“Restless legs” hardly sounds like medical terminology, but it describes a neurological condition first described in the late 17th century. People with the condition describe sensations similar to something crawling over the legs. The legs might also throb, ache or itch. Sufferers relieve this unpleasant feeling by moving their legs, often getting out of bed and walking around. Needless to say, restless legs syndrome can disrupt sleep. Most North American doctors had little to offer patients with this problem until a few decades ago. Then the FDA approved medications specifically to treat this condition. However, people have been swapping home remedies for a long time. Could magnesium or folic acid supplements help ease your restless legs syndrome?
How Can You Alleviate Your Restless Legs Syndrome?
Q. I have restless legs syndrome that keeps me awake at night unless I take a magnesium supplement at bedtime. This gives me excellent results.
On the rare occasion that I get that creepy crawly feeling anyway, I rub magnesium oil on my lower legs. This helps almost immediately, and I am able to go back to sleep.
A. Restless legs syndrome (RLS) was first described in 1944 by a Swedish neurologist, Dr. Karl-Axel Ekbom. People with this condition describe an unpleasant creeping or crawling sensation in the legs that is relieved by moving them. RLS mostly happens when the person is resting, and it frequently interferes with sleep. Doctors do not know the cause of RLS, although people with kidney disease and those with iron deficiency appear to be more susceptible to the condition (Sleep Medicine, March 2017).
Magnesium for RLS:
Many people report that magnesium supplements can help with insomnia, RLS and leg cramps. Unfortunately, we found only one uncontrolled study on magnesium therapy for RLS (Sleep, Aug. 1998). In this “open” study, people with RLS or a related problem, periodic limb movement during sleep, took magnesium supplements and found them beneficial. We wish that scientists had followed up on this approach to see how well magnesium might work for your restless legs syndrome.
One minor note and one important warning: First, magnesium can cause diarrhea, so be careful with the dose of your bedtime supplement. Most people can take 300 mg without problems, but you may need less.
Most importantly, people with limited kidney function must not take supplemental magnesium. It could overwhelm the kidneys and build up to dangerous levels. It isn’t clear whether topical magnesium oil would provide enough magnesium to be dangerous, but it wouldn’t make sense to push the envelope. As we noted, people with kidney disease are susceptible to RLS, but they should avoid this possible remedy.
Other Nondrug Approaches for Your Restless Legs Syndrome:
Many readers have shared their experience with RLS. Some people report that certain medications make the condition worse. Others have found helpful remedies, such as soap under the bottom sheet or a cup of chamomile tea at bedtime. Here are a few other non-pharmacological options you might consider.
Experts often recommend strictly avoiding caffeine, nicotine and alcohol, because these may make RLS symptoms worse (Sleep Medicine Clinics, Dec. 1, 2009). In addition, they suggest regular exercise during the day and/or a brief walk before bedtime. Restless legs syndrome, known in medicalese as Willis-Ekbom disease or simply Ekbom disease after the Swedish doctor who first described it, may respond to exercise, massage, infrared-light therapy or pneumatic compression devices that squeeze the legs to maintain good circulation (Neuropsychiatric Disease and Treatment, May 6, 2011). We don’t know how well these approaches may work, so if you have tried them, let us know whether they were helpful for you.
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Q. You have written about restless legs several times, but I have a new approach. Often when I try to fall asleep, my feet get restless, like they’re buzzing. I feel that I need to move them.
Here’s an unusual method that relieves this restlessness nearly every time: I pop in my earbuds and watch a streaming show on my iPhone. Within 30 minutes, my feet are relaxed and stay that way until I fall asleep.
A. We certainly appreciate your novel remedy. Others have reported that listening to a podcast or a news show can help calm their minds so they can get to sleep. We do caution you, however, that staring at a device like your iPhone shortly before bedtime could expose you to blue light that might interfere with your sleep (Sleep Health, Aug. 2020). Consequently, we fear your approach might not work for everybody.
Another mineral that might be helpful for treating RLS is selenium. Swedish scientists reported on a handful of cases in which people with severe RLS took 100 micrograms of selenium daily and experienced noticeable improvement (Iranian Journal of Neurology, Oct. 7, 2016).
Acupuncture for RLS:
Q. I suffered from restless legs syndrome for many years and took ropinirole (Requip) to treat it. The medication worked, but it caused me many worrying symptoms on a regular basis: dizziness, nausea, feeling like I was going to pass out, even vomiting at times. However, if I didn’t take the drug, I couldn’t sleep because my legs started acting up the minute I laid down in bed.
I accepted this until I happened to speak to someone who recommended that I see an acupuncturist. This woman cured me after only one visit. I’ll never forget that day, three years ago, when she needled my body and left the room. I felt strong movements of energy throughout my body and was so tired after that initial treatment that I went to bed as soon as I got home. I never took Requip again.
For quite a while, I saw the acupuncturist every month. Then over time I visited less frequently, though I still go back for a “tune up” several times a year. I am extremely grateful that I no longer need to take Requip.
A. Many people would prefer to use some method other than medication to control their restless legs syndrome. A review of non-pharmacological interventions found that acupuncture reduces RLS symptoms (Harrison et al, Disability and Rehabilitation, March 21, 2018). Your results are surprising in that you got such long-lasting relief from acupuncture to calm your restless legs. Other people may find that they need to continue with acupuncture to maintain freedom from RLS symptoms.
One randomized study found that massage, specifically massage with lavender oil, could ease RLS symptoms in people on hemodialysis (Hashemi et al, Nursing and Midwifery Studies, Dec. 2015). People with kidney disease often suffer from restless legs syndrome.
Placing the legs on a vibrating pad (Relaxis) for a 35-minute therapy cycle appears to be as effective as the drugs FDA has approved for treating RLS (Mitchell, Therapeutics and Clinical Risk Management, Dec. 3, 2015). Users have not reported adverse effects from using the pad, other than to the wallet–it can cost around $1,000.
Folic Acid Pills for Restless Legs:
Q. Many years ago, I complained to my doctor about restless legs. She prescribed folic acid (1 mg daily). It has to be prescription, not over the counter. It works!
A. Folic acid is a B vitamin. The 1 mg dose is available both by prescription as well as over the counter. The RDA is 400 micrograms, less than half the amount you are taking. Consequently, though 1 mg seems like a tiny amount, it is actually a very high dose of folic acid.
We searched high and low and could find no good evidence to support the use of folic acid supplements to treat restless leg syndrome (RLS). Many doctors consider this supplement innocuous, since B vitamins are water soluble.
A Caution in the Time of COVID:
There is one warning, however. A recent study based on data from the UK Biobank found an unexpected link between prescribed folic acid supplements and susceptibility to COVID-19 (BMJ Open, Aug. 24, 2022). Even worse, people who caught COVID-19 while taking high-dose folic acid were more than twice as likely to die of the infection. The authors suggest that this B vitamin may make it easier for the virus to multiply.
Another Reader Offers a Testimonial on Folic Acid:
Q. You’ve discussed treatments for restless legs syndrome (RLS) in your column but you have not mentioned folic acid.
Decades ago, I was renting a room from a medical student. She observed my distress and pointed out a page in a textbook. That was the first time I had ever heard of “restless legs syndrome.” The book said that it was caused by folic acid deficiency.
I started taking folic acid, and it worked like gangbusters. It’s cheap and readily available, and it has never stopped working for me.
A. Your report is fascinating. Restless legs syndrome has been attributed to vitamin D deficiency (Neuropsychiatric Diseases and Treatment, online May 21, 2014) as well as lack of iron. Although folic acid deficiency is considered less often, it too seems to be linked to RLS (Alternative Medicine Review, June, 2007). We are disappointed not to find reports of controlled trials of this common B vitamin for treating restless legs syndrome.