Dr Ginevra Liptan
By Ginevra Liptan, MD
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The throbbing, pulling or creeping sensations of Restless Legs Syndrome (RLS) can be miserable—and affect at least one third of all women with fibromyalgia. These uncomfortable feelings and urge to move the legs are often triggered by trying to relax or sleep, making it hard to fall and stay asleep. And it is not just the legs, some people experience the restless sensations in their arms or over their whole body! Since sleep is already a huge issue in fibromyalgia, it is really important to be look for and treat any condition that is making sleep worse.
If you answer yes to any of these questions, you may have Restless Legs Syndrome:
o Do you often get a strong urge to move your legs to relieve unpleasant sensations?
o Are the symptoms worse when you’re sitting still or lying down and resting?
o Do you get temporary relief from moving your legs or walking?
o Do the symptoms start or get worse in the evening or at night?
There are definitely medications that can help ease these symptoms, but many of them have significant side effects. Some very effective natural treatments for Restless Legs Syndrome to consider are iron, magnesium and cannabidiol (CBD).
Iron for Restless Legs
We know that restless legs is caused by low levels of the brain chemical dopamine, and many of the prescription treatments for RLS act to increase dopamine levels. Iron is a key player in the production of dopamine, so low iron levels in the brain may lead to low dopamine levels and restless legs symptoms. There has long been a suspected connection between low iron levels and RLS, and people with iron deficiency anemia often experience restless legs symptoms. However people with normal iron blood levels can still experience RLS, and it appears that it is the level of iron that reaches your brain that matters, not the amount floating in your bloodstream. One of my patients with severe RLS and normal blood iron levels had her symptoms eliminated after a series of intravenous (IV) iron infusions, which is the most effective way to get iron into the brain. One study found that IV iron infusions showed significant improvement of RLS symptoms in 76% of the subjects without any major side effects.
For patients with RLS I aim to get their ferritin levels (a blood test for iron) around 70 to maximize how much iron is getting into their brain. Typically any ferritin above 10 is considered “normal”, but if you have RLS it is worth a try to get your ferritin levels up into “optimal” range and see if symptoms improve. In my clinical experience, the results can be pretty dramatic, but be sure to talk with your health care provider before starting iron supplementation as your levels will need to be monitored to ensure they don’t get too high as that can be harmful. You want to find the amount of iron supplementation that keeps your ferritin around that optimal level of 70.
Some forms of iron can be hard on the stomach and cause nausea and constipation. I have found iron bisglycinate to be the best tolerated, my favorite is Opti-feren C by Pure Encapsulations. To optimize iron intake make sure to take it away coffee, tea, and calcium supplements as these can interfere with iron absorption. I often recommend taking any iron with dinner as most of us are not drinking coffee with dinner!
An alternative approach for those that don’t tolerate or absorb oral iron is to apply it transdermally. Yes, we can absorb some iron through our skin! Compounding pharmacies can make a prescription iron cream, although a few of my patients found it discolored their skin. For topical iron I prefer the PatchMD Iron Plus Topical Patch as it is less messy, cheaper, and has no skin discoloration issues.
In addition to getting ferritin levels up to optimal range, for those with severe RLS I will often add some specific nutrients that increase the ability of the body to utilize iron, like the active forms of B-6, B-12, and folate, found in MethylGuard by Thorne Research. For this purpose I have patients just add one capsule of MethylGuard per day.
Magnesium for Restless Legs
Magnesium is another beneficial mineral that can help RLS. Clinically I see this all the time and this study found it was effective for mild to moderate symptoms. Magnesium promotes muscle relaxation and soothes irritable nerve endings. The best form of magnesium for this purpose is magnesium glycinate 240mg to 480mg at bedtime. Magnesium glycinate is the type least likely to cause loose stool, one common and undesirable side effect of magnesium supplementation. Just like iron, we can absorb magnesium through our skin, so you can also apply magnesium oils and lotions directly to your legs. Remember that magnesium is a salt, so some oils can be irritating to the skin. My goal with Frida Botanicals magnesium cream was to make a potent cream that was still gentle and moisturizing. Some of my patients have found that a combination of oral and topical magnesium is the ticket to ease their restless legs symptoms while limiting the laxative effect.
Cannabidiol (CBD) for Restless Legs
Many patients have reported that cannabis (marijuana) eases their restless leg symptoms. This small study found 6 patients reported complete remission of their RLS with cannabis. Cannabis contains lots of different chemicals, so it is unclear which are specifically giving benefit for RLS, but CBD (cannabidiol), is suspected to be the key component of cannabis for RLS. In fact an Israeli company is currently studying CBD as a treatment for Restless Legs Syndrome.
CBD has strong muscle relaxant and nerve calming effects which can really ease the discomfort of restless legs. And just like iron and magnesium, CBD can be taken orally or applied topically to the legs. I have seen patients get improvement from CBD applied topically or a CBD tincture under the tongue before bed. And unlike cannabis, CBD does not have any psychoactive or mind-altering effects and if it is derived from hemp it is legal and accessible in all 50 states. If you want to learn more about CBD safety, effectiveness and dosing check out my other blogs here and here and my videos below.
The throbbing, pulling or creeping sensations of Restless Legs Syndrome (RLS) can be miserable—and affect at least one third of all women with fibromyalgia. Learn how iron, magnesium and CBD can help.
Cannabis for Restless Leg Syndrome
Learn the research relating to the use of cannabis for restless leg syndrome.
What is restless leg syndrome?
Restless Leg Syndrome (RLS) is a neurological disorder defined by an uncontrollable urge to move your legs. This urge is typically a result of uncomfortable sensations; described as tingling, “pins and needles,” prickling, pulling, or crawling. Symptoms are typically worst during the evening or nighttime hours and when a person is sitting down. Moving your legs does provide temporary relief but does not solve the problem. Because the symptoms occur during the evening and night the most significant impact is on a persons’ sleep.
Though restless leg syndrome does most commonly affect a person’s legs it can also affect their arms and/or torso.
There is no one cause of restless leg syndrome. There appears to be a genetic link as it can run in families and it can be caused by other conditions, like low iron. But, for most people who seek treatment there is no clear cause (see HealthlinkBC for more information about causes).
Traditional Treatment for RLS
For those with mild symptoms, lifestyle changes help manage the symptoms. Sleep Hygiene is a fantastic place to start when it comes to sleep-related disorders, check out our detailed post on sleep hygiene. But, we will discuss the changes you can make that are directly related to restless leg syndrome here:
- Exercise: Regular exercise is a healthy activity for our bodies and our brains. Though note that moderate activities such as walking relieves symptoms while exercising too much or at too great an intensity can increase symptoms.
- Stress Reduction Techniques: Stress can aggravate symptoms, so try relaxation activities like yoga or meditation. This is particularly helpful if done in the evening before bed.
- Quit smoking and drink less caffeine & alcohol: Each of these may worsen the symptoms of restless legs syndrome.
- Massage your legs or soak in a hot bath: These can help relax your muscles and alleviate the symptoms.
Use of Medication
Medication is used for those who have moderate to severe symptoms. The medications used are ones that impact the neurotransmitters in the brain, like dopamine. Often these are the same medications used for Parkinson’s Disease or for seizures. For those who experience a lot of pain as a result of RLS are sometimes prescribed painkillers like opiates. Read more about the use of medications for RLS here .
It’s interesting to note the types of medication used for RLS because we’ve already seen that cannabis can be an effective alternative to these medications. Read more about Parkinson’s Disease and Epilepsy (seizures). There are often problems associated with medications like side effects, tolerance, and addiction; therefore in some cases, cannabis can be a healthier alternative.
Cannabis and Restless Leg Syndrome
The major problem associated with RLS is the impact it has on a person’s sleep. Therefore, we can approach cannabis use from the perspective of getting better overall sleep. We talk about how cannabis and CBD can be used to get better sleep and manage insomnia in-depth here.
Initial research on cannabis and sleep shows that cannabis has a significant impact on a person’s ability to fall asleep. One study found that cannabis shortens the time it takes to fall asleep, both for people regardless of whether or not they normally have trouble with sleep. Those people with active difficulty falling asleep, cannabis use resulted in an average of 30 minutes less time in falling asleep. And those who did not have regular trouble falling asleep cannabis use helped them fall asleep even faster, by 15 minutes.
Though restless leg syndrome is more than simply disturbed sleep. People with RLS often experience painful feelings in their legs and therefore use muscle relaxation techniques to relieve symptoms. CBD has strong muscle relaxant and nerve calming effects which can really ease the discomfort of restless legs as well as help with the pain. You can also use cannabis topicals for restless leg syndrome; apply the topical directly to the site of discomfort.
But what does the research say specifically about cannabis and restless leg syndrome?
Unfortunately, there are few clinical trials specifically studying restless leg syndrome. Though one 2017 study discovered that inhaled medicinal cannabis lessened RLS symptoms. Five out of the six subjects experienced full symptom remission, and CBD played a large role in symptom alleviation. After the cannabis treatment ended, all participants experienced sleep improvements. As is the case with many conditions more research is in progress, an Israeli company is currently studying CBD as a treatment for RLS.
Despite the lack of clinical data, there is lots of anecdotal support for the use of cannabis for relieving symptoms of RLS. Check out some of the comments on Sleep Review Mag .
Best strain for Restless Leg Syndrome
With RLS we are focused on sleep, muscle relaxation and pain. So, we recommend starting with indica dominant hybrids that are higher in CBD content. Check out Leafy’s guide to strains that improve sleep as a place to start and talk to your local dispensary.
For those less experienced cannabis users, it may make sense to start with CBD only (vape pen or tincture, or consider CBD caps for easy dosing). THC not only produces a psychoactive high but can make you feel a bit groggy in the morning if you use too much. If you don’t see results from CBD alone after a week consider adding small amounts of THC as they interact with different receptors in the body. We suggest starting with a 3:1 CBD/THC tincture.
Cannabis topicals for Restless Leg Syndrome
Topicals are used for muscle relaxation. So, they can be added to your nightly routine to help manage symptoms associated with RLS. Miss Envy has Buddha Buddha creams that are applied directly to the skin. We also suggest trying a soothing THC bath bomb in your hot bath before bed to add to your relaxation. Note that even though these are THC products you will not experience a high from these body products.
So, even as we wait to see the results of more studies on cannabis and RLS people are seeing results. So, it’s worth experimenting with cannabis to see if it may work for you. Just remember to start at a lower dose and slowly work your way up over a few days until you feel the relief you’re looking for.
Use cannabis for restless leg syndrome and get a better sleep. Even use cannabis topicals for restless leg to relax you muscles.