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Keto and muscle cramps

Is there an association with the keto diet and muscle cramps?

Any effective weight loss program will have some side effects. It’s not just the keto diet that can lead to muscle cramps. The main thing is that not everyone gets muscle cramps. People think of the cramps as part of the ‘keto flu’, but the first thing to know is that not everyone gets it, so don’t let that be a deterrent. Don’t let that stop you from trying keto. Of course, it’s easily treated. There’s a lot of confusion about if it’s a stomach cramp or a menstrual cramp, but when I ask about muscle cramps, it’s typically found in the calf or the leg. There might be a cramping sensation that’s very painful. It’s not something you want to have. I would say that maybe 10-20% of people who follow a keto diet have muscle cramps, and we teach people how to handle it.

Are there any other areas in the body where you would have cramps besides the calves?

The calf muscle is the main one – the charley horse. It might be the thigh or even the quads, so let’s just say “leg cramps.” They don’t typically occur in the back, or the arms or the neck. It would be leg cramps, either in the front or the back.

Do you have any idea what causes these cramps? Is there anything that might help?

The exact mechanism really isn’t known yet. It’s a malfunction or mixing up of the electrolytes and water and salt, and blood volume. There are a lot of treatments that can help. Some people will try to prevent the occurrence by using electrolytes. My approach is to wait, because most people don’t get them. I wait, and if someone complains about the cramps, I’ll teach them how to treat it.

You may have seen in a football or basketball game where someone has leg cramps and they try to work it out manually by moving a leg or putting pressure on the muscle. If that doesn’t work, they get whisked off the field or the court and what you don’t see is that they sometimes give the athlete a liter of fluid into the vein. Not everyone has access to that, but the point is that there’s a phenomenon of low blood volume or dehydration that can lead to a cramp, which can be quickly fixed by just adding a liter of fluid directly into the artery or vein. It’s hard to expand the blood volume that quickly without an IV.

What we do (much more easily) is, we add salt or bouillon or magnesium. We focus on magnesium replacement to treat or even if you want to prevent muscle cramps from occurring. With that blood volume issue, salt can help to prevent cramps from happening. The mechanism really isn’t known, but all of these things can help.

Would you tell people to rehydrate or to drink a little bit more?

Yes. As long as you don’t have heart failure or high blood pressure, the way to hold onto the fluid that you drink is by having salt—by adding a bullion cube to hot water and drinking that. If you want a quick remedy, just have a little squirt of mustard, like a little packet of mustard that comes in a plastic wrap from a burger joint. These work remarkably fast to fix a cramp. I rarely get them, but occasionally I have one and I’ll get up in the middle of the night and I’ll go to the refrigerator and pull out a little squirt of mustard and it’s gone within a minute. It’s amazing. If you only have one cramp, try and fix it immediately with that.

If you have a recurring problem and the muscle cramps are bothersome, then you want to use something to prevent them. That’s where you get into magnesium supplementation and salt supplementation (meaning bullion cubes). The form of magnesium that we like, because it’s widely available and you don’t need a prescription, is the liquid form, called ‘milk of magnesia’. Just a teaspoon of that at bedtime for a week will prevent the muscle cramps from coming back.

Do you suggest potassium as a long-term remedy as well?

If you’re on medicines like diuretics, hydrochlorothiazide, and lasix or furosemide for high blood pressure, these can cause low potassium and you should probably be checked for that periodically. I find that if you normally eat real foods and you’re not not on these medicines, you really don’t have to supplement with potassium. The thing is, magnesium helps the potassium to work. As long as you have plenty of potassium around, that will help the cramps. It is possible to take too much potassium if you don’t have normal kidneys. That’s why magnesium supplementation without worrying about potassium will work so well and it’s easily available.

How long would it take for muscle cramp occurrences to go away?

Most commonly you’ll have one cramp and it’ll never happen again. If you have one or two and it’s recurring, this is a transition thing that might happen for a couple weeks. You’ll want to use the magnesium replacement, add salt in the form of bullion every day to hydrate, and then after a week or two most people have no problem anymore. There are rare cases of people who need more and who need to combine all of these things to relieve the cramps, but what’s fascinating is, I’ve had a few people who have had cramps for years and they come into our program, learn these techniques, and then the cramps go away. Just paying attention to these things—food and nutrition—really matters. It can really be helpful for lots of things.

What time of day would people typically experience these cramps?

I don’t know why, but it seems to be a nighttime thing. Maybe that’s just when it’s the most bothersome that people will talk about it. Usually the tradeoff of the success that people are getting with a keto diet makes it a minor thing in their minds, something to just work out over time.

Check out the full video here.

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