The Gazette, Colorado Springs
Dear Dr. Roach: Are you aware of any correlation between celiac disease and restless legs syndrome? My 72-year-old husband has had RLS for decades. He currently takes gabapentin and pramipexole, but still has symptoms. Plus, he has periodic limb movement disorder (PLMD), which occurs while he’s asleep. — C.S. Answer: The terminology can be confusing. Most people with RLS have periodic limb movements of sleep (PLMS), which sounds very much like your husband. PLMD is a separate sleep issue that doesn’t include other RLS features, such as an uncomfortable sensation in the legs while they’re at rest that causes an urge to move them. A person with RLS often has PLMS, but doesn’t have PLMD. There is an increased risk of RLS among people with celiac disease. Most authorities tie these two together through iron deficiency. Unless celiac disease is managed with meticulous attention to diet, the body has difficulty absorbing iron. Iron deficiency is very frequently found in people with RLS, and iron deficiency makes RLS worse. The diagnosis of iron deficiency needs to be made carefully because most people with RLS and iron deficiency do not have anemia. A ferritin level, rather than blood count, is the best initial test. If he does have iron deficiency, then treatment with iron supplementation can sometimes dramatically improve those nighttime symptoms. Dear Dr. Roach: I recently heard about a pill that helps with alcohol and tobacco cravings, but I don’t remember the name. — J.S. Answer: I think you’re talking about naltrexone, which is indicated for alcohol use disorder by the U.S. Food and Drug Administration. Studies have also shown that it reduces cravings for smoking and improves quitting rates, although it is not one of the first-line medications for quitting smoking (nor does it have an FDA indication for this). Naltrexone is not a medication to be prescribed lightly or without careful consideration of its risks. Some people have depression and even suicidal thoughts after using this medicine, and it should only be used by those familiar with treatment of these disorders.