Restless Legs Syndrome - 4 Less-Known Causes | Chris Kresser

4 Little-Known Causes of Restless Legs Syndrome

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Restless legs syndrome is a seemingly simple condition, but the cause is often difficult to pinpoint. Find out four potential contributing factors and how to address them.

dietary causes of rls
Can certain dietary choices cause RLS? Stockbyte/Stockbyte/Thinkstock

Few things are more frustrating than lying in bed at night exhausted, but not being able to fall asleep because of an uncontrollable urge to move your legs. This phenomenon, known as restless legs syndrome (RLS), affects between 4% and 29% of adults in Western populations, and is a major contributor to sleep loss. (1, 2)

Pinpointing the cause of RLS has been an active research topic for years, but the condition is still not fully understood. The symptoms have been convincingly linked to impaired dopamine function in the brain, but the cause of this dysfunction is still being explored.

In this article, I’ll review four factors that could contribute to RLS, as well as steps you can take for improving your symptoms.

1. Systemic Inflammation and Immune Dysregulation

Restless legs syndrome has been associated with numerous conditions involving systemic inflammation and immune dysregulation. (3) One review paper published in 2012 investigated health conditions that were reported to cause or exacerbate RLS symptoms, and found that 95% of the 38 different health conditions that were strongly associated with RLS have an inflammation or immune component. (4) These conditions include Parkinson’s disease, multiple sclerosis, ADHD, Alzheimer’s disease, Celiac disease, Crohn’s disease, rheumatoid arthritis, sleep apnea, diabetes, and depression.

As further evidence, an elevated blood level of C-reactive protein (a marker of systemic inflammation) has been associated with increased RLS severity. (5) A small crossover trial found that a hydrocortisone infusion, which reduces systemic inflammation, reduced RLS symptoms. (6)

Researchers have proposed three potential mechanisms to explain the association between RLS and inflammatory or autoimmune states: direct autoimmune attack on the nervous system; genetic factors that could predispose an individual to RLS and be triggered by inflammation or autoimmunity; and iron deficiency caused by inflammation, which I’ll talk more about below.

 

What to do: If your RLS is a symptom of underlying systemic inflammation or immune dysregulation, the goal should be to find and treat the root cause. As I’ve mentioned many times in the past, gut infections are often the culprit—even if you don’t have noticeable digestive symptoms—so get your gut tested.

If you already have a diagnosed inflammatory or immune condition such as those I mentioned above, the best first step you can take is to adopt a “low-inflammatory” diet and lifestyle. This means eating a nutrient-rich, low-toxin diet based on whole foods; getting enough sleep every night; prioritizing stress management; and incorporating regular movement into your day.

You can also check out the bonus chapter about autoimmune disease from my book, as well as explore other information on my site about reversing autoimmune disease, the autoimmune protocol, the role of the microbiome, and alternative therapies such as LDN.

Do you have restless legs syndrome? Find out what might be causing it, and what to do.

2. Small Intestinal Bacterial Overgrowth (SIBO) and IBS

Some of the more recent research on restless legs syndrome has focused on a connection with small intestinal bacterial overgrowth (SIBO) and IBS, which is often caused by SIBO. One study found that 69% of RLS patients also had SIBO, compared with only 28% of controls. (7) They also found that 28% of RLS patients had IBS, compared to only 4% of controls. And according to the 2012 review I mentioned in the previous section, 32% of the 38 conditions associated with RLS are also associated with SIBO. (8)

A strong association between SIBO and RLS doesn’t mean that SIBO is causing RLS in these patients. But a few trials have found that in patients with both SIBO and RLS, their RLS symptoms improve after being treated for SIBO. (9)

For example, one double-blind, placebo-controlled study reported that treatment with the antibiotic rifaximin—the standard treatment for SIBO—significantly improved RLS symptoms in patients with both conditions. (10) This, of course, does suggest a causal link between SIBO and RLS.

What to do: If you have both RLS and SIBO, the best option would be to find a functional medicine practitioner who has experience dealing with SIBO and get treated. That said, two steps you can try on your own are a low-FODMAP diet and probiotics. Low-FODMAP diets reduce the amount of fermentable carbohydrates that “feed” bacteria in the small intestine, and a couple studies have shown that probiotics can be as effective as antibiotics for treating SIBO. (11, 12) I’ve found the probiotics S. boulardii (a beneficial yeast), and MegaSporeBiotic to be helpful.

One important note about low-FODMAP diets, however, is that it’s generally not a good idea to stay on one indefinitely. Low-FODMAP diets eliminate sources of prebiotics, which can improve symptoms by starving pathogenic bacteria, but can also starve your beneficial bacteria. The best approach is to follow a low-FODMAP diet until symptoms subside (and your SIBO breath test is normal), and then gradually re-introduce prebiotic foods (or supplements) to support your gut microbiome.

3. Vitamin D Deficiency

As I mentioned in the introduction, one of the most-researched theories about the cause of restless legs syndrome is impaired dopamine signaling, which has led to the conventional treatment of RLS by dopamine agonists (i.e. chemicals that can bind to and activate dopamine receptors). Unfortunately, these treatments can become less effective over time, and can even result in a worsening of symptoms.

And while replacing neurotransmitters might be an effective way to manage symptoms in the short term, the goal should be to figure out why dopamine signaling is impaired in the first place.

This is where vitamin D comes into play.

The role of vitamin D in dopamine signaling is only beginning to be investigated, but some evidence indicates that vitamin D could play an important role by increasing levels of dopamine and its metabolites in the brain, as well as protecting dopamine-associated neurons from toxins. (13)

RLS has been associated with vitamin D deficiency in several studies, and disease severity has been inversely correlated with vitamin D levels. (14, 15, 16) One study has also found that vitamin D supplementation improved the severity of RLS symptoms. (17)

What to do: If you have RLS, one of the easiest first steps you can take is to get your vitamin D levels tested. A good range to shoot for is typically between 25-50 ng/mL, but if you have an autoimmune disease or another chronic health condition, I prefer to bring vitamin D levels up to 35-60 ng/mL. One way to supplement vitamin D is cod liver oil; I recommend extra-virgin cod liver oil. You can also take a D3 supplement, such as this one that contains both vitamin D and vitamin K2. And of course, you should get regular sun exposure to bring your vitamin D levels up naturally.

4. Iron Deficiency

Iron deficiency isn’t exactly a “little-known” cause of restless legs syndrome; in fact, it’s probably one of the most well-researched areas relating to RLS. Iron is required for proper dopamine signaling, but its role is much better established than that of vitamin D, and it’s pretty clear that iron deficiency in the CNS can cause RLS symptoms by impairing dopamine function. (18)

Several studies have found that low iron levels in the cerebrospinal fluid and in the brain occur more frequently in patients with RLS compared with matched controls. (19, 20) And this difference isn’t always reflected in serum ferritin levels.

Other abnormalities in iron metabolism have also been observed in RLS patients, and many conditions that increase the risk of RLS (including pregnancy and end-stage kidney disease) are known to cause iron insufficiency. (21, 22)

Further, iron supplementation significantly improves or even eliminates the symptoms of RLS in many patients. For example, RLS patients with low-normal serum ferritin experienced significant improvements in their RLS symptoms after 12 weeks of iron supplementation. (23) And oral iron was as effective for treating RLS as pramiprexole, a dopamine agonist, although the response rate for both treatments was relatively low (46.7%). (24)

The tricky thing about iron deficiency is that the solution is often not as simple as taking an iron supplement. Iron deficiency is frequently secondary to SIBO, gut infections, or other inflammatory states, which explains at least in part the association between RLS and these conditions. Iron deficiency caused by infection or inflammation is mediated primarily by the hormone hepcidin, which at high levels can decrease serum iron and reduce iron absorption from the GI tract. (25)

One cause of increased hepcidin levels is the production of IL-6, an inflammatory cytokine present in most inflammatory diseases. Another cause of increased hepcidin levels is the presence of lipopolysaccharides (LPS), which are components of gram-negative bacteria that can enter circulation as a result of SIBO or other gut infections. Thus, increased levels of circulating IL-6 or LPS can result in iron deficiency, and subsequently, RLS.

What to do: If you have RLS and iron deficiency, the first step is to identify why you’re iron deficient. If the cause is blood loss (such as from heavy menstruation in women) or dietary insufficiency (such as in vegetarian or vegan diets), increase your consumption of iron-rich foods such as liver and red meat. You can also consider an iron supplement; I recommend Proferrin ES and bovine ferritin, because they are better absorbed and better tolerated than plant-based iron supplements. 

However, if the cause is SIBO or a gut infection, increasing iron intake can often make matters worse by creating an environment that promotes pathogen growth and inflammation. (26, 27, 28) For this reason, it’s best to address the gut before (or at least concurrently with) adding iron supplements.

As you can see, restless legs syndrome is complex, and several factors could come into play when trying to figure out the cause. As with many other health conditions, RLS is best seen as a symptom which signals that something else is amiss, and it’s necessary to dig deeper to find out the root cause, and how to treat it.

If you suffer from restless legs syndrome, I hope this article helped clarify what might be causing it.

293 Comments

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  1. I’m in my fifties and now RLS has started attacking me at night! However, it’s worse when I consume caffeine or alcohol the day before. It’s also worse when I’m physically active the day before (especially with my legs, hips and back). It seems like any soreness in my legs, hips and back triggers the RLS. I can control this with Ibuprofen 400 mg.

    I’ve just started taking Niagen supplements which is the brand name for nicotinamide riboside (NR), a highly effective NAD+ booster and “no flush” form of vitamin B3. Since starting the Niagen I haven’t experienced any restless legs. I’ve been on Niagen for only a few days though.

  2. We give our clients with RLS symptoms 500 mg of Taurine. It immediately relieves symptoms in about 95% of the cases. For the 5% that don’t respond, we add in some D3/K2 and that seems to fit the bill.

  3. My thirteen year old daughter has been complaining that her legs hurt at night. She has already had a couple of major growth spurts already and didn’t complain before now. She’s been having regular periods for about 6 months now. I wonder about her iron and might get that tested. Most of the women in my family complain of RLS and the standard calcium/magnesium/vitD supplement does the trick for us but I stopped taking it after the issues around calcium supplementation a couple of years ago. I have thought of giving her a magnesium supplement. And now I’m wondering if she should take a calcium supplement because we don’t consume much dairy. (I know you can get it elsewhere but I’m concerned it’s not enough.) What would be safe supplementation for a still growing 13 year old girl?

    • I forgot to mention she has celiac but it’s been under control for a few years now (diagnosed 5 years ago). I’m not celiac but gluten free out of solidarity.

  4. I get restless legs sometimes in winter, I guess that could be related to the Vitamin D deficiency. Magnesium sure has helped me sleep better. If I sit a long time my feet swell some, does anyone else have this issue?

  5. Hi I have had restless legs,feet and cramping for as long as I can remember!
    Magnesium supplements and transdermal oil has sadly not worked for me. Nor Epsom salts baths. I have a mitochondrial malfunction where it appears I have mag in my blood but it is not reaching the mito cells properly hence I think maybe causing the issues for my muscles. Does anyone else have similar issues?I already take vitamin D because of deficiency. I also know I have inflammation and sibo but I react to pro and prebiotics and natural supplements that would kill the bacteria infection! I am also deficient of iodine but concerned about supplementing due to nodules! Feel in a catch 22 situation. Could really do with a detective angel who loves a challenge to help as I am running out of energy and money!

    • I take 4000 IU’s of D3 and my RLS and PILM are totally resolved. I am not able to take antihistamines or zolipidem (Ambien) as both trigger RLS and PILM. Subsequent blood tests for Vit D show a normal level. Vit D is a fat soluble vitamin and too much can result in liver toxicity so best to discuss with your MD before embarking on this course of treatment.

      • Be glad you cannot take Ambien. It did very little for my sleep and lots for feeling bad when I took it.

      • VITAMIN D LEVEL
        Most MD’s will tell you a Vitamin D blood serum level of 30 is fine. 30-70 is normal by conventional standards but the lower end of normal is NOT high enough to be OPTIMAL for the numerous needs of vitamin D in the body. Excuse me, did Chris say in the above article “a good range to shoot for is 25-50”? 25 is deficient even by conventional standards. Shoot for and maintain a blood serum level of 50-70. For most people this can take months to achieve by taking around 5,000 IU of daily vitamin D3.

        Regarding prescription sleep drugs, they carry the watered down caution “may be habit forming” and should not be used more than occasionally or very temporarily… but many doctors keep giving them out. They often cause miserable addictions and even more sleep loss.

        • It’s not about the number, it’s about how your body uses it. We’re all different. Parathyroid and calcium, for example, with D would show a better picture. IMHO, people get hung up on specific numbers too much instead of looking at the body as a whole organism

      • Hi Donna, thank you, I am already on vitamin D via the doctor due to a deficiency. Will be having it reviewed soon. x

      • Hi Judy thank you,yes I have had genetic testing and that’s what has made it so complicated and really the reason why I am in a catch 22 situation. When I need something something else gets blocked or reacts. Hence the need for a detective angel x

          • Hi Judy, although I live in France I have been having treatment from a clinic in the UK which specialities are CFS/ME Which is where so much has been revealed but I feel I need more specialist knowledge as I realise I was born with some of the issues as opposed to developing them.It’s difficult finding a functional medicine doctor here. And the gene testing is not really accepted here at the moment.

            • Check out this website: It is the work of Dr. Ben Lynch, ND. http://www.mthfr.net click on “Find a Doctor ” scroll down to list of doctors in the UK click on 3rd one in that group Liz McWatt, then click on her website. Under the topics see Nutrigenetics …click on it. I think this doctor could be your angel. It sounds like she has the training to work with you on the results of your genetic testing.

              • Thank you so much Judy, you are very much an angel detective! I am already linked up to Dr Ben Lynch and a member on his seeking health.org site. The work he is doing is fantastic! He is concentrating now on the end of the chain which involves the Mitochondria. And I have also asked questions re the mito and magnesium. I think part of my issues are that they are only just coming to light as part of the understanding in research and maybe I have to wait a while longer! I will certainly look at her website though! I have been working on the all the factors environmentally to ensure I am doing all I can for my epigenetics. Thank you again x

                • You are very welcome. I am so glad you already know of Dr. Lynch and hope you find the help you need very soon. We are fortunate so much info has become available in our lifetime and there are people working on learning more.

    • Andree — it’s imperative to take probiotics with your health issues. If you react to the probiotics you’ve taken, keep trying others. I, to, react to some — for example, those made on a rice substrate. But you saying you’react’ to probiotics is like saying you react to water. Hi hi quality probiotics, the expensive kind, and started in small qualities as you build up a tolerance, is important. Good luck!

      • Hi Tandy thank you for your comment,I have already been on some of the very best available over the years,in small quantities because of my high sensitivity to supplements,but sadly they still knocked my stomach and mito for six! Just too much for my body and mitochondria to cope with. I will keep trying, i am determined not to give up.I have recently been on a rest from everything as I felt so rough. I know there is a small loophole in my system where I can take hold and start from,it’s just finding it hence the detective.x

        • Could you be toxic? In other words, could you have metals such as mercury, cadmium, or even lead in your tissues which interfere with signaling or compete with receptor sites and thereby block absorption? Just a thought.

    • Have you tried a more absorbed Magnesium like Ionic Magnesium ? I have found that Good State Health Solutions is less expensive. Sorry I don’t know if we can mention the brand name but wanted to suggest it anyway. Not everyone can absorb pills and other forms. You can also Google more on that.

    • Hi Andree,
      All those supplements and medicines are for the temporary release of body problems. They won’t help in the end, but hiding the problems! You need to build a strong body to get rid of the problems.
      eastern qigong exercise, like Reiki, and dietary philosophies, like no raw food, salad, and cold food, will help to strong your body to get rid of the problems.
      Search online for more info.
      Good luck.

    • My family member takes the prescription as nothing else worked. Apple cider vinegar helps people balance flora, along with ginger and peppermint. Garde of Life fungal defense has oils and herbs that works for both bacteria and funghus- and you could add some to male it more appropriate for SIBO, like extra ginger. Bio-botanical research has a natural herbal tincture that may help with SIBO. I read that quinine treats RLS. Look that one up. Not enough in tonic water, but maybe you could get a prescription.

    • Just as damage to the gut (from antibiotics, glyphosate, etc.) can reduce or prevent magnesium absorption from the digestive tract into the bloodstream, damage to the cell membrane can reduce or prevent magnesium from getting into the cell where it is used by the mitochondria to produce ATP (the cell’s energy).

      I have found two supplements that help repair the cell membranes and provide nutrients to the mitochondria for additional cellular repair and ATP production.

      The first is a micronized purple rice product and the second is a new, improved version of the old GH-3 product that was initially developed as a local anesthetic and found to repair the cell membrane. The formula has been reworked and improved so it can now be taken orally (it was injected before).

      Both of these products appear to help in repairing the cell membrane thus allowing the cell to bring in nutrients needed to repair the cell and for the production of ATP. (from what I’ve read and my personal experience) The presence of magnesium in the cell is critical to enzymatic reactions crucial to the metabolism of polysaccharides in cellular energy production.

      The other macro minerals all have their roles to play too. It’s not just magnesium, although it is a major player here.

      • You may want to consider a fulvic /humic acid product from Mother Earth Labs called PH Balancer. Its a multivitamin eith miberals, but the jey component is the fulvic / humic avid. This product makes cell more permeable and is totally organic and gmo free.
        L Carnosine is known to help grow new mitochondria, yes grow new mitochondria. But, you must take 1000-1500 mg/ day followed by about 500mg or taurine.

  6. Increasing my levels of Potassium from near zero on a high carb diet of grains, bread and pastry, and changing to a whole, natural, low carb diet worked for me. Not only did the RLS completely disappear, but also the severe night cramps in the early morning hours. Potassium RDI of 3800mg by diet alone is not easy to maintain and I only average on any day about 75% of that, but have not suffered RLS for several years even at that level.

  7. I have been getting RLS for many years. I’ve also had two frozen shoulders and have Dupytrens contracture. I have now recently started getting myoclonic jerks. I’ve tried all sorts of supplements and detoxing. So far nothing has helped. I found the article very useful and it has given me more food for thought.

  8. I and my two daughter have suffered intermittently from restless legs since being a young teenager. It always started when sitting down especially in a cinema or theatre when relatively immobile. Mg made it worse. However in the past two months when I have been using a grounding (earthing) mat under my feet or legs when sitting down I have not experienced it though I have often had a feeling that it was going to start but it never developed. Because my RL was intermittent it is is not a proof that the earthing mat is helping at all but it is worth a try and good for you in other ways.

    • That sounds anxiety based RSL, which is what I think I have. I’ve never been diagnosed with anxiety because it’s never seem to really affect me too negatively (except the RLS but I don’t think that was considered a symptom) I’ve tried magnesium supp. and paleo but nothing has consistently worked. The past 8 month I’ve been using an essential oil blend on the bottom of my feet before bed or going to the movies or on a long car drive or plane and I haven’t had any issues. Its great this issue is getting a closer look as through the years I’ve spent trying to find a cause, there didn’t seem to be much research out there!

        • I use a mixture of lavender, vetiver, eucalyptus, orange and frankincense and a couple more calming oils. I put a few drops of each in a rollerball bottle and roll it on the bottom of my feet and on my wrists at night and it’s really improved not just getting to sleep but staying asleep.

      • Sometimes people try magnesium and find it doesn’t work for them. Usually they have only tried one form of magnesium and only used it for a month. Not all forms of magnesium are the same. For example, magnesium oxide (one of the more common forms found in drug stores) is so poorly absorbed that even taking 500 mg you would only be able to absorb about 20 mg! That’s not enough to have a beneficial effect especially in someone deficient enough that they have RLS.

        So your magnesium needs to easily absorbable by your body, and you have to take it long enough to allow you to have experienced enough healing to see some results.

        Nutrients, unlike pharmaceutical drugs, work slowly and gently and require time for healing changes to occur.

        Drugs, on the other hand, force your body to do their bidding with quick results which you then pay for with side effects, and eventually the return of the symptoms. Or a need for increasing doses to get the same relief. This is because most of the drugs don’t provide any healing only the suppression of the symptoms.

      • Sinclair, anxiety and depression are symptoms of magnesium deficiency. Check out my responses to others on here to get the full scoop.

        Also, anything that ramps up your metabolism (including stress, anxiety, high caffeine or high sugar intake, stimulant drugs) increases your need for magnesium. It is involved in over 300 different enzymatic functions in the body.

        If your intake is already suboptimal, an increased metabolism will only deplete your stores that much sooner.

        Additionally, with ‘factory-farming’ practices what they are the soil in which most of our food is grown, is becoming magnesium-deficient. f the magnesium is not present in adequate quantities n the soil then it won’t be in adequate levels in the plants we eat.If we d not supplement, we cannot help but become deficient.

        And then there’s the co-factors: vitamins D3 and K2 and magnesium’s sister, calcium; they all wok together and need to be present at the same time and in balance with each other for certain biochemical processes to take place in the body.

        Human biochemistry is more complicated than most people realize, even many doctors and scientists.

  9. Caffeine in any form–coffee, decaf, tea, chocolate — triggers RLS as soon as the very same night I have eaten even the smallest amount of caffeine– eg. in decaf coffee,

    • The same thing happens to me. I believe mine is due to a leaky gut from many years of GERD meds & antibiotics. Magnesium is the only thing that helps me sleep at night.

  10. I’ve had RLS for 17 years after I developed it during the second trimester of my second pregnacy. I’ve tried iron infusions (Pushing my iron levels from 12 to 768!!), Vitamin D,Vitamin C, Vitamin B, Magnesium, Calcium, Liver detox, hot baths, cold baths, more exercise, less exercise, hot drink before bed, no drink before bed, massage, heat packs, cold packs, magnets, muscle binding, homeopathic drops, varicose vein removal, hypnotism, and so many more treatments that I’ve forgotten. I’ve seen, neurosurgeons, neurologists, physiotherapists, Chiropractors, reflexologists, homeopaths, hypnotists and none of them helped (not even close). Approx 12 years ago though, I was prescribed Ropinarole from a sleep therapist and it worked a treat. Wonderful I thought, until after a while I started to need a higher dose to keep the RLS at bay. It wasn’t until I’d crept up from 0.25mg at night to 2mg at 11am, 2mg at 5pm and a final dose of 2mg at bedtime (total of 6mg a da) that I was told that Ropinarole caused Augmentation (Makes the condition worse while treating it). So now I was getting restless leg by lunch time and it would last all day and until approx 5am the next morning if I didn’t take the Ropinarole on time. So I then changed to Pramapexole but unfortunately it wasn’t subsidised at the time and was costing me nearly $400 a month which quickly became an unacceptable option. I then researched and found Methadone (although excessive) was meant to be good at treating RLS. So after many consultations I found a specialist who prescribed this to me and wow!!!! it stopped the RLS in it’s tracks. Not a twitch, not wiggle…..nothing, just normal feeling legs, I was over the moon. Unfortunately one of the side effects of methadone ( although I was on a very small dose) was sleepiness and found myself nodding off anytime I sat time for more than 5 mins. So off the Methadone I went and back onto the Ropinarole which quickly jumped up to the old 6mg per day bringing with it the side effects once again. This wasn’t a long term option as the dose would forever keep accelerating and the augmentation meant more Ropinarole so I am now on a combination of half Methadone and half Ropinarole which is perfect ( so far). If there was some other treatment out there however that was natural and meant I no longer needed any Pharmaceutical Drugs I would most definitely be interested in trying it.

    • High quality magnesium (i take magnesium mallet the a.m. & magnesium citrate & glutamate in the p.m.). That is what I used to wean off mirapex & requip. It took me over a year to do so, but it was well worth it.

  11. I get restless feet, not restless legs. Not sure if this is the same thing. My iron, B12 and Vit D levels aren’t flash either. I need to get them measured again.

    To calm down the restless feet, I poke the feet out of the bed clothes or put them against the window screen if this happens while I”m a passenger in a car. In the evening if I notice my feet getting warm, I take my footwear off. Walking around on a cold floor (we don’t heat our house in winter) helps too.

    Does anyone else just get restless feet, not legs?

    • RLS and PILM are often found together. With PILM, I found my feet were flexing at the ankles, kind of like a little dance. As time went on, this progressed to leg kicking. And still later, the sweeping restless leg motions started. All has been resolved with the Vit D3. My mom suffered with this for years. She was prescribed Gabapentin which did control it.

  12. What about B12 and/or folate deficiency? I have an MTHFR gene mutation, and I take methylated B vitamins (high doses). If I go several days without my B vitamins, my right leg and right arm get very annoyingly uncomfortable when I try to sleep. Keeping up with my B vitamins really helps!

    • Holly, I second making sure folate intake is adequate. I have read (in a number of reputable sources) that a percentage of people have RLS that is related to folate deficiency. I don’t know whether this is an MTHFR issue, and/or that we need a higher amount of folate than most people.

      I am a leading edge Boomer who has had RLS as long as I can remember. Several years ago I tested MTHFR heterozygous (C677T), which is the mildest form. If I eat cooked greens almost daily, I have far less of a problem. I do take a multi with 200 mcg of methylfolate (Seeking Health Chewable, 1 tab), and if the symptoms seem to be increasing in spite of greens intake, I also occasionally take half of a methylfolate-only cap in the evening to make sure I can sleep (Pure Encapsulations 400 mcg caps). Daily magnesium (Natural Calm) seems to help, as does methyB12 sublingual drops.

      And soaking in a hot tub just before turning in is also very helpful.

  13. My two cents worth regarding RLS.

    Iron deficiency (Coeliac Disease & Peri Menopause) linked to RLS for me. My ferritin was 20. Range is 20-300 here in Australia. Supplementation has included 100mg Iron Bisglycinate twice per day with food and a dose of ascorbic acid 1gm as a chaser.

    Magnesium has also been a game changer. Using an oil for dermal absorption. I leave on for 20 mins either at night or after brekky before a shower. It’s messy but far more effective I’ve noticed than the oral supplements. I tried the widely applauded ReMag and the sorbic acid preservative in it made my gut more ‘leaky and sore’.

    My Paternal GF, my Father, my self and all 4 of my children have RLS so I’m thinking there is a strong genetic component too. Four generations all affected and age of onset very varied.

  14. RLS is an expression of unexpressed stress energy. Whether it’s stress from the current crap day of work, or school project deadlines, or inflammation(you mentioned), or surgery and scar tissue, or repressed emotions and expression, or trauma of any sorts(all the way back to birth). Our tissues carry everything on record from prior to day one till day X.

    You let steam out of us pressure cookers and we lessen all these fidgeting symptoms that we keep trying to attack with myopic solutions.

    We aren’t meant to be vessels to store life but conduits to express and experience it. We need to stop teaching ourselves to be storage containers.?

  15. I remember recently that Dr Dan Kalish mentioned on Underground Wellness (the topic was focused on the brain) that RLS is a dopamine related problem. In what ways would this link up with your comments Chris?

    • It is. Largely Chris just stated observational stuff and nothing concrete. Consider Parkinson’s the grand daddy of dopamine signaling degredation and RLS it’s little brother that could potentially lead to Parkinson’s as you age.

      I’m not so sure of the connection between vitamin D that he states, but the treatment of mag and/or taurine makes a lot of sense because they are calming and lower another catecholamine in the same metabolic pathway called adrenalin.

      The gut is an obvious treatment because when the gut is off, anything goes (gut dysregulation is FP’s “catch all”). It will also directly lead to liver abnormalities causing cholesterol/hormone dysregulation. I would guess serotonin would play a part since it’s created in the gut, with increased endotoxin, and thereby stimulating dopamine antagonist prolactin.

      Another way of looking at it is from a dopamine “receptor” degredation view, if you believe in receptors, which begs the question “what’s degrading them?”. Medical science honestly doesn’t know much, but the body is about balance and it wouldn’t be strange to find out that balancing neurotransmitters in various ways may be the answer.

      Btw, I’m surprised Chris didn’t mention that smokers and coffee drinkers have been shown to have less chance of dopamine related diseases…

      • Thanks Nathan, you provided more of the “meat in the sandwich” I was looking for. I am amazed at the diversity in understanding and the variety of solutions provided by all the conversationalists here.

  16. I had RLS so badly that I dreaded going to bed every night. I started taking 500mg taurine and within three days the RLS disappeared.

  17. I have suffered from severe RLS for about 25 years. In the early days my doctor was perplexed when I described my symptoms, he had never heard of it. Great when I started hearing it was being acknowledged as a condition! But the answers have not been simple. For me removing all carbs from my evening meal and reducing carb intake throughout the day brought relief. To me it makes sense that carbs produce energy and too much will produce energy when we don’t want it, ie when we need to be sleeping. My sister-in-law found this works for her as well. Obviously something else is going on I need to look at because a recent sleep study for apnoea showed I am very restless in my sleep. However RLS no longer keeps me awake. I am not aware having the symptoms now unless I eat carbs late in the day. I would be interested to see if others find reducing carbs helps their condition.

    • Hi Janice,
      Yes! I am pretty sure reducing sugar and carbs overall and esp at night has helped my RLS. Plus magnesium supplements, treatment for my thyroid, and Vit D…I still get it every so often–usually later at night and usually when I’ve let myself go a little with the carbs. It’s an ongoing mental power battle–but undoing years of a habit will never be easy. But I am working very well atm…thanks to my naturopath esp but also my doctor and specialist who diagnosed a thyroid problem in the first place. But I also did a lot of reading and pondering about how the human body works and how esp MY body works. I am grateful to have had some science education but also an interest in learning. I do believe without this I would never be chasing good health during my life.

  18. Chris, I could kiss you!
    Your website is my all time favourite. I’m a naturopath and experienced very bad RSL a couple of years ago. I found that all the points you mentioned above helped me to resolve it.
    I also take vitamin A and that has improved my gut health enormously. Michael Ash has written a lot about the importance of vitamin A.

  19. Hey Deane,

    Good to “see you” here. I second the magnesium approach and have actually had good results with several clients using a transdermal application of magnesium as opposed to oral.

    I’m also a huge fan and proponent of using float tanks which contain an average of 1000 pounds of epsom salt that you are immersed in.

    It’s an incredible way to meditate, reduce stress and cortisol imbalance and more. The science books refer to it as “REST therapy”. Pretty accurate name. I have several podcasts on it..

  20. I thought RLS was a condition the drug companies made up so they could sell more drugs. That is until it started happening to me! I didn’t know about these underlying causes and one or more may still apply to me but here’s what nails RLS for me.
    I take a magnesium supplement. That made a HUGE difference.
    Also I need to get the right amount of exercise. I found around 30 – 45 min. to be the sweet spot (I walk, bike, hike or swim.) Either too much or too little can trigger RLS. And oddly I do yoga but find that doing it too late in the evening can trigger RLS.
    And lastly I roll my legs just before bed on a foam roller. Aaahhh.
    My RLS still acts up usually because I don’t heed my own advice. Then I take a homeopathic remedy for RLS by Hyland’s. It may only be placebo but it really does help.

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