Relief for leg cramps; digestive issues
Q: I frequently have leg cramps that wake me up from sleep. How can I quickly stop the cramps, and are there ways to prevent them?
A: Few things are more jarring to a night’s sleep than a sudden cramp in your calf. By the way, you have lots of company. Although nocturnal leg cramps can strike people at any time of life, they become more common with age.
Among people over 50, about half report having leg cramps, a third say they are awakened by cramps at night, and 15 percent report weekly episodes.
Leg cramps are muscle spasms caused by “mini-seizures” of motor neurons (nerves that power muscle contractions). They are common among people with foot problems like flat feet or high arches, metabolic disorders, or neurological conditions such as Parkinson’s disease or neuropathy (nerve damage).
However, most cramps strike people who are otherwise healthy. Dehydration and electrolyte imbalances such as low blood potassium or magnesium levels (a common side effect of diuretics) can increase the risk of cramping.
To stop a foot or cramp once it happens, lean over and grab your toes, then slowly bend your foot back toward your head. Hold for about 20 seconds, then release it. Repeat as needed.
If that doesn’t help, you can try rubbing the cramp with ice wrapped in a towel. Some people find more relief with a heating pad placed on the cramp.
Despite the lack of a scientifically proven and safe therapy to prevent recurrent nighttime leg cramps, a few approaches may be worth trying.
Start with stretching exercises. Stand about two feet from a wall. Lean forward, keeping your legs straight and feet flat on the floor. You should feel the stretch, but it should not be painful. Hold the position for 20 seconds and release. Repeat the stretch four to five times.
Ideally try to do this four times per day for the first couple weeks at least. The most important time to stretch is before bed.
Other preventive measures you can try include avoiding dehydration, wearing well-fitting supportive footwear, and keeping the bedding at your feet loose during the night.
Although the evidence isn’t strong, some people find that taking a daily vitamin B complex helps, or consider over-the-counter diphenhydramine (Benadryl) before bedtime.
Right now, there are no FDA-approved medications for leg cramps. The one drug with solid evidence for reducing the frequency of muscle cramps is quinine. However, the FDA has issued repeated warnings against using quinine to prevent or treat leg cramps because it may cause serious side effects.
Although doctors can still prescribe quinine, it is recommended only when cramps are disabling and the person understands the significant risks.
Q: Food often sits heavy in my stomach. Should I be taking a daily digestive enzyme supplement?
A: Digestive enzyme supplements promise to fix everything from bloating and flatulence to heartburn and gut health. Some of them are clearly beneficial in certain situations.
But enzyme supplements are too often used in situations where there is little evidence that they do any good.
Naturally occurring digestive enzymes help break down food so we can soak up nutrients. Your mouth, stomach and small intestine make some digestive enzymes. However, the majority come from your pancreas, which floods the small intestine (when food arrives there) with enzymes such as:
— lipase, which breaks down fats
— amylase, which breaks down carbohydrates, and
— proteases and peptidases, which break down proteins.
Once nutrients are broken into small enough molecules, they are absorbed through the wall of the small intestine into the blood and then delivered throughout the body.
Sometimes the body doesn’t make enough digestive enzymes. This can slow the digestion process and lead to uncomfortable symptoms.
For example, if you don’t make enough of the enzyme lactase, you’ll have a hard time digesting lactose — the sugar in milk and milk-based products.
If you don’t have lactase, the undigested lactose goes to the colon, which leads to more fluid entering the colon and more gas produced by bacteria in the colon. That creates bloating, flatulence and diarrhea.
For people who can’t make enough digestive enzymes because of a health condition such as chronic pancreatitis or cystic fibrosis, doctors prescribe enzyme pills to substitute for the lack of natural enzyme production. People with known deficiencies clearly get a benefit from these.
Likewise, we know that taking a nonprescription lactase supplement (such as Lactaid or Lactrase) can help people manage lactose intolerance, and taking an alpha-galactosidase supplement (such as Beano or Bean Relief) may reduce gas and bloating if you have a hard time digesting the sugars in beans.
But for other common gut problems, like heartburn or irritable bowel syndrome, there is little evidence that digestive enzymes are helpful.
Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit health.harvard.edu.
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