The Ultimate Guide to Cramps
By Chris Kartalia
© Chris Kartalia, 2013
About the Author
Hi, my name is Chris Kartalia, owner of MgBRIGHT LLC. Since founding this company in 2011, I have learned an extraordinary amount about muscle cramps – and I want to share my knowledge with you.
As part of doing my job, I have answered thousands of phone calls and emails from desperate people all over the world. I quickly became amazed that cramping was such a common issue, and that most doctors have no good remedies. By paying close attention to these conversations with customers, I started to see certain patterns.
Although over 80% of people respond very well to our magnesium product, some don’t. A few even get worse. It quickly became clear that cramps and spasms are a complex phenomenon, with multiple causes and solutions. It also was obvious that certain medications and medical conditions often go hand-in-hand with cramping. Uncovering the true causes of cramps/spasms became a fascinating mystery to me, one that I became obsessed with solving.
Unfortunately, after weeks of research, I was unable to find a comprehensive text or resource that could explain ALL the potential causes of cramps, with clear, easy-to-follow recommendations. I decided that I needed to create that text. My independent research, combined with my first-hand experience in talking to thousands of people with chronic cramps/spasms, makes this e-book one of a kind.
Because I am not a doctor, you cannot take this e-book as medical advice. This information is meant to be shared and discussed with your doctor, because only YOUR doctor can determine what is safe for YOU.
This book should take less than an hour to read. I hope you enjoy it! If you have any questions, contact me at firstname.lastname@example.org .
The 7 Fundamental Causes of Cramps
Severe muscle cramps have a wide variety of causes -- yet, some causes are much more likely than others. For example, it is more likely that you have a dietary deficiency of a crucial nutrient than a neurological condition. This book will help you understand what these frequent causes are, and what you can do to fix them.
CAUSE #1 -- EXTREMELY COMMON: Side Effect of Common Medications
Medication side effects are the most common cause of muscle cramps. There are hundreds of medications that are known to cause muscle cramps to some degree. However, there are certain common drug categories, for very common medical conditions, that are frequently associated with cramps. If you take any of the following medications, it is possible that one (or more) are the culprit. (But it is not certain -- read the entire book to learn what else could be causing or contributing to your cramps.)
If you are taking one or more of the medications listed in the following categories, talk to your doctor about reducing your dose, or trying an alternative medication.
Category 1, Extremely Likely to Cause Cramps: Beta-2 Agonists
These medications are prescribed for asthma, COPD and other breathing disorders. They are "inhaler" medications.
formoterol and budesonide
salmeterol and fluticasone
albuterol and ipratropium
Category 2, Very Likely to Cause Cramps: ACE Inhibitors
These medications are for high blood pressure.
Vasotec or Renitec
Lisodur / Lopril / Novatec / Prinivil / Zestril
Coversy / Aceon
Altace / Tritace / Ramace / Ramiwin
Category 2, Very Likely to Cause Cramps: Angiotensin Receptor Blockers
These medications are also for high blood pressure.
Category 2, Very Likely to Cause Cramps: Diuretics (Water Pills)
For high blood pressure, glaucoma, and edema/water-retention.
Clorpres, Tenoretic, Thalitone
Capozide, Dyazide, Hyzaar, Lopressor HCT, Maxzide, Prinzide
Category 3, Somewhat Likely to Cause Cramps: Statins
For high cholesterol.
Advicor, Altocor, Altoprev, Mevacor
Atorlip, Caduet, Lipitor, Lipvas, Sortis, Torvacard, Torvast, Totalip, Tulip
Inegy, Lipex, Simcard, Simcor, Simlup, Vytorin, Zocor
The medications in the following list have all been associated with muscle cramps -- some very frequently, others, rarely. They are in this list because they span dozens of medication categories, and don't fit in any of the above categories. The below drugs that are highlighted yellow with a *are considered Category 1 and 2 culprits -- very likely to extremely likely to cause cramps. All others can be considered Category 3 to Category 4 -- somewhat likely to occasionally causing cramps. If you find any of your medications on this list, discuss with your doctor. (This information was extracted from the SIDER2 Side Effects Database for keyword "muscle cramps": http://sideeffects.embl.de/ )
(Generic Names Only)
carbenicillin indanyl sodium
polyethylene glycol 3350
CAUSE #2, EXTREMELY COMMON: Too Much Calcium, Too Fast
Calcium is good for you -- in moderation. Unfortunately, it is easier than ever to get more than your body can easily handle. It has been added to many common foods and beverages, like orange juice and breakfast cereal. As always, people love milk, cheese, and yogurt, which have a lot of calcium. On top of that, many are taking large doses of calcium supplements, due to their doctor's instructions for osteoporosis prevention. Unfortunately, when the body gets too much calcium, too fast, it may deposit the excess in soft tissues, like the arteries -- and the muscles. Calcium causes muscles to contract -- and too much contraction often means cramps. To make things worse, Vitamin D, a crucial vitamin, greatly increases the absorption of calcium.
Is there a way to verify if you have too much calcium? A standard blood test may reveal a calcium excess -- or it may not. It depends on when the blood test is performed. For example, you may have elevated calcium at night, but have normal calcium in the mornings -- or vice versa. It depends on your individual metabolism, and your personal schedule of medications and foods that may affect your calcium level. So what can you do?
Our recommendation is to try stopping all extra calcium for 2 weeks. This means no calcium supplements, and only modest dairy intake, if at all. You may continue your Vitamin D. If your cramps improve, this means your body had too much calcium. Be sure to be very careful with your calcium dosage going forward, and you can keep your cramps under control.
Rare but possible: If decreasing calcium makes your cramps WORSE, jump to Cause #6.
Cause #3, EXTREMELY COMMON: Too Little Magnesium
Magnesium is vital for muscle relaxation, but most people don't get nearly enough of it. That's because it is mainly found in dark green leafy vegetables, like spinach and kale, and seeds/nuts. If you don't eat these foods daily, there is a good chance you are low on magnesium. In addition, aging, caffeine, alcohol, stress, exercise, sweating, sleep deprivation, and various medications can all accelerate your body's loss of magnesium. This means you need even more than the average person.
In addition, too little magnesium will magnify the negative effects of too much calcium. People who have too much calcium often have too little magnesium, due to eating the wrong foods.
How can you tell if your magnesium is too low? Unfortunately, the magnesium blood tests that doctors perform are not always accurate indicators of the magnesium level inside your muscles, which is what matters. This is because your body needs a constant supply of blood magnesium to keep your heart beating -- so your body will do whatever it can to maintain your blood magnesium level. This means it will pull magnesium from your tissues and bones, just to keep you alive. The gold standard for determining your true magnesium level is called a magnesium loading test, which is very time consuming and unusual for doctors to perform outside of the hospital. So what can you do?
First, talk to your doctor to see if it is safe for you to supplement with magnesium. A number of medications can affect how your body processes magnesium, so be careful. If your doctor gives the OK, you need to find a method of getting magnesium that is high-absorbing. See Part 3 for specific recommendations. Only take it with food, and start with a low dose, because it can cause diarrhea if you take too much. If you get diarrhea, take less, and spread out your dose more throughout the day. Take it daily for at least 2 weeks, to give it a chance to build up in your system.
Rare but possible: If magnesium makes your cramps worse, jump to Cause #5.
Cause #4, LESS COMMON: Too Little Potassium and/or Too Little Sodium
Low potassium and sodium are uncommon in healthy people, because they are found in sufficient amounts in nearly all diets. However, a number of medications, (especially certain diuretics) and certain medical conditions like diabetic ketoacidosis, Cushing's syndrome, cirrhosis, hypothyroidism, and kidney problems can cause your body to lose potassium and/or sodium. Talk to your doctor or pharmacist to determine if any of your medications or medical conditions have this side effect.
Do you exercise a lot, especially in warm weather? It is possible you are losing too much potassium and sodium (and magnesium) through sweat. You need to increase your intake of all three of these minerals.
If you suspect you might need more potassium and/or sodium, a good experiment to try is to drink a large glass of vegetable juice in the morning and night (You may prefer Low Sodium V8 Juice, which still has plenty of sodium for most people). Upon drinking this, you should be able to quickly determine if it helps your cramps or not.
Rare but possible: If this makes your cramps worse, jump to cause #5.
Cause #5, RARE: Too MUCH Potassium
HIGH potassium can also cause muscle pain. Other symptoms often include malaise, palpitations, and muscle weakness. Although there are many potential causes, elevated potassium most commonly occurs in people with kidney disease/damage, and/or in people taking an ACE inhibitor, Angiotensin receptor blocker, and/or a diuretic (see list of medications above). Also, be advised that magnesium raises potassium, so too much magnesium can actually cause cramps for some people! This is why you need to talk to a doctor before trying it, especially if you take any of the above medications.
If you believe your cramps are caused by too much potassium, there is unfortunately no easy solution. Talk to your doctor.
Cause #6, RARE: Too LITTLE Calcium
LOW calcium routinely causes cramps, but is relatively uncommon compared to the other causes. Low calcium most frequently occurs if you have a very restricted or unusual diet, are grossly Vitamin D deficient, have parathyroid problems, and/or have kidney damage/disease. There are other causes as well; be advised that low calcium can only be confirmed by your doctor.
If you believe you have low calcium, it is best to supplement with a time-release calcium supplement, to avoid large spikes of calcium in your bloodstream, which has been connected to heart disease. Also, Vitamin D and Vitamin K2 are vital to increase calcium absorption and proper retention.
Cause #7, RARE: Neurological Disease or Injury
Cramps can be caused by any number of neurological conditions that result in the nerves to your muscles not firing correctly. Examples include ALS (amyotrophic lateral sclerosis), neuromyotonia, motor neuron disease, peripheral neuropathy, and dystonia.
If you have cramps associated with a neurological condition, you MAY still find some relief from one or more of the above recommended minerals, but you MUST talk to your doctor to determine if they are safe for you.
What to Do
It depends how healthy you are:
Are you healthy, not on any medications, and have no medical conditions?:
Then review the above causes, and attempt to identify what is causing your cramps, then start experimenting with the above recommendations. If you are impatient, you may wish to try the "shotgun" approach that works rapidly for many people in your situation: Temporarily decrease calcium, while increasing magnesium, sodium and potassium. If your cramps decrease or are eliminated by following this protocol, you may reintroduce calcium if you wish. If your cramps come back, that means your calcium is too high, and you need to cut back.
Are you on medications and/or have medical conditions?:
Review the above causes of cramps, and attempt to identify what is most likely causing your cramps. Then, share this information with your doctor or pharmacist, and inquire if any of the recommendations are safe for you to try. Your doctor may be skeptical of some of these recommendations -- that is OK. The important thing is that you confirm it is safe for you to TRY them. Often times, experimentation is the only way to determine what works for YOUR cramps.
And, if all the above recommendations fail:
There are numerous prescription medications that have some efficacy for cramps. However none of them are a cure, and all of them have side effects. Keep reading below to learn information about these and other last-resort options, and then discuss them with your doctor.
Profiles and Reviews of Supplements, Folk Remedies, Pharmaceuticals and Experimental Medical Therapies.
Recommended Nutritional Solutions
Magnesium: If you need to increase your magnesium intake, the best way is through your diet. Foods that are very high in magnesium are dark leafy, green vegetables, like spinach and kale; nuts and seeds, especially pumpkin seeds (shelled) and almonds; and dark chocolate. If you wish to supplement with magnesium, you want something that is highly absorbing and doesn't cause diarrhea, which is a common side effect from magnesium. The best way to rapidly raise your magnesium levels is with an epsom salt soak. Epsom salt is magnesium sulfate, which absorbs through your skin. You may purchase epsom salt at at pharmacy. Instructions: Pour 6 cups or more of epsom salt in a hot bath, and soak for 30-45 minutes. You will need to repeat this daily in order to get lasting results.
After this, the next best thing is our product, oral magnesium bound to malate (MgBRIGHT©, www.mgbright.com), which is high absorbing and does not cause diarrhea like most magnesium products.
Potassium: If you need to increase your potassium intake, you need to generally increase your fruit and vegetable intake. As mentioned earlier, the most convenient way to do this is with vegetable juice, like V8. Another great way is dried fruit, like apricots and prunes. Avocados and beans are two especially healthy, dense sources of potassium. Coconut water is a delicious and refreshing way to get a lot of potassium. You may choose to supplement with potassium capsules, but be aware, that they are limited by the FDA to 99mg each. Considering the recommended daily dose is 4 grams and up, you must take many capsules, to even begin to supplement your dietary intake. You can also ask your doctor for a potassium prescription.
Calcium: If you are low in calcium, the most likely cause is that you are low in Vitamin D, which is vital for calcium absorption. You should take 2000-5000iu of Vitamin D a day, with a fat-containing meal to permit proper absorption. There is a good chance this will restore your calcium levels. You may of course also increase you dairy intake. However, dairy can cause health issues for many people, like allergies and digestive upset. If this is the case for you, there is a good chance you would respond well to Goat Milk/Goat Cheese, which is much easier to digest, and non-allergenic. If you wish to supplement with calcium, you want a SLOW ABSORBING supplement, and you want to take the LOWEST dose that delivers results for you, for the reasons explained earlier.
Sodium: It is obvious that eating more salt will increase your sodium intake; however, I do not recommend eating unhealthy processed foods to achieve this goal. The best way is to use a sea-salt product instead of regular salt with your normal meals. Sea salt contains other trace minerals that your body requires, and improves the taste. However, not all sea-salt contains the vital nutrient Iodine, which you need to maintain proper thyroid function. If you want to "kill two birds", you may wish to supplement with sodium ascorbate, which contains both sodium and vitamin C.
Folk Remedies for Cramps
Besides magnesium/calcium/potassium/sodium as described earlier, there are a number of other natural remedies for cramps. Because they have not been studied by scientists, it is difficult to determine whether or not they work. Although, they may be worth a try, if you are out of options.
Apple Cider Vinegar/Pickle Juice/Mustard
All these contain vinegar. Vinegar, also known as acetic acid, is able to help your body make the crucial chemical Acetylcholine, which is necessary for proper muscle function. If you can handle drinking shots of vinegar, you may get some relief from this remedy. However, it will not fix the root cause of cramps. In addition, it may cause stomach upset and nausea.
Hyland's Leg Cramps
This product is a homeopathic quinine remedy. This means it contains miniscule amounts of quinine -- so miniscule, it is nearly undetectable. It is quite possible this remedy works due to the placebo effect -- but if it works for you, great!
Tonic water contains greater amounts of quinine, but still far below what a doctor would prescribe for muscle cramps. However, if your cramps are not severe, you may get some relief from it. Beware that normal tonic water contains a lot of sugar. You may prefer diet tonic water.
Putting a Bar of Soap in Your Bed
There is no evidence how or why this would work, but some people swear by it. Most likely, it is a placebo effect.
Prescription medications for cramps and their side-effects
Quinine is usually the most effective prescription medication for muscle cramps. However, it rarely stops cramps entirely. Typical results are a decrease in pain and frequency of 20-30%. Be advised, prolonged use of quinine can have rare but serious side-effects, that have even killed numerous people. For this reason, the FDA has issued recommendations against the prescription of quinine for cramps, and many doctors no longer prescribe it. However, doctors CAN still prescribe it if they think your cramps are serious enough. If your doctor is reluctant, and you have exhausted all your other options, you must be forceful in demanding this medication, or find a doctor who will be more accomodating.
Baclofen is a muscle relaxer that is primarily used for spastic muscles. If you have cramps associated with spasms, there is a chance Baclofen might help you. Be advised, baclofen can cause drowsiness and mental slowness. In addition, prolonged use of baclofen can result in dependence, making it difficult to come off the medication. If your doctor prescribes you baclofen, never stop taking it without consulting your doctor. It is important to take it every day as directed.
Gabapentin, Pregabalin, Clonanzepam, Diazepam
These medications are similar in their action to Baclofen, however they are often more potent and have more severe side effects and addiction/dependence risks. You must be very careful with these!
Calcium Channel Blockers
These medications are intended to lower blood pressure, and also inhibit the action of calcium on the muscle cell, which causes a relaxant effect. There are many different medications in this group, and there are risks associated with long-term use. Be advised, magnesium is nature's calcium channel blocker without the risks of a pharmaceutical, and should be tried before one of these medications.
For some people, calcium channel blockers can make cramps worse.
This drug is a vasodilator, which means it widens blood vessels. There is some evidence that it can help severe muscle cramps. Potential side effects include upset stomach, diarrhea, and rash.
This drug blocks the action of sodium in muscles, which has a relaxant and anti-spasmodic effect. However, this drug also effects the heart, which may not make it suitable for daily use for muscle cramping. Dizziness, heartburn, nausea, nervousness, trembling, unsteadiness are common side effects.
Experimental Treatments and Therapies
Medical marijuana has long been known to ease painful cramps and spasms throughout the body. With the growing legalization movement, there are a huge variety of products available that do not require smoking -- for example, capsules, drops, lozenges, and edible products. Furthermore, there are many varieties of marijuana that do not get you "high" or impair you in any way, but simply ease pain. If you wish to research this topic further, look online for information on "CBD rich marijuana". Depending on your state, there are many reputable doctors who will prescribe marijuana if you have serious cramps or spasms that do not respond to other therapies.
Acupuncture, Massage, Sauna, Chiropractic and Yoga.
There is strong anecdotal evidence that these therapies can temporarily decrease the severity and frequency of cramps and spasms for some people. However, the therapies must be repeated frequently, and the cost is often prohibitive for most patients.
Many people with cramps and spasms have claimed that their symptoms improved greatly by cutting sugar from their diets. It is unclear exactly how this works, but some researchers have suggested the sugar is "toxic", especially to an aging metabolism, and can disrupt ALL the body's normal systems and functions, including those of the muscles and nerves. If your cramps and spasms have not responded to anything else, it may be worth a try to cut sugar out of your diet for 2 weeks, and see what happens. But be careful and read labels closely, because sugar can be found everywhere, under many different names -- like corn syrup, sucrose, cane syrup, barley malt. Search online for "Names of Sugar" to learn more.
If you are overweight, it is possible that the added stress on your musclular system, in addition to inadequate activity and general unhealthiness, is leading to your cramps/spasms. It has been proven that the most successful diet is one that you can follow, with the minimum amount of thought and effort. For this reason, I strongly recommend the Slow Carb diet, which simply requires that you cut out sugar (including soda and fruit) and most starches, like wheat, potatoes corn and rice, and replace them with beans, lentils, quinoa, sweet potatoes and other dense carbohydrates. Eat as much of these as you want, along with unlimited vegetables and meat. Then once a week , you can "cheat", and eat anything you want -- pizza, ice cream, candy, whatever your heart desires. No calorie counting, no exercise (unless you want to!), and no complicated schedules to learn. If you follow this, the pounds WILL melt off. And as many people who have experienced weight loss will tell you, all sorts of maladies just tend to "disappear" when you get to a healthy weight. For more information, search online for Slow Carb Diet.
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