Restless Leg Syndrome

Mahes Visvalingam
Post-retirement postings

Please note that this site is under construction.

Some Experiences with Natural Medicine
and related observations

Restless Leg Syndrome : Magnesium and Iron

This article was prompted by Dr Tony Smith's answer to a query regarding cramps in bed (Saga Magazine, Sep 2006: 161). He noted that the symptoms of cramps were similar to those of restless legs and that advertisements in the USA claim that 90% of the people with restless legs who tried magnesium citrate had positive results although this is not backed by evidence from long-term studies.

My symptoms

I have suffered from symptoms similar to those of Restless Leg Syndrome (RLS) since the 1990s. However, There are many conditions which can mimic restless leg syndrome including muscle diseases, joint conditions, nerve problems, and circulation difficulties (MedicineNet.com, online).

I put up with this problem as yet another aspect of an age-exacerbated syndrome caused by a sedentary occupation. It was getting to a stage when I could not sit still at Senate meetings held in Council Chambers with rather cramped seating and had to keep moving all the time when stood talking to people at conferences. Not only were my legs restless, my ankles and feet became increasingly swollen, heavy and painful as the day wore on. I had to keep moving the pillow supporting the legs and feet through the night, keep the quilt off the feet, dangle the feet outside the bed from time to time and get up and walk about two or three times in the night. Needless to say, I got very little sleep with knock on effects during the day. I did mention this and showed my bulging post-menopausal varicose veins to the doctor who did not take them seriously - perhaps wisely. Like many others, whose restless legs feel more relaxed in the morning, I took to working late into the night (when I was often wide awake) and getting up late. Restless legs, varicose veins, cramps and other related problems may not be isolated maladies but may be a part of a syndrome. These problems have become less severe since my retirement but are still very troublesome during the hay fever season and in hot and humid weather/climate. However, there appears to be other aggravating factors and some palliatives which I will come to later.

Observations by others
It is estimated that some 5-10% of people suffer from this condition (Bandolier, RLS Introduction, online). As stated in this site, Some physicians wrongly attribute the symptoms to nervousness, insomnia, stress, arthritis, muscle cramps, or aging. Studies undertaken in Western Europe and Japan suggest that Rates in Japan are lower, at about 1%.(Bandolier, RLSprev, online). There appears to be either a genetic or cultural factor and it would be interesting to have more information about the incidence of restless legs among Japanese living in the west.

This site also lists related factors (including anaemia; chronic diseases; pregnancy; and some medications), treatments for reducing its severity and drug trials but concludes that there is no magic bullet as yet (see site for more details). Heavy metal toxicity, toxins, and many other conditions are also implicated (MedicineNet.com, online)

Some alternative treatments which have been suggested and my experience/comments

In diseases such as this the assessment of the effectiveness of treatment has to rely on subjective assessment in the final analysis. Different people suffer in varying degrees from different symptoms and respond differently to treatments. The following treatments (Bandolier, RLS Introduction, online and other sites) have worked for some people.

Some individuals, finding that RLS symptoms are lower in the early morning, change their sleep patterns. This is not always possible but this strategy enabled me to continue my teaching, learning and research.
Often, treating the associated medical condition, like anaemia, peripheral neuropathy or diabetes, will alleviate many symptoms . I have had blood tests for anaemia, diabetes, kidney, liver & thyroid function which were all clear but Research suggests a possible link between decreased brain iron and responsiveness to dopamine and iron supplementation in RLS (Bandolier, RLS and iron, online). I have not been tested for decreased brain iron but I have noticed that the symptoms improve when I have taken iron tonic to get over exhaustion towards the end of the hayfever season. However, the condition is present even when blood tests show that I am not anaemic.
Decreased use of caffeine, alcohol, and tobacco may provide some relief. I drink a moderate amount of tea and very little coffee and have never had alcohol nor tobacco - so these are likely to be exacerbating factors rather than primary causes.
Doctors may suggest the use of supplements to correct deficiencies in iron, folate, and magnesium. I have not tried folate but when I am desperate to get some sleep, I have found that putting a tablet of Milk of Magnesia (Magnesium Hydroxide) on my tongue does help. Unfortunately, Milk of Magnesia is no longer available in tablet form. Homeopathic Mag Phos also helps but not to the same extent. Sometimes, I have taken half a Dolomite tablet a day again for the magnesium more than the calcium. I have already noted tests with magnesium citrate in paragraph1 above. Wikipedia reports that some people have gained partial or complete relief by taking magnesium oxide or magnesium gluconate (Wikipedia, onine). I have avoided regular use of such 'supplements' hoping that the problem should sort itself out once I retired. I find that a bedtime drink of milky chicory coffee with sugarcane molasses is relaxing. Molasses contain minerals, such as potassium, calcium, magnesium and iron (nutritional information used to be on packets).
Others have found that a program of regular moderate exercise helps them sleep better. Walking can make it worse and can also cause blistering of the soles of the feet when the feet are swollen, especially in hot weather. This is also noted elsewhere (Wikipedia, onine)

In my childhood, it was quite common for Asians to squat. When I initially tried squatting again, I found it impossible but with perseverance it has helped. Squatting helps to straighten the back and it stretches muscles from the feet to the head. Like the Japanese sitting positions at tea ceremonies, squatting also compresses the upper and lower parts of the leg. The compression and decompression during squatting and standing aids circulation while exercising the muscles.
Taking a hot bath, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients. A hot bath and an electric under-blanket made it a lot worse for me. In contrast, immersing the feet in cold water is initially uncomfortable but helps the feet relax enough to allow sleep albeit only for a short time.

Some of the above non-drug treatments are also listed in the RLS-UK site. This site also lists:

Relaxation exercises (biofeedback or yoga)
Massaging affected limbs. I now recall that working through the exercises for relaxing the foot prior to reflexology in Peeters (2001: 44-45) and some of the main treatments not only helped my RLS but it also had a beneficial effect on my varicose veins. Initially, the highest of the bulges below the knee became very itchy and the ugly dark veins are no longer so pronounced.

Other things I have found helpful:

using a pillow under my legs/feet
dangling the feet out of the bed. My niece Kala treated me to a session with a Bowen therapist. The treatment starts with the subject lying on their front on a firm bed with the feet dangling beyond the end of the bed so that the therapist can work along the spine. My body did not like this position initially but it then relaxed such that I could have easily fallen asleep.

In late August 2006, I started experimenting with:

St John's Wort (Hypericum perforatum). According to the University of Maryland site, it takes about 8 weeks to take effect. Also, I am not taking the dried herb but tea made with very small quantities of the fresh herb which presented itself in our garden. I will report on the outcome in due course. Please see warning under Dec 2009.

Aggravating factors

My husband loves gardening and we always had all sorts of soft fruit in the freezer. At one stage I stopped eating raspberries, loganberries, blackcurrants and other acidic fruit because they made the condition worse. I still refrain from thick-skinned oranges and lemons although I can eat grapefruit, clementines, mandarins and the like. I am now able to eat soft fruit, sour plums and all sorts of things I dare not eat before. But, my legs and feet still start to rebel if I sit at the computer for too long.

Conclusion

Now in 2006, I view my much diminished RLS as yet another challenge (rather than a problem) to be studied and overcome.

Your experience

If you have found some other treatment which has worked for you, please let us know through this web log on Restless Leg Syndrome.

Feb 2007
Gyuri noted in my blog page that Bowen Therapy may help RLS sufferers and has provided links.

September 2007

I was not troubled by RLS this past hayfever season. I am beginning to wonder if low blood pressure and poor circulation were the root cause of my RLS, varicose veins and postural hypotension. They have all improved this summer - much reduced swelling of ankles, cracking of heels and blistering of soles.

April 2008 (see April 2008 update in page on Varicose Veins). I now make films, which involve sitting at the computer for long periods of time. But, I no longer suffer from RLS - so you can get rid of it.

December 2009: Warning

Please note the various warnings about St John's Wort at the University of Maryland website. The page warns that St. John's wort can also make the skin overly sensitive to sunlight. In my case, I noticed that my eyes became very sensitive to light, especially when I woke up in the morning. I was getting rainbow coloured after images from even seeing bright sunlight coming under the bottom of the curtains. These after images made it impossible to read or look at anything close until the ghost images faded. I also found that I could not read LED displays since these seemed to flare out and merge. I actually asked to have my eyes checked up at the hospital in case I was having clots in my retinal veins - but there was nothing wrong with my eyes. I stopped having this herb tea in May 2009 and have not had this problem this year. I need to double check if S John's Wort is the cause next summer.

Related topics:

Varicose veins; postural hypotension (low blood pressure).

References:

http://www.jr2.ox.ac.uk/bandolier/booth/booths/RLS.html

http://www.restlesslegs.org.uk/
http://www.rls.org/NetCommunity/Page.aspx?&pid=329&srcid=178

http://en.wikipedia.org/wiki/Restless_legs_syndrome

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