Dietary Supplements to Ease Restless Legs Syndrome: What’s the Evidence?

Certain supplements may calm the uncomfortable symptoms of restless legs syndrome without the side effects associated with medications.

Marian Weyo/Shutterstock

Restless legs syndrome, also known as Willis-Ekbom disease, is more common than you may think. It affects up to 10 percent of adults and up to 4 percent of children in the United States, according to an Epoch Times Essential Guide. Characterized by an overwhelming urge to move the legs, especially when at rest and at night, RLS can cause extreme discomfort and difficulty sleeping.

Whether RLS is idiopathic (of unknown origin) or secondary to a medical condition such as iron deficiency or kidney disease, severe cases can disrupt people’s daily lives and function.

“The decreased quality of life [for people with RLS] is similar to that of other chronic diseases, such as diabetes type 2, depression, and osteoarthritis,” Dr. Mary Stevens, a neurologist and sleep medicine specialist in Kansas City, Kansas, wrote.

Disordered sleep from RLS can lead to complications ranging from cardiovascular disease and high blood pressure to anxiety and social isolation.

According to the Essential Guide, daily low-dose pharmacological treatment is recommended for those whose symptoms are severe enough to affect their quality of life.

Medications used to treat RLS include:

• Benzodiazepines
• Calcium channel alpha-2-delta ligands (gabapentinoids)
• Dopaminergic agents (for short-term use only)
• Ketamine (rarely)
• Opioids (for severe cases)

These drugs all carry risks—some for dependence or abuse, and others for cognitive impairment and psychiatric side effects.

While some people with RLS report finding some relief from natural supplements, doctors don’t yet have enough evidence to use vitamin and mineral supplements as a first-line therapy. In an effort to quantify supplement efficacy, a Spanish research team recently reviewed 10 randomized clinical trials investigating non-pharmacological therapies to treat RLS. Their review, which covered seven types of supplements, was published on July 18 in the journal Nutrients.

Exploring Non-Pharmacological Therapies for RLS

The researchers, from the University of Granada, noted that non-pharmacological therapies in people with severe RLS could help this group be less dependent on medication and could lessen drug side effects such as “augmentation,” the phenomenon of symptoms worsening because of long-term use of drugs, particularly dopaminergic medication.

Their analysis, involving nearly 500 participants in 10 clinical trials, looked at supplementation of:

• Iron
• Magnesium oxide
• Valerian
• Vitamin B6
• Vitamin C
• Vitamin D
• Vitamin E

“The physiological rationale for utilizing dietary supplements for RLS treatment stems from the theory that oxidative stress and the consequent damage from free radicals in the central nervous system affect the balance of iron in the brain, thereby affecting dopamine synthesis, since iron is essential for tyrosine hydroxylase, a dopamine precursor,” the researchers wrote.

Besides the link between iron deficiency and RLS, the researchers note that some people with RLS have low magnesium and vitamin D levels, which is why these supplements have been tested as treatments. Low levels of antioxidant vitamins C and E have been implicated in oxidative stress, a potential contributing factor in RLS, while valerian “has been indicated for the treatment of sleep problems related to anxiety or lack of rest.”

For the study, RLS symptom improvement was measured using the International Restless Legs Syndrome (IRLS) rating scale, the Pittsburgh Sleep Quality Index, and the Epworth Sleepiness Scale.

Results Were Mixed

Using these measurements, the supplements that provided the most significant RLS symptom improvement were magnesium oxide, vitamins B6, C, and E. Interestingly, vitamin D supplementation did not provide significant symptom improvement, even among those patients with vitamin D deficiency. The researchers noted, however, that only one study testing the use of vitamin D was included in their review.

Magnesium is often used to ease nighttime leg cramps, making it a promising candidate for treating RLS, but one past review of eight studies did not find clear evidence that it was helpful. In the Spanish review, however, magnesium oxide statistically significantly improved RLS symptoms.

Another form of magnesium—magnesium citrate—may also hold promise, according to the researchers. Commenting on a study published in May exploring the use of magnesium citrate daily for eight weeks, they wrote that it showed a “significant reduction in IRLS scores in the participants.” They recommend more placebo-controlled randomized clinical trials to examine the effects of magnesium oxide.

As to magnesium’s mechanism of action, it can “currently only be speculated upon until reports about a consensus theory emerge,” they wrote.

The effects of oral iron supplementation on RLS symptoms were “mixed,” the researchers wrote, “showing some symptom improvements but no significant differences compared to other treatments.” They said that iron supplementation is “a promising avenue,” however, especially in patients with iron deficiency.

In one study included in the review, although vitamin B6 was less effective than magnesium in RLS patients, it also improved symptom scores when compared with a placebo.

Only two trials in the study tested the use of valerian, a medicinal herb, and their results were “contradictory.” These two trials were the only studies addressing the efficacy of valerian in reducing the symptoms of RLS that the researchers were able to find.

The researchers noted that several reviews (not included in their study) have also concluded there is insufficient evidence to determine whether valerian is effective for RLS. However, people have used it as a traditional remedy since ancient times to promote sleep, often taking it as a tea before bed.

This was a small study with limitations, the researchers conceded.

“There is a need for more high-quality randomized controlled trials with larger sample sizes and long-term studies to establish the true efficacy and safety of dietary supplements in managing RLS,” they wrote.

Find other natural approaches to treat, prevent, and manage RLS and improve sleep quality in The Epoch Times Essential Guide to Restless Legs Syndrome.