Help on muscle spasms 2.5 yrs in!

(Melissa) #1

Hey there - I’d consider myself ultra educated on the ketogenic diet/lifestyle.

A little about me:

  • I am a clean keto eater and have been strictly following for 2.25 yrs now. I’m 5’6” and have gone from 203 lbs to 139 lbs and hover at about 17-18% body fat.
  • I consume roughly 6-10 servings of veggies (with a vry small amount of fruit mixed in) daily.
  • I’m a data junkie - I’ve moved off of tracking ketones in the last quarter (although I do still check sometimes based on some athletics and/or net carb allowances for the day. I rely on keto mojo blood prick for that but frankly at this stage I sit ant 0.3 ketones on the regular and only after lengthy zone 2 training will I reach 0.8-1 for a short time). I sometimes use the breath sensors but at this stage, I can taste when I’m burning lots of fat quite easily.
  • I am very attached to my CGM and make most of my judgements via glucose now. I am a very active athlete (I exercise 3x a day in zone 3-5 coupled with a few hours of walking in zone 1-2. TMI… I am an entrepreneur and have been fortunate enough to have been forced to build a remote private equity firm because of my chronic pain and disease mentioned below. As a result, I have the ability to take my calls/meetings either during workouts or around them.).
  • Quite sadly, I’m a chronic pain patient (i have a very severe case of endometriosis - which I believe the keto diet has actually completely put into remission for me, however I’ve endured 30+ surgeries in my 40 yrs on Earth, so the vast majority of my chronic and constant pain is likely from adhesions and scar tissue from so many surgeries)
  • i am a chronic exerciser; the keto way of life plus the chronic exercise helps maintain low inflammation and relatively high endorphins that my pain is controlled between this and pain medication.
  • I am likely underfed for my activity level - although i feel better this way most of the time. I consume roughly 1900 - 2400 calories a day, very much depending on my hunger levels.
  • After losing substantial weight I’ve moved to a higher protein, slightly lower fat keto diet. I’m generally about 55-60% fat, 30-35% protein, 5-10% carbs at this stage.
  • I am very cognizant of my electrolyte intake… I consume roughly 6,000-8,500mg of sodium daily, 2,500-3,500mg of potassium (most of that is from food, I only supplement with roughly 800mg so I’m likely higher on the potassium then that but obviously not entirely sure as it’s coming from whole foods) and then roughly 700-900mg of magnesium using a taurate in the morning and a glycinate in the evenings. Obviously I lose a lot of fluid with working out. However between my electrolyte drinks (LMNT) and herbal teas and waters, I’d venture to say I consume about 200oz-225oz a day of liquids.
  • My latest insulin level is about 2.7, so quite low, and avg 90 day glucose is 84 per Levels/Dexcom.

My concern and ask for help from those who have been in the community a long, long time. I am head scratching despite considering myself a true expert on the biomechanics of keto (and especially keto in women) these days…

I mention all of this to say… recently I’ve been getting horrible muscle spasms in my legs when I am using the muscles for anything other than sitting or standing. Nothing during exercise - I have zero problems there. But for example, if I go to turn around in my bed in the middle of the night, the hamstring will cramp; if I squat down a certain way to get low to the floor, the hamstring goes, then the calf and into the foot; if I get out of the car too quickly, the hamstrings spasm. Most of the time I can get them released in 10-30 secs but oh my gosh are they painful. This is every day at the moment - to the point that I’m afraid to move in bed at night! I get two deep tissue massages weekly with a lot of focus here.
THIS IS A NEW PROBLEM - within the last 4-6 weeks.
I’ve not changed my workout routine significantly - I rotate between short and long runs, sprinting, Peleton, rucking, full incline treadmill walk with a 30 lb weighted vest, Arc Trainer, weight training and regular walking. Again, I usually do 3 rounds in a day with regular walking throughout.
My eating has also not changed significantly except I’ve added just a small amount of carbs in some days. We’re talking 5-10g from fresh fruit.
I don’t “cheat”. Meaning my focus is very much around inflammation and I’ve found that strict adherence is the most helpful in pain control. Frankly it’s easier for me to stay fully committed than it is to allow myself a cheat here and there.
My most recent blood work (last week) showed normal levels of sodium, potassium and magnesium. I understand the body keeps them fairly dialed in but it’s abundantly clear one of them is off.
I am dialed in on the sodium, I’m sure as my tell tale signs of low sodium are light headedness upon standing and brain fog in the mornings.
I believe I heard Thomas DeLauer mention in a video (although of course cannot find which now) that specifies muscle cramps during exercise (while on keto) is likely low magnesium and muscle cramps middle of the night or at random is low potassium. However this is from memory and I’ve not really been able to find this stat elsewhere to confirm.

I’m a bit lost here because I certainly need to correct it. I fundamentally know that I’m stressing my body with the amount of exercise I’m doing - HOWEVER, it’s an unfortunate trade off. When I reduce my exercise load my every day pain may be a 5-7 out of 10. When I exercise to this degree, I can hover around a 3-4 out of 10. That’s the difference between a functioning life and an unfunctioning one, so I feel a bit backed into a corner.

Nonetheless - can someone please give me guidance on what to do, perhaps how much of each electrolyte to increase - any knowledge on which electrolyte appears to be too low, with the above information; if it’s magnesium, what carrier should it be attached to (I’m only leveraging taurate for cardiovascular support because of activity and then glycinate at night for sleep).

This is a very long and detailed plea for help - any advice y’all have, please throw it at me.

Grateful to have such an educated community. Thank you in advance!

(Robin) #2

Wow, you are dealing with so much.
I have taken this in salted water for a couple years now… precisely to alleviate the cramps you are experiencing. I add salt to the water for good measure. It has pretty much eliminated the problem.

Natural Vitality Calm Magnesium Citrate Powder, 20 Ounces

(Melissa) #3

Thanks so much! really appreciate the note!

(KM) #4

I’ve found my night cramps improved with a hot soaking bath with Epsom salt (which is magnesium). (The soaking was not new, but adding magnesium changed things.) Your issue sounds more extreme than mine but I did have a period where just about any movement could trigger a cramp or a “mini cramp”, that not quite painful warning sensation that the muscle could tighten at any moment and I better not move it.

(Geoffrey) #5

I’ve been carnivore for nearly a year now and have recently been having some cramps or spasms. These are not located in the muscles per se but more of an extreme drawing or tightening up of the tendons. It can be excruciatingly painful. It happens in the tendons on top of the foot leading to the toes when I am reclining and tend to stretch my foot out and point my toes or in my calves sometimes when I draw a leg up.
The only thing I’ve been doing differently is I have recently stopped taking a magnesium complex supplement for bowel issues and started taking a digestive enzyme instead. I believe I may need to go back to the magnesium complex and see if that helps me.

(Robin) #6

Yes, you do! I also like it for keeping me regular.

(Melissa) #7

This is very interesting how you describe this…. A drawstring. This is EXACTLY the way I feel. It starts at the very top of my hamstring and starts pulling all the way down to the big toe. It is so tight it’s remarkable.
Thanks for this note.
I think I plan on slowly bumping up both potassium and magnesium slowly and see if there’s a “therapeutic” dosage.
Has carnivore helped in ways? I’ve been considering it.

(Melissa) #8

Thank you! Also been considering the epsom salt route - Will try today!

(Geoffrey) #9

I can’t say that it’s helped with any cramping because it started about ten months after I became carnivore. In fact it may have been what exasperated it because carnivore, like any ketogenic diet can flush electrolytes out of our systems with magnesium possibly becoming deficient. At least that’s how I understand it.
I am carnivore for the wonderful healing it has done in my body and also because I have no use for plant matter in my life except the trees I love to sit under and the grass that feeds my cattle and sheep.


I think its electrolyte imbalance due to drinking too much liquids and supplementing. I’ve found out that adding loads of different electrolytes on top of normal food eventually causes problems. Our bodies are used to specific ammounts we usually get just from normal food.

The more you drink water, the more you need to replace electrolytes and the more you add supplements the more you throw off the electrolyte balance that is very hard to simulate perfectly.

I would drop the fruit and reduce veggies.

Also a simple lab test on all of your levels would be a good idea, see what you might be missing or having too much of.

(icky) #11

(B Creighton) #12

I am probably not as pro as you are looking for, but I feel your issue is probably mineral related. I rarely get charley horses, but a few nights back I awoke with a severe charley horse. It was bad enough that I noticed residual aching the next day. I do supplement with magnesium glycinate or taurate at night, and rarely get charley horses since doing so, but did that night… The difference I can come up with is that I am getting into my peak season, and felt really tired the prior day. I do a lot of outdoor work and walking, and I go from not much to a lot this time of year.

What I adopted last year seemed to help create less stress - I have never really drank purified water, but started adding a pinch of sea salt per gallon as well as the contents of a capsule of calcium orotate. The amount of water I drank after that substantially reduced even in the heat of the summer. I was drinking less than 1/2 gal of water per day. Maybe this would do the same as LMNT - I don’t know - but it worked well for me. My muscle cells seemed much less stressed - or in need of water.

(Joey) #13

@mfacchina22 You’ve gotten a lot of earned-on-the-ground suggestions above so I’ll just confirm that electrolytes are tricky to get right for each of us as individuals at various points over time…

Given what you’ve shared, my strong suspicion is that you may be going too heavy on the potassium and not quite high enough on the magnesium for your current needs.

The only downside of too much magnesium is simply getting “the runs” (i.e., a massively higher dose is used as typical over-the-counter colonoscopy prep, but even then, perfectly safe if you stay near a bathroom :wink: ).

Bottom line: Mg is the electrolyte (element) that addresses cramping for most folks - whether ingested or absorbed through an epsom salt bath.

As such, I would focus on getting that particular one right and not worrying so much about overdoing K (which can be problematic) or NaCl (which can be excreted by healthy kidneys within reason, anyhow).

Having said all this, you’ve been doing FABULOUSLY WELL in reversing prior issues. Congratulations on your self-discipline and devotion to your good health.

Keep us posted on developments. :vulcan_salute:


As a male, my knowledge of endometriosis is almost zero. However, for muscle cramps and pain, I have some experience. I have been involved in endurance sports for more than 50 years. Both at a low and at a high level. During my cycling season, I do about 500km per week. 6 years ago, while on vacation (away from exercise), I experienced deep quad pain, spasm, and cramping for 2 straight weeks, then it disappeared. Over the last 6 years, every summer, I have experienced this same problem to varying degrees. The second time it occurred, I had been off the bike for 7 days. The pain was so intense that I went to the hospital. My CRP# was 20x the norm. They put me on an IV. I described it as a muscle cramp. I have since described it as deep muscle pain. I have seen at least five specialists, and I still do not know the cause. My wife is also a medical doctor. The easy answer is that it is an electrolyte imbalance, dehydration, or DOMS. However, then why is it that only my quads and not my entire muscle nomenclature experience this pain? Nobel scientist Rob MacKinnon, a neuroscientist and endurance athlete, believes that exercise-induced cramping is triggered by hyperactive nerves that can get overexcited with exercise and repetitively fire into the muscle. What I experience, I believe, is different, sort of. I will fuel for my workout, and this will include carbs.
My potential triggers are hot weather, increased coffee consumption, and stress. If it’s going to be a 3–4-hour hard effort, then I will bring carbs. My electrolyte drink on hard rides (Skratch Labs) contains 20 grams of carbs per bottle. It is not just a simple electrodrink; there is some research into it. If it’s a 2-hour easy/recovery ride, then no onboard carbs. I would increase my carbs if I were you, especially on the harder efforts; this has been a game changer for me.
Do you know how much water weight you lose when exercising?
I realize you have less pain when you work out, but on what day(s) does your body get a chance to recover?
Does your re-hydration amount match your loss? Maybe it is throwing off the balance. Raise or lower one of the electrolytes for a period of time (a week) and see what happens.

I wish you nothing but great health

(Bob M) #15

My problem with cramps, which for me are typically lower leg cramps, is that they don’t seem to have a pattern. While they’re more likely to occur when it’s hotter, I got one this weekend, and it wasn’t that hot outside. That cramp was when I was kneeling down under the sink. I can get similar ones when exercising in my basement too.

I think LMNT helps, as does extra salt. But what usually happens is that I’ll back off the electrolytes for a while, and that’s when the cramps will pop up.

(Melissa) #16

Thank you for all of this!
It appears you’ve been on quite the journey yourself.
I take your point - through the lines - that those of us who have intense exercise may see a different reaction as our bodies are under immense strain to perform.
Frankly, I don’t have rest days. I have “easier” days built in once a week.
I believe I need to try building in a bit more of that as my legs in general are always aching, always tight, always overworked. So despite any electrolyte imbalances, just the sheer usage of the muscles with literally zero downtime all day must be compounding the problem.
I will try and adjust a few things from water intake to increasing Mg or K one by one.
I don’t know precisely how much I’m losing during exercise - and obviously it varies significantly based on the intensity of that particular exercise but there are certainly times I weigh myself post exercise and am 3 lbs lighter (after both a small breakfast and 25-30oz of fluid intake on a run). This isn’t often but your question has me focusing on taking real measurements, every time, for probably a week straight as I’ve just started thinking about this myself.

Thank you for the time to reply and also sharing your story.

(Melissa) #17

So weird when you just bend down normally and it occurs - this is what happened to me just yesterday!
Thanks for the notes. I gather everyone is unique and different and also life’s circumstances change each individuals needs from day to day, so my question is probably too ominous and simply needs trial and error on my part, over and over!
Thanks for the thoughtful note.

(Melissa) #18

Really appreciate the thoughtful reply!

I too am thinking it could be magnesium now (I originally thought potassium).

I will try an Epsom salt bath, as this is something - shockingly - I’ve not yet done and am sort of gobsmacked that I’ve not thought to do it sooner!


100%. Are you improving your running times or the amount of weight you can lift? Are you getting enough sleep? When was the last time you had a blood test? Have your CRP tested. This is one of the main blood markers for inflammation. My rest days are always after very hard efforts. My rest days consist of 1 hour of walking, maybe a sauna at night, or a cold shower in the morning. I will also consume more calories on those days, as I have found it helps with my recovery.
I did a 200-mile race and lost 7+ lbs.

(KM) #20

Running??? Oh, biking. Still amazing😁