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I can't google anything useful about my issue and Claude is largely unhelpful, the doctors try to diagnose me with depression (I have a very well managed SAD, so I technically might qualify but this is not the main root cause), sports medicine physicians just don't exist where I am, so I want to dump the list of the symptoms I have and see whether you guys can help me come up with a direction to dig.
The main issue: when I do sports, whether it's cardio or weightlifting, I find it really hard to sleep. Fundamentally, my sleep is more fragile. I fall asleep easily all of the time, but when I work out it's easier for me to wake up during the night (for any reason, e.g. noise, wanting to go pee, being too hot, being too cold) and harder to fall back asleep after I wake up.
I desperately want to see a doctor, but they are trying to diagnose me with a mental health problem rather than a chemical imbalance. Feel free to ignore my complaints about doctors and suggest me to see a doctor, but I'd be grateful if you could spell out what I should say to him.
The simplest explanation is that exercise is depleting nutrients that you are currently borderline low in.
Have you tested your Iron and Ferritin levels recently? RLS is caused by not enough dopamine being processed by certain receptors. One of the co-factors for this process is iron. So low iron will by definition cause RLS. It could be something else causing low dopamine but since magnesium helps you temporarily, it seems worth trying.
Do not trust the doctors if they try to pin your problems on something psychological. They just default to that when they don't have a clue. I would also wager that your depression is a symptom of a underlying physical problem.
Solving nutrition / chronic illness problems is very complicated and very few people know what they are doing. Experimentation and sceptical but open-minded reading is sadly the best approach that I have found.
If I were you I'd try a basic multi-vitamin before and/or after exercise (just one with reasonalbe RDA, like 50-100%) and a high-quality (but low potency, iron poisoning is a thing and is very bad) iron supplement. Try it for maybe a week (or until you feel something), then re-evaluate. If something gets better try to figure out what. Since just spamming supplements without understanding them is bad long-term, but fine short-term, usually. So ordering some blood tests and researching the results is also recommended. Doctors will only react when the values are profoundly bad, especially if you are young.
When I got diagnosed with RLS, doctor did a blood test but did not find any kind of deficiency. I think it’s worth trying it again. Testing supplements myself is a good idea, I’ll try it after ruling out electrolyte imbalance. Thank you!
I don’t think I’m currently depressed, but let’s see whether any of the advice I got here changes my mind on this!
Look up the blood test values yourself if possible. Doctors often skip pointing out values on the verge of terrible, because unless they have studied nutrition on their own, they will basically know nothing about it. Except "Value X below Y is very terrible because of Z. But value X = Y + epsilon is fineeeeee". Very few have a coherent model about the body.
I'm sorry. I misread your post. Your reaction seems perfectly normal in that regard then!
Tell me about it.
Me: I think I have anemia. My score is just above the threshold and I’m tired all the time.
Doctor: But it’s not below the threshold, so you don’t.
Me: but it’s literally as low as you can go without passing the threshold, right at the bottom of the ‘healthy’ range. Presumably almost having anemia is pretty nearly as bad as actually having anemia. Can’t we bump up my iron levels a bit?
Doctor: yeah, that’d be normal procedure. If you had anemia.
I can only imagine how annoying that is as a patient but problems like that are unfortunately not what our system is optimized for.
If you recommend something that makes sense but isn't quite justified (because the labs are normal for instance) then you introduce a huge amount of liability if something goes wrong, and good luck getting it paid for if the patient doesn't meet whatever criteria.
Additionally, medical care is in general about preventing someone from dying, "minor inconveniences" (that nonetheless may be subjectively quite inconvenient) are generally not something we are equipped to manage (this being for a huge variety of reasons).
An extra level is the need to avoid fighting with patients unnecessarily.
In this specific case there are other significantly more likely causes of tiredness. Lifestyle habits (including diet, exercises, stress, substances, caffeine, sleep habits, etc etc), psychiatric issues, and boring things like aging are way more likely to be responsible.
I have no idea about you personally, but many patients are extremely resistant to having one of these pointed to.
Lastly there's a bunch of complicated stuff about reference ranges, additional studies, lab uncertainty, diagnostic nonsense... overworked primary care doctor is not going to bother.
Thanks for the reply! It’s always interesting to get a medical perspective on these kinds of interactions.
One wrinkle is that this actually took place in Japan, where medical care is extremely cheap (heavily subsidised) and efficient but as a consequence it’s very process-oriented. Most discussions with a doctor cost $5 but take about 5 min; that transcript was pretty nearly the whole conversation, although to be fair that was partly because I had a more urgent problem.
I take your point about other lifestyle factors; I wanted to treat my ‘anemia’ so I could rule it out and apparently taking strong iron tablets is dangerous without medical supervision.
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I assume that you're a doctor. Have you heard of the work of Derrick Lonsdale? Some articles. He also wrote some very interesting books.
https://hormonesmatter.com/the-wrong-fork-understanding-the-current-medical-model/
https://hormonesmatter.com/western-medicine-house-built-sand/
https://hormonesmatter.com/dysautonomia-hypoxia/
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Nutritional deficiency was more or less also my instinct when I read the description. The mechanism I had envisioned is:
I also agree that blood-work could be helpful here, but it would still be hard to interpret. Finding a physician who can properly interpret the results usually requires a specialist, and even that is hit-or-miss.
Even with a multi-vitamin, do you you think separate supplementation for each under covered nutrient with individual or a multi-mineral would also be advisable? My recollection is most common multi-vitamins still do not come close to even 50% RDA on several important minerals (including iron and potassium). Blanketing the spectrum does seem a lot easier than accurate tracking, but also makes it really hard to isolate variables.
Assuming, you do need supplements in addition to the multi, how important is nutrient timing in your opinion? For example if OP is supplementing vitamin D, calcium, and iron. How strong is the synergistic effect of D+calcium and how strong is the antagonistic effect of calcium+iron?
I was also thinking last night that perhaps the need to supplement magnesium in the first place is already mostly explanatory. OP didn't mention which type of magnesium supplement they was using. Of the zillion options which do you think is best for bio-availability, the ability to cross the blood-brain barrier, and sleep, Magnesium L-Threonate? Is it possible the version OP is using is just barely available enough to affect RLS, but not available enough at the brain? On timing, most recommendations are to take magnesium at night for sleep. In my personal experience if I take magnesium right before bed I end up with crazy dreams. With my last big meal of the day, or even at breakfast, tends to work better for me.
The idea of blanket testing is to do a broad nutrition check. "Do I feel better with this?" If so investigate why. Isolating variables is reasonably simple as long as it's a straight deficiency. For potassium, just buy a powder and see how it feels to eat. One can also look up foods very high in certain nutrients and eat them. The body has the not so suprising ability to 'taste' nutrients it needs. So if you buy seeds high in iron, eat those, wait until next day, eat them again. If at this point they suddenly taste fantastic, I'd wager there's something in those seeds your body wants. However anything connected to the B-vitamins, methylation and similar can get very tricky, since it depends on your specific genes and the ratios of the B-vitamins.
From my experience one reacts to nutrients a lot quicker than what one would assume. But vitamin-D and iron is still in the 'you'll feel it tomorrow' stage, unless you get a iron shot which can be pretty instant if very deficient. Calcium is a lot quicker, a common symptom of low calcium is losing electrolytes like crazy. Sub-communities on reddit are very good for quickly finding out stuff like this, if you have a good filter for people with anxiety disorders. I don't know how antagonistic iron is but I try to take it without any other minerals if I take it. Calcium should be taken with D3 and K2 to prevent health problems.
That is true. It is possible he's using oxide or something similar which is horrible. I usually take magnesium malate for energy. And a 3x magnesium in an attempt to get it everywhere in the body. I wish I could take glycinate to calm down but the glycine makes makes me depressed (and so calm I'd describe it as catatonic).
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I take 400mg Magnesium Bisglycinate 1-1.5 hours before sleep. No weird dreams, no feeling in the legs either
Check the start of this video. https://youtube.com/watch?v=h5Hyhmxli54
I have not watched it completely so I'm not sure if he mentions gut inflammation later on, but I doubt it. But as said in the video, the main cause of RLS is iron deficiency inside the brain. Getting stuff into the brain is complicated, minerals especially. Gut inflammation can screw with this process. If you have gut problems you should probably try to fix it, since it tends to get worse over time otherwise.
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Others have covered this, but from my experience it sounds like overtraining which can be mitigated somewhat by allowing your nervous system more time to recover over hours before sleeping. I don't lift heavy weights or go running after 7pm for this reason. Morning through afternoon workouts are fine. If its a regular issue I would have my workouts in the morning and scale back intensity until I found the sweet spot of exertion that allowed me to sleep.
Do yourself a favour and try other non-exercise related sleep remedies such as reducing caffeine. I found a shocked nervous system (via overtraining) could be further irritated by electronic stimulation so try to cut out screens before bed. Books and audiobooks are encouraged in the hour before sleep. Magnesium as a muscle relaxant before bed is also good for getting to sleep (but not necessarily staying asleep).
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Literally Gatorade? Despite the advertising, the "electrolytes" in Gatorade are mostly sodium. One potato has ~8x the potassium of a 20 oz Gatorade, IIRC. Some of your symptoms are consistent with your electrolytes being completely wack. Slightly supported by the mentioned magnesium supplementation combined with high sodium, but no mention of potassium, phosphorus, or calcium.
Maybe try tracking micro-nutrients in cronometer, and seeing if you are hitting adequate intake for everything? It's hard to get enough potassium, especially at higher sodium intakes since the ratio of potassium and sodium also matters.
I also agree with @jeroboam time of day for physical activity does tend to matter, though more for some people than others. It's also likely that you need to allocate more time to adequately recover if intensity or volume is high. I used to live with a very high level athlete, it wasn't uncommon for him to allocate like 10+ hours for bed. You can get away with a lot less if you are not training hard, other stressors are low, or if it's a short stint but some people just naturally need more sleep time.
I actually don't know anything about micronutrients and that's on me, I'll do the research. I haven't seen anyone mentioning that this can have a connection to sleep quality.
Not just Gatorade, of course. I salt my food a lot which I assume counts as more sodium, but I haven't supplemented anything else. I just checked and Macrofactor also has a micronutrient tracker, I'll start using that today.
I think potassium is a really likely culprit. When I worked out my didn't have a lot of vegetables and the fruits I ate didn't contain a lot of it too. I was likely very short of the required ratio.
I find I feel great with 7:40 hours when I'm not working out and it's hard for me to reshuffle my routine during work days due to family obligations, but I'll see whether I can do it and feel good in case I can't solve it while working out.
Electrolyte pills will have more quantity and types of electrolytes than a gatorade, without the sugar. I have taken this brand.
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I sometimes do very strenuous workouts at night because that's when my sportsball practices are. When that happens, I also have trouble sleeping. In particular I have to get up to pee a lot.
Even though you say it doesn't matter when you do the workouts, it has to matter somewhat, right? For example, if you did a workout 2 days ago you would sleep better than if you did one today.
In any case, if you figure it out let me know! Claude's answers seem to make sense though:
Not sure there's anything to be done, honestly. From a practical level, try to give yourself more than 7hr 40m to sleep. Obviously its better to sleep through the night, but it's okay to wake up if you get overall enough.
Thank you taking your time to respond!
I experience severe side-effects from insomnia so on day 2 I usually just sleep easier just from the sheer lack of sleep on the previous day. But after intense workouts the symptoms usually persist for 2-3 days.
That's what I have been doing, more or less. If I don't get enough sleep during the night, I just wake up later, but I find it inconvenient enough from the work-life balance standpoint to actually try to resolve the underlying issue.
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Overtraining? You could try doing the minimal possible workout and see if the problem persists.
Seems like it, in all honesty. I'll try just doing Zone 2 cardio for a while and increase it in 5 minute intervals weekly.
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