Q: I often have leg cramps. What causes them, and what can I do to alleviate them?
Leg cramps seem to peak in the midsummer and decrease in the winter, according to one study. Cramping among athletes also tends to increase during periods of hot weather, but it seems these cramps aren’t related to dehydration and electrolyte imbalances from sweating, 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.
Yep, pickle juice.
We need to talk about pickle juice
For cramping, athletes have long sworn by pickle juice (strained 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 suggests that pickle juice inhibits muscle cramps through a reflex involving a nerve in our throats. It’s why a tablespoon of pickle brine hitting the back of the throat seemed to bring relief within seconds.
Pickle juice may also work for cramps that aren’t induced by exercise. A randomized controlled trial published last year found that a sip of pickle juice reduced muscle cramp intensity in patients with cirrhosis.
Researchers believe this improvement is due to a similar reflex that occurs almost immediately, rather than by how pickle juice is metabolized by the gut.
More rigorous research is needed on pickle juice’s effect on muscle cramps. And this strategy might be less helpful for people whose leg cramps are rare or disappear on their own too quickly to justify keeping pickle juice handy. But it’s safe and cheap enough that I’d feel comfortable recommending it to anyone.
Remember: No need to overdo it.
“A sip is all it takes. We’re not telling people to chug pickle juice,” said Elliot Tapper, a hepatologist at the University of Michigan and the 2022 study’s lead author.
Preventing leg cramps
Doctors often suggest a trial-and-error approach for preventing leg cramps, including a few weeks of daily calf and hamstring stretching (which might reduce the severity, although not necessarily the frequency of nocturnal leg cramps), a stint of magnesium (although a recent meta-analysis found that this probably does very little) or a sprinkle of vitamin B complex (which showed promise in a small study from the 1990s).
Your physician may also try swapping out any medications that are implicated in cramping, including long-acting beta-agonists like those found in Advair or Symbicort and diuretics like spironolactone.
The funny thing here is that there’s a chance one of these will work — despite much 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 a month reduced the number of night leg cramps by about three times per week. That’s a huge win to go from, say, having a cramp wake you up every single night to having one every other night instead.
Guess what, though? The placebo did the same thing.
Studies have also suggested quinine can reduce the frequency and intensity of muscle cramps. But because of serious safety issues 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 propose a nightly gin and tonic to ease cramping. But prescribed doses of quinine are around 300 mg, and the FDA restricts the amount of quinine in tonic water to 83 mg per liter — far more than you’d get from a standard cocktail.
Considering leg cramps are associated with alcohol consumption, I’d say we all just hold our charley horses on that idea.
What I want my patients to know
Supplements are popular for all kinds of reasons, including when evidence-based medicine doesn’t provide great solutions. Don’t hide what supplements you’re taking from your doctor, even if you think they won’t “approve.” I’d always rather know and work with you to find safe choices. Many supplements interact with common prescriptions, and some may have unintended — and potentially harmful — effects.
