Quinine could cramp your health
Doctors will have to find another way to offer relief from leg cramps for their patients, now that the FDA has ordered unapproved quinine drugs off the market. Not to be confused with the FDA-approved quinine drug that has had a long-time use of treating malaria, these other quinine drugs came onto the market prior to the FDA-approval requirement of testing medicines for safety and effectiveness. And you know how effective those requirements can be. Just look at the safety and effectiveness of drugs like Vioxx and Ketek.
Many of these quinine drugs don't provide warnings of serious risks, including irregular heart rhythms, low platelet counts, which can increase risk of bleeding, and allergic hypersensitivity reactions, which in their extreme forms can result in sudden respiratory failure, cardiac arrest and death. Also, quinine drugs have been linked to 665 reports of serious side effects, including 93 deaths since 1969.
Currently, there are almost 4 million prescriptions written each year for quinine drugs, most for leg cramps. This leaves a lot of people with a notably uncomfortable and inconvenient problem. But do not despair: there are safe and effective alternatives to quinine.
First let's define leg cramps, which are not the same thing as so called "restless legs syndrome" or the intermittent claudication from peripheral vascular disease. Leg cramps or "nocturnal leg cramps" as they are commonly referred to, are sudden, involuntary spasms of the calf muscles that occur at night or while at rest. The pain can last anywhere from a few seconds up to 10 minutes, sometimes with lingering soreness. It is estimated that up to 70% of folks over 50 experience leg cramps at some time or other.
Restless legs syndrome usually involves a crawling sensation - usually at night in bed - that is relieved by walking or moving around. Intermittent claudication is fancy medical terminology for the pain that can occur during walking when the circulation to the legs is diminished by the same sort of atherscelorotic plaque blockage of arteries we observe in heart disease. Here the pain is caused by inadequate circulation to the legs and feet, which means the muscle tissues are not getting enough blood and oxygen.
Leg cramps appear to have numerous causes, which may differ in any one individual. There seems to be a clear association, however, with dehydration, overexertion and mineral deficiencies, especially magnesium. Given that about 50% of the population in this country doesn't get enough magnesium in their diet, treating leg cramps with supplemental magnesium is a good bet, although if you're willing to push your fruit and vegetable intake to the recommended 7-11 servings a day and include healthy nuts such as walnuts and almonds, you may be able to get rid of the problem without a pill. You can go to the local drug store or health food store and pick up some magnesium citrate, which is better absorbed than magnesium oxide. Fancier forms such as magnesium orotate, fumurate or malate are fine as well, but likely to be found in costlier products. Experiment with anywhere from 400 mg to 1200 mg a day (1-3 capsules). You should see results within a few days, if it's going to work. Magnesium is also a mild sedative and can actually work well for sleep. It also supports a healthy heart and helps prevent diabetes. And it's great for constipation. Unless you suffer from kidney failure, the doses above are well within the safe range. Why does magnesium do all these good things? Because it's a key mineral "cofactor" in over 100 important reactions in the body. For example, it's also a useful treatment for migraine headache and fibromyalgia.
Other than magnesium, you should also make sure you get enough fluid - up to six to eight 8 oz glasses of water a day. Wear sensible, comfortable shoes. And keep your calf muscles stretched out, toned and limber. On stairs you can pause for a 15 - 30 second stretch as many times as you think of it during the day. Also a wall stretch - position your feet 30 inches from a wall, keep feet flat, lean forward, supporting your hands on the wall and hold for 15-30 seconds, at least a couple of times during the day. After a few weeks, once you get stretched out, you may be able to maintain your flexibility with a couple of stretches a day, or just stretching out on the stairs now and then. A vigorous 3-5 minute (or more) self-massage or with an electronic vibrating massage device can be helpful.
Tonic water can work. It's simply a low dose of quinine, safer than the higher amount found in common medication forms. But sensitive individuals apparently can still suffer ill effects from it, especially those people prone to a hypersensitivity reaction. I'd rather see a patient on magnesium, due to its many benefits, but a glass of tonic every night, if it works and you've had no problems with quinine in the past is, after all, just a glass of tonic water, preferable to a higher drug dose. By the way, prescribing quinine for leg cramps is not being disallowed. Doctors are just being advised to communicate the new warnings and precautions to patients.
Less common causes of leg cramps include diabetes, Parkinson's disease, chronic low blood sugar, anemia and thyroid disease. Treatments under these conditions are beyond the scope of this discussion, although there's absolutely nothing wrong with starting out with magnesium plus the stretching and massage - if you get better, you can stop there, although obviously each of these particular conditions requires their own treatment in conjunction with your doctor.
A note about intermittent claudicating: There is excellent evidence supporting the use of gingko balboa for this well known circulation problem. I recommend Nature's Way Gingkold, a widely available version of a high quality German pharmaceutical product used with success in most of the major European studies. Use 120 - 240 mg a day, which you can divide into two or three doses. Ginkgo has a mild blood thinning effect, by itself a good thing, but which should be kept in mind if your taking any other herbs, drugs or supplements with any blood thinning effects.
