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):
- Uremia
- Iron Need
- Parkinson's Disease
- Sjogren's Syndrome
- Juvenile Rheumatoid Arthritis
- Iron Deficiency Anemia
- Chronic Fatigue-Fibromyalgia
- Magnesium Need
Step 2: Build a Symptom Checklist
Identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
highly elevated ANA levels
severely impaired ability to walk
non-specific arm pain
unsound sleep
iron deficiency anemia
being very easily irritated
discontinued non-human estrogen use
eleven or more tender points
refined sugar consumption
major joint pain/swelling/stiffness
moderate morning stiffness
severe diffuse bone pain
highly elevated ANA levels severely impaired ability to walk non-specific arm pain unsound sleep iron deficiency anemia being very easily irritated discontinued non-human estrogen use eleven or more tender points refined sugar consumption major joint pain/swelling/stiffness moderate morning stiffness severe diffuse bone pain... and more than 100 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 |
|---|---|---|
| Juvenile Rheumatoid Arthritis | 94% | Confirm |
| Sjogren's Syndrome | 17% | Unlikely |
| Iron Deficiency Anemia | 13% | Unlikely |
| Chronic Fatigue-Fibromyalgia | 3% | Ruled out |
| Magnesium Need | 3% | Ruled out |
| Iron Need | 3% | Ruled out |
| Parkinson's Disease | 2% | Ruled out |
| Uremia | 1% | 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 |
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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Last updated: May 25, 2023