Dear Dr. LaGuardia,
I have terrible Restless Leg Syndrome! Can you help?
Restless Leg Syndrome (RLS) is a relatively common disorder affecting millions of American’s. Nobody is certain what the cause is but several have been postulated. There is a strong association between iron deficiency and RLS, specifically low iron and ferritin levels in the brain. There does not seem to be an association between low iron levels in the blood and those in the brain. Why that is remains obscure, but perhaps is due to a problem with the Blood Brain Barrier. Other causes seem to be hereditary and neurological. Diseases such as diabetes that lead to peripheral neuropathy (nerve damage in your limbs) seem to cause it, and we know this by treating neuropathy with meds such as gabbapentin and others relieves RLS. Some research points to a deficiency of dopamine in specific neurological pathways. In my experience I have found certain vitamin and mineral deficiencies seem to be contributing to RLS, such as iron, magnesium, calcium and folate. The bottom line is we are not sure what causes RLS and it might very well be a constellation of problems that come together in a perfect storm causing RLS.
The first thing you want to do is pick off the “low hanging fruit” of mineral and vitamin deficiencies by replacing magnesium, iron, calcium and folate and other B vitamins. I have found nothing works better than replacing magnesium by using it either orally with Slo mag or other magnesium products or by delivering it transdermally (across the skin) with Epsom salt baths. There are several caveats to the use of Epsom salt baths. First of all you need to use the hottest water possible without burning yourself, in it you need to dissolve several (2-3) cups of Epsom salt depending on how big you are. If you are over two hundred pounds I would use three cups. You must remain in the bath for at least a half an hour. Since Epsom salt is magnesium sulfate the magnesium will work incredibly well to relax and soothe your legs nerves as well as relax your muscles, so much so in fact that your legs will be rubbery like Gumby and hence you must hold onto something as you exit the bath or you might fall. It will also put you right to sleep and alleviate any constipation problems you might have as well…LOL. In my patients there seems to be universal love of this treatment, it takes a little time and effort but rewards you with a great nights sleep. Also of note is the fact that there are over three hundred enzyme reactions in your body that require magnesium and American’s have lower and lower magnesium levels due to their poor diets. I believe RLS is due to a combination of neurological and vascular problems and as such Epsom salt hot baths treat both. Massaging your legs for five or ten minutes before bed also helps immensely. Some patients benefit from using a heating pad at bedtime, there is a product known as the Relaxis pad which is specifically designed for RLS and vibrates for a half hour or so and then shuts off automatically. Epsom salt is inexpensive and readily available.
Almost all of the nutritional/alternative treatments for RLS include B vitamins (you get them all if you take B complex), vitamin C (which inreases iron absorption by 25 %), valerian and chamomile ( both of which are very relaxing and should be taken at bedtime), and iron. Several preparations such as Nervestra and Calm Legs are excellent products that you might want to try after first trying their effectiveness on you.
Other methods that will help are reducing or eliminating your caffeine intake. Remember there are hidden sources of caffeine besides coffee. Tea contains a considerable amount of caffeine, herbal teas do not. Chocolate and products like Mountain Dew also have caffeine and should be avoided as much as possible. Alcohol and smoking also worsen RLS and should be avoided as much as possible.