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restless leg syndrome

  • The most common nutritional deficiency in the U.S. is iron deficiency. And, women are at greatest risk for obvious reasons that include monthly cycles, childbirth, hormone changes, etc. Without hemoglobin, a protein that helps red blood cells deliver oxygen throughout the body, health cannot be achieved—iron delivers that. When iron is deficient it leads to a disorder called anemia but that condition carries a litany of symptoms that can usually only be medically identified through a ferritin test that measures your body’s iron levels.

    Common signs you may be iron deficient:

    • Lethargy
    • Fatigue
    • Malaise/depression
    • Angina
    • Impaired cognition
    • Impaired immune system
    • Anorexia
    • Intolerance to cold
    • Endocrine/metabolic abnormalities
    • Cardiorespiratory disturbances
    • Gastrointestinal disturbances
    • Tendency toward bleeding
    • Reduced exercise tolerance
    • Weakness
    • Shortness of breath
    • Exertional chest pain
    • Impaired concentration
    • Impaired libido/impotence
    • Insomnia
    • Headache
    • Pallor
    • Neuromuscular disturbances
    • Cutaneousdisturbances
    • Musculoskeletal symptoms
    • Pruritus

    The following are the most common signs you may be iron deficient:

    Monthly Menstrual Cycles — women are often anemic due to heavy periods that significantly reduce blood levels; when iron is deficient, the replacement is only about half of the blood loss and the following month the cycle repeats. According to director of gynecology at Mount Sinai in New York City, Jacques Moritz, MD, the monthly period of a woman should only fill a total of two to three tablespoons each month; if you lose more than that, get your ferritin levels checked.

    Unexplained Exhaustion and Stamina — being overly tired is often too easily dismissed as just part of modern day stress. Most of us, especially women, are so programmed to living hectic lives, being all things to everyone that they easily dismiss symptoms, especially if they’re a single mother. That said, if you’re iron deficient then less oxygen reaches your tissues so your body cannot generate the energy needed.

    Those who are diagnosed with iron deficiency are often labeled as having “tired blood” because they experience weakness, extreme fatigue/endurance, irritability, brain-fog and often muscle weakness.

    Colorless Complexion — hemoglobin is responsible for the red color in your blood and that rosy hue/glow to your complexion, regardless of your skin color, because any skin tone can look pale or sickly. This often occurs because low levels of protein suck the color straight from the skin. Those with a light or fair complexion can easily be spotted. However, those with darker complexions may have to look inside their lips, gums, and inside of their bottom eyelids to see if they’re less red/rosy than normal from iron deficiency.

    Short-winded — when you’re iron deficient, oxygen levels are reduced and can manifest as shortness of breath while doing ordinary tasks that you normally handle without those symptoms, like gently climbing stairs or your morning walk.

    Unusual Heart Rhythms— heart irregularities don’t usually show up with mild iron deficiency. That said, when the deficiency is long-standing or you have been diagnosed with a heart condition, your physician should perform an in-depth analysis if you experience irregular heartbeats, heart murmurs, enlarged heart or even heart failure. The Texas Heart Institute Journal suggests getting your iron levels checked if you have any heart irregularity because iron deficiency can worsen a heart condition.

    Restless Leg Syndrome — according to John Hopkins Medical Center, more than 15 percent of those with restless leg syndrome have been found to also to be victims of iron deficiency and the more deficiency the more symptoms of this syndrome.

    Headaches — if no other known cause is present, consider iron deficiency as a cause of chronic headaches. The brain’s arteries can swell when insufficient oxygen is provided, causing headaches.

    Strange Cravings — yes, there is actually a name for strange cravings like those for ice, clay, dirt, chalk, and paper. These cravings are called pica and it’s often caused by an iron deficiency, according to Dr. Berliner of the National Headache Foundation. So, if you begin to have strange cravings, get your iron levels checked.

    Anxiety and Panic — yes, life is stressful but when iron deficient it can turn that normal anxiety into panic as the lack of oxygen triggers your sympathetic nervous system like putting the “petal to the metal” and speeding up your responses. In addition, the panic becomes fight-or-flight mode as the iron deficiency persists even when you keep thinking, “I have no reasons for this unsettling panic.”

    Vegetarian Syndrome — you may believe that all iron is the same, not so quick! Your body best absorbs heme iron, which is derived from meat, poultry and fish at a rate of three or more times more efficiently than non-heme iron derived from plants. Yes, vegetarians can get enough iron but it requires very careful meal planning and adherence. A good way to get enough good iron is to eat dark leafy greens, whole grains, and legumes that are rich in iron and then consume them along with vitamin C-rich foods like peppers, berries and broccoli that help boost absorption.

    Hypothyroid Syndrome — low thyroid function is unfortunately fast becoming the “norm.” When the body is iron deficient, it slows the thyroid function and blocks its metabolism-boosting effects. If you notice unusually low energy levels, weight gain and inability to lose it in spite of healthy eating and exercise, low body temperature and increased sensitivity to cold, have your iron levels checked and also do the iodine absorption test to see how deficient you really are in supporting thyroid function. To download instructions for the iodine patch test you do at home go to www.gloriagilbere.com and look for “Downloadable Forms” in the tool bar.

    Pregnancy — according to Dr. Moritz, if your pregnant (especially with multiples), have pregnancies close together, regularly vomit from morning sickness or lost a substantial amount of blood during delivery, have iron levels checked. Iron doesn’t get the attention in pre-natal nutrition, as does folic acid for instance, but it should, because not only does the mother need to boost iron levels, so does the baby.

    Tongue Disorders — iron deficiency can reduce levels of myoglobin, a protein in red blood cells that supports muscle health, and that includes the muscle making up your tongue. As a result, iron deficient people complain of a sore, inflamed, and strangely smooth tongue with little color.

    Celiac and Inflammatory Bowel Disorders — because these disorders create challenges in nutrient absorption, additional iron is needed. These disorders cause acute inflammation and damage to the digestive system, be sure to check for iron deficiency.

    Getting More Iron —there is no one-size-fits-all for iron supplementation. However, women between ages 19 and 50 need about 18 mg. daily. If pregnant, increase up to 27 mg. with guidance from your physician. If breast-feeding 9 mg. is usually recommended, check with your doctor. Older than age 50, and not menstruating, you usually only need 8 mg. daily — easy to obtain as a single serving of lentils, spinach, beef, nuts, chicken, or chickpeas will provide your daily dose.

  • Do your legs kick around a lot at night? Are your sheets and blankets scattered around a lot when you wake up? Does your spouse note they get kicked around a lot at night or that your legs jump? If so, you probably have restless legs syndrome (RLS), more accurately called periodic leg movement disorder of sleep (PLMD), and it is contributing to your fatigue and pain. Although you may be asleep through the night, your legs are running a marathon and you wake up exhausted!

    Restless leg syndrome is very common, being present in ˜20 percent of the population.

    One of the most common and easily treated causes of RLS is simply iron deficiency. Studies show that bringing the ferritin level (the best iron test) up over 60 is helpful. That your iron levels are in the "normal range" (i.e.— over 12) does not mean that you do not have iron deficiency. Rather, ask your doctor to check a blood ferritin level and get the actual result from them. If it were under 60, I would take iron until your blood ferritin level is over 60.

    Other nutrients, especially B vitamins and magnesium, can also be helpful for keeping your legs and muscles calm while you sleep. These (though not the iron) are present at optimal levels in the Energy Revitalization System multivitamin powder.

    Are you ready to make your restless leg syndrome go away? Read more...

    The Causes of Restless Leg Syndrome

    A number of factors contribute to RLS. These include:

    1. Inadequate levels of the brain neurotransmitter called dopamine. This is very common, and also contributes to increased pain. Iron is critical for the production of dopamine, although once the ferritin level is over 60, you have received the maximum benefit.
    2. Medications. These include antidepressants and allergy medications.
    3. Suboptimal levels of thyroid. Optimizing thyroid often can be very helpful.
    4. Drops in blood sugar while sleeping. This can often be helped by simply eating one to two ounces of protein at bedtime (e.g.-a hard-boiled egg). Try this for a week to see if it helps.

    Diagnosing Restless Leg Syndrome

    If you tend to scatter your sheets and blankets, and especially if you tend to kick your bed partner or if you note that your legs tend to feel jumpy and uncomfortable at rest at night, you probably have restless leg syndrome. You can also have a sleep study done to look for leg muscle contractions. I recommend that you save yourself $2000 though, and simply start by videotaping yourself sleeping one evening, (you can use your cell phone). Leave off your sheets and blankets when you first go to sleep and aim the video camera so you can see both your legs and your face. This way the next day you can watch and look for evidence of either jumping legs (RLS) or snoring associated with stopping breathing (sleep apnea).

    Addressing Restless Leg Syndrome

    There are both natural and prescription approaches to calming down your legs at night, so both you and your legs can get a good night sleep.

    Natural Options For Restless Leg Syndrome

    1. Avoid caffeine in the evening.
    2. Because restless leg syndrome may be associated with low blood sugar, eat a 1-2 ounce protein snack at bedtime.
    3. As noted above, if your serum ferritin score is under 60, take an iron supplement at bedtime. Do not take it within 2-6 hours of thyroid supplements, or you won't absorb the thyroid. Take 25-50 mg of iron and 50-100 mg of vitamin C with it so that you absorb the iron.

    Prescription Treatments
    Neurontin can be very helpful for both restless leg syndrome, and treating insomnia and muscle pain in general. I advise people to adjust the dose to not only get adequate sleep, but to also keep the bedcovers in place and to avoid kicking their partners. You can get your 8-9 hours of restorative sleep a night!

     

  • DOES IT SEEM LIKE EVERY NIGHT AT 2–4 A.M. YOUR INTERNAL ALARM CLOCK GOES OFF? THIS IS ONE OF THE MOST COMMON PROBLEMS PEOPLE WITH FIBROMYALGIA HAVE, AND IS INCREASINGLY COMMON IN THE GENERAL POPULATION AS WELL.

    But what if it was optional?
    Here are some of the major causes:

    1. Drops in blood sugar. This is a major problem in people with adrenal fatigue. It can be especially common in people who are exhausted and "hangry" (hungry when angry) all day and whose minds suddenly go wide-awake at bedtime. The drop in blood sugar triggers an adrenaline rush and you're suddenly wide-awake.

    The solution? Have a 1–2 ounce high protein snack at bedtime such as a hard-boiled egg or some cheese, meat or fish. A sugary or high carbohydrate snack will actually make the problem worse. You will know if this is helping after one or two nights.

    2. Frequent urination. In addition to the other hormonal problems seen in fibromyalgia, people often have a drop in antidiuretic hormone (ADH or vasopressin). This makes it hard to hold onto water so you "drink like a fish and pee like a racehorse." This can keep you up at night as well.

    The solutions?

    • Because we are an upright species, gravity pools fluid in our legs. As much as a quart or two. When you lie down, it goes back into the rest of your body. Kind of like drinking a quart or two of water while you're sleeping. To prevent this, prop your feet up for a few hours before bedtime when you are sitting around. This way they can drain and you can pee the fluid out before you go to bed.
    • A simple prescription nose spray or tablet called DDAVP supplies the antidiuretic hormone. So you aren't up all night peeing. This is the same treatment they give kids who bed wet. Taken during the day, it also has been helpful for low blood pressure problems (orthostatic intolerance). The dose is 1/10 mg, one or two sprays or tablets at bedtime.
    • Avoid drinking a lot of fluids, especially with caffeine, for a few hours before bedtime.
    • If you are only urinating small volumes, hold off on going to the bathroom for five minutes. You will often have fallen back asleep by then, and this will retrain your bladder to sleep through the night.
    • If you have urinary urgency (including incontinence during the day), try the herb Angelica (SagaPro by EuroPharma) which helps promote healthy bladder function. This way you can more easily sleep all night. And during the day you won't find yourself laughing so hard that the tears run down your leg!

    3. Night sweats. This can come from a number of problems. In fibromyalgia, I find that the most common ones are hormonal deficiencies (estrogen and testosterone), and infections (especially Candida). We have discussed how to treat these in earlier articles.

    Another common cause is nighttime acid reflux. Although you may sometimes notice the heartburn when you wake up, other times you won't and you'll just wake up in a sweat after inhaling the stomach acid. This is especially likely to be a problem if you have daytime indigestion as well. After three weeks doing the below, you may find your daytime heartburn starts to settle down as well.

    A. Start by taking an acid blocker such as Prilosec or Nexium an hour before bedtime for three to four nights. If this helps, you've identified the problem. Stop the acid blocker, as it is quite addictive and toxic when used long-term. Instead follow the instructions below.

    Though it's a bad idea to keep your stomach acid "turned off" during the day (you need it to digest food), you don't need stomach acid at bedtime while sleeping. So here are a few tips:

    B. Bicarbonate of soda. Take ½ tsp of bicarbonate of soda (e.g., Arm and Hammer) in 4 oz of water at bedtime to neutralize the acid in your stomach (not for children under 16 years old).

    C. Don't eat within two hours before bedtime and take two caps of a plant based digestive enzyme an hour before sleep. This will ensure your stomach is empty when you sleep.

    D. Sleep with your upper body elevated. Raise your upper body at least 6–8 inches when in bed (just raising your head with pillows won't work). One way to do this is to place a 6–8" brick or phone book under the legs of the bed (just the two legs by the end of the bed where your head is). Another wonderful solution is to use a sleep wedge pillow (you can find one online at www.Hammacher.com.

    E. Melatonin. Take 5–6 mg at bedtime. This decreases reflux.

    F. Immediate Heartburn Relief chewable antacids. Keep a few at bedside to take if needed.

    4. Pain. If pain is keeping you awake at night, it absolutely should be eliminated. Getting sleep will then actually help the pain to decrease over time. Some especially helpful treatments, which also can help support healthy sleep, include (these can all be used in combination in the low doses recommended):

    A- Medications:

    1. Flexeril (cyclobenzaprine) 5 mg. One half—one tablet at bedtime.
    2. Ultram (tramadol) 50–100 mg. Although this is treated like an addictive medication, I've never seen anybody with a tramadol addiction, nor have the addiction specialists I've asked. Still, use the other medications instead if you are taking low dose naltrexone.
    3. Zanaflex (tizanidine) 4 mg. One half one at bedtime. Stop it in the rare event that it causes severe nightmares and it should not be combined with Cipro.
    4. Neurontin (gabapentin) 100–600 mg.
    5. Elavil (amitriptyline) 10–25 mg. This medication combined with Neurontin can be especially helpful for people with pelvic pain, such as interstitial cystitis or vulvodynia.

    B-Herbals:

    1. Curamin. This mix has been a pain relief miracle for many people, and can be taken one or two capsules, three times a day as well. It continues to increase in effectiveness over six weeks and can be taken with any pain medications.
    2. 5 HTP 300 mg. After six weeks, it helps sleep, decreases pain, and even improves mood.
    3. Terrific ZZZZ. It will also have a calming effect.

    For more sleep information, see my recent articles in which we discussed medications and natural remedies as well as treating sleep apnea and restless leg syndrome.

    You can get a solid eight to nine hours of sleep a night—even with fibromyalgia!

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