Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
2 Apr

Dear Mark: Marathon Fuel, Muscle Cramps, and Another Dr. Oz Miracle

crampA few months ago I wrote an article on How to Fuel a Marathon. In this week’s Dear Mark, I answer a reader’s question on how to improve a hydration recipe I recommended in that article. Then I cover a somewhat related topic: muscle cramps, and how to fix them and how to prevent them. Finally, I discuss Dr. Oz’s latest supplement miracle product – raspberry ketones. Sounds delicious, doesn’t it? Let’s go.

Hi Mark,

I am in training for my first ever marathon and have read your how to fuel a marathon. I did try the homemade hydration drink on my training run last week of 24km. I had 2 bottles of hydration and 2 bottles of plain water. I found the drink very sweet and you can definitely taste the black slat molasses. Swigging water straight after did help but it wasn’t overly pleasant.

I thought I would give it a try as I plan to use it on my race day which is July 1st. I was thinking of reducing the black slat molasses to just 1 tablespoon to see if it reduces the very sweet taste and perhaps increase the raw honey to 3 tablespoons, to see if it’s more palatable. Would this have any effect on keeping hydrated?

Also what can I use to keep hydrated on my long training runs? I find water is just not enough and I get thirsty and start to hit the wall around 17km. So basically, how do you fuel your training runs?

It would be great if you could give me some advice on this.

Many thanks.

Regards
Alison

Cut the sweeteners in half. One tablespoon of each should work great and provide plenty of absorbable sugars, electrolytes and other minerals. I would caution against adding extra honey, as it’s actually far sweeter than the molasses, which has a distinctive taste but little outright sweetness. The honey, while imbued with plenty of phenolic compounds that may aid in general health, is really there to provide quick and easy sugar for your muscle glycogen stores. It’s not really giving you much hydration. The molasses is there mainly because it’s rich in calcium, magnesium, and potassium – all important electrolytes – and you don’t really need much more than a tablespoon to do it. To cut back on the sweetness, you could also use plain water instead of coconut water. And don’t forget the pinch of salt.

I don’t really fuel my training runs, because I don’t do them anymore. I’ll bring along a bottle of water, preferably mineral water or otherwise dosed with a pinch of salt, when I go for a long hike, but many times I’ll forget to even take a sip. If I had to choose something for pure hydration, water with a pinch of high-mineral sea salt and a pinch of potassium salt (often sold as “lite salt”) works. My old hangover pre-hab cure, which was designed to hydrate and which I’d always take before going to sleep after a night of drinking back in my younger days, consisted of water, sea salt, potassium salt, and the juice from one lime or lemon. I’d be willing to bet that would work really well, too.

I’ve always had muscle cramps in my legs and feet, but the more I eat PB, the more frequent the cramps get. This is the only thing that isn’t better in how I feel on this diet/lifestyle. Can you explain why this is happening? And possibly offer a suggestion to ease the cramping? Sometimes the cramping is so severe that it wakes me out of sleep and demands I immediately get up and try to stretch out the cramping muscle. Then it will hurt for days.

Susan

My first guess is that you’re just deficient in electrolytes. How’s your potassium intake? Your magnesium intake? How about calcium and sodium? Our interstitial fluid – the fluid that envelopes our cells, enables intercellular communication, and delivers materials to and from the cells – contains all four minerals. Properly controlled muscle contractions require good balance (especially of sodium, calcium, and potassium) in the interstitial fluid, while an imbalance of these minerals can lead to excessive muscle contractions, which can manifest as cramping. So, first off, monitor your electrolyte intake.

Good sources of potassium include avocados, sweet potatoes, potatoes, bananas, chard, spinach, and many more. Fruits and vegetables are pretty much the best sources. Fresh meat has potassium, too, but opt for rarer meat over well-done meat, as the potassium is found in the juices. Potassium, then, is really easy to get through food. You just have to eat some plants. Animals are important too (it’s “plants and animals,” after all), but Primal Coconut water is another good (and delicious) source.

Good sources of magnesium include leafy greens, nuts, halibut, pumpkin seeds, but some people find it difficult to get enough magnesium through food. In your case (lots of cramping), taking a good supplement is probably warranted. It seemed to help pregnant women with pregnancy-related cramping in one study. As for which form to use, most people stick with one of the magnesium “-ates,” like citrate, glycinate, or malate. This guy, on the other hand, had great success with sublingual liquid magnesium.

Sodium intake must also be considered. When people switch from a diet high in refined, processed foods to a diet high in whole foods that must be prepared at home, salt intake usually drops. Furthermore, some newly Primal people assume that Primal means “no added salt.” This isn’t the case at all, but the end result is that many people who go Primal end up taking in less sodium than before. Sodium is found in, well, salt.

You also have to watch your calcium intake. Leafy greens like spinach and collard greens are excellent sources, as is dairy, if you’re into that sort of thing. Yogurt is probably the densest source of calcium, and (in my opinion) it’s also the “safest” way to eat dairy – fermented. Bone-in sardines will also provide a nice whack of calcium, as will real, homemade bone broth (try to simmer it till the bones fall apart to ensure you’re getting all the minerals).

See the answer to the previous question and the referenced post for an electrolyte-rich drink that you can make for a quick remedy.

Are you very low carb – say, under 40 grams a day, enough to be a in a near-constant state of ketosis? Remember, ketosis has a diuretic effect, especially during the initial transition. With the water flush goes electrolytes, and if you never replenish them you’re likely to experience cramping. I’d also be curious about your activity levels. If you’re exercising a lot and really working up a good sweat, you’ll be losing even more water and more electrolytes. Carb intake should be tied to activity levels, as I always say.

You might also try getting more taurine. It’s a non-essential amino acid, meaning we make it ourselves, but supplementary taurine has been shown to help cirrhosis patients with excessive muscle cramping. As the best source of taurine is beef heart, this is the perfect opportunity to explore the wonderful world of offal!

Another, slightly more obscure possibility is the use of certain medications. Diuretics, statins, and long-acting beta-adrenoceptor agonists (or LABAs, used to treat asthma and chronic obstructive pulmonary disease) have been linked to an increased incidence of nocturnal leg cramps. If you’re taking any of those medications, they could be making the problem worse (or creating it altogether).

So, in summation:

  1. Eat leafy greens (and yogurt if you can).
  2. Use salt.
  3. Supplement with magnesium.
  4. Try knocking yourself out of ketosis; consider a carb refeed.
  5. Try taurine.
  6. Tie your carb intake to your activity level.
  7. Track your current meds and see if there are any potential conflicts.

I repeatedly notice that the Primal eaters who have the most problems are the ones who eat little to no plant material. While certain individuals can tolerate (or even thrive on) a total lack of dietary plant, the vast majority do better as omnivores.

Hi Mark,

Like many women, my wife is a Dr. Oz fan and has me view select bits that she finds interesting. Instead of constantly pointing out every flaw I see, I find it more productive to praise Dr. Oz (in front of my wife) for what he gets right.

We saw his segment on Rasberry Ketones and it sparked my interest. Have you looked into this? Can this supplement enhance ketosis for someone already in the 50-80 gram/day carb intake mode? Can it do anything for people with higher carb intake? Thanks.

Dave

Ah, the eminent Dr. Oz! If he says it, generally, I take it as gospel.

Seriously, though, it’s not total bunk. A study in rodents found that raspberry ketone supplementation both prevented fat gain on a proven obesogenic diet and helped already fattened rats slim down a bit. Sounds good, right? I mean, sure, we’re not big hairless, tailless rats, but we’re both mammals, and we can glean a lot of hints about our own physiology by studying rodents. Eh, not so fast: the rodents’ diets were up to 2% raspberry ketones. Yes, it wasn’t quite a supplement, it was a sizable component of their diets. That would be like if you swapped out polyunsaturated fat for resveratrol. When you’re measuring a supplement in calories, rather than micrograms, milligrams, or IU, I think it’s time to step away and reevaluate your relationship with the compound.

I suppose you could replicate the rat dosage and get 2% of your calories from raspberry ketones and hope for a result, but that would get pretty expensive really fast. The typical bottle has 60 capsules with anywhere from 100 to 500 mg per capsule, and you’d be taking at least half the bottle a day to hit the heroic dosages. Good luck.

That’s it for this week, folks.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I’ve suffered through extremely painful cramps in my calves while sleeping a few times.

    They only last a minute or 2 but its the worst minute of my life. I just tend to stay as still as possible and go through the pain.

    Luckily this rarely happens. I have never linked it to diet. I think it has happened after running barefoot too much.

    Ease into this Todd…

    If anyone is going to drink Coconut Water I recommend Amy & Brians Naturals. It is by far the best brand I have ever tried! Nothing beats drinking out of a fresh coconut of course!

    Primal Toad wrote on April 2nd, 2012
    • I also thought that remaining still was the thing to do for calf cramps in the night, but a few months ago a friend advised me to get up and walk right away. Tried it the next time I cramped and it worked like a charm – cramp went away and no pain the next morning!

      Elsa wrote on April 2nd, 2012
      • yeah i got that once when i was swimming and my coach had me stretch my calf out and it helps a lot

        Jeremy wrote on April 2nd, 2012
      • Its your diet, you’re deficient in magnesium & potassium, see the second link in my comment below, BODYBIO article about cramps.

        cancerclasses wrote on April 2nd, 2012
        • If it was diet I think I would get them a lot more often… it’s only happened a few times. It’s been almost a year since that last occurrence.

          I’ve noticed a couple times I got them after running barefoot a bit too much.

          Primal Toad wrote on April 3rd, 2012
      • I’ll have to try this next time! They just hurt so much that I don’t want to move.

        Primal Toad wrote on April 3rd, 2012
    • This happens to a teammate of mine during our rugby games… our coach suggested eating a mustard packet right away (portable) and drinking pickle juice later. It seems to work.

      Jessie wrote on April 3rd, 2012
      • Pickle juice is acetic acid which drives sodium that causes muscle contractions out of muscle tissues and bloodstream, which creates the appearance of relieving cramps by weakening the strength, intensity and ability of your muscles to contract.

        In effect you’re DE-creasing your muscular response & performance, and pickle juice does nothing to restore mag & potassium levels or electrolyte imbalance , only adding the depleted minerals will truly signal the muscles to release the contractions that cause cramping.

        cancerclasses wrote on April 3rd, 2012
        • What kind of pickle juice? Sweet or Dill?

          Bob wrote on April 29th, 2012
    • Toad, if you get leg cramps on a regular basis, you should try gently stretching out your calf muscles every night before bed. Just find a step, and (like a diver going in backwards) VERY slowly ease your heels lower than your toes. You’re not going for pain, you’re going for a gentle stretch. Also, when you’re in bed, you can point and flex your toes (again, gently) before you go to sleep. This worked for me when I was super-pregnant and got leg cramps a lot.

      Also, I just found Zico coconut water, which tastes amazing on its own. But they have a chocolate flavor which tastes JUST like a Yoohoo, without the chemical aftertaste! It’s great. My toddler loves it as a rare treat once in a while.

      Maryanne wrote on April 4th, 2012
      • I too got nightly leg cramps in the beggining of my primal journey and as most i got recommended to supplement magnesium and stuff, this did nothing for me though.

        What did help though was a stupidly simple suggestion I got, do a couple of squats before bed. Guessing this would be a similar solution to the stretching.
        Just a couple of quick full range no weight sqauts and I haven’t had any problems with this since.

        Magnus wrote on April 7th, 2012
  2. What a thorough explanation for cramps! There are so many possible causes.

    I had leg cramps like the reader described most of my life but after going Paleo they disappeared. My nutrition used to be horrible so going Paleo helped with lots of things. The cramps have come back a few times over the years since, but it always is when I have eaten too much dairy. Dairy can throw calcium and magnesium out of balance which can cause all sorts of problems.

    Peggy The Primal Parent wrote on April 2nd, 2012
  3. I should have known that taking 100mg daily of Raspberry Ketones to melt off some extra fat was too good to be true. Bummer!

    Karen wrote on April 2nd, 2012
  4. I have had leg cramps since starting primal and there seem to be lots of unresolved questions about the problem in the forum.

    I feel like I get enough greens, dairy, magnesium, sodium and carbs. I think I stay well hydrated. (I have a history of kidney stones.) The only two meds I take go way back before primal. I guess I could try taurine.

    Harry Mossman wrote on April 2nd, 2012
    • Minerals in vegetables are locked up by phytates and are biologically unavailable to humans.  http://goo.gl/bhGkf

      You may fee like you’re getting enough vegetables but the cramps are proof that you’re deficient in magnesium & potassium.  http://goo.gl/aE48v

      Easiest & simplest way to supplement potassium needed by muscles to release a contraction is drinking a can of Low Sodium V-8 juice which paradoxically has 1180 milligrams of potassium per 1 can serving. You can also buy a shaker of Nu-salt salt substitute for around $1.80 that has 530 milligrams of potassium per 1/6th teaspoon, double that to 1/3 teaspoon & you’ll get 1060 milligrams, I keep several of these, in the kitchen spice rack, my work lunchbox & 1 in the car glovebox for spot supplementation if anybody I’m with starts cramping up, taken with water it works like a charm.

      cancerclasses wrote on April 2nd, 2012
      • Links not going in right, you’ll have to cut & paste it into the address bar or right click & go to.

        cancerclasses wrote on April 2nd, 2012
      • Any particular reason to stick to low sodium V-8?

        SueB wrote on April 2nd, 2012
        • Hi,

          The low-sodium V-8 actually has way more potassium than the regular.

          Island Girl wrote on April 3rd, 2012
        • Yes, the regular V-8 only has around 600 milligrams, the low sodium has alost twice as much, and is the the highest mag content between regular, spicy and the low sodium version.

          cancerclasses wrote on April 3rd, 2012
      • DO NOT drink the V-8′s. They are LOADED with bio-technology derived fruits and veggies. They are not safe!

        Zack wrote on April 6th, 2012
  5. The marathons are hardcore.
    I would try more things to get more a wide variety of responses from my body to see what works and what not.

    Paul Alexander wrote on April 2nd, 2012
    • Marathons are hard on the heart, a recent study found that “during a marathon, over half of the segments of the heart lose function, Larose said. The reason turns out to be an increase in inflammation and a decrease in blood flow through the muscle”, which is caused by excessive blood sugar levels from high carb intake. 

      From my Twitter page @cancerclasses: Micah True #carbloading #ultramarathon #guru dies of #carb induced #SUDS on #run. http://t.co/2qbcVqSo #diet #Caballo

      Carb loading thickens the blood increasing blood pressure and causes dehydration since every gram of carbs requires three times their weight in water to process them.  Carbs pull water from the body’s tissues causing an increased demand for hydration and causes basic electrolyte imbalances that interfere with calcium – sodium ion channel & electrical cardiac signaling.  http://goo.gl/euehl

      I’ve been working to define this problem since last October when I became aware of the connections between marathoning and sudden unexplained cardiac death in marathoners, here’s a link to a discussion I had with cardiologist Dr. William Davis on his WHEATBELLY blog  http://goo.gl/XQRl2
      and a follow up here  http://goo.gl/4NnRY

      cancerclasses wrote on April 2nd, 2012
  6. Great information! Anticipating the pain I will be in when I start training this summer in CO, for my ultimate goal of hiking “the big one” – Denali in 2013. Any advice Mark, on training in altitude? Sincerely, Kristin Breheim

    Kristin Breheim wrote on April 2nd, 2012
  7. tonic water, source of quinine, while not primal, might help for the cramps. give it a shot and let us know…

    primal headshrink wrote on April 2nd, 2012
    • Good call – we tell this to patients at the clinic I work in all the time and it really works for about 75% of people.

      Roxy wrote on April 3rd, 2012
  8. Since going gluten-free, I’ve had issues with leg cramps, too. I finally started taking a high quality magnesium supplement (the best seem to have mag from a variety of sources), and that put a stop to them. You’ll want to take it at night, though, just before bed – it’ll make you very sleepy.

    Sarah wrote on April 2nd, 2012
  9. I start every day with a Nuun tablet and 20 oz. of water. Lots of electrolytes and no sugar.

    Digger wrote on April 2nd, 2012
  10. Potassium might be easy to get from food, but it’s hard to get *enough* potassium from food, unless you’re careful. According to my reading, humans need 2 mg. potassium/calorie consumed. If you’re eating 2000-2500 KC/day, that results in a requirement for 4000-5000 mg of potassium daily. Even if you eat primal, that’s a tall order without some special foods. My special foods are low-sodium V8 (800 mg. K/cup) and spinach (1000 mg K/cooked cup).

    Likewise, getting enough magnesium from diet is tough. You can calculate how much you need each day by following this rule of thumb: 5 to 10 milligrams per day per kilo of ideal body weight or 2.5 to 4.5 milligrams per day per pound of ideal body weight. It’s hard to know how much you absorb from a supplement, even a chelated one like Mg. glycinate, since people absorb only 30-40% of what they take in. Ionized magnesium has a better chance of absorption, and you can make your own cheaply (see instruction at http://www.afibbers.org/Wallerwater.pdf. I drink about 4 oz. of 4-6 oz. of concentrated mg. water daily, and my spinach also has some of the mineral. A stealth ingredient that contains magnesium is chia seed. You can use it as a binder in recipes (e.g., meatloaf), and you’ll get a dose of all the electrolyte minerals. Finally, I take an epsom salts (Mg. sulfate) bath 2x/week and my skin absorbs what my body needs (I hope).

    Since Mark didn’t mention ideal mineral ratios in this post, here’s my understanding:

    Ca:Mg — 2:1
    Mg:K — 2:1
    K:Na — 2:1
    K:Mg — 10

    Since all these minerals are water-soluble, your body will excrete excess amounts. It might store extra calcium, though, in arteries and and under-hydrated synovial joint spaces (but adequate K2 levels should prevent that).

    jake3_14 wrote on April 2nd, 2012
    • Thanks for that link! It’s hard for me to get decent supplements here in Mexico, but they do sell MofM.

      Doug wrote on April 2nd, 2012
      • Conversely, there in mexico it’s easier for you to get great food so unless you don’t take advantage, supplementation should be less important.

        Joshua wrote on April 5th, 2012
  11. That K:Mg ratio should be 10:1.

    jake3_14 wrote on April 2nd, 2012
  12. nice analysis of the raspberry ketone thing.. I saw that the other day, I knew it was bunk!

    Burn wrote on April 2nd, 2012
  13. I like to do 50/50 vita coco coconut water and regular water on my training runs. I find it’s a good balance of hydration, potassium, and carbs, and not overly sweet.

    Patricia wrote on April 2nd, 2012
  14. Nice article! Brought back some painful memories of wicked calf cramps I used to get during some endurance training I was doing instead of my usual high intensity interval training and strength work. The one thing that I found out was that I had trigger points in my calves and some ankle mobility issues that would contribute to muscle cramps in my legs and even some temporary numbness during training sessions. I was able to rid the cramping through some graston and active release work on my calves and hydrating a ton with coconut water! Love that stuff and now it’s a go to over any sports drinks only thing was the taste afterwards…Have you tried any other flavored coconut water products? Would You recommend any?

    Alby wrote on April 2nd, 2012
  15. I am so glad to see you talking about the leg cramp issue!! Not long after going Paleo in Feb of 2011, I began having incessant calf twitching. It’s the ONLY negative thing that has come from the Paleo diet and it drives me NUTS..especially at night.

    I eat tons of avocado and mountains of greens. Always have. I have also been taking a magnesium/potassium supplement for a couple of months in an effort to stop the twitching. It ain’t working.

    I have not tried calcium (assuming I got enough from the greens) and haven’t really paid attention to my sodium intake. I’ll try adding some of both and see if the problem doesn’t subside.

    I desperately need to find an answer. I have to stretch my calves all day long or they get so incredibly tight. It’s maddening.

    Shannah wrote on April 2nd, 2012
    • Do not take calcium, your body recycles that from your bones all the time, heard a doc on Jimmy Moore’s podcast say supplementing calcium metabolically turns your body into stone, heart valves, artifices, etc. Calcium is the signaling molecule for cell uptake of sodium which CAUSES muscle to contract & has nothing to do with relieving cramps, its the opposite of mag-potassium which releases the contraction.

      You don’t say how much mag-k you’re taking, if its just 1 cap try doubling or higher, as what’s his name above says only 30-40 percent of patassium & specially mag is absorbed.

      cancerclasses wrote on April 2nd, 2012
      • Arteries, and if you eat paleo & ever chew a bone you get plenty of calcium.

        cancerclasses wrote on April 2nd, 2012
  16. Were you being facetious when you said you take Dr. Oz’s word as gospel? Please say yes. The man is a quack and a shill and an opportunist and I run in the opposite direction of anything he recommends.

    Norma wrote on April 2nd, 2012
  17. This is intersting.
    I haven’t had leg cramps since I was a teenager eating tons of bread.

    Now I’m on a semi-raw paleo/primal diet and I get TONS of bio-available minerals and enzymes.
    Also, I drink high mineral content geothermal water (cooled).

    I also disagree with Peggy, I think RAW milk has TONS of electrolites and actually prevents cramps in legs…
    The imbalance of calcium/magnesium is only noticable in slowed/hardened bowel movements and intestinal cramping in women. Just take a magnesium citrate supplement.

    Arty wrote on April 2nd, 2012
  18. Cramps are a real mystery. I too have had issues but it was most likely caused by my step up in the amount of strenuous exercise I was doing. I’ve spent a lot of time reading research reports and not surprisingly people don’t do a lot of research on cramps and they’ve found nothing conclusive. I’ve tried all of the above remedies and more and nothing has ever quite reduced the frequency like cutting back on the amount of exercise I was doing. I eventually took that as a sign that I was overdoing it.

    Cha wrote on April 2nd, 2012
  19. Mark, I’m glad you’ve addressed in more detail the very common paleo-related problem of muscle cramping/twitching, but I feel frustrated with the common answer that it’s likely be a lack of electrolytes or dehydration.
    I too have had muscle cramping and twitching issues since about 6 weeks into primal/paleo and it’s a problem I’ve never had before this. I am now about 6 months in and still having this problem. I currently eat lots of chard, spinach, leafy greens fruits and other vegetables; definitely more than I ever did before going paleo when I didn’t have this problem. I drink plenty of water and I never feel thirsty or dehydrated. I frequently add salt to my meals when needed. I have tried supplementing magnesium and potassium, but not calcium though I have cream with my tea or coffee.
    I’m not in ketosis, but I do find that fluids pass through me more quickly than before.
    I find it hard to believe that while on the SAD I had no electrolyte deficiency, but now with all the greens, vegetables and fruits that I’m eating I’ve somehow become deficient.
    There really has to be more to this than electrolyte deficiency and dehydration. Especially since it seems so common among the paleo/primal community, there is definitely a link here. I guess I’ll try the taurine and cross my fingers…

    Travis wrote on April 2nd, 2012
  20. Alison,
    I am a big fan of Ultima Replenisher electrolyte drink. I used to drink gatorade, but went off that for obvious reasons, as well as feeling sick from all the sugar while I was working out. Now I just throw a scoop of Ultima into a litre of water, and it keeps me excellently hydrated -the taste is yummy enough to encourage me to drink, but not overwhelming, plus my stomach handles it really well and I think the extra electrolytes help keep my muscles going. Because it doesn’t have a lot of extra sugar in it though, it’s really only good for hydration but not for extra energy during super long workouts. Good luck with your marathon!

    Sophie wrote on April 2nd, 2012
  21. I, too, get leg cramps at night and at first I thought they were coming on as a result of “old age” and/or going Primal a few years ago. However, I also noticed that the cramps started when I began going to the gym again (concentrating on calf/lower leg workouts)which would coincide with the same time frame that I went Primal.

    On the few occasions that I haven’t worked out for, say, 2-3 weeks, I’ve noticed that I don’t have the leg cramps at night. Maybe just a coincidence, but something worth noting IMHO.

    PrimalGrandma wrote on April 2nd, 2012
  22. I guess Ultima might be useful for the muscle cramps as well! Though natural food sources would probably be more desirable when not on the go with a sport.

    Sophie wrote on April 2nd, 2012
  23. Keep in mind that potassium levels take about two weeks to change in vivo. So just eating a banana after you get a cramp won’t help much as is commonly advised. Be sure you are getting a regular supply in your diet to maintain the necessary levels.

    Sandra Tekmen wrote on April 2nd, 2012
  24. Lower extremity cramping is an indicator of intermittent claudication that comes with peripheral vascular disease. If she has any risk factors at all for having a deep vein thrombosis (being female itself is a big one), this isn’t something to be ignored and dietary changes will have no impact here.

    Roxy wrote on April 2nd, 2012
  25. I’ve only ever gotten leg cramps during two periods of time, BOTH of my dang pregnancies. Magnesium supplements seemed to help lessen the frequency. The other random thing I’ve noticed (you know, amid the muffled screaming and swearing) is that my natural reaction is to point my toes which seems to prolong the cramping process. My husband’s new job during these episodes is to pull my toes out of the pointed position and help me flex my foot back towards myself. The cramp almost immediately dissipates. Hope this helps somebody else, I hate those dang things.

    Shay wrote on April 2nd, 2012
  26. Aha, Mark! I think you pegged it! I have been having bad leg cramps despite being good about fluid intake and getting plenty of the dietary sources of electrolytes (except for beef hearts–any alternatives to them for taurine???). I do only light exercise, and I’m VLC.

    BINGO, I’m on a LABA asthma med (Advair). I’m not sure I can discontinue it at this point, so is there anything in the dietary approach I can do instead–perhaps to make up something LABA depletes? My asthma is very much improved on my Paleo/low carb diet, but I’m not eager to risk a bad exacerbation by cutting out this class of medication just yet. Been there, done that, and it’s not pretty.

    Janknitz wrote on April 2nd, 2012
  27. Re: Rasberry Ketones

    There is already a food that promotes ketosis. It’s coconut oil. I’m now drinking my coffee with a teaspoon of it. Check out Mary Newport’s book.

    Martin wrote on April 2nd, 2012
  28. I suffered muscle cramps after starting my paleo diet, and after a bit of trial and error, discovered that it may have been too much potassium! I was using the potassium salt liberally with every meal. As soon as I stopped with the potassium salt and reverted back to normal salt, my cramps vanished. Maybe the potassium to magnesium ratio was far too big?

    Mark wrote on April 3rd, 2012
  29. Hey Mark – while electrolytes continue to receive the lion’s share of the blame when it comes to muscle cramping, it’s unlikely that they’re relevant for most if not all common crampers. Repeated studies (pubmed search marathon muscle cramps electrolytes) have demonstrated no differences in electrolyte concentration in those who cramp and those who don’t. As a physician, I’ve treated hundreds of folks with extreme deviations in potassium, sodium, and magnesium concentration and never seen one muscle cramp from it. Typically, if concentrations are off enough to cause muscle cramps, these are the least of your worries :)

    On the other hand, the best model for muscle cramping we have are patients with glycogen storage disorders. For them, cramps are common, even with minimal exertion (McArdle’s disease being the most prominent example). Very low carb diets can create an analogous situation in some folks simply by depleting glycogen stores in muscle (this has also been well documented). Some folks are clearly more predisposed to this consequence of VLC than others. However, the prescription is to increase in healthy carb sources, not any type of electrolyte supplementation (I know this now from personal and professional experience).

    Anyhow, it’s a common problem for primal folks, so glad to see you trying to tackle it!

    jturk wrote on April 3rd, 2012
    • JTurk, thanks for posting this. I am so glad Mark brought up the cramping/twitching issue, as it is a common issue with Paleo/Primal types. But I am with Travis on this one. There has GOT to more than an electrolyte problem going on. Like Travis, I eat WAAAYYYY more leafy greens healthy fruit and veggies than I ever did before, yet the leg cramps started within a very short time after I went Paleo.

      I have taken mag/potassium supplement for a couple of months with no noticeable difference at all. After reading Mark’s post last night I decided that sodium might be an issue, since I don’t add salt to much of anything. I did a (possibly) dumb thing and added about 1/8 tsp pink Himalayan salt to my magnesium shot and actually woke up in the middle of the night with a major leg cramp. I haven’t done that since being pregnant. I won’t be taking salt shots anymore.

      So, I will now play with adding more carbs and see if that doesn’t offer some relief.

      Muchas gracias!

      Shannah wrote on April 3rd, 2012
    • Thanks for the alternative explanation to the electrolyte/dehydration mantra. I’ll try upping my carb intake and see where that leads. I wonder why some of us on a low carb diet are more predisposed to this than others.

      Travis wrote on April 3rd, 2012
      • I suspect that individual susceptibility to cramping with low carb diets has to do with individual variability in the genes encoding the glycogen storage machinery. Would make a great research project for any molecular biology grad students out there! :)

        jturk wrote on April 3rd, 2012
    • This resonates with me. The first time I tried Paleo for about 6 weeks I had wake-me-up calf cramps, something I never otherwise get. The electrolyte thing doesn’t make too much sense, since I was eating a ton of greens and plenty of salt, plus vitamins with magnesium and calcium. But I was fairly low carb. This time I am trying the diet with more carbs (sweet potatoes, plantains, etc.). Maybe the cramps won’t come back!

      Katie H wrote on April 20th, 2012
  30. Dr. Eades addressed morning leg cramps awhile back, and his take was that it is often caused by simple dehydration. You lose a lot of water each night as you sleep, and if you are on the edge, this could put you over that edge. I started drinking more just before going to sleep, and it seems to help.

    Damien Gray wrote on April 3rd, 2012
  31. Quinine helps cramps — have a drink mixed with tonic

    Christine wrote on April 3rd, 2012
  32. I’ve been competing in Olympic and Half IM triathlons for the past 4 years. I used to have major cramping issues on the run portion of the race. During the runs I always felt my muscles tense up and ready to cramp if I stopped running or my stride landed awkwardly. I had to be really careful until I got to the finish line. But when I actually got to the finish line, there was no stopping the cramps from coming. I’d usually cross the finish line grabbing my hammys. My friends have taken a few classic pics of my finishes and ended up on Facebook as a humorous reminder of the pain. After I got through the finish line, I would wait for the friendly volunteer to take the race chip off my foot. When I straightened my legs, my quads would cramp, I’d let out a roar due to the pain and probably gave the volunteer a nice scare.
    All of that doesn’t happen anymore though! After two years of cramping up I discovered the wonders of Electrolyte Supplements in capsule form. The supplement that I use seems to be PB friendly, at least according to my 3 months of experience. Anyway, I pop a few of these capsules throughout the bike/run portions of the race and haven’t cramped on race day ever since. These might be something to implement in marathon training as well, especially on long runs.

    Brandon wrote on April 3rd, 2012
  33. I have always had problems with leg cramps – during my pregnancy was the worst! Seems to run in my family. Even living primal, the issue is not so much missing electrolytes as an imbalance. Living in a city that has a really high calcium level in water, I found I have to supplement with magnesium. I take a form that dissolves in the water just before bed and the leg cramps disappear. Good luck!

    Jill wrote on April 3rd, 2012
  34. My cure for leg cramps and night twitches is pickle juice. A shot glass by the bedside in case my leg gets twitchy. Vinegar will do the trick if you get a painful cramp and don’t have pickle juice. There was an article in the NYTimes about this. It really works for me.

    Shalimar wrote on April 3rd, 2012
  35. Leg cramps have been a real problem for me, too, but they predate my diet change so I can’t blame the paleo diet. I have tried everything, lots of magnesium and potassium supplements, magnesium with calcium, lite salt, sea salt, electrolyte drinks. Lately I haven’t been taking my supplements and just put way more sea salt on my food than I normally would like and it actually seems to be better.

    Diane wrote on April 3rd, 2012
  36. If you get a leg cramp just POINT YOUR HEEL!!!!! Works every time! You don’t have to get out of bed and walk around just lay there point your heel and it will be gone.
    Doesn’t take care of the underlying problem but will save you from many seconds of pain.

    Sara H. wrote on April 3rd, 2012
  37. The post is so timely! I have my 3rd Half marathon this week and I refuse to do the traditional supplements! I am grain-free and sugar-free, but not strictly paleo. Thanks for all the great ideas, will definitely use them. Currently I use Nuun, the best on the market if you are looking for a tablet to throw in your water…

    Amber wrote on April 3rd, 2012
  38. I used to get awful calf and foot cramps, especially at night, since I was in high school (26 now). Two years ago, I read Protein Power by the Eades and decided to start taking magnesium supplements for better muscle function. Within a few months, my calf cramps disappeared (I couldn’t even point my toes without feeling like my calls were about to cramp up) and I have been cramp free ever since. I stopped taking the magnesium at one point and the cramps started returning. Despite the best paleo diet, our tap water is likely very low in magnesium compared to what our ancestors use to drink and this could explain why supplementation may be necessary for some people. I take magnesium chelate every day (125 mg). Just don’t over do it, too much caused some bad gas and constipation. For others it may have a laxative effect….

    Laura wrote on April 3rd, 2012
  39. I’ve read your last newsletter about the appropriate exercices to do, linked to the Paleo way of life. And it’s just amazing how it was clear to me that it definitely is the best way to move and exercise.

    A part of my work is with parents and their children, even very young. And they need to do this kind of exercises. They do certain movements like the yoga ones when they are babies, but a bit later, they do what you describe. I just have to remember my 2 yeared-old son this mornin pushing big chairs, carrying bottles of water or of almond milk (one by one of course). What interests him, is their weights, walking with them.

    (here I can also testify that it is a natural essential need : I oberved it in Montessori schools. Actually, Maria Montessori created activities to support these needs from 3 to 6 years old)

    And when we go for a walk, my son walks at this own pace and suddenly he starts to run quickly, for a short time, then walks again. We just have to follow him… His our paleo exercice’s master ! lol

    (the bug : he doesn’t like eggs, except when they are mixed in tort, cakes and so on. And he LOVES carbs, pastas…avoiding a lot of vegetables…)

    Sev wrote on April 4th, 2012
  40. Apple cider vinegar is great for cramps !!!!

    Evan The caveman wrote on April 4th, 2012

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