Stomach Cramps? It Could Be the Juice You’re Drinking

"An apple a day keeps the doctor away," the proverb says. But for some people, that apple — especially when it's squeezed into apple juice — could serve up some stomach cramps. Stomach pain after drinking juice is not likely a serious issue, but there are steps you can take to avoid it.

Almost everyone has stomach cramps at some point, and they're usually not serious, according to the National Library of Medicine. They're most likely caused by gas and bloating, and are often followed by diarrhea. You should see a doctor, though, if the pain, bloating, or diarrhea doesn't improve in a day or two, or becomes more severe and is accompanied by nausea, vomiting, and fever.

When Juice Causes Stomach Pain

Everyone has gas in the digestive tract, according to Johns Hopkins Medicine, and it usually comes from swallowing air or the breakdown of certain foods by bacteria in the colon.

Gas begins when some sugars, starches and fiber aren't fully digested in the stomach and small intestine, and this undigested food passes into the large intestine, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

There, it's broken down further by the bacteria in the large intestine, creating gas, such as hydrogen, carbon dioxide, and sometimes methane, in the process. Several kinds of sugars can cause gas, according to Johns Hopkins Medicine, including lactose, raffinose, fructose, and sorbitol. These can be found both in whole foods and as added sweeteners.

Stomach cramps after drinking fruit juice are very common and result from sensitivity to different types of sugar, says Dr. William D. Chey, MD, FACG, AGAF, FACP, RFF, professor of gastroenterology at University of Michigan Medical School in Ann Arbor, Michigan.

Not all sugars contribute to gas equally: While sucrose and glucose are easy to digest, fructose and sorbitol can present problems. Dr. Chey explains that when these unabsorbed sugars get into the colon, the bacteria there ferment the sugar. "That's what produces the gas and cramps," he says.

Apple, prune, and pineapple juices are the main culprits for most people, Chey says. The concentration of sugar in fruit juice can also cause problems for some people who are okay eating whole fruits, he adds, because the amount of sugar in juice is much higher than in whole fruit.

A Low-Fructose Diet May Help

For some people, excess gas after drinking fruit juice might be caused by fructose malabsorption, an issue where the small intestine can't completely absorb the fructose. Dietary fructose intolerance is fairly common, estimated to affect between 30 and 40 percent of people, according to Beyond Celiac. A doctor can diagnose this with a fructose hydrogen breath test, according to the University of Michigan Health System. The treatment is straightforward: Stick to a low-fructose diet.

In addition to passing on fruit juices, that also means, per the University of Michigan Health System, avoiding:

• Certain whole fruits, including apples, pears, watermelon, figs, mangoes, and cherries
• Some vegetables, including artichokes, sugar snap peas, and asparagus

While some fructose-containing sweeteners to avoid — like honey, agave, and high-fructose corn syrup — will be easy to spot, fructose can be hiding in less obvious foods, too, like:

• Salad dressing
• Barbecue sauce
• Ketchup

Always read labels carefully, and make sure the food doesn't contain fruit juice concentrate either.

A step beyond a low-fructose diet is avoiding FODMAP foods — those that contain a group of carbohydrates including fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, according to the University of Michigan Health System. These foods might contribute to symptoms like bloating, gas, abdominal pain, constipation, or diarrhea, especially for those who have irritable bowel syndrome. In select patients, a low FODMAP diet may be helpful in managing inflammatory bowel disease or celiac disease.