I was just flicking through a book that I used as a junior doctor when I first started working. Oxford Handbooks are the pocket sized bibles for anyone starting in medicine. Page 87 got me thinking – the page of nutritional requirements. At the top […]
I’ve been catching up with Hugh Fearnley Whittingstall and his fat fight. He likes a good fight and I’m so glad he has chosen this one. Whilst I’m a little down that the calories-in-calories-out mantra is still prevailing, there was something that was even more […]
Leg cramps are a common complaint for those starting out on a low carb or ketogenic diet. I was a bit worried, if I’m honest, because I have a grizzly history with cramps. I was afflicted from an early age (long before keto) and my mother was the same. My pregnancies were just nine long months of painful cramps and endless peeing. They are benign, nocturnal or exercise induced cramps and I also often get some less troublesome post-exercise fasciculations (twitching as opposed to big muscle contractions).
My blood levels of Potassium, Sodium and Magnesium have never been anything other than normal (when being tested of course). I went to my GP once, when I was 19, I was playing rugby, drinking beer, partying a lot and waking at night with vicious cramps. His suggestion – stop eating tomatoes. He meant well and was genuinely looking for up-to-date answers but I was sceptical and never took his advice.
My cramps were noticeable when I started a proper ketogenic diet this time round. I’ve played about with low carb/ketogenic diets previously but don’t remember thinking about cramps in depth. The cramps occur most often in my calves but also in the front of my legs (so so painful), throughout my feet and also my hands (that’s actually quite funny when it happens, as long as it doesn’t last). I get cramps in my abdominal muscles and in my big back/neck muscles. You name them, lots of my muscles like to cramp. It can from time to time be distressing and can leave me sore for many days. You can see why I went to the GP. My cramps may have increased on the ketogenic diet but at the same time I increased the amount of exercise I was doing. I am rugby training as well as martial arts training, I recently ran a 10km and have been in competition for steps with my fitbit friends. I have also been very self-aware since ditching carbs, clocking every feeling and twitch, so it may not have been an increase, just an increased awareness.
Of course I have seen the advice to drink more water, take more salt, check my potassium and magnesium intake, drink bone broth, drink pickle juice. I take supplements. I haven’t noticed any change. I see a lot of people advising potassium or magnesium supplementation but I never saw any of them quote any evidence.
I wanted some answers and so I started researching. There is some interesting physiology research out there, there are some brain tickling N=1 thoughts and there is lots of very general advice around keto-flu and supplementation of various electrolytes. It will be difficult though to find out what helps for me if I don’t actually quantify the cramps. I already diligently record what I eat, so I have started to record cramps, including the details of muscle groups, extent and timing. Then when I have some idea of the extent of the problem, I can start to look for correlations and can start to change up the diet and supplements to look for any changes. Again, I’m sceptical that I can find an answer after so many years, but I’m looking.
So, watch this space and I will publish some results – one way or another. I have more questions than answers just now. Here are some links…
Central nervous system or peripheral generation? I always assumed that the mechanism was a peripheral one (local to the muscle and local motor neurons/terminal nerve branches) but it looks like there could be a central mechanism that is important. This has interesting bearing on prevention.
Then there’s what Diet Doctor says. They mention Volek and Phinney’s book – I haven’t read that yet (gasp, what an admission!).
I will get back to you.
Navigating the food pyramid with the next generation is really hard, especially when you are trying to turn it upside down. The next generation, and by that, I mean my kids, are going to need a lot of help. My children are already being taught […]
I can’t get through a day without being asked – are you allowed to eat this or that. My response is always the same: there is nothing I am not allowed to eat, there are many things I choose not to eat, because I am […]
A few years ago I was a junior doctor at the end of the a long line of medics on a ward round. We came to an eighty year old lady who told the boss that she had been having trouble sleeping, that she felt a bit sick. The consultant knew the answer, “Well, take a PPI (this is a proton pump inhibitor, you may have heard of them, or you may even be taking Omeprazole or Pantoprazole) and you will feel better” he proclaimed and much like Sir Lancelot Spratt he was off, entourage in tow. As I walked away, the lady in the bed looked at me and said “It’s typical of you doctors, all you want to do is give us tablets”. The other ladies in the ward nodded in agreement. My first thought was simple, we are doctors, it is what we do. I have thought about that a lot though, in the years since.
Medicine and the world of medicine is about throwing drugs (and other treatments) at an established health problem. This is great, if you have established a health problem. But I think we have our priorities wrong. Why? Because the doctor who rushes in to save the heart attack victim is the superhero and the doctor sitting at a desk trying to help whole populations from having them is, well, more of a geek than anyone’s hero. They don’t make fast-moving, exciting TV shows about him or her. As a disclaimer, you will have been more likely to find me in the first camp over the years, than in the latter.
Prevention might well be better than a cure but let’s face it, the cure is much sexier, unless you are the one suffering. The problem is, we are all starting to suffer. You can’t make superstars out of preventative medicine and I’d suggest you can’t make as much money…unless you’re selling preventative drugs, you know, like Statins. What needs more of our emphasis, time, money, effort, concern and priority is prevention.
Well, OK, that is all well and good but the prevention interventions we have tried have not been working. The calorie restrictions, the eat-less-move-more mantra, the dietary guidelines to avoid fat and eat all the pasta are not working. Drugs are not the way out when bad nutrition got us into trouble in the first place. We are all going down the wrong path and we need to turn around as soon as possible because the only thing doing really well here, is the diet industry.
I’ve been keeping a diary on Instagram @keto.edges but I wanted to rant a little more, so here is a new blog about nutrition and health. Still to come…What is a ketogenic diet? Kids and teachers, intermittent fasting, artificial sweeteners…and this is just a start. Welcome aboard.