Blog Post

Nutrition for Cramps in Athletes

Male Athlete Experiencing a calf cram

As somebody who has gone deep down the rabbit hole of nutrition for cramps in sport, in a bid to help give my clients an edge over their competition, I can confirm that cramps can be a complex topic.

There is a lot that is not known. There is a lot that does not work. And there are also a lot of people who try to simplify it down to one thing as if one specific strategy will solve cramps for all athletes.

It is clear that cramps are multifactorial. And I would wager that in the coming decades, we will probably have better solutions than we have now.

Cramps are also hard to study. They are relatively hard to induce naturally in a reliable way. Of course, there are ways around this to induce them in studies, but the methods used may or may not be overly relevant for athletic performance.

But for now, I will share insights that are currently available, since there are some practical strategies that can be helpful if you suffer from cramps.

What Causes Cramps?

As mentioned above, cramps are multi-factorial.

The two main hypotheses are based on:

  1. Dehydration and electrolytes
  2. Neuromuscular fatigue

From my perspective, both aspects look relevant. The neuromuscular fatigue hypothesis seems to be more accepted amongst experts as the common cause in sports, but I still think it is worth not completely ruling out hydration and electrolytes.

The dehydration-electrolyte imbalance theory seems to be the most common amongst the general population. And a factor that supports this is that cramps are more commonly experienced at higher temperatures in humid climates.

However, athletes exercising in cooler temperatures, without dehydration, still experience cramps, so it obviously is not that simple.

With the neuromuscular fatigue aspect, athletes often report cramps more commonly after an increase in training/competition load. For example, one study on American Footballers identified that cramps most often occur during the first 3 weeks of training practice.

In this study, the incidence of cramps was 37% during the first week of the training camp, then 27%, 18% and 4% in the succeeding weeks. This seems relatively clear that building up training capacity to handle certain loads is an important factor.

The neuromuscular theory for cramps in athletes proposes that muscular overload and neuromuscular fatigue cause an imbalance between excitatory and inhibitory impulses. These impulses result in the involuntary contraction known as a muscle cramp.

Training

Cyclist Endurance Training

Since we have an abundance of evidence that cramping is associated with increases in intensity and/or duration in comparison to what you have been consistently been training for, it makes sense that this needs to be mentioned, even though the article is on nutrition.

Nutrition can help. But we need to factor in the big picture first.

Ideally, your training prepares you for the events you are prioritising. And it is also beneficial to be acclimatised to the temperature/humidity you are competing in as well.

Training to reduce cramps can actually be relatively nuanced. Although I have a massive interest in training as well, I would prefer to focus on nutrition and encourage you to look elsewhere for that advice. But I did want to mention this at the start, to highlight the importance of it.

Pickle Juice

Pickle Juice

Pickle juice is my secret weapon for cramps right now.

The research on it is relatively new and the results are not necessarily overwhelmingly positive. It is still quite mixed.

But the reason it is my secret weapon is that it is something that not a lot of athletes in Australia are using yet. Some are, but not many.

There has been a long history of anecdotal evidence from athletes claiming pickle juice helps reduce cramping.

From a research perspective, one study in 2010 indicated that consuming pickle juice at the onset of a cramp resolved it 45% faster than water.

Another study found that cramp duration was reduced by about 37% on average when pickle juice was ingested directly after induction of cramping, compared with a trial where water was ingested.

While a lot of people immediately assume this is due to the sodium content, the outcomes occur so quickly that it is not possible. It is more likely related to the neural reflex triggered by the acetic acid in the pickle juice.

Pickle juice triggers nerves in the mouth that signal the spinal cord neurons which reduce motor neuron activity to the cramping muscle.

This lines up well with the neuromuscular fatigue theory.

It is based on transient receptor potential (TRP) channels, which also plays a role in other options for reducing cramping that I will discuss later.

The anecdotal evidence is strong and there is some support with research. But it is not all positive. A recent study that is yet to be printed and reviewed (at the time of writing) indicated that pickle juice was no more effective than water for inhibiting electrically induced cramps, in a small sample size.

This makes it clear that it is not some miracle option that solves cramps in everybody.

The most consistently positive evidence is related to consuming it directly when the cramp starts.

Most commonly it is consumed as 1ml/kg (e.g. 80ml for an 80kg athlete) taken as a shot. An alternative, which might be more appealing for some, is that it can be taken as a mouth rinse, and spat out, while still likely providing the same benefits.

The evidence for cramp prevention if taking it in advance is a bit shakier. I have seen some smart people in this field downplay any potential TRP related products have for cramps prevention. But there is also some research supporting it, which I will mention later.

It is early days for pickle juice. I am super comfortable changing my mind as more evidence comes out.

For now, if you are prone to cramping and it is affecting your performance, it is worth a crack in my opinion.

At this stage, if I were an endurance athlete and was desperate, I would consider also trialling it before events/training and seeing if it makes a noticeable difference. The benefits are reported to last for 2-8 hours, so it could be worthwhile, although I still would view it through a sceptical lens.

Hydration

Kipchoge Drinking Water

With hydration, I am going to start with the current consensus amongst experts.

The consensus is that hydration really does not seem to be a common factor in cramping amongst athletes.

Fluid losses are typically not significantly different between those who cramp and those who do not.

And if cramps were caused by dehydration, the simple solution would be fluid replacement. But when fluid intake matches sweat loss, cramping still occurs at similar levels.

The final nail in the coffin is that athletes who cramp, appear to be taking on a similar amount of fluid as those who do not cramp.

That being said, I would not rule out hydration completely.

It is still a good idea to aim to avoid having your fluid loss accounting for a greater than 2% reduction in body weight. Even from a performance perspective, this is a good idea regardless, in addition to the anecdotal evidence that it could help with cramping.

One note I have to add here though is that I am aware that a lot of top-level athletes actually go beyond this 2% number frequently. Winners of marathons, to the best of my knowledge, are routinely beyond this number, since taking time to drink could arguably slow down overall race time.

So, this is a tough balance. This is standard advice, but I would not overthink it. I would just keep it in mind and play around with what you find works best for you.

At a minimum, it is a good idea to be well hydrated leading into training/competition.

There are also arguments to be made for being hyper hydrated prior to events in hot climates. This is part of why products like Prepd exist that utilise resistant starch in a way that allows you to hydrate beyond normal amounts.

Glycerol

Glycerol powder

Glycerol can help from a hydration standpoint.

If consumed orally, typically as part of a beverage, it creates an osmotic gradient that favours fluid retention.

This means that the kidneys, which are responsible for fluid excretion and maintaining fluid and electrolyte balance, will reabsorb more water as the water passes through them.

Thereby reducing urinary output and allowing the body to be more hydrated than what is normal (i.e. hyper hydrated).

Studies have shown that up to 1L of extra body water is achievable through sufficient glycerol supplementation.

The effects of glycerol supplementation last for up to 4-hours.

Glycerol can improve performance, without even factoring in the cramping aspect. This is partly due to improved hydration, which is particularly relevant on hotter days and more humid climates.

The most common way to utilise it is to consume 1.2g/kg BW with a volume of fluid equal to 26mL/kg BW. Sip on this slowly over the course of an hour, with the end of that hour being 30 minutes before the event starts.

If cramping is related to hydration, glycerol could help. I would not rate this as highly likely to help, but it has potential in some cases.

Electrolytes

Similarly to hydration, there is not strong support that electrolytes play a large role in the reason why athletes cramp.

Do not overinterpret what I have just said. If you mess up your electrolyte intake significantly, then yes, it likely will contribute to cramping.

More what I am saying is that if you get 100 athletes who have cramped, and try to identify the cause, you would be hard-pressed to identify electrolytes as the issue for many of them, based on the data we have available.

There is a lot of anecdotal evidence supporting electrolytes though. And there are specific situations where the evidence supports their role as well.

Sodium

Crystals of shallow salt in a scoop, spoon on a dark gray table. Background for advertising salt. Table salty. Salted food.

As a starting point, common recommendations are to have ~0.6-1g/L of sodium within fluids consumed during exercise.

Some recommendations are even higher at 3-6g/L, which could be relevant for those who are prone to cramping wanting to try other options.  

This seems to be far more relevant if sweating at exceptionally high rates, and/or experiencing whole body cramps instead of just localised ones.

Another relevant point is that although hydration and electrolytes are not often identified as issues, there are clear-cut cases where they are.

Even as early as the 1930s there is a study involving subjects who underwent low-salt diets, drank lots of water and took hot baths to increase sweat output and sodium losses.

When sodium depletion kicked in, they started cramping. Within 15 minutes of having a salty meal, they were no longer cramping.

More recent evidence also supports this concept in a more relevant way for athletes.

For example, one study involved exercising to the point that 2% of body mass was lost. And one group rehydrated with water alone, while the other group rehydrated with a product that contained electrolytes.

The water alone group had significantly more cramps than the one that had electrolytes.

A key point from this is that while sodium and other electrolytes are not often the cause of cramps in athletes who routinely have cramps, they CAN be a contributing factor.

This also explains why there is so much anecdotal evidence supporting sodium for cramps as well. Because there will be a lot of athletes who individually run into this issue of training hard without sufficient sodium. They then find that by adding sodium, they no longer experience cramps.

Magnesium

Magnesium is an interesting one for me.

A while back a supplement company promoting sports gels asked me to do a video for them promoting their regular gel and also one that contained high amounts of magnesium.

Because there was a financial incentive to find positive evidence, I looked into magnesium and cramping. But surprisingly, there is a strong lack of evidence in favour of it. So obviously I could not accept the offer.

This kind of blew my mind a bit because there is a LOT of people who anecdotally identify a reduction in cramping related to magnesium supplementation.

For those with a deficiency in magnesium, there is reason to believe it can help. For those without a deficiency, the evidence at this stage leans in favour of it not providing any benefit.

My thoughts are that for particularly long events, it makes sense to have some form of magnesium coming in at some stage, just to be on the safe side. But you probably do not need to go far out of your way to achieve this.

I think there is enough anecdotal evidence to try increasing magnesium if you are absolutely desperate. The evidence does not support it, but personally, I have tried things with less chance of success, so it is up to you what you want to do.

Potassium and Calcium

Potassium and calcium are often anecdotally linked with cramping as well.

Going deep down this rabbit hole of identifying ways to prevent/manage cramps, one of the things I noticed is that pretty much all of the reliable sources of information barely discussed potassium and calcium.

There is a good reason for that, they just do not seem to play much of a role.

If you have exceptionally low intakes of these nutrients, or you are in a situation where your blood levels are low (which is often related to factors beyond intake), then yes, they will contribute to cramping. It is just that on a percentage basis, they are unlikely to be factors for athletes who are experiencing cramps.

Overall Fuelling

Healthy Food FODMAP

Since cramping is often associated with fatigue, you could argue that fuelling appropriately likely could help offset the likelihood of cramping.

This is not a research-based statement, it is more of an interpretation of the overall mechanisms. If you do not agree with me on this one, that’s fine, feel free to move on to my more research-backed statements.

Consuming sufficient calories in general on a day-to-day basis could be helpful.

In addition, a lot of athletes undertake sub-optimal pre-competition and intra-competition nutrition practices.

Potentially, if you are experiencing issues during endurance events, performing a better carbohydrate load could help.

Undertaking better intra-race nutrition could also help too.

I recommend reading the two articles linked above if you are interested in those topics.

These things could potentially allow you to get the same work done at a lower percentage of your maximal capacity or allow you to get more done before the onset of cramps.

HOTSHOT

HOTSHOT Supplements for cramps

Another TRP option is an American product called HOTSHOT. It is a blend of ingredients such as ginger, cinnamon and capsaicin, which is promoted to result in reductions in cramps through similar mechanisms to pickle juice.

Reportedly, drinking a shot of this product triggers nerves in your mouth and oesophagus to send a calming signal to your spinal cord. And then that inhibits cramping.  

The ingredients list: Filtered Water, Organic Cane Sugar, Organic Lime Juice Concentrate, Organic Gum Arabic, Sea Salt, Pectin, Stevia Extract, Natural Flavor, Organic Cassia Oil, Organic Ginger Extract, Organic Capsicum Extract

It also contains 10g sugar and 40mg sodium.

For cramps, the protocol involves having the product either 15 minutes before exercising, or immediately at the onset of a cramp.

Ideally, you avoid other food and beverages a few minutes before and after consumption.

It reportedly works within 30 seconds for helping to stop an active cramp, which also lines up with the timeframe that pickle juice is reported to work.

In one trial specifically on HOTSHOT, 20 subjects were given the supplement 15 minutes before inducing calf cramps. The TRP channel activation appeared to reduce the intensity and duration of the cramps. Subjects also reported less muscle soreness the next day as well.

Graph demonstrating benefits of HOTSHOT supplementation

Another study on HOTSHOT with 37 subjects showed it reduced cramp intensity by 3-fold. The effect took place within minutes and lasted for 6-8 hours.

To point out the obvious, there is obviously a massive conflict of interest with the above studies, since they were both funded by Flex Pharma, which is the company involved in HOTSHOT.

I am fine with industry-funded research. It needs to happen. But obviously, at minimum, we need to factor in publication bias.

If these studies showed it did not work, are they likely to publish it? Even though I have read the founders say they have published research that is counter to their products, I still think this is a relevant point to consider.

Another argument for HOTSHOT over pickle juice is that it might be more palatable than pickle juice though – although reportedly a lot of people still do not enjoy it.

Looking through the lay press, I noticed a few other things worth mentioning. One of the founders of this product says “it doesn’t work for everybody.”

This is great from an honesty and transparency perspective. But it also can be used to simply brush things off if you purchase it and do not get the results the marketing promised.

Once again though, even on that article, a lot of commenters noted that they had tried the product and noticed huge improvements.

Another lay press article highlighted that when they had two people test the product, one got cramps during some bodyweight exercises designed to induce cramps. HOTSHOT was not able to stop that. The second tester underwent a boxing protocol designed to induce cramps and did not experience any cramps.

My thoughts are that it is not magical. But it also looks relatively promising and worth trialling if you suffer from cramps.

If looking to purchase internationally, since it is a US product, you can purchase it from here. Obviously, this is not sponsored content either. I just personally think the product looks like a good option worth trying.

Graph demonstrating benefits of HOTSHOT supplementation

Take Home Points

It is important to be aware that no prevention or treatment strategy is consistently effective. You can do everything “right” based on the knowledge we have available right now, and still experience cramps.

To prevent cramps impacting your performance though, it makes sense to:

  • Train in a way that prepares you best.
  • Maintain adequate hydration.
  • Maintain appropriate electrolyte intake.
  • Consider trialling TRP products such as pickle juice or HOTSHOT, in the ways described above.
Managing cramps in sport summary
By Aidan Muir

Aidan is a Brisbane based dietitian who prides himself on staying up-to-date with evidence-based approaches to dietetic intervention. He has long been fascinated by all things nutrition, particularly the effects of different dietary approaches on body composition and sports performance. Due to this passion, he has built up an extensive knowledge base and experience in multiple areas of nutrition and is able to help clients with a variety of conditions. One of Aidan’s main strengths is his ability to adapt plans based on the client's desires. By having such a thorough understanding of optimal nutrition for different situations he is able to develop detailed meal plans and guidance for clients that can contribute to improving the clients overall quality of life and performance. He offers services both in-person and online.