Doctor's Note

The burning sensation during strenuous exercise may be related to the build-up of lactic acid in our muscles, but that's different than the delayed onset muscle soreness that occurs in the days following a bout of extreme physical activity. That's thought to be due to inflammation caused by muscle cell damage, little micro-tears in our muscles. If it's an inflammatory reaction, than might anti-inflammatory phytonutrients help? Find out in the next video Reducing Muscle Soreness with Berries.

More about what citrus phytonutrients can do in my last video Keeping Your Hands Warm With Citrus.

For more context check out my associated blog: How Citrus Might Help Keep Your Hands Warm, Citrus to Reduce Muscle Fatigue, and Berries to Prevent Muscle Soreness.

If you haven't yet, you can subscribe to my videos for free by clicking here.

To post comments or questions into our discussion board, first log into Disqus with your account or with one of the accepted social media logins. Click on Login to choose a login method. Click here for help.

  • TMR

    Dr Greger, Speaking of triglyceride levels: If one has a genetic predisposition to low hdl levels and elevated triglyceride levels despite exercise, good overall cholesterol levels and the consumption of a plant based diet, is there anything that can be done to increase the hdl and lower the triglycerides? Is one eventually likely to have heart problems due to this continual elevation of triglyceride levels?

    • JB

      Highly recommend reading “The Cholesterol Myth” by Dr. Stephen Sinatra (Cardiologist) to get bigger picture of cholesterol and heard disease connection.

      • Veganrunner

        JB just curious. Have you watched the videos under cholesterol and the role it plays in heart disease? Or the videos under Heart disease? Why would you choose to believe Dr Sinatra and not all the current research presented here? I believe both dr Greger and Dr Sinatra have an issue with prescribing cholesterol lowering drugs although maybe for different reasons.

        I am not being flippant. I really want to know how someone makes the decision to follow a guy selling a book vs the overwhelming research suggesting something different.

        Darryl’s posted article above on the Tarahumaras is fascinating and I think highlights the importance of exercise in the equation along with a low fat diet. And of course they don’t eat junk. Although they do eat this really high energy porridge I believe made from a root vegetable. Very interesting group of people.

        • Darryl

          A good narrative source on the modern Tarahumara is Chris McDougall’s [i]Born to Run[/i] (no relation to Dr. John McDougall). The traditional Tarahumara diet is (by calories) 71% corn and 19% beans, about 75% carbs (6% of which being sugars), 13% protein, and 12% fat. Coronary disease among these ultra-marathoners was unknown and their total cholesterol is a low (by American standards) 125 mg/dl, while their mean triglycerides of 120 mg/dl was slightly above (the then) mean American level of about 116 mg/dl.

          Though the post you reply has been deleted (it happens a lot on weekends), I thought I’d share a statement from the AHA on triglycerides, which notes the difficulties with using their level as an independent CVD risk factor.

          • Veganrunner

            I read that book. Of course afterwards I had to try barefoot running.

          • Veganrunner

            Why do they get deleted? That was very informative.

    • Darryl

      Worth noting the “heart attack proof” Tarahumara of Mexico have elevated triglycerides, triglycerides increased slightly in Ornish’s landmark low-fat diet heart study, and those genetically predisposed to high triglycerides are not at elevated risk for atherosclerosis.

      This paper argues that the association of high triglycerides with coronary risk isn’t causal, but is instead a marker for metabolic syndrome (diabetes etc) which increases risk by other mechanisms.

  • Brocca

    Leg cramps at night. Potassium, magnesium, calicum, hydration all check out okay. What else to check?

    • lynda

      Consider side effects of any medications that you are taking.

    • JAH

      Try drinking more water.

    • How about some body work? Stretching, yoga, or massage? Perhaps mind/body work might help, too. Meditation, progressive relaxation?

    • vegFXeditor

      Dear Brocca,

      A few years ago I had severe leg cramps at night, perhaps similar to those of yours. At that time I wasn’t a “real” vegan, but more of a “bread-milk-coffee” vegetarian, eating (much) too little vegetables, and (much) too much of my home-made whole-grain bread (whole wheat, either alone or mixed up with rye), coffee with milk, and also some factory-made white bread, and butter and olive oil occasionally.

      Although I cannot exactly remember all circumstances involved, I do remember that I some days were out walking a couple of miles. And I never did any stretching afterwards of any parts of my legs. So that could have been one causative factor.

      More likely, though, is an explanation based on something that I ate, or did NOT eat: so either it was a toxins issue (most likely), or a vitamin/mineral deficiency issue.

      As for the toxins explanation, it could have been the coffee or the bread (or both). Perhaps the coffee and the grains had some pesticides or storage chemicals on them. This could be related also to the idea that I at this time had a very poor blood sugar management, and frequently woke up with cramps. This poor blood sugar management was probably (partly) an effect of that I did not eat any beans and lentils, and thus I did NOT get the “lentil effect” (see Dr. Greger’s video “Beans and the Second Meal Effect”: ).

      If one plays around with a deficiency type of explanation, one could note that I did NOT take any vitamin B12 or vitamin D at the time. So it could have been a vitamin B12 or/and vitamin D issue. It is interesting to note that some researchers link B12 deficiency with seizures (Kumar 2004, “Recurrent seizures: An unusual manifestation of vitamin B12
      deficiency”, ).

      It may also be interesting to note that I haven’t had any cramps since I started my “serious” vegan diet. So I have skipped all milk, coffee, tea, butter, and olive oil, and most bread. Instead I now focus on green veggies and beans and lentils, and being very careful to ALWAYS sprinkle some lemon or orange over the veggies AND at the same meal also eat some fat (whole nuts or avocado, NOT any oils). I think this has really helped to maximize the vitamin and mineral absorption from all the (mostly cooked) green veggies that I eat: kale, spinach, broccoli, cauliflower, cauliflower stalks and leaves, celery, dill, parsley, fennel, carrots, tomatoes, etc.

      As for other explanations for leg cramps, I came across on the web a person who reported that eating three Brazil nuts every day for a month was the trigger ( ). Although it would be easy to simply say that it might have been the total amount of selenium that triggered it, or, perhaps, that it was the relative high dose of saturated fat that triggered it (which one might compare with my own previous intake of saturated fat in milk), another, perhaps more realistic explanation, might be that there were some pesticide or some storage-chemical sprayed on the brazilnuts that was toxic to the nervous system.

      • vegFXeditor

        I forgot to explicitly state a before-and-after effect in my reply above, so here it is.

        Previously when I was a bread-milk-coffee vegetarian I sometimes got leg cramps at night after having been out walking for miles. But nowadays, being a more strict mostly-green-veggies-and-beans vegan, I can be out walking for miles, even on hot days, and hardly drink anything at all (not before, during, or after the walk), and NOT doing any stretching at all (not before, during, or after the walk), and STILL not getting any leg cramps during the night (or at any other time).

        So in my case it is seemingly NOT about dehydration, or stretching. I attribute my new state to the synergetic nutritional effect of all the different green vegetables and beans (no soy!) and lentils that I am now eating, and to the vitamin B12 (1000 mcg/day) and D3 (2000 IE=50 mcg/day) and iodine (using Dr. Vogel’s Herbamare vegan salt with kelp) and selenium (one brazilnut/day), and to the complete avoidance of coffee, milk/dairy products, and commercially produced breads.

    • Wade

      This is likely dehydration/electrolyte deficit. I bicycle about 100 miles per week average, and sometimes get leg cramps. What helps me is coconut water post ride on hot days. Dr Greger said that coconut water has been used as a blood volume expander directly into the blood stream. When I drink coco water the cramps stay away. 11 ounces, sometimes I mix with blended cranberries and mango for a post ride smoothie. It tastes awesome, and no cramps.

      • tedster

        I don’t know what brand coconut water you use, but be aware that VitaCoco paid a $10 million settlement for, in part, knowingly overstating the electrolytic content of their product.

        • Wade

          What I know is that I don’t get cramps when I drink it, and do get cramps if I don’t (on hot days). Even if its a placebo effect, it works, and that’s what’s important for me. ;)

    • Andrew Towbin

      Most of my patients with back pain have leg pain or cramps when lying down or walking, because straightening the back and the hips at the same time causes pain down the legs, due to various mechanisms. Lying down with a pillow or two under the knees flexes the thighs slightly, so they have less pain. These patients also tend to have more back and leg symptoms when walking but not when bicycling, for the same reason. Consult with your doc or a spine doc if this seems to describe you. Andy, Physical Therapist

    • Rachel

      Might need to consider having your veins checked. Leg cramps at night can be a sign of poor circulation in your legs due to faulty vein valves–Allowing blood flow back down and circle in your legs instead of moving up to the heart. This condition is called chronic venous insufficiency.

    • Wade

      Another thing to think about is hypothyroidism. That can cause muscle cramps. I take synthroid for the condition, and if I don’t get enough (and my TSH numbers go up) I start getting vicious leg cramps from that.

      • vegFXeditor

        Yes, leg cramps may have something to do with hypothyroidism. But it may also be connected to alcoholism, i.e. liver problems, as well as with kidney failure or some kidney condition (see University of Maryland Medical Center’s “Muscle cramps” page at ).

        My own theory is that these apparently different manifestations all are connected to vitamin D deficiency (and potentially other factors as well). Here are some observations:

        First, vitamin D deficiency is commonly linked to LIVER problems, for the liver may have problems hydroxylating the D2 or D3 to 25-hydroxyvitamin D (which is needed by the kidneys to further convert it); also, “Vitamin D functions intricately with parathyroid hormone (PTH) to maintain plasma calcium and phosphate concentrations” (Stokes et al. 2013, ).

        Second, we know that a not fully functional KIDNEY may result in a decline in the production of 1,25-dihydroxyvitamin D (from 25-hydroxyvitamin D), and that this may be linked to hyperparathyroidism (Wisam Al-Badr and Kevin J. Martin 2008, “Vitamin D and Kidney Disease”, ).

        Third, since the parathyroid (despite its name) is not the immediate controller of the thyroid (for the pituitary gland is), we are not surprised that some studies associate *increased* concentration of parathyroid hormone with HYPOTHYROIDISM (see Bouillion and de Moor 1980, “Influence of Thyroid Function on the Serum Concentration of 1,25-Dihydroxyvitamin D3”, )

        Fourth, we are also not surprised to see that vitamin D apparently upregulates gene expression in the pituitary gland (Perez-Fernandez et al. 1997, “Vitamin D receptor gene expression in human pituitary gland”, ). This might support the idea that vitamin D deficiency is one factor that may lead to hypothyroidism; and perhaps low iodine levels are not as important as some think, in terms of being a factor behind hypothyroidism.

        So because my own leg cramps were NOT caused by any dehydration or by “forgetting to stretch” (see my separate posts in this thread), it seems possible to suggest that my D3 supplementation has positively contributed to the elimination of my cramps (which I nowadays don’t have at all), perhaps in combination with the extra supplements that I take: iodine (kelp), B12 (methylcobalamin), and selenium (brazilnut).

  • Plant Lady

    Pasteurized over the counter OJ makes me gassy, but freshly squeezed does not. Any ideas? Placebo effect?

    • Wade

      What about eating oranges? Any problems there? I personally refuse to drink juice unless I blend whole oranges as a smoothie.

      • nc54

        I juice oranges, eat the pulp first, then drink the juice. Same as eating whole oranges. I can down 20 oranges this way after a strenuous morning workout. Then I rinse my mouth out with water and little baking soda to neutralize the acids.

  • Jo

    What about lemon, lime, or grapefruit? Can we assume these would help as well?

    • LynnCS

      Using a centrifugal type juicer will give you all parts of the orange…except the fiber which is needed, so not great. We need the fiber for proper digestion and use. Using a food processor on the whole orange, some maple syrup, or whatever suits you, some great seasonings…cinnamon, allspice, nutmeg, or again…whatever suits you…gives you a great whole “marmalade.” Pile on sweet potatoes…or again, whatever suits you and mmmmmm! Healthy and delicious. Eating the whole fruit give us everything that is built into the orange including the bioflavanoids, which I think is found in the skin. Enjoy! Try to use a non sprayed fruit or wash well.

  • painterguy

    The sugar spike from citrus juice is concerning. I would also be concerned with the acid/tooth decay curve. I want to eat more citris fruit, especially with the benefit described in the video. On something maybe related, I’m working on aroma scents. The lavender video got me started. I bought several little bottles of food extracts—vanilla, mint, strawberry, cinnamon and so on. I gave a box full of them to my 85 year old mom to see if she could identify the scents. She did fair to midland, but her strongest hits were on lemon and orange and there was a happy face that went with it.

  • Johnny Utah

    The United States currently has the greatest number of known centenarians of any nation, with 53,364 according to the 2010 Census, or 1.73 per 10,000 people. -Wikipedia-

    How can this be if we are the largest consumers of meat and why are we going to China to do studies when we are the ones living longer.

  • BYOL

    So would consuming an orange or drinking OJ while performing an endurance event help reduce lactic acid build up?

    • James

      Good question. I want an answer to this too.

  • WaltYz

    Last winter I spent some time in Norway and I was surprised how insistent the Norwegians were in taking tangerines with them on their cross country ski trips.They almost wouldn’t go without any. I couldn’t see why (except that they’re tasty). Now with the last two videos (citrus might help against hypothermia and lactic acid build-up), it starts making a lot more sense :)

  • heatfanmiami

    No biggie, however, lactic “acid” is not formed in the body. Lactate in the plasma is simply a maker of glycogen utilization and not responsible for pain or fatigue. It does correlate / corresponds with pain and fatigue since the body at this point has an increased reliance on glycolytic, fatigable muscle fibers. It is not an acid at a physiological pH (PKa ~ 3.5); at high intensities muscle acidity is due to intracellular hydrogen ion formation within the cell due to higher levels of ATP hydrolysis and NADH formation (a high ATP demand/O2 supply ratio). Also, in some cases, higher levels of SNS activity leading to vasoconstriction and anoxia in working muscles to maintain adequate central blood supply at maximal exercise intensities.

  • James

    The study from Aptekmann NP, Cesar TB. uses untrained individuals where improvement is always easy. It would be interesting to see a study with highly trained athletes. Also, the study doesn’t mention timing. I’d like to know the best time to drink the juice before my target event. My instinct says to time the big blood sugar spike so it coincides with the hard effort?