In praise of balanced diet: There are... - Restless Legs Syn...

Restless Legs Syndrome

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In praise of balanced diet

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There are numerous claims on this forum for the benefits of this or that diet in reducing RLS symptoms. I am always happy to hear when any of us finds something that works for them.

However, I'd like to stress the importance of maintaining a balanced, healthy diet, such as the Mediterranean way of eating: a good balance of plenty of fruits and vegetables, whole grains, legumes, reasonable amounts of healthy fats (not saturated), and for non-vegetarians, perhaps some poultry and/or fish.

I certainly agree that reducing sugars and refined flour can be very beneficial. But eliminating all grains including whole grains, such as the ketogenic diets (which include Atkins and Paleo), result in a very unbalanced diet that should only be used for short-term weight loss, not as an ongoing way to eat. The British Dietetic Association named the ketogenic diet one of the "top 5 worst celeb diets to avoid in 2018". Link:

From this article: "side effects may include low energy levels, brain fog, increased hunger, sleep problems, nausea, digestive discomfort, bad breath and poor exercise performance... It is never a good idea to ‘over-restrict’ any one food group (including carbohydrate), as this can mean it is more difficult to achieve a balanced diet overall with respect to vitamins, minerals and fibre in particular."

Fiber, it turns out, is very important in maintaining a healthy gut microbiome, which is in turn vital in maintaining good health, largely through reducing systemic inflammation. Inflammation is now being posited by some researchers as a possible cause of RLS.

In addition, there is no solid evidence that gluten is a problem for any of us, unless we have diagnosed celiac disease. However, refined wheat flour may very well be a culprit for us. I propose that we experiment on ourselves: if you believe yourself to be gluten-sensitive, try replacing your wheat-containing food ( e.g. bread) with a similar food made from a non-gluten-containing grain, such as bread from refined oat or millet flour. Then see if your RLS symptoms improve. If not, try eliminating all bread, and see what happens.

As for myself, I have greatly reduced my intake of refined sugars and flours of all kinds, including bread. I do eat a balanced Mediterranean-style diet, including whole grains and legumes. I have found this to be very helpful in reducing my RLS symptoms.

So all I'm asking is that we take a clear-eyed look at how we're eating and whether it's well-balanced. We might experiment to see what triggers our RLS, for instance alcohol, coffee, and refined sugars and flour. And to really investigate whether whole grains vs. no grains actually helps. And finally, please, let's be careful about promoting unbalanced ways of eating. Thanks for hearing me out.

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I agree and would add that, for me, the stress caused by worrying about my diet and trying to cut out foods I like negates any possible benefit. For other reasons I did follow a vegan diet for a few months (before I was diagnosed with PLMS) and didn't feel any better for it.

I really admire those who can follow and stick to exclusion diets but - again, for me - the lack of physical and mental energy that comes with this condition makes it impossible for me to find the focus and willpower to do it. I admit that reading some of the posts advocating particular diets initially gave me another stick to beat myself with (why can't I do that, it's all my own fault etc) but now I just know that's not the answer for me, for now, and I skim over them.

Absolutley!! .regardless of having RLS , I think it's very important to eat a balanced diet

For one, I can't have and never have had any *EXTRA * added salt to any meal, I regulate not to have no more than 2g per day, if i do go over then I don't worry as long as its for special occasions.

Three years ago, I went slightly overweight, I decided to cut out gluten , this was not for medical reasons, it was a clean eating plan.

Well ... I lost weight very slowly, but not just that, my skin, nails and sleep felt so much better, I had only dark chocolate but the good sort, oats at breakfast, loads of vegetables and increase of my daily water, intake.

Due to my long term liver disease of ten years, I have to eat good protein daily, unfortunately for me I have slipped this past twelve months due to chronic pain.

After reading today's posts it has given me the wake up call I need to 're valuate my eating.

Thank you ..

If it helps my RLS ,then I will be more than happy , if not, then at least I have tried and ruled out what may have been a trigger

Linda 😊

I'm sure that everyone agrees that a balanced diet is good for you. But you can have a balanced diet that excludes foods that your body can't tolerate. I have read many times that avoiding gluten is only desirable if you are a diagnosed celiac. Yet if I eat gluten I will loose two or three nights sleep and I a not celiac. Once again it proves that what helps one person does not help everyone.

However it is well accepted that many RLS patients have trigger foods. All you have to do is find your triggers and then stop eating them. Many people try the available diets and find they are no help. That's very sad for them. They have to keep trying other paths to find relief. I think it is wise for anyone with RLS to find out if a diet can help them and the best way to do this is to follow a systematic approach of trying an exclusion diet for a few weeks to see if there is an improvement in their RLS In my case it took 12 weeks before I saw a real benefit. You are then in a position for your dietician to re-introduce foods in an orderly and systematic manner which gives you a very good chance of identifying a whole group of foods that you have to avoid. If a FODMAP diet doesn't work then try the Low Chem diet and then the vegan diet. The diets work for some people and they might work for you.

I am not pushing a FODMAP diet for any reason other than that in my case it has worked wonders and I am sure that there must be 5% or 50% of other RLS patients who it will also help.

Its a bit like the iron infusion that I have had. It may be 12 weeks before it contributes to relief from RLS or it might be useless. If it doesn't help me then that doesn't alter anyone else's chance that it will help them. It seems to be a lot of mucking about to get the job done but if we accept the opinion of the most prominent RLS doctors everyone with RLS should try raising their blood ferritin level to about 350 (unless there is a medical reason not to) just to see if it works for them. Unfortunately this treatment might be too expensive for many people. We should be supporting any campaign to have this included among treatments provided by the public purse or recognised as a legitimate treatment by health insurers

Good Luck


My point about gluten is that people tend not to really investigate to see if it's really gluten that's the trigger. They make wholesale modifications in their diet, changing many variables at once. As I wrote, is it really gluten that is the trigger, or is it the refined flour containing it? To prove it one way or the other, I need to change one variable at a time; otherwise, I can't be sure if it's actually gluten, or the form of the wheat I'm eating (I.e. milled flour bread vs. whole grain) So I could try one or both of two experiments:

1. Eliminate wheat bread made with flour, and instead eat a whole-grain form of wheat, such as farro, cooked like rice.

2. Alternatively, eliminate all wheat including wheat bread. Substitute the same amount of bread I was eating with some other bread made with equally fine-milled flour from a different grain such as millet or oats without gluten.

I actually did the first one for myself last year. I stopped eating wheat bread, and found that it really helped my RLS. But I continue to eat whole-grain forms of wheat such as farro, as well as other grains.

I'm really glad that the anti-Fodmap diet has been so helpful to you. But I do wonder whether gluten is the problem here, or all the short-chain polysaccharides that are the main focus of that diet, and that I assume you're minimizing in your eating plan.

I'm a bit confused. I thought polysaccharides were different from fodmap's? I have to re-read about this to answer. Some homework when I have time.

As far as the diet goes I think we are looking for the same destination. But getting there by different paths. You are suggesting eliminating foods one at the time to see which are triggers. The idea of a short term exclusion diet is that you start eating a diet that consists of only foods that are known to be extremely unlikely to cause intolerance. IF that results in an improvement of your symptoms then something you have excluded is probably a trigger for your RLS.

If you get no improvement then the foods you excluded are not the cause of your problem.

Only if you find an improvement then you can introduce the foods you just excluded usually called challenging your body. Now you could start with an alphabetical list and work through but the more efficient approach is to identify groups of foods with something in common, In the low FODMAP diet the foods can be separated by the FODMAP or FODMAPs they contain So our groups are those foods containing one or more FODMAPS in significant amounts. For the challenging process it's clearer to choose foods that contain only one FODMAP. You start adding this food to your diet in small amounts for a few days and then increase the daily dose over a period until you either get a RLS reaction or you eat lots of it with no reaction. You have now identified a FODMAP that you can or can't tolerate. You can say that other foods that contain the same FODMAP are either allowed in your body or have to be avoided. Repeat for each FODMAP and at the end you have a list of foods that contain FODMAPs that are acceptable to you. You then just limit your diet to these foods and you are right.

Of course its not always that simple. In my case I have also tested for gluten intolerance and found that if I eat gluten I get RLS. I have also tested for lactose intolerance and found that if I drink ordinary cow milk I get RLS.

If you still have a problem and sorting the food grouped by FODMAPs doesn't help then there are other ways to define the food groups. The Royal Prince Alfred Hospital Low Chem diet is such an alternative. There are probably other food grouping systems that can be applied.

A lot of FODMAP food is not intuitive. Good food is no good if it contains something that your body can't tolerate. Apples are an easy example. If you are intolerant to the FODMAP in apple then its a bad food for you.

There are also effects I didn't expect like a time delay between eating a FODMAP and getting RLS In my case it used to be that my RLS followed about one to two days after I ate the food. Now, after a few years, it seems to be less precise which is confusing.

The other important effect is the thresh-hold. If you avoid your FODMAP for a few weeks and then eat a small amount it might have no effect. You might find that you can eat the small amount every day and it has no effect. That's good because it means that if you take care you can expand your diet to include a small amount of this food, any day you like. If you eat a larger amount every day then you might find that after three days you get RLS. You have built up the amount in your body to cross the thresh-hold. If you stop the FODMAP then your body level will drop back below the thresh-hold again and, in my case, the RLS goes away again quite reliably in a couple of days. Of course if you eat five foods with the same FODMAP then you will reach the threshold sooner.

I wish it were as clean cut as it sounds here but of course its not. Sometimes I can get RLS for a week with no idea what I've done wrong. The good thing is that I never get RLS as bad as I used to before the low FODMAP, gluten free, caffeine free, lactose free diet. At worst I have to walk a bit, perhaps only ten minutes, and usually have a cup of hot water or tea then back to bed and sleep.

An example of a complication are bananas. As a banana ripens it manufacturers a chemical. If this chemical affects you then you can probably eat green bananas. But how do you define a green banana? Bright green and almost inedible? yellow with a touch of green? I haven't found a definition yet. If a banana is stored for months in a cold room does it develop the chemical without changing colour? I limit myself to one banana per day to avoid having to answer such simple questions. This probably works for me.

Hi, Graham, my term polysaccharides isn't quite right. FODMAPS also includes monosaccharides. But they are all short-chain sugars. Here's a definition I came across: "FODMAP stands for "fermentable oligo-, di-, mono-saccharides and polyols." (Polyols are sugar alcohols like polysorbitol.) I'm no expert on these, but as a Bioinformaticist, I specialized in proteins and sugars, and their role in human biology and diseases.

FODMAPS are one type of dietary fiber. All dietary fiber is indigestible, and passes through the body. It's mostly helpful in keeping digested food moving through the bowels. The difference is that unlike other fiber, FODMAPS are fermentable. So I believe that's why they can cause problems: they pass through to the large intestine where certain bacteria go to town, sometimes creating bloating, etc. The theory, if I understand it correctly, is that those bacteria can themselves cause other problems, perhaps altering the motility of nutrients across the gut wall.

I like your scientific approach. You are quite right that it is a very valid approach to wipe the slate clean and start with a very restricted diet, adding in challenges bit by bit to see what the result is. It looks like that's how you have determined that too many FODMAPs and possibly gluten are triggers for you.

I hope I have not left the impression that I'm defending gluten. I'm really not. It just seems to me that the jury is still out on whether the culprit is gluten or the types of fiber (including FODMAPs) that often accompany gluten in food. Here are a few journal articles I've come across that raise this issue:

The following one in particular interested me, as it appears to show that reintroducing gluten after following a low FODMAP diet for awhile made no difference to the subjects' symptoms. (All subjects had self-reported non-celiac gluten sensitivity,)

It's a very complex area, and it's really hard to tease apart the confounding factors. It seems you are finding this to be true in your case, where it's sometimes hard to get repeatable results.

I enjoy our discussions. I think you're on to something here.

Thanks for your comments from an expert in this area. My main concern is that people must not think of a traditional "healthy diet" with RLS. That "apple a day that keeps the doctor away" might be the one thing ensuring a lifetime of RLS. I don't really know if I am intolerant of gluten or just wheat At the moment I avoid gluten which I think covers wheat and a couple of other things.

I know that there are tests available for many things like gluten and lactose but I have heard that the tests are not as reliable as I think we need considering the importance of the decision we make based on their outcome.

Incidentally I am here at the computer at 5am probably because I "cheated" a bit on New Years Eve at a bit of a party at a friend's place and undoubtedly ate something I shouldn't have. I expect to be awake tomorrow night as well, but there were some delicious bits and pieces there.



Now I am confused 🤔🤔 lol .

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