Nocturnal Leg Cramps: Reasons why and what you can do about it
Dear Dr. Susan,
QUESTION Three or four times a week, I awaken in the middle of the night with an excruciating charley horse in my calf muscle. I've started dreading bedtime because I'm afraid that "tonight's going to be one of those nights." I heard quinine helps, but it is no longer available. Do you have any other suggestions? —Mary
What you are experiencing is called nocturnal leg cramps (NLC), and it afflicts half of the over-50 population.
Despite many theories, there's no real understanding about what causes NLC, which most often affects the calf (gastrocnemius) muscle.
Quinine, an antimalaria medicine, used to be a popular treatment for NLC, but the evidence of its benefits has always been weak, and because of its significant side effects, the FDA recently disapproved its use for NLC.
The silver lining in all of this is that there is renewed interest in NLC among researchers, so maybe soon we'll get more answers about this little-understood condition. In the meantime, you need help right away.
I'll review mainstream medicine's views on NLC and preventing future episodes, and then I'll give you all the new research and information that's out there.
Coping with NLC the Conventional Way
If you are awakened by a nasty leg cramp, most doctors will tell you to turn onto your back, straighten the affected leg, and cock your toes up toward the ceiling to stretch the cramping muscle.
If you're still cramping, you should gently massage the muscle. If that doesn't work, carefully get up and bear weight on the cramping leg and try walking around a bit.
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If that doesn't help, get a better stretch by standing on a stair or other elevated surface with your heels hanging over the edge, and gently lower the heel of the affected leg. If all else fails, you can try taking a hot bath or applying a heating pad.
But at that point, you've either resolved the problem or it's resolved itself, because NLC episodes rarely last more than 10 minutes. To prevent repeat attacks, untuck your bed covers so that they're not so confining.
Before going to bed, do some calf stretches. And, during the day, wear shoes that have good arch support because flat feet supposedly predispose you to NLC. In addition, drink plenty of water and eat foods rich in magnesium and potassium, such as pumpkin seeds, raisins, beans, bananas, and tomato juice.
A Fresh Look at NLC
The connection between age and NLC begs the question: What risk factors does the average over-50 crowd have that younger people don't?
Here are some common risk factors and what you can do about them.
Risk factor #1: A medicine cabinet full of prescription drugs
Half of the people seeking medical help for NLC are taking statins, diuretics, and/or beta-agonists. It's unusual for Americans who are over 50 to not take at least one of these medications.
Ask your pharmacist if the side effects of any drugs you're taking include leg cramps. If so, ask your physician about reducing your dose or finding alternative treatments.
Risk factor #2: Unreliable digestion/ absorption of nutrients
For a motor nerve to successfully stimulate a muscle fiber, its electrical signal must be delivered across cell membranes on the backs of certain nutrients, especially calcium, potassium, and magnesium. If that's impaired, sudden, rapid-fire discharge of several motor units at the same time (i.e., a spasm) can result.
To reduce the risk of this happening, stop using stomach acid reducers, which seriously impair your ability to digest your food. In addition, take a top-quality multinutrient designed for a woman in your age group, such as TwinLab Women’s Ultra Daily, 120 capsules (link to Amazon Affiliate program)
And clinical trials have suggested that taking extra B vitamins can also help (Harvard Health Letter).
In addition, make sure your daily diet includes foods naturally high in calcium, potassium, and magnesium. One excellent source is coconut water, which has a natural balance of all three.
Remember that if you're taking a diuretic or are diabetic, your increased urine output is flushing minerals out of your system. One cup of coconut water twice daily should be extremely helpful. You can buy coconut water at health food stores.
Risk factor #3: Less oxygen in peripheral muscles
There are several ways to combat this problem.
► Increase the frequency, intensity, and duration of your aerobic exercise.
► Take CoQ10 for increased oxygen uptake at the cellular level. This is especially important if you're taking a statin, which depletes natural CoQ10 levels. I recommend 50 mg twice daily in an oil base (for enhanced absorption).
► Practice deep breathing. Infants, who have 100 percent blood oxygen saturation, pull in oxygen by lowering their diaphragm. But adults, with oxygen saturation between 80 and 95 percent, expand their chest cavity and hold their belly in, leaving the largest portion of lung tissue idle.
Some other nutritional ways of coping
► Take hesperidin, the citrus flavonoid, which may protect against NLC by improving leg circulation (Phytotherapy Research).
Studies show that hesperidin in fruit isn't particularly bioavailable. You can overcome that by taking a higher dose in supplement form (Journal of Nutrition).
► Invest in light therapy, which has been proven to boost cellular metabolism, reduce inflammation, and improve the speed of nerve transmission (Electromyography and Clinical Neurophysiology).
My favorite at-home light therapy are red light LED’s for energy and health support and an an infrared device for pain relief.
► Don't eat within three hours of bedtime. Digestion diverts blood and oxygen to your gut, leaving your legs in the dark.
Risk factor #4: Thyroid disease
The incidence of thyroid disease, which is a muscle cramp risk factor, increases with age. Thyroid problems often go undiagnosed because the conventional medical community still uses the wrong tests. Ask your physician to assess your thyroid function with a blood test for free (not total) T3 level, as well as thyroid stimulating hormone (TSH).
Risk factor #5: Inadequate vitamin D
Vitamin D is essential for calcium absorption, and deficiency is particularly common in older people who don't live in the sunbelt. Taking cod liver oil (a rich source of vitamin D) seems to reduce the frequency and severity of NLC. If you cannot stand the fishy smell (it is cod liver oil after all,) you can try the capsule or softgel form of cod liver oil which may be more palatable.
I also recommend getting 15 minutes of unprotected sun exposure every day to build up vitamin D in your body. Be sure to avoid the peak hours of 10 AM to 2 PM, when the sun is the strongest, and if you plan on being outdoors for longer than 15 minutes, apply sunscreen. Mary, I hope these solutions bring you significant relief—and a much-needed good night's sleep.
Best wishes to you and your loved ones as you enjoy the week!
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