Restless Legs When Resting

What Causes Restless Legs?

To successfully treat and prevent recurrence of restless legs we need to understand and — if possible — remove the underlying causes and risk factors.  We need to ask: "What else is going on inside the body that might allow restless legs to develop?"

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Accurate diagnosis of the factors behind restless legs consists of three steps:

Step 1: List the Possible Causative Factors

Identify all disease conditions, lifestyle choices and environmental risk factors that can lead to restless legs.  Here are eight of many possibilities (more below):
  • Iron Need
  • Neuritis/Neuropathy
  • Sleep Apnea
  • Low Serotonin
  • Chronic Fatigue-Fibromyalgia
  • Hypoglycemia
  • Gluten Sensitivity
  • Rheumatoid Arthritis

Step 2: Build a Symptom Checklist

Identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
poor recovery from exertion
morning stiffness lasting hours
slight diffuse bone pain
strong appetite
adverse reaction to delayed meals
meals worsen left iliac pain
abnormal taste in mouth
being easily irritated
unsound sleep
frequent morning stiffness
low energy/stamina
refined sugar consumption
... and more than 110 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of restless legs:
Cause Probability Status
Neuritis/Neuropathy 99% Confirm
Gluten Sensitivity 29% Unlikely
Rheumatoid Arthritis 12% Unlikely
Low Serotonin 5% Ruled out
Chronic Fatigue-Fibromyalgia 3% Ruled out
Sleep Apnea 3% Ruled out
Hypoglycemia 2% Ruled out
Iron Need 2% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

In the Nervous System Symptoms section of the questionnaire, The Analyst™ will ask the following question about restless legs when resting:
When at rest, do you ever experience 'odd feelings' in your legs, and feel the need to move them in order to stop those feelings? This is known as Restless Legs Syndrome.
Possible responses:
→ Don't know
→ No
→ Yes, slightly / occasionally
→ Yes, definitely / often
Based on your response to this question, which may indicate either not having restless legs at night or restless legs at night, The Analyst™ will consider possibilities such as:
Caffeine Intoxication

Excess caffeine levels cause restlessness.  Caffeine has been shown to increase subjects' proneness to develop RLS at lower levels of blood glucose.  It is therefore no surprise that a xanthine-free diet (no coffee, tea, cola beverages, cocoa) has been reported to be another effective dietary measure RLS sometimes following a short period of caffeine withdrawal.  [J Clin Psychiatry 39: pp.693-8, 1978; Ann Intern Med 119: pp.799-804, 1993]

Folic Acid Deficiency

Restless Leg Syndrome may be an early neurologic manifestation of folate deficiency, the most common of all the vitamin deficiencies.  Often the deficiency is not due to a poor diet, but to a genetic factor causing a folate dependency.  While not all RLS patients complain of uncomfortable sensations, folate-deficient patients always suffer from them.  [Folic Acid in Neurology, Psychiatry and Internal Medicine, New York, Raven Press, 1979]

Hypoglycemia

Based on afternoon glucose tolerance testing, many patients with RLS – particularly if they also have spontaneous leg cramps – appear to have hyperinsulinism causing functional 'hypoglycemia' during testing.  In fact, some patients may have an attack of muscle cramps at the same time as their lowest level of plasma glucose.  In an open trial, a group of 350 patients with this type of glucose tolerance curve were placed on a sugar-free, high protein diet along with frequent nibbling and at least one night feeding.  The vast majority experienced a prompt remission or, at least, a striking reduction in symptoms.  [J Med Assoc 60(5): pp.29-31, 1973]

Iron Requirement

Iron deficiency (specifically blood ferritin below 50 mcg/L) accounts for 20% of all cases of RLS.  A 2007 study observed RLS features in 34% of patients having iron deficiency as compared to 6% of controls.

Low Serotonin Level

Tryptophan, a serotonin precursor, has been shown to help a small percentage of RLS sufferers.  [Am J Psychiatry 143(4): pp.554-5, 1986]

Magnesium Requirement

Magnesium deficiency, which is known to increase neuromuscular excitability, can also cause Restless Leg Syndrome.  [Rom J Neural Psychiatry 31(1): pp.55-6, 1993]

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