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. 2024 Jul;69(7):2522-2529.
doi: 10.1007/s10620-024-08457-y. Epub 2024 Apr 25.

Coffee, Alcohol, and Artificial Sweeteners Have Temporal Associations with Gastrointestinal Symptoms

Egbert Clevers  1   2 , Darren Launders  3 , Damian Helme  3 , Sanna Nybacka  4 , Stine Störsrud  4 , Maura Corsetti  5 , Lukas Van Oudenhove  6 , Magnus Simrén  4   7 , Jan Tack  4   6
Affiliations

Coffee, Alcohol, and Artificial Sweeteners Have Temporal Associations with Gastrointestinal Symptoms

Egbert Clevers et al. Dig Dis Sci. 2024 Jul.

Abstract

Background: Various dietary strategies for managing irritable bowel syndrome (IBS) target mechanisms such as brain-gut interactions, osmotic actions, microbial gas production, and local immune activity. These pathophysiological mechanisms are diverse, making it unclear which foods trigger IBS symptoms for a substantial proportion of patients.

Aim: To identify associations between foods and gastrointestinal symptoms.

Methods: From the mySymptoms smartphone app, we collected anonymized diaries of food intake and symptoms (abdominal pain, diarrhea, bloating, and gas). We selected diaries that were at least 3 weeks long. The diaries were analyzed for food-symptom associations using a proprietary algorithm. As the participants were anonymous, we conducted an app-wide user survey to identify IBS diagnoses according to Rome IV criteria.

Results: A total of 9,710 food symptom diaries that met the quality criteria were collected. Of the survey respondents, 70% had IBS according to Rome IV criteria. Generally, strong associations existed for caffeinated coffee (diarrhea, 1-2 h postprandial), alcoholic beverages (multiple symptoms, 4-72 h postprandial), and artificial sweeteners (multiple symptoms, 24-72 h postprandial). Histamine-rich food intake was associated with abdominal pain and diarrhea. Some associations are in line with existing literature, whilst the absence of an enriched FODMAP-symptom association contrasts with current knowledge.

Conclusions: Coffee, alcohol, and artificial sweeteners were associated with GI symptoms in this large IBS-predominant sample. Symptom onset is often within 2 h postprandial, but some foods were associated with a delayed response, possibly an important consideration in implementing dietary recommendations. Clinical trials must test the causality of the demonstrated food-symptom associations.

Keywords: Artificial Sweeteners; Coffee; Diary; Food; Irritable Bowel Syndrome; Symptoms.

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