Announcing two NEW nutritional resources from Physician Nutrition:
this E-Source newsletter, covering our recommendations for specific concerns,
and our new Ask the Dr. knowledge base—quickly look up supplements and care!

The more I talk to people at or near retirement age, the more I realize how prevalent nocturnal cramps are. They may be variously located in the toes, sole of the foot, or in the calf. They are not usually terribly painful, but they are certainly annoying, and worse, they will wake you up in the middle of the night and not let you go back to sleep. Stretching has not been shown to be an effective preventative or therapeutic help. Alcohol seems to make them more prevalent.

The treatment of nocturnal cramping has been a pharmaceutical failure so far. Believe me, everything has been tried, including narcotics. Quinine tablets, or even quinine tonic water, is effective in many cases. The problem with quinine is that the difference between the therapeutic range and toxicity is often narrow. Rather severe gastrointestinal symptoms, blindness and deafness are all possible. We need to look for a better answer.

Nocturnal cramps have been associated with iron deficiency anemia. It seems low hemoglobin causes cramps at night when the heart rate naturally slows down. A simple blood count and a ferritin level (a measure of iron stores) will reveal iron deficiency anemia and thus a way to successfully treat nocturnal cramping. If you ask most nutritionists what most Americans are missing in their diets, magnesium will be usually be at the top of the list.

When you look at the physiology of muscle, it takes a molecule of calcium to make a muscle contract, and a molecule of magnesium to help it relax. For this reason, nutritionists will recommend magnesium for any condition where hyper-excitability is present, from seizures, to irregular heart beat, and muscle spasms. Therefore, taking a magnesium capsule prior to bedtime is the first thing to try. My recommendation is Magnesium Citrate, as the citrate form is the easiest to absorb. If 1 capsule at bedtime is insufficient, increase it to twice daily. I personally have tried as much as 2 capsules, four times a day. There is a problem with too much magnesium by mouth--loose stools. Please do not use so much magnesium that diarrhea ensues. By the way, magnesium absorbed through the skin does not cause GI problems. Soaking in Epsom Salts is a wonderful way to increase magnesium into your system. For those of you with hot tubs, please refer to my much earlier article on using MgSO4 in your hot tub rather than chlorine or bromine.

Another nutrient I recommend a lot is Taurine. Taurine is a sulphonic acid, a very close relative of amino acids. Taurine is not built into enzymes or structural proteins like other amino acids, but rather helps cells with their osmotic and electrical functions. While you may never have heard of Taurine, it is extremely well researched, having more than 9000 papers available in the medical literature. Taurine is the most common amino acid in the retina, which is why I recommend it in many retinal conditions, including glaucoma. Considering its function, it is highly concentrated in muscle (hence the name taurus), heart muscle, brain, and retina. From a food standpoint, meat and shellfish are good sources.

Taurine is very inexpensive, and has virtually no toxicity. A number of years ago, I tried, unsuccessfully to treat my atrial fibrillation with Taurine. At one point I was taking up to 20 grams of Taurine daily. It did not work to cure my atrial fibrillation, which had to be treated surgically. The point I am making is that Taurine has few problems, even in high dosages. For nocturnal cramping, I would start with 1 Taurine at bedtime, increasing every few days until you find a level that works for you. Hopefully, some combination of taurine and magnesium will work for you.

Jim McNabb, M.D.
Eye Physicians of Austin