Restless Leg Syndrome

 My mom suffers from what the doctors believe is restless leg syndrome. She was prescribed a prescription which costs $130.00 for 30 days. She does not have RX coverage so my question is: Are there OTC medicines, herbals of any kind or other remedies to help her with RLS other than a pharmaceutical?

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Restless leg syndrome is characterized by the irresistible desire to move one’s body to avoid an uncomfortable sensation often at night when attempting to sleep.  The legs are most often involved, but it can affect any of the limbs and more rarely the trunk.  No clear cause is known, but it is more prevalent in women and might have a genetic link based on the fact it is often seen in related family members.   It is understood that dopamine, a very powerful brain neurotransmitter, plays a key role in the development of RLS. 



The Standard Approach:

Prescription drugs for RLS can often be effective but are well known to cause, over time a rebound type effect.  This is often characterized by the emergence of symptoms earlier in the day or a worsening of symptoms if the medication is not taken.  The most popular drugs for RLS are called dopamine agonists, meaning they enhance the effects of dopamine in the brain.  Not only do these drugs cause most RLS symptoms to become worse over time, there is emerging evidence they can influence certain behavior patters.   In 2007 the Mayo clinic released the first study to describe the link between compulsive gambling in RLS patients who are being treated with medications that stimulate dopamine receptors in the brain.  They recommend all physicians screen RLS patients for impulsive behavior tendencies before prescribing a dopamine agonist drug.


Natural Approaches:

One of the most well documented non-pharmaceutical approaches to treating restless leg syndrome is iron supplementation.  Iron plays a key role in the production of dopamine.  It seems particularly effective if an individual has a ferritin level below 60 micrograms.  Ferritin is the way your body stores iron.  Making sure your mom has had her ferritin levels checked is a great place to start.  Iron supplements are extremely inexpensive and as noted can be very effective in certain cases of RLS.


Other natural approaches to RLS can be effective but few of them have rigorous scientific backing.  Most are strategies passed among doctors who have seen widespread success in their patient populations.    


One of the most effective supplements seen to aid RLS is high dose folic acid.  Most reports from clinical practice use anywhere from 10mg per day to up to 60mg per day.  I have seen 20mg per day be very effective and safe.  High doses of folic acid are often a prescription item but they can be found as OTC preparations as well.  The reason why the FDA mandates high dose folic acid be a prescription is because taking too much folic acid can mask a B12 deficiency.  However, if someone is eating foods rich in B12 like meat products, diary products and eggs and taking a multivitamin with B12 there is very little chance they will have a B12 deficiency.  To be safe, your mom can ask her doctor for a very simple blood test to measure B12 levels.  Otherwise, folic acid is considered very safe and has no known toxicity in humans. 


Some people also find vitamin B6 and Magnesium to be helpful for their RLS symptoms.  Magnesium deficiency is quite common in our population and this key nutrient plays a critical role in muscle relaxation.  The exact mechanism of how B6 affects RLS is not clear but due to its low toxicity and possible effectiveness it is often worth a try. 


Other things to consider are removing exposure to dietary and lifestyle influences that can worsen RLS symptoms.  Dietary stimulants like coffee and chocolate often worsen symptoms.  In addition, alcohol also seems to have a negative effect on some RLS patients and discontinuing all use for a trial period of 4 weeks should be considered. 

Back to all Questions     View More by Dr. Kevin Passero

Lead Medical Director

As a certified and fully trained Naturopathic Doctor, Passero has trained and preceptored with some of the nation's leading doctors in the field of natural medicine, working under the guidance of MD’s, Chiropractors, Naturopaths and Acupuncturists. Furthermore, he is currently the Vice President of the Maryland Association of Naturopathic Physicians.

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