Restless Legs Syndrome (RLS), also known as Willis-Ekbom disease, is a neurological disorder characterized by an irresistible urge to move the legs, often accompanied by uncomfortable sensations. These sensations, frequently described as aching, crawling, creeping, electric, itching, pulling, or throbbing, tend to occur when at rest, particularly in the evening or at night. RLS can significantly disrupt sleep and diminish overall quality of life. While there's no definitive cure, various strategies, including dietary modifications, lifestyle adjustments, and medications, can help manage the symptoms. The ketogenic diet (KD), a high-fat, very low-carbohydrate diet, has emerged as a potential therapeutic intervention for various conditions, including sleep disorders. This article explores the relationship between the ketogenic diet and restless legs syndrome, drawing upon recent research and clinical observations.
Understanding Restless Legs Syndrome
Restless Legs Syndrome (RLS) is a condition marked by an overwhelming need to move your legs, usually accompanied by unusual sensations. This often happens in the evening or at nighttime, and it may affect you more when you sit or lay down because your legs are not moving. Moving your legs often eases the sensations you feel in your legs that make you want to wiggle or kick.
The overwhelming need to move your legs is the main way restless legs syndrome is diagnosed. However, you may also have:
- Sensations in your legs that are only present when you are at rest
- Relief when you move or stretch your legs
- Symptoms that get worse in the evening or at night
- Uncontrollable twitching or kicking
Restless leg symptoms usually happen in your legs or feet, but they can also affect your arms in rare cases. The symptoms usually affect both sides of your body equally. The sensations tend to affect your actual leg tissue and not the surface of your skin. Your symptoms may lessen sometimes and feel much more intense other times. Diet may be a factor in your symptoms being better or worse.
The Ketogenic Diet: A Metabolic Shift
The ketogenic diet (KD) is characterized by a very low carbohydrate intake, high fat intake, and moderate protein intake. This dietary composition induces a metabolic state called ketosis, where the body primarily uses fat for fuel instead of glucose. When carbohydrate intake is drastically reduced, the liver begins to break down fats into ketone bodies, which then serve as an alternative energy source for the brain and other tissues. This metabolic shift has been shown to have various therapeutic effects, including potential benefits for neurological conditions and sleep disorders.
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The Link Between Keto Diet and Sleep
Sleep disturbance in MS is common and can significantly impair overall quality of life. The effects of disordered sleep on metabolic, vascular, and immune function may further contribute to disease progression, poor quality of life, and elevated risk for comorbidities. Specifically, sleep deprivation is associated with an increase in pro-inflammatory cytokines. Dietary intake influences immune function through direct effects of macro- and micronutrients and via the gut-immune interface. Diets that mimic a fasting state show evidence of reduced pro-inflammatory cytokines, reduced serum Th1 and Th17 cells, and increased Treg cells in an MS mouse model. Ketogenic diets (KDs) are very low carbohydrate diets that are high in fatty acids and adequate in protein, mimicking a nutritional fasting state through the production of biologically-active ketone bodies. Growing data suggests that KDs improve sleep quality and induce beneficial alterations in the sleep cycle. For example, KDs have been linked with an improved proportion of rapid eye movement (REM) sleep and overall sleep quality in children with epilepsy and reduced sleep complaints in people with migraine.
Keto Diet and Restless Legs Syndrome: The Evidence
A study involving forty-five patients with relapsing MS enrolled into a 6-month KD intervention trial and completed self-reported assessments of sleep quality and sleep disorder symptoms prior to diet initiation and while on diet, using the Epworth Sleepiness Scale (ESS) and Sleep Disorders Symptom Checklist-25 (SDS). Participants who did not complete sleep assessments at baseline and 6-months were excluded from analysis. Thirty-nine of 45 (87%) participants completed the required sleep assessments. There was a mean reduction in ESS score of 1.90 (95% CI [−2.85, −0.94], p<0.001). Total SDS score decreased at 6-months on KD (−4.4, 95% CI [−7.1, −1.7], p=0.002), with improvements noted in insomnia (−1.55, 95% CI [−2.66, −0.43], p=0.008), obstructive sleep apnea (−0.91, 95% CI [−1.57, −0.25], p=0.008), and restless leg syndrome screening scores (−1.00, 95% CI [−1.95, −0.051], p=0.04).
The study demonstrated that KD associates with improvements in daytime sleepiness, independent of sleep duration, and common comorbid sleep disorders in people living with relapsing MS. The findings herein support the benefits of KD on sleep quality and highlight the potential role of dietary therapeutics for sleep disorders in neurological disease.
Potential Mechanisms
Several mechanisms may explain the potential benefits of a ketogenic diet on RLS symptoms:
- Electrolyte Balance: Restless Leg Syndrome (RLS) may have a strong link to the keto diet because of electrolyte deficiencies. Electrolytes are minerals that carry a positive or negative charge, with two essential electrolytes being potassium and magnesium. When on the keto diet, it can be very difficult to get enough of these nutrients without eating more carbs than you’re allowed. Supplementing these nutrients with tablets or electrolyte drinks may be an option.
- Neurotransmitter Modulation: Muscle movements are regulated by dopamine (a neurotransmitter) in the brain and spinal cord. Dopamine tells leg muscles to relax at night, so without enough dopamine, muscles can remain hyperactive. The KD may influence neurotransmitter activity, potentially modulating dopamine levels and reducing RLS symptoms.
- Reduced Inflammation: Sleep deprivation is associated with an increase in pro-inflammatory cytokines. The ketogenic diet has been shown to have anti-inflammatory effects, which may indirectly alleviate RLS symptoms.
- Improved Sleep Quality: By improving sleep quality and reducing sleep disturbances, the KD may indirectly reduce RLS symptoms, as RLS often worsens with poor sleep.
Dietary Strategies to Manage RLS
While there is no cure for restless legs syndrome, maintaining a healthy diet may help lessen your symptoms. If you’ve been diagnosed with restless legs syndrome, it’s important to:
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- Incorporate a variety of fresh fruits and vegetables into your diet with an emphasis on dark leafy greens.
- Eat a variety of iron-rich foods like lean meat.
- Include seeds, tree nuts, and legumes in your diet.
- Avoid processed foods, sugar, and fried foods that may make you gain weight.
If you make changes to your diet and don’t have any improvements within a few weeks, talk to your doctor. They may be able to prescribe a medication that can alleviate your symptoms and complement a healthy diet.
Key Nutrients for RLS
Vitamin D3 and Iron: This specific type of vitamin D is found in animal protein sources. Iron and vitamin D3 work together to improve your red blood cell production and other body functions. Lack of these and other nutrients are linked to leg cramps and may contribute to restless leg syndrome. Low levels of iron in your blood are often seen in people who have restless legs syndrome. You can get iron and other types of vitamin D from leafy greens like spinach and some fish.
Potassium: Low levels of potassium can cause muscle spasms and contribute to restless leg syndrome. Potassium aids your body with muscle and nerve function. Potassium also helps your body process protein and carbohydrates for more efficient use. It can lower your blood pressure and decrease your risk of heart disease or stroke. Tips for increasing your potassium include: Eating more fruits, like bananas, can help restless legs syndrome. Eating more vegetables, like leafy greens, can help restless legs syndrome. Talk to your doctor before taking a potassium supplement to make sure you don’t take too much. Pay attention to the amount of potassium in some salt substitutes, so you don’t get too much of the nutrient.
Folate and Magnesium: You can also add folate and magnesium to your diet to improve your restless legs syndrome symptoms through diet. Some studies show that these nutrients ease symptoms of restless legs syndrome. Folate is also called vitamin B9 and promotes health at a cellular level. Similar to potassium, magnesium helps by promoting healthy nerves and muscles.
Foods to Avoid
What you cut out of your diet is just as important as what you include. Avoid stimulants like alcohol and caffeine, especially right before bed. They may worsen your symptoms and make it harder to fall asleep.
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Other Health Conditions
Studies on restless legs syndrome show that people who have this condition are also more likely to:
- Be obese
- Experience depression
- Have diabetes
- Have cardiovascular disease
By treating or preventing these conditions, you may also improve symptoms of restless legs syndrome.
Lifestyle Adjustments
Simple self-care steps and lifestyle changes may help relieve symptoms. Medications also help many people with RLS.
Sleep Habits
Sleep disturbance in MS is common and can significantly impair overall quality of life.
Other Changes
Other changes that may help relieve symptoms of RLS include:
- Quitting smoking
- Getting regular exercise
- Taking a warm bath before going to bed
- Massaging the affected area
- Limiting alcohol consumption, especially before bedtime
- Using heat or ice on the affected area
- Using a foam roller
Cautions and Considerations
- Individual Variability: The response to a ketogenic diet can vary significantly from person to person. Some individuals may experience significant improvements in RLS symptoms, while others may not.
- Nutrient Deficiencies: Strict adherence to a ketogenic diet may lead to nutrient deficiencies if not carefully planned. It's essential to ensure adequate intake of essential vitamins and minerals, either through diet or supplementation.
- Medical Supervision: Before starting a ketogenic diet, especially if you have underlying health conditions or are taking medications, it's crucial to consult with a healthcare professional.
- Medications: Certain medications may cause RLS. Talk to your doctor about other drug options if you take antipsychotic drugs, antidepressants, or sedating antihistamines.