Natural Solutions for Hypoglycemia, Hyperglycemia and Insulin Resistance
Do you reach for a snack when you feel your energy levels drop mid-afternoon? Or maybe you’re just the opposite: lunch makes you so sleepy, you feel like curling up under your desk for a nap?
I’m going to let you in on a little secret…
The only thing eating should make you feel is not hungry.
If meals either give or drain your energy, that’s a sure sign you’re dealing with blood sugar dysregulation such as hyperglycemia, hypoglycemia, and insulin resistance.
Unstable blood sugar causes everything from cravings to mood disorders. It can hold you hostage from your ideal weight, cause inflammation, and even impact fertility. Not to mention, it can be the start of blood-sugar related diseases like Type 2 diabetes and Alzheimer’s (which is sometimes called Type 3 diabetes!).
On the other hand, stable blood sugar is the secret to reducing inflammation, having stable energy, better sleep, a better mood, and balanced hormones. I’ve even seen stable blood sugar have a positive impact on relationships (that’s why I always carry snacks for my toddler… and my husband!)
The bad news is that blood sugar issues are one of the most common problems I see in practice… but the great news is that there is an entire suite of things we can do to bring blood sugar back into balance.
What Are Normal Blood Sugar Levels?
Blood sugar is exactly what it sounds like: the amount of sugar in our blood. When we eat carbohydrates, they are broken down by the body into a simple sugar called glucose. Glucose crosses from the small intestine into the bloodstream where it can be taken up by the mitochondria - the “powerhouses''of our cells - and converted into energy, called adenosine triphosphate (ATP).
This process is helped along by key hormones like insulin and glucagon. Insulin is released by the pancreas and helps lower blood sugar levels by allowing sugar to enter the mitochondria, as well as be stored in the liver and muscles as glycogen, or stored in fat. Glucagon works in the opposite direction: it helps free stored glucose to raise blood sugar levels when they drop too low.This give and take is extremely important, as the body thrives when blood sugar remains stable - not rising too high or dropping too low.
When blood sugar levels are chronically low, it is called hypoglycemia. People with hypoglycemia often feel tired, anxious, or unfocused when they are hungry - and a meal helps energize them and allows them to focus. On the other hand, those with hyperglycemia (also called insulin resistance) have blood sugar levels that are too high. They feel tired after eating. Many people have symptoms of both hypo- and hyperglycemia at different times.
According to the American Diabetes Association (ADA), normal fasting blood sugar is below 100 mg/dL. Levels between 100-125 indicate pre-diabetes, and anything over 126 when fasting is considered diabetic. After eating (postprandial), the ADA considers 70-140 mg/dL to be normal.
But, what’s “normal” isn’t necessarily optimal. Fasting glucose can be “normal,” but you may still experience glucose spikes over 140 mg/dL throughout the day. Instead, I prefer to look for these signs of optimal blood glucose levels:
- Fasting: 70-90 mg/dL
- Postprandial: Below 120 with a return to pre-meal glucose levels within 2 hours (ideally below 100)
(For how to find your blood sugar levels, see “Testing Your Blood Glucose and the Benefits of Continuous Glucose Monitoring” below.)
What Is Hypoglycemia and What Causes Hypoglycemia?
Hypoglycemia is low levels of blood sugar, generally less than 70 mg/dL when fasting.
A Lactate dehydrogenase (LDH) level below 140 is also a sign of hypoglycemia.
Clinically, a person with hypoglycemia is often on the thinner side, and a “healthy” eater. However, they may skip meals (or just never feel hungry - only realizing they need to eat when they are shaky, foggy, or depressed), then have a mid-day crash, anxiety, and irritability. They often have strong sugar cravings in the afternoon or after dinner. When they do finally eat, they have improved energy and mental function- but it doesn’t last long! They also often struggle to stay asleep, as they don’t have the necessary glycogen stores.
The main complaints I see with hypoglycemia are:
- Fatigue, especially an afternoon or mid-day crash, or between or after meals
- Insomnia, trouble staying asleep or falling asleep
- Mood swings
- Anxiety
- Depression
- Hair thinning
- Infertility and hormone imbalances
- Impaired metabolism or weight gain
What causes hypoglycemia? The main culprits I see are a habit of missed meals, high-sugar snack, using caffeine or nicotine to suppress appetite, eating sweets or snacks instead of meals, and overtraining without properly replenishing glucose.
Low blood sugar can also be the first step toward developing insulin resistance and hyperglycemia. Low blood sugar causes a stress response, where cortisol rises and catecholamine spikes, to “save'' low blood sugar, which can cause nervousness, shakiness, and anxiety. Catchelomanes also suppress appetite, masking hunger and leading to more hypoglycemia.
What Is Hyperglycemia and What Causes Hyperglycemia?
Hyperglycemia is elevated blood sugar levels, with a morning fasting glucose above 99 mg/dL (though I prefer to see it below 92!), and levels after meals rising above 140 mg/dL. It is also signaled by an HBA1c above 5.6, though this marker isn’t always accurate. Fasting insulin levels above 5 indicate mild hyperglycemia, while levels above 10 indicate pre-diabetic levels of hyperglycemia.
If not addressed, hyperglycemia can intensify into diabetes, where fasting glucose is above 126, HBA1c is above 7, and fasting insulin is above 20.
Clinically, people with hyperglycemia often complain that after they eat, they feel fatigued, have impaired mental function, and often crave sugar. Chronic inflammation is another hallmark of hyperglycemia, and may present as anything from chronic joint pain to acne to autoimmune disease. Frequent urination is another key sign of hyperglycemia I look for. Finally, those with hyperglycemia often have a very hard time exercising, but once they do, have notable improvements in energy levels.
Hyperglycemia and insulin resistance are often used interchangeably. Hyperglycemia is simply the state of having high blood sugar - it could be a one-time thing due to a particularly high-carb or sugary meal. Insulin resistance, on the other hand, is a result of ongoing, sustained high blood sugar, which tells the pancreas to constantly make more insulin to help lower blood sugar levels back down. Over time, the body becomes less sensitive to elevated levels of insulin, and essentially “stops listening” - keeping blood sugar levels high.
What Are the Root Causes of Insulin Resistance?
Chronic stress, eating too many highly processed carbs, and lack of exercise all play a role in the development of hyperglycemia and insulin resistance. However, there are other factors at play that aren’t as simple to control as skipping the bun on your burger.
For instance, people with polycystic ovarian syndrome (PCOS) are genetically prone to be less insulin sensitive, even with a “perfect” diet.
In addition, the normal phases of the menstrual cycle can have a major impact on blood sugar levels. As progesterone rises in the week before your period starts, insulin resistance also increases, leading to elevated blood sugar levels. In addition, progesterone can also increase cravings for carbs and sugary foods, intensifying the problem. (It can also tank workout performance and hinder proper recovery!) On the other hand, estrogen, which rises during the follicular phase, actually increases insulin sensitivity.
For these reasons, I recommend people workout harder and eat more whole-food carbs during the follicular phase, then reduce carbs and do lighter training in the luteal phase. Use the last week of your cycle as a recovery period, and prepare to bounce back hard right after your period ends.
Testing Your Blood Glucose and the Benefits of Continuous Glucose Monitoring
You might have some symptoms of hyper or hypoglycemia, but the only way to know for certain is with blood glucose monitoring. I recommend continuous glucose monitoring with a monitor like NutriSense. This little device is convenient, painless, doesn’t require any finger sticks, and gives you 24-hour-a-day data on your glucose levels. Plus, you can wear it during workouts, sleeping, and everything in between.
Continuous glucose monitoring allows you to see the impacts of everything you do on your blood sugar levels - these are just some of the things I like to pay attention to:
- The types of carbs you eat whole food vs. processed)
- Eating carbs with or without other foods
- The time of day you eat carbs
- Workouts
- Sleep
- Menstrual cycle
- Stress
- Meditation and stress management techniques
You can use this information to optimize your lifestyle for wellbeing and glucose control. You may have never guessed that eating an apple alone at 10 AM would give you a crazy blood sugar spike - but now that you know it does, you can make a point to pair it with almond butter.
One other test I use with those with hyper or hypoglycemia concerns is the ION panel. This gives us a look at nutrient levels, so that we can make personalized supplement recommendations - like adding key blood-sugar control nutrients like magnesium, folate, and other B vitamins.
Elevated levels of Pyruvate, L-Lactate, and/or B-Hydroxybutyrate on an organic acids panel (like the ION/Organix or the OMx) are also potential signs of impaired insulin metabolism. But, because other things - like a strict ketogenic diet or deficiencies of specific nutrients such as CoQ10, B1, or pantothenic acid - can cause elevations in these markers, I only consider them in the context of other symptoms or lab markers.
Food, Fiber and Supplements to Help Stabilize Blood Sugar Levels
Fortunately, if your blood glucose levels aren’t stable, there is a lot you can do about it!
First up, let’s talk about what you can do at meals. Start with a glass of water with 2 teaspoons of apple cider vinegar mixed in. Next, take a look at your plate. Start by eating the greens on your plate - and if there aren’t greens (ideally you’re having greens with every meal) - instead grab a serving of fiber like PureLean Fiber, or Glucomannan Caps if you are on the go (I prefer powder in water as it works better!).
Once you’ve had your greens/fiber, move on to eating your protein and fat. Make sure you’re prioritizing eating enough protein - especially early in the morning. Finally, go ahead and eat your carbs as the last component of your meal. Bonus points if you eat meals containing carbs earlier in the day, as most people are more insulin sensitive in the morning and early afternoon. (And avoid refined carbs and added sugars, in general). If you find that you’re sleepy after meals, it's simply a sign you ate too many carbs at one time.
When you’re done eating, go for a walk. And if you don’t have time to walk, even just doing a few squats can really help. And when you’re done with dinner, be done, and skip those bedtime snacks. A 12-hour fast (from dinner to breakfast) is an easy goal to aim for. But just be aware: fasting longer than your body likes can actually backfire and drive cortisol levels up, so stick to 12-13 hours to start. If you’re not sure about the ideal fast length for your body, a continuous glucose monitor can help clue you in.
Away from the table, actively minimizing stress is key. Stress causes increases in cortisol, and cortisol spikes also spike glucose. If you don’t believe me, just look at your continuous glucose monitor. My glucose has gone up during a couple’s therapy appointment! Sleep is also essential: getting less than 6 hours of sleep per night increases insulin resistance.
I also encourage all my clients to fix any underlying gut health issues, especially an imbalanced microbiome. A lack of butyrate-producing bacteria decreases insulin sensitivity, which many of the proteolytic bacteria are gram-negative and contain pro-inflammatory LPS, which causes or increases insulin resistance.
Hormones play an important role, as well. In women, getting support for hormone balance early on in the peri-menopausal window (after around age 35 for most of us) is essential. Keeping levels of progesterone and estrogen adequate maintains insulin sensitivity. The decline in estrogen that eventually occurs can push up to 40% of women into pre-diabetes or diabetes at menopause. Alternately, having too much testosterone as a woman can make you more insulin resistant (like in many cases of PCOS). Progestin-containing birth control pills have the same effect, as they convert into androgen-like substances in the body. In men the opposite is true: too little testosterone can cause insulin resistance.
And finally, grab some weights: research has shown that building muscle is one of the best tools we have for improving insulin sensitivity.
For my clients, I also like to create custom supplement plans utilizing these nutrients:
- Alpha LIpoic Acid - one of the only substances actually known to recondition insulin receptors to make them more sensitive over time!
- Vitamin B1 (Thiamine) - shown to improve glucose tolerance.
- Chromium - regulates and enhances the effects of insulin.
- Myo-inositol and D-Chiro-Inositol- reduces glucose variability and improves fasting blood glucose.
- Berberine - lowers blood sugar comparably to the drug Metformin, increasing insulin sensitivity and production.
- Magnesium - low consumption of this mineral is associated with poorer blood sugar regulation and a higher risk of type 2 diabetes.
Other herbs I use include fenugreek, cinnamon, bitter melon, pycnogenol, and gymnema, among others.
Get Personalized Help with Your Blood Glucose Levels
Whether you’re dealing with hyperglycemia or hypoglycemia, insulin resistance, or even a diagnosis like diabetes, you have the power to take back control and help your body (and blood sugar) get back into balance.
For a customized plan, step-by-step support, and expert guidance, the first step is to book a free, no-obligation discovery call with my health team.
Learn about how we work with clients to achieve their unique health goals and help them step back into radiant health, so they can stop worrying about how they feel and start living a purposeful life.
>>> Book your free discovery call here
A Functional Medicine Practitioner’s Approach To Treating IBD
When a patient visits me for the first time with inflammatory bowel disease (IBD)—ulcerative colitis or Crohn’s—they’re usually in bad shape.
They have abdominal pain and cramping, diarrhea, fatigue, and other problems, such as visible blood in the stool.
In other words, they’re experiencing an IBD flare.
People who suffer with ulcerative colitis or Crohn’s experience usually have flare-ups when symptoms are much worse, as well as periods of remission, when their symptoms go away. It can be frustrating and hard to have a “normal” life.
When patients come to me for IBD treatment, the first step is to get the patient out of the flare so we can focus on putting the IBD into remission- for good.
In this blog post I’m going to dive into what I do to treat IBD naturally. We can get lasting remission without the use of medications, as seen in this real-life success story from one of my patients. But, first, a word of caution.
Do NOT try this at home!
There’s a very strategic order of operations. If you do any of the things I mention in this article in the wrong order, you can make yourself worse.
Much worse.
For example, if a patient is in a severe flare I might not throw betaine hydrochloride, a digestive aid, at them until later. If they take betaine hydrochloride during an IBD flare it can make things worse.
That’s why it’s so important to work with a functional medicine provider.
I can’t say it enough: If you have ulcerative colitis or Crohn’s, get yourself a good functional medicine practitioner.
Okay, with that out of the way, let’s briefly recap what IBD actually is and the symptoms it causes.
What Is IBD?
Inflammatory bowel disease refers to conditions like ulcerative colitis and Crohn’s disease. These conditions are linked to ongoing inflammation in the gastrointestinal tract. In ulcerative colitis, patients develop inflammation and lesions on the lining of the large intestine and rectum. Crohn’s disease is a type of IBD that involves the lining of the digestive tract. Crohn’s usually involves inflammation in deeper layers of the digestive tract compared to ulcerative colitis.
What Causes IBD?
IBD is an autoimmune disease believed to be caused by an abnormal immune response to gut microbiota or food in susceptible people. In IBD, the immune system malfunctions and attacks the cells in the gastrointestinal tract. The cells in the intestines are innocent bystanders but the immune system thinks they’re foreign invaders. The primary cause and the triggers of IBD are still unknown.
IBD may have a genetic component, since it occurs in some people who have family members with the disease. However, most IBD patients don’t have a family history of the disease.
IBD risk factors include:
- Younger Age – Most people with IBD are diagnosed before the age of 30, but some patients don’t develop the condition until they’re in their 50s or 60s.
- Family History – People with a close relative who has IBD are at higher risk of the condition.
- Cigarette Smoking – This is a risk factor for Crohn’s disease.
- Nonsteroidal Anti-inflammatory Medications (NSAIDS) – Anti-inflammatory drugs like ibuprofen (Advil, Motrin, etc.) and naproxen sodium (Aleve) as well as others in this class may increase the risk of developing IBD or worsening the condition in people who already have it.
Inflammatory Bowel Disease Symptoms
IBD symptoms are different depending upon how severe your inflammation is and where it’s located. IBD patients usually go back and forth between disease flares and periods of remission.
Symptoms of ulcerative colitis and/or Crohn’s include:
- Abdominal pain
- Blood in the stool
- Constipation, especially when inflammation occurs in the rectum.
- Diarrhea
- Fatigue
- Poor appetite
- Unintended weight loss
IBD Complications
Ulcerative colitis and Crohn’s disease share several complications. These include:
- Increased risk of blood clots
- Increased risk of colon cancer
- Increased risk of primary sclerosing cholangitis, a condition that causes scarring within the bile ducts, leading to liver injury.
- Inflammation of the skin, eyes, and joints
Patients with IBD also take medications that can have side effects. For example, corticosteroid drugs increase the risk of osteoporosis and high blood pressure, as well as other conditions.
Possible complications of Crohn’s disease:
- Anal fissure, a small tear in the tissue lining the anus.
- Bowel obstruction
- Fistulas. Inflammation leads to these abnormal connections between different body parts. In Crohn’s, fistulas can develop near the anal area and may become infected.
- Malnutrition
Possible complications of ulcerative colitis:
- Dehydration caused by frequent diarrhea.
- Toxic megacolon, a condition where the colon rapidly widens and swells.
- Perforated colon, a hole in the colon that often occurs due to toxic megacolon.
Fight The Flare
The first thing I do for a patient who’s in the middle of an IBD flare is to begin an anti-inflammatory protocol while at the same time ordering important tests. The two goals at first:
- Prevent tissue inflammation
- Bring symptoms into remission
One of the best ways to calm the tissue inflammation and get out of flares is the specific carbohydrate diet (SCD). The SCD diet is a whole-foods diet including vegetables, fruit, fish, meat, nuts, beans, and healthy fats and oils. It excludes sugars, processed foods, preservatives, all grains, starchy vegetables, and lactose. In patients with diarrhea, I’ve really seen the SCD make a HUGE difference. The elemental diet is also very useful for seven to 10 days. An elemental diet is a liquid formula providing all of the basic nutritional elements you need for health, in a form that your body can easily absorb. One clinical trial of 23 patients with ulcerative colitis found that 56% went into remission on an elemental diet and nearly half of those remained in remission for 7 to 28 months.
Even if the patient isn’t gluten sensitive, I urge the patient to go on a gluten-free diet. Gluten promotes leaky gut, a condition that will stop a patient from going into remission. Mostly, I encourage any patient in an IBD flare to go on a paleo-type diet, with no gluten and no carbs.
For patients in flare mode, I also recommend a Chinese herbal formula called Yunnan Paiyao. In addition, I put them on high-dose DHEA to support the adrenals as they withdraw from corticosteroid drugs.
It’s also important anyone with diarrhea take electrolytes like magnesium and potassium. And Epsom salt baths and butyrate enemas are a part of my anti-flare strategy.
Interpreting Test Results and Treating Accordingly
While making those initial changes to diet and supplements, I order a number of tests in IBD patients. These include stool tests, as well as tests to find out if a patient is nutrient deficient, and tests for markers of oxidative stress, methylation, and neuroinflammation. Figuring out a person’s specific problem areas helps build a protocol precisely for their needs.
Oxidative stress is what you might know as free radical damage. Oxidative stress happens when free radical production goes out of control. Inflammation from IBD can cause oxidative stress in the colon.
Methylation is an important process that affects many bodily functions. People can have genetic defects in methylation. These defects are linked to the development of IBD. Often the genetic defect involves the inability to metabolize the folic acid form of the B vitamin folate. We get around this by giving patients a special form of folate that can bypass the pathway needed to use folic acid. This special form of folate is called 5-MTHF.
You’re probably wondering what neuroinflammation has to do with IBD. Well, one is inflammation in the brain and the other is inflammation in the gut. I am interested in markers of neuroinflammation in IBD patients because of the gut-brain axis. What’s happening in the brain is linked to the gut and what’s happening in the gut is linked to the brain.
Stool testing is another important test in patients with IBD. Stool testing detects parasites, an imbalance in the gut microbiome, and fungal infections—all of which can impact your gut health. This type of testing can let me know if specific types of good bacteria are lacking. In this way, I can build up what’s missing in the gut by giving high-dose probiotics, fiber, prebiotics and more to patients who need them.
Adrenal Testing
I order adrenal hormone testing for my IBD patients. Adrenal testing is important because the adrenals make the stress-hormone cortisol. Many patients with IBD are vulnerable to mental stress, which can make IBD attacks worse or even knock someone out of remission.
Patients who are in a flare and on corticosteroid drugs cannot take the adrenal test right away. This type of drug raises cortisol levels and will throw off adrenal test results. In this case, I may have to wait until symptoms are more controlled and the patient can wean off of corticosteroids. I also take them off high-dose DHEA. Only then am I able to test adrenal function.
Mycotoxins Testing
In the past, I only ordered mycotoxin tests in IBD patients who were not getting results from the usual treatments. But now, after years of treating IBD patients, I’ve noticed there’s a strong connection between toxins made by mold (mycotoxins) and ulcerative colitis.
Yes, this is a thing. Even studies published in medical journals confirm it.
That’s why I no longer wait to test IBD patients for mycotoxins. Instead, my attitude is usually: let’s just get ahead of this and deal with mycotoxins if they are a problem.
Food Sensitivity Testing
Food sensitivities are an important factor in IBD. They can trigger inflammation in the gut. They can stress the immune system so that it malfunctions. They can promote intestinal permeability, or leaky gut.
In IBD patients, there could be two things going on:
- Actual food sensitivities where you have an immune reaction to certain foods.
- Foods irritating the gut without causing any immune reaction. In this case, the irritation and inflammation occurs in a biochemical way. These types of foods are still difficult to digest or are feeding the bad bacteria even if you’re not actually having an immune reaction to them.
The type of food sensitivity testing I like to use not only tests for IgE and IgG but also other aspects of food sensitivities, such as complement. This helps me capture food reactions that are immune-mediated and those that are not.
How To Stay in Remission During IBD
Best Diet For IBD
Conventional “wisdom” says you shouldn’t eat salads and fiber when you have IBD.
Wrong. Very wrong.
You eventually want to emphasize roughage and fiber so you’ll have the prebiotics you’ll need to feed the beneficial bugs in your gut. But timing is everything.
During the remission phase, the goal is to emphasize resistant starch and various types of prebiotics. This type of starch feeds the good bacteria in your colon. I personalize this plan based upon the results of your microbiome testing. The key is to choose prebiotics that only feed the good bacteria, not the harmful ones.
When in remission, expand your diet a little compared to when you were in a flare. Dairy and gluten probably are only going to make things worse. But you can add other things back into your diet one at a time and watch how you react.
The key? Choose foods less likely to cause a flare-up. Avoid gluten, dairy, eggs, nuts, and seeds.
Identify Your IBD Triggers
Another helpful strategy during remission? Focus on preventative management of your stress. For example, if you know you get stressed around the holidays, be proactive and plan ways to reduce your stress such as extra self-care during that time of the year.
The key is to pinpoint your triggers. Do your flares only happen in the winter? Then we need to find out what’s causing them. At that time of year I also want to look at vitamin D levels to make sure yours aren’t too low.
The Best Type of Exercise for IBD
Healthy exercise is also important. By healthy I mean don’t overdo it, especially if you have IBD. Aim for mild cardio three times per week but focus more on weight training, which can help build the microbiome and reduce inflammation.
On the other hand, too much intense cardio (more than 30 minutes), can increase inflammation and spike cortisol levels. Intense cardio can boost levels of an inflammatory protein known as IL-6. High levels of IL-6 are linked to IBD flares.
When you do any cardio exercise, aim for shorter walks or hikes in nature.
Dietary Supplements for IBD
Each of my patients with inflammatory bowel disease has a different supplement protocol customized to their test results and where they are in the course of the disease. Here are some of the supplements I may use in IBD patients:
- Yunnan Paiyao, a Chinese herbal formula for inflammation.
- High-dose probiotics
- Prebiotics
- Liposomal glutathione, which as an antioxidant reduces oxidative stress. In the early stages of treatment, I prefer this over the glutathione precursor N-acetyl cysteine (NAC) because NAC can thin the gut lining.
- Nutrients that show up deficient on testing such as B vitamins.
- Curcumin or turmeric extract to reduce inflammation.
It’s Critical To Work With a Functional Medicine Provider
As I mentioned earlier, if you try to treat yourself you could really make things worse.
Or you could delay your recovery.
There’s an order of treatments that need to take place and this order is unique to each patient.
That’s why I invite you to reach out to me for a free 15-minute troubleshooting call to find out the best course of action for you. If after the call you come on board as a patient, I’ll order the right tests for you and start you on an anti-inflammatory protocol.
The goal is to get you into a long-lasting IBD remission. My protocol has worked on many patients and it’s very effective, but it may take time. At first, you might take one step forward and two steps back. But with persistence, testing, and modifying your protocol, we can find the winning combination to turn off your IBD. In the end, we can calm your gut’s inflammation and get your digestive tract feeling comfortable and healthy again.
If you’d like to see an example of how this approach can bring lasting remission, read a real-life case study of one of my patients with UC (coming soon).
What Causes Restless Leg Syndrome? Natural Remedies for RLS
You’ve just fallen asleep when it hits. That uncontrollable urge to move your legs.
Your legs also ache and throb.
It’s known as restless leg syndrome (RLS), and it makes you feel like you need to put a leash on your legs to keep them from trying to run away. Down boys! Down!
Restless leg syndrome is a condition where your legs are fidgety and uncomfortable, usually at night during sleep. But sometimes it can happen during the day when lying down or sitting for a long time, like when you’re in the car or at the movies.
Symptoms of Restless Leg Syndrome
The main symptom is the urge to move the legs. However, people with restless legs describe other symptoms such as:
- Aching
- An “electric” feeling
- Crawling
- Creeping
- Itching
- Pulling
- Throbbing
The condition is known for:
- Happening when lying or sitting for a long time.
- Relief with movement. The urge usually goes away when walking or stretching.
- Occurring mostly at night.
In some people, the disorder happens together with twitching or kicking of the legs while they’re sleeping. This condition is known as periodic limb movement of sleep.
Causes of Restless Legs Syndrome
There are a lot of reasons why you have restless legs. Since I specialize in treating women with gastrointestinal disorders I’m really familiar with one of the most common causes of RLS—small intestinal bacterial overgrowth, or SIBO for short. An imbalance in the gut microbiome—what scientists call dysbiosis—is also often to blame.
But there are other factors that can cause restless legs. In fact, there might be more than one culprit involved. Let’s dive into all those factors in this blog post and I’ll tell you the natural remedies for restless legs syndrome that have worked for my patients.
SIBO and Restless Legs
In my clinical practice, I see a lot of patients with SIBO who also have restless legs. Studies in medical journals confirm the link between SIBO and restless legs.
If you want to know more about what is SIBO, I recommend you read this blog post I wrote. Meanwhile, in a nutshell, SIBO is an imbalance in the microbes that live in the small intestine.
This can mean that there are too many bacteria or the wrong kind of bacteria that don’t belong in the small intestine.
So what does SIBO have to do with restless legs? A lot.
SIBO causes inflammation in the gut, which leads to the release of hepcidin, a hormone critical in delivering iron to the body and the brain.
Iron is necessary for growth and development as well as supplying the body with oxygen through the blood. But more important for our topic here, iron is a cofactor in the production of dopamine, a brain chemical (neurotransmitter) that tells leg muscles to relax at night. Without enough dopamine, muscles can remain hyperactive. The result? Restless legs syndrome.
When the body releases too much hepcidin, you might not even realize there’s a problem with iron. When you get tested for iron levels or for ferritin, the tests come back normal. And yet your body isn’t able to use the iron that’s available.
Eating enough protein is also critical for making dopamine. The body needs the amino acids tyrosine and phenylalanine from protein as well as iron to make dopamine.
I’m not the only one who connected the dots between SIBO and restless legs. In a small study published in the online version of the journal Sleep, SIBO was found in all seven participants with RLS. Compare this to the general population without restless legs; SIBO occurs in less than 15% of people.
Restless Legs Treatment #1: Work with a functional medicine provider to test for and treat SIBO. Dietary changes, probiotics, fiber, digestive support, and antimicrobials are often used to turn around SIBO. Eat 1-1.2 grams of protein per kilogram of body weight, taken daily in divided doses.
Gut Microbes Gone Bad
Sometimes, treating SIBO isn’t enough and the restless legs continue. There could be many reasons for that, but one of them could involve gut dysbiosis beyond just SIBO. Gut dysbiosis causes inflammation in the gut and the body. In my practice, I don’t just test for SIBO. I use stool testing to look for bacterial overgrowth, fungus, and parasites.
Imbalanced gut bacteria lead to many of the same problems that occur with SIBO, such as the release of hepcidin and the inability of the brain to use iron.
Restless Legs Treatment #2: Balance the gut microbiota through the use of a good probiotic and avoid factors that lead to an imbalance such as eating too much sugar and processed foods and stress. Your functional medicine provider may use antimicrobials, antiparasitics, and/or digestive support to optimize your gut microbiome. Eat 1-1.2 grams of protein per kilogram of body weight, taken daily in divided doses.
High Histamine
Another reason why SIBO or dysbiosis causes restless leg syndrome is because they can lead to histamine excess.
Histamine is a chemical found in many cells of the body. It causes allergy symptoms like itchy, red eyes, runny nose, and sneezing. When the body makes too much of it, it changes how the nervous system functions. This can be a problem for people with restless legs.
People who make too much histamine or who have histamine intolerance often have problems sleeping, since histamine is a brain stimulant.
The catch? Because histamine revs up the brain, people with restless legs who also are making too much histamine can get by on little sleep. They’re not sleepy in the daytime and can function even though they’re exhausted.
Scientists are now beginning to believe that targeting histamine receptors may reduce restless leg syndrome. Histamine receptors are proteins found on the surface of some cells. These proteins are triggered by histamine. Think of receptors like locks on a door and histamine as the key that fits into the lock and gets it to open.
Mast cells are immune cells found in the blood that release histamine as part of an allergic reaction. Now researchers are finding that when mast cells are activated, it may cause restless legs. People who have a condition known as mast cell activation syndrome are more likely to have restless legs compared to healthy controls.
Restless Legs Treatment #3: You can start by supplementing with DAO, an enzyme that breaks down histamine. Two other ways to support histamine levels are Natural D-Hist from Orthomolecular Medicine and quercetin. A low-histamine diet may also help.
But keep in mind that histamine excess is complicated. There are different pathways through which people have problems. It’s best to work with a functional medicine provider to find out if histamine excess is part of your problem and if so, why you’re making too much histamine.
B Vitamins for Restless Legs Syndrome
Vitamins B12 and vitamin B1 (thiamine or benfotiamine) can both fend off restless legs. For example, in patients with inflammatory bowel disease, vitamin B12 deficiency is linked to an increased risk of restless legs syndrome.
Vitamin B1 helps the body make a chemical called acetylcholine, which is involved in motor control. In other words, B1 supports the health of the nerves that control the muscles. So it makes sense that if you’re low in vitamin B1, your legs and body will fidget.
The body also needs vitamin B1 to make dopamine. As I mentioned earlier, dopamine is a brain chemical that says to the leg muscles: “Relax! Relax!”
I’ve had patients tell me that even when other restless legs treatments didn’t help, vitamin B1 worked miracles.
Restless Legs Treatment #4: Start by taking a B complex vitamin or vitamin B1 (up to 100 mg). You may need to go up to 300 mg, which you should only do under the supervision of a functional medicine provider.
Food Sensitivities
Food sensitivities may be to blame for restless legs in some people. A case study of three patients found that food sensitivities caused movement disorders including repeated shrugging of the shoulders. In these patients, milk, coffee, eggs, aspartame (Nutrasweet), tea, chocolate, citrus, raspberries, strawberries, potatoes, beef, and pork caused the most problems. This matches my experience in clinical practice.
Restless Legs Treatment #5: Work with a functional medicine provider, who can order food sensitivity tests to find out which foods don’t agree with you. They may also suggest an elimination diet or just removing the foods that bother you from your tests. After a trial period without the foods, your practitioner will instruct you to introduce one at a time while watching for symptoms. That way you can see which food is causing your restless legs.
Other Causes of Restless Legs
Here are other common reasons why my patients develop restless legs:
- Alcohol, caffeine, nicotine
- Certain medications
- Low vitamin D
- Pregnancy
- Stress/anxiety
- Vigorous exercise
Drugs That Cause Restless Legs Syndrome
Sometimes, the cause of restless legs is a certain prescription medication. Here are some of the most common drugs that cause restless legs.:
- Allergy meds
- Diphenhydramine
- Neuroleptics
- Selective serotonin reuptake inhibitors (SSRIs)
- Tricyclic antidepressants
Getting Rid of Restless Legs
I specialize in treating GI disorders and women’s health. So if you have digestive symptoms and restless legs, I know how to get at the root cause of why your legs are so fidgety.
The first step? Book a free 15-minute troubleshooting call with me to find out the best course of action.
If after the call you come on board as a patient, I’ll order certain tests to show whether your restless legs are caused by nutrient deficiencies, gut dysbiosis, or histamine excess. Whatever the cause, I’ll be on it until I find out what’s wrong. Book a call today so you’ll sleep more deeply tomorrow.