Restless Legs Diet
by Sue Kira, Naturopath & Clinical Nutritionist
Restless legs syndrome (RLS) is a condition of the nervous system that creates a compelling need to move the legs, and if not moved, the legs will twitch and move involuntarily. It is usually worse in the evening and can affect quality of sleep or getting to sleep.
The strange sensation in the calves and sometimes upper legs can be like a cramp, soreness, or a creeping, crawling feeling or even feel like squirming insects inside the legs. Usually it can be felt it only one leg, but both legs can be affected.
The symptoms can be mild, moderate, or severe. In severe cases it can be difficult to sleep, with a need to pace around throughout the night until being unable to stand anymore and falling asleep with exhaustion.
In this article I will be share some of the possible causes of restless legs syndrome and some of the foods that can help alleviate the symptoms. However, do see your health care professional to be tested for any of the more serious contributors to this condition. There is no test for RLS, but tests can eliminate any other related conditions and help to identify potential triggers.
In many cases the exact cause of restless legs syndrome is unknown, but there are a few things to consider as potential drivers of this condition to help understand what could alleviate the symptoms.
Some of the common theories are: a pinched nerve in the lower back that is triggered by lying down or sitting on the lounge with your feet up; iron deficiency anaemia; dopamine deficiency; kidney disorder; magnesium deficiency; certain infections; diabetes; Parkinson’s disease; thyroid; and pregnancy – to name just a few to consider.
Following are some of the common causes and triggers and what can be done to support these imbalances naturally.
Dopamine and restless legs syndrome
There is evidence to suggest that restless legs syndrome is related to a problem with a part of the brain called the basal ganglia which uses a neurotransmitter (brain chemical) called dopamine to help control muscle activity and movement.
Dopamine helps the brain to regulate and co-ordinate movement, which is why people with Parkinson’s disease (a dopamine issue) have uncontrolled movements. Nerve cells can become damaged, which reduces the amount of dopamine available to the brain which then causes muscle spasms and involuntary movements.
Dopamine levels are known to fall as the day ends, which helps to explain why restless legs syndrome symptoms are often worse in the evenings.
Iron deficiency anaemia and restless legs syndrome
Low iron in the blood can lead to a fall in dopamine which can then trigger restless legs syndrome, so it’s advisable to get your iron levels tested. If you are a meat eater and your iron is low, you will need to see a practitioner to investigate bacterial imbalances in the gut (bugs eat iron) or poor digestion.
If you feel you have good digestion but eat a vegan or vegetarian diet, then ensure you have plenty of iron rich foods such as green vegetables and you may also need a supplement for a while to top up your iron level.
Systemic Inflammation, Immune Dysregulation, and restless legs
Restless legs syndrome has been associated with many conditions involving systemic inflammation and immune dysregulation. A study found that 95% of health conditions associated with RLS have an inflammatory or immune component.
Inflammatory conditions such as Celiac disease, Crohn’s disease, Diabetes, Parkinson’s disease, Multiple Sclerosis, ADHD, Alzheimer’s disease, Rheumatoid arthritis, sleep apnoea, and depression have all been linked to restless legs syndrome.
If you already have a diagnosed inflammatory or immune condition such as those mentioned above, ensure that you and your practitioner investigate the cause of your condition and adopt an anti-inflammatory diet and lifestyle. This means eating a nutrient-rich, low-toxin diet, getting enough sleep every night, instigating stress management strategies, and exercising most days.
Small Intestinal Bacterial Overgrowth (SIBO) and restless legs
Some of the recent research on restless legs syndrome has focused on a connection with small intestinal bacterial overgrowth (SIBO) and RLS. Someone with SIBO does not necessarily have RLS, but a few trials have found that people with both SIBO and RLS had their RSL symptoms disappear after treating the SIBO.
A Low-FODMAP Diet or SIBO Diet can help to reduce the amount of fermentable carbohydrates that feed the bacteria in the small intestine. You can be tested for SIBO and if you have it, the diet and support from your practitioner may help to remove the restless legs symptoms.
Vitamin D Deficiency and restless legs syndrome
Studies have shown that vitamin D can improve the symptoms of restless legs syndrome by activating the dopamine signalling pathways, increasing dopamine and its metabolites in the brain, and protecting dopamine-associated neurons from toxin exposure.
It is worthwhile to get your levels tested and aim to have your vitamin D at the upper end of the reference range. Regular sun exposure, eating fatty fish and taking a vitamin D supplement can help to boost your vitamin D levels.
Spinal nerves and restless legs syndrome
It is worth getting your spine checked for any pinched nerves in your back, especially the lower back, as this is another potential trigger. I know personally that if I lay on my back or sit on the lounge with my feet up that I can get restless legs, but if I adjust my position it goes away. I also experienced restless legs during late pregnancy, which is common because the baby presses on the spine at times. Laying on your side can relieve the pressure.
There are some triggers that don’t cause restless legs syndrome, but they can make the symptoms worse. These include:
Medications such as some antidepressants, antipsychotics, lithium (used to treat bipolar disorder), calcium channel blockers (used to treat high blood pressure), some antihistamines, and metoclopramide (used to relieve nausea).
Other possible triggers include smoking, caffeine, sugar, alcohol, being overweight, stress, lack of exercise or even excessive exercising. Some of these triggers create a loss of magnesium and B vitamins needed for dopamine release and the relaxation of the muscles and nerves that are over-firing i.e. restless legs syndrome.
If your restless legs are purely due to low iron, then iron rich foods may be helpful such as red meat, liver, spinach and other dark leafy greens, dried apricots, poultry, pork, and seafood.
However, if your restless legs are due to other causes mentioned above then you will need more than these iron rich foods. A low fermentable foods diet, an anti-inflammatory diet, and addressing any underlying health issues may be necessary.
As you can see treating restless legs can be quite complex. Many of my clients had remission from RLS simply from a magnesium supplement followed by a magnesium rich diet, which is also an iron rich diet (greens have iron and magnesium). Whereas other clients had to be treated for SIBO or parasitic infections or they needed to settle the inflammation in their gut by removing pro-inflammatory foods that set up a bacterial imbalance in the gut.
I can’t stress enough the importance to be under the care and guidance of your health practitioner. Recommendations may include support for your body with foods that are rich in iron, magnesium and vitamin D, dopamine promoting foods, and diets such as Low FODMAP, Level 2 SIBO, or Anti-inflammatory to give you the best possible outcome to treat your restless legs along with any medical advice given to you.
Before you commence your diet, see your medical or health care professional for qualified guidance about what foods and supplements are best for your body. While on the diet do not stop any medications or supplements previously prescribed unless advised otherwise by your medical or health care professional.
During the early stages of a new diet, you may experience symptoms such as fatigue, headaches, or body aches, which may occur because your body is detoxifying. However, if you are unsure about a symptom at any time, check immediately with your medical or health care professional.
Client name and identifying information changed
Sometimes there can be multiple factors in Restless Legs Syndrome (RLS). June was a client who suffered terribly from RLS. Every night after she went to bed she woke within 20 minutes of lying down and then stayed up pacing the floor. If she didn’t keep moving until she was exhausted she just couldn’t lay down at all. By the time I saw her, she had RLS for a couple of years and was severely sleep deprived.
Her doctor initially suggested Quinine tablets (normally for malaria) which is a treatment that does work for some, but not for June. He also suggested sleeping tablets and non-steroidal anti-inflammatory drugs, but her restless legs would override both. Then she decided to see if I could help.
We organised some tests with her doctor as well as some private pathology to see if she had any gut issues. The results showed low iron and B12, low vitamin D, and the stool test showed she had leaky gut and a small intestine bacterial overgrowth (SIBO) of the wrong bacteria and insufficient good bacteria.
She did get a lot of bloating and flatulence and was very tired most days which she thought was due to not sleeping well (which was only part of the story). The low iron and B12 along with SIBO were draining her energy.
Bacteria in the gut, if the wrong kind, feeds off our nutrients like iron. Also with the leaky gut she wouldn’t have been absorbing nutrients efficiently, leaving her weak, deprived and lethargic.
So we set to work with a three-month healing program to clear and heal the gut, using a SIBO Diet along with herbs to kill off the bad bugs and then good bacteria to re-establish the good guys.
Within a couple of days, the diet made a huge difference to her bloating and flatulence and her energy levels also began to pick-up. I also put her onto some vitamin D drops as she didn’t like going out into the sun.
Two months later I asked June to repeat the tests which showed improved levels of Iron and B12, which meant she no longer had the gremlins sucking the good bacteria out of her. Her vitamin D was in the normal reference range, but we continued with the vitamin D treatment for a while longer to bring the levels to ‘optimal’.
June’s energy was much better, and the great news was that she was sleeping well because her restless legs syndrome had almost disappeared.
After the three-month healing program, she then switched to the Diet for Restless Legs, which was a moderate Level 2 SIBO diet, rich in iron and B12 foods, and I kept her on probiotics for a while longer.