Natural Leg Cramp ReliefJuly 30, 2010 Written by JP [Font too small?]
On July 8, 2010 the U.S. Food and Drug Administration issued a warning about the use of quinine (Qualaquin) for night time leg cramps. The basis for the alert were reports of “serious and life-threatening blood-related reactions, including serious bleeding due to severe lowering of blood cells (platelets) and a condition known as hemolytic-uremic syndrome/thrombocytopenic purpura which, in some cases, may result in permanent kidney damage”. In actuality, Qualaquin has only been FDA-approved for the treatment of malaria. However, it is frequently used “off-label” to reduce the incidence and severity of nocturnal leg cramps. The reason for this is pretty straight forward: quinine improves cramping symptoms in many patients. But the issue of potential toxicity must also be taken into account. Fortunately, there are several dietary supplements that may offer a safer way to achieve a cramp-free night’s sleep. (1)
Addressing a nutritional deficiency or imbalance tops the list of options for addressing muscle cramping of any kind. The mineral magnesium is perhaps the best studied nutrient for “chronic persistent leg cramps”. Most, but not all trials involving magnesium have found significant symptomatic improvement when administering about 300 mg of elemental magnesium daily. The most common form of magnesium used in the studies has been magnesium citrate. Side effects of magnesium therapy are generally considered mild and include occasional reports of diarrhea. This adverse reaction can be virtually eliminated by spreading out the daily dosage into two or more servings. One the other hand, if constipation is an issue, a single dosage may help address this unrelated health concern. (2,3,4,5,6,7,8,9)
Calcium has also been evaluated as a possible candidate for use in those with nocturnal cramping. The evidence thus far has been mixed. A study from November 2008 found no reduction in cramping in a group of 323 middle-aged men receiving either 600 mg or 1,200 mg of calcium daily over a 2 year period. However, a trial from way back in 1987 did find partial or total symptomatic relief in 60 pregnant women who received 2,000 mg of calcium/day. The 1987 study built upon a pilot trial from 1981 which also found good success when providing 1,000 mg of calcium twice-daily to 42 pregnant women. (10,11,12)
Select vitamins including B-Complex, Vitamins C and E have likewise exhibited some degree of success in the natural management of leg cramping associated with sleep disturbance. It should be noted that most of the trials using vitamins tested the effect in specialized patient populations such as the elderly and those undergoing hemodialysis. Nonetheless, they still serve as a good reminder that nutrient deficiencies/inadequancies can manifest in various symptoms including muscle cramping. (13,14,15,16)
- B-Complex Dosage Used: 250 mcg of Vitamin B12, 50 mg of thiamine (B1), 30 mg of Vitamin B6 and 5 mg of riboflavin (B2)
- Vitamin E Dosage Used: 100 IUs of alpha-tocopheryl acetate, three times daily
- Vitamins C & E Combination: 250 mg of Vitamin C & 400 IUs of Vitamin E
Another important consideration in cases of long term leg cramping is poor circulation to the legs, otherwise known as chronic venous insufficiency (CVI). Several fruit and plant extracts have been shown to improve a number of symptoms relating to CVI including ankle and calf circumference, cramping, edema (fluid retention), “leg heaviness” and pain in the lower extremities. The dietary supplements that have demonstrated the greatest success in this arena are: diosmin, grape seed extract, hesperidin, “micronized purified flavonoid fraction”, oxerutins and Pycnogenol. These individual ingredients and combinations are often found in products used to discourage the formation of broken capillaries and varicose veins. The potential benefit in relation to cramping is a lesser known attribute and rarely advertised. (17,18,19,20,21,22,23,24,25)
Although the drug Qualaquin is only available via prescription, some patients and physicians consider it a legitimate alternative to conventional medications. After all, quinine was originally synthesized from the cinchona tree and has been used medicinally by native cultures for hundreds of years. However, the conventional and traditional short term use of quinine is quite different than the chronic administration that often occurs in those with recurrent leg cramps. This may partially explain the adverse reactions more commonly reported in the modern age. To my mind, it’s more important to address the cause of the cramping in the first place. If it’s a lack of essential minerals or vitamins, a nutrient dense diet and/or supplementation should be provided. Poor circulation is the next suspect on the list. Numerous scientific studies tell us that this can be safely improved by using select dietary supplements as well. Therefore, it is my opinion that quinine should not be on the top of anybody’s list of preferred therapies for this prevalent condition. (26)
Tags: Calcium, Magnesium, Vitamins
Posted in Alternative Therapies, Diet and Weight Loss, Nutritional Supplements
July 30th, 2010 at 12:15 pm
I can vouch for magnesium being of great benefit in regard to leg cramps! I used to have terrible leg cramps about once a week. These were the type of cramps that feel like the muscle was in a tight knot. The pain was so intense that only standing up and pacing the floor could help relieve it. Sitting down was an invitation for pain on top of already intense pain. There was no room to think about anything other than pain for a good quarter of an hour. Once the muscle cramp eased I would spend the remainder of the evening on edge and trying not to sit, step or rest wrong because the cramp was just lying in wait and ready to jump back into play at any moment. JP is the savior to my leg cramp problem. Ask him about the topical magnesium study he hosted. Thanks so much JP!
July 30th, 2010 at 8:42 pm
My son got relief from restless leg syndrome by taking magnesium malate. He said that magnesium citrate didn’t help.
July 31st, 2010 at 5:17 am
Good morning, JP ☻
great article, JP!
i have to add that anemia causes leg cramps too. Iron deficiency leads also to cramps in legs and also to symptoms of restless legs. Women should be aware of that 😉
wish you two a wonderful weekend ☼☼☼
ps: could you consider to write an article about poisons (and how to avoid) in pc hardware? read something about that today and im shocked, the most producers of pc systems don’t care about poisons, recycling etc. we all here spend more or less time with this poisoning hardware 🙁
Greetings from the far side ☼
July 31st, 2010 at 6:33 am
My mom suffered with cramps for years and used a popular homeopathic remedy sold in stores with some success. A co-worker just this week mention she was having cramps at night. She needs to see this and use some of the suggestions.
July 31st, 2010 at 11:31 am
Thank you so much for sharing that, Oct! 🙂
For anyone who’s interested, here are some of the details of the topical magnesium trial. A follow up column is long overdue:
July 31st, 2010 at 11:35 am
Thank you for adding that, Iggy. It’s possible that the malic acid component is partially responsible for the your son’s success. It’s certainly worth trying if other forms of magnesium don’t yield positive results, IMO. MM is well absorbed and safe as well.
July 31st, 2010 at 11:48 am
Iron-deficiency should always be addressed. Too little or too much iron is problematic. A lack of iron is of particular concern in cases of restless leg syndrome. My understanding is that it’s less likely to be an issue in instances of recurrent cramps. Nonetheless, testing for iron-status could only yield useful information.
I’ll see what I can find about PC-related toxins. There seems to always be something negative, along with the positive, associated with technology. Ah, life in the 21st century …
I hope you and your husband have a wonderful weekend as well! 🙂
July 31st, 2010 at 11:51 am
I hope your mom’s friend sees this information and benefits from it. Perhaps you can get it to her? Let me know if I can help.
April 11th, 2015 at 12:44 pm
Update: Another alternative …
J Am Board Fam Med. 2015 Jan-Feb;28(1):21-7.
The effects of myofascial trigger point injections on nocturnal calf cramps.
BACKGROUND: The purpose of this study was to elucidate the effects of injection at trigger points on pain and sleep disturbance in patients with nocturnal calf cramps (NCCs).
METHODS: Patients with NCCs that occurred at least once per week and who had myofascial trigger points (MTrPs) on the gastrocnemius muscles were enrolled in the study for 9 months. At the first visit (T0), we measured the intensity of NCC pain on an 11-point numeric rating scale, recorded the frequency of NCCs, and calculated the Insomnia Severity Index (ISI). We then checked for MTrPs on the gastrocnemius muscles and injected 1-2 mL of 0.25% lidocaine into each of the trigger points. At 1 (T1), 2 (T2), and 4 (T3) weeks after the first visit, we repeated the process performed at T0.
RESULTS: Twelve patients completed the treatment schedule and attended the follow-up visits. Mean values of the numeric rating scale pain score, frequency of cramps, and ISI declined significantly at T1, T2, and T3 compared with baseline (all P < .01). Of 12 patients, 10 had clinical insomnia before treatment, and this number decreased significantly to 3 patients at T2 and 1 patient at T3 (P = .012 and P = .001, respectively). CONCLUSIONS: These preliminary data show that injection at MTrPs in patients with NCCs not only alleviated pain and reduced the frequency of cramps but also lessened the severity of insomnia as measured by the ISI. A larger randomized controlled trial is needed to confirm these findings and determine whether the effect lasts over the long term. Be well! JP