Pickle juice reduced cramp severity in patients with cirrhosis

A small trial randomized 82 patients with cirrhosis and frequent muscle cramps to drink either a sip of pickle brine or tap water when they developed cramps and found a significant reduction in cramp severity scores in the former group.

Sipping on pickle juice appeared to help alleviate muscle cramps in patients with cirrhosis, a small new trial found.

The Pickle Juice Intervention for Cirrhotic Cramps Reduction (PICCLES) trial included 82 patients with cirrhosis and a history of at least four muscle cramps in the prior month. Half were randomized to instructions to purchase three jars of brined pickled cucumbers of their choice (dill or kosher, not sweet or bread-and-butter) and keep the juice on their person for 28 days. While the intervention patients took 1 tablespoon of pickle juice at cramp onset, an equal number of control patients were instructed to sip tap water. The primary outcome was the change in cramp severity measured by the Visual Analog Scale for cramps (VAS-cramps), assessed 10 times over 28 days using interactive text messages. Results were published April 10 by the American Journal of Gastroenterology.

A total of 74 patients completed the trial (average age, 56.6 years; 54% male), 41% of whom had ascites and 38% of whom had encephalopathy. Many of the patients were receiving other cramp therapies at baseline. The mean baseline VAS-cramps score was 4.2 (±3.4), which decreased by 2.25 (±3.61) points in the pickle juice group compared to 0.36 (±2.87) in the tap water group (P=0.03). The proportion of cramp-days on which the VAS-cramps score was less than 5 was 46% in the pickle group versus 35% in the control group (P=0.2). The groups showed no significant differences in sleep or quality-of-life measurements.

The study authors concluded that sips of pickle brine consumed at cramp onset reduced severity without increasing adverse events. “As a cramp therapy that must be taken at the time of a cramp, pickle juice is likely to be most effective for people with cramps that are either frequent (where effort to keep pickle juice on hand is worthwhile), long-lasting (where time spent finding pickle juice is worthwhile), or both,” they said.

The authors noted that many patients with cirrhosis suffer from high-frequency, long-lasting cramps and that pickle juice could serve as a first-line therapy for them, although therapies to prevent cramps are still needed. Other agents with a similar pH to pickle brine might also work as therapy for cramps, they added.