoms that concern you

How does it work?

• You start with a tiny or “insignificant” amount of a food (for example, one pea, one blueberry, or one bite of biscuit).
• After eating, you notice how your body reacts.
• Over time, and with repeated exposure, the gut can become less sensitive, and your fear and symptoms may reduce.
• This is a gradual process. At first, progress may feel slow, but many people find it “snowballs” – improvements start to happen more quickly as your confidence and tolerance grow.

Why is this important?

• It is a long-term strategy for managing gut symptoms linked to eating.
• It helps break the cycle of avoidance and fear, which activates our brain’s threat response to food and often leads to over-restriction of foods.
• The method creates new learning for your gut and brain, so that foods which once triggered symptoms can often be tolerated again.

Getting Started: Practical Tips

1. Choosing a Starting Portion

• Use the portion guide (see table below; How Fast Should I Progress?) to decide where to start.
• Your starting point depends on how sensitive you feel.
• Remember: the first exposure itself is the treatment. Even a crumb or a sip is enough to begin retraining your gut and brain.
• “Start low, go slow” – Start small and increase gradually, the key is increasing as your body adapts.

2. Expect Some Symptoms at First

• At the beginning, you may notice symptoms after eating even a tiny amount.
• This happens because the gut can be hypersensitive (called visceral hypersensitivity).
• Repeated exposure usually helps desensitise the gut over time, so symptoms reduce over time in most people who can commit to graded food exposure.

3. When to Do Food Challenges

• Many people test foods daily, but you can also try every second day or once a week.
• Choose times that feel practical and safe for you. For example, you might start on weekends rather than workdays.
• As you become more confident, try challenging foods in different settings (e.g., home, work, social situations).
• Ideally, test the food with a typical meal, though this may not suit all foods.
• The aim is to slowly increase the amount until you reach a suitable portion, or until you find a level that triggers severe symptoms (at which point you pause increasing).

4. After a Successful Challenge

• Once you can tolerate a certain portion, keep that food and portion in your regular diet to maintain your progress.
• Then, move on to another food challenge.
• Be patient – slow and steady progress prevents setbacks.

Personalising Your Goals

• There can be many different goals when using graded food exposure, such as improving meal patterns, increasing range of foods and increasing the quantity of food eaten. Here are some tips for each of those goals.

Improve meal patterns

• Use the graded food exposure method to follow a regular meal pattern
• To avoid skipping meals; For example, if you typically skip breakfast, you can start a new breakfast routine with one bite of biscuit or a teaspoon of yoghurt and build up slowly.

Increase food variety or portion sizes

• Use graded exposure to try new foods or larger amounts of foods that previously caused symptoms.
• For increasing food variety; choose a food you wish to bring back into the diet and follow the tips above to grade your exposure and test tolerance
• You can choose any food or food product; but do not choose a food that really concerns you at first, instead try some other foods that are less concerning but you have been avoiding
• Texture may matter:
  • Sometimes you may find starting with softer (e.g. mashed) or liquid forms (e.g., smoothies, soups) of food helps with tolerating the food.
  • See the patient information sheet below that provides more details on modifying the texture of foods and providing some practical options.
  • Dietary Management of Functional Dyspepsia and Nausea and Vomiting Disorders including Gastroparesis – See the tips section on adjusting food texture.
  • As tolerance improves, gradually move to firmer textures.

How Fast Should I Progress?

Everyone is different. The table below shows example progression plans based on gut sensitivity. Similar plans have helped many people with gut sensitivities overcome the cycle of food avoidance and unpleasant worrying about eating and not eating.

Key Points to Remember

• The goal is progress, not perfection.
• Tiny steps count. Even tasting a food is success.
• Patience is key: going too fast can cause setbacks.
• Celebrate each milestone – every small success builds your confidence and tolerance.

Where can I get more information?

Please contact your Doctor or Dietitian should you require further information.

Contact Details

If you have a physical copy of this page, please fill out your Dietitian's name below.

Name of Dietitian:

Address: Department of Nutrition and Dietetics, 3rd Floor East, 250 Euston Road, London, NW1 2PG

Direct line: 0203 447 9289

Switchboard: 0845 155 5000

Extension: 79289

Fax: 0203 447 9811

Email: uclh.dietitiansdept@nhs.net

Website: www.uclh.nhs.uk