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

Clevers, Egbert; Launders, Darren; Helme, Damian; Nybacka, Sanna; Störsrud, Stine; Corsetti, Maura; Van Oudenhove, Lukas; Simrén, Magnus; Tack, Jan

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.

Citation

Clevers, E., Launders, D., Helme, D., Nybacka, S., Störsrud, S., Corsetti, M., Van Oudenhove, L., Simrén, M., & Tack, J. (2024). Coffee, Alcohol, and Artificial Sweeteners Have Temporal Associations with Gastrointestinal Symptoms. Digestive Diseases and Sciences, 69, 2522-2529. https://doi.org/10.1007/s10620-024-08457-y

• Journal Article Type: Article
• Acceptance Date: May 15, 2024
• Online Publication Date: Apr 25, 2024
• Publication Date: 2024-07
• Deposit Date: Jun 13, 2024
• Publicly Available Date: Apr 26, 2025
• Journal: Digestive Diseases and Sciences
• Print ISSN: 0163-2116
• Electronic ISSN: 1573-2568
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 69
• Pages: 2522-2529
• DOI: https://doi.org/10.1007/s10620-024-08457-y
• Public URL: https://nottingham-repository.worktribe.com/output/36013201
• Publisher URL: https://link.springer.com/article/10.1007/s10620-024-08457-y
• Additional Information: This version of the article has been accepted for publication, after peer review (when applicable) but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at https://link.springer.com/article/10.1007/s10620-024-08457-y