Experiments with patients suggest brain stimulation may be a viable treatment
Johns Hopkins Medicine researchers say new experiments using magnetic pulse brain stimulation on people with moderate to severe restless legs syndrome (RLS) have added to evidence that the condition is due to excitability and hyperarousal in the part of the brain’s motor cortex responsible for leg movement.
The researchers say their findings, published online in Sleep Medicine on May 31, may help devise safer, more effective ways to treat RLS and the chronic sleep deprivation it causes, using electrical or magnetic pulses to calm or interrupt the hyperarousal. Some 10 percent of adults in the U.S. experience RLS at one time or another, and about 1 in 500 report that the condition is severe and chronic enough to interfere with their quality of life, work productivity or mental health, according to the National Sleep Foundation.
People with severe RLS describe symptoms of the condition as an overwhelming urge to move their legs when they are at rest. They may feel pain, or the sensation of soda bubbles in their veins or worms crawling in their legs, with relief coming only when standing or deliberately moving their legs. Long-term effects include fatigue, anxiety and depression, much of it linked to repeated interruption of sound sleep. Standard treatments, which may carry significant side effects, include medications that behave like the neurotransmitter dopamine, opioids and anti-seizure drugs.
Although many conditions, such as kidney disease and diabetes, have been associated with RLS, the neurological roots of the condition have been subject to much debate.
The new study, the Johns Hopkins researchers say, supports the idea that the underlying mechanism for RLS rests in the brain’s “move my legs” center and makes even more sense of the relief those with RLS experience when they get up and move them.
“Essentially the brain sends the signal when it’s preparing to move a limb, even when you aren’t planning to move, so your body is ready and amped up,” says Richard Allen, Ph.D., professor of neurology at the Johns Hopkins University School of Medicine. “The only way to alleviate the feeling is to move.”
In the new study, the researchers identified 32 adults with a moderate to severe RLS diagnosis from patients and asked them to stop their treatments for 12 days. They recruited 31 adult matched controls with no history of RLS or other sleep disorders and healthy sleeping patterns as controls. Participants in both groups were an average age of 58, and 59 percent were women.
For the experiments, the researchers used transcranial magnetic stimulation (TMS) to apply safe pulses able to selectively stimulate various regions of the brain that control movement of the muscles in the hand or the leg. They then used electrodes attached to the hand or leg to measure muscle responses in that hand or leg during such stimulations in those with RLS and in the control group.
Pairing two pulses as a stimulus can either cause a reaction or suppress/inhibit a reaction in a muscle depending on the timing between the two pulses. The researchers looked at one type of excitatory paired pulses and two types of inhibitory pulses¾short- and long-interval ones.
For each analysis, the researchers took the ratio of the responses. The ratios were greater in the leg for those with RLS, at 0.36 compared with 0.07 for those people without RLS, when looking at the inhibitory long-interval pulses, but not with the short-interval pulses. They said they didn’t see a difference in excitatory pulses in the legs.
“This basically means that inhibition is reduced or weakened in people with restless legs syndrome compared to people without the condition,” says Rachel Salas, M.D., associate professor of neurology at Johns Hopkins. “The reduced response means that the region of the brain controlling the legs shows increased cortical excitability in the motor cortex.”
In a separate set of experiments measuring the effect of paired pulses given to the brain in the region that controls the hand, they found no real differences in the ratios of either of the inhibitory pulses¾short- or long-interval ones¾between people with RLS and those without the condition.
But the researchers say they did find that the ratios picked up from the hand muscles using excitatory pulses were lower, at 1.01 compared with controls with a ratio of 1.85.
“The measurements from the hand muscles show that the activity in the brain is reduced in the region that controls the hand in people with restless legs syndrome compared to controls,” says Salas.
Salas says that previous research shows that inhibitory pulses are associated with the action of the neurotransmitter GABA, a brain chemical typically known for tamping down activity in the brain’s neurons. The researchers say that since there is hyperactivity in the leg-controlling portion of the brain, it’s possible that cells and tissues there are lacking enough GABA to prevent hyperactivity.
“Other studies with TMS have been done on people with RLS, but they didn’t look at people with severe forms of the condition or at the long-interval paired pulses in the leg,” says Salas. “We are fortunate to have access to such individuals because the Johns Hopkins Sleep Center attracts people worldwide and many who have exhausted treatment options available elsewhere,” she adds.
Salas notes that medications that act like the neurotransmitter dopamine, such as ropinirole or pramipexole, work in the short term but can exacerbate the condition over time. Opioids are effective, but not ideal due to their risk for dependency. With the results of this new study, the researchers are hoping to use electrical stimulation to suppress the brain’s activity, and planning of these studies is in the works.
Additional authors on the study included Aadi Kalloo, Christopher Earley, Pablo Celnik, Tiana Cruz, Keyana Foster and Gabriela Cantarero of Johns Hopkins.
The study was funded by a National Institute of Neurological Disorders and Stroke grant (R01 NS075184).
Sleep is important (we all know this) … but just how important is it?
Poor sleep is associated with increased depression, anxiety, systemic inflammation and decreased immune function.
For those with Restless Leg Syndrome, a lack of sleep is likely a nightly occurrence. It’s also the most dangerous side effect of this frustrating condition.
Worse yet, many suffer from Restless Leg Syndrome and don’t know it.
RLS can often be misdiagnosed as another sleep disorder, depression, poor circulation, arthritis, back problems and even growing pains in children.
If you have extreme fatigue, trouble falling or staying asleep, depression or anxiety, take the time to keep reading.
WHAT IS RESTLESS LEG SYNDROME?
Restless Leg Syndrome (RLS) is a neurological condition characterized by an uncomfortable feeling in the legs (most commonly). The unpleasant feeling causes an intense urge to move the lower extremity in order to find relief. The sensation is more prominent at night and is often described as “bugs crawling up the legs.”
The side effects of RLS are more concerning than the condition itself, and include:
Insomnia
Extreme daytime fatigue
Increased use of sleeping medications or alcohol to sleep
Increased use of stimulants in order to function
Increased stress (likely due to lack of sleep) and anxiety
Restless Leg Syndrome, also known as Willis-Ekbom Disease or WED, is most common in middle to older-age women, although anyone can experience it. The National Sleep Foundation estimates up to 10% of adults suffer from RLS.
HOW IS RLS DIAGNOSED?
The International Restless Leg Syndrome Study Group requires the following clinical features to be present in order to confirm a diagnosis of RLS:
Strong urge to move the legs due to uncomfortable sensations in the leg(s)
Symptoms become worse during periods of rest or inactivity
Symptoms are partially or totally relieved by movement
Symptoms become worse in the evening or nighttime
Symptoms are not solely accounted for by another condition (i.e leg cramps, positional discomfort)
Perhaps the most important tool, though not always performed, is a test to determine your iron levels. The most accurate way to determine if iron deficiency plays a role in RLS is to measure ferritin. Ferritin is an iron binding protein in which low values (less than 50 ng/ml) indicate low iron storage in the brain (more on iron below).
IS RLS A GENETIC CONDITION?
First degree relatives are 3 to 6 times more likely to suffer from the condition and over 50 percent of affected individuals report having at least one immediate relative with the condition.
Studies suggest when children experience RLS (early onset) it is more likely due to genetics as opposed to onset later in life (after the age of 45). Several gene variations have been studied as possible contributors to RLS, including the following genomic regions: BTBD9, MAP2K5, MEIS1, PTPRD, SKOR1 and TOX3.
Risk allele BTBD9 is associated with RLS and decreased peripheral iron stores – a well-defined environmental factor in which the risk of RLS is about 9 times greater than the general populations.
A change in the BTBD9 gene is present in about 75% of patients who have RLS but also present in about 65% of patients who don’t have RLS…
The difference? Environmental factors.
It’s the environmental triggers in combination with the right genes that trigger Restless Leg Syndrome.
Genetics alone rarely tell the whole story (and that holds true for each of the autoimmune conditions we’ve covered).
TRIGGERS FOR RESTLESS LEG SYNDROME
Caffeine – Caffeine, most commonly found in coffee, tea, chocolate, and soda may aggravate the symptoms of RLS. For many, caffeine activates excitatory neurotransmitters and has an arousal effect on the central nervous system. Ultimately, it’s effects promotes motor activity and inhibits proper control of fine motor movements, worsening the symptoms of RLS.
Iron Deficiency – The most consistent finding and the strongest environmental risk factor associated with RLS is iron insufficiency. Studies suggest that restless leg syndrome is related to a deficiency of iron in certain parts of the brain despite normal levels in the blood. (See information on testing iron in the diagnosis section.)
Vitamin D Deficiency – One of the most common theories about the cause of RLS is impaired dopamine signaling, and vitamin D is now being researched for its role in this process. Several studies support the hypothesis that a deficiency of Vitamin D correlates with more frequent and more severe symptoms of RLS.
Diet – Vitamin B12 is a critical part of a healthy nervous system, helping to maintain and protect the myelin sheath around the nerves. Researchers are led to believe it could play a role in the onset and treatment of RLS, due to its central role in our nervous system and brain.
A study published in the Journal of Postgraduate Medicine found both iron and vitamin B12 deficiencies to be common and treatable cause of RLS.
The best dietary sources of Vitamin B12 come from beef liver, grass-fed beef and eggs. But in order to absorb Vitamin B12, we must have adequate stomach acid levels and a healthy gut.
Stress – Chronic stress can alter cortisol production and lead to nighttime cortisol release, which researchers have found to be correlated with RLS. Stress levels can also decrease dopamine in the brain – a neurotransmitter necessary for smooth muscle activity and movement. When dopamine is decreased in the brain, it may cause movement problems seen in Parkinson’s disease and RLS.
Pregnancy – The prevalence of RLS during pregnancy is two to three times higher than in the normal population. Hormonal changes and iron status are the two main factors that may contribute to RLS during pregnancy.
Researchers have discovered another piece to the puzzle in the onset of RLS – systemic inflammation.
SYSTEMIC INFLAMMATION – THE CAUSE OF RESTLESS LEG SYNDROME?
What if the cause of those frustrating leg twitches is something you can’t see or touch… and is rarely a diagnosis you’d receive at the doctor’s office?
We’re talking about systemic inflammation (inflammation relating to the whole body).
54 diseases, syndromes and conditions have been reported to cause and/or exacerbate RLS – all interconnected by inflammation.
The fact that 89% of RLS-associated conditions are associated with inflammation and/or immune changes have led researchers to develop 2 possible theories in the RLS – Inflammation connection:
Systemic inflammation can contribute to an iron deficiency in the brain:
Inflammation can lead to the production of IL-6, an inflammatory cytokine which can stimulate hepcidin production.
Hepcidin is the main hormone involved in the regulation of iron and increased levels can lead to decreased serum iron levels. The result? Decreased availability of iron to the brain.
Systemic inflammation can trigger autoimmune disorders associated with RLS.
RLS is associated with Multiple Sclerosis, Rheumatoid Arthritis, Sjögrens syndrome, Scleroderma, Celiac disease and Crohn’s disease – all autoimmune diseases plagued by systemic inflammation.
RLS is present in up to one third of MS cases and is also common in those with Crohn’s disease – a disease associated with iron deficiency, inflammation, and bacterial overgrowth. One study of 272 Crohn’s disease patients found 30% were affected by RLS.
The bottom line is this – we have to address the factors in our life that cause inflammation and the best place to start is a damaged gut.
A LEAKY GUT – THE MISSING LINK IN RESTLESS LEG SYNDROME?
You might wonder what the gut has to do with that uncomfortable feeling in your legs.
A damaged or leaky gut is a breeding ground for inflammation – the very inflammation that can lead to RLS.
A leaky gut allows conditions like SIBO (small intestine bacterial overgrowth), and irritable bowel syndrome (IBS) to wreak havoc on the body and contribute to things like RLS.
One study found 69% of RLS patients had SIBO while 28% also suffered from IBS symptoms (i. e. gas, cramping, bloating, and changes in bowel habits).
SIBO can lead to systemic inflammation and autoimmune changes (which can result in the nerves being attacked in RLS) and SIBO induced inflammation can increase hepcidin (the main hormone responsible for regulating iron).
No matter which way we look at it, inflammation is the common denominator.
So, how do we stop the inflammation that can lead to Restless Leg Syndrome?
Considering the overwhelming amount of research on the topic of systemic inflammation and a leaky gut, your gut is too important to be ignored.
However, a large majority of the medical community has yet to accept the role of the gut in the fight against RLS.
THE MEDICAL APPROACH TO TREATING RESTLESS LEG SYNDROME
Dopaminergic agents are often the first line of treatment in RLS. These drugs work to increase dopamine in the brain and include Requip, levodopa, and Neupro to name a few.
Known for their short-term effectiveness, they come with a long-term effects.
Augmentation is the most common side effect of dopaminergic drugs and occurs when the symptoms of RLS become more severe, happen earlier in the day, and spread to other parts of the body (i.e arms).
It’s estimated that over 80% of patients receiving levodopa for RLS develop augmentation.
With augmentation, the brain sees the extra dopamine (via medication) as a signal to decrease its natural production. The result? Patients become increasingly dependent on the drugs for relief.
Compulsive behavior is also a common side effect.
A study including 100 people with RLS (all were treated with dopaminergic agents) revealed well over 50% engaged in some type of compulsive behavior (ie. pathological gambling and compulsive eating habits).
After reading this, you may be wondering if there is a better way to treat RLS than the use of these dangerous medications.
THE LEAKY GUT – AUTOIMMUNE CONNECTION
If you’ve been keeping up with the latest information in natural health, you already know it’s nearly impossible to ignore a leaky gut as part of the cause and solution to autoimmune conditions like RLS.
Alessio Fasano, M.D. has been on the forefront of recent autoimmune disease research and published a paper titled “Leaky Gut and Autoimmune Diseases.”
His findings present the idea that in order for an autoimmune disease to develop, 3 conditions must all exist together:
1. A genetic predisposition to autoimmunity (i.e. BTBD9 gene in RLS)
2. An exposure to the environmental trigger (i.e. Iron Deficiency)
3. Increased intestinal permeability (a.k.a. Leaky Gut Syndrome)
For those with Restless Leg Syndrome, healing the gut means getting to the root cause so you can stop chasing your symptoms.
Healing a leaky gut is one factor that’s in our control and it can be done step-by-step with the right plan.
HOW TO TURN OFF AUTOIMMUNE DISEASE
Overcoming Restless Leg Syndrome requires a multifaceted approach to heal the gut and decrease inflammation – and that is exactly what we’re here to help you do.
Hippocrates, the famous Greek physician, stated “all disease begins in the gut,” and some 2,000 years later Fasano and many other leading experts agree.
Ancient and current wisdom both suggest that powerful healing must begin in the gut.
Jordan Reasoner is a health engineer and author. He was diagnosed with celiac disease in 2007 and almost gave up hope when a gluten-free diet didn’t work. Since then, he transformed his health using the SCD Diet and started SCDLifestyle.com to help others naturally heal stomach problems.
Below is another study that supports the idea of inflammation being at the core of Restless Legs Syndrome.
It’s an older study I recently ran across that dispensed low-dose hydrocortisone to a small study group to see if their RLS symptoms would improve. The results of the study showed that symptoms were significantly lessened.
I’ve included an overview of the study below.
I’ve also included an excerpt from a SECOND study that demonstrates the powerful anti-inflammatory properties of hydrocortisone.
AND PLEASE NOTE, this is NOT an endorsement of hydrocortisone as a solution for RLS. It’s simply more evidence supporting the idea that INFLAMMATION is the PRIMARY cause of RLS. Which means, logically speaking, as you lessen your inflammation, your RLS will lessen.
This lessening of inflammation can be done in a natural way through diet, lifestyle, proper digestion etc. It doesn’t have to be a pharmaceutical anti-inflammatory.
STUDY ONE
“Low-dose hydrocortisone in the evening modulates symptom severity in restless legs syndrome.” Hornyak M1, Rupp A, Riemann D, Feige B, Berger M, Voderholzer U. Neurology. 2008 Apr 29;70(18):1620-2. doi: 10.1212/01.wnl.0000310984.45538.89.
BACKGROUND
Circadian symptom manifestation in the evening and night is one of the main characteristics of restless legs syndrome (RLS). Although the inverse temporal course of corticosteroid rhythm and RLS symptom severity is obvious, this relationship has yet to be studied. We investigated the effect of late-evening application of exogenous cortisol (hydrocortisone) on sensory leg discomfort (SLD), one of the main complaints of patients with RLS.
METHODS
Ten untreated patients with idiopathic RLS participated in the study. Change of SLD was rated on a visual analogue scale during the 60 minutes resting period of the so-called Suggested Immobilization Test. Patients received either hydrocortisone 40 mg or placebo (saline) IV in random order in a double-blind crossover design, with 1 week between the experiments.
RESULTS
Severity of SLD was lower during hydrocortisone infusion than during placebo (p = 0.032). Though blind to the experimental condition, 5 of the 10 patients experienced improvement in symptoms during hydrocortisone administration, but no patient felt an amelioration during the placebo condition.
CONCLUSIONS
Our data indicate a probable physiologic relationship between evening and early night hour restless legs syndrome symptom increase and low cortisol level.
STUDY TWO (excerpt)
“Low-dose hydrocortisone infusion attenuates the systemic inflammatory response syndrome.” The Phospholipase A2 Study Group. Briegel J1, Kellermann W, Forst H, Haller M, Bittl M, Hoffmann GE, Büchler M, Uhl W, Peter K. Clin Investig. 1994 Oct;72(10):782-7.
ABSTRACT
There is increasing evidence that the hypercortisolemia in inflammatory diseases suppresses the elaboration of *proinflammatory cytokines, thus protecting the host from its own defence reactions.
*A proinflammatory cytokine or more simply an inflammatory cytokine is a type of signaling molecule (a cytokine) that is excreted from immune cells like helper T cells (Th) and macrophages, and certain other cell types that promote inflammation from “Wikipedia Proinflammatory cytokine”
For helpful tips on how to lessen your RLS symptoms NATURALLY, please visit http://www.RLCure.com
If you have followed this blog for awhile, or have visited my RLS website http://www.RLCure.com, you know that at the CORE of everything I present is that INFLAMMATION is the cause of RLS. In other words, eliminate the inflammation in your body and you will eliminate your RLS.
There are an ENDLESS number of ways in which inflammation can be introduced into your system, and there are unlimited ways in which it can be removed.
However, the REMOVAL requires a bit of effort and in most cases, a lot of sacrifice.
The articles below highlight how another anti-inflammatory agent has demonstrated success in lessening the effects of RLS.
Unfortunately for many of you, in this case the healing agent is MARIJUANA.
I want to make VERY clear that this post is not about promoting marijuana and endorsing it as a highly effective method to lessen your RLS symptoms. The idea of the post is to again emphasize that the KEY to your SUCCESS is to move towards an ANTI-INFLAMMATORY LIFESTYLE. That means that dietary, environmental, emotional, digestive changes etc. are required – anything that will move you away from continuing the inflammatory cycle that is at the heart of your RLS.
This is a total NON-ENDORSEMENT of smoking pot as a solution from yours truly, a man that has been in recovery from alcohol and drug addiction for over 30 years.
Smoking a DOOBIE may give you temporary relief, but unless you CHANGE your lifestyle, nothing permanent is going to take place. Your RLS will return.
Below are TWO articles. The FIRST one features a scientific study in which 5 out of 6 subjects had their RLS symptoms disappear thanks to the CHRONIC.
The SECOND article focuses on the tremendous anti-inflammatory properties of cannabis.
ARTICLE ONE
MARIJUANA CAN STOP RESTLESS LEGS SYNDROMEby Trey Reckling, The Fresh Toast
A small report published in the journal Sleep Medicine from the Bordeaux Hospital University Center in France is posing the question whether or not marijuana may help people with Restless Leg Syndrome to sleep better. The answer to that question is a crucial one for the 10-15 percent of people in the U.S. afflicted with the condition.
It’s easy to take sleep for granted when it’s working. When it’s not, it’s enough to drive you mad.
This is no secret for people who suffer from Restless Leg Syndrome (RLS). Even trying to classify the disorder is a challenge because it has crossover effect. It is sometimes classified as a sleep disorder because symptoms such as involuntary muscle twitching and jerking are initiated by inactivity or attempting to sleep. It can also be classified as a movement disorder because people affected sense an almost irresistible urge to move to reduce the uncomfortable sensation. But because the sensations originate in the brain, it could be argued that it is best identified as a neurological sensory disorder.
Regardless, to those who suffer from it, it means lack of sleep for starters. They can have a hard time both falling asleep and staying asleep. That lack of sleep impacts overall health, with negative impact on ability to concentrate, significant increase in daytime sleepiness and significantly lower productivity.
Sleep medicine expert, Dr. Imad Ghorayeb led the study.
Some subjects reported taking seizure medications clonazepam and gabapentin with unsatisfactory results. All subjects reported prior efforts to alleviate their condition with prescription opiates and dopamine agonists for their RLS. They were ready for a new approach because nothing had worked for them or even made situations worse. Two subjects had experienced compulsive shopping and binge eating as a result of using dopamine agonists.
To be fair, there were a meager six subjects in the study. However, 5 of the 6 reported that smoking marijuana relieved their symptoms completely; one reported complete loss of RLS symptoms after using cannabidiol (CBD).
Researchers could not claim to understand why cannabis worked so well in the small group. They do suspect that it is related to the herb’s pain relieving properties and the effect could be enhanced by the sleepiness marijuana can induce.
While the researchers were not willing to fully endorse marijuana for those with restless leg syndrome, they admitted all subjects reported it was the most effective remedy they had tried so far.
Though small scale studies such as this one may not prove anything yet, they do lay important groundwork and interest for more in depth research.
CANNABIS FOR INFLAMMATION, WHY DOES IS WORK SO WELL?by Dana Smith, cannabis.net
Medical Marijuana For Inflammation and Swelling Works Wonders
Living a lifestyle that prevents inflammation is necessary in preventing chronic illnesses. This means eating a proper diet high in nutrients and inflammation-fighting foods, getting enough rest as well as regular exercise. Once you do have inflammation, it’s important to address it immediately otherwise it can lead to more serious conditions. Most people actually aren’t aware that inflammation affects almost every aspect of your health: arthritis, celiac disease, cancer, asthma, fibromyalgia, heart disease, diabetes, thyroid problems, and ADD just to name a few. Inflammation can be happening right now in your body, but you won’t know it because it takes years for it to be clinically significant, or until it manifests through symptoms of another disease.
How Does Cannabis Treat Inflammation?
Numerous studies have proven that cannabis is effective in treating inflammation as well as addressing the accompanying pain. This is because of the presence of its 2 major cannabinoids, THC and CBD.
Both THC and CBD are effective in reducing inflammation that is linked to several diseases. But another compound found in cannabis called the beta-carophyllene also affects the CB2 receptor. A 2008 study analyzing mice who had swollen paws and were given oral doses of beta-carophyllene showed a 70% decrease in inflammation. The mice without CB2 receptors didn’t see any improvement.
A study published by the US National Library of Medicine found that cannabinoids control the response of the immune system and works in suppressing inflammatory responses. The human endocannabinoid system has 2 receptors: CB1, which is located in the central nervous system, is responsible for psychoactive effects; and CB2, which is found in the tissues and is responsible for inhibiting inflammation.
Cannabis is also useful in keeping c-reactive protein levels down; high levels of this protein can lead to fatal heart disease. A study published in the Drug and Alcohol Dependence Journal revealed that people who smoked cannabis had lower levels of c-reactive protein than those who didn’t smoke. Another study showed that CBD was effective in blocking the progression of rheumatoid arthritis and was also beneficial in providing relief for pain caused by joint swelling. It’s already well known that cannabis is effective in treating chronic pain, which is a side effect of inflammation.
While we now know that THC and CBD work in treating and preventing inflammation, they both work in the body in different ways. Both cannabinoids have demonstrated efficacy in decreasing both the release and production of pro-inflammatory cytokines and also works to decrease the activation of LPS-induced STAT 1 transcription factor, which contributes to some inflammatory processes. However scientists find that CBD is much more potent in addressing inflammation, and for this reason high CBD strains are recommended particularly for those who suffer from extreme inflammation. CBD actually supports the concentration of endogenous cannabinoids which gives the body the ability to self-heal and ward off disease.
Individuals with restless or unpleasant feelings in their legs at night or at rest, that are relieved by movement are needed. We are studying the possible benefits of yoga versus an educational film program for reducing symptoms of restless legs syndrome. Participants will attend up to two classes per week in Morgantown for 12 weeks. The study also involves two visits to WVU to complete questionnaires. Compensation is $150 upon completion of this research study. IRB approval on file (1505699758)
For additional information, contact:
WVU School of Public Health, Department of Epidemiology
Restless legs syndrome is a seemingly unique condition and the cause is often difficult to pinpoint.
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. It seems so strange, doesn’t it? 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.
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. Here are my top causes:
One review paper published in 2012 investigated health conditions that were reported to cause or exacerbate RLS symptoms, and found that 95% of the health conditions that are associated with RLS have an inflammation or immune component. As further evidence, an elevated blood level of C-reactive protein (a marker of systemic inflammation) has been associated with increased RLS severity.
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 vitamin D 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 & reduce the stressors to the central nerve system and spine. Often we see the issue target to L5/S1 regions.
2. Small Intestinal Bacterial Overgrowth (SIBO) and IBS
A recent study found that 69% of RLS patients also had SIBO, compared with only 28% of control subjects. They also found that 28% of RLS patients had IBS, compared to only 4% of controls. And according to the 2012 review I mentioned above 32% of the health conditions associated with RLS are also associated with SIBO. As I’ve mentioned many times in the past neurological interference & gut infections are often the culprit—even if you don’t have noticeable symptoms—its worth getting your gut tested.
What to do: If you have RLS and suspect you may have SIBO or a gut issue its best to get tested to find our what is going on in there. Generally speaking, the intestines need to be flushed or cleansed then re-inoculated with healthy living strains of bacteria. Your typical probiotic won’t be able to do that. Overall the best approach is to follow a ketosis diet with bone broth until symptoms subside (and your SIBO tests are normal), and then gradually re-introduce fermented foods and probiotics.
3. Vitamin D Deficiency
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.
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.
RLS has been associated with vitamin D deficiency in several studies, and disease severity has been inversely correlated with vitamin D levels. One study has also found that vitamin D supplementation improved the severity of RLS symptoms.
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 40-60 ng/mL. If you have an autoimmune disease or another chronic health condition, optimal levels are between 60-80 ng/mL. One way to supplement vitamin D is through taking it directly. And of course, you should get regular sun exposure.
We’re still learning more and more about this syndrome, and hopefully we’ll come to some truly concrete answers soon enough. But as is so often the case, watching your nutrition and lifestyle goes a really long way in taking care of these sorts of issues.
Dr. Aaron Ernst completed his undergraduate education in pre-medicine/biology at Messiah University in Grantham, PA. As a first generation holistic practitioner, he began his career with a Doctorate in Chiropractic from Logan College of Chiropractic in Chesterfield, MO. While in Missouri, Dr. Aaron began helping patients rebuild their health in a Maximized Living Health center, which was the largest wellness clinic in Missouri. His experience has led him to spend countless hours studying and researching to create procedures and protocols to rebuild health naturally. Dr. Aaron has traveled all over North America, Europe and Africa teaching the principles of Maximized Living and educating all generations on gaining victory over disease naturally.
There are a number of simple ways to boost circulation. Simply standing up and walking more frequently can work wonders.
You can also stretch, touch your toes, and practice deep breathing. Strengthening your circulation is especially important for people in office jobs, as sitting for many hours is known to be bad for your health on a number of levels, specifically cardiovascular.
I particularly recommend an ancient and extensively researched Tibetan herbal formula ( find out more here: http://www.dreliaz.org/recommended-product/tibetan-herbal-formula ) which has been shown in clinical studies to support circulation and cardiovascular health, along with other benefits. The formula includes Iceland moss, costus root, cherubic myrobalan, and other more unusual botanicals. In addition to boosting circulation, the formula also supports cellular health and immunity and provides antioxidant protection, demonstrated in more than 40 years of published studies.
We’re still learning about RLS, so I would encourage people to keep an eye on emerging research. However, by combining moderate exercise and minor lifestyle changes, together with circulation-boosting formulas and essential minerals, people struggling from RLS may find significant relief.
Even better, by supporting circulation and cardiovascular health, they can help lower their risk for heart disease and other serious conditions.
Dr. Isaac Eliaz, MD, MS, LAc, integrates Western medicine with his extensive knowledge of traditional Chinese, Tibetan, ayurvedic, homeopathic, and complementary medical systems. With more than 25 years of clinical experience and research, Dr. Eliaz has a unique holistic approach to the relationship between health and disease, immune enhancement, detoxification, and cancer prevention and treatment. For more health and wellness information, visit http://www.dreliaz.org.
When you think of the herb St. John’s Wort you probably think of depression. But new research published in the medical journal Clinics found that you might also want to consider this herb to help with Restless Leg Syndrome.
Officially known as Willis Ekbom’s disease, Restless Leg Syndrome is a common condition affecting the nervous system and characterized by jumpy legs that can’t remain still at night. It’s not a dangerous condition but it can be uncomfortable for sufferers and can interfere with quality of sleep and life.
The study is called “Saint John’s wort, an herbal inducer of the cytochrome P4503A4 isoform, may alleviate symptoms of Willis-Ekbom’s disease” by José Carlos Pereira et al.
The study found that St. John’s Wort effectively boosted certain liver enzymes that tend to drop to low levels in individuals suffering from restless legs. Researchers believe that the herb’s effectiveness in the pilot study may be attributed to the significant enzyme boost, resulting in a calming effect on restless legs.
That is potentially good news for sufferers of the condition who are often placed on a drug known as pramipexole, which has many side-effects, including: fainting, dizziness, suddenly falling asleep, unexpected gambling or sexual urges, tiredness, abnormal dreams, muscle pain, difficulty walking, skin growths, weight gain, difficulty breathing or swallowing, and an increased risk of the skin cancer melanoma. Ironically, the drug can also cause unusual twitching or muscle movements, which are what sufferers of Restless Leg Syndrome are trying to alleviate when they seek medical intervention.
While the study was a small pilot study, the herb showed impressive results, improving the symptoms of 17 of the 21 participants. The study results are also invaluable considering the superior safety record of St. John’s Wort in comparison to pramipexole. Some of the potential side-effects of St. John’s Wort include: photosensitivity when taken within a few hours of direct sunlight exposure, anxiety, headaches, muscle cramps, sweating, weakness, dry mouth, or skin irritation; however, many of these symptoms tend to be infrequent.
Conversely, St. John’s Wort is commonly recommended as a treatment for: anxiety, mild to moderate depression, cancer, nerve pain, and obsessive compulsive disorder. The dosage used in the study to treat restless legs syndrome was 300 mg daily of St. John’s Wort extract for three months. For other health conditions, dosages vary greatly. For more information about dosages for other health conditions, consult my article “St. John’s Wort is for Much More than Depression.”
Because many drugs can interact with this herb it is important to check with your doctor, pharmacist, or natural health provider before taking. Avoid taking if pregnant or nursing.
Michelle Schoffro Cook, MSc, DNM, ROHP, PhD is an International Best-selling & Sixteen-time Book Author, Doctor of Traditional Natural Medicine. She lives in British Columbia.
Over 30 years ago Dr. Stanley Lang, MD developed a program to treat RLS and has been helping his patients to heal their RLS ever since (starting way back before the condition had an actual name).
His success rate is around 90% for those patients that have followed his regime.
A nationally-recognized sleep expert has published an article explaining Restless Legs Syndrome (RLS) as a possible biomarker for underlying disease.
The editorial was in the March 5, 2014 issue of Neurology the medical journal of the American Academy of Neurology and was authored by Boston Medical Center neurologist Sanford H. Auerbach, MD.
Restless Leg Syndrome is a disorder of the nervous system. It is characterized by throbbing or other uncomfortable sensations in the legs with an uncontrollable urge to move them. Symptoms typically occur at night when a person is relaxing or getting ready for bed and can increase in severity during the night. Most people with RLS have difficulty falling asleep and staying asleep, which can lead to fatigue. Many people with RLS report that their job, personal relations, and activities of daily living are strongly affected as a result of their sleep deprivation. They often have difficulty concentrating and brain fog.
The editorial was in response to an analysis of 12,556 men who were followed over time by the Health Professionals Follow-Up Study, published in the same issue of Neurology, which showed multiple disease associations with RLS.
The team found patients with RLS had a higher mortality rate than similar men, and showed an especially strong tendency toward cardiovascular disease and hypertension. In addition, men with RLS were more likely to be diagnosed with lung disease, endocrine disease, as well as diseases of nutrition and metabolism and immune system problems.
Researchers suggest that restless leg syndrome is a meaningful biomarker for serious disease, and that RLS screening may become more common as a tool for primary care providers to identify patients at risk.
I have had personal success with patients simply by adding magnesium and calcium at bedtime. They both calm muscles and nerves. Calming botanicals such as valerian, passion flower, lemon balm, and skullcap can also be added to support sleep and relaxation. You can also assess RBC nutrients such as magnesium, calcium, and potassium through many functional laboratories. In addition to assessing nutrient status they do play a significant role with blood pressure regulation and overall cardiovascular health. This provides a better indicator of nutrient status, compared to the serum.
I would also recommend an organic acid test. An organic acid test can identify imbalances occurring in the body that precede abnormal findings on a CBC or an MP. Organic acids are products of metabolism that can sensitively identify nutrient deficiencies that lead to metabolic roadblocks. Organic acids go a step further then measuring nutrient concentrations by measuring whether the nutrient is functionally adequately. Abnormal concentrations of organic acids in the urine can provide a functional marker for metabolic effects of nutrient deficiences, genetic polymorphisms, impaired enzyme function, toxic exposure, neuroendocrine activity, and intestinal bacterial overgrowth. Organic acid testing can indicate the functional need for specific nutrients, diet modification, antioxidant protection, detoxification, and other therapies.
There is also some evidence that indicates low iron levels in the brain being associated with RLS. A CBC w/diff and an Iron Panel (Serum Iron, Ferritin, % Saturation, TIBC, UIBC) can identify an iron deficiency.
Restless leg syndrome may only be just a small part of the picture. It may be a simple nutrient deficiency in many cases, however, it is important to look deeper into the patient’s health. This includes thoroughly reviewing the patient’s history looking deeper into the cardiovascular system and other inflammatory markers. Looking deeper into the above factors can provide an effective treatment plan for patients with restless leg syndrome.
Dr. Michael Jurgelewicz, DC, DACBN, DCBCN, has been studying wellness for the past 10 years. He has a B.S. degree in Health & Wellness, a B.S. degree in Anatomy, and is a Doctor of Chiropractic. He is Board Certified in Nutrition by the American Clinical Board of Nutrition, a Diplomate of the Chiropractic Board of Clinical Nutrition, has completed Functional Medicine University with a Certificate in Functional Medicine and has studied under both world renowned thyroid expert, Dr. Datis Kharrazian and Chiropractic Neurologist, Dr. Frederick Carrick. He is also active in continuing education through the Clinical Nutrition Certification Board. http://www.thefunctionalmedicinecenter.com
REFERENCES
S. Auerbach, A. S. Walters. Restless legs syndrome: A predictor of lower physical function. Neurology, 2014; DOI: 10.1212/WNL.0000000000000298
Restless Legs is best described as an uncontrollable, strong urge to move your legs. You feel the need to move your legs, mostly when you are trying to relax, causing difficulties in sleep. Restless Legs, also known as Restless Legs Syndrome, or RLS, could give you unpleasant sensations in your legs, that occur mostly at bedtime. These sensations usually only feel better when you move your legs. You feel very uncomfortable and feel worse unless you move your legs. When the disorder is severe, you also may have the urge to move your arms, but that only happens in rare cases.
Many different symptoms have been described by people suffering from RLS, such as:
leg pain
cramps
tingling
itching
burning
aching
These symptoms will start or get worse when you’re inactive, or in the evening. The urge to move increases when you’re sitting still or lying down and resting. Restless leg syndrome usually begins slowly. Over time, the legs become more affected.
NUTRITION PRESCRIPTION: RELIEVE RESTLESS LEGS
We know that RLS has a lot to do with Inflammation. When you have less inflammation, you have less restless legs. The process to remove what is causing your inflammation is a job. And a big one at that.
Because this means that you will have to change your eating habits. Changing your eating habits by avoiding foods that cause the inflammation will set you on the right path of relief from RLS.
And adding more anti-inflammatory foods to your diet will set you on the road to recovery. Moving in this healthy direction will have more benefits for you than just relief from RLS.
As you begin removing the bad foods that are causing inflammation and adding in the good foods that will fight inflammation, you will be gaining relief from other things that may be weighing heavy on your mind. Weight, for one thing, is something that can be reduced as well when you begin to implement these changes to your diet. Some of the same healthy foods that will help with your RLS symptoms will also assist in getting you and keeping you at your goal weight.
The foods that are causing inflammation in your body are high in sugar and saturated fat.
You can figure these out on your own by looking at nutrition labels and by also using common sense. But here are the worst culprits that do the most damage:
Corn is at the top of the ‘bad’ list. Corn is in everything, and is causing lots of problems in our systems. GMO corn, is linked with inflammation in the stomach. You should read the nutrition labels and try to avoid foods with high fructose corn syrup or corn oil.
Gluten is another one on the ‘bad’ list. Gluten is found in most grains and is highly inflammatory. Bagels and other starches contain gluten and are famous for triggering inflammation in the body. If you try to avoid foods that contain gluten and choose healthy grains or seeds like buckwheat, quinoa or millet instead, you will feel much better.
Trans fats and hydrogenated oils found in margarine, shortening and baked products that contain these fats like cookies, pies, buns, etc. are huge culprits of causing high inflammation in your body.
Look for the healthy alternatives because even small amounts of trans fats are dangerous and should be avoided.
Sugary foods are bad news for inflammation as well. Consuming foods like candy, or drinking soft drinks and even sweetened yogurt will elevate your blood glucose levels. When this happens, it activates the body’s response to cause inflammation. If you eat sugary foods, stick to 13 grams or less per serving.
Deep Fried foods like french fries, onion rings, chips, hamburgers, etc. are harder to digest than baked or even pan-fried foods. Consumption not only causes inflammation but also dramatically increases exposure to free radicals, which damage our body sort of like rust damages a car.
Iodized salt or any sodium is important to our body’s function, but too much can be harmful. It has been known to trigger high blood pressure, liver, kidney and heart disease. Especially in people who are overweight.
Deli meat is on the ‘bad’ food list for causing inflammation. Any meat that contains preservatives, that have been found to cause cancer are very bad for you. Bacon and sausage are the biggest culprits.
Omega 6 fatty acids that are found in cooking oils like canola, corn and soybean oil is something you should never have in your kitchen. Also, these oils are extremely fragile, that if exposed to heat, air or light they go rancid. Almost all store-bought corn, canola and soybean oil that have been sitting on the shelf for a long period of time has gone rancid. Rancid oils in the body causes free radicals which cause inflammation and could cause cancer. Replace these oils with the healthier alternatives like olive oil or coconut oil.
Un-natural sweeteners like nutrasweet, splenda, saccharin, aspartame, aminosweet, etc. have been linked to many serious health conditions and should be avoided all the time.
Dairy products like yogurt, ice cream, cottage cheese, butter, cheese, etc. are very inflammatory foods because they contain lots of hormones, antibiotics, and other harmful ingredients.
Wheat products are a highly acid-forming and inflammatory item for the body. Also, most wheat now available is genetically-modified (GM). Many serious health concerns are starting to be linked to the consumption of GM wheat.
Alcohol is high in sugar and a burden on the liver. Alcohol is another inflammatory food item that should be used in moderation or avoided altogether.
Now that you know what to avoid that will cause inflammation in your body, here is the list of foods that fight inflammation in the body.
Fatty fish. Oily fish, like salmon, mackerel, tuna and sardines are high in omega 3 fatty acids, which have been shown to help reduce inflammation in the body. To get the most benefits, you will need to eat fish several times a week and it should be cooked in healthy ways, by avoiding fried, dried or salted. Fish oil supplements are a healthy alternative if you don’t enjoy eating fish.
Whole grains as opposed to white bread, cereal, rice and pasta, can help keep harmful inflammation away. Whole grains have more fiber, which has been shown to reduce levels of C-reactive protein, a marker of inflammation in the blood, and they usually have less added sugar.
Dark leafy green veggies contain one of the best sources of vitamin E, which has been known to play a key role in protecting the body from inflammation. The veggies that contain the higher concentrations of vitamins and minerals are spinach, kale, broccoli and collard greens.
NUTRITION AND RESTLESS LEGS
Nuts are another source of inflammation-fighting healthy fats. Almonds, which are also rich in fiber, calcium and vitamin E are at the top of the list. Then comes walnuts, which contain high amounts of alpha-linolenic acid, a type of omega-3 fat. All nuts are packed with antioxidants, which can help our bodies fight off and repair the damage caused by inflammation.
Soy contains isoflavones, estrogen-like compounds, that may help lower CRP and inflammation levels in women. Avoid heaviliy-processed soy and instead go with more soy milk, tofu, and edamame (boiled soybeans) for your diet.
Low-fat dairy milk products as well as yogurt, which can also contain pro-biotics, have been known to reduce inflammation in the stomach. Foods with vitamin D and calcium, like skim milk and yogurt are good for all with their anti-inflammatory properties.
They are also important to keep up bone strength and possibly reduce cancer and other risks.
Peppers contain high quantities of antioxidant vitamins and lower levels of starch.
Hot peppers like chili and cayenne are rich in capsaicin, a chemical that is used in topical creams that reduce pain and inflammation. This may not be true for people suffering from rheumatoid arthritis, though. You should stick with what works for you.
Tomatoes may also help reduce inflammation in some people. Juicy red tomatoes, specifically, are rich in lycopene, which has been shown to reduce inflammation in the lungs and throughout the body. Cooked tomatoes contain even more lycopene than raw ones, so tomato sauce works too.
Beets have a brilliant red color which has been shown to reduce inflammation, as well as protect against cancer and heart disease, thanks to their fiber, vitamin C and plant pigments called betalains.
Ginger and turmeric spices, common in Asian and Indian cooking, have been shown in various studies to have anti-inflammatory properties.
Turmeric, the ingredient that gives curry its yellow color, works in the body by helping to turn off the trigger that processes inflammation. Ginger has been shown to reduce inflammation in the intestines when taken in supplement form. Garlic and onions both contain anti-inflammatory chemicals.
Olive oil, along with anything fitting into a heart-healthy diet is good for inflammation. The compound oleocanthal, which gives olive oil its taste, has been shown to have a similar effect as NSAID painkillers in the body.
Berries are low in fat and calories and high in antioxidants. Berries have been shown to have anti-inflammatory properties, possibly due to their anthocyanins, which gives them their rich color.
Tart cherries have the highest anti-inflammatory content of any food. Experts recommend eating 1.5 cups of tart cherries, or drinking 1 cup of tart cherry juice a day to see similar benefit, they have to be tart.
Drinking plenty of water is one of the most effective natural remedies for inflammation. Water reduces inflammation and promotes cartilage health. To reduce internal inflammation, drink water to carry away waste products. Your body releases histamine in order to stop water loss. If you give your body adequate amounts of water, less histamine will be released. Avoid caffeinated drinks as much as possible, day or night.
Considering dietary supplements? You should first check with a doctor or nutritionist to find out if you are low on iron, vitamin B, folic acid, or magnesium first because deficiencies can bring on RLS symptoms. There are many supplements, vitamins & minerals and herbs to you to help fight inflammation.
Calcium + Magnesium (CalMag), Carrot Juice, Curcumin, Grape seed extract, iron, L-Theanine, Omega 3, Valerian Tea, Vitamin C. All of the above listed have anti-inflammatory properties. Some even also act as a natural antihistamine, or lowers glutamate levels.
While limiting or eliminating some foods and adding others, may just do the trick to stop RLS, there are a few other lifestyle changes that may contribute to the quickness of your relief from RLS.
You should also try to get to bed at the same time every night, while allowing plenty of time to wind down first, no eating 2 hours before bed, and take a really warm shower or bath to relax about an hour before sleep. As a bedtime routine, try relaxation and stretching techniques as well.
I hope this information is helpful to you.
Cynthia Crozier is a graduate of the Spencer Institute with a Certification as a Wellness Coach. She provides people with the assistance, motivation, guidance, inspiration & knowledge they need to gain proficiency in making healthy lifestyle changes, and to achieve the ability to create new wholesome habits on your own to live a happier, healthier more fulfilling life. http://www.thejoys.us
“Drug therapy focuses on alleviating the nervous system imbalance to calm restless legs. However, taking these drugs is like using a SLEDGEHAMMER to crack a nut. They are quite powerful and dangerous and should be reserved for only the most severe cases.
Natural medicines and therapies, on the other hand, can be very effective, safe and without side effects.
Many of my patients have proven that certain herbs provide AMAZING treatment for RLS. You don’t need to wait another day to start getting fast and permanent relief from RLS misery.”
– Dr. Jonathan V. Wright, MD, Medical Director of the Tahoma Clinic, Tukwila, WA
Stress and adrenal function affect sleep, particularly the circadian pattern of cortisol secretion by the adrenal glands. Circulating cortisol normally rises and falls throughout the 24 hour daily cycle, and is typically highest at around 8 AM and lowest between midnight and 4 AM. Both high and low nighttime cortisol levels can interrupt sound sleep. Stress normally causes a surge in adrenal hormones like adrenaline and cortisol that increase alertness, making it more difficult to relax into sound sleep–especially when they remain high or rise and fall irregularly through the night. Frequent or constant stress can chronically elevate these hormone levels, resulting in a hyper-vigilant state incompatible with restful sleep.
If this is the reason for poor sleep, anything that reduces stress and enhances the ability to handle stress may improve sleep. This can include relaxation, breathing and/or meditation techniques, certain yoga postures, healthy lifestyle changes, and stress-relieving life alterations. Refraining from vigorous exercise in the evening and taking time to consciously relax before going to bed may calm the adrenals and help lower cortisol and adrenaline levels.
When the adrenals fatigue, adrenal hormone levels may become low, leading to another possible source of nighttime sleep disruption–low blood sugar. Cortisol plays an important role in maintaining blood sugar (glucose) levels around the clock. Although blood glucose is normally low by the early morning hours, during adrenal fatigue cortisol levels may not stay sufficient to adequately sustain blood glucose. Low glucose signals an internal alarm (glucose is the main fuel for all cells, including brain cells) that disrupts sleep so the person can wake up and refuel.
Low nighttime blood glucose can also result from inadequate glycogen reserves in the liver. Cortisol causes these reserves to be broken down into glucose that is then available to the cells. When low cortisol and low glycogen reserves coincide, blood glucose will most likely drop, disrupting sleep. Waking between 1 AM and 3 AM may indicate low blood sugar resulting from inadequate glycogen reserves in the liver, low adrenal function and cortisol, or both. This is often the culprit when panic or anxiety attacks, nightmares, or fitful, restless sleep occur between 1 and 4 AM.
If low blood sugar is disrupting sound sleep, supporting healthy adrenal function and dealing with the adrenal fatigue may contribute long term to sound sleep. Also having a healthy snack before bed can help fortify the body’s nighttime energy reserves. The snack should be one or two bites of food that contains protein, unrefined carbohydrate, and high quality fat, such as half a slice of whole grain toast with peanut butter or a slice of cheese on a whole grain cracker. Eating or drinking sugary, refined foods will only aggravate the problem. Sometimes exercising before bed can help, since exercise tends to raise cortisol levels. (more on blood sugar and adrenal function)
Lack of sleep can be a significant body burden that, in itself, can contribute to adrenal fatigue. Every time the wake/sleep cycle is altered, it takes several days to weeks for the body and cortisol levels to adjust. In fact, sleep ranks with diet and regular exercise as an essential component of a healthy life. People on alternating shifts with less than three weeks between shift changes are continually hammering their adrenal glands and may become very susceptible to adrenal fatigue.
Chronic lack of sleep is now regarded as a health hazard and has been associated with several possible health consequences. These include lowered immunity with increased susceptibility to infections, impaired glucose tolerance, low morning cortisol levels, and increased carbohydrate cravings. Lack of sleep can also elevate circulating estrogen levels, upset hormonal balance, and slow healing and prolong the recovery period. These are in addition to the decreased alertness and concentration that most people experience when missing an inordinate amount of sleep.
The consensus from research and clinical observation is that it is necessary to sleep an average of eight hours per day. Some people need even more in the beginning phases of recovery from adrenal fatigue. A saliva cortisol test done at night and compared with daytime levels and with the test standards for those times will help determine if either high or low cortisol may be interfering with sound sleep. If cortisol is a likely culprit, cortisol levels will be significantly higher or lower than normal for those times.
With a researcher’s grasp of science and a clinician’s understanding of its human impact, Dr. Wilson has helped many physicians understand the physiology behind and treatment of various health conditions. He is acknowledged as an expert on alternative medicine, especially in the area of stress and adrenal function. Dr. Wilson is a respected and sought after lecturer and consultant in the medical and alternative healthcare communities in the United States and abroad. His popular book Adrenal Fatigue: The 21st Century Stress Syndrome has been received enthusiastically by physicians and the public alike, and has sold over 400,000 copies. Dr. Wilson resides in sunny Tucson, Arizona.
If you have an uncontrollable urge to move your legs or if your lower limbs feel itchy and twitchy while you’re sitting or resting, you could have the neurological condition restless legs syndrome (RLS). Deficiencies of dopamine, the brain chemical that controls movement, and iron are major triggers for RLS.
The treatment:
Iron is needed to produce dopamine, so take 25 to 29 milligrams at bedtime with 100 milligrams of vitamin C, which aids absorption, plus 400 IU of vitamin E to enhance dopamine levels. Increasing the production of the neurotransmitter GABA will also relax your legs, so try theanine (50 to 200 milligrams) and magnesium (200 to 400 milligrams) before bed. The anti-spasmodic herb wild lettuce helps as well. — Jacob Teitelbaum, M.D., of Kona, Hawaii, medical director of the Fibromyalgia and Fatigue Centers
A nutritionist says:
When your muscles aren’t getting enough vital nutrients, such as iron, folate, magnesium, zinc, tryptophan and vitamin E, they tend to spasm. Another culprit: acid-reflux meds such as Prilosec, Prevacid or Tums, which prevent absorption of those nutrients as well as enzymes and protein.
The treatment:
Eat foods rich in the nutrients needed to ease your RLS; these include kelp, pumpkin seeds, beet greens, avocado and turkey. Buy organic foods when possible, because they’re thought to be more nutrientdense than nonorganic foods. To improve the absorption of nutrients, try stirring a tablespoon of apple-cider vinegar into 4 ounces of water and sip it slowly throughout your biggest meal of the day. It’s also smart to avoid caffeine, alcohol and processed foods, which inhibit mineral absorption. — Victoria M. Wood, R.D., C.N.S., M.P.H., a nutritionist in Washington, D.C.
A naturopath says:
Homeopathic medicine can ease specific symptoms with diluted doses of plant- and mineral-based remedies.
The treatment:
Take Zincum metallicum first because it helps relieve RLS sufferers’ most common complaint—the inability to control their leg and, sometimes, arm movements. If your jerky limbs wake you up at night, try to tame them with Causticum. Use Arsenicum album to ease the creepy-crawly sensations, especially if you also feel restless or cold. But if you’re itchy and hot, try sulphur. Rhus toxicodendron and Kali carbonicum may help, too. With all remedies, start with a 6C potency and take three pellets before bed. You can also buy combination formulas that will treat numerous symptoms. — Jamie Oskin, N.D., a naturopathic physician specializing in homeopathy at the Arizona Natural Health Center located in Tempe –
Out of all of the people suffering from RLS that I’ve had the great privilege of talking to over the last few years, none have been as heart-wrenching as my talks with Darcy Taylor, whose daughter Jules was born with Restless Legs Syndrome.
Can you imagine the horror of being a newborn, having those twitchy sensations pulsating through your legs, torturing you endlessly, and not being able to communicate what’s happening?
Not to mention the severe mental and emotional toll it takes on the family, as you will learn from Darcy’s story.
I hope that Darcy and Jules’ story inspires those of you that are still suffering from RLS, and feel a deep sense of hopelessness.
What Jules’ story tells us is there is hope, no matter how dark things seem at the moment.
“My daughter Jules is currently 3 1/2 years old.
Jules had extreme sleep issues starting within the first week or two of life. There were a few nights when we slept a total of thirty minutes, and if we got a total of two hours of sleep, it was a good night.
We eventually did get a little more sleep than that, but still not much. By the time Jules was one year old, we were in a pattern of Jules not being able to fall asleep until 10 or 11 pm (no matter how many hours we bounced and paced or how tight we swaddled her…no ‘Happiest Baby on the Block’ in our house, sadly) and then waking up by about 1 am to then be unable to fall back asleep for 2-6 hrs. Also by one year old, Jules had her adenoids removed and was put on reflux meds, as her adenoids had enlarged and were “huge”, according to her ENT. The ENT felt that her adenoids had enlarged due to inflammation, and the assumption was that the source of inflammation must be a silent form of reflux, thus the reflux meds. Neither the surgery nor the reflux meds improved her ability to sleep, but she was once again able to breathe through her nose after surgery. (Due to later discoveries, I now wonder if it was actually dairy and gluten intolerance that were the underlying source of inflammation causing the enlargement of her adenoids.)
By the time Jules was 2, our lives had kind of been destroyed by Jules’ insomnia. I think people think I am joking or at least exaggerating when I talk about losing my mind during this time and my world falling apart, but I am not. There were some very, very dark times behind the closed doors of our home as we dealt with the serious repercussions of sleep deprivation. To this day my husband and I have still not recovered physically, and I feel emotionally scarred by an intense period of depression and anxiety and just ‘losing it’ at night when I couldn’t just go to sleep and abandon my baby to be awake alone. My son who is older than Jules showed significant signs of stress during this period as he lost his happy and healthy parents and instead had parents who could barely cope with life. We spent some time with a family therapist to help heal some of the anxiety and hurt on his end using play therapy (PCIT method), and this has helped. He is now a happy and well-adjusted kid.
So around the time Jules was turning 2, no amount of sleep training or discussions with other parents or our pediatrician had led to a solution. I was repeatedly told by well-intentioned people to let her “cry it out”. When we did try this, even committing to it for days on end, nothing changed. Instead of just hanging out with me for a few hours she would just scream for a few hours. It was cruel and nothing came of it. (I should note that we used sleep training and cry-it-out for my son and it worked miracles, so I was not a newbie to it). I had researched pediatric insomnia over and over online and had seen restless leg syndrome mentioned, but I just skimmed past it. I assumed that if Jules did suffer from restless leg syndrome, I would have noticed obvious kicking or her grabbing at her legs.
One night, I finally decided that I should investigate RLS as a possibility, because I had found a description of a typical sleep pattern for a child with restless leg syndrome that matched the pattern we were experiencing with Jules – basically, a child who cannot fall asleep unless crazy, crazy exhausted (so exhausted they can fall asleep before they start to feel the sensations in their legs, or at least before it becomes too strong)…. late bedtime, and unable to fall asleep for long periods if they wake up at night. I sat next to Jules after putting her in her bed and I laid my hand under her blanket next to her legs. I think my jaw must have dropped when I felt her legs twitching in a really subtle but unnatural way. I could not believe that I had finally found an answer. I was actually overjoyed to have finally found a reason for the suffering and insanity of our lives, something that I could actually now focus on finding a solution for.
I started rocking Jules to sleep every night so that I could feel the effects of restless leg syndrome and learn about it. The movements in her body caused by the RLS became so obvious, I cannot believe that I hadn’t noticed it before. She would both voluntarily move her legs in a bouncing fashion, and she would also have involuntary twitching. I realized that I actually had been aware of the bouncing, and in the past that had been a cue that she was not going to be able to fall asleep – I thought it meant that she did not feel tired and had excess energy. As I became very sensitive to what were natural ‘changing position’ movements and movements caused by the RLS, I discovered that the RLS affected not only her legs, but her arms and hands (perhaps more than her legs and feet) and sometimes her head and torso. She would rock her head a certain way, roll her pacifier incessantly between her fingers, contract her abdominal muscles, etc.
Our pediatrician had never heard of a child having RLS, but she was fantastic, because she was willing to trust my hours and hours of research and my observations. She ordered the bloodwork that I wanted (ferritin, iron, etc) and referred us to a sleep specialist. Jules’ ferritin levels were at 28, which would not have been flagged as abnormal, but I knew from my research that anything below 35 is a definite issue for pediatric cases of RLS, and some kids might need their ferritin levels to get up to 80 before finding relief from symptoms. (Currently Jules is at about 50, this after over a year of daily Floradix liquid iron).
Our experience with the sleep specialist wasn’t what I had hoped for. Our sleep specialist had not personally worked with a child with RLS and he wasn’t knowledgeable about options other than some scary medications that even he was nervous about prescribing. We were desperate enough to be willing to pursue the medication route, however, even if just for a while to allow us to pull our lives back together. (An interesting side note is that one of our appointments with the sleep specialist involved me hauling Jules asleep all the way to the appointment and her laying on his exam table asleep through the entire appointment and then sleeping all the way back to our car, because she had hardly slept the night before. So glad those days are long gone.)
We did a sleep study to rule out sleep apnea, particularly because sleep apnea would have meant that we didn’t even have the option of trying some of the medications used to treat insomnia caused by RLS in pediatric patients – the meds combined with sleep apnea can apparently lead to a child not breathing at night. A sleep study is a scary thing for a two year old, but the study went reasonably well. Jules did not have sleep apnea and she did not have periodic limb movement disorder, but she did have a higher than normal amount of non-rhythmic leg movements – we were told there is no diagnosis name for a high amount of these kinds of non-rhythmic movements. We decided to try clonazepam, because we felt desperate to have a period of sleep until we could raise her ferritin levels and try diet changes.
Unfortunately (or fortunately, as I now perceive it), Jules had a paradoxical reaction to the clonazapam and became very hyper when she took it. We lasted two or three days trying it and then had to quit.
At this point, I felt lost. The sleep specialist had no other treatment options for us, but he did suggest using melatonin to aid sleep onset and discussion with him relieved me of the fears I had about using melatonin. We began using a very small amount of melatonin thirty minutes before bedtime to aid sleep onset: 0.25 mg, or one quarter of a 1 mg dissolvable tablet that we cut with a pill cutter. The use of melatonin allowed us to shift Jules’ bedtime from 10-11 pm to 7-8 pm. My assumption of how this helps her is that it makes her drowsier than normal, and thus she requires less time sitting/laying still before her brain is ready to fall asleep. Less time sitting/laying still before sleep means less time for the sensations and movements of RLS to build. So by adding melatonin, we shifted her bedtime up by a few hours, which was amazing, but melatonin aids sleep onset, not sleep maintenance. So Jules would still wake up a few hours later and then be up for 2-6 hrs.
Just prior to the sleep study and our attempt at using clonazapam, we had discovered that Jules was gluten intolerant (in addition to being lactose intolerant, which we had discovered when she was about one year old). Removing gluten actually did seem decrease the RLS movements a bit (and improved her daytime behavior a lot!), but not enough to let her sleep any better. Studying this out online, I found David’s website http://www.RLCure.com and then was in contact with David discussing how to apply his advice to our situation with a toddler.
Once medication was definitely not an option, even for a short period, I began to focus solely on diet/supplement/lifestyle changes to help Jules. Because of Jules’ age, what I have been able to apply in our case has been a bit limited (for example, Jules won’t touch carrot juice and I was not successful hiding it in popsicles), but we have made AMAZING progress without any scary prescription medications.
At this point Jules is now 3 1/2 and sleeps pretty much through the night. Our norm is for her to wake up once each night, waking me to help her get back to sleep. When she does wake up, however, she can actually fall back asleep in a reasonable amount of time instead of being awake for hours.
HERE IS OUR TYPICAL ROUTINE/THERAPY:
IRON – Floradix liquid iron, daily on an empty stomach, first thing in the morning – Dr. Suresh Kotagal of the Mayo Clinic in Minnesota studies pediatric RLS and treats it with iron. Children with RLS have lower than normal body and brain stores of iron (ferritin), and lower than normal brain levels of dopamine (dopamine production requires adequate iron stores, so possibly a secondary issue). Ferritin levels lower than 35 have been found to be low enough to contribute to RLS, with some children needing ferritin levels of up to 80 to find relief. We give Jules Floradix using the mg/lb dosage suggested by her pediatrician, a dosage that would be given to a child considered anemic. After one year on Floradix, her ferritin levels increased from 28 to 50. We plan to continue at treatment level dosage for another year and then check her levels again. Warning: iron supplementation will cause stool to be black at times, but Floradix does not constipate like some forms of iron.
CALCIUM, MAGNESIUM, AND ACTIVATED FOLIC ACID – powder versions mixed into juice, daily with food – We worked with a naturopath to choose the appropriate supplements and dosages. Calcium blocks iron absorption, so we never give her iron and these supplements at the same time of day. Sometimes she has runny bowel movements from the supplements, especially the magnesium. Some forms of magnesium are more gentle on the digestive system, thus using a naturopath to guide us in our selection. Even when only given tiny amounts of the gentle versions, however, Jules will sometimes have runny stool. Part of the issue may actually be the juice in conjunction with the supplements – maybe too acidic. As she gets older, we will be able to find a better balance with these things. Jules may be extra sensitive digestively. She does have dairy and gluten intolerance, so maybe she is just prone to these kinds of issues. In all honesty, this is the part of our routine that I sometimes skip for weeks at a time due to the digestive component. And the juice-addiction component that I find really grating to deal with as a result of the consistent use of juice as a supplement vehicle – frequent tantrums demanding juice make me grumpy J.
MELATONIN – 0.25 mg daily, 30 minutes before bed – We use a pill cutter to cut up 1 mg Source Naturals peppermint-flavored sublingual tablets made for adults. We cut the tablets into four to make 0.25 mg pieces.
ESSENTIAL OILS – I was a serious skeptic when a friend recommended that I consider implementing the use of essential oils to treat restless leg syndrome, but I did research it and found testimonies of people who suffer from seizures using Frankincense to reduce the number of seizures they have. Because the medication typically used to treat RLS is also used to treat conditions such as epilepsy, I decided to try it. We now rely on it. I have seen consistent results that when we use this (I will explain how in a bit), the twitching in Jules’ legs as she is trying to fall asleep is decreased.
When life happens and we fall out of the habit, the twitching slowly increases over time, and when we add it back into our routine, it slowly decreases again over a matter of days. Since
Jules is a young kid who doesn’t know why we even use this stuff on her, there is no chance of placebo effect. How we use it: before bed, and ideally after a warm bath which creates absorbent skin and dilated blood vessels, we massage unprocessed solid coconut oil along her spine (base of skull to tail-bone) and on her legs and feet (knee down). We then massage about two drops of pure frankincense essential oil along her spine and about two drops per leg/foot. The amount used may need to be higher for an adult. This stuff is expensive, costing us about $60 per small bottle, which lasts us about a month, but for Jules it really does work. I have purchased oil through both Doterra and Rocky Mountain Oils and both had the same effect, despite having different fragrance notes (depends on the location of growth, time of year harvested, specific species, etc).
When we do give Jules a bath before bed, we often add a few drops of lavender essential oil, which is relaxing not only because it has a nice smell (for those who like it), but because it truly does have a chemical compound that acts as a sedative.
If Jules wakes up at night and is having a difficult time falling back asleep due to her legs, we massage her legs with coconut oil and then massage in an essential oil blend by Doterra called Past Tense that comes in a little roller-vial meant to be used on the forehead for headaches. Past Tense has peppermint oil and other oils that result in an icy sensation wherever it touches your skin, and this seems to be a distracting sensation that can help ‘cover up’ the uncomfortable sensations caused by RLS.
We also have an essential oil diffuser in Jules’ room and have used various sleep-aid blends, with one in particular that we have relied on a lot being made up of this ratio: 10 drops roman chamomile, 7 drops palmarosa, and 5 drops mandarin.
DIET – Jules is already dairy and gluten free due to intolerance, so I have not toyed around with adding and subtracting these from her diet for experiment sake and cannot say how they play into RLS. There is a definite increase in issues with the RLS when she eats chocolate and sometimes if she has too much sugar. We have had some horrible nights that seem to have come directly because of chocolate.
ROCKING TO SLEEP – Even though Jules is 3 ½, we still rock her to sleep! (Though she is so tall now, we are trying to wean her of this). The rocking movement is a distraction from the RLS sensations. This was a requirement for sleep onset when we were just beginning this journey (as was the use of hot baths before bedtime, heat pads under her legs or arms, and constant squeezing/massage of her legs and arms), but I think that we could get away without it now, we just need to train her to fall asleep without it.
I should mention that when Jules gets sick with a cold, we have a much harder time with RLS. I think this is because of two things – the twitching may actually be worse when sick, maybe related to systemic inflammation due to the actual cold, and then she just naturally wakes up more at night when coughing or uncomfortable, so more opportunities to experience the RLS sensations.
As Jules gets older, I look forward to her becoming part of the process of figuring out what helps her by playing around more with diet and supplements, but that is so hard to do at her age.
If she worsens at some point in the future despite our current routine, I will of course become more strict with things like low sugar diet, nightly baths, etc.
We have yet to try things like earthing sheets (a recent discovery to help lessen inflammation) or consistent use of probiotics (methods to creating a healthy gut to cut down on the production of inflammation). We did test our house for mold spores and that does not seem to be an issue, but we could revisit that.
One option that I am very interested in, should we ever find ourselves desperate again, is an incredible cannabis oil (ultra-potent, non-psychogenic) being produced by a company in Colorado called Realm of Caring/Charlotte’s Web Hemp Products that is a miracle treatment for seizure sufferers. Once again, because the medications used for RLS are often the same as those used for epilepsy, I have a hunch that what works for seizures is likely to work for RLS. This might be an option for those who are desperate and nothing else is working for them, but is currently only available in Colorado, I believe, and not legal to ship. You Can Read How It Has Helped a 6 Year Old Girl Here. The video in this link is amazing and definitely worth watching!
So anyway, I have cannabis oil as a last resort idea and have even contacted the company to be informed when their product is available in Oregon.
I am so, so grateful for people who are putting their studies, observations and experiences online for others to discover in their desperation! I found David’s website at a time when the medical professionals of our area were telling me that they did not know what else to do for us.
Learning that diet and supplements really could be used to treat RLS gave me hope and confidence and we really did make progress and now have a pretty normal life. RLS is a handicap that still affects us daily, as we generally do not sleep through the night without waking up once with Jules, but we are at least living again instead of being in a downward spiral. I believe that as Jules gets older and can play a role in moving toward an anti-inflammatory diet and better supplementation, she really will be able to get it under better control.
I really hope this information can help someone else. I am so glad the insanity is over! “
Experiments with patients suggest brain stimulation may be a viable treatment
mechanism for RLS rests in the brain’s “move my legs” center and makes even more sense of the relief those with RLS experience when they get up and move them.
“This basically means that inhibition is reduced or weakened in people with restless legs syndrome compared to people without the condition,” says Rachel Salas, M.D., associate professor of neurology at Johns Hopkins. “The reduced response means that the region of the brain controlling the legs shows increased cortical excitability in the motor cortex.”
people with severe forms of the condition or at the long-interval paired pulses in the leg,” says Salas. “We are fortunate to have access to such individuals because the Johns Hopkins Sleep Center attracts people worldwide and many who have exhausted treatment options available elsewhere,” she adds.
HOW IS RLS DIAGNOSED?
SYSTEMIC INFLAMMATION – THE CAUSE OF RESTLESS LEG SYNDROME?
THE MEDICAL APPROACH TO TREATING RESTLESS LEG SYNDROME
Jordan Reasoner is a health engineer and author. He was diagnosed with celiac disease in 2007 and almost gave up hope when a gluten-free diet didn’t work. Since then, he transformed his health using the SCD Diet and started SCDLifestyle.com to help others naturally heal stomach problems.
Below is another study that supports the idea of inflammation being at the core of Restless Legs Syndrome.
STUDY TWO (excerpt)
If you have followed this blog for awhile, or have visited my RLS website 
Some subjects reported taking seizure medications clonazepam and gabapentin with unsatisfactory results. All subjects reported prior efforts to alleviate their condition with prescription opiates and dopamine agonists for their RLS. They were ready for a new approach because nothing had worked for them or even made situations worse. Two subjects had experienced compulsive shopping and binge eating as a result of using dopamine agonists.
How Does Cannabis Treat Inflammation?
they both work in the body in different ways. Both cannabinoids have demonstrated efficacy in decreasing both the release and production of pro-inflammatory cytokines and also works to decrease the activation of LPS-induced STAT 1 transcription factor, which contributes to some inflammatory processes. However scientists find that CBD is much more potent in addressing inflammation, and for this reason high CBD strains are recommended particularly for those who suffer from extreme inflammation. CBD actually supports the concentration of endogenous cannabinoids which gives the body the ability to self-heal and ward off disease.
Monday, April 03, 2017
Restless legs syndrome is a seemingly unique condition and the cause is often difficult to pinpoint.
cause or exacerbate RLS symptoms, and found that 95% of the health conditions that are associated with RLS have an inflammation or immune component. As further evidence, an elevated blood level of C-reactive protein (a marker of systemic inflammation) has been associated with increased RLS severity.
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.
The Restless Legs Blog (or how I tried to convince Big Pharma that my legs are better) 