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Q: I often have leg cramps. What causes it and what can I do to relieve it?
A: Leg cramps can strike anyone — often in the middle of the night without warning or around the time of exercise — and doctors usually don’t know why.
We know that muscle cramps are more common in older people and athletes, during pregnancy and dialysis, and in people with certain medical conditions such as diabetes, liver cirrhosis, or amyotrophic lateral sclerosis. If you experience frequent seizures, be sure to consult your doctor to rule out any concerns.
According to one study, leg cramps seem to peak in midsummer and subside in winter. Cramps in athletes also tend to increase in hot weather, but it appears that these cramps are not related to dehydration and electrolyte imbalances from sweating, as some have suggested.
There is little evidence on how best to treat leg cramps. But after reviewing the state of the medical literature, I often recommend trying two simple solutions: gently stretching the muscle or taking a sip of cucumber juice.
We need to talk about pickle juice
For cramps, athletes have long sworn by pickle juice (strained from jars of dill or kosher pickles) and other acidic substances like mustard or apple cider vinegar.
Experimental data on healthy college-age men suggests that pickle juice inhibits muscle spasms through a reflex affecting a nerve in our throat. Because of this, a tablespoon of brine down the throat seemed to provide relief within seconds.
Cucumber juice can also work for cramps that aren’t caused by exercise. A randomized controlled trial published last year found that sipping pickle juice reduced the effects muscle Spasm intensity in patients with liver cirrhosis.
Researchers believe this improvement is due to a similar reflex that occurs almost immediately, rather than the way pickle juice is metabolized in the gut.
The effect of cucumber juice on muscle spasms needs to be studied in more detail. And this strategy may be less helpful for people whose leg cramps occur infrequently or go away on their own too quickly than justifying having pickle juice on hand. But it’s safe and cheap enough that I’d happily recommend it to anyone.
Remember: there’s no reason to overdo it.
“One sip is enough. We don’t tell people to drink pickle juice,” said Elliot Tapper, a hepatologist at the University of Michigan and lead author of the 2022 study.
Doctors often suggest a trial-and-error approach to leg cramp prevention, including a few weeks of daily calf and thigh stretching (which might reduce the severity, but not necessarily the frequency, of nighttime leg cramps), a dose of magnesium (although a recent A meta-analysis found that this probably does very little) or a dash of vitamin B complex (which showed promise in a small study from the 1990s).
Your doctor may also try to switch out any medications associated with seizures, including long-acting beta-agonists like those found in Advair or Symbicort and diuretics like spironolactone.
The funny thing is, there’s a chance one of these might work — although plenty of data is screaming that it shouldn’t be. Case in point: A double-blind, randomized, controlled study published in JAMA Internal Medicine in 2017 found that taking magnesium oxide for one month reduced the number of nighttime leg cramps by about three times per week. That’s a big win if, for example, you’re not being woken up by a cramp every night and instead have a cramp every other night.
But guess what? The placebo did the same.
Studies have also shown that quinine can reduce the frequency and intensity of muscle spasms. However, due to serious safety issues associated with its use, including an increased risk of death, quinine is not approved by the Food and Drug Administration to treat nighttime leg cramps.
Some might take the logical step of suggesting an evening gin and tonic to relieve cramps. However, regulatory doses of quinine are around 300 mg, and the FDA limits the amount of quinine in tonic water to 83 mg per liter — far more than you would get from a standard cocktail.
Considering that leg cramps are associated with drinking alcohol, I would say that the thought just bugs us all.
What I want to tell my patients
Dietary supplements are popular for all sorts of reasons, even when evidence-based medicine doesn’t offer great solutions. Don’t hide the supplements you’re taking from your doctor, even if you don’t think they “approve” it. I always prefer to know you and work with you to make safe decisions. Many supplements interact with popular recipes, and some can have unintended — and potentially harmful — effects.
Meet the Doctor: Trisha S. Pasricha is a Physician at Massachusetts General Hospital, Associate Professor of Medicine at Harvard Medical School, and medical journalist.
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