Dr. Keith Roach

DEAR DR. ROACH: I am an active senior and have started to feel symptoms of restless legs syndrome (RLS). I’m wondering how and why this started. In the evenings, I use an athletic foam roller, drink water, and take magnesium supplements. I’d like to hear how to remedy this so that I can get some much-needed sleep. — J.L.

ANSWER: We don’t understand exactly why people get RLS. One common finding is low iron stores, so you should have this tested by your regular doctor. If your iron is low, it should be supplemented, but your doctor should also find out the cause of why it’s low. Sometimes iron supplementation is all that is necessary.

Before considering specific medicines for RLS, your doctor should consider any other medicines that you’re taking, a few of which can trigger RLS. Moderate exercise and avoiding alcohol are wise. Magnesium doesn’t have strong evidence that it helps, but it’s pretty safe.

In some ways, RLS resembles neurological diseases like Parkinson’s, which is why the anti-Parkinson’s drug combination carbidopa-levodopa is often used, especially in people with occasional flares. In people with symptoms that occur for two or more days per week, most experts try a drug like gabapentin. Other dopamine drugs like pramipexole can be considered.

Sometimes poor sleep itself can trigger RLS, so considering other types of sleep disturbances (especially sleep apnea) should be considered. Behavioral techniques to help sleep can also be tried.

DEAR DR. ROACH: I just had some blood tests run, and I have a very low alkaline phosphatase score of 38 U/L, which, I guess, should be between 49-135 U/L. (A similar test from two years ago was within the normal range.) I’m overweight but generally healthy. My mother and sister had low thyroid levels. Is this something I need to worry about? — A.P.

ANSWER: A high level of alkaline phosphatase usually indicates a liver problem, especially one that is related to the bile ducts, but it can occasionally represent a bone disease such as Paget’s.

A low alkaline phosphatase blood level usually isn’t an indication of a medical problem, but there are rare exceptions. A rare inherited disorder called hypophosphatasemia is associated with problems of bone and teeth mineralization. It’s unlikely that you have this because your test results have been normal in the past.

Hypophosphatasemia is worth considering in people with osteoporosis, and a highly specialized blood test can support the diagnosis, which is confirmed with genetic testing.

Other causes include severe malnutrition (often including low magnesium and low zinc levels) and hypothyroidism (low thyroid levels). This one is worth checking for (it’s a simple blood test of TSH and thyroxine) because of your family history. Problems absorbing food, like with celiac disease, can sometimes cause low alkaline phosphatase levels, and this condition can often be missed.

Still, it’s important to remember that the “normal” ranges are usually defined as the range that is found in 95% of healthy people, meaning that 5% of healthy people will be outside the range. If your thyroid tests are normal, and you don’t have osteoporosis, it’s likely that this is within your normal range than it is a medical problem.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.