Pickle juice relieves cramps in cirrhotic patients

Sipping pickle brine at muscle cramp onset reduces cramp severity with no serious adverse events among patients with cirrhosis, a study has shown.

Eighty-two patients with cirrhosis and a history of >4 muscle cramps in the previous month from December 2020 to December 2021 participated in this randomized controlled trial. They were randomly assigned to sips of pickle juice vs tap water at cramp onset.

Change in cramp severity, as measured by the visual analogue scale (VAS-cramps, scaled 0‒10), was the primary outcome. The investigators evaluated these cramps 10 times over 28 days using interactive text messages. Secondary outcomes were the proportion of days with VAS-cramps <5, change in sleep quality, and global health-related quality of life measured using the EQ-5D.

Of the patients, 74 (mean age 56.6 years, 54 percent male, 41 percent with ascites, 38 percent with encephalopathy, and model for end-stage liver disease­‒sodium score 11.2) completed the trial. At baseline, many patients were being treated with other cramp therapies. The baseline VAS was 4.2, the EQ-5D was 0.80, and 43 percent had poor sleep quality.

At the end of the trial, the values of the VAS for cramps were ‒2.25 points for the pickle juice arm and ‒0.36 for the tap water arm (p=0.03). The proportion of cramp days with VAS-cramps <5 were 46 percent and 35 percent (p=0.2), respectively. No significant between-group difference was observed in change in sleep quality (p=0.1).

In addition, the EQ-5D for pickle juice and tap water was 0.78 vs 0.80 (p=0.3) at trial completion. There were no differences seen in weight change for patients with and without ascites.

“Muscle cramps are common among persons with cirrhosis and associated with poor health-related quality of life,” the investigators said. “Treatment options are limited.”