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A “gut-brain mis-interaction”—that’s how gastroenterologist Michelle Cohen, MD, refers to irritable bowel syndrome (IBS), a condition experienced by five to 15% of the global population, and much of her own medical practice.
“We evaluate the different sub-types of IBS—diarrhea, constipation, and mixed pattern—and try to look at it in terms of whether a patient is experiencing the condition mildly, moderately, or severely, and how much it impacts their quality of life,” explains Dr. Cohen, Assistant Professor of Clinical Medicine in the Division of Gastroenterology and Hepatology at Weill Cornell Medicine (WCM).
Based on a detailed medical history and limited test workup, gastroenterologists can diagnose the condition and help patients manage it by creating an individualized treatment approach.
Medication can be of limited use for some IBS patients, so diet is an effective way to start addressing IBS.
“The response rate for medications for IBS is not crazy high and can sometimes cause only a modest improvement in symptoms,” Dr. Cohen says. “That tells us we need to look at other things at play.”
For patients with less severe cases of IBS, diet can sometimes be enough to improve symptoms. But even dietary changes have to be customized based on the patient.
“The puzzle picture of IBS is the same from one patient to the next, but everyone’s puzzle pieces are different,” Dr. Cohen says. “But we know there is some response to diet—it can be a key player in managing symptoms for patients with a mild case of IBS.”
One of the go-to diets for patients with IBS-D (diarrhea) is called the low FODMAP diet, which can be used to help patients identify which foods trigger their symptoms. The diet is an attempt to limit foods that may cause gas and bloating, namely, fructose, lactose, fructans, galactans, and polyols.
“Certain foods definitely promote diarrhea, and some patients have food intolerances that get tied into IBS symptoms,” Dr. Cohen says.
Constipated patients, she adds, may see results by balancing the different fibers the ingest and making modifications to the low FODMAP diet.
“Other dietary tweaks like lowering fat and caffeine intake can be helpful,” Dr. Cohen says.
WCM dietitians and nutritionists can be an important resource for IBS patients.
“We know some patients need a lot of dietary help, and it’s useful to find their specific triggers,” Dr. Cohen says. “They sit with patients and go through their diets to talk about what works and what doesn’t work.”
It’s also an effective way to individualize care.
“Adjusting a patient’s diet is not a one-size fits-all approach,” Dr. Cohen adds. “Sometimes adjusting diet is enough for a patient to experience relief, and sometimes it’s just one way to help treat the overall condition.”