Do you have an uncontrollable urge to move your legs, especially at night? Does this twitching and crawling feeling cause you to get up and walk even when you're tired, interfering with your sleep and daytime activities? Until recently, many doctors would dismiss you by saying it's all in your head. Well, it's not. I'm here to tell you what causes it and give you some simple, effective solutions to help you get a better night's sleep while avoiding daytime tremors.

The condition is restless legs syndrome (RLS), and it often goes under-diagnosed and under-treated. In fact, a surprising number of doctors still don't even know about it. Some researchers call it "the most common disorder that you never heard of."

RLS is the fourth leading cause of insomnia. It can keep you up at night and exhaust you during the day. This lack of sleep interferes with your ability to think clearly and contributes to depression. What's more, it's dangerous. If you have RLS be extra careful. Poor sleep quality can cause you to fall asleep while driving. Or fall down.

One woman with RLS spent most of each night walking around or standing to get relief from her twitching. As a result, she fell numerous times and broke both of her arms, several ribs, and her nose. This may be the exception, but the exception happens. And you don't want it to happen to you.

RLS recently made the news — and was proclaimed "real" — when two studies identified the genes responsible for RLS. Gene identification may be helpful for genetically based RLS. But other forms of this "real" movement disorder have other causes. These include medications, pregnancy, or nutrient deficiencies.

RLS is more common in women than in men and tends to be worse in people over 60. This could be due to age-related nutrient deficiencies.

Here's an overview of the causes of RLS, along with possible solutions:

Pregnancy: Pregnancy increases a woman's need for iron by three to four times, and folate by as much as 10 times. Pregnancy is stressful, both physically and emotionally, and stress causes the body to excrete higher amounts of magnesium. This often creates a magnesium deficiency. All pregnant women should be evaluated periodically for sufficient levels of these three nutrients. A deficiency of any of them can trigger RLS.

Donating blood: Researchers at the famed Mayo Clinic found that all patients in an RLS study group had donated blood at least three times a year for the preceding three years. Everyone had iron deficiency (blood ferritin levels less than 20 mcg/L). You don't have to be anemic to need iron. Giving blood can cause RLS if you only donate occasionally.

Medications: Some antidepressants can induce RLS or make it worse. They include SSRIs (selective serotonin reuptake inhibitors) like Prozac, Zoloft, and Paxil, as well as tricyclic antidepressants like Elavil and Tofranil. If you have RLS and are taking any medications for anxiety or depression, ask your pharmacist whether or not there could be a connection. Mood disorders frequently respond to lifestyle changes, nutrient therapy, and dietary changes. If you need medication, ask your doctor for recommendations that won't trigger RLS.

Migraines: The association between RLS and migraines is not as far-fetched as you might think. Scientists now believe that the two conditions may have a joint origin. They have found the same gene in an Italian family that plays a role in both diseases. What's more, they've found a correlation between both RLS and migraines with fibromyalgia. RLS, fibromyalgia, and migraine headaches frequently respond to magnesium therapy.

Solutions:

Iron: Many postmenopausal women avoid iron supplements because they know that iron is an oxidant. It produces dangerous free radicals that can lead to illnesses from heart disease to cancer. But this attempt to guard against free radical damage may contribute to RLS.

Blood levels of iron drop by 50-60% at night, which coincides with worsening RLS symptoms at that time. In addition, RLS patients' brains often lack sufficient iron.

Studies show that the lower the ferritin, the more severe the RLS symptoms. Tell your doctor to run an ordinary ferritin blood test. If your levels are lower than 50 mcg/L, you may want to take an iron supplement. A British study found that 200 mg of ferrous sulfate (iron), taken three times a day for two months, gave excellent results when ferritin levels were low.

One of the best absorbed forms is iron picolinate. It doesn't cause constipation and you might be able to take less of it. It's available in health food stores or from Thorne Research (800-228-1966).

Magnesium: A pregnant woman with a 13-year history of evening tremors went to the hospital in premature labor. Her doctor gave her intravenous magnesium as part of her treatment for this pre-term labor. Her RLS stopped completely. Here's why: Magnesium relaxes muscles. Several studies found that magnesium supplementation decreased symptoms in people with mild to moderate RLS.

Stress is a serious factor in RLS, and both insomnia and pregnancy are physically and emotionally stressful. Stress triggers your body to increase its excretion of magnesium, often leading to a deficiency.

Since ordinary blood tests for magnesium are inaccurate, and subclinical magnesium deficiencies are common, I give all of my RLS patients magnesium to bowel tolerance — from 100 to 1,000 mg per day. In some cases, that's all they need. I've found magnesium is often all or part of their solution.

Folate: Some cases of RLS are hereditary. If this is your case, you may need folic acid supplementation. Deficiencies are common in RLS sufferers. Ask your doctor to check your blood levels of folic acid. It should be 10-12 ng/mL. When participants in one study took enough folic acid to bring their blood levels up to normal, their RLS disappeared. Their IQ significantly improved, also.

Don't depend entirely on blood tests, though. In some cases, lab tests showed no folate deficiency, yet symptoms improved with supplementation. Patients have responded to 1-10 mg of folic acid. Most people will need 5-10 mg.

Lifestyle changes: Give nutrients the best chance to work by avoiding medications that could lead to RLS and decreasing or eliminating caffeine, alcohol, and cigarettes. Stretch your legs daily for 5-15 minutes to loosen up tight muscles. You may get temporary relief by taking either a hot or cold bath, or rubbing your legs manually or with a vibrator or massager before bedtime. The key is to increase circulation.

You also might want to try an excellent herbal formula that increases circulation in the legs. Doctors using it report it has helped RLS when poor circulation and inflammation are involved. The formula is called Padma Basic (800-728-2288) and it consists of 20 herbs with antioxidant properties. Give it a three-month trial (two tablets with each meal) and let me know how it works for you.

Is Stress Killing You? Watch For These Subtle Signs

Have you ever noticed that many people get cancer during times of extreme stress? Or that heart attacks hit when stress peaks? Stress is a killer. That's no secret. In addition to cancer and heart disease, stress contributes to many other health problems, including cold sores and shingles.

But did you know that there are milder symptoms of stress that indicate it's time to handle the stresses in your life differently? If you listen to these signals and reduce some of your stressors, you may be able to prevent more serious, painful, and even deadly ones.

Two of the most common signals that stress is affecting your body are hair loss and brittle nails. Dermatologists know that stress can contribute to skin problems, as well. These can include acne, rosacea, eczema, and even psoriasis. Your doctor may recommend hormones or drugs to treat the problem. But before you reach for hormones, antibiotics, or expensive skin care products, take a look at the part stress plays in your life. Begin by making a few adjustments and you could have healthier hair, skin, and nails.

How stress causes skin problems

Stress causes your body to produce more hormones, namely cortisol. And cortisol causes your skin to make more oil. Oily skin is more likely to produce blemishes, even in people who don't ordinarily get acne. So if your face is breaking out, the first step is to take a look and see whether or not you're under more stress than usual.

Stress also affects how quickly your skin heals. A study published in the Archives of Dermatology took over two-dozen students and tested their skin's ability to heal both during exam time and after coming back from a school break. The researchers put cellophane tape on the participants' forearms and then stripped it off repeatedly until their skin became irritated. The students' skin healed faster after their break than during exam times. This was the first study to show that psychological stress affects the way the skin normally functions.

If you notice blemishes or skin that heals abnormally slow, it could mean you're under too much stress. Take action now to keep stress from causing bigger health problems. In a moment, I'll show you how to reduce your stress quickly.

Why stress causes your hair to fall out

It is possible, however, that you do need hormones to treat your problem. For instance, if your hair is thinning, you could need thyroid or other hormones. However, before getting expensive tests to determine your hormone needs, take a look at the stresses in your life. When you're under stress, your hair can go into a "falling out" phase. And this thinning phase doesn't necessarily occur at the time you're most stressed. It can occur up to three months after a stressful situation.

When stress causes your hair to become thinner, it usually grows back in six to nine months. If it doesn't grow back, it's time to get evaluated for thyroid and other hormonal imbalances that can affect your hair.

Another cause of hair loss is surgery. While surgery can be stressful, it may cause hair loss for an entirely different reason. There's a limit to how much healing your body can do at any one time. After any surgery, your body takes a break from growing hair and nails to concentrate on more serious repair work. At this time, your hair could grow more slowly, or fall out and not grow back as quickly as usual. If you've had recent surgery, give your hair some time to grow back. If it doesn't, then ask your doctor to test for hormone deficiencies.

Why stress causes nails to weaken

Your nails may be a reflection of how you're handling stressors in your life. Chemotherapy, for example, can cause white horizontal lines to appear on your nails. Other more general stressors, such as regular family arguments or travel, can lead to brittle or peeling nails.

Many people bite or pick at their nails when they're under stress. Some even rub their fingers over their nails repeatedly, causing a ridge to appear. All of these are signs that you need to find another way to reduce your response to stressful events. You may not be able to prevent anxiety-provoking situations, but you can lessen their impact on your body and emotions. Let me show you how.

Tips to reduce stress

Earlier, I talked about how cortisol contributes to skin problems. Well, it does much more. This hormone is secreted in response to any form of stress. Too much cortisol can destroy brain cells, lower your immunity, and accelerate aging. It's a real killer.

To reduce excessive cortisol, talk with your doctor about taking DHEA (see page 8 for more on DHEA).

But there's something else you can take without talking to your doctor. There are several herbs known as adaptogens that regulate cortisol production as well. Adaptogens are nutrients that help your body achieve balance. My favorites are tinctures of Rhodiola, Eleutherococcus senticosa, or Ashwaganda (Withania somnifera). They are safe and I've found them very effective.

I first learned about adaptogens when I was in my 30s and had an herb business, The Herb Lady. With the help of a Chinese herbalist, I learned about many Chinese herbs. I also stumbled upon an herb called Siberian ginseng. This root was not a member of the ginseng family at all. Rather, it was an Americanized name for Eleutherococcus — one of the most powerful adaptogens we know.

I began taking an extract of Eleutherococcus when I was under stress. One day I noticed that my symptoms of stress were gone. Vanished! I used Eleuthero for fatigue, nervousness, and insomnia, and found that it helped all of them.

Adaptogens work differently in different people. They help regulate body functions. So don't expect the same results as I got. Your results may be better than mine ... or less obvious. But I must say that my experience with Eleuthero led to my using Rhodiola successfully for stress. I'm impressed with all of the adaptogens I've used.

The herbal tinctures I like the best are from HerbPharm. You should be able to find them in your health food store. If not, call them at 800-348-4372, or contact them at www.herb-pharm.com.

The dosage I've used for these tinctures is 20 drops, three times a day in a little water or juice. You can take capsules instead of tinctures, but I've found the tinctures work fastest and best. This is because some herbs are best absorbed in an alcohol base.

And, finally, make sure you're getting some exercise. Exercise reduces stress by releasing endorphins (feel-good chemicals). It takes my body 20 minutes on a treadmill or in an exercise class to get this endorphin boost. It may take you a little more or less. I didn't believe it would work, but it does. Give it a try. See which exercises work for you and how long it takes for the endorphins to kick in. Then, put exercising into your daily routine.

All of these stress relievers are especially important if you're in the middle of highly stressful situations. So don't forget them when times get especially hard. Relieving your stress could save your life.

Is Your Doctor Treating You Like a Man? If So, the Results Could Be Life-threatening

I've told you in the past that doctors base their treatments on scientific studies. That sounds good. But it might not be for you. For years, most studies followed men and not women. And that's a problem. As you know, men and women are not alike. What works for one gender doesn't necessarily work for the other.

For instance, I've told you in the past that women have different symptoms of heart attacks than men. Missing the symptoms of a heart attack could cost you your life. Men get a tightening in their chest, but not all women do. We tend to experience unusual fatigue, shortness of breath, anxiety, sleep disturbances … and nausea or indigestion — symptoms you may not think of as being heart-related. You could have pain, burning, or pressure in your chest or in one or both of your arms that's either constant or comes and goes.

Most women have at least one of these symptoms for more than a month before their heart attack. Very few (30%) experience discomfort in the chest. If you have any of the above symptoms continuously for three to four weeks, see your doctor immediately. Some of them are so common that you — and your doctor — might tend to overlook them. Don't, especially if you're at a high risk for heart disease.

But heart attacks aren't the only place that differences exist. We respond differently to certain medications, and we're more likely than men to have various specific illnesses.

Here are some of the gender differences that could affect your health — and your life.

Medications act differently in women

Talk with your dentist: Dr. Christine Miakowski, from the University of California in San Francisco, found that 10 mg of nalbuphine, a pain reliever used by many dentists after tooth extractions, reduced pain in women. But it actually increased pain in men. Higher and lower doses of this synthetic opioid painkiller had no impact on women, however. Ask your dentist what he or she is going to prescribe after dental surgery, and make sure that if it's nalbuphine (Nubain), your dentist gives you just 10 mg. That's the amount that works.

Ineffective anti-inflammatories: Many painful conditions like rheumatoid arthritis and osteoarthritis occur more frequently in women than in men. Doctors often give us non-steroidal anti-inflammatory drugs (NSAIDs). The problem is, NSAIDs don't work well in women. A study published back in 1998 found that 400 mg and 800 mg of ibuprofen (a popular NSAID) had no effect in reducing pain in females. However, the medications did work in men. If you're taking NSAIDs and are still in pain, consider switching to some of the herbal anti-inflammatory products I've mentioned, including turmeric, Padma Basic (800-728-2288), or InflaThera (ProThera 888-488-2488). These supplements work on men and women alike.

Having surgery? If you are, be sure to talk to your anesthesiologist before your operation. Make sure he or she is fully aware that women wake up sooner from anesthesia than men. The idea is to not feel any pain. You want your doctor to keep you sedated during surgery, and not allow you to wake up until it's over.

But that's not the only difference with surgery. Women have more blood transfusions during bypass and valve replacement surgeries than men, sometimes with serious consequences. Doctors give these transfusions to prevent anemia and improve oxygen delivery. The problem is a donor's blood can trigger immune problems, such as fever and infections, which can be fatal.

In a recent study conducted at the University of Michigan, researchers followed 380 women heart surgery patients and found that all of the women who died had received blood transfusions. Their deaths were all strongly related to infection. Women were four times as likely to die in the hospital than men. They also had three times as much lung dysfunction as men.

Gender differences in diseases

Smoking and lung cancer: We all know that tobacco causes cancer. But women are more susceptible to its cancer-causing effects than men. It doesn't matter whether you're a smoker or are exposed to second hand smoke. Cigarette smoke is more harmful to women than to men. Smoking — even occasionally – is the single most harmful thing you can do for your present and future health. Remove yourself from all sources of cigarette smoke today and breathe easier tomorrow.

Immune differences: Autoimmunity is when your immune system becomes overactive and attacks its own cells. Some autoimmune diseases include type-1 diabetes, multiple sclerosis, lupus, some thyroid diseases, and rheumatoid arthritis.  Nearly 80% of people with autoimmune diseases in this country are women. Lupus affects nine times as many women as men.

Adaptogenic herbs like Eleutherococcus and Rhodiola, as well as medicinal mushrooms, can help regulate autoimmune diseases (for more information, read the articles on my website).

Other gender-specific conditions: The list goes on. We're twice as likely to be depressed as men and twice as likely to have insomnia and interrupted sleep. We're three times as likely as men to develop gallstones. And we're at an increased risk for both osteoporosis and osteoarthritis. In fact, 80% of hip fractures occur in women. Are any of these conditions related to hormones? At least some of them may be. And it looks like we're on our way to finding this out.

Help is on the way

Northwestern University's Feinberg School of Medicine recognizes the problem of gender differences and has decided to do something about them. They're starting the Institute for Women's Health Research to take a closer look at some of the health concerns that affect us. They plan to examine both hormone-related conditions and those that don't appear to be caused by hormones. With the help of this new research institute, I expect we'll see more gender-specific information in the future.

Health Detective

The Other Citrus You Shouldn't Take With Some Drugs

You've probably heard that grapefruit and grapefruit juice can cause dangerous interactions if you're taking certain medications. This is because grapefruit contains chemicals that affect an enzyme that helps metabolize these drugs. When you take both, you get much more of the drug you're taking. Dangerously high amounts. Until now, we didn't know why. Now we do. And this explanation reveals another citrus you should never take if grapefruit is a no-no for you.

The chemicals in grapefruit that cause a higher absorption of some drugs are called furanocoumarins (FCs). FCs cause an increased absorption of certain drugs. To better understand this interaction, researchers at Johns Hopkins took a group of people on blood pressure medication. They gave some of them ordinary grapefruit juice and some grapefruit juice without FCs. A third group served as the control group. They drank orange juice, which is safe because it has no FCs.

The blood levels of the patients who drank plain grapefruit juice were three times higher than those drinking FC-free juices. This proved that FCs are the culprit.

Except for grapefruit, almost no other fruit contains FCs. With one exception: Seville oranges. Orange juice companies are now making a few juices with these oranges. They're also making a condiment that may be a staple in your diet: orange marmalade.

If you're taking any medications that have interactions with grapefruit, and your pharmacist can tell you if you are, do not use orange marmalade. It could cause the absorption of your medications to skyrocket to dangerous levels.

www.johnshopkinshealthalerts.com.

Ask Dr. Nan

Q: I survived estrogen-receptor positive breast cancer. Is it safe for me to take DHEA? — R.L., e-mail

A: DHEA is a hormone that's a precursor to estrogen. It helps your body make a little estrogen. Not much, but to be on the safe side, I would suggest you NOT take it. DHEA could be fine, but there are various kinds of estrogen-sensitive cancers, and it's not worth you taking any risk.

I haven't recommended DHEA across the board for years. It's just not safe for all women. At the same time, my personal doctor checked my blood for DHEA (the test is called DHEA-Sulfate) and found that I needed to take it. But she made that decision based on blood tests and took into account my not having had any estrogen-receptor positive cancer.

DHEA may be available without a prescription, but it's not for everyone. You were smart to ask about it.

Q: I recently had my gallbladder removed. Is there any special diet I should be on? My doctor hasn't told me anything about this. — A.W. Pahrump, NV

A: There certainly is, and shame on your doctor for not saying anything to you about this! Your gallbladder is a sac that stores bile, a bitter digestive liquid secreted from your liver. Your liver releases the bile into your duodenum when you eat foods containing fats.

When your gallbladder is removed, there is no place to store this digestive fluid. And there's nothing to "tell" your body to release bile. This means that if you have no gallbladder, you need to eat a diet low in fats because you don't have an efficient way of breaking them down into useable particles.

You also may need to take a digestive enzyme to help break down fats for those times when you do eat more fats. The enzyme that digests fats is called lipase. You can find both plant-based and animal-based digestive enzymes in any natural food store. Look for the one highest in lipase, and take it with or right after eating a meal containing fats.

Q: I've been taking PectaSol for many moons now and believe it is truly a great product. Thank you. My question is: Does PectaSol have any positive effects on cholesterol? — D.F., e-mail

A: Yes, it does. There was a double-blind, placebo-controlled study published in the journal Clinical Cardiology way back in 1988 that answered this question. Researchers gave participants with high cholesterol pectin supplements for four month and made no dietary or other lifestyle changes. Their cholesterol dropped by 7.6%, and their LDL (bad) cholesterol dropped by 10%.

But PectaSol is not the same as the grapefruit pectin used in this study. It's better. The manufacturer has modified it to be a certain size and weight. The pectin used in the 1988 study could bind only to cholesterol in the intestines. Its molecules were too large to pass through into the bloodstream.

PectaSol binds to cholesterol both in the bloodstream and in the intestines. Its smaller size allows it to get into the bloodstream and attach itself to cholesterol there. So using PectaSol, which is a modified citrus pectin, should give much better cholesterol-lowering results (800-728-2288).

Cerda, J.J., et al. "The effects of grapefruit pectin on patients at risk for coronary heart disease without altering diet or lifestyle," Clin Cardiol, 1988.