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

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

doi:10.1007/s10620-024-08457-y

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

Dig Dis Sci. 2024 Apr 25. doi: 10.1007/s10620-024-08457-y. Online ahead of print.

Authors

Egbert Clevers^{1

2}, Darren Launders³, Damian Helme³, Sanna Nybacka⁴, Stine Störsrud⁴, Maura Corsetti⁵, Lukas Van Oudenhove⁶, Magnus Simrén^{4

7}, Jan Tack^{4

6}

Affiliations

¹ SkyGazer Labs Ltd, Cambridge, UK. e.clevers@waddinxveen.nl.
² The Data Strategist, Duiven, the Netherlands. e.clevers@waddinxveen.nl.
³ SkyGazer Labs Ltd, Cambridge, UK.
⁴ Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁵ NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
⁶ Translational Research Centre for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.
⁷ Center for Functional GI and Motility Disorders, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.

PMID: 38662159
DOI: 10.1007/s10620-024-08457-y

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.