Dr Ginevra Liptan
By Ginevra Liptan, MD
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The throbbing, pulling or creeping sensations of Restless Legs Syndrome (RLS) can be miserable—and affect at least one third of all women with fibromyalgia. These uncomfortable feelings and urge to move the legs are often triggered by trying to relax or sleep, making it hard to fall and stay asleep. And it is not just the legs, some people experience the restless sensations in their arms or over their whole body! Since sleep is already a huge issue in fibromyalgia, it is really important to be look for and treat any condition that is making sleep worse.
If you answer yes to any of these questions, you may have Restless Legs Syndrome:
o Do you often get a strong urge to move your legs to relieve unpleasant sensations?
o Are the symptoms worse when you’re sitting still or lying down and resting?
o Do you get temporary relief from moving your legs or walking?
o Do the symptoms start or get worse in the evening or at night?
There are definitely medications that can help ease these symptoms, but many of them have significant side effects. Some very effective natural treatments for Restless Legs Syndrome to consider are iron, magnesium and cannabidiol (CBD).
Iron for Restless Legs
We know that restless legs is caused by low levels of the brain chemical dopamine, and many of the prescription treatments for RLS act to increase dopamine levels. Iron is a key player in the production of dopamine, so low iron levels in the brain may lead to low dopamine levels and restless legs symptoms. There has long been a suspected connection between low iron levels and RLS, and people with iron deficiency anemia often experience restless legs symptoms. However people with normal iron blood levels can still experience RLS, and it appears that it is the level of iron that reaches your brain that matters, not the amount floating in your bloodstream. One of my patients with severe RLS and normal blood iron levels had her symptoms eliminated after a series of intravenous (IV) iron infusions, which is the most effective way to get iron into the brain. One study found that IV iron infusions showed significant improvement of RLS symptoms in 76% of the subjects without any major side effects.
For patients with RLS I aim to get their ferritin levels (a blood test for iron) around 70 to maximize how much iron is getting into their brain. Typically any ferritin above 10 is considered “normal”, but if you have RLS it is worth a try to get your ferritin levels up into “optimal” range and see if symptoms improve. In my clinical experience, the results can be pretty dramatic, but be sure to talk with your health care provider before starting iron supplementation as your levels will need to be monitored to ensure they don’t get too high as that can be harmful. You want to find the amount of iron supplementation that keeps your ferritin around that optimal level of 70.
Some forms of iron can be hard on the stomach and cause nausea and constipation. I have found iron bisglycinate to be the best tolerated, my favorite is Opti-feren C by Pure Encapsulations. To optimize iron intake make sure to take it away coffee, tea, and calcium supplements as these can interfere with iron absorption. I often recommend taking any iron with dinner as most of us are not drinking coffee with dinner!
An alternative approach for those that don’t tolerate or absorb oral iron is to apply it transdermally. Yes, we can absorb some iron through our skin! Compounding pharmacies can make a prescription iron cream, although a few of my patients found it discolored their skin. For topical iron I prefer the PatchMD Iron Plus Topical Patch as it is less messy, cheaper, and has no skin discoloration issues.
In addition to getting ferritin levels up to optimal range, for those with severe RLS I will often add some specific nutrients that increase the ability of the body to utilize iron, like the active forms of B-6, B-12, and folate, found in MethylGuard by Thorne Research. For this purpose I have patients just add one capsule of MethylGuard per day.
Magnesium for Restless Legs
Magnesium is another beneficial mineral that can help RLS. Clinically I see this all the time and this study found it was effective for mild to moderate symptoms. Magnesium promotes muscle relaxation and soothes irritable nerve endings. The best form of magnesium for this purpose is magnesium glycinate 240mg to 480mg at bedtime. Magnesium glycinate is the type least likely to cause loose stool, one common and undesirable side effect of magnesium supplementation. Just like iron, we can absorb magnesium through our skin, so you can also apply magnesium oils and lotions directly to your legs. Remember that magnesium is a salt, so some oils can be irritating to the skin. My goal with Frida Botanicals magnesium cream was to make a potent cream that was still gentle and moisturizing. Some of my patients have found that a combination of oral and topical magnesium is the ticket to ease their restless legs symptoms while limiting the laxative effect.
Cannabidiol (CBD) for Restless Legs
Many patients have reported that cannabis (marijuana) eases their restless leg symptoms. This small study found 6 patients reported complete remission of their RLS with cannabis. Cannabis contains lots of different chemicals, so it is unclear which are specifically giving benefit for RLS, but CBD (cannabidiol), is suspected to be the key component of cannabis for RLS. In fact an Israeli company is currently studying CBD as a treatment for Restless Legs Syndrome.
CBD has strong muscle relaxant and nerve calming effects which can really ease the discomfort of restless legs. And just like iron and magnesium, CBD can be taken orally or applied topically to the legs. I have seen patients get improvement from CBD applied topically or a CBD tincture under the tongue before bed. And unlike cannabis, CBD does not have any psychoactive or mind-altering effects and if it is derived from hemp it is legal and accessible in all 50 states. If you want to learn more about CBD safety, effectiveness and dosing check out my other blogs here and here and my videos below.
The throbbing, pulling or creeping sensations of Restless Legs Syndrome (RLS) can be miserable—and affect at least one third of all women with fibromyalgia. Learn how iron, magnesium and CBD can help.
Using CBD for Restless Legs May Help You Manage Your Symptoms
Restless legs syndrome (RLS) affects up to 10% of the U.S. population, but not many people know what it is, or that it might be the cause of sleep issues and other symptoms they’ve been experiencing. Unfortunately, RLS often goes unrecognized or misdiagnosed as a number of other conditions.
Although the medical community is becoming more adept at recognizing and treating the syndrome, it can be difficult for those suffering from it to find an effective way of alleviating their symptoms. For those with RLS who struggle with insomnia, CBD oil is an alternative treatment that people have used to reduce the sensations restless legs syndrome triggers and help get a good night’s sleep.
What is Restless Legs Syndrome?
Restless legs syndrome, also known as Willis-Ekbom Disease, is a nervous system disorder connected with the component of the nervous system that causes an urge to move the legs. This usually interferes with sleep, causing the condition to also be classified as a sleep disorder.
RLS results in tingling, itching, and other uncomfortable or painful sensations in the legs. They usually occur when you’re sitting or lying, most often at night or in the evening. This results in a compulsive urge to move the legs in order to relieve the sensations. Symptoms of RLS also include daytime fatigue, unintentional movements, and general restlessness.
While most of those who are severely affected are middle-aged or older, the syndrome can develop at any age. It affects both sexes, but is most common in women. Doctors are unsure what causes it, although it is believed that genes play a role. Almost half of those with RLS have a family member with the condition.
Treatment for RLS
Because misdiagnosis of restless legs syndrome is common, patients are often prescribed medication better suited for another condition, which may worsen their symptoms. If you’ve been diagnosed with a similar condition but found that your medication produces negative effects, talk to your doctor about RLS.
For those struggling to treat restless legs syndrome, there are certain lifestyle changes that might reduce your symptoms. Exercising regularly, going to bed at a consistent time, and eliminating alcohol, caffeine, and tobacco from your consumption habits may be helpful.
There is no known cure for RLS, but there are many alternative treatments that produce new success stories. Possible remedies include leg massages, hot baths, heating pads, and hemp-based extracts like CBD. The end goal is to ease your symptoms and make your everyday tasks and activities more manageable.
How CBD can Help You Manage Your Symptoms
Cannabidiol (CBD) is a cannabinoid that interacts indirectly with receptors in the body’s endocannabinoid system. This action essentially greases the system’s gears and maximizes its ability to do its job—which is to promote optimum functioning in the body’s other systems.
Taking CBD can help your body maintain homeostasis and lessen any symptoms that are preventing certain bodily functions from operating properly. In the case of RLS, this applies to CBD’s ability to help those who suffer from lack of sleep. Many people experience difficulty maintaining a consistent sleep-wake cycle, but taking CBD for sleep has shown to improve sleep quality and make it easier to fall asleep.
There are a limited number of clinical trials on the effects of medical marijuana or other forms of cannabis on RLS. However, one 2007 study determined that Sativex, a sublingual spray containing both CBD and THC, helped about half of the participants with treating insomnia.
Scientists believe CBD is the component of cannabis that plays the largest role in alleviating symptoms. Another study from 2017 found that inhaled cannabis reduced the symptoms of RLS. Following treatment, all of the study participants experienced improvements in sleep quality, supporting the notion that CBD’s soothing, sedative qualities allow the body to relax and fall into a proper sleep cycle.
Restless legs syndrome can cause painful sensations and general discomfort that keeps you up at night, but CBD may help reduce these symptoms.