I've had RLS for over 5 decades; cannot sleep without opiod meds, which do work. Have tried megadose of IV iron--no benefit at all. Have been borderline anemia for decades also, despite taking iron supplements much of that time. Recently the anemia got worse, and with the iron connection to RLS, I thought I'd better do some more research. Taking more iron seemed pointless. Why repeat what hasn't worked before?
I learned from PubMed in the US that a copper deficiency can block iron uptake and bone marrow cell production. A hair analysis showed I was deficient in copper, so I have been taking ionic copper for a couple of weeks now. My doctor noticed that my levels are coming up. I quote from the PubMed article, "Hematological manifestations are fully reversible with copper supplementation over a 4- to 12-week period."
Be aware that it is NOT WISE to supplement with copper unless you are deficient. There is such a thing as copper toxicity, too! But for those of you who are copper deficient, this is something you can check into. If increasing iron absorption will help even some of you, this post will be worth it.
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TimeEnd
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Good sleuthing!!! Love it! We don’t need a lot of copper but definitely some. I have to research it but I believe zinc is the yin to copper’s yang and there should be some kind of balance there. Zinc is the calming mineral. Anyways, over 10 years ago I read on a site similar to this one to “just take some iron at night…there’s just something about that free floating iron that helps.” I’m so very glad that someone shared that as you have done. That is all I need for my RLS - 50mg of ferrous bisglycinate on an empty stomach about an hour before bed. The RLS vanishes in one hour for one night. I researched this phenomena and found out that serum iron (NOT ferritin) plummets at night with a nadir of midnight. Because we with RLS have VERY little stored BRAIN iron (and a lousy dopamine transport system), we rely very heavily on that serum iron. When it drops at night our RLS rises 😅. I’m not the only RLSer for whom this works.
I just received my hair trace mineral analysis (HTMA) a couple of weeks ago and I’m also deficient in Copper (as well as all other trace minerals). I came to the same conclusion as you , that Copper deficiency could be the issue of the improper iron absorption, so I started to take trace mineral supplement containing 2mg Copper Bisglycinate a week ago and will see if it’s help. Based on my HTMA I’m also deficient in Sodium and Potassium, which very likely a cause of adrenal fatigue, which on it’s own can cause sleep problems, so now I’m working on this as well.
The best IMHO is copper glycinate or bisglycinate, but citrate has good bioavailability as well, but can compete with other minerals taken as supplements, so it’s better to take it separately from other supplements. Gluconate is not recommended.
But as TimeEnd warned in his post, no one should supplement copper without checking if deficient, because copper can be toxic as well.
Zinc can worsen RLS. It also inhibits/lowers copper if taken in amounts higher than 50mgs a day. Here's a study that found high levels in RLS patients:
See more relevant info I've posted below about copper deficiency. Also look into supplementing raw cold pressed cod liver oil to build your ceruloplasmin.
I’ve been reading posts for a while but first time I’ve replied. I’m a RL sufferer with pain and chronic migraine for 52 years I’m 70. I’m at my wits end now and feel I can’t carry on any longer. I’ve had no quality of life at most now I might endure 10 agonizing more years. For what! I feel my consultant cannot help me he sees me yearly. For me that is not enough, I realise he has other patients. I was on topirimate for migraines which I have been taken off as I have been on too long, not allowed any pain relief, and Pregabalin the side effects not good, weight gain, spaced out, palpitations, hot flushes, but he thinks this is the best drug. Any thoughts
Have you had your ferritin checked? If so, what was it? Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. If not when you see your doctor ask for a full iron panel. Stop taking any iron supplements including multivitamins that have iron in them 48 hours before the test, don't eat a heavy meat meal the night before, fast after midnight and have your test in the morning before 9 am if possible. When you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. You want your transferrin saturation to be over 20% but less than 45% and your ferritin to be at least 100. If they are not, post them here and we can give you some advice.
You might want to try gabapentin. Although they are basically the same drug except you need to divide the doses, and the side effects are basically the same, some people find that the side effects that bother them on one don't bother them on the other. Beginning dose is usually 300 mg gabapentin It will take 3 weeks before it is fully effective. After that increase it by 100 mg every couple of days until you find the dose that works for you. Take it 1 to 2 hours before bedtime as the peak plasma level is 2 hours. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime. Most of the side effects of gabapentin will disappear after a few weeks and the few that don't will usually lessen. If you take magnesium, even in a multivitamin, don't take it within 3 hours of the gabapentin as it reduces the absorption of the gabapentin. If you take calcium don't take it within 2 hours for the same reason.
Another one to try is dipyridamole. You might want to discuss this with your doctor. It has helped some people on this forum and another forum I am on and has completely eliminated RLS in some. In the winter 2022 edition of Night Walkers, the publication of RLS.org there is an article by Sergi Ferre about dipyridamole discussing the effectiveness of it in a 2 week double blind placebo controlled study showing it completely ameliorated all symptoms. The study was by Dr. Garcia Borreguero movementdisorders.onlinelib...sciencedirect.com/science/a...movementdisorders.onlinelib...
If none of the above work, there is clonidine. Https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.22254
And then there is a low dose opioid. I would recommend buprenorphine.
Check out the Mayo Clinic Updated Algorithm on RLS which discusses the latest guidelines on RLS treatment including opioids. Https://mayoclinicproceedings.org/a...
You have probably see this one but in case you haven't some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium, foods that cause inflammation, ice cream, eating late at night, estrogen including HRT, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, stress and vigorous exercise. Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, fennel, low oxalate diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, CBD, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, vibration devices, using a standing desk, listening to music, meditation and yoga. Keep a food diary to see if any food make your RLS worse
Many medicines and OTC supplements can make RLS worse. If you are taking any and you list them here, I can tell you if any make RLS symptoms worse and if so may be able to give you a safe substitute.
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RLS link to iron deficiency and dopamine. Interesting article.
For those seeking rest from RLS
I’m Coco & today Joolsg suggested I post re upcoming NHS Iron Infusion 
Some Answers
Iron article
