How to get rid of leg cramps? Try pickle juice.

Q: I often have leg cramps. What causes them and what can I do to relieve them?

ONE: Leg cramps can happen to anyone—often in the middle of the night without warning or around exercise time—and doctors usually don’t know why.

We know that muscle cramps occur more frequently in the elderly and among athletes, during pregnancy and dialysis, and in those with certain health conditions such as diabetes, cirrhosis or amyotrophic lateral sclerosis. If you experience cramps frequently, be sure to check with your doctor to rule out any concerns.

Leg cramps seem to peak in midsummer and subside in winter, according to a study. Cramps among athletes also tend to increase during periods of hot weather, but it appears that these cramps are not related to dehydration and electrolyte imbalances from sweat, as some have thought.

Evidence on how best to treat leg cramps is weak. But after reviewing the state of the medical literature, I often recommend trying two simple solutions: gently stretch the muscle or take a sip of pickle juice.

We need to talk about pickle juice

For cramps, athletes have long sworn by pickle juice (derived from jars of dill or kosher pickles) and other acidic substances such as mustard or apple cider vinegar.

Experimental data in healthy college-aged men suggest that pickles inhibit muscle spasms through a reflex involving a nerve in the throat. That’s why a tablespoon of pickle hit the back of the throat seemed to bring relief within seconds.

Pickle juice can also work for non-exercise-induced cramps. A randomized controlled trial published last year found that a sip of pickle juice reduced muscle cramp intensity in patients with cirrhosis.

Researchers believe that this improvement is due to a similar reflex that occurs almost immediately, rather than how pickle juice is metabolized by the gut.

More rigorous research is needed on the pickle juice’s effect on muscle cramps. And this strategy may be less helpful for people whose leg cramps are infrequent or resolve on their own too quickly to justify keeping the pickle juice on hand. But it’s safe and cheap enough that I can recommend it to anyone.

Remember: No need to overdo it.

“One sip is all it takes. We’re not asking people to chug pickles, says Elliot Tapper, a hepatologist at the University of Michigan and the 2022 study’s lead author.

Doctors often suggest a trial-and-error approach to preventing leg cramps, including a few weeks of daily calf and hamstring stretches (which can reduce the severity but not necessarily the frequency of nighttime leg cramps), a pinch of magnesium (although a newer meta-analysis found this probably does very little) or a sprinkling of vitamin B complex (which showed promise in a small study from the 1990s).

Your doctor may also try switching medications involved in seizures, including long-acting beta agonists such as those found in Advair or Symbicort and diuretics such as spironolactone.

The funny thing here is that there’s a chance that one of these will work – despite a lot of the data screaming that it shouldn’t. Case in point: A 2017 double-blind randomized controlled trial published in JAMA Internal Medicine found that taking magnesium oxide for one month reduced the number of nocturnal leg cramps by about three times per week. It’s a big win to go from, say, having a cramp that wakes you up every single night to having one every other night instead.

Guess what, though? Placebo did the same.

Studies have also suggested that quinine can reduce the frequency and intensity of muscle cramps. However, due to serious safety concerns associated with its use, including an increased risk of death, quinine for nocturnal leg cramps is not approved by the Food and Drug Administration.

Some might make the logical leap to suggest a nightly gin and tonic to ease cramps. But prescribed doses of quinine are around 300mg, and the FDA limits the amount of quinine in tonic water to 83mg per liter – far more than you get from a standard cocktail.

Considering leg cramps are associated with alcohol consumption, I’d say we’re all just holding our charley horses on that idea.

What I want my patients to know

Dietary supplements are popular for all kinds of reasons, including when evidence-based medicine does not provide good solutions. Don’t hide the supplements you take from your doctor, even if you think they won’t “approve”. I would always rather know and work with you to find safe choices. Many supplements interact with regular prescriptions, and some can have unintended – and potentially harmful – effects.

Meet the doctor: Trisha S. Pasricha is a physician at Massachusetts General Hospital, an instructor of medicine at Harvard Medical School, and a medical journalist.

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