I’ve been told by three medical doctors that I have restless leg syndrome. However, none will tell me what to do about it. I have leg and arm spasms all night long. The condition is getting worse (over a long period of time). At first it was just my legs, now my legs and arms. At first it started after I fell asleep, now I can feel it coming on before I fall asleep. Some evenings my leg muscles will start tightening up while I’m just sitting, relaxing before I even go to bed. What can I do about it? I’m losing a LOT of sleep!
—V. S., Shelby Township, Michigan
Stansbury responds: Restless leg syndrome is a poorly understood ailment involving altered motor nerve impulses in the legs, primarily. Although the muscles are most obviously affected, the underlying cause involves the nervous input that controls muscle tone. Muscle relaxants and nerve sedatives are the most widely used pharmaceuticals for this complaint, with varying degrees of success, and often with numerous side effects such as fatigue and muscle weakness. Alternative treatments include both nutrients and herbs that affect nerve impulses and muscle tone.
Magnesium is important to try because this mineral is involved with both muscle tone and the synthesis of neurotransmitters enabling nerve conduction. Calcium is also involved in muscle tone, and a deficiency of this mineral is associated with muscle cramps. Try 750 to 1,000 mg of magnesium and 1,000 to 2,000 mg of calcium per day, taken in the evenings.
Another important supplement to begin is a B-complex vitamin. B vitamins are also involved in the synthesis of neurotransmitters, and deficiency states are associated with muscle twitching, tingling in the arms and legs, and numerous nerve symptoms. Look for a “high dose” multi B-vitamin combination, one that claims to have ten times the RDA or even substantially more of thiamine (B1), riboflavin (B2), niacin (B3), pyridoxine (B6), and cyanocobalamin (B12). Take B vitamins with meals two or three times a day. Improvements may be noted fairly quickly with magnesium, calcium, and the B vitamins, perhaps in just a few weeks’ time, with more substantial and lasting effects being obtained over a few months.
Herbs to consider include the nerve-toning and muscle-relaxing plants. First, the nerve toners: Milky oats (Avena sativa), gotu kola (Centella asiatica), and ashwaganda (Withania somnifera) have long been used for nervous deficiency. By various mechanisms, these herbs may all improve nerve tone and adrenal and central nervous system control of muscle tone and reduce the restless leg condition over time. You may take one or all of these herbs several times per day for several months—gradual improvement should occur over time.
Muscle-relaxing herbs taken before bed may improve the quality of your sleep. Passionflower (Passiflora incarnata), valerian (Valeriana officinalis) and kava (Piper methysticum) are all muscle-relaxing and sleep-enhancing herbs. Take one or more of these at night before bed—perhaps a dose an hour before bed and a dose at bedtime. If you don’t notice anything upon the first night of use, double or even triple the dose on the following evenings, as these should work right away. These muscle relaxants, although fast-acting, may not correct the underlying problem in any lasting way (as may the previous suggestions) and will likely have to be used over and over again.
Willard responds: Restless leg syndrome is becoming more common these days, being one of the more frequent causes of insomnia, especially in the elderly. The bad news is that no one really knows what causes it. The good news is that the practitioners in my clinic have been having great success providing relief for the syndrome. There are a few things we use: folic acid, iron supplements, alpha lipoic acid, magnesium, kava, ginkgo (Ginkgo biloba), garlic and reishi mushroom. I usually start with folic acid, about 2 mg twice daily. Most of the research in this area suggests that a person needs between 35 and 60 mg of folic acid; however, this quantity is hard to obtain without a prescription. Instead, I have tried lower doses with good success. I would easily say that well over 40 percent of my patients get better within two weeks with folic acid alone. If I haven’t seen results within the two weeks, the next item I use is iron. There have been several studies suggesting that iron deficiency, without anemia, is related to restless leg syndrome. I usually recommend 50 mg of iron (amino acid chelate), twice daily for about a month (or until the symptoms abate), then reduce to 25 mg daily for six months.
Alpha lipoic acid has also been very useful in these conditions. If I don’t get the desired results within one month, I add 100 mg of alpha lipoic acid, twice daily. If I get into the third month without significant results, then I bring out all of the guns. In this case, I double the folic acid and alpha lipoic acid and add magnesium (250 mg before bed), kava (two 500-mg capsules twice daily), ginkgo (80 mg twice daily), garlic (two 500-mg capsules twice daily), and reishi extract (two 60-mg capsules twice daily).
Even though this seems like an extensive protocol, I am confident that this will relieve your restless leg syndrome. I hope you can reduce your symptoms after the first two weeks.
Terry Willard is a clinical herbalist, president of the Canadian Association of Herbal Practitioners, and founder of the Wild Rose College of Natural Healing in Calgary, Alberta, Canada. He is the author of eight books and a CD-ROM, Interactive Herbal.
Jill Stansbury has been a naturopathic physician for more than ten years, with a private practice in Battle-ground, Washington. She is the chair of the Botanical Medicine Department at the National College of Naturopathic Medicine in Portland, Oregon, and the author of many books including Herbs for Health and Healing (Publication International, 1997).
The information offered in “Q & A” is not intended to be a substitute for advice from your health-care provider.