Keep Salad on the Menu, but Hold the Gas Pain

It's hard to believe that something as innocuous as lettuce could cause stomach pain. However, many people find that they have stomach cramps and diarrhea after eating salad, and sometimes it's pretty severe.

It's not likely it's the lettuce that's causing your pain. Lettuce is generally easy on the stomach and not gas-producing, according to University Hospitals in Ohio.

So, what is causing the pain? Niket Sonpal, MD, an internist and gastroenterologist in New York City, offers some reasons your lettuce/salad could be causing you gastric upset:

It may be contaminated. Within the last few years, the Centers for Disease Control and Prevention (CDC) has recalled romaine lettuce on a number of occasions because it has been linked to outbreaks of E. coli (Escherichia coli) infection.

Symptoms of an E. coli infection include severe stomach cramps, diarrhea (often bloody) and vomiting. Symptoms can start a few days after you eat the contaminated lettuce, the CDC says. Check to see if there are recalls and avoid any lettuce on the banned list.

Read more: Is It Unhealthy to Eat Old Lettuce?

You're constipated. If you eat lettuce or salad and find you're gassy, it could be "due to underlying constipation that is trying to make its way 'out,'" Dr. Sonpal says. "Eating salads and lettuce puts a heavy fiber 'load' on the intestines, and, if you are slightly backed up, your bowels will work a bit overtime to get it all out."

If this is the case, stools will be hard initially and then may become softer, he says. "Ironically, this does not mean you should stop eating salads," he adds. "It actually means continue and add more fiber."

You're overeating. You're thinking it's "just a salad" and "salad is healthy," so you pile it on and on, Dr. Sonpal says. But you could be downing something akin to the "big salad" on Seinfeld, and it's too much at once for your gastrointestinal system to handle, Dr. Sonpal says.

It's what else that's in that salad bowl. The pain also could be caused by all the fixings in your salad, Dr. Sonpal says. Lettuce is just cellulose and water. Perhaps it's the dairy in the creamy ranch dressing and you are lactose intolerant. Or it's the croutons and you're sensitive to gluten. Or the hot peppers and spicy foods can do you in.

Any of these ingredients can cause gas, cramps and diarrhea in some people. If you suspect it may be another food in your salad, do some experimenting. "Slowly remove each component of the salad to narrow down what it is that is truly getting to the crux of matter," Dr. Sonpal says.

Salad is still a favorite. Can you eat it and avoid the pain? Some ideas, from Mayo Clinic and Brigham and Women's Hospital in Boston:

• Try supplements before you eat. You can buy a number of over-the-counter supplements (Beano, BeanAssist, Gas-X, Mylanta) and activated charcoal that can help control gas when taken before you eat.

• Slow down. When you eat slowly and chew your food well, you're less likely to swallow air, which can cause painful gas. Also, if you watch your portions and keep them small, you're making it easier for your stomach to digest your food.

• Make sure drinks are just right. Drinks that are too hot or too cold can cause gas.
  

• Don't slouch. Sit up straight when you're eating and after. Slouching puts pressure on your intestines and can cause gas.
  

• Get moving. Regular exercise helps to keep you regular and from being constipated, which can cause gas pains.

• Go green. Consider trying different greens in place of lettuce. "All greens have the potential to make you bloated or cause some discomfort, especially kale and other newer superfood types," Dr. Sonpal says. But everyone is different. "My advice to patients is, as long as you are not truly allergic, experiment with different greens. Some people find spinach is safe while for others it's iceberg lettuce rather than romaine.

Read more: Is There Anything That Helps Digest Lettuce?