We have all probably had some type of muscle cramps at one point in our lives. I’m talking about those involuntary contractions or spasms of the muscles in our legs or feet that happen most often at night or while we rest. It seems to be much more common in the elderly. As many as 70% of older people have experienced nocturnal leg cramps. Even though we don’t know the direct cause of these cramps, there are risk factors associated with these symptoms. These include dehydration, electrolyte/mineral imbalance, diabetes, and pregnancy. Here are several treatment options that have worked for my patients:
1. Magnesium- magnesium deficiency does not need to be severe to cause cramping. Majority of magnesium blood levels will be normal. We often run a red blood cell magnesium level in our office and will find low or low-normal levels in patients that benefit from magnesium. Presumed cause of magnesium deficiency is excessive exercise. Chronic stress will also deplete magnesium levels. A study involving 14 trained swimmers whom experienced muscle cramps was done. They received only 65 mg of magnesium, from either magnesium ascorbate or magnesium aspartate on 3 consecutive days, just before starting their swim workouts. Muscle cramps were reduced by 86% in the magnesium ascorbate group and by 44% in the magnesium aspartate group. Both treatments reduced the severity of symptoms. I recommend starting with 300 mg daily of magnesium citrate (in the evening) and increase up to bowel tolerance. Too much magnesium can cause loose stools, so stay at a dose right below the dose that causes problems. Common medical conditions associated with magnesium deficiency are diabetes, coronary artery disease, and high blood pressure.
2. Potassium- low potassium levels (again, not seen on blood tests) can also cause leg cramps. Hypokalemia can occur in people using potassium-depleting diuretics (commonly used to treat high blood pressure), or in those with diarrhea or certain disease states. Another common cause of low potassium can be the result of an inadequate intake of fruits and vegetables. One option is to use 2g/day of potassium magnesium aspartate (this preparation contains 50% magnesium aspartate and 50% potassium aspartate). This formulation is best because aspartate enhances the intracellular uptake of potassium and magnesium.
3. Calcium- this is another important mineral that I find helps my patients…especially those who avoid dairy. Doses of 500 mg twice daily of a calcium citrate works well.
4. Vitamin E- several studies have shown improvement in leg cramps after using Vitamin E 300-800 IU daily.
5. Vitamin C and Hesperidin (a citrus flavonoid)- 200 mg of each compound was used 4 times daily in a study of postmenopausal women in which resolution of symptoms were seen in 2-12 weeks.
6. B12 and B-complex- This is where I recommend checking a B12 and B6 level in my patients with leg cramps. It is a very easy and reliable test and can determine if deficiencies are the cause of cramps. It can also relieve fatigue, cognitive decline and migraines. Many elderly have vitamin B-deficiencies and don’t know it. These vitamins can be depleted due to age, chronic stress and in vegetarians.
7. Taurine- this amino acid is a common cause of muscle cramps for those with cirrhosis of the liver. Three to six grams daily along with whey protein showed significant improvement with these patients. Also, L-Carnitine at a dose of 300 mg three-to-four times a day also decreased muscle cramps by up to 63% in patients with cirrhosis in one study.
8. Intravenous Nutrient Therapy- intravenous nutrients of magnesium, B-vitamins and Vitamin C almost immediately relieves muscles cramps. We use this therapy followed by daily oral nutrient supplements with excellent results.
9. Stretching- calf stretching and massage before you hit the pillow at night can be very helpful.
Hope this helps some of the mystery behind muscle cramps.
References: Gaby, A. Nutrition Medicine, 2nd edition, chapter 163.
Jenna, C, Radu, G. Magnesium in preventing muscular cramps in swimmers. Magnes Res 1993; 6:73.
Ayres S Jr, Mihan R. Nocturnal leg cramps (Systremma): a progress report on response to vitamin E. South Med J 1974;67:1308-1312.
Horoschak A. Nocturnal leg cramps, easy bruisability and epistaxisin menopausal patients: treated with hesperidia and ascorbic acid. Del State Med J 1959;31:19-22.