By Cade Baughman, Student Pharmacist and Karen L. Kier, Pharmacist
ONU Healthwise Pharmacy

Cramping your style is an idiom used when you are asking someone if your activity is preventing them from acting naturally or enjoying their time. The idiom is believed to have started in the early 1900s as a saying to impede or restrict one’s actions or expression. The word cramp was used intentionally due to the pain caused by leg cramps. Leg cramps can definitely restrict your actions and style. 

It has been estimated that 50-60 percent of American adults have experienced nighttime leg cramps. As common as this is in adults, it is more unusual for children with less than 10% experiencing leg cramps while they sleep. 

There is not one specific cause of nocturnal leg cramps but some reasons for their occurrence can include dehydration (lack of fluid intake), overuse of the muscle during the day, electrolyte imbalances such as potassium, calcium, and magnesium, underlying medical conditions and some medications. Other causes can be sitting too long and bad posture. The pain is often located in the calf of the leg and it can make it very difficult to sleep. 

Diuretic medications such as hydrochlorothiazide, chlorthalidone and furosemide can cause dehydration and electrolyte imbalances primarily potassium resulting in leg cramps. These diuretics can be very helpful in controlling blood pressure and reducing fluid for individuals with heart failure. This is why your healthcare provider will do blood work to monitor for electrolytes. 

There is little published evidence on good therapies for nighttime leg cramps. Stretching and massaging the area is considered a good practice. Some limited studies have shown benefit with magnesium supplementation or the use of electrolyte drinks. Before using these supplements, talk to your healthcare provider. 

A very popular product in the past has been the use of quinine for leg cramps. Quinine is found in small quantities in tonic water providing its bitter taste. Quinine use for leg cramps has been discouraged due to the side effect profile and its potential drug-drug interactions. The FDA banned the sale of over the counter quinine for leg cramps in 1994 due to safety concerns.

A study in JAMA Internal Medicine evaluated the use of vitamin K2 to reduce the number of leg cramps per week. Vitamin K2 is known as menaquinone 7 and was given at a dose of 180 micrograms daily for 8 weeks to adults over the age of 65 years who had experienced at least 2 leg cramp episodes per week. One half of the participants received the active vitamin K2, while the other half received a placebo. 

The study demonstrated a reduction in the frequency, duration and intensity of leg cramps in the group receiving vitamin K2 compared to the placebo group. In addition, the researchers reported the active treatment group with vitamin K2 were more likely to sleep better. 

It is thought that vitamin K2 works to relieve nighttime leg cramps by helping to prevent unintended muscle tightening or contractions. Vitamin K2 is available in both dietary supplements and foods. Some foods rich in vitamin K2 include gouda cheese, blue cheese, and green leafy vegetables. It is recommended from the study for adults to consume 180 micrograms of vitamin K2 daily. 

If you are thinking about starting vitamin K2 supplementation, it is important to note that vitamin K2 can interact with the drug warfarin (Coumadin). The use of antibiotic medications can cause low vitamin K2 levels. Speak to your healthcare professional about vitamin K2 before starting it if you are prescribed any of these drugs. 

Don’t cramp your style, talk to your healthcare provider about options such as vitamin K2!