Restless Legs Syndrome

Restless Legs Syndrome (RLS) is a poorly understood condition that causes leg symptoms shortly before going to sleep—symptoms that are temporarily relieved by movement. Occasionally the condition may also involve the arms. It can cause sudden jerking motions of the legs and can lead to insomnia. It is most common in middle-aged women, pregnant women, and people with severe kidney disease, rheumatoid arthritis, and nerve diseases (neuropathy). Restless legs have also been reported to occur in people with varicose veins and to be relieved when the varicose veins are treated.1

Checklist for Restless Legs Syndrome

Rating Nutritional Supplements Herbs
2Stars Iron (Only in people who are iron-deficient)  
1Star Folic acid
Vitamin E		  
See also:  Homeopathic Remedies for Restless Legs Syndrome
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of RLS? RLS is characterized by an almost irresistible urge to move the affected limbs because of unpleasant sensations beneath the skin, which are described as creeping, crawling, itching, aching, tingling, drawing, searing, pulling, or painful. These symptoms occur primarily in the calf area but may be felt anywhere in the legs or arms. The sensations are typically worse during rest or decreased activity, such as lying down or sitting for prolonged periods.

How is it treated? In severe cases, symptoms are treated with medications, including dopaminergic agents (e.g., pramipexole [Mirapex®], pergolide [Permax®], ropinirole [Requip®], bromocriptine, and levodopa with carbidopa [Sinemet®]), benzodiazepines (e.g., diazepam [Valium®] and clonazepam [Klonopin®]), and opiates (codeine, propoxyphene, or oxycodone). Unfortunately, these medications tend to lose their effectiveness with nightly use. Symptoms may also respond to correction of an underlying medical condition, such as iron-deficiency anemia, kidney disease, diabetic neuropathy, amyloidosis, chronic venous insufficiency, or malignancy.

Dietary changes that may be helpful: Preliminary studies of large groups of people with reactive hypoglycemia have reported that 8% have restless legs. These symptoms have been reported to improve following dietary modifications designed to regulate blood-sugar levels;2 changes included a sugar-free, high-protein diet along with frequent snacking and at least one night-time feeding.3 For patients with reactive hypoglycemia, some doctors recommend elimination of sugar, refined flour, caffeine, and alcohol from the diet; eating small, frequent meals; and eating whole grains, nuts and seeds, fresh fruits and vegetables, and fish. One study found caffeine ingestion to be associated with increased symptom severity in people with RLS.4

Lifestyle changes that may be helpful: Anecdotal evidence suggests that RLS symptoms my decrease with a cessation of smoking.5 Although additional research is needed to confirm such reports, a trial of smoking cessation seems prudent for people who suffer from restless legs.

Nutritional supplements that may be helpful: Mild iron deficiency is common, even in people who are not anemic. When iron deficiency is the cause of RLS, supplementation with iron has been reported to reduce the severity of the symptoms. In one trial, 74 mg of iron taken three times a day for two months, reduced symptoms in people with RLS.6 In people who are not deficient in iron, iron supplementation has been reported to not help reduce symptoms of RLS.7 Most people are not iron deficient, and taking too much can lead to adverse effects. Therefore, iron supplements should only be taken by people who have a diagnosed deficiency.

In some people with RLS, the condition may be genetic. People with familial RLS appear to have inherited an unusually high requirement for folic acid. Although not all people with RLS suffer from uncomfortable sensations, folate-deficient people with this condition always do.8 In one report, 45 people were identified to be from families with folic acid-responsive RLS. The amount of folic acid required to relieve their symptoms was extremely large, ranging from 5,000 to 30,000 mcg per day.9 Such amounts should only be taken under the supervision of a healthcare professional.

In a group of nine people with RLS, 300 IU of vitamin E per day produced complete relief in seven.10 Doctors who give vitamin E to people with RLS generally recommend at least 400 IU of vitamin E per day, and the full benefits may not become apparent for three months.11

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

References:

1. Kanter AH. The effect of sclerotherapy on restless legs syndrome. Dermatol Surg 1995;21:328–32.

2. Roberts HJ. Spontaneous leg cramps and “restless legs” due to diabetogenic hyperinsulinism: observations on 131 patients. J Am Geriatr Soc 1965;13:602–8.

3. Roberts HJ. Spontaneous leg cramps and “restless legs” due to diabetogenic (functional) hyperinsulinism. A basis for rational therapy. JFMA 1973;60:29–31.

4. Lutz EG. Restless legs, anxiety and caffeinism. J Clin Psychiatry 1978;39:693–8.

5. Mountifield JA. Restless leg syndrome relieved by cessation of cigarette smoking. Can Med Assoc J 1985;133:426.

6. O’Keeffe ST, Gavin K, Lavan JN. Iron status and restless legs syndrome in the elderly. Age Ageing 1994;23:200–3.

7. Davis BJ, Rajput A, Rajput ML, et al. A randomized, double-blind placebo-controlled trial of iron in restless legs syndrome. Eur Neurol 2000;43:70–5.

8. Botez MI. Neuropsychological correlates of folic acid deficiency: facts and hypotheses. in: Botez MI, Reynolds EH, eds. Folic Acid in Neurology, Psychiatry and Internal Medicine. New York: Raven Press, 1979.

9. Botez MI. Folate deficiency and neurological disorders in adults. Med Hypotheses 1976;2:135–40.

10. Ayres S Jr, Mihan R. “Restless legs” syndrome: Response to vitamin E. J Appl Nutr 1973;25:8–15.

11. Ayres S, Mihan R. Leg cramps and “restless leg” syndrome responsive to vitamin E. Calif Med 1969;111:87–91.