Restless legs syndrome (RLS) continues to be a difficult illness to manage. Patients describe uncomfortable sensations in their legs that are improved with movement. Genetics are a risk factor, as patients with RLS often report family members with the illness. A number of other conditions can also increase a patient’s risk for RLS, including a history of Parkinson’s disease, cardiovascular disease, diabetes, depression, or periodic limb movements of sleep. RLS is also common during pregnancy.

The etiology of RLS is unclear, although there does appear to be an association with iron metabolism, vitamin B12 deficiency, and folate deficiency. Any patient with symptoms of RLS should have their ferritin, vitamin B12, and folate levels assessed. Patients suffering from RLS symptoms should eat foods rich in iron, such as green leafy vegetables, and keep their ferritin levels above 50 ng/mL. Supplementation of deficient minerals may also be necessary.

Recent information from Brigham and Women’s Hospital and Harvard Medical School notes that certain lifestyle factors should also be considered. Two large cohorts that included over 65,000 individuals found that the risk of developing RLS may be reduced by changing unhealthy behaviors.

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According to the findings, patients who were sedentary and those who were obese had an increased risk of developing RLS. Cigarette smokers also had an increased risk.

Patients who consumed alcohol appeared to have a decreased risk of developing RLS; however, the researchers cautioned that suggesting alcohol consumption may pose risks associated with overuse.

Other studies have associated caffeine with an increased risk of developing RLS, but it was not found to be an aggravating factor in this study.

Given this new information, remind your patients to watch their weight, exercise, and avoid smoking, especially in those groups who are more susceptible to RLS. For patients who already have been diagnosed, remind them that these lifestyle modifications can potentially decrease their symptoms.

Sharon M. O’Brien, MPAS, PA-C, is a practicing physician assistant and health coach in Asheville, N.C.


  1. Batool-Anwar S, Li Y, De Vito K, et al. Lifestyle factors and risk of restless leg syndrome: prospective cohort study. J Clin Sleep Med. 2016; 12(2):187-194.