Cramps - the cause and treatmentCramps typically occur in the leg muscles, usually at night or after intense exercise. Cramps tend to be more frequent as we get older, when blood vessels lose flexibility, blockages are more common, and valve function diminishes.
Typical causes of cramps:
- Poor circulation in legs
- Prescription medication
- Low electrolytes, especially Magnesium
- Long-term Exercise
Poor circulationPoor circulation in legs can be caused by:
Weak heart and/or lungs
As we age, our heart and lung capacity decreases. This can be prevented and actually reversed by eating healthy vegetables, limited fruit, and avoiding processed foods, trans fats and sugars. When combined with short bursts of high-intensity exercise and deep breathing, we can build up our heart and lung capacity, so we can then deliver more oxygen and nutrients to every part of the body, reducing risk of cramps.
Hardened blood vessels
As we age, our blood vessels tend to lose their elasticity as the walls get harder. This means they cannot expand as much to promote blood flopw, or restrict as much when required, so circulation is compromised.
Blocked blood vessels
Plaque buildup in blood vessels can restrict blood flow, starving the muscles from oxygen and nutrients.
Faulty valves in venous blood vessels This is probably the most common cause of cramps, usually accompanied by large, lumpy varicose veins (as distinct from the fine, spidery veins).
If we spend too much time standing or sitting, more strain is placed on the one-way valves in our venous vessels that carry blood back to the heart. The strain eventually balloons the vessel around the valve, causing the valve to leak blood back down the leg, now flowing in the wrong direction. Now all of the oxygen is used up, and the blood is overloaded with Carbon Dioxide and other waste products from the body.
If iron levels are low, we cannot make enough haemoglobin, the component of red blood cells that carry oxygen from the lungs to all parts of the body, and return carbon dioxide to the lungs where it is breathed out. Low oxygen, low haemoglobin, low iron, low ferritin all have the same effect as poor circulation, cramps.
We should all have an annual blood test (and always ask for a printed copy). Check your haemoglobin levels. If the level is low, ask for a complete iron study (serum iron, serum ferritin, TIBC (Total Iron Binding Capacity) and %transferrin saturation tests).
If the %transferrin saturation test has been omitted it can be calculated as follows: serum iron divided by TIBS, multiplied by 100. This can be from 20% to 50%, but best kept below 40%.
If iron and ferritin are low, get the doctor to check your thyroid levels. Low thyroid (hypothyroidism) can cause low stomach acid, in turn reducing our ability to absorb iron (as well as B12 which is essential for iron metabolism, along with folate).
Also if we have a defective MTHFR gene mutation, iron levels can be high, as the body has trouble breaking iron (and other heavy metals) down, and ferritin levels will often be low to normal in these cases.
For more explanation of iron issues, see my article Ferritin and Iron.
ExerciseExercise is important, but we should never exercise strenuously before bed time.
Exercise earlier in the day, and avoid any over-exertion, especially in hot weather, as dehydration will bring on cramps by affecting the ability of electrolytes to do their job in nerve transmission.
Prescription MedicationSeveral types of prescription medication can aggravate cramps. Here are some of the most common ones:
DiureticsWe obviously need the correct balance of potassium and sodium, but what happens when we take a diuretic?
Many blood pressure, glaucoma and edema medications are diuretics, generally of three classes:
Each class works by a different method, but all control how the kidneys deal with water and electrolytes.
Diuretics increase the excretion of water, but with it go electrolytes: sodium, chloride and potassium, lost through the urine, causing extreme fatigue and muscle weakness, painful joints, bones and muscles. A better alternative is a low dose of a long-acting loop diuretic like torsemide (Demadex), reducing risk of electrolyte loss. Reducing salt intake will help eliminate water, but also electrolytes. Exercise will help by losing excess body fat, improving circulation, and decreasing the load on all body organs. Avoid salt substitutes as many contain potassium, which may upsets the delicate sodium-potassium ratio. Use sea salt or himalayan salt instead.
Thiazide DiureticsTypical examples: Chlorothiazide (Diuril), hydrochlorothiazide (Microzide), indapamide (Lozol), metolazone (Zaroxolyn) are also prescribed for blood pressure, glaucoma, congestive heart failure and edema
Thiazide diuretics, like short-acting loop diuretics, may deplete important electrolytes, especially potassium, causing hypokalemia (not enough potassium in the blood). This leads to leg cramps and muscle weakness and/or pain.
Short-acting loop diureticsTypical examples: Bumetanide (Bumex) and furosemide (Lasix, Puresis). Prescribed mainly for high blood pressure, congestive heart failure and edema (swelling of the ankles), designed to help the body lose excess fluid by moving it into the urine, taking electrolytes with it.
Potassium-sparing diureticsThese can cause hyperkalemia (too much potassium in the blood) and this imbalance can cause cramps.
Long-acting loop diureticIf you are taking any of the above and are suffering with cramps, ask your doctor for a long-acting loop diuretic instead (lesser of the diuretic evils).
Beta-blockersTypical examples: Atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), propranolol (Inderal), sotalol (Betapace), timolol (Timoptic) and some others ending with olol slow the heart.
Prescribed for blood pressure, arrhythmias (erratic heart rhythm), tachycardia (fast heart rate), angina, migraines, tremors, and in eyedrop form, glaucoma. They lower blood pressure by blocking adrenaline. They can cause leg cramps, probably because arteries are narrowed, reducing blood flow, especially to the hands and feet (peripheral vasoconstriction). Leg cramps may not start until months or years after starting Beta Blockers, making it difficult to see a connection.
Benzothiazepine calcium channel blockers may be a safer alternative for beta-blockers, espeially for seniors.
ACE (Angiotensin-Converting Enzyme) inhibitorsTypical examples: Benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace) and trandolapril (Mavik). Prescribed for blood pressure and congestive heart failure, and prevent production of angiotensin II, (the hormone that narrows blood vessels), helping relaxation of vessel walls.
Can cause excess buildup of potassium, leading to electrolyte imbalance and leg cramps, painful joints, bones and muscles. Another common side-effect is a persistent dry cough, often unreported because the patient is not aware of this side-effect.
A benzothiazepine calcium channel blocker may be a better option, especially for the aged, African Americans and Asian Americans, who tend to have greater risk of adverse effects. If the patient has fluid retention, a long-acting loop diuretic, e.g. Torsemide may help (low dose).
Angiotensin II-receptor blockers (ARBs)Examples: Candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan (Diovan). Prescribed for coronary artery disease or heart failure in patients who cannot take ACE inhibitors, or have type 2 diabetes, or diabetes-induced kidney disease. Instead of blocking production of angiotensin II, ARBs prevent angiotensin II from effectiveness in constricting blood vessels. Similar to ACE inhibitors, ARBs can lead to high potassium, causing leg cramps, painful joints, bones and muscles.
Alternative may be a benzothiazepine calcium channel blocker, and for fluid retention, a long-acting loop diuretic, e.g. Torsemide may help (low dose).
StatinsTypical examples: Atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor) and fibrates such as fenofibrate (Tricor) are prescribed for high cholesterol.
They can inhibit the production of satellite cells in the muscle, interfering with muscle growth. They stop the liver from making Co-Enzyme Q10 which is essential for muscles. They cause muscle weakness and aches throughout the body (statin-induced rhabdomyolysis) where broken-down muscle fibers are released into the blood, often causing kidney damage. Older adults taking statins can develop sarcopenia (wasting skeletal muscle and strength).
Unless there is existing serious heart disease, a much safer and more effective option is to avoid processed foods, trans fats and sugar. Homocysteine blood levels are a better measure of cardiavascular disease, and can be lowered with Vitamin B12 with Folic Acid and Vitamin B6
Beta2-agonistsTypical examples: Albuterol (Proventil, Ventolin), formoterol (Symbicort), levalbuterol (Xopenex), metaproterenol, pirbuterol (Maxair), salmeterol (Advair) and terbutaline are normally administered via an inhaler, or sometimes in injectable form or as a pill. They relax smooth muscles around bronchial tubes (bronchodilators), making breathing easier. They cause leg cramps for unknown reasons, and are ineffective anyway unless the patient actually has COPD (Chronic Obstructive Pulmonary Disease).
Better alternative: Tiotropium bromide (Spiriva), which may often work better than beta2-agonists.
AntipsychoticsAripiprazole (Abilify), chlorpromazine (Thorazine), haloperidol (Haldol), olanzapine (Zyprexa), risperidone (Risperdal) and ziprasidone (Geodon) are prescribed for schizophrenia, bipolar disorder and other serious psychiatric conditions, also sometimes for agitation and depression. Antipsychotics depress the CNS (Central Nervous System), and lower dopamine levels, causing fatigue, weakness, drowsiness, leading to muscle stiffness and muscle cramping. Major dopamine reduction caused by too much use of antipsychotics can cause muscle rigidity, sometimes non-reversible movement disorders such as akathisia (an urge to keep moving around) and tardive dyskinesia (a syndrome characterized by involuntary, repetitive body movements).
Ask for a smaller dose or a different medication, especially if you are on an antipsychotic drug for sleeping, anxiety or depression, as these drugs are not designed for these disorders.
Sleeping medicationsToo many to list here, but these sleeping aids can also cause cramps. How can anyone sleep with leg muscles locked up, or still in pain from a previous lockup?
Combination medicationsMany other blood pressure medications also affect electrolytes, and are often added to other blood pressure medications, or mixed with one or more classes of diuretics, and have statins added on top of everything else, leading to even worse muscle cramps and other side effects.
If you read the side-effects listed with each drug, generally "muscle cramps" is common to many, usually because of the electrolyte insufficiency or malfunction.
In spite of research that proves that blood pressure medication given to patients with less than 140/90 is only detrimental (invokes more cardiovascular events than those on a placebo), many doctors still give them to many patients when there is no need.
For patients with any high blood pressure, we must look at the cause first: obesity, fried food, over-cooked food, bad fats (canola oil, margarine), sugar, lack of exercise, etc.
ElectrolytesElectrolytes are elements in the body existing as ions, which conduct electricity, and are responsible for correct working of every cell, nerve and muscle in the body.
Electrolytes stabilise cell walls, move fluids around the body, generate energy, and countless other functions.
An imbalance of electrolytes is one of the main causes of cramps, some imbalances caused by prescription medications, some caused by diet and/or supplements.
Common salt, or NaCl (Sodium Chloride) is the best-known electrolyte, but there are more, including, but not limited to:
- Sodium (Na+)
- Potassium (K+)
- Chloride (Cl−)
- Calcium (Ca2+)
- Magnesium (Mg2+)
- Bicarbonate (HCO3-)
- phosphate (PO42-)
- sulfate (SO42-)
This is different from a covalent bond, where atoms are held tightly together and cannot easily be separated. (remember your high school chemistry class)?
Most doctors still advocate a salt-free diet, mainly because they mistakenly belive that salt always increases blood pressure.
This is partly true, because the kidneys remove excess salt from the blood and excrete it through urine, along with many other healthy electrolytes. If the kidneys are overworked, then blood pressure rises to force more blood through the kidneys. For some people, those who are sensitive to excess sodium - Hypernatremia (from Sodium Chloride, the main ingredient in common table salt), but these sensitive people are a small percentage of the population.
Of course, if we consume large amounts of processed food, which is normally loaded up with very large amounts of the wrong sort of salt, it will give us problems.
But if we eat a "healthy" diet of fresh veggies and other natural foods, we can easily become deficient in sodium - Hyponatremia, and other electrolytes if we abstain from any added salt.
Risk factors for salt sensitivity include:
- Being of African American descent
- Having kidney disease
- Being overweight
- Being in the 45+ age group
- Having ancestors with high blood pressure
Safest and best options are Sea Salt and Himalayan Salt which contain over 80 important minerals, not just sodium chloride, and are usually natural, found in nature, and not treated with heat or chemicals.
Sea water has very similar electrolytes to the human body. In fact, in the Second World War, filtered sea water was used for blood transfusions when no blood was available, saving many lives (not used today!)
If we are low in potassium, we can supplement with Potassium Citrate which also helps alkalise the body, or Potassium and Iodine which can also support the thyroid gland if iodine insufficiency is another factor (and very important for nerve transmission).
Why we need saltWe need salt for our Electrolytes.
Electrolytes are essential to carry electrical signals through the body, via a sodium-potassium pump. To contract a muscle, electrical signals are carried by many nerves to the muscles, but each individual nerve does not actually touch the next. Nerves are seperated by small gaps, and each gap is called a synaptic cleft. The transmitting neuron (nerve) is called the presynaptic cell, and the receiving neuron is called the postsynaptic cell. The electrical signal cannot cross the gap, so a chemical action must occur, a system called the sodium-potassium pump. Each neuron has a cell membrane surrounding it, like every other cell in the body, and inside the cell are potassium ions (K+) while outside the cell are sodium ions (Na+). Inside an inactive cell, there is a negative charge, but once an electrical connection is stimulated, a calcium-driven gate opens up in the cell membrane to allow sodium ions to enter. This changes the electrical potential inside the neuron, and once that potential reaches a set threshold, the channel is opened up completely, allowing more sodium ions to rush in. The gate then reverses direction, allowing potassium ions to move out of the cell. These ions physically cross the synaptic cleft, and the reverse happens at the adjacent neuron. This exchange of electrical signals happens very fast using ions as carriers of electrons between nerves. So fast that at the end of this impulse, the signal carries over too far, then must rebound back to attain the original resting state. But what happens if the threshold is not reached?
No transmission takes place. Nature made us this way, otherwise our nerves would be transmitting with just the slightest stimulation, and we would all be jumping around continuously.
What happens if nerves are over-stimulated?
The nerves then transmit signals we do not want. Depending on the stimulation, this can vary from ithching or tingling feelings to violent, jerky movements or cramps, where our muscles lock up and will not relax.
What happens if our sodium, potassium, calcium and water balances are out of whack?
Obviously, we must have the correct ratio of sodium and potassium, with adequate calcium and other electrolytes, as each has an important role. And we need sufficient water for these ions to transport in and out of cells and across the synaptic cleft, so we must always remain well hydrated. Any change in these ratios will upset how our nerves react.
How soon can another impulse take place?
After the impulse we have a refractory period, where the sodium and potassium ions move back to their original sides, and neurons are busy returning to the normal state. During this time, they cannot respond to any new stimulus. When the neuron has returned to the normal state, it is now ready for the next stimulus to arrive.
Are all synapses the same?
No, and they can contradict each other. Some synapses are excitatory, causing a rapid impulse, others can be inhibitory, reducing the chance of an impulse occurring. Nature made us this way so that we have a feedback mechanism, allowing us to gently close a door without slamming it.
Are there other factors which affect nerve transmission?
Yes. All of the other electrolytes impact the threshold voltage before a nerve can "fire" across the gap. Other hormones and chemicals play a part in this process. The best-known inhibitor is GABA (gamma-aminobutyric acid), which mainly affects neurons in the brain, but can affect every other cell and nerve. Valium and other tranquilisers enhance effects of GABA, reducing the ability of a neuron to "fire" across the synaptic cleft, which invokes a sense of calmness.
GABA is available on the LeanMachine online shop.
GABA supplements may help prevent cramp sufferers by reducing the risk of too many neurons "firing" at once.
Other chemicals usually inhibitory are Dopamine, Glycine and Serotonin (mainly in pain pathways).
Some prescription drugs can affect nerve transmission, also drugs of abuse: nicotine, alcohol, methamphetamine, heroin, etc are generally inhibitory and/or releasing extra dopamine, another inhibitor.
Usually excitatory chemicals include Acetylcholine and Glutamate. Prescription drugs like panadol, antihistamines, acid blockers and antidepressants all block acetycholine, causing cognitive decline, poor heart function, poor muscle function, all related to poor nerve transmission at each synapse.
Supplements to help build acetylcholine include Phosphatidylcholine, Choline and Inositol, and coffee (caffeine).
Norepinephrine, also a hormone, and involved in the "fight or flight" response, also in regulating blood pressure and calmness, as a neurotransmitter is usually excitatory, but can also be an inhibitor in some brain areas.
There are several different types of sensory neurons, each having nerve endings encased in structures similar to above, and each sensing a specific stimulus.
- Chemoreceptors sense odours, which are chemicals in the air, using the olfactory which monitors our sense of smell
- Chemoreceptors sense taste, which is chemicals in liquids
- Chemoreceptors in the brain control our breathing by sensing carbon dioxide in the blood and cerebrospinal fluid
- Mechanoreceptors sense touch, pressure and distortion or stretching, e.g. invoking a "knee-jerk" reflex
- Photoreceptors in the eye retinas sense light
- Thermoreceptors sense temperature
- Nociceptors sense pain, pressure, chemicals, heat
- Auditory receptors in the inner ear sense sound wave vibrations
Still want to remove all salt from the diet?
We NEED salt, we NEED potassium, we NEED choline, calcium, magnesium, chloride, carbonate and all electrolytes, as each has important work to do in the body.
We can normally get all of the calcium we need from a regular diet, as long as we have enough Vitamin D3 to assist in the absorption of calcium.
This description is very much an over-simplification of the nerve transmission process, as a full explanation would fill a large book by itself.
TreatmentThe modern diet of processed foods depletes many electrolytes from the body. Add to this prescription drugs, other drugs, obesity, insufficient intake of correctly-balanced electrolytes, poor exercise, and we have a recipe for cramps, which are not only annoying and painful and debilitating, but are a warning sign of potential heart, circulation or other problems and these symptoms should not be ignored.
First thing is to get the doctore to test the blood. A typical blood test will include hgaemoglibin levels, sodium, potassium, sodium/potassium ratio, the kidney panel and the liver panel. If haemoglobin is low, then ask for a ferritin/iron study. If iron is low, change the diet, or use supplemental iron: Chelated Iron but never use a cheap iron supplement like Ferrous Sulfate, the dangerous inorganic kind.
Other supplements which may help cramps:
Choline and Inositol
Active Folate if the faulty MTHFR gene is responsible.
And avoid paracetamol (also called panadol, tylenol, and many different brands in many countries).
Avoid all drugs of abuse.
Check other articles: Blood Tests and Ferritin and Iron
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DisclaimerLeanMachine is not a doctor, and everyone should consult with their own health professional before taking any product to ensure there is no conflict with existing prescription medication.
LeanMachine has been studying nutrition and health since 2011 and has completed many relevant studies including:
Open2Study, Australia - Food, Nutrition and Your Health
RMIT University, Australia - Foundations of Psychology
Swinburne University of Technology, Australia - Chemistry - Building Blocks of the World
University of Washington, USA - Energy, Diet and Weight
Johns Hopkins Bloomberg School of Public Health, USA - Health Issues for Aging Populations
Johns Hopkins Bloomberg School of Public Health, USA - International Nutrition
Johns Hopkins Bloomberg School of Public Health, USA - Methods in Biostatistics I
Johns Hopkins Bloomberg School of Public Health, USA - Methods in Biostatistics II
Johns Hopkins Bloomberg School of Public Health, USA - Principles of Human Nutrition
TUFTS University, USA - Nutrition and Medicine
TUFTS University, USA - Lipids/Cardiovascular Disease I and Lipids/Cardiovascular Disease II
Technical Learning College, USA - Western Herbology, Identification, Formulas
Bath University, England - Inside Cancer
WebMD - The Link Between Stroke and Atrial Fibrillation
LeanMachine has now read thousands of studies, journals and reports related to health and nutrition and this research is ongoing.
Updated 10th December 2016, Copyright © 1999-2017 Brenton Wight and BJ & HJ Wight trading as Lean Machine abn 55293601285