E289: The Restless Leg Case I Missed Twice – Clinical Thinking Episode 3

What causes restless leg syndrome when magnesium, valerian, and adaptogens don’t work?

In this episode, I walk you through a case I missed – not once, but twice. A patient with 20+ years of restless legs who couldn’t sleep, was up walking and eating in the middle of the night, and had seen me twice before without seeing any results. When she came back the third time, I finally stopped treating the symptom and started asking better questions.

What I discovered changed how I think about RLS entirely. This isn’t a muscle problem. It’s not an electrolyte imbalance. It’s a nervous system excitability disorder driven by overlapping dysfunctions – and the key to unlocking it was understanding how inflammation affects iron metabolism in the brain, not the blood.

In this episode:

• Why serum iron can look normal while brain iron is depleted
• The role of hepcidin, dopamine, and inflammation in RLS
• Why diphenhydramine (Advil PM, NyQuil) makes restless legs worse
• The exact Phase One protocol I used – and why I didn’t include the legs at all
• What changes in duration, frequency, and intensity tell you about progress

Resources:

• Download: The 6 Principles of Clinical Thinking
• Join Clinical Academy