Can Melatonin and These Other Vitamins Help With Restless Legs Syndrome?
If you suffer from restless legs syndrome, you know that falling asleep and staying asleep can be difficult.
Also known as Willis-Ekbom disease, restless legs is a common neurological sleep and movement disorder that causes an uncontrollable urge to move the legs because of involuntary kicking, itching, or crawling sensations that overtake the lower half of the body, according to Mayo Clinic.
Can vitamins and supplements help? Sleep medicine doctors who specialize in restless legs syndrome suggest patients ought to tread carefully when it comes to these OTC fixes.
“There’s a lot of support for iron — and very little support for anything else. I’d be wary of products that make claims that they help with the condition when there’s not been anything proven,” says J. Andrew Berkowski, MD, a neurologist in Ann Arbor, Michigan, and the founder of ReLACS Health, a direct specialty care sleep clinic dedicated to the management of complex sleep conditions, including restless legs syndrome.
“They can be useful in mild restless legs syndrome cases, but when you’re dealing with moderate or severe restless legs, they’re going to be less likely to be helpful,” adds Brian Koo, MD, a neurologist and the director of the Yale Medicine Program for Restless Legs Syndrome in New Haven, Connecticut.
What the Evidence Says About These 5 Vitamins for Restless Legs Syndrome
Here are the facts you should know when it comes to trying out these vitamins to help with restless legs syndrome (RLS) — and when to consider a supplement.
1. Iron
Of all the supplements out there, iron should be your first choice to manage restless legs syndrome symptoms.
Iron deficiency in the brain may be a key cause of RLS, research has found.
Dr. Berkowski says that restless legs syndrome tends to be associated with several conditions in which iron levels are low, such as kidney disease, pregnancy, inflammatory diseases, and anemia.A study published in Frontiers in Neurology in 2020 that looked at 196 people with RLS found that 42 percent had iron deficiency, and those with iron deficiency tended to have worse sleep.
Furthermore, a 2019 review found that iron supplements improved the severity of RLS symptoms compared with a placebo.
This is why treatment guidelines call on providers to test iron levels in patients with restless legs syndrome, says Dr. Koo, adding that he typically continues to test patients’ iron levels once they've been diagnosed.
Berkowski says he wouldn’t advise patients to take iron without consultation, however. For those who fit the criteria, treatment guidelines call for about 65 milligrams (mg) of iron taken with about 100 to 200 mg of vitamin C every one or two days on an empty stomach (vitamin C helps with iron absorption).
Berkowski suggests it’s best to get iron naturally through diet. Red meat is a top source. “Not only do red meats have the most iron, they’re best absorbed by the body too.”
Other iron-rich foods include: leafy greens, egg yolks, dried fruit, iron-fortified cereals and grains, turkey, beans, and lentils, according to the Harvard School of Public Health.
RELATED: The Top Food Sources of Vitamin C
2. Vitamin C and E
“Vitamin C enhances the absorption of iron and helps to reduce the effects of inhibitors of iron absorption,” says Preeti Devnani, MD, a staff physician at the Cleveland Clinic Sleep Disorders Center and a fellow member of the American Academy of Sleep Medicine.
Treatment guidelines also suggest that taken together, vitamin C and E benefit patients with restless legs syndrome who are grappling with kidney failure.
(Restless legs syndrome is two to three times more common in patients with kidney disease than in the general population.)
A trial that found a combination of vitamin C and E were safe and helpful in reducing the severity of RLS symptoms in dialysis patients.
“Vitamins were helpful for symptoms in patients with kidney failure, but this research hasn’t been done in the general population,” says John Winkelman, MD, PhD, a professor of psychiatry at Harvard Medical School and the chief of the sleep disorders clinical research program at Massachusetts General Hospital in Boston. Dr. Winkelman was a coauthor on both sets of the aforementioned restless legs syndrome treatment guidelines.
RELATED: Health Benefits of Vitamin C Supplements
3. Magnesium
Magnesium is an essential mineral in the body that plays a key role in nerve and muscle function; research shows it helps maintain a healthy sleep schedule, according to Cleveland Clinic.But there isn’t enough recent research to suggest magnesium supplements yield additional benefits for people with restless legs syndrome, Winkelman says (which is the conclusion of treatment guidelines that he contributed to).
Dr. Devnani says there is anecdotal evidence that magnesium is useful for treating other types of leg cramps, but not necessarily restless legs syndrome. “We’re unable to make a conclusion as to the effectiveness of magnesium for RLS or in which select patient groups benefit may be seen,” she says of the evidence to date.
“It’s so often that I’m asked about this — magnesium is often recommended but there’s no evidence to support that it’s helpful for restless legs syndrome,” Berkowski says.
RELATED: Food Sources of Magnesium
4. Melatonin
Melatonin is a popular over-the-counter sleep aid people turn to for help with insomnia, sleep disorders, jet lag or, simply to fall and stay asleep. It’s also a natural hormone our brains make in response to darkness, which helps cue our body to sleep. The supplement form should be taken about 30 minutes before bedtime to increase drowsiness and bring on sleep.
While many Americans rely on melatonin for their sleep routine, patients with restless legs syndrome should steer clear of it. That’s because research has found that melatonin may increase leg movements in restless legs syndrome patients.
A small 2010 study with eight participants with severe restless legs syndrome found significantly more leg movement when they took 3 mg of melatonin in the evening.
Melatonin assists in circadian rhythm sleep disorders, such as jet lag or shift work disorder, but restless legs syndrome is a movement disorder, Berkowski notes.
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5. Vitamin D
Early work suggests for people with restless legs syndrome who are vitamin D deficient, a supplement may help with sleep. But experts caution there’s not enough evidence yet to recommend it more widely to patients yet.
A small 2022 study published in the journal Frontiers in Endocrinology found a link between vitamin D deficiency and poorer sleep quality in people with restless legs syndrome.
Another 2023 study published in Tremor and Other Hyerkinetic Movements had a similar result: it said patients with restless legs syndrome may be deficient in vitamin D and that vitamin D supplements could help.
Still, Berkowski says there isn’t enough evidence for sleep specialists to recommend vitamin D supplements as a treatment option yet. “We don’t have a plausible mechanism for why it would work so we need more testing for this,” he says.
RELATED: What Is the Recommended Intake of Vitamin D?
The Bottom Line: Should You Consider Supplements to Help With Restless Legs Syndrome?
First and foremost, Koo, Berkowski, and Winkelman say people with restless legs syndrome should work with their doctor to discuss lifestyle changes and treatment options that can help manage symptoms.
Winkelman says that although there is some evidence some supplements may play a role in managing the condition, there’s still not enough evidence to widely recommend them to all patients.
“Given that we have a number of effective approaches that work, we shouldn’t tell people who are really suffering to try (vitamins or supplements) for which there is no evidence that they’re helpful,” Winkelman says. That said, ensuring you get enough of these vitamins in your diet is a smart move to avoid deficiencies.
Evidence-backed treatment options for restless legs syndrome do include:
- Lifestyle changes Avoiding alcohol, caffeine, or tobacco can help with symptom management, Berkowski says. Sitting still for too long can be a trigger for restless legs syndrome symptoms, too, so making time for daily exercise is a good idea.
- Antiseizure drugs Medications including gabapentin (Neurontin, Horizant) and pregabalin (Lyrica) are often first-line treatments. They relieve both discomfort in the legs and nerve pain.
- Dopaminergic agents The U.S. Food and Drug Administration (FDA) has approved several options, including ropinirole (Requip), pramipexole (Mirapex), and rotigotine (Neupro), to treat moderate to severe restless legs syndrome.
- Opioids Opioids are a class of drugs used to reduce pain, but they carry a risk of addiction. They are sometimes used to treat severe RLS symptoms when other medications don’t bring relief. Examples include codeine, oxycodone, and hydrocodone.