You’ve been at work all day, you’re tired, you have managed to get to bed early, you’re asleep and then…….
Your legs decide to go for a walk.
Restless leg syndrome is no laughing matter.
Good quality sleep is critical for healing and energy in the day.
Tired in the day = poor food choices (too much sugar and carbs plus caffeine), less exercise and this spikes your blood sugars up and down.
Unstable blood sugars = stress for your sympathetic system.
Sustained sympathetic stress response (SSR) = Sustained Inflammatory Response (SIR).
And inflammation = insomnia.
It is a right vicious cycle.
But fear not, once again, we can help your patients above and beyond the average neuro-mechical clinician.
There are four things to consider for restless leg syndrome:
– Vitamin D
I am almost bored (almost) of telling people to take vitamin D.
It is the middle of winter people, if you are not supplementing (or spending ages somewhere hot on holiday), you are deficient or insufficient.
If you are non-Caucasian or carrying some extra weight, it is 100%.
Around a 60% decrease, if they were deficient.
Magnesium or B6
In this study they gave 40 mg of B6 (which is an OK entry point for therapeutic dosing. Many studies go to 80-100mg) or 250 mg of magnesium oxide, which is low-ish dose in a crappy form (we prefer 400-600 mg in a citrate or glycinate form).
Despite that and despite not using them together (which we also do with Magesium Plus – 150 mg Mag citrate with 15 mg B6 (P5P) remember B6 gets magneisum into the cells and calms your nerves down)
They still had great results:
Nearly 50% reduction in restless symptoms and a 66% ish improvement in sleep quality.
Last week’s topic B12 is also an option to look at, though less consistent in my clinical practice.
But the most consistent is…….iron.
This is well established to be one cause or one part of restless leg syndrome.
One thing to be clear about, just because you are not anaemic does not mean you have enough iron.
Iron is used in many pathways as a enzyme co-factor and this will affect those pathways long before you get anaemia.
Note they were not anaemic but they had bottom end iron saturation and ferritin (ferritin is your iron reserves, as your iron blood levels reduce, you draw down your reserves to maintain blood levels).
Depending on the lab and the GP, these may well be reported as “normal”.
This is why you MUST ALWAYS get the patient to get hold of the test results.
We like ferritin at least 50 ng/ml, if not around 80-100 ideally, anything under 50 is starting to suggest a lack of reserves.
Iron gave them over 50% less movements at night and reduced sleep
latency from 2 hours 23 minutes to 23 minutes.
Note none of the four nutrients discussed 100% resolved restless leg syndrome.
We all love silver bullet, but lets not try to play medicine with supplements.
Together as a combination?
But another thing to consider is dopamine.
This is well documented to help, but it comes at a cost with medications like dopamine agonists.
The lack of dopamine might also be because you need iron as a co-factor to turn tyrosine into L-DOPA which is then turned into dopamine.
I try all the other four first, often in combination, then if it is still a big issue, try some tyrosine 1000 mg x3 daily, but start with 1000mg daily first and build up.
Note the needs for magnesium/B6 also in the pathway from L-Dopa to Dopamine, hmmmmmmm.
Please let me know how you get on with any patients, I am all ears