Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Reintroduction in Clinical Practice:...

The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (LFD) consists of 3 phases: restriction, reintroduction, and personalization. Despite the importance of the reintroduction phase, there are limited real-world data on its implementation. This study examined variations in registered dietitians' (RDs) practices during LFD reintroduction.

Cross-sectional national online surveys were conducted. One hundred forty-five RDs were recruited via professional networks, social media, and listservs. Survey questions assessed food dosage at initiation, progression, challenge doses, number of foods tested per subtype, and reintroduction duration.

Participants worked in private practice (50%) and academic hospitals (26%). Over half of RDs challenge 1 food per fermentable oligosaccharides, disaccharides, monosaccharides, and polyols group, while 37% use 2 or more. Reintroduction sequencing is typically collaborative (73%), though some RDs leave it to patients. In the absence of symptoms, most wait 1-3 days before increasing doses, while 20% wait over 4 days. When symptoms occur, challenge timing is adjusted based on severity, though 37% follow fixed intervals. Nearly, all RDs (98%) conduct reintroductions one-on-one, with 63% completing them within 1-2 months and 37% taking longer. While the reintroduction practices patterns were similar between academic and nonacademic settings, academic RDs met with patients less frequently during reintroduction phase but more likely to meet with patients after reintroduction compared to nonacademic RDs (P < .05 for both).

The variability in LFD reintroduction practices underscores the need for a standardized protocol. While most dietitians offer one-on-one sessions and follow-up care, inconsistencies in timing, frequency, and sequencing persist. Although shared decision-making is common, approaches to managing reactions and determining challenge timing vary, highlighting the need for clearer guidelines.