There is a strong association between poor iron processing in the body and RLS; this seems to be specifically related to iron processing in the brain, in particular in a part of the brain called the Substantia Nigra which is thought to be malfunctioning in RLS. Iron is important for certain steps in making dopamine in the brain.
This is why all patients should have their iron status assessed. If there is poor iron absorption, then this should be treated first, and may avoid the need for any further medication .
If there is a low ferritin level, even in the absence of true anaemia, then iron supplements will help some people with RLS symptoms, and a low ferritin level should also be treated .
There is also clear evidence that augmentation is commonly linked to a problem with iron transport or absorption, and your GP may not be aware of this. In addition poor iron processing may not show on the the basic test your GP asks for and we recommend a more subtle test called Transferrin Saturation. For example, a patient who had responded well at first to dopamine drugs for her RLS found that her symptoms were getting more severe and more frequent. This is what is called augmentation and seems to occur quite commonly. Her iron and ferritin levels were normal, but further testing showed that her transferrin saturation level was low however. When she was treated with iron supplementation she was able to stop her dopaminergic medication.
For best iron absorption, iron pills should be taken at night on an empty stomach with vitamin C. They should not be taken with food, milk, antacids, calcium supplements or medications used to treat acid reflux and thyroid.
FOLATE AND VITAMIN B12
Vitamin B12 and Folate (vitamin B9) and iron are all essential in the manufacture and recycling of red blood cells, and we know that disturbances in iron processing in the body also disturb dopamine production in the brain.
Deficiencies of B12 and Folate have been linked to RLS symptoms and have been shown to affect the severity of RLS, so that symptoms are worse with lower levels of B12 and Folate.
Low levels of B12/Folate may cause other symptoms such as tiredness, muscle weakness, fatigue and prickling sensations over the skin. These symptoms could easily be confused with those of Restless Legs Syndrome itself.
Improvement in B12/Folate status by supplementing with these vitamins has been shown to reduce symptom severity in RLS.
VITAMIN D3 (25 (OH) VITAMIN D)
There is good evidence that a low level of Vitamin D is associated with RLS, and in one small study there was a significant improvement in the severity of RLS symptoms when sufferers were treated with high doses of Vitamin D3, either as tablets or intravenously.
We believe that everyone should have their Vitamin D level checked anyway because of the link with other diseases such as cancer and Alzheimer’s Disease. If your Vitamin D level is low then raising it to normal will help to protect against these diseases.
Vitamin D is an essential nutrient to maintain health and low levels of Vitamin D are associated with an increased risk of cancer, including cancer of the breast, prostate, and colon.
A low level of Vitamin D is a sign of increased risk of cardiovascular disease and high blood pressure.
There is an association between low Vitamin D and increased risk of diabetes.
Vitamin D helps to protect against autoimmune diseases and the inflammatory response.
Low levels of Vitamin D are associated with increased risk of depression, Alzheimer’s Disease and cognitive decline.
The link between osteoporosis, osteomalacia and increased fracture risk, and low vitamin D levels is well known.
Because of these widespread links with other health problems probably everyone should have Vitamin D levels assessed.
Some early research linked magnesium deficiency with RLS and Periodic Limb Movements during sleep (PLMS).
It was found that supplementing Magnesium produced a significant improvement in the severity of symptoms in RLS.
Some patients have found that massaging their legs with magnesium oil also reduces the severity of symptoms and leads to better sleep.
HIGH SENSITIVITY C- REACTIVE PROTEIN (HS_CRP)
This is a marker for chronic inflammation in the body. (Chronic means it has been going on for a long time). Chronic inflammation can disturb iron processing which, in turn, may disturb dopamine pathways in the brain.
C-Reactive Protein increases when there is inflammation in your body, which is why we suggest the hs-CRP test. It won't tell you the underlying reason for chronic inflammation, but it is an indication to look more deeply.
It may indicate infection or a chronic inflammatory disease, such as rheumatoid arthritis or lupus, and is a marker for increased risk of coronary heart disease which could lead to a heart attack.
If your hs-CRP level is raised and your vitamin D is low as well then you definitely should talk talk to your GP about further tests to assess the risk of heart disease.
Even if your only symptoms are the restless legs, but you have a raised hs-CRP, then you really do need to look further to find a cause.
2018 Webinar Series. Iron Biology: What We Should Know When Managing Restless Legs Syndrome, Earley, C. www.RLS.org
"All patients with symptoms of restless legs syndrome (RLS) should be tested for iron deficiency. At a minimum, a ferritin level should be obtained. A complete iron panel, including iron levels, ferritin, transferrin saturation, and total iron binding capacity, is preferable because the ferritin level can be falsely elevated in acute inflammatory states."Bozorg AM, Restless Legs Syndrome 25 July 2015 http://emedicine.medscape.com
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