Restless Legs Syndrome and Heart Disease Risk

February 5, 2018 | Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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Restless Legs Syndrome and Heart Disease Risk
Twitchy, jumpy, restless legs before sleep or after resting or sitting for an extended period of time can interfere with life. It can affect a good night’s sleep and ultimately disrupt daytime energy. Sleep may even be upset for those who share a bed with the person with restless legs syndrome. Restless legs are more than legs that are restless – it may also be a predictor of other health concerns, including cardiovascular disease. These symptoms reflect a need for further support.

Restless Legs Syndrome

Restless legs syndrome (RLS) is a neurological sleep disorder. Restless legs syndrome symptoms typically worsen at night, especially when trying to get to sleep. Symptoms may also occur after a period of rest or sitting, especially with traveling. The sensation of needing to move the legs or a jumpy, creeping, crawling, itchy, jittery feeling can be overwhelming and unpleasant. Movement relieves the symptom.

Sleep deprivation, daytime fatigue and sleepiness, anxiety, stress, and reduced work performance occur. Studies also indicate a higher risk of cardiovascular disease. Children and adults alike have restless legs syndrome. Pregnant women and kidney failure patients are more likely to have severe restless legs syndrome.

Iron Deficiency and Dopamine

Iron deficiency is recognized as the main cause for restless legs syndrome. Iron deficiency may occur without anemia. Another reason for restless legs syndrome is lower dopamine in the brain. These two reasons can be inter-related as iron is required for dopamine production and function. In restless legs syndrome, iron stores in the brain are iron deficient

Serum ferritin is the lab test that identifies early stage iron deficiency. This lab marker may be the only indication of iron deficiency as changes in hemoglobin, hematocrit, red blood cells, and other iron tests may not yet show changes with more advanced iron deficiency anemia. Serum ferritin identifies the first stage of iron deficiency. Those who have a history of iron deficiency or are at higher risk (pregnancy, kidney failure, and children) and have jumpy restless legs should check their iron and serum ferritin levels. Iron supplementation is recommended if the serum ferritin level is below 75 µg/L.

Restless Legs Syndrome Linked with Cardiovascular Disease

Restless legs syndrome research shows a higher prevalence of cardiovascular disease in those who have restless legs syndrome. While research is still ongoing and full conclusions haven’t been reached, there is strong evidence of a link between restless legs syndrome, cardiac distress, and a stressed nervous system.

Research published in Sleep April 2017 issue evaluated 2823 men, average age 76 years for restless legs syndrome and heart attacks and cerebrovascular disease. After evaluation of statistics, it was found that there was an independent risk of heart attack associated with restless legs syndrome. Long-term restless legs syndrome sufferers for 10 years or longer had a higher incidence of cerebrovascular disease and possibly stroke. Other recent research shows women with restless legs syndrome, especially chronic restless legs syndrome, had a higher risk of cardiovascular mortality.

Increased Blood Pressure and Changes in Blood Flow

One reason why cardiovascular disease is linked with RLS may be related with how the nervous system and blood pressure are affected with restless legs syndrome. Researchers evaluated patients with restless legs syndrome and monitored blood pressure during sleep. Restless legs syndrome patients had about a 10 point higher systolic blood pressure at night than those who did not have RLS. The sympathetic nervous system had increased dominance at night which is just the opposite of what the body needs to rest and repair.

Note that in some cases, blood pressure medications such as beta-blockers and some calcium channel blockers may worsen restless legs syndrome symptoms even though they are prescribed to help lower blood pressure and help restless legs.

RLS research also shows that there are changes with blood vessels. Small blood vessels in the extremities show impaired blood flow and capillaries were tortuous and twisted and led to impaired oxygenation. Unhealthy changes in endothelial function were also found. Unhealthy changes in endothelial function are definitely connected with heart disease.

Increased Sympathetic Nerve Tone and Inflammation

Decreased blood flow, tortuous capillaries, the elevated systolic blood pressure may be related to increased tone of the sympathetic nervous system. The sympathetic (fight/flight) autonomic nervous system activity or tone was found to be increased. Recent research suggests that this increased tone affects blood vessel flow and peripheral blood flow and may be at the root of restless legs syndrome and higher incidence of cardiovascular disease.  

Other research shows that more severe restless legs syndrome is related with higher levels of inflammation as seen with C-reactive protein (CRP) and 8-OHdg. Elevated levels of C-reactive protein correlated with severe restless legs syndrome in chronic kidney patients. Other recent research shows patients with severe restless legs syndrome had more than “triple the odds of elevated C-reactive protein than others. Other studies show a higher level of 8-OHdg, a marker of oxidative stress was associated with more severe restless legs syndrome.

It is conceivable that mild lack of iron can contribute to the subtle stress responses seen with the nervous system, changes in blood flow, and resultant inflammation found in restless legs syndrome, especially if it is chronic. But don’t forget about other essential nutrients.

Other Essential Nutrients for Restless Legs

In normal physiology, the minerals magnesium and potassium are vital to the function of vasodilation and the parasympathetic (rest/relax) autonomic nervous system tone. It counterbalances the sympathetic fight/flight nervous system. Restless legs syndrome was found with increased sympathetic nervous system tone and an increased systolic blood pressure.

Magnesium is well known for it vital role with nerve relaxation. We have had great success for decades of using magnesium for nerve and muscle stress. Research shows a positive impact of magnesium on restless legs syndrome, especially in pregnancy. Magnesium deficiency, even a short-term lack, is linked with increased oxidative stress and elevated 8-OHdg with the heart.

Research is lacking on potassium and restless legs syndrome, but if we follow the principles of physiology, it seems like that potassium may help some of the underlying physiology and possibly contribute to symptomatic relief. Potassium works in tandem with magnesium for heart, blood pressure and nerve function.

Patients with chronic kidney disease often struggle with restless legs syndrome. Restoring iron levels is helpful for many, but others still struggle with restless legs syndrome. In one study in patients with chronic kidney disease, vitamin C and vitamin E were helpful for restless legs syndrome and were well-tolerated. Antioxidants like vitamin C and vitamin E help manage C-reactive protein levels. Other studies in pregnant women with restless legs syndrome showed that those who had better iron, folate, and vitamin B12 levels had considerably less concerns with restless legs syndrome than those who lacked these nutrients.

A Game Plan for Restless Legs Syndrome

Restless legs syndrome is more than a nuisance or something that randomly occurs. That jumpy, restless feeling provides an indication that something is going on with the nerves and circulation. Mainstream medicine offers dopamine supporting drugs, opioids, and anti-seizure medications for restless legs syndrome

But at the heart of restless legs syndrome are iron deficiency, dopamine function, sympathetic nervous system stress, oxidative stress, and inflammation -- all of which can impact the cardiovascular system.

Iron deficiency is the most common nutritional deficiency in the world and must be remedied if present. If serum ferritin levels are normal, then consider magnesium and potassium to help support the parasympathetic nervous system and balance the tone against sympathetic dominance.

Folate, vitamins C and E have been used for restless legs syndrome and may be very helpful with nerve support, endothelial lining, inflammation and oxidative stress. Dopamine support may be needed by some individuals especially if there are other indications of impaired dopamine. Dopamine production needs iron along with tyrosine, zinc, copper, vitamin C, and vitamin B3 and B6.

There is enough evidence that shows an increased risk of cardiovascular disease when restless legs syndrome is present. The medical treatment of RLS may provide relief for severe restless legs syndrome symptoms, but they will not address the nutritional needs that have been identified. Long-standing or severe concerns may take some time to fully calm down.

Get your iron and serum ferritin levels checked. Supplemental iron bisglycinate provides a gentle, easily absorbed iron. Add in minerals like magnesium glycinate, magnesium malate, and potassium with taurine to help the nerves and blood vessels relax. Some may need to add a coenzyme B complex or high quality multiple vitamin along with tyrosine, zinc and copper for dopamine support. Being able to fall asleep without restless jumpy legs is priceless for those who have suffered with it. It is also valuable to the spouse or parent who has been on the receiving end of the jumpy legs.

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