Q&A: Drinking pickle juice may reduce muscle cramp severity in patients with cirrhosis

Pickle juice consumed at the onset of muscle cramps improved severity but did not prevent future cramps in patients with cirrhosis, according to research published in the American Journal of Gastroenterology.

In a randomized trial, researchers instructed 74 patients with cirrhosis (mean age, 56.6 years; 54% men) and a history of more than four muscle cramps per month to either sip pickle juice or tap water at cramp onset. Studied outcomes included change in cramp severity measured by the Visual Analog Scale (VAS, scored 0-10), proportion of days with cramps scored less than 5 on VAS, change in sleep quality and quality of life measured by the EQ-5D questionnaire.

Researchers assessed patient cramps 10 times over a 28-day period using interactive text messages. Baseline VAS was 4.2, EQ-5D score was 0.8. and 43% of participants rated their sleep as poor.

Participants who drank pickle juice compared with tap water had a greater reduction in VAS score for cramps (–2.25+3.61 vs. –0.36+2.87; P = .03), as well as improvements in proportion of cramp days scored less than 5 (46% vs. 35%; P = 0.2) and end-of-study EQ-5D (0.78+0.1 vs. 0.8+0.1; P = 0.3). Researchers noted no change in reported sleep quality.

Healio spoke with study author Elliot B. Tapper, MD, of the division of gastroenterology and hepatology at the University of Michigan, about the study and how the results may inform the care of patients with cirrhotic cramps going forward.

Healio: Why did your team undertake this investigation?

Tapper: Patients with cirrhosis frequently report severe and disabling muscle cramps associated with terrible quality of life; the treatments available for these cramps are ineffective and have many side effects.

Healio: How was the study designed?

Tapper: The study was fully remote, and we enrolled people who responded on a survey that they had more than four cramps in the past month. It's important to note that participants were blinded to the intervention; they only knew pickle juice was involved if they were randomized to the pickle juice arm.

After that, participants received text messages every few days asking them if they had a cramp, how bad it was and if they took the treatment that they were assigned. At the end of 28 days, we assessed the primary outcome of cramp severity and the secondary outcome of health-related quality of life.

Healio: What was the most important take home message from this study?

Tapper: To me, the most important take home message is that cramps are a major source of discomfort for patients with cirrhosis that deserves our attention. There are some people for whom a simple intervention, like pickle juice, can go a very long way. But there is an urgent need to develop or study interventions that can prevent these cramps from occurring.

Healio: What was the main outcome and how does it inform patient care going forward?

Tapper: We showed that pickle juice can stop a cramp and can reduce cramp severity, which we think was meaningful, but it did not prevent cramps. We think that we have a useful tool to provide to patients to help stop a cramp when it's happening, and because some of these patients will get cramps that last hours, having that tool is highly valuable.

But we were disappointed and are currently strongly motivated to do more research on the lack of impact on quality-of-life, meaning that the study of interventions to prevent the cramps from happening in the first place is key to improving quality of life and sleep.