Chasing Life

Hey there, welcome to Paging Dr. Gupta. Every week you've been sending in questions, things that you're curious about, and I've been listening. We're digging into the facts to help you understand your health better. And with that, we'll get to our first question.

'Hey, Sanjay! Our first question is from a 60-year-old listener named Florence.

I'm a physical therapist and I have been getting nocturnal cramping in my peroneal muscles, sometimes other muscles of one foot or one leg and each doctor seems to just say this is just age. I'm wondering if you could address this. I hear a lot of this from my patients about night cramps. It seems like it's something that's just brushed aside as not important. Of course, I've heard things like eat bananas, take magnesium, take... Potassium, I've tried those things, no effect. So I'm wondering if you have any insight or research on that.

Okay, Florence, thank you very much. First of all, for those of you who might not be aware, Florence's question is specifically about peroneal muscles. Now, that's a group of three muscles that run down the outside of your lower leg. Okay, the outside your lower legs. They help lift the outside edge of your foot. They provide stability to your ankle. Now, her specific question is about cramps. And we get a lot of questions about this topic, because I think. Almost all of us have felt this at some point or another.

The scenario is this, you're lying in bed, maybe even asleep. And then out of nowhere, your leg or your foot just seizes up in a cramp. It can be sudden, it can be jarring, and it can really be uncomfortable. It can painful. So the question is, why do our legs cramp up at night? And what can you actually do to prevent it from happening? We'll get into what we know right after the break. Stay with us.

All right, Florence wants to know why our legs cramp up at night and why things like bananas, magnesium, potassium don't seem to help her. First of all, what are these lower leg cramps that happen suddenly? They are known as nocturnal leg cramp or rest cramps. Nocturnial just means night. Not surprising because it often happens during the night or during rest, and they are pretty common. You have probably experienced them before. In fact, up to 60% of adults report experiencing these types of cramps. Now, what exactly is happening when you get a cramp? You might assume that it has to do with your muscles. But actually, no.

'We spoke with Dr. Scott Garrison, a family physician and professor at the University of Alberta in Canada. He does a lot of research on these so-called nocturnal cramps, and what he told us is it's actually a disorder in your neurons that affect your muscles. He said, as you age, you begin to lose motor neurons. We all do. Those are the nerve cells that allow your brain to talk to your muscles. As a result, this can cause some communication problems between your brain and your leg muscles, causing the muscles in your legs to tense up rather than relax. And that is how you experience that cramp in the middle of the night, right when your muscles should be resting. So now you have a sense of how these cramps happen.

But the question I think Florence is asking, a lot of people are asking, is why do they happen? Well, some theories do point to dehydration or electrolyte imbalance to be the cause because those things can affect both muscles and neurons. Some medications might increase your risk of experiencing these cramps more often. Those can be, for example, inhalers for asthma or COPD, specifically something known as inhaled beta agonists. Also, certain blood pressure medications can do it. And then also remember Dr. Garrison said these cramps become more common as you age, especially when you're over the age of 50, like I am. That said, it is important to know when this is a problem, when you should see a doctor. Though the likelihood of something serious going on is very low, there are a few red flag symptoms. So if you're experiencing muscle weakness, especially in your legs or arms, during the day, or without much exertion, that could mean there's something else going on. If you experience any redness or swelling or warmth alongside the pain and things don't improve within a few minutes, that could be something like a deep vein thrombosis. That requires medical care.

Again, remember, we're not talking about something like a Charlie horse that comes and goes after a few minute. The symptoms we're talking about here with thromboses can last days. Also, if you started one of the medications we mentioned, you might wanna talk to your prescriber about an alternative. Your best bet would be your primary care doctor. Again, this is unlikely, but good to be aware of if you're worried.

'Now let's get to the second part of Florence's question. Why do remedies like bananas or magnesium or potassium not seem to help her or her physical therapy patients? First of all, there's not a lot of solid research to prove that these modalities will help. There's some research that in fact says the opposite. Dr. Garrison has done a bunch of research on the exact solution for cramps. He found that if you're taking something called potassium-sparing diuretics, then your overall potassium actually increases. So there might be a correlation between more potassium and more cramping, but the findings aren't clear.

The key takeaway is that if it's not working for you, then don't do it. Don't eat the bananas. Don't take the extra magnesium. If you find potassium helps, then stick with it. Either way, there is no research to indicate that it will definitely help you or harm you. So personal judgment and experience will be your best bet. Same thing for magnesium. Based on existing research, there's little evidence that it actually helps with leg cramps. So, what you can tell your patients is this. Check your medicine cabinet. If you're taking any of the medications such as those inhaled beta agonists, diuretics that can increase your potassium. Consider talking to your doctor about other options. Stay hydrated, that's universal. Avoid Gatorade and other potassium heavy drinks that you might be tempted to try. Water is gonna be the best way to go.

Stretching is an effective way to try and relax your cramps when they happen at night. Specifically, flexing your foot, rather than pointing your toes, can immediately ease the pain. Doesn't prevent the cramps, but it might make the experience end more quickly. And again, if there's weakness associated with this, if there is redness or warmth associated with it, then do consult your doctor.

All right, Florence, I hope that helps answer your question. Hopefully you can pass it along to your patients as well. Let's take a quick break. When we return, we'll get into the question of whether swollen feet and ankles are something to be concerned about.

I know what that sound means, another listener voicemail, Jennifer, who do we have next?

Okay, we have a listener named Kunjal who is 44 and calling from California.

I'm having regular foot swelling in my ankles and it gets worsened after traveling and can last for a few days. But now I feel it's regular like every time my foot are swollen. Can you please explain the possible reason for the root cause and why it happened?

All right, thank you for your question, Kunjul. The sort of foot and ankle swelling you're mentioning that happens after a long travel day, that's pretty common and usually thankfully harmless. Typically this kind of travel related swelling happens because of gravity. It's as simple as that. You're sitting with your feet on the floor for a long time without really moving around like you do on a plane, for example, that causes blood to pool in the leg veins. And when you're seated for a longtime, the position of your legs also increases the pressure in your leg veins. This can cause fluid to leave the blood and move into the surrounding soft tissues, and that's what's causing the swelling. Note, the swelling can happen when you stand or walk for long periods of time as well, which is why being on your feet all day can cause swollen feet.

'Now, with this sort of travel-related swelling, it does tend to go down pretty quickly, especially after you start moving around. But typically it should not last more than a day or two, especially if you elevate your legs and help the fluid drain. But I think what Kunjul is asking about is the regular swelling in her legs and ankles that happen even without traveling. And that's different. That's something that does deserve a closer look. First things first, this swelling in the feet, ankles, legs, elsewhere in the body, it has a name. It's called edema, E-D-E-M-A. Edema is swelling caused by too much fluid trapped in the body's tissues. But that doesn't necessarily have to do with being on your feet too long. In fact, there are a variety of reasons why someone might be experiencing this sort of swelling in their lower limbs outside of travel. Certain medications, especially high blood pressure medications, they could be the culprit.

Pregnancy. Swelling is a pretty common side effect of pregnancy. But if you're noticing extreme swelling, that can be a sign of something known as eclampsia. That's a serious condition, you should get it checked out. Venus insufficiency can also be a cause of swelling. This is something President Trump has It's a condition where the valves in the leg veins don't work as well as they should. Typically the valves and the veins of our legs Keep blood from being pulled down by gravity and pooling in the lower limbs as we age those valves age as well and many function less efficiently.

And also, it can come down to just everyday lifestyle habits. Sometimes swelling isn't about any specific medical condition at all. Cutting back on salty foods, that can make a real difference. I really watch my salt, especially when I'm traveling. Salt pulls water into the tissues, so the less you have, the less fluid buildup you're likely to see. Losing weight, if you're overweight, that can obviously help with swelling. And then just movement. Move around when you can. Even small movement breaks can help keep the blood flowing and prevent that fluid from settling in your legs.

But that said, there are some conditions which can be concerning as well. Things like heart problems, heart disease, liver or kidney problems, blood clots, they can cause swelling. We talked about DVT or deep venous thrombosis with the previous question. And as a reminder, that's when a blood clot forms in the deep veins of the leg, blocking blood from returning to the heart. And that can cause significant swelling in the leg and foot. One thing about DVT, it usually affects just one leg. So new swelling on just one side, in addition to symptoms like redness and warmth, that's a red flag. Something to talk to your doctor about right away. All right, Kunjul, that doesn't even cover everything, but hopefully there's something in there for you to explore and hopefully do something about that swelling. There are a lot of reasons for swelling. So, talking to your doctor makes a lot of sense. They can help pinpoint what's actually causing it, rule out anything serious, and hopefully get you the right treatment, get you back on your feet, and get you chasing life as soon as possible.

Thanks so much for listening to the podcast. Thank you for your question. That's all the time we have for today. I want to say again, your questions, they steer our conversation. They shape the topics we cover. They give us a real window into what you're thinking about. So thank you for calling in.

'And if you've got a health question, send it in. We could feature yours on the next episode. Reach out to us, record a voice memo, email it to pagingdrgupta, pagingdrgupta at cnn.com, or give us a call, 470-396-0832, and leave a message. Thanks so much for listening.