Restless Leg Syndrome
Fighting the Urge

A disorder of the central nervous system, restless leg syndrome (RLS) is characterized by the irresistible urge to move the legs. This urge usually occurs during sleep or periods of inactivity and is frequently accompanied, or caused by, uncomfortable and unpleasant sensations that are partially or completely relieved by movement. Some of the words patients with RLS use to describe the feeling include “creepy-crawly,” “burning,” “tingling,” “twitching,” and “painful.”

A narcotic addict experiences this "jerking" due to the abrupt cessation on the endorphins the brain was receiving from an outside source.  The body and brain are finely tuned and during the abuse of narcotics, the brain slowed down on production as it sensed the outside source of dopamine (endorphins). The brain will heal fortunately to the degree that the brain will begin producing adequate endorphins again. The incidence of RLS among addicts who exercise is less than among addicts who are sedentary. During withdrawals, exercise can help produce the much needed endorphins and can actually reduce the symptoms of RLS for the recovering addict.

The symptoms of the condition tend to occur at exactly the wrong time—when people are trying to relax or sleep. As quality and quantity of sleep become an issue, daytime fatigue and exhaustion follow, affecting work and mental performance 

Although the cause of RLS is unknown, researchers believe that it results from abnormal functioning of the central nervous system. RLS produces excitability in a region of the brain known as the subcortical area. This excitability is caused by a dysfunction in a nerve-signaling chemical called dopamine. Dopamine is a central neurotransmitter that is particularly important in the regulation of movement.

The exact prevalence of RLS is undetermined. It may be more common than is currently thought because people may not report it to their physicians, and some physicians may wrongly attribute the symptoms to nervousness, insomnia, stress, arthritis, muscle cramps, or aging.  RLS is associated with diabetes and smoking. Studies show that it affects between 1 percent and 5 percent of younger adults and up to 20 percent of adults older than 60 years. There is also a clear familial connection; about one third of patients with RLS have multiple family members who are also affected by the condition. There are those who suffer from RLS chronically and those who have it only temporarily, which incudes an addict during withdrawals. 

Although the exact cause of RLS is unknown, a number of conditions are associated with it including:

• Iron deficiency
• Low dopamine levels (the reason a person in withdrawals experiences temporary RLS) 
• Lesions within the spinal cord or peripheral nerves
• Pregnancy-related deficiencies in iron, folate, and magnesium
• Kidney disease, particularly end-stage kidney disease
• Medications, such as tricyclic antidepressants, selective serotonin reuptake inhibitors, lithium, and caffeine 

Iron and Dopamine Abnormalities

The brains of patients with RLS exhibit abnormalities in the relationship between iron and dopamine. An enzyme involved in dopamine synthesis—tyrosine hydroxylase—requires iron for proper function. In animal studies, iron insufficiency appears to cause abnormal dopamine function.  It is believed that patients with RLS may have impaired iron absorption in the brain . The iron deficiencies are pronounced in certain parts of the brain that help control body movement. In autopsies of people with RLS, iron levels have been particularly low in a region of the brain called the substantia nigra.

Further evidence of the relationship between iron deficiency and RLS is found in the three major secondary causes of RLS—end-stage renal disease, pregnancy, and iron deficiency, which all involve low levels of iron.

Diagnosis and Conventional Treatment

The diagnosis of RLS begins by excluding other conditions, such as anemia, diabetes, kidney disease, and iron deficiency.  Some of the more common conventional medications used to treat RLS include:

• Levodopa—Levodopa (L-dopa) is a form of dihydroxyphenylalanine, the immediate precursor to dopamine. However, unlike dopamine, it can be taken orally and cross the blood-brain barrier. Once inside brain cells, the medication converts to dopamine. L-dopa is usually given with other medications that inhibit its effect outside of the central nervous system. The disadvantages of L-dopa are its short-term effects (1 to 2 hours) and a side effect known as augmentation, whereby RLS symptoms appear earlier in the day and with increasing severity.
• Dopamine agonists—Alternatives to L-dopa including dopamine agonists such as cabergoline, ropinirole, and pramipexole. In general, dopamine agonists have milder augmentation symptoms compared to L-dopa and are considered the treatment of choice. They have had success in relieving symptoms in more than 70 percent of patients. L-dopa and dopamine agonists can significantly reduce the number of limb movements per hour and improve the subjective quality of sleep.
• Sleep agents—Minor tranquilizers such as benzodiazepines
• Anticonvulsant medications—Medications that slow convulsions
• Some medications that  worsen RLS include neuroleptic drugs, caffeine, nicotine, H2-blocking agents, lithium, metoclopramide, and mianserin

Nutrients to Help Resist the Urge

Because RLS has been associated with specific nutrient deficiencies, researchers have studied the effects of supplementation in patients who have RLS. The results have been promising.

Iron

A deficiency in iron can trigger RLS. Not only can iron levels be low in people with RLS, but iron storage in the body appears to be abnormal due to a low level of a protein called ferritin and a high level of the transporter protein transferrin. Transferrin transports iron in cerebrospinal fluid and in plasma. Fewer symptoms of RLS are apparent in people with ferritin levels greater than 50 micrograms per liter (mcg/L) . A ferritin deficiency can arise from low iron intake, inadequate absorption, or excessive blood loss.

Symptoms of RLS can improve or be resolved completely through oral or intravenous iron supplementation. Studies showed relief from symptoms of RLS after supplementation with 200 milligrams (mg) of intravenous iron administered over a few days

The absorption of iron from food and supplements can vary based on the form of iron used. Intestinal uptake can vary based on biological need. Heme (deep red, ferrous component of hemoglobin) sources of iron, such as red meat, are utilized the most effectively by the body. Other chelated forms of iron, such as iron protein succinylate or iron bis-glycinate are also excellent. These forms of iron can reverse anemia more quickly and with less constipation than the typical iron salts most doctors prescribe .

Other nutrients can enhance the activity of iron in the body.

Adequate vitamin A is essential, as it helps to mobilize iron from storage sites. Adding zinc to iron supplements may increase hemoglobin levels more than taking iron supplements alone. In the same way, taking 250 to 500 mg of vitamin C can raise the absorption of iron, although it may also increase its side effects. Iron absorption will increase if it is ingested on an empty stomach.

Often addicts are undernourished as their drug of choice overtakes their need for proper nourishment and hydration.

Folic acid

Folic acid is the synthetic form of folate, the water-soluble B vitamin that helps produce and maintain new cells in part through the creation of DNA and RNA. Folate can even protect cells from changes to DNA . Also, folate is needed to make red blood cells and prevent anemia.

 RLS is related to folate deficiency, particularly in the form of RLS that is associated with familial inheritance and with pregnancy. Patients with this type of RLS have benefited from intake of between 5 and 10 mg of folic acid per day, or from taking folinic acid.  People taking folic acid should ensure that they receive at least 500 to 1000 mcg of vitamin B12 each day to make sure the folic acid isn’t masking a vitamin B12 deficiency.

Magnesium

Magnesium has also been shown to partly relieve RLS. Particularly for people with nighttime RLS, 250 mg of magnesium citrate taken before bed may decrease symptoms and aid sleep. Therapeutic dosages range from 250 to 800 mg of elemental magnesium a day.