Orange Juice Placebo?

fls said:
Please note that it isn't the potassium in the orange juice which is having an effect. Most of the potassium in your body is stored in your cells, so to actually affect potassium stores through supplementation in the face of low potassium takes hours to days. Even if the potassium in the orange juice would somehow magically get immediately distributed into your muscle cells, the amount is too trivial to make a difference. Diets low in potassium aren't usually a problem because the kidney simply holds on to potassium. Some drugs specifically interfere with that process, causing you to fail to hold on to potassium (a kind of drug which is often used to treat hypertension). And some medical conditions can lead to increased losses of potassium.

While you wondered about the nature of the effects from your ritual of taking orange juice, I didn't get the impression that this meant you wanted to perform experiments...once you had a routine which was sufficient to keep your problems tolerable, you were mostly curious about why.
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You were correct regarding what I was curious about. I think I spelled it out in the OP. But if (fairly simple) experiments would help, I am open to hearing about them.

If I gave you the impression that I wanted you to stop taking the OJ, I apologize. If you have a ritual that gives you satisfaction, why bother changing? I was just pointing out that trying to figure out whether a particular routine has a specific effect is difficult under circumstances where most anything will be found to "work" anyway. The advice you are getting to try various things simply plays into that.
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You hadn't given me the impression that you wanted me to stop, but your tone has come across at times as mocking (the word "ritual", for example), and, at times, a bit harsh. But I do appreciate your no-nonsense input.

Thanks, Linda.

RSL
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If you want to try drinking water instead of OJ, one thing you could try is having water within easy reach. Then when you get a cramp, you know you have water there. I suggest you have it in bottles that have a straw, so they are hard to spill.
 
RSLancastr said:
You hadn't given me the impression that you wanted me to stop, but your tone has come across at times as mocking (the word "ritual", for example), and, at times, a bit harsh. But I do appreciate your no-nonsense input.

Thanks, Linda.

RSL
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I'm sorry. I didn't realize you would consider the term "ritual" derogatory. It's used to refer to all the elements of an intervention (as in "therapeutic ritual"). In this case, it's not just the drinking of the OJ, but would include stuff like the waking of your wife and her bringing you the drink (as well as other aspects, such as the need for you to sit up to drink it).

Linda
 
fls said:
I'm sorry. I didn't realize you would consider the term "ritual" derogatory. It's used to refer to all the elements of an intervention (as in "therapeutic ritual"). In this case, it's not just the drinking of the OJ, but would include stuff like the waking of your wife and her bringing you the drink (as well as other aspects, such as the need for you to sit up to drink it).

Linda
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I see. Well then, the "ritual" even worked when I was able to fetch the OJ myself, and the times when one of my kids would bring it for me, and even a time or two when I kept a bottle on the nightstand so I could grab it if needed. And I think (but am not sure) that the sitting up is a relatively new part of it, added since the stroke, as I am less able to successfully drink from thebottle while supine without spilling it all over, especially with the bedrail (again, new since the stroke) in the way.

So, it's remarkably flexible, as rituals go.

Perhaps I am a bit sensitive to your (what I perceive as) scorn of the whole thing because of what Susan recently said of it, which motivated me to start this thread. Susan is a Christian. I am an Agnostic. One recent night I woke up yelling with a cramp and called out to her to please bring me some OJ. Perhaps I did so more demandingly than usual, or perhaps she had just managed to get to sleep, but something made her react poorly to it. When she finally brought the OJ to her by-then whimpering hubby, she said "I don't understand how you can not believe in God, but you believe this stuff works so quickly!" Angry about her using the situation foe quasi-proselytizing, I managed to stifle all of the responses that came to mind, and just downed the OJ. The cramp went away.

I have known, from the first time the OJ "magically" worked immediately, that there was almost certainly a placebo effect at work. I knew that more than a decade before I had even MET Susan, and had told her that the first time she witnessed me use the "ritual". So, for her to have said the above, on top of her recently starting to refer to my OJ, sarcastically, as my "Magic Elixir", bothered me. Was she hoping to shame me into no longer accepting that the OJ worked (whatever the reason it does or seems to)?

It was then I resolved to ask the members of the Forum what they thought of the Oj "working", hoping against hope that someone could come up with a convincing theory as to how drinking the OJ would relieve the cramp in some non-placebo way.

Susan apologized the next day for her comment, and has dropped the "magic Elixir" remarks too. She is under a tremendous amount of pressure as my caregiver, wife, best friend, chauffer and so much more, that episodes like I described above are bound to happen. The fact that they happen so seldom is a testament to her good nature as well as to her love for me.

And Linda, your apology was unnecessary but is accepted and appreciated.
 
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You could try some other juices for a start - apple, grape, grapefruit. If it isn't entirely placebo effect, you may be able to narrow down the responsible substance.
 
Modified said:
You could try some other juices for a start - apple, grape, grapefruit. If it isn't entirely placebo effect, you may be able to narrow down the responsible substance.
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I know that I tried Apple Juice in the distant past - it had no effect. I can't try grapefruit, as it interferes with many BP meds. I'll try grape, but don't know if it has much Potassium in it. And I'll try water (already have small bottles chilling in the fridge for it) and milk.

No cramp last night, so no experimenting done.
 
rjh01 said:
If you want to try drinking water instead of OJ, one thing you could try is having water within easy reach. Then when you get a cramp, you know you have water there. I suggest you have it in bottles that have a straw, so they are hard to spill.
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Yes, but a problem with this is the fact that I can only guzzle down water if it is COLD (as in, straight from the fridge). Otherwise, it tastes awful to me.
 
RSLancastr said:
I see. Well then, the "ritual" even worked when I was able to fetch the OJ myself, and the times when one of my kids would bring it for me, and even a time or two when I kept a bottle on the nightstand so I could grab it if needed. And I think (but am not sure) that the sitting up is a relatively new part of it, added since the stroke, as I am less able to successfully drink from thebottle while supine without spilling it all over, especially with the bedrail (again, new since the stroke) in the way.

So, it's remarkably flexible, as rituals go.
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This is what would be expected under these circumstances.

Perhaps I am a bit sensitive to your (what I perceive as) scorn of the whole thing...
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So now you are calling my contribution scorn?

A bit late, but I get the message. I'll leave you to it.

Linda
 
fls said:
This is what would be expected under these circumstances.

So now you are calling my contribution scorn?

A bit late, but I get the message. I'll leave you to it.

Linda
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Linda, as I said above, I have appreciated your posts in this thread, but yes, I have found some mocking and scorn in some of your posts, but I am up for the possibility that I am reading into your words things which you did not put there.

Here are some of your posts, and what I saw in them as mocking and/or scorn all emphasis mine:

fls said:
From the perspective of a physician...

You don't hear about various concoctions for the treatment of leg cramps from doctors because they tend to make evidence-based recommendations.
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To me, the word "concoction" has always had a negative connotation, possibly because my mother used it to mean a made-up story, or lie. You might see or taste some odd-looking/tasting drink or soup and ask "What on earth is THIS concoction?" But according to dictionary.com, it simply means "a mixture", so I withdraw my reaction and apologize for it.

I have to admit that it didn't occur to me that I had to tell anyone that basic treatment for a leg cramp is stretching and rubbing/massaging the muscle. I thought that was common knowledge.
Linda[/QUOTE]

I took this as saying, in effect, "even a CHILD would know this.", as in "I'll admit that it didn't occur to me that I had to tell anyone that their two o'clock appointment was when the big hand was on the twelve and the little hand was on the two"

fls said:
Evidence-based medicine would apply to this part as well. You made a self-diagnosis
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In my experience, physicians usually say "self-diagnosis" with an eyeroll.

but I wouldn't really expect a doctor to bring it up unless it was a legitimate concern, and we don't know that this was the case.
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I didn't even understand what you meant by that.



I think it is as children that we learn about these things. That's when we first start doing sports and get exposed to things like Charley horses, for example. I'm not chastising you for not knowing something, it's just that doctors don't necessarily realize that a patient is doing something out of the ordinary if the patient doesn't bring it up. And it may not be fruitful to play twenty-questions with all your patients in order to avoid missing something like this. Open-ended questions might help pick something like this up, such as, "describe what happens when you get a cramp". That was one thing which experience taught me very quickly...learning how to ask questions in a way that will bring something non-obvious to light.

Linda
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Again, even a child would know this, Robert.

fls said:
That's a nice example of why we thought leeches worked for hundreds of years and why people swear by homeopathy now - it turns out that we are bad at guessing how long it will take to get better. In the absence of the orange juice, you might discover that a bad cramp takes three minutes (or whatever) to resolve, but we don't want to wait that long so we have rituals whose real benefit is to distract us. The problem is that we attribute the benefit to the ritual, rather than to simply allowing adequate time to pass. It wasn't until we started performing randomized, placebo controlled trials that we discovered just what a poor job we had been doing at guessing we weren't going to get better unless we "did something". I suspect your story is compelling (and why you are comfortable damning science) because you are confident in your guess that it wasn't going to stop. It is hard to shake that confidence, even though we now know that it plays us false.

Linda
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Reading your posts now, possibly feeling less defensive, I don't read into it nearly what I did before.

Again, my apologies.

And again, thanks for your facts.
 
Another idea for a blind test:

If orange juice works so well for you, potassium supplements should work equally well (if not better).

You could be blindly administered oral potassium supplements one day and a placebo of the same size and color- such as a multivitamin pill, iron pill or sugar pill- another day. I know you don't like pills but, hey, it's for science. :p

For a double blind test, even the person giving them to you shouldn't be told which is which. A third party, such as a doctor or physical therapist, could give it to him or her and then ask him or her for the results. Then the third party could determine if the potassium ones worked better than the fake pills.

Or maybe that's really stupid and Susan already has enough work and we should all move on. :p

Anyway, here is some info on potassium supplements:

http://www.mayoclinic.com/health/drug-information/DR602373
 
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Eeney, as has been mentioned a few times in this thread, I DO take Potassium supplements every day.

Specifically, 595mg of Potassium Gluconate, containing 99mg of Potassium.

Atleast one person in this thread has stated that, since I get the leg cramps even while taking this supplement, that shows that it is not the Potassium in the OJ which brings the relief.
 
I'm wondering if it's all got to do with the preliminary effects of digestion. When you body gets something it needs to digest, all sorts of things happen in response to what you've ingested. For example, production of acetylcholine is increased, which triggers vasodilation and contraction of stomach muscles. Guess what - a lack of acetylcholine has also been linked to muscle cramps. It's been theorised that Quinine may work on cramps because it has effects on things like acetylcholine.

If this is what's going on, the question is - why does OJ work and not apple juice? Studies have indicated a link between the flavanoid hesperidin, found in significant amounts in OJ, but not apples, and acetylcholine metabolism, but it was tested some 6 hours after ingestion. Hesperidin has also been linked to NO production, which is known to trigger muscle relaxation. It's not out of the question that at least some hesperidin in OJ is being absorbed sublingually and getting an almost immediate effect.

So if this is a real effect, my money is on hesperidin.
 
Sorry, I hadn't read through the whole thread.

To Linda: I used to have iron deficiency and it gave me awful pains in my knees and legs.

My knees and legs felt as though I could never stretch them out, no matter how hard or long I stretched them or rubbed them.

It only changed once I started eating iron rich foods and taking iron pills regularly.

So stretching apparently doesn't work for all cramps.
 
IceRat:

Thanks, I'll wade through the studies as time allows.

Great - now I may be deficient in something I've never even heard of... :)

Some of what you said sounded similar to what Joey McGee was hypothesizing about earlier!
 
And now I'm afraid I will no longer be posting in this thread. I seem to...

Never mind. I may post here again when I try some of the suggested tests, but other than that, I'm done. yet again I have screwed up and unnecessarily/unintentionally offended someone.

My thanks to ALL for their suggestions and ideas.

RSL
 
Is it considered a placebo if things get better in the mean time, or only if there is a mental/psychosomatic component?
 
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