3. Increasing the stress response
Caffeine is problematic for IBS sufferers who experience stress or anxiety since this tends to create a spasmodic effect on the gut, which may be worsened by caffeine. Caffeine can also increase heart rate and the stress response, causing further symptoms. Since stress is known to worsen IBS symptoms, caffeine may contribute to an IBS stress-symptom cycle.
4. Coffee contains Salicylates
Coffee contains a type of chemical compound called salicylates, which occur naturally in many foods and also produced artificially in products like aspirin and toothpaste. Salicylates are not FODMAPs (carbohydrates that cause IBS symptoms) but can cause similar gut symptoms. A small proportion of people are sensitive to salicylates, and this may cause symptoms of IBS. If you are unsure, it is best to consult a doctor or dietitian.
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Does coffee cause acid reflux?
Not only can coffee cause IBS symptoms, it may also worsen symptoms of acid reflux, sometimes known as heartburn. If you experience reflux, or a longer-term form called gastroesophageal reflux disease (GERD), it may be best to avoid coffee. Some studies have shown coffee worsens symptoms of GERD. However, a large meta-study concluded that there was no association between caffeine and GERD in most subgroups. More research is needed to confirm whether this link exists and, if so, if it's the caffeine or the bitter flavored compounds that cause reflux in some people.
Coffee and low FODMAP diet
FODMAP is an acronym for “fermentable oligo-, di-, mono-saccharides and polyols” - carbohydrates found in many fruits and vegetables known to worsen IBS symptoms. The low FODMAP diet is an elimination diet that has been shown to improve IBS symptoms.
Coffee is considered low FODMAP, so you don’t have to remove it while on the diet if it is well tolerated. But certain types of coffee and how it is prepared can increase the FODMAP content. For example, instant coffee and ground coffee may differ in FODMAP content:
Instant coffee: Check the ingredients to ensure the coffee is made of 100% ground coffee beans. Some instant coffees contain chicory root, which is high in FODMAPs.
Ground coffee: Coffees prepared from 100% ground coffee beans are generally considered low FODMAP.
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Should you have milk in your coffee?
If you take your coffee with milk, this may contribute to digestive symptoms. Cow’s milk contains lactose, which is a FODMAP that may contribute to gut problems. In small quantities, milk is usually tolerable to people with IBS, but you may wish to remove it from your diet if symptoms become severe.
Are there milk alternatives?
If you are worried about IBS symptoms from milk, you may wish to order a milk-free coffee such as an Americano or short or long black. Otherwise, many available milk substitutes do not include lactose, including soya, oat, and almond milk. Another suitable substitute is lactose-free milk, which is similar to regular milk. Lactose-free milk may taste sweeter, but it doesn’t contain added sugar. Lactose is a natural carbohydrate (sugar) molecule that is made up of two smaller sugar molecules, one of which is glucose; these are separated in lactose-free milk. Because of this, some people find they can taste the sweetness of glucose more strongly.
Should I cut caffeine?
Before you decide to cut caffeine completely, remove it from your diet for a couple of weeks and then re-introduce it in a small portion. This will allow you to test your tolerance in a controlled manner. If the caffeine does not seem to trigger symptoms, you should be able to include it in your diet.
If you decide to include coffee in your diet, keep your caffeine intake to around 400 mg per day or less. Coffee has a high amount of caffeine, but be aware that there are other sources of caffeine too in different foods and beverages. Below indicates the typical amount of caffeine in:
Coffee: 100-150 mg
Cold brew: 100-150 mg
Decaf coffee: 2-5 mg
Dark chocolate: 20 mg
Black tea: 25-50 grams
If you need an energy boost and are concerned about caffeine intake with IBS, consider a small healthy snack, meditating, taking a cold shower, or going for a brisk walk instead.
What do doctors recommend?
Patients have traditionally been advised to reduce caffeine intake to improve IBS symptom control. Several clinical guidelines suggest that caffeine intake be restricted (but not necessarily removed) if IBS symptoms are suspected. However, caffeine may improve digestive symptoms in some people, so it is worth talking with your doctor about any symptom changes.
The Wrap-Up
Coffee has many benefits for health and may promote productivity and alertness. However, some people with IBS find that coffee exacerbates their symptoms. People with diarrhea as their primary symptom of IBS are likely to experience worsening symptoms; however, those with constipation may find the effects of coffee to be beneficial. If you have IBS, you should limit your coffee intake to one to two cups per day. If symptoms are particularly severe, you may want to consider cutting out coffee altogether or asking your doctor for advice.
References
Sperber, A.D., Dumitrascu, D., Fukudo, S., Gerson, C., Ghoshal, U.C., Gwee, K.A., Hungin, A.P.S., Kang, J.Y., Minhu, C., Schmulson, M. and Bolotin, A., 2017. The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review. Gut, 66(6), pp.1075-1082. https://gut.bmj.com/content/66/6/1075.short?casa_token=PYeEu18FK2oAAAAA:-qZmI1lKt3mG-N0cxJPAInbjl4vz2gIkkaYQaj18mLNtowP1kArIWnMObyejVYbDuYROL8hSKw
Silvarolla, M.B., Mazzafera, P. and Fazuoli, L.C., 2004. A naturally decaffeinated arabica coffee. Nature, 429(6994), pp.826-826. https://www.nature.com/articles/429826a
Mayer, E.A., 2008. Irritable bowel syndrome. New England Journal of Medicine, 358(16), pp.1692-1699. https://www.nejm.org/doi/full/10.1056/NEJMcp0801447?casa_token=xO-jYmsmUOgAAAAA%3AwFefuxaq8cYA3CriS8O-OMb9g-LsPkGahI8f3uiElXA68MHoeyMcYunYSO5mg7RZveaSrArwO4xB
Farah, A., 2012. Coffee constituents. Coffee: Emerging health effects and disease prevention, 1, pp.22-58. https://www.sciencedirect.com/science/article/pii/S1043661807000291?casa_token=WTtAy-FajpAAAAAA:9OLVOIr0KTVZlbDsDDsrFzyui8Wi_fo3QDammF3MDhg9VFBisSvJlqKgoEtuhMyqqlpA3-nH
Sudano, I., Binggeli, C., Spieker, L., Lüscher, T.F., Ruschitzka, F., Noll, G. and Corti, R., 2005. Cardiovascular effects of coffee: is it a risk factor?. Progress in cardiovascular nursing,
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