Record what else was going on

01A symptom needs its context

Some symptoms swing a lot, even within a month. In a study of 185 people with irritable bowel syndrome who rated every bowel movement for up to 90 days, 78% had both loose and hard stools, switching between the two about three times a month (Palsson et al., 2012). Even so, each person’s overall pattern stayed much the same from one month to the next. So a bad day in the middle of a test may simply be one of the ordinary ones.

A record of symptoms alone says nothing about what else a day held. Researchers who studied 52 recorded talks by self-trackers found that people new to tracking often logged their symptoms closely but not what was going on around them, which left them short of clues (Choe et al., 2014). One speaker blamed beer for their symptoms after a single day of heavy drinking and feeling their worst in the days that followed. The researchers noted that the speaker hadn’t allowed for anything else that might explain it (Choe et al., 2014).

02Sleep

Two small studies followed sleep and symptoms day by day. In 24 people with irritable bowel syndrome, nights with more waking, measured by a wrist sensor, were followed by worse abdominal pain and gut distress the next day (Patel et al., 2016). They were not followed by changes in bowel habit, or by symptoms such as bloating. Mood seemed to carry part of the link.

In another study of 24 women with irritable bowel syndrome, a night they rated as worse was followed by more abdominal pain, anxiety and tiredness the next day, but not by other gut symptoms or low mood (Buchanan et al., 2014). It didn’t work the other way round: the day’s symptoms did not predict a worse night afterwards.

Both studies were small, and in people with one condition, so how far this holds for others isn’t known.

03Stress

The evidence on stress points two ways. In one study, 37 people with irritable bowel syndrome rated their stress and abdominal pain from 0 to 10 at random moments for a week (Vork et al., 2020). Each 1-point rise in stress went with, on average, a 0.10-point rise in pain at the same moment, and stress at one moment did not predict pain at the next.

In a month of daily diaries from 181 women with irritable bowel syndrome, women who were more stressed overall had more gut symptoms, but within each woman, a more stressful day showed little relation to a worse gut day (Hertig et al., 2007). Day-to-day stress did go closely with anxiety and low mood.

So within one person, neither study found more than a small link between stress and gut symptoms.

04A food is several things at once

Foods that contain gluten often contain fructans too, a type of carbohydrate (Skodje et al., 2018).

So a test of a food is a test of everything in it. Two new foods on the same day are tangled in the same way: a change that follows can’t be put down to either one. If another new food does turn up during a test, write it down, with the time.

05What to note each day

A line or two is enough:

• sleep: roughly how long, and how rested you felt;
• stress: one rating, on the same 0 to 10 scale each time;
• illness: even a mild one;
• anything new you ate or drank, and when.

None of the studies on this page measured minor illness. Note it anyway, so that a day spent unwell isn’t read as a result.

06What the studies found

• In a 2014 study, researchers analysed 52 recorded talks in which self-trackers presented their own data (Choe et al., 2014). Common pitfalls included tracking too many things, tracking symptoms without their context, and experiments with no comparison period. The speakers were volunteers, so they may not be typical.
• In a 2012 study, 185 people with irritable bowel syndrome rated every bowel movement for 90 days and their symptoms each night (Palsson et al., 2012). Over an average of 73 analysed days, 78% of them had both loose and hard stools, yet each person’s pattern was stable from month to month. The study was partly funded by McNeil Consumer Health, which employed one of the authors at the time.
• In a 2016 study, 24 people with irritable bowel syndrome and 26 without wore a wrist sensor that tracked their sleep for 7 days and kept daily symptom logs (Patel et al., 2016). In those with the condition, more waking in the night went with worse abdominal pain and gut distress the next day, but not with bowel habit, bloating or urgency.
• In a 2014 study, 24 women with irritable bowel syndrome kept sleep and symptom diaries for one menstrual cycle and wore a sleep sensor for 7 days (Buchanan et al., 2014). Worse sleep, as they rated it, was followed by more abdominal pain, anxiety and tiredness the next day. Sleep as the sensor measured it went with next-day anxiety and tiredness, but not pain.
• In a 2020 study, 37 people with irritable bowel syndrome and 36 without rated stress and abdominal pain from 0 to 10 at up to ten random moments a day for a week (Vork et al., 2020). In those with the condition, each 1-point rise in stress went with a 0.10-point rise in pain at the same moment, and neither predicted the other at the next moment. The study was partly funded by Grünenthal, which employed one of the authors.
• In a 2007 study, 181 women with irritable bowel syndrome and 48 without kept a daily diary of stress and symptoms for a month (Hertig et al., 2007). Women who were more stressed overall had more gut symptoms, a link that weakened once anxiety and low mood were allowed for. Within each woman, day-to-day stress showed little relation to day-to-day gut symptoms, but went closely with anxiety and low mood.
• A 2018 double-blind trial notes that foods containing gluten often contain fructans too, and tested the two separately, hidden in muesli bars, in 59 people (Skodje et al., 2018).

07Sources on this page

Each source is listed once, with links to its record. The reference list says what was read for each, and when it was checked.

1. Buchanan et al., 2014Buchanan DT, Cain K, Heitkemper M, Burr R, Vitiello MV, Zia J, et al. 2014. Sleep measures predict next-day symptoms in women with irritable bowel syndrome. Journal of Clinical Sleep Medicine 10(9):1003–1009.DOI 10.5664/jcsm.4038 · PubMed 25142761 · PMC4153105
2. Choe et al., 2014Choe EK, Lee NB, Lee B, Pratt W, Kientz JA. 2014. Understanding quantified-selfers' practices in collecting and exploring personal data. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 1143–1152.DOI 10.1145/2556288.2557372
3. Hertig et al., 2007Hertig VL, Cain KC, Jarrett ME, Burr RL, Heitkemper MM. 2007. Daily stress and gastrointestinal symptoms in women with irritable bowel syndrome. Nursing Research 56(6):399–406.DOI 10.1097/01.NNR.0000299855.60053.88 · PubMed 18004186
4. Palsson et al., 2012Palsson OS, Baggish JS, Turner MJ, Whitehead WE. 2012. IBS patients show frequent fluctuations between loose/watery and hard/lumpy stools: implications for treatment. American Journal of Gastroenterology 107(2):286–295.DOI 10.1038/ajg.2011.358 · PubMed 22068664 · PMC3855407
5. Patel et al., 2016Patel A, Hasak S, Cassell B, Ciorba MA, Vivio EE, Kumar M, et al. 2016. Effects of disturbed sleep on gastrointestinal and somatic pain symptoms in irritable bowel syndrome. Alimentary Pharmacology & Therapeutics 44(3):246–258.DOI 10.1111/apt.13677 · PubMed 27240555 · PMC5020700
6. Skodje et al., 2018Skodje GI, Sarna VK, Minelle IH, Rolfsen KL, Muir JG, Gibson PR, et al. 2018. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology 154(3):529–539.e2.DOI 10.1053/j.gastro.2017.10.040 · PubMed 29102613
7. Vork et al., 2020Vork L, Keszthelyi D, van Kuijk SMJ, Quetglas EG, Törnblom H, Simrén M, et al. 2020. Patient-Specific Stress-Abdominal Pain Interaction in Irritable Bowel Syndrome: An Exploratory Experience Sampling Method Study. Clinical and Translational Gastroenterology 11(7):e00209.DOI 10.14309/ctg.0000000000000209 · PubMed 32764210 · PMC7386351