Linzess and Coffee: A Synergy of Benefits or a Risky Combination?

Linzess and coffee, both affect the gastrointestinal tract. While Linzess primarily relieves constipation, Coffee may enhance the release of acid production and stimulate gut movements.

How the combination of Linzess and coffee may affect you is not a simple answer as there is not enough data in this regard.

However, knowing the effects of Linzess and coffee separately might make it somewhat clear as to what we should expect when using Linzess and coffee together.

In addition, the effects of Linzess and Coffee in relieving or exacerbating the symptoms of IBS also need to be discussed.

The Effects of Linzess and Coffee on the Stomach and Acidity:

Coffee has been demonstrated to induce acid production in the stomach. It does so by increasing gastrin levels which in turn releases acid.

More acid means more peptic ulcers and GERD. However, the effect of Coffee on GERD is variable. Some studies point to an increased risk of GERD while other studies point against it.

Furthermore, acid production has been related to the amount of caffeine in coffee. Decaffeinated coffee does not significantly cause stomach acid production. The effect on gastrin production is also minimal with roasted coffee [Ref]

Linzess on the other hand does not directly affect the stomach acid. It may help improve the symptoms of peptic ulcers and gastric ulcers because it causes the release of bicarbonate-rich fluid in the gut.

The Effects of Linzess and Coffee on the Intestines:

Linzess primarily affects the small intestines. It activates the intestinal epithelial cells to pour bicarbonate-rich fluid into the intestines.

This causes the influx of more fluid in the intestine which has multiple favorable effects:

• There is an increase in the volume of undigested food which stimulates peristalsis (gut movements)
• The undigested food softens and is easily moved forward by the intestinal peristaltic movements.

In addition, Linzess enhances the peristaltic movements in the gut and decreases the sensitivity of pain nerves in the gut relieving visceral pain.

Coffee, like Linzess, also stimulates small intestinal secretion in a dose-dependent mechanism [Ref].

However, most studies suggest that intestinal secretion of fluid is not the cause of diarrhea or gut movements in most patients. It is rather the gut-brain axis and stimulation of the intestinal muscles that cause diarrhea [Ref]

Coffee changes the gut microbiota. It was thought that coffee increases the colonies of good bacteria in the gut and has a probiotic effect. However, in one study it was found that coffee consumption, whether caffeinated or decaffeinated, has bacterial inhibitory effects.

Coffee may inhibit intestinal bacterial growth by 10 to 1000 times and has antibacterial properties rather than probiotic properties [Ref].

The Effects of Linzess and Coffee on Patients with IBS:

Linzess is an FDA-approved drug for the treatment of IBS-C and chronic constipation. IBS-C is a condition in which the patient has small infrequent defecation more than 25% of the time associated with pain and changes in the stool types.

Most frequently, patients have small lumpy, nut-like stools that are hard to pass. Pain and discomfort without anemia, weight loss, or blood in stools is one of the hallmarks of the disease.

In one study, consisting of 804 participants, 33.7% of participants reported a beneficial effect of Linzess compared to only 13.9% in the placebo group. The responders to treatment had:

• improvement in the worst pain score by at least 30% from the baseline
• At least one CSBM (complete spontaneous bowel movements) during the same week.

FDA end-point responders were those who had an improvement in pain as well as had spontaneous complete bowel movements. Here is a table demonstrating the effects of Linzess on pain and bowel movement in individuals with IBS [Ref]

Linzess significantly improved pain and bowel movements compared to placebo as can be seen in the table above.

The effect of Coffee on patients with IBS is still not clear. Some studies suggest a positive role of coffee on pain and constipation in patients with IBS-C while other studies suggest that coffee may cause IBS or worsen the symptoms of IBS.

In a study comprising more than 3000 individuals, the odds of developing IBS, especially in women, who consumed coffee were high compared to those who did not [Ref].

Another article on the impact of food on patients with IBS stated that coffee can worsen the symptoms of IBS. In particular, it may worsen the symptoms of IBS-D (IBS with predominant symptoms of diarrhea) [Ref].

In addition, caffeine can cause acidity, dyspepsia, and diarrhea [Ref]. Hence, caffeinated coffee can worsen the symptoms of IBS-D more than IBS-C.

Since Linzess and coffee both cause diarrhea, using them together may result in severe diarrhea and dehydration. However, in patients not responding to Linzess, coffee use may improve their symptoms. 

Summary of the PROS and CONS of Taking Linzess and Coffee together: