The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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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.
Regrettably I don't think your interaction would have been any less unsatisfying if it was in the U.S unless you were seeing a concierge or something like that. While the social pressures at play are pretty different in Japan it's also possible that you were getting a "saying you should try a little iron but not too much" without saying it type interaction, as you might here but it would be more easy to understand.
The problem is that you are more likely to catch someone who demands some form of intervention, any intervention and does so incautiously and then injures themselves than someone who actually has a personal biochemistry that is somewhat atypical and would benefit. Not saying you are one of those, but the majority of the global population is total morons so the practice of medicine has to be optimized around that (and smart people can also be morons when it comes to medicine).
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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/
Haven't heard of him, but looking at it briefly looks like total quackery as per usual.
Here's why.
The advice "live a healthy life" is known to all, prescribed by doctors 100% of the time, totally ignored, and incredibly hard to intervene in. "You are missing some common sense lifestyle intervention X" is included within things like "eat a healthy diet for fucks sake." The few people who grab onto something (like thiamine or whatever) tend to ignore all else including extremely important medical intervention (fun fact: Steve Jobs died from one of the more survivable pancreatic cancers because he refused mainstream medicine). Outcomes in "healthstyle fad" type people tend to be incredibly bad, and then we see them avoidably dying in the hospital for no reasons with something preventable and demanding last second intervention.
Admittedly nutritional type interventions like OP's comment are a bit trickier because establishing evidence burden is hard, but that's not really what your link is getting at.
I work in software and academia. The idea that the best solutions win was something i believed in until i started to observe things a bit more critically. Now it just seems like a laughable statement. A reason for this is that certain things are extremely complicated, which makes measurements on how well something works, or will work in the future, difficult. Add in the fact that most people are good at following processes, not building coherent models of something that's hard to see, but is none the less real. What you get seems to be a certain kind of system that sort of works if you don't zoom out enough. Why do we have 5 guys solving the problems that are created by another 5 guys? It's just patches upon patches upon patches. And eventually the system gets stuck in a local (hopefully) maximum.
I would assume medicine works similarly, but since everything is even harder to measure there, and the fact that as you said, patients suck. The default should therefore be that nothing works even close to as well as it should. I have IBD along with extreme fatigue. Conventional medicine does not really have a solution to this. To combat this I've changed up my diet in multitude of ways. I saw the most improvements using Carnivore, to the point where it felt unbelievable, but it introduced other problems so it was not sustainable. So if Carnivore, a very "woo" thing with a hint of "bro-science" works well. What other things that are deemed "woo" actually works?
I tried a bunch of things, most did nothing, some had temporary positives, some negatives. Some, like folinic acid has minor but long term positive improvements. But I swear that something about B1 therapy that that Doctor proposed worked, in the sense that it's solving the problem. I've been a lurker on the internet my entire life, simply because it's never been worth the effort to type without a clear reward (money from work), but now writing feels easy and fun. Another, more objective measurement is that my hamstring/hip mobility has gone from -2 to almost normal. I can almost touch my toes now. I've attempted to fix this problem for 5+ years through PT and exercise. Nothing had any impact before.
Here's a study that I found, there are more if one looks around. Indicating it improves things in all kinds of problems https://pubmed.ncbi.nlm.nih.gov/33210299/. As another anecdote is that it also worked for my girlfriend with her POTS. First it made the symptoms a lot worse, then much better. And it improved her anxiety massively. His book also attempts to explain the science behind it. It would be interesting if those explanations also sound like woo since I don't have enough knowledge to know if they are wrong.
But if you think about it, different nutrients do different things in the body. It makes certain processes work faster / slower depending on what is available. If say fighting a virus needs certain nutrients, unless proof that we have enough, the reasonable assumtion is that more of these nutrients will help in that fight right?
If you have some good arguments that this is the wrong path to go down on I'd be very happy to hear it, since I'm still skeptical despite the fact that it's obviously working for me. I mean if there is something real here, and "real" medicine does not touch it, the "woo's" are the only ones that will.
Thanks for your time!
There's a few layers of problems here.
First:
Yes I need to acknowledge that a lot of medicine is guess work and throwing up our hands and going "this makes sense" or "anecdotally this works." This is because proper research is extremely expensive, difficult, and is often unethical to do correctly (a lot of research in Peds is just not performed because nobody wants to test shit on kids). We do have things that we have really good quality research for, or know with a good deal of certainty. Medicine has some of the strongest validated research evidence and some of the weakest. It is totally a shit show and it's important to acknowledge that.
Second:
Again most medical care is centered around reducing mortality and morbidity. Optimization is considered less important and rewarding but it is what most people want since most people aren't actively dying at any given time.
Third:
Optimization is orders of magnitude more complicated. Individual genetics, lifestyle, life history, gut microbiome and so on radically impact the effect of these types of interventions. You'll see vegan or paleo diet advocates, touting the general wisdom of something that may have worked for that specific person. We don't have the research base and money for too much personalized medicine at this point which is a weakness of ours but any of this type of evangelism is fundamentally worse since people are bad at nuance and anyone involved in fad diets or whatever has a tendency to be extremely bad at "try it for a little bit and see if it works for you" type preaching instead of "behold, this is magic."
Fourth:
As alluded to above some people are capable of responsibly using this type of information, but by the numbers most people (or just enough) who get into "alternative medicine" (or however you want to label it) decide to abandon traditional medicine, and that includes the wealthy, intelligent, and educated. A common path is starting on a "fad" intervention and then just refusing mainstream medicine leading to future poor outcomes which can be extremely disturbing for the patient and care providers. This also makes most of us reflexively hate this shit which isn't productive but is the reality. Most people who are suffering are very willing to engage in black and white thinking and assume that mainstream medicine doesn't have much to offer them if this other plan helps with relief.
Vaccine refusal is a parallel - there's some nuanced discussion to be had on the COVID vaccines but any doctor who has seen a kid avoidably die from measles is going to want to put an anti vaxxer into a woodchipper because in their head it's the same crowd that is letting kids die.
Fifth:
One of the reasons for the difficulty in good research for this stuff is subjectivity vs objectivity. "I don't feel right" is a lot harder to chase, scale, and improve than "my blood pressure/sugar is elevated." This also means that the placebo effect and psychiatric impacts are extremely important and in all honestly might predominate.
People don't like to be told "this only works because you think it does" or "no there's nothing physically wrong with you it is a complicated psychiatric problem" but the reality is that many things are like this.
Unfortunately POTS is a good example, as is CFS/EDS/Long-COVID. People do appear to really have these diseases but the vast majority of people who say they have them, don't. This is magnified because of the importance of patient reviews and lack of time to actually speak to patients. Your doctor might be sitting in the back room going "yeah no way does this chick have POTS, but I don't have time for this fight so whatever I'll go along with it" and of course the fact that the physical and psychiatric side of things are tightly linked together doesn't help anything.
Ultimately almost all symptoms of these kinds of things (examples: tiredness, weakness, sleep problems, concentration problems) are equally or better explained by just depression/anxiety and are known to be symptoms of such. Treat the depression adequately and they go away, but identifying the issue as medical is more ego-syntonic and often impairs recovery.
You also see patients identifying as having ADHD because they can't concentrate and its really depression, bipolar, or personality and they refuse to acknowledge it but ADHD seems like a "better" disease to have and importantly has a clear treatment.
For a wildly different example: aging men demanding testosterone because they are feeling symptoms of aging or unhappy with their life course. It's not wise, but people refuse to not pursue it.
Fundamentally PEOPLE (all people) aren't really psychologically equipped to navigate these sorts of things in the modern world and it adds an enormous layer of complexity to the proceedings.
Sixth:
Assuming the previous point didn't turn you off the next layer is the assumptions of the math brain type person. If you've seen me post here before or on my previous account on Reddit you'll have seen me going at it with a bunch of hard science/math/finance people about how hard medicine is. People used to working in fields with way less ambiguity struggle to understand the realities of health and medicine (and research on the same). Your code runs or does not, the $$$ goes up or down. Why can't you turn medicine into an algorithm just like in our fields?
Medicine is an art as much of a science, translating what patients are actually saying, interacting with patients, figuring out how to interpret p-hacked and clearly biased research, navigating legal environments and regulatory burden all make the field way more complicated and subjective than you'd expect from something that seems to so firmly abut hard science.
Epistemic certainty on the vaguer things is going to therefore be shitty as hell.
Seventh:
Okay so what does all of that boil down to?
I have no idea if what you are doing is working because you think it's working, because it's turning some corner psychologically, or because it is doing something biochemically useful for you. I have no idea how likely it is that it would work for you specifically and you just got lucky.
Nor do I really care, and perhaps you shouldn't either. If it makes you feel better than power to you!
You just have to be careful and have some insight. Still get regular medical care. Don't overdo it. Don't do it if your medical status changes in some way that makes it unsafe.
B-vitamins are pretty benign but lots of people end up overdosing on some supplements.
Is your improvement really for the reason you think it is? Probably not...but maybe? However because actually verifying that is nearly impossible it isn't something we can reasonably roll out as population level advice.
I'll leave you with one final example - one of the common ways to hack research studies for novel psychiatric drugs is to take advantage of improvement in an inpatient setting. Turns out that being checked in on and cared for every day, being surrounded by peers and social opportunities, and getting regular therapy makes people feel a lot better. Do these things and dump a new psych drug on them and they'll get better! But uh, not clear it really is the medicine doing it.
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Speaking as someone whose mother's go-to crazy for disease and illness was that magical eating would make all things better, I just want to second this skepticism. Diet and nutritional supplements did not cure my little brother's ADHD, diet and nutritional supplements did not cure my father's dementia and Alzheimer's, my own diet and (lack of) nutritional supplements did not cause my acute appendicitis when I had that, etc.
Yeah. Unfortunately all this is not a theoretical problem, or annoying but harmless - seeing people come in with completely avoidable but fatal disease because they were led astray by alternative medicine isn't every day, but it is extremely common.
For some reason these people have no liability and it's nearly enough to make me want to fedpost.
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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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