21 August 2017
Caffeine (usually in the form of coffee) is commonly implicated as a trigger of IBS symptoms. But does caffeine really play a role in triggering IBS symptoms and should you adjust your intake?
Studies that have investigated the proportion of people with IBS who implicate coffee with the onset of symptoms reveal that 26-40% identify coffee as a symptom trigger[1, 2]. Other studies have shown that up to one third of people with IBS experience a recurrence of symptoms (commonly diarrhoea) with the open reintroduction of caffeine (following symptom improvement on an elimination diet)[3-6]. While these findings are interesting, they are derived almost exclusively from observational studies, so cause and effect relationships (between caffeine intake and symptom inset) cannot be drawn. The studies also used ‘open challenges’ and thus failed to exclude the powerful placebo effect – that is, the response triggered by expectation, not by the treatment per se.
Assuming that caffeine plays a role in triggering IBS symptoms in some individuals, how might this occur? The effect of caffeine on gastrointestinal symptoms may be related to its effects on colonic motor activity. This was shown in a study which showed that coffee induced the need to defecate (poo) in nearly one third of healthy participants. These effects were observed after coffee, but not water. Another small study in healthy participants showed that coffee may increase gastrointestinal motility to a similar extent as a meal, and a greater extent than water and decaffeinated coffee. Gastrointestinal motility refers to movements of the digestive system and the transit of the contents within it.
On the basis of these anecdotal reports, observational findings and a few plausible mechanisms, patients have traditionally been advised to reduce caffeine intake to improve IBS symptom control. A number of clinical guidelines endorse this approach, recommending that caffeine intake be restricted (but not necessarily removed) if it is suspected to trigger symptoms[9, 10]. Others have suggested that the simulating effects of caffeine may be harnessed to promote laxation in patients with constipation predominant IBS, along with other diet and lifestyle changes to promote laxation, such as including breakfast, increasing fluid and soluble fibre intake and encouraging regular exercise. Either way, there is virtually no literature suggesting that manipulating caffeine intake improves IBS symptom control.
So should you change your caffeine intake to improve your IBS symptoms? Given the lack high quality evidence in this area, blanket recommendations about caffeine intake are certainly not warranted. Instead, work with your dietitian to determine whether your symptoms are related to your caffeine intake. If there appears to be a link, make sure that any change in your caffeine intake (up or down) is made in isolation so that any effects can be monitored and detected.
1.Simren, M., et al., Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion, 2001. 63(2): p. 108-15.
2.Monsbakken, K.W., P.O. Vandvik, and P.G. Farup, Perceived food intolerance in subjects with irritable bowel syndrome-- etiology, prevalence and consequences. Eur J Clin Nutr, 2006. 60(5): p. 667-72.
3.Jones, V.A., et al., Food intolerance: a major factor in the pathogenesis of irritable bowel syndrome. Lancet, 1982. 2(8308): p. 1115-7.
4.Nanda, R., et al., Food intolerance and the irritable bowel syndrome. Gut, 1989. 30(8): p. 1099-104.
5.Petitpierre, M., P. Gumowski, and J.P. Girard, Irritable bowel syndrome and hypersensitivity to food. Ann Allergy, 1985. 54(6): p. 538-40.
6.Heizer, W.D., S. Southern, and S. McGovern, The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc, 2009. 109(7): p. 1204-14.
7.Brown, S.R., P.A. Cann, and N.W. Read, Effect of coffee on distal colon function. Gut, 1990. 31(4): p. 450-3.
8.Rao, S.S., et al., Is coffee a colonic stimulant? Eur J Gastroenterol Hepatol, 1998. 10(2): p. 113-8.
9.McKenzie, Y.A., et al., British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet, 2016. 29(5): p. 549-75.
10.Hookway, C., et al., Irritable bowel syndrome in adults in primary care: summary of updated NICE guidance. BMJ, 2015. 350: p. h701.
11.Halmos, E.P., When the low FODMAP diet does not work. J Gastroenterol Hepatol, 2017. 32 Suppl 1: p. 69-72.12.Spencer, M., W.D. Chey, and S. Eswaran, Dietary Renaissance in IBS: Has Food Replaced Medications as a Primary Treatment Strategy? Curr Treat Options Gastroenterol, 2014.