The Trail of Clues in Restless Leg Syndrome: Part I
OK friends, let’s take a quick quiz straight from the pages of the National Institute of Health. These 4 questions are a simple “yes” or “no” answer, and will help identify if this next set of clues resonates with your current situation.
✅Do you have a strong and often overwhelming need or urge to move your legs? (Often the urge may be accompanied by abnormal, unpleasant or uncomfortable sensations.)
✅Does the urge to move your legs start (or get worse) during rest and inactivity?
✅Does the urge to move your legs worsen in the evenings/at night?
✅Is the urge to move your legs partially or totally relieved by movement (at least temporarily)?
If you have answered yes to these questions, this post series may shed light on both why your legs may be restless and (next week) natural ways to help relieve the situation. Bear in mind that beyond the questions above, there are several mimickers of restless leg syndrome, so the process of elimination may come in handy! Poor circulation in the legs, fibromyalgia, neuropathy, and ADD/ADHD are a few disorders known for restless leg mimicry.
Restless leg syndrome (RLS) is a very common condition affecting about 10% of adults in the USA and even some children. There are several medications commonly used to treat RLS. According to many pharmacy clients I’ve worked with over the years, the medications are often minimally effective, not without unpleasant side effects (GI distress, constipation and/or diarrhea), and do not address root causes.
RLS is not generally a precursor of things to come thankfully….but it is highly annoying and life disruptive nonetheless, especially as it often leads to chronic insomnia.
As any good detective would do, you’ll want to discover the motive (root cause) of your RLS. Motives vary in each case, right?
*Occasionally, restless legs may be blamed on genetics, but that is the exception rather than the rule. Overwhelmingly, restless leg syndrome is given the dubious distinction of having an idiopathic origin. My personal feeling is that “idiopathic” is an overused medical term used when not enough time has been spent looking at clues to find the root cause! Understandably so….. insurance companies do not usually allow doctors the time or tools (comprehensive lab work) to actually find the source of the problem.
There are MANY factors leading to or exacerbating restless leg syndrome:
*Approximately 15% of RLS cases have an underlying iron deficiency. Iron deficiency may be easily checked with lab work. Checking iron alone is insufficient. Ferritin levels also need to be evaluated.
*Other nutritional deficiencies contributing to RLS include magnesium, calcium, potassium and/or zinc. Again, blood work is key. (If you get magnesium tested, make sure it is magnesium bound to red blood cells “mRBC” for a more accurate reading)
*Hormone imbalance is another common cause. Approximately 20% of pregnant women develop RLS, usually in the third trimester. This symptom tends to dissipate about 4 weeks after delivery of the baby. Women are more likely to have hormonal imbalances than men overall, and women are also more likely to develop RLS than men in life. Hyperthyroidism, another type of hormone imbalance, is an additional contributor.
*Dopamine is a neurotransmitter that plays many roles in the body, most notably in motivation and positive reinforcement of behavior. It also plays a critical role in the control of movement. So, as you might imagine, a dopamine imbalance may also play a key role in RLS. (We’ll cover dopamine deficiency in the near future.)
There also appears to be a relationship between ADD/ ADHD and restless leg syndrome. Additionally, pediatric restless leg disorder is sometimes misdiagnosed as growing pains or ADD.
*Symptoms of restless leg syndrome are common in people who have chronic kidney disease. When the kidneys are not functioning as they should, anemia, iron deficiency, and high calcium levels in the blood commonly occur. As you’ve just learned, all of those conditions exacerbate RLS.
*Hypertension, diabetes, and increased BMI (body mass index) also contribute to the incidence of restless leg syndrome. (The medications used to manage these conditions are also worthy suspects!) Uncontrolled high blood sugar often leads to peripheral nerve damage; another contributor to restless legs.
*Medication induced restless legs may be among the most common (idiopathic?) causes for developing this disorder. Every medication acts in multiple ways throughout the body. Immediate side effects of medication are fairly easy to spot, but often side effects such as restless legs creep in slowly, making it hard to pinpoint the culprit. Medications known to cause restless legs over time include:
💊Psychotropics (ex: haloperidol, aripiprazole, risperidone, quetiapine, mood stabilizers)
💊Antidepressants (SSRI’s,SNRI’s, and tricyclics, ex: fluoxetine, sertraline, venlafaxine, paroxetine, imipramine, amitriptyline)
💊Some nausea medications (metoclopramide and prochlorperazine)
💊Calcium channel blockers
💊Some sleep medications
I’ve talked to many pharmacy clients over the years who struggle with restless legs, and while it is a relatively benign condition, it is definitely life altering…anything that negatively affects quality sleep is! Westernized health culture is often very quick to prescribe or suggest over the counter medication to quickly solve a problem, overlooking the unintended possible consequences. Often, there is a gentler solution, but it does require ownership and a willingness to take personal responsibility for one’s own health management. There will always be a time and a place for western medicine, but it behooves us all to leave that as a last resort whenever possible.
I hope this helped someone identify their restless leg trigger(s). Next week I’ll talk about healthy options for living with RLS.
The Trail of Clues in Restless Leg Syndrome: Part I