Should You Drink Coffee if You Have Ulcerative Colitis?

If you have ulcerative colitis (UC), you may be wondering whether your daily cup of coffee is a friend or foe to your gut. The answer isn’t always straightforward if you have a digestive condition like UC.

One reason: Coffee and one of its main components, caffeine, stimulate the gastrointestinal tract. That can speed up motility (movement of food through the digestive tract) and increase bowel movements, which might be problematic for some people with UC. But for others, it may not cause any noticeable issues, especially if their disease is in remission. What you drink with it, such as dairy, sweeteners, or other ingredients like flavored creamers, may also affect symptoms for some people.

Some people with UC may be sensitive to coffee because one of its main components, caffeine, is a stimulant, says Supriya Rao, MD, a gastroenterology, internal medicine, obesity medicine, and lifestyle medicine physician and a professor of gastroenterology at Tufts University in Massachusetts, where she treats people with IBD or other digestive health issues.

“It speeds up motility, which means things move through the gut more quickly,” says Dr. Rao. “That can be helpful for some people, but for people with UC, especially during a flare, that added urgency can make things worse.”

It’s also acidic, which typically isn’t helpful during a flare, when your intestines and stomach lining may be ultra-sensitive, Weekley says.

“Your stomach is already an acidic solution, so with coffee you’re dumping more acidity on top. During active inflammation with ulcerative colitis, it’s like you’re spreading more acidity on an open wound. It’s going to hurt,” she says. This is why you may feel symptoms like cramping, acid reflux and belly pain, too, especially if you’ve consumed coffee on an empty stomach, she says.

Beyond caffeine, a cup of coffee may contain other additives that may irritate the GI lining, including dairy and sweeteners, Rao says. “Many studies and anecdotal reports suggest that caffeine, dairy and artificial sweeteners can trigger symptoms in sensitive individuals,” she says.

Both Weekley and Rao suggest avoiding coffee during an active flare. That’s because during a flare, the gut lining is more inflamed and sensitive, which makes it harder to tolerate potential irritants like caffeine. Drinking coffee during a flare may exacerbate symptoms such as diarrhea, urgency, and abdominal pain.

“I usually advise patients to avoid caffeine or at least greatly reduce it. Your gut is already under a lot of stress, and coffee and additives like dairy or artificial sweeteners and creamers can make things worse,” Rao says.

Pay attention to how your body feels after you drink coffee. It might be worth cutting back or eliminating it from your diet, then slowly reintroducing it when you’re safely in remission, she says.

As mentioned, some people with UC may tolerate coffee well, and others may not. If you want to enjoy coffee with UC, there are ways to reduce the odds of triggering your symptoms.

• Limit your intake. Stick to one small cup per day to start, track your symptoms, and see how your body reacts, Rao says. “Cold brew or low-acid coffee tends to be gentler on the stomach. And sometimes switching to half-caf or a caffeine-free alternative is a smart middle ground,” she says.
• Don’t drink it on an empty stomach. When you’re drinking your cup of joe, make sure it’s with a meal so the acidity is easier on your stomach lining, Weekley says. Pair it with breakfast, such as a piece of toast and eggs, or a sandwich or some crackers in the middle of the day. “Putting something else in your belly while you’re drinking coffee is going to offset some of those symptoms of heartburn and acid reflux,” she says.
• Skip the cream and sugar. Dairy and added sugars can irritate the gut or cause bloating in some people, Weekley says. “The artificial flavored creamers have emulsifiers that long-term can be hard for the gut,” she says. Indeed, artificial sweeteners, cow’s milk, cream, and sugar sweetened beverages are trigger foods among people with UC.

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• Monitor your symptoms. Keep a food and symptom diary to track how coffee affects you and make adjustments accordingly, Rao says. If you’re in remission, you’re in a safe space to try adding coffee back into your diet, noting how you feel when you drink a cup of black coffee compared with a milky latte, for example. If you notice urgency, diarrhea, or stomach pain, your body may not respond well to one or some of the ingredients.
• Have it in a controlled setting. Weekley tells her clients that if there’s an element of unpredictability with their symptoms when they drink coffee, do so in a safe setting. Save it for a day where you’re working from home and close to the bathroom or on the weekends when you aren’t out and about. “Don’t drink your cup of coffee on the way to work. Drink it at home and know that you may have a loose and urgent bowel movement,” she says.

• Coffee isn’t off-limits for everyone with ulcerative colitis (UC). In some people, it may trigger symptoms like urgency and stomach pain, but in others it may not be an issue at all, especially if they’re in remission.
• It may be best to limit or avoid coffee during flares to minimize digestive distress.
• If you’re not sure whether coffee is helping or hurting your symptoms, pay attention to how your body responds to it, including whether coffee prepared with dairy, sweeteners, or other ingredients causes symptoms.