Is Tonic Water a Cure for Foot/Leg Cramps?
Posted:
2024-08-07
What’s happening?
Earlier this year, one of the PEN Team members overheard a conversation where an individual was told by a family member to drink tonic water before going to bed to help with foot cramps. The PEN Team thought a review of recently updated PEN content on muscle cramps would help to assist practitioners if they have clients with a similar practice question.
Review of the evidence
Muscle cramps are sudden, painful contractions of muscles which can negatively affect your sleep and quality of life (1). Legs, feet, hands, arms and the abdomen are areas that can be affected. Not all muscle cramps can be explained but some have been caused by:
- Altered nutrient levels, e.g. magnesium is involved in regulating muscle function, in older adults, during pregnancy and in various health conditions such as liver disease. More evidence is needed before specific magnesium supplementation recommendations can be made (2).
- Exercise, that may be related to dehydration and/or the loss of electrolytes from sweating during exercise (2). Evidence on other beverages that may help protect against and reduce severity of muscle cramps is described below.
- Health conditions, particularly in individuals with cirrhosis of the liver and those undergoing hemodialysis.
- Taurine, L-carnitine and branched-chain amino acids (BCAAs) may be lower in individuals with liver cirrhosis who experience muscle cramps. Supplementation with these nutrients may help reduce the frequency, severity and/or duration of muscle cramps in individuals with liver cirrhosis by improving energy metabolism that is altered due to the disease (2). The role of vitamin D and zinc in treating muscle cramps in this population is unclear (2).
- Electrolyte abnormalities, low blood pressure and the dialysis may cause muscle cramps in individuals undergoing hemodialysis. Supplemental vitamin K2 may reduce the frequency, severity and duration of muscle cramps experienced during hemodialysis, but higher quality research is needed before specific recommendations can be made (2).
- Alcohol intake, possibly related to the destruction of muscle fibres, thereby making them vulnerable to cramps (2).
So where do tonic water and other beverages fit in, to address muscle cramps?
- Tonic water is a carbonated beverage that contains quinine, a botanical from the cinchona bark (3). Some low quality evidence suggests that quinine may reduce muscle cramps (4). While the level of quinine in tonic water is negligible, quinine is not recommended for treatment of frequency or intensity of muscle cramps due to potential adverse events (4,5).
- Sports drinks may help protect against and reduce pain associated with exercise-induced muscle cramps in healthy young adults (2). The added water and electrolytes may help maintain the body’s fluid and electrolyte balance.
- Pickle juice may shorten the duration of exercise-induced muscle cramps in healthy young adults and may reduce the severity of cramps in adults with cirrhosis (2). The acetic acid (vinegar) in the juice may trigger an oropharyngeal reflex that reduces the motor neuron activity in cramping muscles.
Bottom line
When counselling clients who may have food/nutrition questions related to muscle cramps consider the following (1,5,6):
- Assess your client for nutrient deficiencies and the potential need for supplementation. This may include vitamins/minerals/supplements such as magnesium, taurine, L-carnitine and BCAAs in individuals with liver cirrhosis and vitamin K2 during hemodialysis. The potential benefits and the risks of nutrient supplementation should be balanced against the negative impact of the cramps on the individual’s life.
- Provide general dietary guidance:
- Drink plenty of fluids to stay hydrated, including water, milk, fortified plant based beverages or sport drinks, especially during hot weather and when exercising in hot weather conditions.
- Eat a variety of foods including vegetables, fruits, whole grains and protein foods to provide adequate nutrients, especially for clients who are pregnant.
- Limit or avoid alcohol, especially for adults over 60 years, as it may worsen muscle cramps.
See Additional Information:
References:
- MedlinePlus. Leg cramps. N.d. Available from: https://medlineplus.gov/musclecramps.html
- Dietitians of Canada. What nutrients or beverages exacerbate or alleviate muscle cramps? In Practice-based Evidence in Nutrition® [PEN]. Available from: https://www.pennutrition.com/KnowledgePathway.aspx?kpid=6928&pqcatid=146&pqid=6963 2023-05-26. Access only by subscription. Click Sign Up on the PEN login page.
- Graham C. What is tonic water? The Spruce Eats. 02/23/23. Available from: https://www.thespruceeats.com/what-is-tonic-water-5101606
- Tawil S, Al Musa T, Valli H, Lunn MP, Brassington R, El-Tawil T, Weber M. Quinine for muscle cramps. Cochrane Database Syst Rev. 2015 Apr 5;2015(4):CD005044. doi: 10.1002/14651858.CD005044.pub3. PMID: 25842375; PMCID: PMC11055607. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/25842375/
- University Hospitals. Painful leg cramps can stop you in your tracks. June 05, 2023. Available from: https://www.uhhospitals.org/blog/articles/2023/06/painful-leg-cramps-can-stop-you-in-your-tracks
- Dietitians of Canada. Neuromuscular – muscle cramps practice guidance toolkit. In Practice-based Evidence in Nutrition® [PEN]. Available from: https://www.pennutrition.com/KnowledgePathway.aspx?kpid=6928&tkid=21462 2023-05-31. Access only by subscription. Click Sign Up on the PEN login page.
