We have all been there – middle of the night, you awake from a deep sleep with the slow, intense, cramp in the lower leg, foot, or thigh. The cruel spasm can last for hours, releasing itself slowly just to add to the misery. Commonly referred to as charlie horses or leg cramps, the medical term is actually “nocturnal cramping.”
Why would your body inflict this horrible torture? And, more importantly, what can you do to immediately stop this and prevent it from happening ever again? The answer to these questions is actually a bit of a medical mystery. Even the esteemed and respected British Medical Journal concluded in 2002 that pharmacological treatment for this painful situation “remains elusive.” (1)
“Pharmacological treatment” is the operative phrase in that sentence. Meaning, solving the mystery is likely NOT prescription related, but nutritional, involving minerals, and structural, involving circulation. There are actually four key mineral depletions involved in nocturnal cramping: magnesium, potassium, sodium, and calcium.
The muscle contraction actually begins when the brain signals an electrical impulse along a neuron. Calcium, stored in the muscle cell, triggers the contraction of the muscle fiber by binding to muscle proteins to change their shape and contract. The muscle relaxes when calcium is taken back up by various pumps. When depleted, the muscle freezes in a contraction.
Calcium needs vitamin D for absorption from the gut. So, if you are about to say, “But, I take calcium and have leg cramps!” I would ask, when have you had your vitamin D blood levels checked? Remember, vitamin D is dosed according to your blood test; if you are deficient, you need more. Typically people need 4,000-5,000 IU per day, but many people may need up to 10,000 IU per day. Ask your doctor to help with dosing this for you. To supplement your body’s calcium, typical doses are 600-1,000 mg per day.
Lack of potassium or sodium
Potassium and sodium create a gradient that helps balance out the calcium for muscle contraction. When the nerve impulse triggers the muscle fiber to contract, sodium races into the cell and at the same time, potassium leaves the cell. The reverse of this happens with muscle relaxation. So, when these are depleted, the muscle freezes in the contraction.
Typically potassium and sodium are replenished easily in the diet by adding electrolytes to your water. The Elete Drops and Trace Mineral Drops are quality electrolytes that provide very effective sodium support. For a more nutritional approach, adding 1 teaspoon of pink salt to 1 liter of water can help. If this doesn’t work, go for the drops.
Potassium can be easily obtained by eating green leafy vegetables, avocado, banana, squash, or salmon. I typically don’t like to start out with potassium supplementation because people can take too much and develop hyperkalemia, a condition that causes a dangerous heart arrhythmia.
Lack of Magnesium
Like sodium and potassium, magnesium regulates calcium, just in a slightly different way. Magnesium plays a huge role in relaxing the muscle contraction by blocking calcium channels. This is how we know magnesium to be effective with stiff, tense, and tight muscles. Topical muscle applications (gels and lotions) and epsom salt baths are very helpful for muscle tension.
As a supplement, many forms of magnesium exist. Remember, magnesium is carried by an amino acid. To deliver magnesium to the muscles, you need a magnesium that is with an amino acid that targets the muscles. The top picks would be magnesium taurate, magnesium malate, or magnesium citrate. Typically, dosages are 200-600 mg per day, depending upon the needs of the body. Taking too much magnesium would result in a loose stool, so then you would just know to back down by 100-200 mg.
How does my body get so depleted?
Exercising or working outside in the hot sun and humidity depletes these minerals because of our excessive sweating. More studies are showing that calcium supplementation before exercise is vital to bone health. Sweating leads to significant dermal calcium loss, and some research actually concludes an increase in the body’s hormonal signaling for bone loss. Calcium supplementation before exercise has been shown to reverse all of this. (2) However, do make sure you are incorporating strength training into your exercise regimen rather than just cardio, as doing so will improve bone density. (3)
In addition to the hot sun and sweltering humidity, medications are a main culprit for nutrient depletions. Many diabetes and blood pressure medications will deplete magnesium and potassium. In addition, psychiatric medications like Seroquel and Risperdal, and even your albuterol inhaler all cause potassium depletions.
Various antibiotics, chemotherapeutic agents, and proton-pump inhibitors cause magnesium depletion. Long-term use of medications that inhibit stomach acid (the H2 blockers as well as PPI’s) are notorious for calcium depletion and can even lead to osteopenia if taken long term. Make sure to have a conversation with your pharmacist about these nutrient depletions.
Dietary inflammation, alcohol, processed foods and high-sugar diets all create depletions in calcium, magnesium, and potassium. Cane sugar actually depletes the body of nutrients; which is why it is actually classified as an anti-nutrient. (4) Be honest with yourself and your nutrition. You simply cannot expect to sustain adequate nutrient levels in the tissue if you eat this way most of the time. If you open a can, box, or a bag to cook a meal, you likely are nutrient deprived. Remember, vegetables and fruits need to be fresh and cooked by you, not a factory
The last contributing factor to leg cramps is actually blood flow. People who have leg deformities, are wheel-chair bound, have atherosclerosis or other circulatory compromise in their legs are prone to leg cramping. This also lends itself to a sedentary lifestyle. If you work for many hours sitting at a desk each day or drive a vehicle for many hours, your lower leg circulation will be stalled. Massage, stretching, and trigger point release are vital to these situations.
There is certainly a lot that goes into understanding what your body is trying to communicate in the midst of that tortuous leg cramp. But, eating right, taking key minerals and electrolytes, understanding your medication nutrient depletions, and regular stretching will help you prevent nocturnal cramping.
Amy Nelson, ND* received her Naturopathic Doctorate from the National College of Natural Medicine in Portland, OR where she studied nutrition, homeopathy, herbal and functional medicine. In addition, Dr. Nelson was the Associate at The IBS Treatment Center in Santa Monica where she treated irritable bowel syndrome and complex food allergies. Dr. Nelson utilizes her experience in natural medicine to address female and male hormonal imbalances, mental health, and digestive disorders. Amy is available for consultation at Peoples North.
*Although licensed in other states, Naturopathic Doctors are not currently licensed in Texas.
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(1) Butler JV, Mulkerrin EC, O’Keeffe ST Nocturnal leg cramps in older people Postgraduate Medical Journal 2002;78:596-598.
(2) Barry DW, Hansen KC, van Pelt RE, Witten M, Wolfe P, Kohrt WM. Acute calcium ingestion attenuates exercise-induced disruption of calcium homeostasis. Med Sci Sports Exerc. 2011;43(4):617-623. doi:10.1249/MSS.0b013e3181f79fa8
(3) Hong AR, Kim SW. Effects of Resistance Exercise on Bone Health. Endocrinol Metab (Seoul). 2018;33(4):435-444. doi:10.3803/EnM.2018.33.4.435
(4) DiNicolantonio JJ, Berger A. Added sugars drive nutrient and energy deficit in obesity: a new paradigm. Open Heart. 2016;3(2):e000469. Published 2016 Aug 2. doi:10.1136/openhrt-2016-000469