Category: Health

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Restless Legs Syndrome (RLS)

Can’t sit still? Leg discomfort keeping you awake? Read on to find out if Restless Leg Syndrome (RLS) might be your problem…

What is Restless Legs Syndrome?

People with RLS have a strong compelling urge to move the legs, described as uncomfortable or painful, that:

  • Occurs when inactive

  • Increases in the evening and at night

  • Is relieved by movement of the affected arm or leg

  • Often causes difficulty falling or staying asleep

  • May cause involuntary jerking of limbs when asleep or awake

You may have difficulty describing the sensation, using words such as creepy-crawley, tingling, pulling, tightening or uncomfortable. Children can also have the syndrome and are sometimes misdiagnosed as being hyperactive or having “growing pains”.

As many as 15% of the population may have RLS, but because it is so difficult to describe and people affected with it often don’t realize there are effective treatments, symptoms may never be mentioned to their doctor. It is also sometimes misdiagnosed as another condition.

How is it diagnosed?

RLS can mimic other conditions such as: diabetic neuropathy, nighttime leg cramps, arthritis pains, back pain, depression or insomnia of other causes. There is no specific test for RLS and it is diagnosed by its symptoms, once other conditions have been ruled out. It will sometimes run in families (“Familial or Primary RLS”) and is often diagnosed sooner in these cases, as the family is familiar with the symptoms.

What are the causes?

RLS-like symptoms can also be caused by other conditions:

  • Low iron, magnesium, folic acid or vitamin B12

  • Problems with the spinal cord (spinal stenosis or a damaged disk) or nerves

  • By-products of kidney disease

This is called “Secondary RLS” and treating the underlying cause will result in improvements of the RLS symptoms in these cases.

There is also a third type of RLS, called “Idiopathic RLS”, where the cause cannot be identified. “Idiopathic” simply means “unknown cause”.

Research suggests a cause of RLS may be decreased function in a specific part of the brain called the “substantia nigra”, the same part that malfunctions in Parkinson’s Disease. However, in Parkinson’s the cells are gradually destroyed whereas in RLS function is simply reduced, either because of a lack of the iron they need to function or because the iron cannot be transported into that part of the brain properly.

What medications are helpful or harmful?

Because RLS is caused by the same part of the brain involved in Parkinson’s Disease, some Parkinson’s medications can be helpful, increasing the dopamine that the affected part of the brain is supposed to produce.

Eliminating any drugs that block production or action of dopamine can also be helpful. This means your symptoms may improve if you avoid drugs such as certain stomach medications (ranitidine, cimetidine, famotidine, omeprazole, lansoprazole and others in these groups), antihistamines, phenytoin, lithium, calcium channel blockers (used for heart disease and blood pressure), and others that decrease the effect of dopamine. Ask your pharmacist to review your file for any of these medications.

Because of the tie to decreased dopamine action, drugs that increase dopamine or act like dopamine can be helpful for RLS. These include levodopa/carbidopa (Sinemet), ropinirole (Requip), pramipexole and others. Be sure to tell your pharmacist why you are taking these medications, if they are prescribed for you, so they will explain their use correctly. For example, taking short-acting levodopa/carbidopa in the morning would be helpful for Parkinson’s but wouldn’t help nighttime RLS symptoms.

Narcotics can help some people with daytime symptoms. Some seizure medications, such as carbamazepine and gabapentin, may be tried when dopamine therapy fails.

Sleeping medications are sometimes used to help sleep, but they do not have any effect on the actual symptoms of RLS. Also, as these medications and the narcotics mentioned above can be habit-forming, it is better to improve sleep problems and other symptoms by treating the cause if possible.

Clonidine can be particularly helpful when symptoms are associated with substances that are increased in patients with kidney failure.

Caffeine, alcohol, and smoking can make symptoms worse and, if so, should be avoided.

In summary…

RLS is often untreated or under-treated because patients have difficulty describing the sensations that they are experiencing and are often unaware the syndrome exists. There is no cure, other than correcting underlying causes in secondary RLS, and the symptoms tend to worsen with time. As well, the effect of medications may diminish over time requiring the patient to change therapy periodically.

It is easy to become confused about your new medication, as the various medications for RLS are also used for other conditions such as Parkinson’s disease, blood pressure, seizures, etc. Be sure to tell your pharmacist why you were prescribed this medication so you can have an effective discussion.

Remember that there are additional things you can do, like exercise, hot or cold therapy, or distracting activities than can help to reduce the severity of symptoms, improving your sleep and your ability to sit still when travelling or doing other sedentary activities.

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Health

Preventing Bladder Infections… Update!

I received a useful comment from a reader and have decided to pass her suggestion along. She tells me she has had good success in preventing bladder infections by taking d-mannose powder daily. This product was actually somewhat familiar to me from my study of natural medicines several years ago. I decided to do a little research to update my knowledge.

D-mannose is a simple sugar found naturally in apples, oranges, peaches and some berries, including blueberries and cranberries. It may actually be the d-mannose content of cranberries that gives it its ability to prevent bladder infections. Like cranberry, d-mannose works by preventing bacteria from sticking to the bladder walls and starting an infection.

I found a study that compared d-mannose 2 g daily mixed in 200 ml water, with nitrofurantoin 50 mg and no treatment. The effect of d-mannose in reducing recurrence of bladder infection was similar or slightly better than the effect of nitrofurantoin, and both were significantly better than taking no treatment at all. It should be noted that d-mannose only works to prevent infection from e-coli, the bacteria normally present in our anal area that causes an estimated 90% of bladder infections. So, although an infection caused by other types of bacteria could still occur, d-mannose can still make a significant difference in the infection rate.

Other studies, done in mice, suggest that d-mannose is safe to take long-term if taken in appropriate amounts, but excess may cause kidney damage. Side effects may include bloating or loose stools and, if this occurs, reducing the dose would likely reduce these effects.

Caution is recommended in women who are pregnant or breast-feeding — although it is thought by some experts to be safe, being a simple sugar, it has not been studied in these populations. It is also recommended to use caution if you have diabetes, as it may make it harder to control your blood sugar, since it is a sugar. However, as most d-mannose is absorbed more slowly than regular sugan and excreted intact through the urinary system relatively quickly, people with well-controlled diabetes generally do not have any problem, according to other sources. Checking your blood sugar more often when starting this therapy would be advised to alert you to any potential problems.

As an interesting sideline, studies also suggest d-mannose may act as a prebiotic, encouraging growth of “good” bacteria in the digestive system.

The recommended dose of d-mannose for prevention of urinary tract infections, as used in the study, is 2 g (or approximately one teaspoon) once daily in adults, and one half to 1 teaspoon for children, dissolved in a glass of water. Dr. Jonathan Wright, one of the first physicians to begin using d-mannose, claims 85 to 90% effectiveness from this treatment in his patients. D-mannose is available in health food stores and some pharmacies. He also discusses a high success rate in treating active infections with the same dose given every 2 to 3 hours, but cautions that another treatment should be considered if no improvement within 1 to 2 days. I noted that he used an equivalency of 1gram = 1 teaspoonful… Regardless of the actual equivalency, 1 teaspoonful appears to be the dose commonly recommended for adults. Your pharmacist could weigh a sample of the powder for you, if you want to calibrate your 5ml teaspoon from your set at home!

If you decide to stay with cranberry, it is probably best to choose a cranberry concentrate capsule with a high amount of cranberry content (and presumably more d-mannose) rather than the sweetened juice to avoid the increased intake of glucose (sugar) it contains. A price calculation I did several years ago also found high-dose capsules were less expensive than an equivalent amount of juice!

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Preventing Bladder Infection…

I received a question from a reader asking what women can do to prevent bladder infections. Here is some information about these infections that are so common and some strategies to prevent them.

Bladder infections can affect both men and women, but are 10 to 50 times more common in women (depending on which reference you read!), probably due to the much shorter urethra we have. The actions you can take to prevent a bladder infection will likely also reduce your risk of a vaginal infection and, in men, prostate infection.

Generally, infections start in the urethra, travel up to the bladder and, if not treated, can continue to spread up the ureters to the kidneys, leading to a much more serious infection. The recommendations below are for preventing infection; if you have signs of infection – pain or irritation with urination, needing to go frequently or urgently, blood in the urine, pelvic pressure or lower abdomen discomfort – you should see your doctor right away for diagnosis and treatment.

Bacteria that are normal to have in the bowel can cause an infection if they move into the reproductive or urinary systems. So, one of the first preventive measures is to pay attention to how you wash your genital area, making sure you are moving bacteria away from your vagina and urethra and toward the rectum when you wash or wipe these areas. Basically, always wipe from front to back with a clean tissue or cloth.

Infectious organisms also like warmth and moisture, so wearing looser-fitting cotton underwear can help keep the area drier – boxer shorts for men may help but I haven’t seen this style for women yet! However, at least we can choose comfy 100% cotton undies and avoid synthetic “non-breathing” materials. Thong-style underwear may increase the chance of movement of bacteria from the rectal area to the vagina or urethra, and are also more likely to irritate these areas – might be best to avoid this style of undies if you have recurring problems with urinary tract infections (UTI).

Avoiding long baths can be helpful, as bath water can become contaminated with bacteria fairly quickly, and using tampons is advised to keep the bladder opening drier, limiting bacterial growth.

Avoiding long intervals between urinating can also be extremely effective, and make sure to completely empty the bladder each time. Try to urinate every 4 hours if you are prone to infections, even if you do not feel the need to go. Drinking more water is thought to be helpful to dilute the urine, encourage more frequent urination and flush any bacteria from the bladder before it can attach to the bladder wall and start an infection.

Sexual activity can increase the risk of infection because it tends to introduce bacteria to the urethra opening. Keep in mind that spermicidal jellies and creams also kill normal flora that help keep harmful bacteria in check. If an association between sexual activity and infection is identified, doctors will sometimes prescribe a dose of a mild antibiotic to be taken afterward. Urinating after sex can help to flush away bacteria before it has a chance to enter the urethra, too.

The tissues of both the urethra and vagina are dependent on estrogen for growth and, as women age, these tissues can become thinner, less healthy and more prone to infection. Sometimes doctors will prescribe estrogen in suppository or cream form to improve the health of this area directly. Only a low dose is needed (for example, 10 micrograms of estradiol is used as a suppository, as compared to 1000 micrograms as a common strength of the tablets given by mouth for menopause symptoms). Compounding pharmacists can also make a gel or cream using estriol, a very weak estrogen that is very effective in improving the health of the genital tissues. Estriol has little or no effect in stimulating the growth of breast or endometrium tissues and is therefore sometimes preferred for women who would benefit from a local estrogen effect but have increased concerns about reproductive cancers.

The normal human bacterial flora, a mixture of non-harmful bacteria that grow on and in our bodies, is increasingly recognized as an important defense to infection. And since antibiotics kill normal flora along with the infecting bacteria, they may actually set us up for recurrent infections. As well, bacterial resistance to antibiotics is a growing problem – they quickly learn how to survive our cures. We need to be careful to only use antibiotics when they are truly needed, and to finish the full treatment so none of the infectious organisms are left behind… the bacteria that are the slowest to be destroyed are those that have already begun to develop some resistance to the antibiotic being used.

Probiotics are products containing live, non-harmful organisms that are beneficial when given in adequate amounts. When taken by mouth or applied to an area of the body that needs protection, they tend to overgrow disease-causing organisms and create an environment that is resistant to infection.

Studies suggest that when taken by mouth or applied vaginally, probiotics can reduce recurrent urinary tract infections (UTIs). Although somewhat less effective at prevention than low dose daily antibiotic therapy, probiotic treatment does not cause the bacterial resistance that is seen with antibiotics. So, although more research needs to be done to find the ideal way to use probiotics, it’s worth discussing with your doctor if you have recurrent UTIs.

Lastly, cranberries and blueberries contain a substance that can help prevent bacteria from sticking to the bladder wall, an essential step in the beginning of an infection. Cranberry juice, however, contains a lot of sugar to counter its bitter taste, and this sugar can promote the infections you are trying to prevent. Cranberry concentrate capsules are an option without sugar, but you need to read and compare the labels carefully – all cranberry supplements are not created equal! Some may contain as little as 5mg of concentrate but be labeled as over 1000mg – the amount of fruit it was extracted from… very misleading! Also, cranberry, like grapefruit, can interact with other medications you may be taking. Be sure to check with your pharmacist before taking large amounts of cranberry if you take other medications!

In summary, actions that reduce the amount of bacteria that reach the urethral opening, prevent bacteria from sticking to the bladder wall and maintain a healthy bacterial flora (especially after a treatment with antibiotics) will all help to prevent recurrent urinary tract infection.