Although any muscle can cramp, the legs and feet tend to be particularly susceptible. Considering how common muscle cramps are to humans, it may be surprising to learn that we still don’t fully understand why they occur. The oldest theory on muscle cramping suggests that cramps happen as a result of fluid imbalance in the body often caused by sweating, dehydration, and an electrolyte imbalance. A newer theory that has gained traction is that muscle cramps are caused by the nervous system and that it is the inappropriate, spontaneous, and repetitive firing of nerves that causes muscles to cramp. Changes brought about by things like fatigue, injury, or the wear-and-tear of aging may cause these nervous system disruptions. It is likely that the reason we get muscles cramps is multi-factorial and possibly different for different people at different times in their lives.

Anyone, at any time in life, can experience muscle cramps. We often tend to think of the athlete dropped to the ground during competition when we think of cramps (Exercise Associated Muscle Cramps, or EAMC), but while athletes are certainly at a higher risk of experiencing cramps, they are not the only ones. Many pregnant women, especially in their third trimester, experience regular muscle cramping due to changes in blood flow and nerve compression from extra weight. Muscle cramping also tends to increase as we age, with over half of those over 80 reporting nocturnal or at-rest cramps.¹ A loss in neuron function and muscle mass as we age is thought to be a contributing factor. For many older adults, age also brings less physical activity and a decrease in mobility which can cause tendon shortening and increase nerve terminal excitability, contributing to cramping.

Since we don’t fully understand why cramps occur in the first place, it should come as no surprise that we also don’t know the best ways to prevent and treat them. Different treatment approaches may work for different people and it may take some experimentation to find the approach that works best for you. Bear in mind that although muscle cramps are normal, they can also be a sign of something more serious, so talk with your doctor if you’re unable to improve cramping with the following tips.

Build a Strong Foundation

A healthy diet is always the foundation of good health. A diet for muscle cramps should include plenty of fresh vegetables and fruits, which are excellent sources vitamins and minerals, including those important electrolytes like potassium. Be sure to get enough protein for your body and age. (Hint: as we age, we need more!) Protein is critical for maintaining muscle mass and helps to balance blood sugar. Finally, keep those added sugars and refined flours to a minimum to help balance blood sugar. A high sugar and carbohydrate diet depletes the body of important minerals and contributes to inflammation.²  It also puts us on the blood sugar rollercoaster where the blood sugar highs flush water and electrolytes out in the urine, and the inevitable blood sugar dips starve the muscles of the glucose needed to properly contract and relax.

Maintaining muscle mass throughout our lifetimes is another important foundational piece and one the most important things we can do to ward off the negative effects of aging. Losing muscle mass puts more strain on your muscles, which can lead to more frequent muscle cramps.³ There is also an association between a sedentary lifestyle and a higher risk of nocturnal muscle cramps.⁴ Lifting weights (even light ones) is great at any age, but you can also try yoga and tai chi, both of which build muscle mass but have the added benefit of increasing flexibility and balance.

Stay Hydrated

Even if dehydration isn’t the main cause of muscle cramps, staying hydrated is still important, since it is likely a contributing factor. A general recommendation is to drink half your body weight in ounces each day. And beware that caffeinated beverages may contribute to muscle cramping in some.⁵

Try Supplements

A high quality multi vitamin and mineral formula is a great place to start. It helps to ensure you are getting the most important vitamins and minerals every day.

If you regularly sweat a lot, it is also important to replenish electrolytes (such as sodium, potassium, magnesium, and calcium). These minerals are involved in the normal contraction and relaxation of muscles and can be depleted with heavy sweating. Electrolytes may also be important for those on restrictive diets, like keto. Consider adding an electrolyte supplement to your routine and get adequate sodium by salting your food to taste with a mineral-rich sea salt.

Magnesium plays an important role in muscle and nerve function. In fact, muscle cramps are sometimes a sign of magnesium deficiency, yet many people don’t get enough of this important mineral.⁶ Magnesium may be particularly helpful for pregnant women who are experiencing muscle cramps.⁷ (Be sure to check with your doctor or midwife before supplementing with magnesium if you are pregnant.)   

In one small study, supplementation with a B-complex for four weeks led to significant improvements in leg cramps compared to placebo.⁸ Participants took a B-complex that contained 50 mg of B1, 250 mcg B12, 30 mg B6, and 5 mg B2, three times a day.   

Homeopathy is a type of natural medicine that treats illnesses using very small, dilute amounts of certain natural substances that in higher doses produce symptoms similar to those being suffered. There are numerous homeopathic remedies that may be applicable to those suffering muscle cramps including combination products specifically designed for leg cramps.

Don’t Throw Out the Pickle Juice

Strange as it may sound, there is ample anecdotal evidence suggesting pickle juice (and mustard) can stop a cramp once it’s begun and can even prevent them from happening in the first place. Research into this phenomenon suggests that pickle juice triggers a reflex in the mouth, throat and esophagus (likely the transient receptor potential channels or TRP) that inhibits nerve activity in cramping muscles.^{9 10} Further research has found that it is likely the acetic acid in pickle juice (and perhaps the sour taste in general) that is responsible for this effect. Researchers recommend athletes consume 2.5 ounces of pickle juice, ¾ to 1½ teaspoons yellow mustard, 3 teaspoons sweet relish, or 1 teaspoon apple cider vinegar (diluted in water) divided between the beginning of a workout and at the onset of a cramp.¹¹ In a similar manner, there is also some research to suggest that strong tastes such as capsicum (found in hot chilies), cinnamon, and ginger may also activate TRP channels and reduce the intensity of cramps and the soreness felt after.¹² While most research has focused on cramping in athletes, these low cost, simple remedies might be worth a try for others suffering from cramps.

Stretch it Out

Stretching is not only the most effective way to stop a cramp once it has begun, it may also help prevent cramps from happening in the first place.¹³ In one study, adults 55 and older with a history of nocturnal cramps did a 3-minute leg stretching routine before bed for six weeks and saw a decrease in the number of nightly cramps and a slight decrease in cramp severity compared to the placebo group.¹⁴ Adequate warming up and stretching before exercise is also recommended.

Check Your Prescriptions

The most common medications linked to muscle cramps are diuretics, statins, and inhaled long-acting beta 2 agonists.¹⁵ But numerous other medications can cause leg cramps, so be sure to check with your doctor or pharmacist if you are on prescription medications and are experiencing frequent muscle cramps.

One of the most common side effects of statin drugs is muscle cramping.¹⁶ This occurs because these drugs block an enzyme that the body needs to make Coenzyme Q10 (CoQ10), a vitamin-like nutrient intimately involved in energy production. In those experiencing cramps as a side effect of statin drug use, try 100 to 200 mg of CoQ10 a day and consider investigating safer and more natural cholesterol lowering alternatives.¹⁷

While most muscle cramps are not cause for serious concern, they can cause serious distress. Explore the diet changes, natural remedies and lifestyle habits that can bring relief so you can get back to feeling and performing your best.

References

1. Rabbitt, L., Mulkerrin, E.C., O’Keeffe, S.T. (2016, Nov). A review of nocturnal leg cramps in older people. Age and Ageing, 45(6), 776-782. https://doi.org/10.1093/ageing/afw139
2. https://www.vtfc.com/insights/blog/this-just-in-over-consumption-of-sugar-contributes-to-muscle-joint-pain/
3. American Academy of Orthapaedic Surgeons. (n.d.). Muscle Cramps. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/muscle-cramps.
4. Delacour, C., Chambe, J., Lefebvre, F., Bodot, C., Bigerel, E., Epifani, L., Granda, C., Haller, D. M., & Maisonneuve, H. (2020). Association between physical activity and Nocturnal Leg Cramps in patients over 60 years old: a case-control study. Scientific reports, 10(1), 2638. https://doi.org/10.1038/s41598-020-59312-9
5. Molema, M. M., Dekker, M. C., Voermans, N. C., van Engelen, B. G., & Aarnoutse, R. E. (2007). Caffeine and muscle cramps: a stimulating connection. The American journal of medicine, 120(8), e1–e2. https://doi.org/10.1016/j.amjmed.2006.07.035
6. Murray, M. (1996). Encyclopedia of Nutritional Supplements. Prima Publishing.  
7. Dahle, L.O., Berg, G., Hammar, M., Hurtig, M., Larsson, L. (1995). The effect of oral magnesium substitution on pregnancy-induced leg cramps. Am J Obstetrics Gynecology. 173(1), 175-180. https://doi.org/10.1016/0002-9378(95)90186-8
8. Chan, P., Huang, T. Y., Chen, Y. J., Huang, W. P., & Liu, Y. C. (1998). Randomized, double-blind, placebo-controlled study of the safety and efficacy of vitamin B complex in the treatment of nocturnal leg cramps in elderly patients with hypertension. Journal of clinical pharmacology, 38(12), 1151–1154.
9. Miller, K.C., Mack, G. W., Knight, K. L., Hopkins, J. T., Draper, D. O., Fields, P. J., Hunter, I. (2010). Reflex inhibition of electrically induced muscle cramps in hypohydrated humans. Med Sci Sports Exerc, 42(5), 953-961.  DOI: 10.1249/MSS.0b013e3181c0647e
10. Schwellnus, M.P., Hoffman, M.D. (2017). Transient receptor potential channels and exercise-associated muscle cramping: A tale of multiple complexities. Muscle & Nerve, 56(3), 355-357. DOI:10.1002/mus.25668
11. Hooper Marosek, S. E., Antharam, V., & Dowlatshahi, K. (2020). Quantitative Analysis of the Acetic Acid Content in Substances Used by Athletes for the Possible Prevention and Alleviation of Exercise-Associated Muscle Cramps. Journal of strength and conditioning research, 34(6), 1539–1546. https://doi.org/10.1519/JSC.0000000000003595
12. Craighead, D.H., Shank, S.W., Gottschall, J.S., Passe, D.H., Murray, B., Alexander, L.M., Kenney, W.L. (2017). Ingestion of TRP channel agonists attenuates exercise-induced muscle cramps. Muscle Nerve, 56(3),379-385. doi: 10.1002/mus.25611
13. Miller, K.C., Stone, M.S., Huxel, K.C., Edwards, J.E. (2010). Exercise-associated muscle cramps. Sports Health, 2(4), 279-283.  doi: 10.1177/1941738109357299
14. Hallegraeff, J. M., van der Schans, C. P., de Ruiter, R., & de Greef, M. H. (2012). Stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults: a randomised trial. Journal of physiotherapy, 58(1), 17–22. https://doi.org/10.1016/S1836-9553(12)70068-1
15. Rabbitt, L., Mulkerrin, E.C., O’Keeffe, S.T. (2016, Nov). A review of nocturnal leg cramps in older people. Age and Ageing, 45(6), 776-782. https://doi.org/10.1093/ageing/afw139
16. Bowden, J., Sinatra, S. (2012). The Great Cholesterol Myth. Fair Winds Press.
17. Challem, J. (2010, June). Coenzyme Q10: Energy for life. Natural Grocers Health Hotline. Available at https://www.naturalgrocers.com/article/coenzyme-q10-energy-life