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Short Summary
Main recommendation: Address leg cramps by checking seven causes in order, starting with low salt and electrolyte intake (magnesium, potassium, calcium, and arachidonic acid), then ruling out overexertion, medications, blood clots, arterial blockage, and serious conditions like cancer, liver disease, or lumbar stenosis. Dr. Ken Berry frames these as a ranked list from most common to least common, with the most dangerous causes last.
Key Points
- The seven causes, ranked from most to least common: (1) not enough salt, (2) electrolyte deficiency (magnesium, potassium, calcium, and arachidonic acid), (3) temporary overexertion, (4) medications, (5) a deep vein blood clot (DVT), (6) blocked leg arteries (peripheral artery disease), (7) serious conditions such as some cancers, autoimmune diseases, cirrhosis or other liver disease, and lumbar stenosis.
- Dr. Berry argues the advice to limit salt has no supporting research, and that mammals need salt daily.
- Arachidonic acid helps calcium move into muscle cells so muscles can contract and relax properly; it is found in fatty meat and seafood.
- Medications named as possible causes include statins (Zocor, Lipitor, Crestor, Lovastatin), Forteo and Evenity, synthetic estrogens, naproxen, Celebrex, ibuprofen and other NSAIDs, calcium channel blockers (Procardia, Norvasc), diuretics taken daily for years, Cipro, and Celexa or other SSRIs.
- One-sided cramps that worsen with walking, or cramps in one calf or foot that do not improve, warrant prompt medical evaluation for a DVT.
Details Worth Noting
- Concrete instructions: Eat salt to taste and choose real salt from an ancient ocean source rather than superstore salt with dextrose, multi-dextran, or added aluminum, and avoid salt from modern oceans that may contain microplastics.
- Concrete instructions: Eat calcium-rich foods such as bony fish like sardines and anchovies and dark leafy greens; eat magnesium- and potassium-rich foods; Dr. Berry also uses an electrolyte drop added to coffee and other liquids.
- Concrete instructions: Eat fatty red meat, white meat, and seafood to supply arachidonic acid.
- Concrete instructions: Increase everyday activity and stretching/strengthening of leg muscles so that occasional hard exertion, such as a long uphill hike, is less likely to cause cramps; post-exertion cramps usually resolve within a few days.
- Concrete instructions: If you suspect a medication is the cause, talk to your doctor about changing the dose, switching medications, or weaning off; for osteoporosis, discuss alternatives with your doctor. Do not change medications without medical guidance.
- Concrete instructions: For cramps in one leg while walking, see a doctor and request a venous Doppler ultrasound to check deep veins. For suspected arterial disease, your doctor may order an ankle-brachial index (ABI), ultrasound, angiography, or CTA.
- Dr. Berry notes that on routine lab work, cirrhosis or liver disease may not show up, so the doctor may need to look further; lumbar stenosis can cause leg cramps even without lower back pain.
- Dr. Berry says that if one cause has been addressed and cramps persist, they should move on to the next cause in the list; he also mentions bioidentical hormones as an alternative to synthetic estrogen pills.
Bottom Line
Leg cramps have many possible causes, and the most common and easiest to fix is inadequate salt and electrolytes, but persistent or one-sided cramps, especially with walking, should be checked by a doctor to rule out serious conditions.
