Restless Leg Syndrome and Nutritional Supplements

Article by Don Goldberg

Restless legs syndrome is defined as “a neurological disorder characterized by a periodic need to move the legs in order to relieve an unpleasant or uncomfortable sensation in the legs. The symptoms are usually worse in the evening or at night, and occur primarily during periods of inactivity, such as while lying down or sitting. In the United States, an estimated 5–15% of the population suffers from RLS, with older people being affected more often than younger people. The condition occurs frequently in the later stages of pregnancy. RLS often interferes with sleep, resulting in chronic sleep deprivation and a reduced quality of life.” (Gaby, Alan R., MD. Nutritional Medicine. Alan R. Gaby, M.D., 01/2011.)

What causes this condition? Stress can be a factor, as is nicotine, or smoking, and alcohol. Certain dietary factors may cause the problem as well, and I will elaborate on this shortly. For those with reactive hypoglycemia, improving blood glucose control can help. Food allergies should be ruled out.

Those nutrients that have been associated with restless leg syndrome include folic acid, iron, magnesium, vitamin E, flavonoids and vitamin C.

Iron deficiency is common in patients suffering from restless leg syndrome. I suspect this is more common than we realize, as there has been a tendency, perhaps misguided, to refrain from iron supplementation. People have become fearful of including iron in their supplement regimen. Iron, of course, is essential to many crucial body functions, including the conversion of the amino acid tyrosine to dopa and dopamine. One class of drugs shown to be useful in treating restless leg syndrome are “dopamine agonists.” As iron deficiency can lead to reduced dopamine activity in the brain, correction of the deficiency often leads to improvement. In fact, some studies indicate that treatment with supplemental iron will improve the condition even if the patient is not iron deficient. Not all studies support this, but I would certainly suggest a trial period of at least modest iron supplementation, unless you have been diagnosed with the inherited disorder, hemochromatosis, or some other medical condition that precludes iron supplementation. Even if you are not clinically iron deficient, a dose of at least 9 mg to 18 mg per day when suffering from restless leg syndrome would be worth trying. Maybe more. If it seems to help, you should talk to your physician, and get properly tested for iron status.

Another nutrient shown to cause restless leg syndrome when a deficiency exists is folic acid. For many reasons, supplemental folic acid is now recommended in higher dosages than in past years. The maximum level in supplements used to be 400 mcg. Now, 800 mcg is considered by many to be minimal. If you are not taking extra folic acid and you have restless leg syndrome, you should check with your doctor, as relatively high “therapeutic” levels may be needed (from 5 to 30 mg per day). At the very least, check you supplement labels. You want to make sure that your daily multivitamin provides at least 800 mcg per day.

Magnesium deficiency is a very likely culprit in restless leg syndrome. With the emphasis on “calcium supplements,” many people take supplements that do not have the proper balance of calcium to magnesium. It is now thought that the amount of magnesium should be at least half the level of calcium. Most nutritionists and health professional feel it should be even higher–perhaps one to one. In other words, if you take 1000 mg of calcium, you should be taking from 500 mg to 1000 mg of magnesium as well.

As Dr. Gaby reports in his text, Nutritional Medicine, “One of the manifestations of magnesium deficiency is neuromuscular and central nervous system irritability, which could contribute to the development of RLS (restless leg syndrome). Suboptimal magnesium intake is common in Western societies. Certain factors that tend to deplete magnesium, such as pregnancy, stress, alcohol consumption, and caffeine intake, are associated with an increased risk of RLS.
 “Six patients suffering from insomnia related to mild-to-moderate RLS received 300 mg of magnesium (as magnesium oxide) each evening for 4–6 weeks. Five of the 6 patients reported a decrease of RLS symptoms and/or an improvement in insomnia.18 Because there is a high prevalence of marginal magnesium status in the general population, magnesium supplementation should be considered for all patients suffering from RLS.” (Gaby, Alan R., MD. Nutritional Medicine. Alan R. Gaby, M.D., 01/2011.)

You can switch to a calcium-magnesium supplement with a heavier ratio of magnesium to calcium. You can also take additional, separate magnesium. A good option, in this case, would be magnesium citrate, which is available from various companies (Allergy Research Group has a nice magnesium citrate in capsule form).

While there may not be a great body of research to support the value of bioflavonoids and vitamin C in alleviating restless leg syndrome, it certainly makes sense. Flavonoids are known for their effect in enhancing the strength of the peripheral vascular system, along with vitamin C. You can take a conventional “bioflavonoid” supplement. Solgar, for example, has a product called “Hy-Bio” tablets, with 600 mg of flavonoids and 500 mg of vitamin C per tablet. Or, you can take one of the various phyto-antioxidant complex formulations, that contain blends of flavonoid-rich extracts from a number of natural plant sources. The Willner Chemists product, “Antiox Phyto Complex” is an excellent example.

The last supplement I will suggest you consider when struggling with restless leg syndrome is vitamin E. In one study, nine patients with a history of restless leg syndrome were treated with vitamin E at a dose of 300–1,600 IU/day. Seven of the patients experienced prompt and almost complete relief and the other 2 patients reported improvements of 75% and 50%, respectively. Symptoms tended to recur if vitamin E was discontinued. (Ayres S Jr, Mihan R. “Restless legs” syndrome: response to vitamin E. J Appl Nutr 1973;25(3–4):8–15.;  Ayres S Jr, Mihan R. Leg cramps (Systremma) and “restless legs” syndrome. Calif Med 1969;111:87–91.)

When choosing a vitamin E supplement, I suggest a natural, mixed tocopherol vitamin E softgel. The initial dosage should be at least 400 to 800 IU daily. Some vitamin E supplements have high levels of “tocotrienols.” Under certain conditions (if you have heart disease, for example) you might want to choose a mixed tocopherol vitamin E with tocotrienols. Talk to the pharmacists or nutritionists at Willner Chemists, or your health professional, for guidance on which type of vitamin E supplement you should be using. Whatever you do, be sure to avoid the synthetic form of vitamin E, dl-alpha tocopherol.

Don Goldberg, R.Ph.
Willner Chemists