The Hidden Cause of Restless Leg Syndrome

It’s the middle of the night, and I’m lying awake, feeling restless in general, but my legs are particularly troublesome, full of staticky energy. If I weren’t exhausted, I would get out of bed and jog in place, hoping they would settle down. If this scene sounds familiar, you may have experienced the unsettling discomfort of restless leg syndrome (RLS).

The conventional explanation for RLS is an abnormality in dopamine levels. However, I believe nutritional deficiencies are the root cause, with magnesium deficiency being a primary suspect, especially if the discomfort includes cramping. When a patient reports painful and restless legs, I recommend an evening bath with several cups of Epsom salt or transdermal therapy with magnesium oil applied before bed. If magnesium deficiency is the issue, symptoms typically resolve in a few days to a couple of weeks.

This was the first thing I tried when long February nights found me tossing and turning with RLS. In my case, magnesium didn’t help, but racking my brain in the middle of the night brought a revelation. Thinking about other causes, I recalled that iron deficiency can underlie RLS. While on vacation, this insight prompted me to order a blood draw. A few days later, I received the results: my ferritin (the storage form of iron) was 10 points below the normal range.

If I had been better at advocating for myself, I would have ordered an iron panel sooner, as I had lost a fair amount of blood during surgery three months prior. The key takeaway is that symptoms of iron deficiency anemia showed up later. My serum iron was normal, but my ferritin was low, indicating that my body was compensating for the blood loss. However, my diet wasn’t providing enough iron-rich foods to replenish my total body stores of this essential mineral, reflecting a subtle difference between blood volume and quality.

Traditional Chinese Medicine (TCM) has a diagnosis called blood deficiency. When blood is lost due to trauma, surgery, or a woman’s menstrual cycle, the therapeutic principle is to help the body build new red blood cells—this is blood volume. TCM also considers the vitality of the blood, looking for corroborating signs like pale tongue color, to indicate that blood quality may be affected even when standard blood tests do not suggest anemia.

After returning home from travel, I grabbed a bottle of whole-food iron from my dispensary. Within a few days, my restless legs were gone. It’s important to note that heme iron from an animal source is superior in absorbability to either non-heme, plant-based iron or an iron supplement that may cause constipation. Combining iron with cofactors such as vitamin C, necessary for iron absorption, ensures the quickest resolution of anemia.

Coming full circle to the conventional paradigm that an abnormality in dopamine levels causes RLS, it turns out that iron is essential for proper dopamine function. If you know someone suffering from RLS, let them know that relief may be just a mineral or two away.