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Cramping Your Style

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 deficiency 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 your body does 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. People who take cheap calcium carbonate supplements, oyster shell calcium, and TUMS are taking the wrong type. 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 and flax oil, 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. This is due to their inflammatory and destructive effects on the body. 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 (such as bursitis and kidney stones).

What are other soft tissue calcium deficient symptoms? A 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 this doesn’t help yet 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 also 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 even 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 she 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 cause 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.


Leave a comment
  1. Randy Crew permalink

    “Cramping Your Style” is an excellent article. As a follow up, I’d appreciate some information on the treatment of calcium displacement which I believe is the cause of my early morning leg cramps, mostly in the calf muscles. I get my calcium from yogurt and raw or steamed veggies. I eat roasted almonds and roasted sunflower seeds daily. I don’t take any calcium/mag/potass supplement as that has led to morning leg cramps in the past. What am I doing wrong? And what other things should I be doing. The cramps are daily. Thank you.

    • Thanks Randy. Consider either a need for omega 3 fats or betaine HCL (stomach acid supplement) as I note in the article. You most likely have the calcium available, but you’re not using it correctly because it can’t get into those soft tissues without fats and acid. Some people use apple cider vinegar (1-2TB a day) to get the acid. Almonds and sunflower seeds are omega 6. Omega 3 is fish oil, flax, and walnut.

      If that doesn’t work, consider a blood sugar handling issue. Calcium parallels with blood sugar. So if you’re waking up hypoglycemic, then Ca levels may be low too. The fix for that would be to make sure you’re eating frequently thru the day, including a sufficient amount of protein.

      Let’s hear what works…

  2. Ben Turner permalink

    Hello, I play indoor volleyball and don’t usually suffer from leg cramps, however when I play beach volleyball I get servere cramps in pretty much ever muscle in my legs. It gets to a point where i can no longer stand and any position i try to stretch to relieve the pain causes cramp elsewhere. My fitness levels are exellent and I have gone through trail and error with plenty of water and changes in diet. Can you give any advice on what the problem may be? Many thanks.

    • Cramps like that are typically due to your inability to actually hold onto the water. So you may drink plenty of water but still be very dehydrated. Salt and carbohydrates are two main reasons for this (lack of either one, or both). If your sodium level is low, you can’t hold onto water – this could be because you are not getting enough salt in your diet or because your adrenal glands are fatigued, so you don’t hang onto sodium well.

      If your glycogen levels are low that could cause you to cramp too – either you’re not getting enough carbohydrates in your diet, or you’re training too anaerobically so you use up stores constantly. I had this problems many years ago racing triathlons – I’d get intense cramps to the point I had to stop. Once I ate more regularly, with adequate carbohydrates, especially after high intensity or long duration training, the cramps went away. Interestingly, my body weight went from 150 to 158 with no fat gain. I was about 8 pounds chronically dehydrated.

      • Anna permalink

        This also may have to do with increased Vitmain D sending calcium to her bones instead of staying in the blood.

      • Andy Briggs permalink

        Possibly because the soft sand is causing extra “drag” on your leg muscles and making them work much harder. I am not an athlete but a 62 year old builder who suffers horrendous cramps after a hard days work out on site. Trudging my way through deep mud carrying heavy weights certainly does exasperate the problem. Regards, Andy……ouch!

  3. Rich permalink

    I have been getting cramps during intensive cross country mountain biking after about 2 hours. I have been told to reduce salt in my diet by my GP to prevent Hypertension, which seems to have worked. I make a point of avoiding transfats, eat fish, cook with olive or peanut oil and take a fish oil supplement daily. I always hydrate with purpose made drink before and during training and eat ‘shot blocks’ every 10 or 15 minutes. This weekend during a prolonged ride and getting cramp I experimented with a Calcium Carbonate tablet and my crams had gone within a few minutes and didn’t come back for the rest of the ride. Have I taken my lack of sodium in my diet too far?

    • Did you have high BP prior because salt does not cause high BP unless a person has kidney issues? Salt may provoke hypertension that is already a factor from another reason, but removing salt from your diet can do more harm than good. It’s a necessary nutrient, and one that many athletes are deficient in. As noted in this article, fatigued adrenals often result in athletes dumping too much salt in their sweat and urine and then cramping.
      The shot blocks are okay but only if you’re training anaerobic or long aerobic (2-3 hours or more). If you’re not, then you’re shifting your body from fat-burning to sugar-burning during training and that can deplete your glucose and glycogen stores and along with that you’ll lose water and cramp.
      Could be a calcium problem since that helped you but calcium parallels blood glucose so it may just be a Band-Aid during that time and not addressing the true problem. Sounds much more like a glycogen depletion/dehydration problem to me since it happens during intensive riding, or a salt issue. More aerobic training will help too and getting carbs in immediately after training should also help a lot.

  4. Margaret permalink

    Hi – The excruciating leg cramps returned after resuming my BP meds(Norvasc) and now the magnesium powder (Calm) isn’t as effective. They start in the evening and move from one leg to the other, usually triggered when attempting to stretch after sitting or resting an hour after working out.I workout 1-2 hours a day, mostly aerobics, but 2-3 hours of light to medium weight lifting. I recently started eating 8 – 10 veggies a day. Not getting enough protein, just 4 – 6 oz, and bingeing on bad carbs about 1 – 2 times per week. Any clues on why the leg cramps are so severe?

    • Norvasc is a calcium channel blocker and thus can be the reason for your cramps. Since they returned after resuming this med I’d say that’s pretty much your answer. You should talk to your prescribing doctor about this.

      • Margaret permalink

        Hi – Thanks for your helpful advice. It turned out the calcium channel blocker was the source of my severe leg/body cramps. After dropping the amlodopine, my cramps are history. I’m looking for more natural ways to resolve my bp issues. I am convinced that it can be done if I can get to the root cause, which appears to be the daily stress that I encounter. Meditation and getting a little more sleep appear to be dropping my bp, and I can now exercise without the pain. Any advice you have on natural remedies for controlling bp would be very helpful.

  5. LisaC permalink

    Hello Dr. Ganegmi,

    I read your article after doing a search on adrenals and sore muscles, very informative, thank you.

    I have adrenal fatigue and recently started working with someone who started me on a diet that included foods I didn’t eat. In the past when I would drink orange juice, I noticed I wouldn’t feel well for a few days.

    The diet had me drinking about 4oz of OJ a few times a day, eating yellow squash and peaches, all of which have a lot of potassium. I was also eating salt during the day as well.

    In two weeks, the diet has my sleep dropped back and, my leg muscles tensed up and very sore. I stopped eating the foods a few days ago but my legs are still sore.

    This morning, after five hours of not great sleep, after I got up, my heart rate went up to 130, muscles tensed. I ate some salt, it took the HR down some but my body still won’t relax and my HR is still high. Salt would help before but it isn’t right now.

    I read about potassium and salt, there has to be a balance but I’m not finding that after eating those foods. This was not happening before.

    Do you have any ideas as to what I could do?

    Any suggestions you can give would be more than appreciated!!

    Thank you kindly,


    • Hi Lisa, salt and potassium supplements may help short term, but they are not the way to fix the problem. Think of it like someone with blood sugar handling issues – even to the point of diabetes. If your blood sugar is low – you eat some sugar/carbs to increase your sugar. If it is high, you either exercise vigorously or take insulin to bring it lower. Obviously the ideal way to address this is to eat right and change the lifestyle so blood sugar swings don’t occur and the body heals. Same goes for the K/Na balance. You’ve got to figure out what is causing the adrenal fatigue and address it that way – proper diet (not orange juice!), exercise, lifestyle, etc. That’s about the best I can tell you without seeing you or a phone consult.

  6. Aram permalink

    Hi I get foot cramps when I swim. I’m not sure if it’s because I am kicking at a wrong angle of my foot or if its another factor. Have you ever had anyone else with this problem? I drink plenty of water before swimming and make sure to stretch my foot a little right before getting in the pool. I am also an avid runner and I never cramp when I run. any help would be greatly appreciated.

    • It is probably from a muscle imbalance in one of the calf muscles. If course, stretching won’t prevent the cramps. Check out the Achilles Tendonitis video on the sock-doc site to learn how to treat the trigger points in the gastroc and soleus.

  7. Cherry Read permalink

    Regarding your interesting perspective about cold sores and calcium absorption: People suffering from herpes simplex are generally told to avoid high quantities of arginine in their diet which means no nuts or seeds. So this, in effect, could be contributing to a deficiency in Omega 6 and so less effective absorption of calcium and more herpes…! Would you recommend ignoring the no nuts and seeds advice or just trying to get adequate Omega 6 from other sources?

    • Yes that is true on the arginine because it’s the arginine that tends to feed the virus – which is actually why a lot of people take lysine since it opposes the arginine. I’ve never asked a patient to cut down arginine foods, and I don’t use lysine too much. Rather, I use a product that helps metabolize arginine via the urea cycle – and sometimes nutrients such as manganese, biotin, and certain B-Vitamins help with this.

      But as I write and as you ask, yes – often it is a fatty acid imbalance (could be omega 6) and therefore you won’t push calcium into the soft tissue. I’m not sure how much arginine is actually in nuts/seeds – I know that it’s rather high in dairy, oats, and cocoa though. Typically you don’t want to eat too many nuts/seeds (Omega 6 fats) anyway as I discuss elsewhere.

      • rachelle permalink

        If what you say is true about the calcium….then another reason why lysine probably works is because it increases calcium uptake

  8. Cherry Read permalink

    Thanks for your reply :) I’ve never seen dairy on any of the lists of foods high in Arginine though I knew about cocoa. Perhaps dairy is also high in Lysine & therefore they cancel each other out? I never found taking Lysine to be effective but I do react strongly to cocoa, nuts and chick peas which are all on my list as high in Arginine.
    I’ll definitely bear your approach in mind :)

  9. Diane Dahlin permalink

    Is there a brand of Calcium that you’d recommend? In your article, you said to avoid Calcium Carbonate. Do you recommend Calcium Lactate of Citrate instead? Or is there another form you recommend?


  10. belinda richardson permalink

    Hi. Researching causes for leg cramps came upon this article and comments. I have had a thyroidectomy and one parathyroid removed. Since having issues with my thyroid then the removal of both, I have suffered with leg cramps. My doctor recently changed and upped my T3 meds and lowered my T4 because my blood work was showing an imbalance. I eat no white foods following the Atkins program. I am carbohydrate sensitive. I have suffered the last 6-8 weeks with extreme!! leg cramps leaving me feeling bruised and like a noodle. Because of lack of sleep I feel, my blood pressure was very high, too. It seems nothing was working for the leg cramps. My potassium and magnesium levels on blood work were good the last time checked about 3 weeks ago. I remembered once at my mom’s drinking orange juice and the cramp subsiding. I am wondering if there is a connection with the lack of carbs or sugar in my diet that is causing the cramps. I experimented last night because yesterday I was nonfunctional with weak muscles and shakes and more leg cramps even in the day. I drank off and on orange juice every 2-3 hours and at bed time. This is the first time I have not had cramps!!! I don’t need the carbs and sugar for weight control issues especially with no thyroid. Any suggestions or help regarding this would be greatly appreciated. Thanks…B

    • Yes there is a link actually to blood sugar levels and calcium in the tissue. So if your blood sugar is running a bit low you could be suffering from calcium starvation.

      Staying on an Atkins-Type diet is not healthy. It’s okay for a short term but if you can never handle carbs then that is a metabolic problem you should have looked into.

      One little trick for leg cramps is this: Take a bar of Dove soap and put it under your covers close to your feet. You can keep it in the box. I know it sounds nuts but it resolves cramps at least 75% of the time. It doesn’t correct the problem, but it’s better than dealing with the painful cramps. I don’t know why it works but it does, usually. I’ve been telling patients about it for years with good success, but we still address the cramping issue since you don’t have a “Dove Soap Deficiency”. I’d love to hear back from you if this helps (or doesn’t).

  11. Ellen permalink


    • If you’ve been fine “until today” then you can’t just go by one day. Just realize that there’s more to most problems than just calcium. If you take too much Ca you can definitely throw off your Ca-Mg balance.

  12. Nancy permalink

    I’ve read elsewhere that iodine and proper thyroid function is also important for calcium absorption. Could you comment on that? I’ve been taking levothyroxine for hypothyroidism and stopped using iodized salt. Can that be contributing to my frequent, severe nocturnal cramps?

    • Your thyroid works in harmony (hopefully) with your parathyroid to balance calcium and phosphorus (vitamin D too). A low thyroid could result in low Ca in the blood which then does not get into your soft tissue, resulting in cramps.

      Iodine is needed for proper thyroid function. A person can be hypothyroid because of low iodine and then that hypothyroid can result in the calcium problems just described.

  13. Tanika permalink

    what actually robs your body of iodine and even folate, I thought that this keeps a healthy functioning thyroid and does iodine help with healthy functions of a thyroid…This month luckily I didn’t have any episodes of paralyzing leg cramping.

    • Many things can for both, and some people have tendencies to be deficient because of genetics or lifestyle. I never said iodine isn’t necessary for the thyroid, actually I say the opposite but that doesn’t mean if you have a thyroid issue you just go take iodine.

  14. Andy Fischer permalink

    My son is an above average athlete and has suffered from leg cramps in his calfs and hamstrings for the last 5 years. They come on when he is playing football at the start of the third quarter, after halftime. We have tried gatorlytes, salt pills, riding a stationary bike, carb loading, and every other imaginable thing with little success. It seems that when the level of the competition is more intense than the level of the training, the cramps come on. We recently had 4 days off of basketball practice and he cramped up in the fourth quarter of the next game he played. He sweats profusely, and his football uniform is soaked from pre-game warmups. We had his blood checked for electrolyte imbalance and there was no deficiency. I have done extensive research on the internet and have talke to multipel trainers and doctors. Have you ever heard of “altered neuromuscular control”? That seems to fit him. Do you have any ideas?

    • I have never heard of that term and most likely it is a diagnosis given when they can’t figure something out.

      Consider glycogen depletion – that’s common when someone cramps after prolonged exercise; common with training too hard and burning up too much sugar too fast. More on the Sock Doc site.

  15. Sunil Bajaj permalink

    I suffer from serious stiffness and cramps in bith my calf muscles. Also pain in the ankle joints. I had a doppler done for my legs as Dr wanted to rule out varicose veins and that was normal. Ran thru blood tests for TSH which was normal, CBC which showed Hematocrit (PCV) 38.3% and RBC 4.13 million/ul both of which are only slightly below normal. What is recommended for this?

    • Something like this you should go see a doctor who understands the body more than just looking at the area of problem; seek out a more naturally-minded doc.

  16. Soccer Player permalink

    Very informative article as well as the discussion.

    I am former soccer player but now in 40s my calf muscles cramp a great deal not just from (and during) running but from prolonged walking. After done with excercise calf muscles are in pain as though I have been lifting heavy weights on a muscle that has never been excercised. There is often achiellies pain as well.

    Anti-inflammatories like ibuprophane does not help.

    I’ve been using heat treatment, especially wrapping up the calf muscles in a plastic bag and sleeping with it. Pain would subside.

    As of late I’ve used magnesium-calcium-vitamin D supplement and found to be of help in cutting down on the pain while excercising and relaxing them afterwards (that football player in above post may wanna try this supplement).

    This has increased my ability to do the amount of excercise, but the increase in excercise has not caused any weight loss.

    I have also found that iodine has something to do with muscle pain as well as weight loss/gain. Lack causes muscle pain and weight gain.

    Could you explain how iodine deficiency ipacts muscle pain/weight gain or have good links to such texts, what is safe dosage for iodine intake and what type of iodine (i take blood pressure pills) is good to take


  17. Cathe Cappannari permalink

    I’m a 59 y/o F with chronic muscle spasms. Mostly in my neck, back, hips and upper legs. I had 1 parathyroid adenoma removed by Dr. James Norman in Jan. ’05. He told me to take a calcium supplement the rest of my life. Only when I take calcium the spasms are worse. So I don’t take it. This winter my alternative/internal med Dr. asked me to take magnesium. Within a week the spams were so bad I practically lived with the Chiro and massage therapist. I quit taking it and the Dr. said that Magnesium relaxes muscle not the opposite. Now he has asked me to take Viusid to build up my immune system( it has calcium pantothenate) in it. Within 8 hours I began to have leg cramps. Wow, now what? I thought about doing the Paleo diet. I feel that I have a good diet but something is interfering with absorbtion. I do have low cortisol in the a.m. between 9 and 11. Has been shown on labs also. I spend hundreds of dollars a week trying to control the pain from spasm. I search the internet all the time and all I see are statements about how these 2 elements are necessary and how they make you feel better. You are the first Dr. I’ve seen discuss absorption. What type of Dr. deals with this issue? Do you think you could give me some direction. Also, I am on cozaar. 25mg QD. Although the muscle spasms have been going on for years, I have to say time is of the essence. The last 6 months they have escalated and I now have more down time that up.

  18. TYSMOOTH1 permalink

    Hello drgangemi. I was wondering if this blog topic was still open because I would like to ask you a specific question about cramping. Thank you.

  19. Thank you for your quick reply. For the sake of your time I will be as brief as possible. I have a severe problem with muscle cramping on days that I lift weights and play basketball. I am not a professional bodybuilder or basketball player, however, I’m a level right beneath. Therefore, my workouts are extremely challenging. About 3 to 4 times per week I will workout out at 7am and have a basketball game anytime after 7pm. During my workout I drink at least 1/2 gallon of water and before my game I will have at least one gallon of water plus an additional 1/2 gallon of water while I am playing (I also drink a sports drink while I play. Drinking all this water is NOT fun at all.) Whatever body part that I workout in the gym that morning, will be the ONLY muscle that cramps up during my basketball game that night. The cramping is severe and once it starts, my muscles will just lock up for quite sometime. Very painful. My diet is exceptional (for my fitness goals) and I get plenty of Potassium from the multiple Green Smoothies (many times with Coconut Water) that I drink. My carbs only come from occasional sweet potato and the fruit in my Green Smoothies. The Sodium I would intake would only come from any ground turkey or chicken that I consume. So obviously no processed foods in my diet. I sweat a lot during my workouts but I sweat excessively while I am playing basketball. But I always have. At 35 years of age, I’ve never experience this before, but at this point, I am physically at my strongest. So I just wanted to give you as thorough description of my profile as I could. Do you see anything that I am doing wrong or not doing?
    Thank you for you time Dr. Gangemi

    • Might be too much anaerobic work. That’s where I’d look into – more aerobic training.

      • I was a afraid of that. But that just might be it. Thanks for the help.

  20. Denise permalink

    For the past few months actually from June this year, I have been suffering from cramping in my calves, I do do quite a bit of long distance running, and in the last couple of weeks they seem to come more frequently, take last night for instance doing our 8km time trial I hadn’t even gotten to the 1km marker and my calves were burning it was as if they had somewho got shorter, what can you suggest that I do to combat these cramps?
    I eagerly await your email reply.

  21. Ryan permalink

    I am a professional soccer player in Sweden (born in the US) and have experienced terrible muscle cramping in my legs (always in my calves, many times in my hamstrings, occasionally in my groins and hip muscles) since I was young. I have literally tried every possible thing to fix them: hydrate more, eat more bananas, try pickle juice, more calcium, etc., yet nothing has been able to fix them for all these years. They are horrible and I cannot finish most games during a season because my muscles tense up so much and I cannot run at all. I’d say that I get them in about 85% of games. If there are games where I do not experience any (or only get a little tensing of a calf muscle for a few seconds) during a game then I feel like a million bucks and have no idea what I did differently than the times when I cramp a lot. Any idea what could be causing these? It’s the most frustrating thing I have encountered…Thanks for any help you can give me on this.

    • I used to have similar problems in running and triathlon races. For me, it was a glycogen issue. I wasn’t eating enough carbohydrates which also keeps you more hydrates. Maybe something for you to consider.

  22. Judianne permalink

    I’m a bodybuilder with hypertension inherited from the maternal side of my family and small kidneys from the paternal side of my family. I also work in the health care industry, which, as you know, is a high stress profession, especially at the present time. I have failed on Cozar, cannot take HCTZ, because it elevates my A1C … despite a fasting blood sugar well within normal limits, and I ‘m not able to tolerate beta blockers or ACE inhibitors. A combination of Norvasc and Spriranolactone have worked the best for controlling my blood pressure, but the cramping, particularly in my lower extremities has me worried. One morning I after waking up and doing my usual yoga bed stretches, I stepped down onto the floor to an amazing pain in my right foot, and knew immediately that it was highly symptomatic for both achilles tendonitis and plantar faciiitis. I understand this can happen on calcium channel blockers. It’s been over a year since that happened, and it still kicks me now and then. Now, a new symptom has developed. Pain without swelling at the insertion of my hamstrings on the left leg. It sometimes will heat up out of nowhere even when I am at rest, then, for no discernable reason, it will disappear. It’s as if this medication is magnifying every natural muscle imbalance I must have. I have to be on the Norvasc, because it’s the only way I can contol my hypertension. Is there any way in which I can work with diet to overcome some of the pain and cramping. My tibialis anterior muscles are starting to stay contracted so long that they feel like rocks, and I’m not even optimizing for my gasts and tibs anymore. … Oh, … I am using trigger point therapy, too.

    • I obviously can’t personally advise you on your meds but I will say – you are taking Norvasc and Spironolactone which will deplete/affect sodium too as well as the calcium and typically it’s the sodium that will cause those calf problems. So you might check with your prescribing MD about trying a different ACE inhibitor or ARB over the Spironolactone to see if that helps alleviate your problem.

  23. Nadia permalink

    Thank you for the article Doc. Now that I know which supplements to get my question is: How do I get rid of the old cramp calf pain?

    On 11/16/13 I ran a half marathon and my right calf cramped little past mile 12. I kept jogging for 10 more steps, but had to stop and walk it out, and then resumed running and finished, but was hurting.

    The pain, however, has gotten worse and I feel as if my calf is going to cramp any second and it’s very, very tender to the touch :-(

  24. RiyadS permalink

    This article has given me greater insight into a problem I’m having for years now. I’m a sportsman and I’ve been troubling with cramps for the past 4 years at least. I have tried many things but to nothing seems to help. Just this past weekend I had a match, after 2 hours in the sun I felt my forearm start to cramp. Eventually it spreads to my hands/fingers until I have no control of them. Then my calves. Today I noticed a cold sore above my lip.
    A few months ago, frustrated from the reoccurring cramps, I was recommended to do a blood test. He told me everything else was fine except my Calcium level, which was of an old man as he put it. He recommended Caltrate -600D. I’ve been using it on and off since but havent seen much difference.
    I’ve tried many different remedies. : Gatorade, Salt, lots of water, bananas and now the Calcium but It still occurs about 2-3 hours after activity without fail.
    Even a day after my forearm and calves are still very sore.
    What more do you think I could do to help stop these cramps? Its getting to the point where I’m almost ready to give up, since it prevents me from giving my best. Appreciate any advice! and thanks again for a great article.

    • Really hard to say. Could be a lack of fats or vitamin D so you’re not metabolizing the calcium properly. Could be a glycogen issue and you’re using up sugar stores after those 2-3 hours. This occurs when you train too hard and aren’t utilizing fat efficiently for energy – so you deplete glucose & glycogen and cramp up.

      • RiyadS permalink

        Thanks Doc. Something to consider. I’ll keep working on it

  25. David permalink

    I have had leg cramp issues for several years now and it seems to be connected to sleep and when I have not had enough deep sleep.

    I started to take magnesium supplements and at first I thought it helped for a few days as I fell asleep much quicker and slept deeper but eventually after a few days it made my legs worse in the morning. Dull aches all over and odd stabbing sensations.

    More recently I have found that taking a small amount of calcium (50% rda) stops the cramps but the vit d3 in the calcium sometimes makes me wake up more times in the night even though I take the pill in the morning. This is after taking 1 a day for several weeks though.

    I am at a loss as most advise says magnesium for sleep and leg aches but for me it make it 10x worse. I exercise regular with lots of stretching of legs and eat very well. Little red meat and mostly fish.

    It seems more like calcium displacement in my case.

  26. Kathleen permalink

    I am a 60 year old woman who goes to the gym 6 days a week for 1 to 1 1/2 hours – cardio 25 mins, resistance 20-30 minutes and cool down cardio 20-30 mins average. I am hypothyroid and have been taking Levothyroxine for over 20 years as well as high doses of Calcium Citrate and Vitamin D. I do not eat processed foods or salt. I don’t each much red meat, but do indulge in a turkey burger wrapped in lettuce. I eat 4-5 servings of vegies per day 6 oz chicken and 4-5 fruits daily. Over the last few weeks, I have had paralyzing leg cramps while sleeping (extremely painful). I haven’t made any diet or exercise changes and don’t know why I am getting these. I starting taking L-Taurine a few months ago to ease cramping (nothing like the cramping I have now) and it seems to have helped those cramps, but now I am having these awful ones. I drink water during the day, and during my workouts, and I do sweat heavily with exercise. Any advice on why I am getting these awful cramps? Thank you

    • Sorry I cannot give personalized advice on-line; we’d have to set up a consult for that.

  27. Stephanie permalink

    Hi Doc,

    I am a rather active individual – I do a spin class every Monday, combat classes on Tuesdays and Yoga on Wednesdays. Every other weekend, I am training in preparation for a 100km overnight trailwalk which will happen in August. I am a 31yr old female of Asian heritage. Weighing 54kg.

    These training walks have considerable ascends and descends and are about 20km-30km each training. I have done about 4 training walks so far with different terrains with different physical ‘difficulties’ each time. The first walk, I started cramping at 10km. And I was mildly cramping on and off for the next 15km. I started taking magnesium complex [powder form] which gives the adequate amount of 300mg each day since that weekend to see if it helps with preventing cramps.

    The next training walk seemed much better with my cramping only beginning at 20km for a 30km walk. Two weeks after that, we walked the same terrain but this time my cramps started very early around 8km in. Cramps got much worse in the kms that followed and this time it was happening in my calves,the muscle arnd the ankles, front of my thighs etc. I am starting to look into calcium supplements in hopes that this will help with the cramping. I have been told by a nutritionist that cramps are not exactly due to lack of these minerals but more closely related conditioning of the muscles. In your opinion, what would be my best bet to improve this cramping issue? It is frustrating when I can’t perform optimally not due to being tired but because of the cramps that get in the way. I cramp every step up the rocky mountain and it’s really demoralising in a team event.

    Please let me know if there is anything that you can suggest?

  28. Carriw permalink

    I have had foot cramps when I move my toes for years, any time of day. Now I have cramps in my shins, calves and sometimes my abdomen or other sites just from daily activities. I have tried magnesium and potassium with no real improvement. A hair mineral analysis showed very high Mg and Ca which I understand means low bioavailability. My serum Ca is always normal (9.9 – 10.0) though. Is it just as simple as taking HCL with a Ca/Mg supplement?

  29. Troy permalink

    I’m curious what you think might be the cause of leg cramps being caused by magnesium supplementation (event at low doses), despite deficiency?

    • If you’re taking magnesium and you’re getting cramps then it could be because it is causing other electrolyte imbalances – most likely with calcium or potassium.

  30. Joel Nitikman permalink

    Doctor, I am training for a long-distance cycling race. I am a 53 year-old white male. On very long rides (4 hours+) with lots of hills I get severe leg cramps. I have tried drinking Gatorade but my doctor told me a few years ago that my sugar levels in my blood were just slightly high so I stopped drinking Gatorade and fruit juices. Is there a drink that can replace electrolytes during long-distance riding yet does not contain sugar? Thanks?

    • Check out the sock-doc site where I address this much more; especially in the Sock Doc Training Principles.

  31. carol severson permalink

    hello , i have read your article , its very interesting. i have been getting muscle cramps since i was a kid, I’m 61 now, when i was younger i would get them in my toes, and feet. the older i got the worse they got. i get them in my feet , calves, sometimes in my knees, my fingers , my ribs , my sides, my back, i don’t think there is a part of my body that doesn’t get them , but the ones i get that run from my ankle to my butt on the outside of my legs are the worst! its like I’m getting them in my sciatic nerve, and it can happen on the inside or the out side, they are so painful i told my husband if i had a gun i would shoot my leg or kill myself , thats how bad they are, i have tried vitamins , pickles, drinking lots of water, but it seems like i drink the water and I’m peeing it out, its not absorbing in by body, I’m not a salt eater, i have recently started putting salt on my food to see if it would help , but all it does is make me swell. so I’m thinking i probably need to go to the doctor and get a blood test ( which i have done before and everything is fine) is what he tells me. so my question is what kind of blood test do i need to find out what I’m lacking and how do you tell if your body is absorbing water or not. i know when i go to bed i drink about a half bottle of water and then I’m up in a couple of hours going to the bathroom and if i don’t drink the other half of the bottled water i will start cramping, and other times I’m just going to cramp all night , so I’m lost at what to do.

    • Often a blood test won’t give you the info you need to address this issue. Look for a practitioner who understands hormones and the chemistry involved with cramping.

  32. Gladys permalink

    I notice that everyone on the blog has cramps mostly on there legs and calf. I have recently been getting them on my toes and my left arm which causes my fingers to cramp and kind of hook themselves. I take Furosemide 40 mg. a day for water retention and potassium pills. I do spinning every now then. I am worried that my toes and fingers will stay in this cramped position. Is there a possibility that I may be lacking some nutrient? I juice everyday and do not eat wheat or carbs on a daily basis. Do you have any idea what could be causing this?

    • You should talk to your prescribing doctor about what is going on and the possible relationship to the meds.

  33. Brent Zabel permalink

    Hi Doctor,

    I am teaching an anatomy and physiology course and my question is if calcium is required to cause a muscle contraction (calcium binds to troponin) then why is it that if you have a calcium deficiency you get a muscle contraction? Wouldn’t you have less muscle contractions? Wouldn’t a increase in calcium result in a increase of muscle contraction? Any help understanding this would be greatly appreciated. Thanks for helping me any my students!

    • It’s all about balance. Not too much and not too little. Same situation really with all the other electrolytes – Na, K, Mg.

  34. David Swingle permalink

    My experience with salt tablets is that they give me cramps.
    Yesterday I was running a 50 mile ultra, I felt fine at mile 30,
    although in retrospect i was probably dehydrated. At the aid station
    everyone was taking salt tablets, so I thought I would take 1. Not long after i was cramping. Other runners offered me more, and I think I ultimately took 3 or 4 over the next hour. I ended with extreme cramps, and literally blacked out on the trail. Other runners kindly offered me water (and more salt tablets). I drank several bottles of water, and miraculously recovered and was able to finish the race with only some minor twinges along the way.
    So, my conclusion is that salt tablets are actually very detrimental if you are already dehydrated.

  35. Gabi permalink

    Hi there Doctor,
    My husband is a professional athlete and tends to get leg cramps. His cramps aren’t coming about due to a lack of fitness but rather what I think to be his insanely low body fat percentage, well under 4%. As a soccer player he has to run for 90+ minutes in hot weather, which he is well accustomed to, and he has a routine for being plenty hydrated. He maintains an incredibly nutritious and balanced diet so I just have no idea where his diet would be lacking in nutrients..We’re wondering what we can do to help him get past this. Any suggestions would be greatly appreciated! Thanks

    • Well I can say my BF was recently measured at 4.6% in a BodPod which is about as accurate as you can get, and I don’t cramp up. I’d look at glycogen issues for something like this.

  36. Marty Rhodes permalink

    I cannot take ANYTHING with calcium. magnesium, or any minerals. Even with food enzymes – they cause extreme binding. I have suffered from RLS and (during my pregnancy) am now waking up in the early am’s with severe foot and calf cramps. What foods might help?

  37. Donna permalink

    I have restless leg syndrome which I have had for years my father had my mother had it and I have cramps almost every night of my life but the real bad thing is the spasms that I get up and my top part of my legs and it last for about 15 minutes off and on and I can’t take it much more I don’t know what to do I have done everything everybody tells me to do and soap in the bed I’ve done everything

  38. Chantelle permalink

    I have been on a low carb high fat lifestyle for a year. Since I started my shoulder muscles goes into spasm or are rock hard constantly. It literally gets bad overnight. As soon as I eat more than 30mg carbs the cramps goes away (tried 100’s of times and indeed works). Why is that? I have heard that when you no longer eat processed foods and eat healthy/clean, your body no longer holds onto salt as it used to. I don’t want to go off of this lifestyle as it has bettered every other illness, only the Shoulder Muscles are a problem. I am on a strong Omega 3 and Vit D3 because of previous blood tests. I am taking some natural Potassium and Magnesium Glycinate too hoping it will work but only to a low effect. Except eating more carbs, would Calcium help this carb related issue? or more salt? Or any other Mineral?

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