Muscle Cramps

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Calcium and Magnesium. The presence of both Calcium and Magnesium are necessary if smooth, trouble-free muscular contractions are to occur, and research has demonstrated that supplementation of these minerals can cure, or reduce the frequency of muscular cramps. Both of these minerals are in fact electrolytes and are therefore contained within the ingredient list of electrolyte containing sports drinks. Calcium and Magnesium supplements are available separately too, so you could also try this approach.

Quinine. Originally from the bark of the cinchona tree and now synthetically produced, this drug is available in tablet form, but you may need a prescription from your GP to get it. A much more readily available source of the chemical is in Tonic Water. Quinine is the chemical that gives Tonic Water its bitter taste and is used by the medical establishment to treat regular cramp sufferers. Try drinking a half-pint glass of Tonic Water before you ride or race and see if it helps. If you think you may need a bit more, try a pint, it wont kill you! The word is on the street that it does work, very well.

St Johns Wort. This herb, extracted from the St Johns Wort plant, has been used for centuries for the treatment of depression. Although not its main function, this herb can allegedly be used to relieve muscular cramps and spasms. Its worth a try, but I wont stake my reputation on it.
If I get cramp, how do I treat it?

As cramp is an involuntary contraction, in the cramped state, the muscle is shortened. The only way to remove the cramp is quite simply, to ease the muscle back to its original length, then to gradually and progressively stretch it out to lengthen it further. Dont be in too much of a hurry to stretch though, or you risk tearing it. Once stretched, hold this position for at least thirty seconds, or the cramping muscle will spring back to its original spasmodic state. Once the cramp has gone you can try to carry on riding, but this may prove fruitless. When youve returned to base, continue to stretch the cramp stricken muscle and give it a good massage when youre in the bath. This will reduce the soreness likely over the next few days.

By Matt Hart, Torq Fitness

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Most cramps are in the legs and at night. Causes of muscle cramps include calcium and magnesium imbalance, vitamin E deficiency, dehydration, poor circulation, inactivity, anaemia, fibromyalgia, arteriosclerosis, hypothyroidism and arthritis.

If cramp occurs during the day, while you are active, or occurs after walking but is better when you stop walking, visit the doctor to check for impaired circulation or arteriosclerosis.

Nutrition Facts & Diet Advice for Muscle Cramps

Consider the following nutrition guidelines:

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Eat green leafy vegetables every day.
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Eat almonds, sunflower seeds and sesame seeds frequently (ground in a coffee grinder if possible and eaten with meals).
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If slightly hypothyroid, take a little kelp every day.
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If circulation in the legs is poor, take the herbs Butchers Broom and Horse Chestnut (available from Solgar)
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Have a regular massage if possible, or massage your own legs with a little olive oil.
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Keep your legs warm at night, perhaps having a soak in a hot bath with some mineral salts prior to bed.

Health Supplements and Muscle Cramps

Often, a combination of supplements may help in alleviating this condition. You may wish to consult a nutritional therapist for personal advice. Supplements that may be helpful in alleviating symptoms are shown below:

(please also read this important notice concerning supplement medical claims)

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2 x True Food Calcium and Magnesium with evening meal (Higher Nature)
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1 x Vitamin E mixed softgels 400iu (Solgar)
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1 x Vitamin B Complex (Biocare)
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1 x Ultra Vitamin C Plus Bioflavonoids (Higher Nature)
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1 x Multivitamin and Mineral (VM75 Solgar)
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Lecithin, 1 tablespoon with 2 meals a day (recommend Higher Nature)

Also consider:

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For circulation in legs, Butchers Broom and Horse Chestnut from Solgar
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1 x Microcell Co-enzyme Q10 with linseed oil (BioCare)

Recommended Books

health book - After Stroke
health book - Solved: The Riddle of Illness

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Provided there are no neurological or neurodegenerative causes such as multiple sclerosis, cerebral
palsy, stroke, or spinal cord injury - extra calcium is usually the solution for muscle spasms or muscle
cramps in many nocturnal cases. The extra requirements for calcium may be a result of high protein or
phosphate levels (kidney disease, poor diet), hormonal diseases or imbalances, nutritional imbalances
(high Mg/Ca ratio, low pantothenic acid), celiac disease or other intestinal conditions that interfere with
calcium absorption, prescribed medications that promote calcium loss, random self-supplementation
of the wrong vitamins and minerals, and others. (see also Acu-Cell Nutrition "Calcium & Magnesium").

When high calcium is suspected but no resources are available to measure cellular calcium levels
(serum calcium cannot be used for that purpose), an acidifying approach may be tried such as taking a
very large amount of Vitamin C for a few days. If the muscle spasms or cramps get worse, then at least
one can assume that calcium was likely on the low side, and one needs to increase its dietary intake,
and/or use calcium supplementation.
If on the other hand the muscle cramps or spasms improve, then calcium is likely too high and requires
co-factors to make it more bioavailable by supplementing either magnesium, or a phosphorus source
such as lecithin, a higher daily intake of Vitamin C, or one could increase one's protein intake as
another option.

Consuming foods or beverages containing lactic acid is another acidifying strategy to reduce muscle
cramps when working out, despite the buildup of lactic acid in muscle tissue during strenuous exercise
being actually a common cause of muscle spasms or cramps. This happens from insufficient oxygen
not being able to oxidize lactic acid, which would otherwise get rid of it from muscle. Inosine and
creatin supplements also help to reduce the buildup of lactic acid in muscle.
As exercise tolerance increases from repeated training, it takes increasingly longer before lactic acid
is produced in muscle, so there is less of a chance of muscle cramps to develop. Lactic acid is found
in a number of foods and beverages, and it is also commercially added to increase their acidity (olives,
sauerkraut, cheese, beer, soft drinks, pickles...). Lactic acid-containing drinks can serve as a valuable
fluid replacement for athletes before, during, and after competitive training and exercise.

One-sided leg cramps or spasms can help with the decision of what to supplement, whereby the left
side is usually indicative of calcium, while the right side is generally an indication of magnesium being
needed, although some individuals require a calcium / magnesium combination for relief as a result
of both being low. If right-sided muscle cramps respond to calcium (rather than to magnesium or other
acidifying strategies), then dehydration is suspect, and extra sodium may be additionally required.

While electrolyte or other nutritional imbalances can be a cause or contributing factor for toe spasms
or cramping of one's toes also, if one never experiences spasms or cramps in other parts of the body,
then they may occur as a result of poor circulation, wearing tight shoes, or sitting in a particular position
(car, plane, theater) for longer periods of time. Briefly exercising one's toes, or taking a short walk
usually provides relief and resolves the problem.

If poor circulation causes muscle cramps, Vitamin E might be a good choice for its blood-thinning and
vasodilating properties. Gingko biloba also provides a blood-thinning effect and may be considered.
Sodium and/or potassium imbalances tend to become more of a problem during, or after physical
activity, but less so during rest, so for exercise-induced leg cramps or muscle spasms, their addition
in the form of a sports drink, or through extra Sodium / Potassium supplementation in tablet form may
be a consideration. However, sufficient hydration (taking in enough fluid) is equally important before,
during, and after a workout!

In practice, not all cases are that straightforward. The following example presents the chemistry of an
individual who experienced severe muscle cramps in his quadriceps (front of the thigh) within only a
few minutes on an exercise bike. It also demonstrates a seemingly possible - but in the long-term
incorrect - interchangeability of similar-acting minerals (calcium versus sodium in this case):

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Since calcium is quite low in Ratio to magnesium, supplementing 500mg of elemental calcium per day
quickly resolved the problem - but only symptomatically!
The right strategy of course was to raise sodium, since continuing to supplement calcium would in time
only lead to a greater increase in cellular magnesium, which in turn would lower sodium even more and
result in all sorts of additional medical problems. While using extra salt works in some individuals, it will
not work with low-aldosterone types (whose sodium levels are chronically low - even with high sodium
intake), so supplements such as choline are indicated instead to raise sodium levels, which in time will
lower magnesium also and thus normalize an individual's Ca/Mg ratio as well. In the above case,
silicon / silica (which also inhibits magnesium), was another very important addition.

Once it is established that calcium and/or magnesium are needed, then the mineral type should be
matched to stomach acid levels. If they are high, then calcium / magnesium "carbonate" is preferable,
and when low, "citrate" is better. Carbonate is also generally better with a tendency for diarrhea, and
citrate is generally better with a tendency for constipation.

Since low calcium and/or low magnesium-induced muscle spasms or cramps go hand in hand with
disturbances of bone mineral metabolism, it may be worthwhile to consult a medical practitioner and
be evaluated for other possible medical problems such as osteopenia or osteoporosis, whereby
additional supplements such as Vitamin D, or other dietary adjustments may be indicated.
Those suffering from leg cramps that are due to insufficient potassium intake should be aware of - or
at least use their symptoms as a warning sign - that ongoing low potassium levels increase the risk for
cardiovascular disease and/or stroke.

Acute muscle spasms in the back are oftentimes triggered as a result of injuries, but chronic attacks
can also result from curvature of the spine (scoliosis), age-related degenerative disk disease, and/or
spinal alignment problems. Osteopathic / chiropractic adjustments, physiotherapy, muscle relaxants,
needle acupuncture, needle-less electro-acupuncture or electro therapy are common treatment options,
depending on the type of medical system one is most comfortable with.

Nutritional imbalances, i.e. abnormal Mineral Ratios are also capable of affecting spinal alignment,
or they can even lead to scoliosis over time (and subsequent muscle cramps and spasms), in which
case drug therapy or frequent visits to a chiropractor, physiotherapist, or acupuncturist can become
frustrating, since the therapy won't last. However, once a nutritional balance is re-established, the spine
is less likely to go out of alignment and trigger muscle spasms, cramps, and/or other health problems.

***

"Sleep Starts" (myoclonic or hypnagogic jerks) describes a type of involuntary muscle jerking that
takes place just before drifting off to sleep. While felt by most people at some point in their lives, these
sudden muscle twitches or jolts don't generally interfere with someone's sleep unless they occur on a
regular, nightly basis. When they start to take place seconds apart, they will seriously affect a person's
ability to fall, or remain asleep. Some individuals experience shorter bouts that only last a few weeks,
however other people are less fortunate and may suffer "sleep starts" for several months, or on an
ongoing basis.

There are some known medical conditions associated with myoclonus, including brain or spinal cord
injury, Parkinson's disease, Tourette syndrome, multiple sclerosis, stroke, epilepsy, drug or chemical
poisoning, organ damage, and others, however "sleep starts" is considered to be a type of 'Periodic
Limb Movement Disorder' that as of yet lacks a specific medical cause or has a known relationship to
a specific medical condition, although females are affected more than males, partly due to monthly
hormonal fluctuations that seem to aggravate this condition around the time of their menstrual cycle.

Standard treatments for "sleep starts" consist of clonazepam therapy (a benzodiazepine type of
tranquilizer), which - while able to help the symptoms, invites the usual long-term dependency this class
of drugs is known for. Some patients require additional drugs or drug combinations that may include
barbiturates, sodium valproate, phenytoin, or primidone.

Unfortunately, nutritional approaches (as listed above) that are helpful for conventional muscle spasms
and cramps do not offer any benefits for most types of myoclonus, however I have found Taurine in the
1500 mg to 2000 mg+ / day range to be somewhat helpful for "sleep starts," provided reasonable care
is taken at the same time to avoid stimulants such as alcohol, caffeine, and excessive intake of white
sugar, which are known to worsen symptoms. ¤

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Symptoms

Leg or foot spasms can cause sudden *pains in bed which disrupt sleep. They commonly occur with strenuous exercise, when using a group of muscles repeatedly, or when circulation is cut off from sitting awkwardly. Most cramps last only a few seconds, and at most a few minutes. Leg cramps are particularly common in *pregnant women and the elderly. *Menstrual cramps, also known as dysmenorrhea, cause pain and discomfort in the lower *back and abdomen. (see also Menstrual Cramps)

Causes

The uncontrolled contraction of muscle fibers causes cramps and is more common when *circulation is poor, or when the limbs are cold or being exercised unusually strenuously. It will also occur when the body is overacidic. Cramps that occur after exercise are usually due to lactic acid build-up from not warming up enough beforehand and from muscle overuse. If *twitching accompanies cramping, an overstrained nervous system will also be at fault. Writer’s cramp is the result of repeated use of the same muscles in the hand. Leg cramps that occur at night often signal a lack of minerals necessary for muscle contraction, especially calcium and magnesium, or insufficient oxygen supply from poor circulation. Magnesium, for instance, is lost through alcohol and coffee, which leach this mineral from the body. Acidic foods are also a problem, including white vinegar, which is found in many foods such as pickles, mayonnaise, mustard and salad dressings. Apple cider vinegar and other natural wine vinegars are not a problem.

Cramps are more likely to occur in the heat and during vigorous exercise, when a great deal of water and minerals may be lost through perspiration. If muscle cramps are related to dehydration from heat, exercise or loss of body fluids, water and salt are needed immediately to prevent collapse. If leg cramps or a heaviness in the legs appear after minimal exercise, such as a short walk, the cause usually lies in the more serious *arteriosclerosis and *thrombosis in the veins.

*Menstrual cramping is the result of the uterus contracting when the menstrual period begins, but it can also be caused by *pelvic inflammatory disease or similar disorders, especially if the cramping occurs apart from the period.

Nutrition

Cramps appearing regularly indicate a nutritional deficiency which needs to be addressed. A lack of fluids and alkalizing minerals can predispose the muscles to cramp. Adopt a more alkaline diet, avoiding acid-causing foods like red meat, baked goods, sweet foods and processed foods. Avoid any food containing white vinegar, often hidden in mayonnaise, pickles, mustard and commercially prepared salad dressing. Apple cider and natural wine vinegar can be used, as their natural fruit content burns to alkaline ash. For chronic cramps, combine one tablespoon of apple cider vinegar and one tablespoon of unpasteurized honey in a glass of water for a daily drink.

The best source of alkalizing minerals is fresh raw vegetables and vegetable juices. Alfalfa sprouts are particularly rich in minerals because the tiny roots of the alfalfa plant penetrate deep into the soil and store the minerals in the seed. Snack on dried seaweeds like dulse or nori, which are packed with all the minerals of the sea. Magnesium and calcium are particularly important in the prevention of muscle cramping. Leg cramps which occur at night are often due to a deficiency in calcium and magnesium. Foods rich in magnesium, in addition to green vegetables, are raw wheat germ, corn, figs, dates, lemons, grapefruit, apples, cocoa, nuts and seeds. Peanuts, sesame seeds and walnuts are good nut choices, as these are rich in both magnesium and calcium. Other calcium-rich foods, besides green vegetables, are fermented dairy products like yogurt and kefir and soy beans. Avoid large amounts of coffee or alcohol, which will cause magnesium to be lost in the urine.

Nutritional Supplements

Most cramps, whatever the form, can quickly be relieved with calcium and magnesium supplements. Both of these minerals are important for nerve conduction and muscle contraction.

* Betaine HCl is a digestive aid which acidifies those minerals so they are more easily absorbed by the body.

* Silica helps calcium assimilation and should be taken as well.

* Pantothenic acid is necessary for the nervous system.

* With a B complex, imbalances among the B vitamins can be prevented.

* Vitamin E is highly recommended when cramps arise from poor *circulation. Vitamin E improves oxygen supply by opening the blood vessels. The elderly with nightly leg cramps and restlessness will find vitamin E particularly beneficial.

* Coenzyme Q10 also increases oxygen supply to the tissues, and should be taken additionally when circulation is poor.

Daily Dosages

* Calcium, 1,500 mg in divided doses

* Magnesium, 750 mg in divided doses

* Betaine HCl, 5 capsules three times daily with meals

* Vitamin E, with mixed tocopherols, 400-800 IU
* Silica, 3-6 capsules

* Vitamin B complex, 100 mg with 100 mg pantothenic acid

* Coenzyme Q10, 60 mg

Herbal Remedies

Herbal juices, tinctures, baths and compresses provide soothing relief for muscle cramps.

* For cramps and spasms take 1 tbsp. yarrow juice daily. Yarrow relaxes and dilates blood vessels. Silverweed juice supports the action of yarrow synergistically.

* Take 5-10 drops wild yam tincture in liquid to relax smooth muscle.

* To build up the blood, drink an Iron Cocktail every day for a week: combine 2 tbsp. stinging nettle juice or spinach juice, 4 tbsp. red beet juice and 2 tbsp. yarrow juice; mix with grape juice for oxygenation.

* Rub St. John’s wort oil into the muscle to dilate the capillaries and help relax tense muscles.

* Apply hot herbal compresses or poultices of St. John’s wort leaves and blossoms, yarrow, comfrey or horsetail grasses.

* A warm rosemary bath is relaxing for tense muscles. Add 5 drops rosemary oil to bath water.

* Muscle cramps can be released by massaging with arnica lotion or eucalyptus oil. Do not rub arnica into open cuts or wounds.

Homeopathy

Choose one of the below in a 6c strength, placing two tablets under the tongue. Repeat every ten minutes for three doses, then hourly if necessary. It is not recommended that these remedies be taken on a regular basis unless the underlying problem is being treated.

* Sudden, severe muscle cramps in the legs or feet, usually with muscle *twitching, can be quickly relieved with a dose of Cuprum.

* If extreme muscle *fatigue after heavy exercise is the problem, use Arnica.

* Many cramps can be relieved with Magnesia phosphorica when warmth and pressure provide relief.

Tissue Salts

Allow 4 tablets to dissolve under the tongue. For a recurring problem, repeat three times daily for two weeks.

* Mag phos is the most important tissue salt for cramping muscles. There is twitching and jerking of muscles. It can also be used for writer’s cramp.

* Calc phos is appropriate when calcium is lacking, and when the cramp is accompanied by coldness or numbness. This is common during *teething in children, since they have a greater need for calcium at this time.

* Kali phos will help cramps that occur as a result of a nervous affliction, after a fright, for instance, or when it involves the nervous system.

External/Physical Therapies

* If the cramps are in the calves, put the feet up occasionally.

* Apply hot compresses dipped in a solution of 1/2 cup apple cider vinegar and 1 cup hot water during intense cramping.

* Warm baths are relaxing for tense muscles. Add 2 or more cups of apple cider vinegar to bath water.

* Avoid tight shoes and clothing which cuts off circulation and causes cramps and spasms.

* Stretch before and after exercising.

* Cold-water stepping will help alleviate night cramps.

Acupressure

* For cramps in the leg apply deep thumb pressure for one minute to the points on the leg, as illustrated.

Reflexology

* Work the reflexes of all endocrine glands and the uterus, ovaries and lower spine.

Available Brand Name Products: Nutritional Supplements

* Auxima Liquid Organic Calcium (Inno-Vite)

* Auxima Liquid Organic Magnesium (Inno-Vite)

* Magnesium Complex (Klaire Laboratories)

* P-5-P w/Magnesium (Klaire Laboratories)

* Calcium and Magnesium Citrate (Natural Factors)

* E 400 IU Mixed Tocopherol 100% Natural (Natural Factors)

* Ester (Natural Factors)

* Calcium & Magnesium w/ Vitamin D (Sisu)

* Liquid Calcium and Magnesium w/ Vitamin D (Sisu)

* Magnesium Citrate 100mg w/ Malic Acid (Sisu)

* Woman Maxi-Cal (Sisu)

Available Brand Name Products: Herbal Remedies

* Horsetail Leaves (Flora)

* Salus Herbal Calcium/Magnesium Liquid (Flora)

* Muscle and Joint (Natural Factors)

* St. John’s Wort Extract (Natural Factors)

* Silica-Power (Nature’s Herbs)

Available Brand Name Products: Homeopathy

* Arnica (Nelsons Homeopathy)

* Phosphorus (Nelsons Homeopathy)

Available Brand Name Products: External Therapies

* Basil Oil (Karooch Essential Oils)

* Chamomile Oil (Karooch Essential Oils)

* Clary Sage (Karooch Essentail Oils)

* Ginger Oil (Karooch Essential Oils)

* Juniper Berry (Karooch Essential Oils)

* Lavender Oil (Karooch Essential Oils)

* Lemongrass Oil (Karooch Essential Oils)

* Marjoram Oil (Karooch Essential Oils)

* Pepper Oil, Black (Karooch Essential Oils)

* Rosemary Oil (Karooch Essential Oils)

* Vetivert Oil (Karooch Essential Oils)

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EVERYONE EXPERIENCES muscle cramps from time to time. Perhaps your neck gets cramped after a day at your desk or you get a leg cramp after exercise. When you've been sedentary for a long time. Some women get leg cramps after wearing high heels. The solution to most of these common cramps is to stretch the muscles regularly, and, in the case of high heels, avoid them.

There is another, more troubling kind of cramp that my patients often ask about: nocturnal leg cramps. Just as you've fallen into a deep, comfortable sleep, you're wakened by a severe and painful cramping of your calf muscle. Most people leap out of bed and hop around on the affected leg until the cramp goes away. But occasionally it returns. Sometimes the cramp is in the thigh, and sometimes in the foot. In any case, it's annoying and painful.

The first thing to check if you have leg cramps is your prescription drugs. Some can cause cramping; your doctor can tell you the side effects of your medication. Diuretics taken for high blood pressure or heart disorders, for example, can cause an imbalance of your potassium and magnesium levels. A blood test can tell you if this is a problem, and if it is, supplements of the appropriate mineral will alleviate the symptoms.

The most common cause of nocturnal leg cramps is calcium deficiency. If you are postmenopausal, trying to lose weight, or don't consume enough calcium, you are vulnerable to developing leg cramps. It's quite alarming to realize the extent of calcium deficiency in our population, particularly among women. While leg cramps are just an annoyance, another result of calcium deficiency--osteoporosis--is a crippling disease that can be prevented. To relieve leg cramps and prevent the long-term problems associated with calcium deficiency, begin now to increase your calcium consumption. If you're avoiding fat, try nonfat yogurt and skim milk. In addition, I've had great success with patients who complain of leg cramps by advising them to take a calcium supplement at bedtime.

Pregnant women are sometimes vulnerable to leg cramps, which usually occur with the changes in their calcium metabolism. Calcium supplements can help. Taking calcium daily should give relief. Please check with your obstetrician before beginning the supplement and check to see what amount of calcium, if any, there is an any pregnancy vitamin you may be taking.

Another help for nocturnal leg cramps is vitamin E. In one study of 125 patients with nocturnal leg and foot cramps, all but 2 had complete or nearly complete relief from their symptoms when they took vitamin E supplements. In most cases, the symptoms returned when the supplements were discontinued.

If neither calcium nor vitamin E gives you relief, you may benefit from magnesium, potassium, or vitamin A.

Because as it has been shown that sugar and caffeine reduce the absorption of vitamins and minerals, particularly calcium, I advise patients with cramping problems to eliminate as much sugar and caffeine from their diets as possible.

NATURAL PRESCRIPTION FOR LEG CRAMPS

* Eliminate as much sugar and caffeine as possible from the diet.

IN ADDITION TO YOUR DAILY SUPPLEMENTS, TAKE:

* Calcium: 1,200 mg. at bedtime, if no results, you can discontinue but be sure that you are getting 1,200 mg, of calcium daily through diet and/or other supplements. For pregnant women: Check with your doctor before beginning supplementation,
* Vitamin E: 400 I.U. twice a day after meals for two weeks. If symptoms are relieved, cut down to 400 I.U. once a day, If symptoms recur, up the dosage until symptoms are relieved but never take more than 1,200 I.U. daily,
* Magnesium: 400 mg. daffy.
* Vitamin A: 10,000 I.U. daily.
* Potassium: 100 mg./daily,

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Why some people get muscle cramps
Many people experience cramps when they sleep, which can be associated with excruciating pain. Athletes, on the other hand, tend to develop muscle cramps when they are exercising.

A wide variety of factors can cause muscles to contract painfully. The following are common causes:

* A mineral deficiency involving potassium, calcium, magnesium and/or sodium.
* Dehydration, which can occur in athletes when they exercise hard in hot conditions and do not drink sufficient liquid.
* Excessive intake of fluid (drinking 2-3 litres or more of water in addition to your daily fluid intake) - this can ‘wash’ the above-mentioned minerals out of your body and lead to cramps.
* Lack of fitness - well-trained muscles are less likely to cramp. Although this mainly applies to athletes, people who are not fit and get too little exercise often develop cramps because their muscles are so poorly used.
* Wearing tight constrictive clothing, especially in bed. Try to wear comfortable, loosely fitting clothes at all times (be comfortable, rather than stylish if you are plagued by cramps), as constriction of the blood supply to muscles can cause them to contract painfully.

Minerals that play a role
There are four minerals that can influence how a muscle contracts, namely calcium, potassium, magnesium and sodium.

a) Calcium
Most people are not aware of the fact that calcium is essential for the normal contraction of muscle tissues, including those of the heart. Patients with extremely low blood calcium levels can develop a condition called tetani where the muscles fibres contract continuously. When this occurs, heart failure can ensue.

Fortunately, such severe calcium deficiencies are rare, but on the other hand, sub-optimal calcium intakes are relatively common, especially in teenagers and young women who cut out calcium-rich foods like milk and dairy products because they are afraid of gaining weight. If you hardly drink any milk and never eat yoghurt, or cheeses, you may well be inclined to a subclinical calcium deficiency and will need to top up on these foods or take a calcium supplement (Calcium Sandoz or Caltrate or Berroca Calcium, for example).

b) Magnesium
Once again, outright magnesium deficiencies are relatively rare, but people eating a western diet that lacks fresh fruit, vegetables, legumes and unprocessed grains and cereals, may well have inadequate intakes. If you suffer from muscle cramps, you can try increasing your intakes of the foods listed above (especially green, leafy vegetables such as spinach, cabbage, lettuce, broccoli) or take a calcium and magnesium supplement (taking these two minerals together improves their mutual absorption).

Note: Magnesium, if taken in excess, can cause diarrhoea. You may have to take your Slow-Mag or Magnesite supplements only every second day.

c) Potassium
Potassium is one of the most abundant minerals available in common foods and most people should not develop a deficiency. However, eating minimalistic or monotonous diets to lose weight or cutting out all fruits and vegetables and grains and cereals, can cause a potassium deficiency. Drinking too much water can also deplete your potassium reserves.

The easiest way of ensuring that you have abundant potassium is to eat five or more servings of fruit and/or vegetables a day. If you think you lack potassium, buy a variety of fresh or frozen vegetables and boil them lightly in chicken stock to make a delicious, fat-free soup that is loaded with potassium. If you have a juicer, make an apple or grape and carrot drink to boost your potassium intake.

Potassium supplements should preferably only be taken if your potassium levels have been checked by a medical doctor and have been found to be low.

Potassium supplements should also only be taken under the supervision of your doctor, because a number of medications can influence the potassium levels in the body - for example, the so-called ‘potassium-sparing diuretics’ prevent loss of potassium from the body. If you take a potassium supplement, you could develop hyperkalaemia (excess potassium in the blood), which is also harmful. So rather eat fruit and vegetables and whole grains to top up on potassium, unless your doctor has prescribed supplements like ‘Slow-K’ for you.

d) Sodium
Most people on a western diet, which is based on processed foods, won’t develop a sodium deficiency. However, drinking too much water, sweating a lot, and certain imbalances in kidney function can lead to sodium depletion, which in turn can cause cramps.

If you do a lot of exercise in hot weather or if you are an athlete training hard, you need to make sure that you are getting some sodium in your diet. Luckily, most sports drinks like Energade and Powerade contain sodium to assist with hydration, so drink some while you exercise and during the recovery phase.

People who develop cramps and do not eat any salt or use salt substitutes (which are rich in potassium) should consider that they might have a sodium deficiency. Try adding a pinch of table salt to your food for a week or two to see if this alleviates the problem.

Other tips on preventing cramps

* Get as fit as possible - the fitter you are, the fewer cramps you will develop.
* Drink sufficient liquid to prevent dehydration, but don’t overdo your fluid intake.
* Follow a low-fat diet to prevent clogged arteries as poor blood circulation to the limbs can cause cramps.
* Do stretching exercises every day, especially with the muscles that tend to cramp.
* Wear loose, comfortable clothes, especially at night.

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22/09/2004- As the UK launches a drive to reduce salt in the consumer diet, a recent study in Germany finds an extra dose of salt a day could benefit the elderly.

Speaking at the European Geriatrics Congress in Vienna last week, Professor Ingo Füsgen from the University of Witten-Herdecke claimed that 10 per cent of older people suffer from sub-acute sodium deficiency, which can result in problems such as nervous disposition, hallucinations, muscle cramps and incontinence.

"Sodium deficiency is common for elderly people but it is often not recognised," said Professor Füsgen.

According to a survey Füsgen conducted, 80 per cent of elderly people 'try to consume salt sparingly due to a misapprehension that too much salt causes high blood pressure'. He maintains that a low salt diet is not appropriate for the majority of elderly people.

"Many older people are not aware of the danger of a low salt diet and try to reduce their consumption of salt because they assume it is healthy," he added.

Controversy linked to the most common food ingredient in the world sparked off in June this year when UK health minister Melanie Johnson rejected plans submitted by the industry to reduce salt levels, accusing food manufacturer's of not going 'nearly far enough.'

In a letter Johnson surprised over twenty food players - among them Kerry Foods, Heinz, Sainsbury, and McDonalds - warning them they had until 18 September to come back with a better plan to beat the 'unacceptably high levels of salt'.

"We are astonished," a spokesperson from the UK Food and Drink Federation told FoodNavigator.com at the time.

Eating too much salt is a significant risk factor in developing high blood pressure, itself a cause or contributing factor in the rising incidence of heart disease.

Recent figures from the UK's Food Standards Agency claim that every day at least 26 million people eat more than the recommended daily limit of 6g of salt. Men are eating the most with a daily average of 11.0g of salt while women consume an average of 8.1g a day.

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Muscle cramps are often associated with dehydration. If you have ever experienced the excruciating pain of a severe muscle cramp, you may fearfully wonder if it will strike again. Because no one totally understands what causes muscle cramps, these unpredictable spasms are somewhat mysterious. They most commonly occur among athletes who work their muscles to the point of exhaustion. They are likely related to overexertion, but fluid loss, inadequate conditioning, and electrolyte imbalance may also be predisposing factors. The solution often can be found with massage and stretching. Other times, nutrition may be involved. Although the following nutritional tips are not guaranteed to resolve this malady, I recommend that people who are predisposed to getting cramps rule out these possible contributing causes:

* Lack of water. Cramps commonly coincide with dehydration. To prevent dehydration-induced cramps, drink more than enough fluids before, during, and after you exercise. Always drink enough fluids daily so that your urine is clear, pale yellow, and copious. During a long exercise session, you should target eight ounces (250 milliliters) of fluid every 15 to 20 minutes.

* Lack of calcium. Calcium plays an essential role in muscle contractions. Some active people report that their problem with cramping disappears when they boost their calcium intake. For example, one ballet dancer found that once she reintroduced yogurt and skim milk into her diet, her cramping disappeared. A mountaineer resolved his muscle cramps by taking antacid tablets containing calcium when hiking. But some exercise scientists question the accuracy of these anecdotes. Calcium imbalance seems an unlikely cause of muscle cramps because the bones are a huge calcium reservoir. If a dietary deficiency should occur, calcium would be released from the bones to provide what is needed for proper muscle contraction.

Nevertheless, to rule out any possible link between a calcium-poor diet and muscle cramps, athletes plagued by cramps should consume dairy products at least twice each day, such as low-fat milk on cereal and yogurt for a snack. This good nutritional practice certainly won’t hurt them and possibly may help.

* Lack of potassium. Electrolyte imbalance, such as lack of potassium, may play a role in muscle cramps. You can rule this out by eating potassium-rich foods on a daily basis, focusing on fruits and vegetables. But a potassium deficiency is unlikely to occur as a result of sweat losses, because the body contains much more potassium than even a marathoner might lose during a hot, sweaty race. Nevertheless, a daily potassium-rich diet certainly won’t hurt anyone, and in fact is a health-protective choice.

* Lack of sodium. Active people who restrict their sodium (salt) intake on a daily basis despite losing a significant amount of sodium through sweat may be putting themselves at risk of develop-ing a sodium imbalance that could contribute to cramps. This circumstance is most likely to occur in athletes with habitual low-sodium diets who exercise hard for more than four hours in the heat, such as tennis players, triathletes, or ultrarunners. The risk increases if they consume only water during the event and have eaten no foods or beverages that contain sodium. Sports drinks and salted pretzels would be wise snack choices during exercise.

Although the suggestions for resolving muscle cramps are only suggestions and not proven solutions, you might want to experiment with these dietary improvements if you repeatedly suffer from muscle cramps. Adding extra fluids, low-fat dairy products, potassium-rich fruits and vegetables, and a sprinkling of salt certainly won’t harm you, and it may resolve the worrisome problem. I also recommend that you consult with a physical therapist, athletic trainer, or coach regarding proper stretching and training techniques.

As I mentioned above, nutrition may play no role at all in your cramps. Given that cramps occur when muscles are fatigued, the problem may be related to a nerve malfunction that creates an imbalance between muscle excitation and inhibition, which prevents the muscle from relaxing. When that’s the case, stretching the cramp is the best solution.

* To reprint this excerpt with permission from Human Kinetics Publishers, Inc., please contact the publicity department at 1-800-747-4457 or

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Have you been awakened in the middle of the night by a sudden painful cramp in your leg? So have lots of other people.

Cramping during sleep is usually due to an exaggeration of a normal muscle reflex. When you turn during sleep, you contract your calf muscles and stretch their tendons. This stimulates nerve stretch receptors in the tendon and sends a message back to the spinal cord, telling the calf muscles to contract. Sometimes, the muscles remain contracted and hurt. Painful muscle cramps at night can also be caused by nerve damage such as that caused by pinching a nerve, muscle damage, a partially-obstructed flow of blood to the legs and abnormal mineral or hormone levels, so if you have this problem, check with your doctor. If you do not have a serious cause, you can often prevent night cramps by exhausting the stretch reflex before you go to bed by stretching your calf muscles with wall pushups, and applying a heating pad for 10 minutes before you go to sleep.

The only drug that has been shown to be effective in treating night-time leg cramps is quinine, but the Food and Drug Administration stopped over-the-counter marketing of this remedy because of concerns about irregular heart beats and other side effects. Doctors may still prescribe quinine pills for relief of leg cramps, but they can cause birth defects and miscarriages, so they should never be taken by a pregnant woman. Quinine can also cause ringing in the ears, headache, nausea, disturbed vision, chest pain, asthma and other problems.

By Gabe Mirkin, M.D., for CBS News Radio
Checked 6/1/07

1) KM Leclerc, FJ Landry. Benign nocturnal leg cramps: Current controversies over use of quinine. Postgraduate Medicine 99: 2 (FEB 1996):177.

2) FDA Consumer November, 1994.

3) Quinine does not help to prevent or treat night-time leg cramps. Journal of the American Geriatrics Society June, 1993.

4) M Mansonhing, G Wells. Meta-analysis of efficacy of quinine for treatment of nocturnal leg cramps in elderly people. British Medical Journal 310: 6971 (JAN 7 1995):13-17-The results of six double-blind studies show that quinine can prevent nocturnal leg cramps in general ambulatory populations.

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Q: I have night time leg cramps that wake me up. What can I do?

A: Nocturnal leg cramps become increasingly common with age. They are also common during pregnancy.

Leg cramps affect the muscles in the calf or along the sole of the foot. The cramp usually goes away within a few minutes. You can help relieve the pain by grasping your toes, pulling toward you, stretching your calf muscles.

Prevention - stretching, exercise

Night-time muscle cramps are often caused by tight muscles and inactivity. The best preventative treatment is regular stretching and exercise. If you suffer from regular nocturnal leg cramps, you should stretch your calves and affected areas as part of your bedtime ritual.

The ‘‘runner's stretch'' involves leaning against the wall and stepping forward, leaving the back foot flat on the floor. The ‘‘stair stretch'' requires standing on the edge of a step and dropping your heels while holding on to the banister. It is important to hold these stretches for at least 30 seconds.

Other treatments

Despite the frequency of this problem, there is limited understanding and treatment for leg cramps. Supplemental potassium or calcium is not effective because electrolyte abnormalities do not cause nocturnal leg cramps. Magnesium is only helpful in pregnancy. Bananas do not help. Hydration does not help this kind of muscle cramp.

The following treatments do not help all people and should complement your stretching regimen.

A tonic for cramps

Quinine is one of the few treatments shown to help reduce nocturnal cramps. Quinine is found in low concentrations in tonic water (one-tenth of prescription dose). Drinking eight to 16 ounces at night can be a simple remedy.

Quinine is available in a stronger dose by prescription. Quinine is considered safe when used at low doses. Quinine can interact with medications including digoxin and warfarin (coumadin). It should be avoided if you are pregnant or have kidney, liver or heart disease. Quinine can cause rare side effects including tinnitus (ringing of the ears), visual changes, vertigo, nausea, decreased platelets (needed for clotting), and heart arrhythmias. Potential interactions and side effects prompted the FDA to remove it as an over-the-counter treatment in 1995.

Other treatments that may be helpful but have not been studied extensively include: the muscle relaxant, orphenadrine (Norflex), the anti-seizure medicine, gabapentin (Neurontin), and the blood pressure medicine, verapamil. Vitamin B complex may be helpful. Vitamin E is often recommended but studies show that it may not be helpful.

It is important to differentiate leg pain from cramps. Neuropathy (nerve damage), sciatica, as well as clogged arteries in the leg (vascular disease) can cause leg pain. These types of pain, tend to occur throughout the day and not just at night. Vascular disease also causes cramping with walking. In vascular disease, nighttime pain is relieved with hanging the foot over the bed so that gravity draws more blood into the feet. Poor circulation also causes poor healing that results in persistent sores (ulcers). Leg cramps that occur at rest may have a different cause and treatment than cramps associated with activity.

Nocturnal leg cramps must be distinguished from restless leg syndrome, which is a crawling, uncomfortable sensation that forces you to get up and move the legs.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at

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Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

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Nocturnal leg cramps are caused by unopposed foot flexion while in bed, placing the muscles of the calves and feet in their most shortened and therefore most vulnerable position nighttime leg cramps, night time, nocturnal leg cramps. Without modulation by opposing muscles, the sustained contraction produces the painful cramp, which is experienced as sudden severe calf pain, often with a palpable or visibly hardened muscle. In many instances, a voluntary contraction triggers the cramp.

A detailed description of the cramping is essential and should include the setting in which the episodes occur. Those that develop at night or in the context of hemodialysis, hypoglycemia, or heavy sweating from prolonged exertion are likely to be true cramps, as are those coincident with use of calcium channel blockers.

Dystonic cramping is suggested by onset with occupation-related fine motor activity, and contracture by a lifelong onset with exercise. Associated symptoms should be reviewed for the paresthesias and carpopedal spasm of tetany, the weakness and fasciculations of lower motor neuron disease, and the cold or heat intolerance, skin changes, and related symptoms of thyroid disease. Location of the cramping is a less specific finding, but if calf pain is reported, one should include intermittent claudication in the differential diagnosis.

Review of medications is always useful, but use of a potassium-wasting diuretic is not tantamount to an etiologic diagnosis, because hypokalemia is rarely responsible for true cramps (although it should be considered in the differential diagnosis of tetany). Also potentially pertinent in suspected tetany is any distant history of thyroidectomy.
Treatment of Nocturnal Leg Cramps

To relieve an established cramp, one must passively stretch the contracting muscle and gradually contract the apposing one. In some cases, this can be accomplished by simply walking around, which produces a relative dorsiflexion of the foot. Consciously dorsiflexing at the first sign of a leg or foot cramp might abort it. Prophylactic stretching can also prevent attacks.

Patients who suffer from repeated attacks of nocturnal leg cramps seek a reduction in the frequency and severity of episodes. Quinine sulfate has been prescribed for decades for this purpose, but only recently have randomized, double-blind, controlled clinical trials been performed to assess its efficacy.

Studies using low-to-moderate dose regimens (200-300 mg qhs) show less benefit than do those using higher doses (200 mg at supper, 300 qhs). This pattern suggests that response rates are related to serum level attained, which can vary greatly with age and preparation used. Risk of serious side effects is quite small but increases with dose and serum level. Cinchonism (nausea, vomiting, tinnitus, hearing loss), visual impairment, and ventricular arrhythmias are the most important of these adverse effects, appearing when serum levels exceed two.

An immune thrombocytopenia, occasionally fatal, has also been reported. The small, but real, risk of serious toxicity and the modest drug efficacy should temper one's uncritical use of quinine for this otherwise benign condition. The drug is available without prescription in low-dose formulations. For those who suffer disabling nocturnal cramps unresponsive to nonpharmacologic measures, a careful trial of quinine may be useful after reviewing risks and benefits with the patient. Starting with small doses (200-300 mg qhs) is best, and platelet count should be monitored periodically. Only if meaningful benefit is obtained should quinine prophylaxis.

Other drugs shown to be of some benefit include methocarbamol and chloroquine. Vitamin E is promoted in health food stores for treatment of nocturnal cramps, but it has been found to be no better than placebo when tested in double-blind, placebo-controlled fashion. It may be found in combination with quinine.