Cramping during athletic competition can be a great deterrent of performance. Cramps can be present for a variety of reasons, all which must be thoroughly investigated to determine why they are occurring so the proper treatment may be applied. In this issue, I am going to discuss the chemical-nutritional role in cramp involvement.

The balance between calcium and magnesium in the body is crucial. A normal level of one nutrient can be perceived low by the body if the opposing nutrient is high. This is seen often in women taking a high dose calcium supplement. They may have a functionally low magnesium level, sometimes evident in a blood test, especially those who consume a high carbohydrate diet. A high carbohydrate diet tends to increase the body's need for magnesium, an issue I have touched upon slightly before.

A cramp due to calcium is many times overlooked. Although not as common as a cramp brought upon by a sodium-potassium imbalance, the calcium cramp is tricky because it is usually due to calcium displacement, rather than lack of the nutrient. Simply put, that means you can consume all the calcium you want, but what you do with it is another matter. Soft tissue calcium starvation is what causes these types of cramps, not calcium deficient bones.

To prevent calcium starvation of tissues, three factors must be present. First, and obviously, you must have the calcium available. Second, the form should be in a more acidic (rather than basic-neutral) form, such as calcium lactate or citrate. Calcium carbonate should be avoided; it is very difficult for the body to absorb. Third, and what most people lack, is a proper fatty acid balance. That means a diet rich in "good" fats - Omega 3 and 6 oils such as nuts, seeds, vegetables, and fish, to name a few. It also means eliminating all trans fats, also known as partially hydrogenated fats, from your diet - not decreasing them, but eliminating them, due to their inflammatory and destructive effects on the body. (More on this next time.) It is these "good" fats that allow the calcium to be driven into the soft tissue to prevent cramping and a host of other problems.

What are other soft tissue calcium deficient symptoms? One big one is a cold sore/fever blister. Many people take the amino acid lysine for their cold sore, aiming to bump out arginine and starve the sore away. But for the vast amount that this doesn't help, calcium with the proper fats works wonders. The cold sore acts as a blessing in disguise; they know when their body chemistry is off, and can address the problem before it spills over into other symptoms. This is evident in those who get their cold sores in temperature extremes, such as exercising in the hot sun.

Cramping of the calves at nighttime, especially those that are of the "Charley horse" type, can indicate calcium deficiency or displacement. Lying in bed for a prolonged period without being able to fall asleep can be an adrenal symptom as I've mentioned before, but it can also be from a calcium issue.

The sodium-potassium balance becomes an important factor in cramping for athletes, particularly those under a great deal of stress or during high volume training. The aerobic base is crucial to help maintain healthy adrenal function and sodium re-absorption by the kidneys. An overtrained athlete leaning more towards the anaerobic side will show signs of adrenal fatigue, resulting in sodium loss. This can reveal itself with symptoms such as cramping, physical and mental fatigue, a chronic feeling of thirst, a feeling of dizziness or lightheadedness upon standing, and craving for salty foods. Though salt tablets and sodium-rich foods may help the athlete short term or through a race, the key is to address rebuilding the adrenals so the sodium isn't lost.

Sodium is more of a culprit in this case than potassium. However, there are those whom extra sodium will cause more cramping which potassium will prevent. These individuals will also have signs of overtraining but due to a hyper-adrenal function (high cortisol), rather than that of the tired, low-adrenal output. Yes, it can get complicated.

Cramping can also be a result of dehydration. That may sound obvious, but you'd be surprised how many athletes don't drink enough water during the day and during training/competition. This is why, for example, the carbohydrate gel packs tell you to drink water with consumption. The suddenly high glucose solution entering your stomach will draw fluid from your working extremities to absorb the glucose. This can help with the energy, but leave your limbs tired and cramped. Adrenal fatigue can result in an under-hydrated body from the constant loss of sodium. So with water, like calcium and all nutrients, you can drink plenty of it, but it doesn't mean you'll absorb it.

A 24-year old woman came into my office complaining of fatigue, menstrual cramps, and difficulty falling asleep, along with some general aches and pains. Her running performance had been sub-optimal for the last few months for unknown reasons. She was taking a calcium supplement for some time recommended by a friend for the cramps, as well as a multi-vitamin, and was on a high carbohydrate, low fat diet. Using manual medicine techniques, a fatty acid imbalance was revealed, and she noted that her bread contained partially hydrogenated vegetable oil, and she used margarine, also a trans fat. She also showed a need for flax oil, and was advised to continue with her calcium supplement, but reduce her carbohydrate consumption and eat more "good" fats and eliminate all trans fats. She returned a month later noting that didn't get the menstrual cramps that she thought "every woman gets" and was sleeping much better, and her energy picked up. Most all of her nagging aches and pains had subsided, most likely from her body's ability to now properly fight inflammation, rather than provoke more. There were adrenal issues to treat due to the stress she had been under, but a simple change in diet had made a world of difference.

You can see that the value of a nutrient can be looked at not only as a therapeutic agent, but a clue to what may be awry in the body. An athlete constantly needing salt to prevent cramps needs to address the adrenal glands, not live off the salt. Another whose cramps are prevented by magnesium need not take mega-doses of the nutrient, but understand why they need so much, perhaps due to carbohydrate intolerance, or an unmanaged stress pattern.

There are also structural-physical reasons for cramping. Muscle imbalances and gait disturbances can spring a muscle cramp. These tend to reveal themselves in the ever so familiar "side-stitch". Some athletes live with these pains constantly, pushing through the agony and only having a good day when the pain decides to give them a day off. It doesn't have to be that way, but that is a story for another day.