Inflammation and RLS

[WideBody]

I have always believed that inflammation was part of my RLS. I believe this because my RLS responds well to ibuprofen.

A recent blog was using this study

smj.org.sg/sites/default/fi...

The study is from 2016.

The study proposes to use the neutrophil-to-lymphocyte ratio (NLR), a simple and inexpensive marker of inflammation, to investigate this relationship.

The study reports the results of the analysis, showing that the NLR was significantly higher in the RLS group than in the control group, and that it was predictive of RLS at a cut-off value of 1.58. The document also shows that the RLS group had lower levels of vitamin B12, ferritin, and folate, but they were within the normal range.

NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count.

Anything Higher than 1.58 can be indicative of RLS

*****************

Well this is pretty easy test and I have about 20 years of blood tests in an excel spreadsheet...... Now I have to find the spreadsheet. In the meantime, this is my most recent test

ABSOLUTE NEUTROPHILS 1904

ABSOLUTE LYMPHOCYTES 976

NLR = 1.95, FML

OK, Now I have to go find my spreadsheet.

Please post your values below. Let's see if the study is correct.

[SueJohnson]

2.31

[ChrisColumbus]

Are you in the US? In the UK my results are shown linked to normal ranges which are expressed as e.g. (as usual there's some variation on 'normal'):

Neutrophils Adult 1.8 - 7.5 x10^9/L

Lymphocytes Adult 1.0 - 4.0 x10^9/L

My last recorded results in June '23, after finishing treatment for prostate cancer in late 2021, were 4.52 and 1.53 respectively, a ratio of 2.95:1. I was not - and still am not - suffering RLS symptoms at the time.

In March '21, during hormone treatment but before radiotherapy, the figures were 4.28 and 1.92 respectively, ratio 2.23:1. I had terrible RLS symptoms at the time (I was on atorvastatin after a TIA in late Feb '21).

Does this make any sense to you?

[WideBody in reply to ChrisColumbus]

Chris, I am in the US. Here are the full lines for my labs:

ABSOLUTE NEUTROPHILS 1904 1500-7800 cells/uL

ABSOLUTE LYMPHOCYTES 976 850-3900 cells/uL

Looks like your still high, but that is just indicative of inflammation.

[ChrisColumbus in reply to WideBody]

Similar relationships on the normal ranges between the US and UK then. But interestingly from my point of view, my RLS was rampant in 2021 when my ratio was 2.23 but almost totally absent in 2023 when it was 2.95 (I'd had Covid in autumn '22 but not knowingly in '23).

I have an annual check-up next week so will hopefully get new figures then - but still RLS free without medication.

[WideBody in reply to ChrisColumbus]

I won't say I am RLS free, but my RLS is managable.

[SurvivorD in reply to ChrisColumbus]

I am desperate to go off all RL medication. I am currently on 0.25mg per day of Pexola Cut down from 1mg. Second time I have gone through withdrawal!! Not been an easy journey!! I am super sensitive to many medications. I read your post regarding anti inflammatories. Unfortunately I am allergic to them. Do you perhaps know an alternative??

My triggers are alcohol chocolate too many carbohydrates and the worst is sugar.

[WideBody in reply to SurvivorD]

Have you done the standard morning fasted full iron panel? What were your numbers? Specifically Ferritin and Transferrin Saturation Percentage?

[SurvivorD in reply to WideBody]

Thank you for your time and prompt reply. Yes had them all done last week. Is it at all possible to take a camera shot and post the results to you. Not sure which numbers to use. The doctor just said everything was normal.

[WideBody in reply to SurvivorD]

Yes, please screen shot and post here. Remove name and account and other info. I had an infusion the same week the Doctor said my ferritin was normal (30).

[WideBody in reply to SurvivorD]

If you prefer, feel free to DM me the info.

[SurvivorD in reply to WideBody]

Thank you for your time. Greatly appreciated 🙏

Iron Results

[WideBody in reply to SurvivorD]

Ferritin is low. TSP is in the normal range. If I were you I would try oral iron supplements for 3 months to see if affects your RLS.

[SueJohnson in reply to SurvivorD]

Just post the ferritin and the TSAT (transferrin saturation percentage here. We all want to know so we can advise you.

[SurvivorD in reply to SueJohnson]

Thank you have posted results on Widebody profile

[SurvivorD in reply to SueJohnson]

Thank you

Iron Profile Results

[SueJohnson in reply to SurvivorD]

( may have told you this before: take 325 mg of ferrous sulfate which contains 65 mg of elemental iron, the normal amount used to increase ones ferritin, or 50 mg to 75 mg (which is elemental iron) of iron bisglycinate with 100 mg of vitamin C or some orange juice since that helps its absorption. Ferrous sulfate is fine for most people, but if you have problems with constipation, iron bisglycinate is better. Take it every other day, preferably at night at least 1 hour before a meal or coffee or tea and at least 2 hours after a meal or coffee or tea since iron is absorbed better on an empty stomach and the tannins in coffee and tea limit absorption. If you take magnesium, calcium or zinc, even in a multivitamin take them at least 2 hours apart since they interfere with the absorption of iron. Also antacids interfere with its absorption so should be taken at least 4 hours before the iron or at least 2 hours after. Don't take your iron tablets before or after exercise since inflammation peaks after a workout. Don't take tumeric as it can interfere with the absorption of iron or at least take it in the morning if you take your iron at night. If you take thyroid medicine don't take it within 4 hours. It takes several months for the iron tablets to slowly raise your ferritin. Ask for a new blood test after 3 months.

[SurvivorD in reply to SueJohnson]

Thank you Sue. Unfortunately, doctors put so much fear of the risk of overdosing on iron. I read the forum everyday and the research done is extensive and proven that RL suffererers can benefit from iron supplementation/infusions. I will now proceed with iron as suggested. Thank you Sue, Jools and many members for your time and knowledge.

[ChrisColumbus in reply to SurvivorD]

I'm rather brain-fogged today (think I may have caught something...) but I don't recall posting re anti-inflammatories...Don't know whether this is any interest/help:

healthline.com/nutrition/13...

Forgive me if I've missed the point.

[SurvivorD in reply to ChrisColumbus]

Apologies 😐

[SurvivorD in reply to ChrisColumbus]

Interesting and informative study. Will definitely be eating more of suggested foods. Thank you

[RLSLearner]

Science by the people - beware the ivory towers collapsing around us! From memory of the study there was certainly a statistical difference between RLS and nonRLS ratios but the ranges overlapped significantly. So maybe not useful as a diagnostic marker but possibly to follow your inflammation level . I certainly think inflammation has a significant role and that everyone should review what they put into their body if they are concerned about their health. The best marker then is how your restlessness improves. But please everyone put in your ratio!

[Eryl]

There is no proof that the inflammation is caused by the lower levels of vitamin B12, ferritin, and folate, it is probably the inflammation which is causing the lower levels therefore supplementing vitamin B12, ferritin, and folate will not reduce the RLS. The way to reduce RLS is to remove the causes of the inflammation which for most people is the ingestion of processed food.

[WideBody in reply to Eryl]

Ferritin rises in the presence of inflammation. (supposedly) The issues with B12, Ferritin and Folate is that a deficiency in any one of those parameters can cause anemia.

I feel better if I don't eat processed food, absolutely. However, I am being honest, at age 63 I have no self control. After 8pm, if there are cookies in the house, I will find them and I will eat them. All of them. The only time if affects my RLS is if I REALLY overeat. It happens, but not that often, thank goodness.

[Eryl in reply to WideBody]

Ferritin rises with alcohol consumption which causes inflammation. If I fancy a snack after 8 pm I try to stick to nuts that won't cause rls.

youtu.be/GIAgaaXueFw?si=dvV...(Not working as expected?)

[WideBody in reply to Eryl]

Interesting, I don't drink since my RLS started. Alcohol is most definitely a trigger for me. I had not heard about the nuts. Thanks.

[Eryl in reply to WideBody]

I usualy stick to walnuts which are high in anti oxidants and not only do not contribute but actualy help to fight inflammation.

[Eryl in reply to WideBody]

youtu.be/lGLzq3GxhcE?si=lyq...(Not working as expected?)

[RiversW]

Sorry, not sure how one arrives at the ratio, but here are the only relevant numbers I could find in my last panels. Is the ratio between these counts. Or are these the wrong numbers altogether?

Absolute Neut Count 2.95 1.80 - 6.90 x10E3/uL Final

Absolute Lymphocyte Count 2.10 1.30 - 3.40 x10E3/uL Final

[WideBody in reply to RiversW]

I am not an expert but yours looks good 1.4 Do you have any other inflammation markers like CRP or SED rate?

[RiversW in reply to WideBody]

Ok, so I went back an looked a panel taken in April 2023. The numbers are vastly different. The Ratio if I am understanding correctly in April is much greater. I understand that you are not an expert WideBody, no worries. Just thought this might be notable.

I could not find in my panels CRP or SED rates.

Thanks for taking the time.

Rivers

April 2023

Absolute Neut Count 7.64 High 1.80 - 6.90 x10E3/uL Final

Absolute Lymphocyte Count 0.90 Low 1.30 - 3.40 x10E3/uL Final

October 2023

Absolute Neut Count 2.95 1.80 - 6.90 x10E3/uL Final

Absolute Lymphocyte Count 2.10 1.30 - 3.40 x10E3/uL Final

[WideBody in reply to RiversW]

Do you remember if your RLS was particularly bad in April? Were you fighting a cold? What was your white cell count?

For what it is worth, I have about 15-20 years of blood work in a spreadsheet somewhere.

[RiversW in reply to WideBody]

I believe I can go to the UCLA patient portal and see bloodwork going back about 10 years. I will look for my white cell count to see it was elevated.

In fact, it is possible that I was sick. Typically I get bloodwork done after having travelled from Brasil, where I live now, to Los Angeles, where I used to live. I still carry insurance in the states.

I remember on one of the trips this year I was not well. So perhaps that accounts for the variance in the numbers.

My RLS over the past few years has been severe due to augmentation. However, when I travel, I often get a break for a few days. I can't really say why I get the break. It has been the case since I switched from mirapex to Neupro. On Mirapex, any breaks from RLS were totally unpredictable.

I am in the process of weaning myself off the Neupro. Hopefully, I can get my life back to some kind of normal. However, I cannot remember what normal is since I have lived with RLS for so long.

Pardon my poor spelling. I am sure it's a result of augmentation.

Take care,

Rivers

[PoorRichard]

Interesting. I viewed my patient portal test results and could not find this info. However, I did find results of another test for inflammation: C REACTIVE PROTEIN. My results were .7 on a scale of 0.0 to 10.0 mg/L, last November (very low inflammation). Meanwhile, horrible breakthrough last night after days of peace. Such an idiopathic condition!

[707twitcher]

I have lots of blood test data from 2016 forward, due to having chronic lyme disease and getting frequent labs related to lyme treatment. My NLR has varied from 3 to 8, mainly caused by low lymphocyte count (which can be caused by autoimmune disease, MS, infection, radiation). My RLS was pretty constant during this period - managed by .25mg of pramipexole nightly until augmentation kicked in 6 or 8 months ago. So I don't see a correlation between my NLR and intensity of RLS - RLS stayed constant while NLR bounced between high and really high.

[CalmRestPeace]

One of the issues with inflammation is that it can skewer any type of test results we're trying to get to learn about our bodies. That includes the results of an iron/ferritin test.

If you have Restless Legs, which is caused by inflammation, that means whatever results you're reading for whatever test you've taken may not be accurate.

There's a study that shows how the iron tests can be skewered due to the inflammation.

I can track it down if anyone is interested.

It's for this reason that you really have to learn to listen to your body when you're attempting to lessen your RLS by dealing with the underlying inflammation.

Any data results you receive through testing cannot be trusted.

[WideBody in reply to CalmRestPeace]

Ferritin rises in the presence of inflammation which makes the ferritin levels higher than normal. It is necessary to look at any inflammation markers at the same time. SED rate, CRP and this new one called NLR.