Quinine: Medicine or Mixer?
Quinine is a bitter compound that’s used in tonic water but also has a long history of medical use. Can quinine prevent leg cramps? Are there side effects to drinking it? Nutrition Diva has all the details.
Nutrition Diva podcast listener Sherri writes: “Is there anything about quinine (or tonic water) that makes it worth drinking? I know some older people who are convinced it helps with neurological issues. Does it have side effects, or is it fairly benign even if ingested daily?”
What’s in Tonic Water?
Quinine is a bitter chemical that is extracted from the bark of the cinchona tree. It’s used in tonic water to impart that characteristic bitter taste. In fact, I’ve made my own tonic water, using cinchona bark that I bought online.
My recipe involved boiling cinchona bark with other spices like coriander and juniper and combining that with citrus juice, grated citrus peels, and sugar and straining the whole concoction to produce a syrup. To use it, I would add a tablespoon or two of the syrup to a glass and fill with plain soda water. (Gin optional.)
Making your own tonic water is fun, especially if you like those sort of DIY projects that require a bunch of esoteric ingredients or equipment, take a lot of time, make a big mess, and ultimately produce something that you could have bought at the store for a buck. Of course, my tonic water tasted nothing like store-bought tonic water. Some of my friends thought that was a plus; others frankly preferred the store-bought stuff. The other interesting thing about homemade tonic water is that it is not clear like store bought tonic water, but more the color of weak tea.
In addition to being used as a flavoring agent, quinine from cinchona bark can also be an effective treatment for malaria.
What Are the Medical Uses of Quinine?
In addition to being used as a flavoring agent, quinine from cinchona bark can also be an effective treatment for malaria. Qualaquin is a prescription anti-malarial medication containing quinine sulfate. However, as more effective drugs have been developed, quinine is no longer the first-line treatment for malaria. It’s basically only used in cases where no other drugs are available, or in areas that have developed strains of malaria that are resistant to the first line drugs. It is also sometimes used to treat malaria in pregnant women.
Cinchona bark contains another closely related compound called quinidine. It has some of the same medicinal benefits as quinine, such as fighting malaria. However it tends to have more serious effects—so it’s not widely used. There is some ongoing research involving quinidine to treat certain rare neurological conditions, but toxicity remains a real issue.
Does Quinine Prevent Leg Cramps?
Quinine also gained a reputation as a treatment for Restless Legs Syndrome and nighttime leg cramps. Many physicians were prescribing Qualaquin (a quinine-based drug) to patients who suffer from leg cramps. However the FDA has issued a warning against this “off-label” use of quinine-containing medications.
In rare cases, these drugs can have serious side effects, such as severe bleeding disorders or kidney damage. Less serious side effects like digestive upset and ringing in the ears are more common.
Malaria is a serious, sometimes life-threatening disease. For people with malaria that is not responsive to other drugs (or in cases where other drugs are not available), the benefits of quinine may outweigh the risk of side effects. But it’s harder to justify those risks for the treatment of leg cramps, especially because there is not a lot of evidence to show that quinine is all that effective.
There is also some folk wisdom that drinking a glass of tonic water before bedtime will reduce nighttime leg cramps but this is very unlikely to have any benefit, simply because the amount of quinine that you’d get from drinking tonic water is far too small to have any pharmacological effect.
How Much Quinine Is in Tonic Water?
Just to give you some idea what we’re talking about here, the recommended dosage of Qualaquin for the treatment of malaria is about 2,000 mg per day. The typical dose for off-label treatment of leg cramps (which the FDA does not prohibit but does recommend against) is 200 to 500 mg per day. And the amount of quinine you’d get from 8 ounces of tonic water is about 20 mg. My homemade tonic water probably contained more quinine than store-bought tonic water but still probably less than 50 mg.
Tonic water—even when homemade—is unlikely to contain enough quinine to cause any side effects…or produce any medical benefits either.
My point is that tonic water—even when homemade—is unlikely to contain enough quinine to cause any side effects. However, it doesn’t contain enough quinine to produce any medical benefits either.
There is one final thing to take into consideration and that is the amount of sugar in tonic water. Eight ounces (or a quarter liter) of tonic water contains about 20 grams of added sugars.
To give you a frame of reference, the recommended guideline for added sugars is 25 grams or less—so one little glass of tonic water uses up almost your entire allowance for the day. One advantage to the homemade stuff is that you can use a bit less syrup and reduce the sugar. You could do the same thing by diluting store-bought tonic water with plain club soda.
Thanks for your question Sherri! If you have a question or comment for me you can call the Nutrition Diva listener line at 443-961-6206. I always love to hear from you.
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Gin and tonic drink image courtesy of Shutterstock.
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About the Author
Monica Reinagel is a board-certified licensed nutritionist, author, and the creator of one of iTunes’ most highly ranked health and fitness podcasts. Her advice is regularly featured on the TODAY show, Dr. Oz, NPR, and in the nation’s leading newspapers, magazines, and websites. Do you have a nutrition question? Call the Nutrition Diva listener line at 443-961-6206. Your question could be featured on the show.
