Restless legs syndrome – Is it a sign of a bigger health problem?

In the March 5, 2014 online issue of Neurology, neurologist and nationally-recognized sleep expert Sanford H. Auerbach, MD published an article on restless legs syndrome (RLS) and discussed this condition as a possible biomarker for underlying disease.

Restless legs syndrome is a disorder of the nervous system and is characterized by throbbing or other uncomfortable sensations in the legs with an uncontrollable urge to move them. Symptoms typically occur at night when a person is relaxing or getting ready for bed and can increase in severity during the night. Most people with RLS have difficulty falling asleep and staying asleep, which can lead to fatigue. Many report that their job, personal relations, and various activities of daily living are strongly affected as a result of their sleep deprivation. Sufferers of RLS also often have difficulty concentrating and many experience brain fog.

The editorial was written in response to an analysis – published in the same issue of Neurology – of over 12,000 men who were followed over time, which showed multiple disease associations with RLS. Auerbach found that patients with RLS had a higher mortality rate than comparable men without RLS, and they showed an especially strong tendency toward cardiovascular disease and hypertension. Previous analyses of the same data discovered that men with RLS were more likely to be diagnosed with lung and endocrine conditions, as well as metabolism and immune system problems.

Through these analyses, researchers suggest that restless legs syndrome is a meaningful biomarker for serious disease, and that RLS screening may become a more common tool for practitioners in order to identify patients at risk.

I have had personal success with patients simply by adding magnesium and calcium at bedtime because these minerals calm muscles and nerves. You can also assess RBC nutrients such as magnesium, calcium and potassium through many functional laboratories (provides a better indicator of nutrient status, compared to the serum). In addition to indicating nutrient status, these minerals play a significant role with blood pressure regulation and overall cardiovascular health.

I would also recommend an organic acid test because it can identify imbalances occurring in the body that precede abnormal findings on a CBC or an MP. Organic acids are products of metabolism that can sensitively identify nutrient deficiencies that lead to metabolic roadblocks. Organic acids go a step further then measuring nutrient concentrations by assessing whether the nutrient is functioning adequately. Abnormal concentrations of organic acids in the urine can provide a functional marker for metabolic effects of nutrient deficiencies, genetic polymorphisms, impaired enzyme function, toxic exposure, neuroendocrine activity and intestinal bacterial overgrowth. Organic acid testing can indicate the functional need for specific nutrients, diet modification, antioxidant protection, detoxification and other therapies.

There is also some evidence indicating that low iron levels in the brain may be associated with RLS. A CBC w/diff and an iron panel (serum iron, ferritin, % saturation, TIBC, UIBC) can identify an iron deficiency.

Restless leg syndrome may only be just a small part of the picture. It may be a simple nutrient deficiency in many cases, however, it is important to look further into the patient's health. This includes thoroughly reviewing the patient's history, looking deeper into the cardiovascular system and other inflammatory markers in order to provide an effective treatment plan for these patients.

by Michael Jurgelewicz, DC, DACBN, DCBCN Magnesium, probably the greatest predictor of all aspects of heart disease

It is a fact that more than 50% of Americans are magnesium deficient. I cannot stress enough the importance of recognizing magnesium deficiency as a serious health problem here in the United States. Magnesium plays a key role in more than 350 enzymes in the body and is involved in virtually every metabolic process. Its involvement is significant with overall cardiovascular health, blood pressure regulation and muscle relaxation. A deficiency in magnesium, referred to as hypomagnesemia, has been associated with cardiac arrhythmias, ischemic heart disease, sudden cardiac death, hypertension, transient ischemic attacks (TIA), and stroke. Interestingly, cardiovascular disease research studies dating as far back as 1937 found that a low magnesium level, and not cholesterol or saturated fat intake, is probably the greatest predictor of all aspects of heart disease.

Researcher Andrea Rosanoff, PhD, Director of Research & Science Information Outreach Center for Magnesium Education & Research, Pahoa, HI, conducted an ongoing comprehensive review of magnesium and cardiovascular disease for over 10 years, building upon work originally done by Mildred Seelig, MD, who studied this relationship for over 40 years. Rosanoff discovered that low magnesium was shown to be associated with all known cardiovascular risk factors, such as cholesterol and high blood pressure, atherogenesis, hardening of the arteries and the calcification of soft tissues. According to Dr. Rosanoff, “By 1957 low magnesium was shown to be, strongly, convincingly, a cause of atherogenesis and the calcification of soft tissues. But this research was widely and immediately ignored as cholesterol and the high saturated-fat diet became the culprits to fight.” Since then, research has continued to show that low magnesium is associated with cardiovascular risk factors.

In addition, Dr. Rosanoff noted that after years and years of Americans focusing solely on increasing dietary calcium intake without paying equal attention tomagnesium, dietary calcium-to-magnesium ratios have increased over time, and research shows that calcium supplementation that is not balanced with magnesium can actually contribute to an increased risk of heart disease.

Sources of magnesium

Magnesium gets its name from the Greek region Magnesia, near where it was first discovered. It is the central ion of chlorophyll, making leafy green vegetables one of the best food sources of this mineral. Other sources include nuts and seeds, legumes, and whole, unrefined grains. One thing to consider, however, is that the presence of phytic acid and enzyme inhibitors in grains and legumes may interfere with magnesium absorption, unless steps are taken to neutralize these substances through specific preparation and cooking techniques such as soaking, sprouting, or fermentation. Also, many common prescription drugs are known to deplete magnesium, including certain oral contraceptives, antacids, diuretics, and antibiotics.

How much magnesium is enough?

Unfortunately, we do not have a great way to measure magnesium status. For example, serum magnesium represents only 1% of the body’s magnesium stores. Magnesium is homeostatically controlled in the serum and measuring serum magnesium levels provides many false negatives. By the time your serum magnesium is low, you are very deficient, meaning that the body cannot maintain the serum magnesium levels. So, serum magnesium is not the answer. Magnesium, RBC is definitely better and can be done by most labs and all functional medicine labs. I test RBC magnesium levels on all my patients and it is surprising to see how many patients who are deficient in this critical mineral. In addition, for patients with high blood pressure and other cardiovascular-related conditions, it is important to assess other minerals such as potassium, magnesium, zinc, copper, selenium, and calcium, as well as laboratory markers that include cardio CRP, homocysteine, fibrinogen, CoQ10, and vitamin D 25-OH.

By Dr. Michael Jurgelewicz, DC, DABCN, DCBCN Magnesium Depletion and Chronic Disease

For reasons that elude me (perhaps it’s because calcium is the most common mineral in the human body), calcium has historically been the primary dietary mineral that has received the most attention in both medical research and the mainstream media. Over the last couple of years however, the mineral magnesium has quickly been the focus of intense scientific study, recently culminating with the latest report that suggests that magnesium may be just as important, if not more so, to children’s bone health than calcium.

While magnesium is the fourth most abundant mineral in the body, it is needed for more than 300 biochemical reactions. It is involved in supporting proper nerve function and a healthy immune system. It helps keep heart rhythm steady and bones strong. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, and is involved in energy metabolism and protein synthesis.

The metabolism of carbohydrates and fats to produce energy (which includes ATP production) requires numerous magnesium-dependent chemical reactions. Magnesium is also required for a number of steps during DNA and RNA synthesis. Glutathione, an important antioxidant, requires magnesium for its production.

Only 1% of magnesium is found in the blood, the rest being bound in the tissues and bones. Therefore the mineral is hard to test for and as a result, magnesium deficiency can be difficult to detect. Symptoms of magnesium deficiency can be varied and potentially fool even the best clinician. Insomnia, irritability, nervousness, fatigue, anorexia, muscle twitching, abnormal heart beat and poor memory are some of the signs. When you take into consideration the myriad functions magnesium performs and the multiple systems the mineral affects, a magnesium deficiency can affect virtually every system of the body. Magnesium deficiency has even been associated with epilepsy and M.S.

Additionally, if you look closely at the symptoms of magnesium deficiency and apply some of them to a child, would this not describe symptoms of ADHD?

Magnesium deficiency has also been shown to be a predictor of both diabetes and heart disease, providing some direct evidence that greater intake of dietary magnesium may have a long-term protective effect on lowering risk in both conditions or, in the case of its long term, chronic depletion/deficiency, directly participate in the development of both conditions.

In the case of diabetes, it is suggested that insulin resistance can be directly related to long-term magnesium exhaustion while in cardiovascular heath, hypertension and endothelial dysfunction appear to be associated with chronic decline as well.

Finally, several studies have shown an increased cancer rate in regions with low magnesium levels in soil and drinking water (the same for selenium). In Egypt, the cancer rate was only about 10% of that in Europe and America. The main difference was an extremely high magnesium intake of 2.5 to 3g in these cancer-free populations, ten times more than in most western countries.

In the face of magnesium’s incredible importance in human health, it goes without saying that the possible deficiency of this mineral in the clinical setting may need to be more closely scrutinized, as the consequences could be quite impactful.

Michael Fuhrman, D. C.