"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 U.S. 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.
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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, 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, William Chey, MD, a professor of gastroenterology and nutrition science at the University of Michigan in Ann Arbor, tells LIVESTRONG.com
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, Dr. Chey says. The concentration of sugar in fruit juice can also cause problems for some people who are OK 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. A doctor can diagnose this with a fructose hydrogen breath test, according to the University of Michigan Health System (UMHS). The treatment is straightforward: Stick to a low-fructose diet.
In addition to passing on fruit juices, that also means, per the UMHS, avoiding:
- Certain whole fruits, including apples, pears, watermelon, figs, mango 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
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 UMHS. These foods might contribute to symptoms like bloating, gas, abdominal pain, constipation or diarrhea, especially for those who have irritable bowel syndrome, inflammatory bowel disease or celiac disease.
What About Diluted Juice?
Could fruit juice ever relieve stomach trouble? In one specific case, fruit juice — though diluted — was shown to actually be beneficial for stomach pain recovery. A May 2016 randomized trial with more than 600 children in JAMA showed that children visiting the emergency department due to gastroenteritis (which causes stomach cramps and other symptoms) and minimal dehydration who were given diluted apple juice instead of an electrolyte maintenance solution had fewer issues during recovery.
However, there haven't yet been any studies suggesting diluted juice has benefits for adults recovering from stomach issues.
- U.S. National Library of Medicine: “Abdominal Pain”
- Johns Hopkins Medicine: “Gas in the Digestive Tract”
- National Institute of Diabetes and Digestive and Kidney Diseases: “Symptoms & Causes of Gas in the Digestive Track”
- William D. Chey, MD, gastroenterologist, professor of medicine, director of the GI Physiology Laboratory, and co-director of the Michigan Bowel Control Program, Ann Arbor, Michigan
- JAMA: “Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial”
- University of Michigan Health System, Division of Gastroenterology: “Low Fructose Diet”
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.