WHY THIS IS IMPORTANT
According to the CDC, 4.5 million adults in the USA were diagnosed with cirrhosis in 2018.1
Muscle cramps affect 2 out of 3 patients with cirrhosis.2
These cramps have been shown to impact most health-related quality-of-life domains.
Previous treatments for cramps including quinidine, baclofen, and taurine have limited efficacy and significant side effects, indicating the need for a safe, effective, and affordable alternative.3,4
Investigators examine the effect of pickle juice on the reduction of symptoms and severity of muscle cramps in patients with cirrhosis, as it is thought that the acid in the pickle juice reduces the cramping pain3
RESULTS
This trial enrolled 38 participants in the pickle juice group and 36 in the control group (tap water). Ninety-two percent of the patients were white and 54% were male, and the average age was 56 years. The average MELD-Na score of trial participants was 11.5.
Pickle juice was associated with a significant reduction in cramp severity (− 2.25 points ± 3.61 vs. − 0.36 points ± 2.87), based on the visual analog scale (VAS) for cramps (p value 0.03) (Fig. 1).
There was no significant change in the proportion of days trial participants went without muscle cramps.
Due to the high sodium content of pickle juice, weight change was evaluated as a safety outcome. No significant change in weight was seen between the two groups.
Fig. 1.
Change in visual analog scale (VAS) scores for trial participants
STUDY DESCRIPTION
Setting
This study was an open-label randomized control trial conducted at three large academic medical centers. Patients diagnosed with cirrhosis aged 18 years or older with more than 4 muscle cramps in the past month were included in this trial. Patients with cerebral palsy, stroke with paralysis, multiple sclerosis, and prior liver transplant were excluded.
Intervention
Patients were instructed to buy jars of dill or kosher pickles, not sweet pickles. At the onset of a cramp, patients were to consume 1 tablespoon or a small sip from a squirt bottle of pickle juice or tap water based on whichever treatment group they were randomized to during study entry. All participants were prompted, through a SMS system, to report cramp frequency, cramp severity, and the response of cramps on a VAS to sips of pickle juice or tap water. The VAS for cramps ranges from 0 to 10, where 0 means no cramps and 10 the worst imaginable cramps over the last 3 days.
Study Quality and Application to Patients
The quality of this trial is good (USPSTF rating). Strengths of the trial included the larger sample size compared to that of previous trials and feasibility of the intervention. Loss to follow-up in this study was minimal. It is important to note these results may not generalize to patients with more advanced-stage cirrhosis or infrequent episodes of muscle cramps. The type of pickle juice used in the intervention group varied between participants as the study authors allowed patients to buy whichever brand of kosher or dill pickles was preferred by study participants. The trial adjudicated patient important outcomes to include cramp severity and incidence along with impact on sleep and quality of life. Concerns around the high salt content of pickle juice impacting patient outcomes did not occur in this trial.
Declarations
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Footnotes
Tip for patients: For patients with cirrhosis experiencing muscle cramps, pickle juice sips at cramp onset reduced cramp severity.
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The Bottom Line summaries reflect the expertise and opinions of the SGIM EBM Task Force as of the date of release of this summary. The views expressed in this summary are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or U.S. Government.
Contributor Information
Vian E. Pulous, Email: vpulous@uthsc.edu.
Christopher D. Jackson, Email: cjacks67@uthsc.edu.
Stephanie G. B. Wheeler, Email: stephanie.wheeler@va.gov.
References
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