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How Much Tonic Water Must You Drink to Ease Leg Cramps?

People with leg cramps sometimes suffer excruciating pain, but what can be done to alleviate it? For some, home remedies like tonic water may be the answer

People took quinine pills for decades to prevent leg cramps. Quinine comes from the bark of the cinchona tree in South America. The dose was substantial–200 to 300 mg. Researchers have described the mechanism of quinine’s action as “unclear” or “obscure” (Journal of Clinical Pharmacology, June, 1995). In other words, they really don’t know how, or even if, it works (Consultant Pharmacist, Feb., 2008).

One theory has it that a high dose of quinine makes muscles less “excitable.” We have come up with a novel new theory that would explain why a tiny “dose” of bitter tonic water might in fact work to prevent or ease leg cramps (see below for details).

Doctors Prohibited from Prescribing Quinine:

The Food and Drug Administration banned quinine in over-the-counter pills because of fears of serious side effects. Later, the FDA advised physicians that they should never prescribe quinine for anything but malaria. Not surprisingly, the agency was loathe to ban tonic water. The public backlash would have been fierce. After all, the amount of quinine in tonic is small. (A glass of tonic has one tenth the prescribed leg cramp dose of quinine.) Recommending quinine to patients with leg pain or cramps might be considered malpractice. That left people like this reader in a terrible quandary.

Q. For years I have suffered with leg cramps; debilitating, put-you-on-the-floor leg cramps.

I used to be able to buy a leg cramp medicine in pill form from the pharmacy. The medicine was a complete success.

On a trip to Walgreens I purchased another bottle of the leg cramp medicine. After taking it for a few days, I noticed I was getting those leg cramps again. I went back to the pharmacy and told the pharmacist the pills were worthless. His answer was, ‘that’s because the FDA made them take the quinine out of it.’

They still sell leg cramp medicine, but it does not work at all. I just love it when some government agency decides what’s best for me. If you watch virtually any commercials on TV about virtually any drug, you will hear the magic words that XYZ med is not meant for everybody. You can bet your life that one of the side effects is death, in rare instances of course. The thing is that the FDA has approved all these dangerous drugs that are advertised, but we can no longer get quinine.

I have read that mustard will take care of the problem of leg cramps. It’s probably the salt in the mustard that does the job. It takes about 4 pain-filled minutes to work. Pour a little salt in the palm of your hand, lick it off and chase it with a little water. It works.

With so many new drugs coming on the market, how much money did that drug manufacturer have to pay to get it approved? I guess there wasn’t enough money in quinine. By the way, if you’re thinking of getting your quinine by drinking tonic water, you would have to drink two litres a day.

This will probably not be posted, we don’t want to upset the FDA. It might give them cramps.

A. The FDA banned quinine because it does occasionally cause serious adverse reactions in susceptible people. Such individuals can develop a deadly blood disorder.

As little as one 5-ounce glass of tonic water can be disastrous for these vulnerable people, though we hope that the FDA never bans tonic water. Other quinine side effects may include nausea, stomach cramps, ringing in the ears, headache, anxiety, blurry or double vision, irregular heart rhythms, skin rash and fever.

We do understand your point. The FDA allows many dangerous drugs on the market. Watching drug commercials on television is a scary proposition, especially when the announcer says things like:

“Call your doctor if you have high fever, stiff muscles and confusion to address a possible life-threatening condition or if you have uncontrollable muscle movements, as these can become permanent. High blood sugar has been reported with Abilify and medicines like it and in extreme cases can lead to coma or death.”

What’s the Right Dose of Quinine vs. Leg Pain & Cramps?

So how much tonic water would you have to drink to get a pharmacological dose of quinine? The doctor-prescribed dose to prevent leg cramps has been between 200 and 300 mg. A liter of tonic contains around 83 mg of quinine.

That means one eight-ounce glass has about 20 mg. You would have to drink about 10 glasses to get the dose of quinine that doctors used to prescribe to prevent leg cramps. That’s not practical and may not be necessary.

A New Explanation for Tonic Water’s Effectiveness:

We used to wonder why some people would report success with a small glass of tonic water to prevent or treat muscle cramps. It defied pharmacologic logic. They also reported fast action. Too fast! It takes time to absorb the quinine from the stomach, get into the blood stream and affect the muscle. We suspected it might be a placebo effect.

Well, we have changed our minds thanks to a whole new understanding of leg cramps. Here are some stories from readers that opened our eyes to a new explanation:

Earlene in Washington reports amazingly fast results with tonic water:

“I use regular tonic for occasional leg cramps. I keep a single serving bottle in the refrigerator, take a swallow or two as needed and the cramp stops in seconds. I tried the routine without the swallow of tonic and the cramp persisted. So it seems to be that tiny amount of quinine that does the trick. I have type 2 diabetes and a sip or two doesn’t affect my blood sugar levels.”

B. in the U.K. also uses a small amount of tonic water:

“Tonic water has been and is a great remedy for my nighttime leg cramps. I drink about 3 fluid ounces before bed and have no side effects. It’s a great relief!”

Salome in Australia shares her success in treating RLS:

“I was suffering from restless leg syndrome (RLS)  for over 6 years. It’s worse at night, but I also suffer during the day. Going to the movies it was shocking.

“I am 66 yrs old. Last weekend I started looking on the web and came across someone who was using tonic water. I tried it. I began drinking a 3/4 glass of Schweppes Tonic just before I sleep. What a find. What a gem. I sleep like a baby. No more restless legs at night nor during the day

“I had pain down my leg in front and that’s gone too. My hubby is happy, I am happy and a HUGE thanks to Schweppes for putting some quinine in the tonic. If you know of anyone who has RSL tell them to give it a go. I am loving my legs now.”

Is There an Explanation for Quinine’s Effectiveness?

Until recently we thought about quinine’s action as pharmacological. We assumed someone would have to swallow a fairly big dose (200 to 300 mg) to achieve an effect. As mentioned, that would require at least 10 glasses of tonic water and take a long time to go to work.

More recently we have come up with a whole new theory to explain the benefits of quinine. It involves TRP (transient receptor potential) channels. These channels are found throughout the body and respond to sensations such as taste, heat, cold and pain. They can be activated by a variety of flavors including vanilla, cinnamon, ginger, garlic or chili peppers. Bitter flavors can also stimulate TRP channels. Guess what? Quinine is about as bitter a taste as you can get.

There are TRP channels in the mouth, throat and stomach. When they are stimulated they immediately impact nerves in the spinal cord. These messages in turn can affect the neurons that are overwhelming muscles and triggering cramps or possibly restless leg sensations. Because this is a neural pathway, the effect is very fast compared to a classic drug effect. That would require a medication be absorbed from the stomach into the blood stream and eventually reach the cramping muscle. That can take 20 to 30 minutes. People report that a sip or two of tonic or a spoonful of mustard goes to work in under two minutes.

To read more about TRP channels you may wish to read this article and listen to our streaming audio interview with Dr. Bruce Bean. Just click on the green arrow in the black circle above his photograph:

Other Remedies for Leg Cramps:

What else can you do to prevent those excruciating leg cramps? We recognize that some people cannot tolerate tonic water. Others find the taste unacceptable.

Visitors to this website and readers of our newspaper column sing the praises of soap as a preventive. They also like magnesium or potassium, pickle juice, V-8 Juice, turmeric, yellow mustard and apple cider vinegar. Salt may work, but many people are on low-salt diets, which is why pickle juice is probably out for such folks.

To learn more about how to use any of these these alternate approaches you may find our book, The People’s Pharmacy Quick & Handy Home Remedies, of great value. You will also find a list of our favorite foods for good health. Remember, Mother Nature’s medicine can frequently be found in your kitchen cabinet! For more information about these and thousands of other remedies, check out our publications. You may also find “Bed Soap” or “Leg Soap” worth considering.

Share your own leg cramp remedy below.

Revised 5/4/17

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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