[INTERVIEW]
Ronda Nelson: Well, listen. Today I’m going to tell you about a case I got completely wrong twice. I got it wrong. A patient I’ve known for a long time came to me with the same complaint that she’s had for two decades: restless leg syndrome. I’d worked with her before and did everything I knew to do — magnesium, bolstering, calming the nervous system, minerals, all the things. She moved away. We lost touch. She went to a functional medicine clinic that prescribed a whole bunch of supplements and spent thousands of dollars on tests — only to come up with the same diagnosis and no good solution. So she came back to me. I started down the same rabbit hole again. But this time, I figured out what was missing. So I’m going to show you exactly what I missed, what everybody else missed, and I’m going to tell you what I’m doing now. Let’s go.
Welcome to the Clinical Entrepreneur Podcast. I’m Ronda, your no-fluff, tell-it-like-it-is business bestie for wellness practitioners just like you who want to build a practice you love and make a bigger impact — and a little money while you’re at it. So if you’re ready to ditch the overwhelm, attract your dream ideal patients, and finally run your practice with complete confidence, you’re in the right place. Each week, we’re tackling things from programs to patient retention to marketing strategies that actually work — sprinkled, of course, with a little sass, a lot of heart, and the step-by-step strategies that will help you get there. So grab your cup of coffee, your notebook, or whatever keeps you going, and let’s build a practice you love — and a life you love — together.
Well, hey friends. Welcome back to the podcast. This is episode number three in the series of six where we’re going to be talking about — well, it’s the clinical thinking series — and I’m just giving you lots of wins and misses. The last two have been pretty good. This one? Epic, epic miss. One hundred percent. Like, I missed it not once, not twice, but probably two and a half times. And this sweet patient — she just keeps coming back and I don’t know why. But now I know how to get her better, and I’m going to walk you through it today.
We’re going to talk about restless leg syndrome. And this poor lady has had this for 20-plus years. And honestly, in preparation for this podcast, I kind of had a moment. I was like… because I’ve known her for so long, I don’t even remember if there was a known trigger. Kind of important to know. So I did make a note to follow up with her and just say, “Do you even remember what caused this?” But nonetheless, we’re going to look at it. I have a suspicion, but I’d have to go back. I think the first time I saw her was probably six or seven years ago. I knew her family well. She’s got several sisters. I worked with her mom. So I honestly don’t know if I ever asked her what that “never been well since” moment was — what the trigger was. But nonetheless, here we are.
Restless leg syndrome. And 20-plus years — she literally does not sleep. So she said, “You know, when we worked together before…” And she comes in, and I think, easy. We’re going to calm the nervous system down, give a little magnesium, do a little stress, give her, you know, Cala, do all the nighttime things. Oh, for sure she’ll sleep through. Nothing worked. Nothing worked. Last time, nothing worked. And then she just drifted away. Well, I don’t blame her because it didn’t fix her.
And then she came back the second time, and we kind of tried the same things again. She’s like, “I’m desperate. I’ve got to get this. I’m not sleeping. I literally am up… the only relief that I get is up walking around at night.” And then in the middle of the night, she’s up walking around. Her blood sugar drops, so then she eats in the middle of the night. So I’m like, “Oh my gosh, you’ve got to stop eating.” She said, “I can’t, because if I eat, I feel better.” Like… that’s kind of a good clinical clue.
Well, alright. So she moves away, I kind of lose touch with her, and out of the blue she sends me an email. She says, “I’m desperate. I need your help.” So I get on the phone with her and I say, “Okay, tell me what’s going on.” She said, “I moved far away — another state — and I’m so desperate. I’ve got to try again.” She goes to a functional medicine clinic, and she goes in, they order over $2,000 worth of tests. Could’ve told you that was going to happen. And they came back and said, “Yeah, we’re just going to give you all the things. You have leaky gut. You have autoimmune. You have inflammation. You have this. You have that.” They literally gave her — what was it — like 14 supplements or something like that. And all of them were synthetic.
And when she asked them — because I’ve trained her well — my heart was very happy about that, because she was like, “No way. Ronda says never take that crappy stuff.” So she asked them, “Why are you giving me these terrible supplements that are just made of synthetic white powders?” And their answer to her — no kidding — was, “Well, most people can’t afford to pay for the good stuff, so we just use this instead.” Can you believe that? I could not believe it. And she said, “That was my clue.” And I left. I didn’t buy any of the supplements. They gave her the list of them. She said, “I didn’t buy any of them. But I was $2,000 out the tests.” The tests didn’t really say anything except that she had leaky gut and her immune system and inflammation and, you know, Hashi’s and all. We’re going to talk about all that.
And so she said, “I was driving home from the appointment and all of a sudden I thought, ‘Oh, I need to call Ronda.'” And in my mind, as she’s telling me this, I’m thinking: I don’t know why you called me, because clearly I didn’t do the job the first time. So she goes, “I just know you can figure it out. I just know.” And I’m thinking, well, thanks for the vote of confidence, because I’m not feeling so confident at the moment. But that’s alright. We’re going to just march ahead.
So I go back down the same rabbit hole. I’m thinking, okay, restless legs — that’s her primary complaint. But this time, there was a little bit of a twist. Just a bit. Actually, it was kind of a big twist. Since I had talked to her, her husband of a number of years died suddenly. Didn’t expect it. Somebody from his work called her and said he’s collapsed on the floor. The paramedics are on the way, and it doesn’t look good. And he passed away within about 45 minutes. She saw him for about 15 minutes at the hospital. He was unresponsive — and then gone. Nothing. Fine in the morning, dead by the afternoon. So that was just a smidge of trauma for her. And then in the middle of all that, not surprisingly, she went into menopause. So now we’ve got hormone shift — likely provoked or maybe accelerated into menopause. And she’s of that age, which is okay, but she was still cycling, and then she very quickly went into menopause — probably because of the stress of losing her husband. And she still has restless legs.
Her chief complaints were weight. She said, “I cannot get this weight off.” But number one, she’s just like, “I have got to sleep.” She said, “I can’t fall asleep. When I get ready to go to sleep, my legs start to move and wiggle. I can’t stop them. I’ve tried everything. I’ve tried everything over the counter. I’ve tried all the things.” She said she’s having some skin issues. She’s got some digestive issues. Her memory is starting to get bad — that’s probably the lack of hormones. Her energy is terrible. And she said, “I just really feel hopeless. Like no one’s ever going to be able to figure this out.” And I’m thinking: there has to be a reason why. I think I just was not looking in the right place. And she said, “I can’t be physically active anymore. I can’t get up off the floor. My joints feel inflamed. I am the shell of a person that I was before.”
So she said her fiancé — she met somebody in the meantime. She met someone. She’s engaged. And she said, “It’s great. We’re really happy.” But she said the emotional trauma of losing her first love still weighs on her. She said, “I’m in counseling. I’ve been in counseling. It’s better.” But she said, “It doesn’t go away.” And I said, “You know what? It’s probably never going to go away. The pain is never going to not be there. It’ll always be there because he was part of your life.”
So she’s struggling with that. And then she tells me, “Oh yeah… I’m on my phone before I go to bed.” I said, “Geez, you can’t do that.” She said, “Well, I wear blue light glasses.” I go, “Yeah, but…” So I’m thinking, well, we need to get rid of that. She eats in the middle of the night — I told you that. She has erratic daytime eating as well — she’s not always consistent. She’ll kind of skip. And then she said, “Sometimes I even take Advil PM to go to sleep.” I’m thinking, oh, that is never a good idea. She gets bloated from fat. So you know what this is going to be — gallbladder issue, right? She said, “But I love fats. I just can’t tolerate them.” I’m thinking, okay, that’s good. And then she tells me — this was not the case when I saw her last time — she said, “Yeah, I’m constipated.” I said, “Okay, well, what does constipated mean?” She didn’t give me a lot of detail on the intake form. She skipped a couple questions. And I always know when they skip things — that means you’re not going to tell me the truth on paper. So I’m going to ask. So she said, “Well, I go about once a week.” What? Once a week? What? So again, she tells me, “I just feel hopeless. Like I don’t even know what to say.”
So here’s what her labs said. Her glucose and her A1C: very elevated. Big problem. Her homocysteine was high, her CRP is high, etc., etc. So what I ended up doing was… I said, “Okay,” I looked at her blood labs and I thought, alright, let’s start to just kind of… I start over. Basically, I really don’t want to tell you what I did. I kind of did the same thing I did the first time — because I didn’t know what else to do. Like the first time, I gave her minerals and valerian and adaptogens and magnesium and all the sleep things. And then the second time, kind of the same thing — a little different variation. And now this time I’m thinking, okay, well, I’ll give her Candex for constipation. And I’ll give her some Revive HPA from Gaia because that one is good for high stress and she just lost her husband a few years ago. So that’s probably good. Obviously, I need to give her bile support, digestive support. I just wasn’t thinking. I wasn’t thinking. I was kind of going on autopilot. You know how we do. But yet, this lady is just so desperate and she’s hopeless — and I kind of fell down the same wrong path that I did before.
So I thought, alright, I’ve got to figure out and learn more about RLS. I have to know more about it. And I was not prepared for what I learned. And I’m going to tell you, here it is. I’m going to give you the Cliff Notes version, because otherwise this podcast is going to go on for two hours.
Here’s the Cliff Notes version: there is so much data and science behind this. Restless leg syndrome is not a leg problem. We already know that. It’s not a muscle problem, even. It’s not an electrolyte imbalance. It’s not a mineral deficiency. And it’s not poor sleep hygiene like blue light before bed. It is not that. It is a nervous system excitability disorder. And it’s driven by overlapping dysfunctions. And this is why many RLS patients don’t get help — because there’s no specialty in medicine for restless leg syndrome. So they’re going to treat it like, well, it’s maybe a structural thing, or a muscular thing, or it’s an autoimmune thing. And you’re going to go doctor to doctor to doctor to doctor. It’s got so many overlapping dysfunctions that it’s hard to pin it down.
So then I thought, okay, well what are these overlapping dysfunctions? I’m going to give them to you. First of all: dopamine. It’s the dopaminergic signaling that is the problem. The basal ganglia rely on dopamine to regulate movement. And when that dopamine signaling gets impaired, the nervous system creates the involuntary urges to move. So dopamine’s involved. That would have never crossed my mind. But truthfully, I didn’t go do the research. I just was feeling all sassy with myself, thinking, “Yeah, I got this. No problem.” It didn’t work. So I had to go digging. That’s number one: dopamine.
Number two is iron metabolism. This one made my jaw drop. And I’m going to talk to you about this in a hot minute, okay? I’m going to give you some more details, but it’s not serum iron. That’s not what the iron metabolism issue is. It is iron metabolism in the brain. Because here’s the thing: iron is needed for dopamine synthesis. But serum iron can look normal when brain iron is depleted. And the reason that that happens — so stay with me here — the reason that happens is because when there’s inflammation, it causes iron sequestration. Basically, it holds onto the iron. The body hides the iron from the pathogens. It hides it from the brain. It hides it. It’s called inflammatory iron sequestration. So when in the presence of inflammation — and her CRP is high — in the presence of inflammation, that iron sequestration happens, and now the brain doesn’t get enough iron. And her labs don’t look bad. I would have never suspected this. But I didn’t know that iron played such a role anyway.
The third reason — kind of the overlapping condition — is the nervous system imbalance, which we know: it’s a sympathetic dominant state. So there’s heightened arousal at night, and the nervous system just can’t settle. The fourth thing is inflammation — or inflammatory signaling. So when we have elevated CRP, which is the case for her, and some kind of systemic inflammation, we’re going to end up likely with neuroinflammation as well. The glial cells in the brain become activated. That perpetuates the excitability, and then we end up with legs that cannot stop moving.
And then lastly, what the studies have shown — what the research bears out — is that poor bile flow affects detoxification. And when we have poor bile flow, we will have dysbiosis. When we have dysbiosis, we cannot detoxify well, and we are going to have poor neurotransmitter production — namely dopamine. The last thing I found that made me kind of go, “Wait… what?” is that liver congestion — when the liver is not working — affects what’s called hepcidin. And hepcidin controls iron trafficking in the body. And therein is the smoking gun. It’s with this hepcidin.
So now if we look at her iron labs, there are other markers that are off — I’m going to tell you about those. But if we look at her iron panel, her ferritin is 127. Beautiful. Just absolutely perfect. Her iron is 93. Her TIBC: 328. Beautiful. But her percent saturation is a little bit on the lower side at 28. And it’s low-normal, so you wouldn’t go, “Oh yeah, that’s a big problem.” But for RLS, it is definitely not ideal. So on paper, she is not iron deficient. But her utilization and delivery of iron is way compromised because the inflammatory — whatever is causing the inflammation — is blocking iron from being used by the brain. Isn’t that wild? It is really, really wild.
So I’m going to give you just a tiny bit more information about this, and then I’m going to record this as a lesson and stick it in Clinical Academy because this was mind-blowing for me when I started diving into this. So I want to talk a little bit about dopamine. Dopamine production — I mentioned that iron is that cofactor, right? Iron is a needed cofactor for the enzyme tyrosine hydroxylase, and that enzyme is the first step in making dopamine. You can have iron in the body — as I said — and still not have sufficient iron in the brain, and that’s what causes the RLS. So not only does iron help to build dopamine, but it also helps dopamine bind and signal correctly. So when there’s low iron in the brain from inflammation, and then we’ve got liver congestion, so we have limited hepcidin… we’re going to have insufficient dopamine receptors. We’re going to have very poor receptor sensitivity, bad signaling. And what the research said was that it basically creates kind of “noise” — in quotes — inside those motor pathways. That’s what creates the sensation of RLS. It’s just an urge to move. It’s not cramps. It’s not anything like that. It’s just an internal nervous system restlessness.
And so dopamine isn’t just a feel-good motivation neurotransmitter. It actually helps the brain suppress motor activity that’s unnecessary — or at the wrong time — because there is a circadian pattern that happens to this. So all of this completely opened my eyes. The restless leg gets worse during the night because (a) there’s a circadian rhythm, and (b) if the daytime dopamine is just enough… you know, they don’t have quite enough… then the nighttime dopamine is going to drop, and now we’re going to get restless leg. So the answer is not giving dopamine. The answer is going to be fixing it.
Now that I have all this information, I think, okay, I’m going to go back and look at the rest of her labs. I’m going to see what other things I can tie together in her labs because the iron is looking normal, but based on what I’m finding, restless legs is directly tied to iron — poor iron when there’s inflammation and the liver and all the things — blood sugar, and then hormones, which I’m going to walk through with you. So this poor lady… I mean, I don’t know. I lost money on this case for sure because I’ve spent so many hours researching. But I was so committed to helping her — and I’m helping myself because now I’m learning something that I didn’t know. We can’t all be experts at all the things. Sometimes you just have to say, “I didn’t know,” and we go figure it out.
So now, let’s look at the rest of her labs. I’ll give you the things that are related. Her glucose: 110. Yep. And her A1C is 6.2. I would argue that this is probably pre-diabetes. And I looked back at some of her past labs, and it has been slowly creeping up, up, up. So when we have high blood sugar, we have neuroinflammation. It’s like, okay, this is starting to pull together for me now. It also promotes nocturnal firing. Because we have too high a blood sugar during the day, we’re going to have limited glycogen availability, and we’ll get those ups and downs — those surges — in the middle of the night. And so that nocturnal nerve firing of the nervous system in the middle of the night because of the lack of dopamine ends up worsening sleep quality, and we start to get these blood sugar surges in the middle of the night. This is why she eats in the middle of the night.
So there’s a lot of these restless leg cases that I found that they were misdiagnosing as just metabolic dysfunctions or sleep disorders, and they were blaming it on sleep when it wasn’t that at all. Because when you get that drop in blood sugar around bedtime or in the night, that triggers adrenaline and cortisol to rescue the blood sugar, and then you get that surge in the middle of the night that wakes up the nervous system. Just as you fall asleep, that blood sugar is dropping. And then we get up, and for her she has low brain iron, I’m suspecting, and then she gets the urge — she has to get up and walk around. And of course she has low blood sugar, so then she eats, and so the cycle starts to continue.
So then I started looking — what is her inflammation? Well, her CRP is 4.2, which is high. The case I talked about two weeks ago, her CRP was in the 80s. So sometimes it’s really inflamed. This one still inflamed. Not horrible, but there is some kind of inflammation somewhere. I don’t know where it’s coming from. I suspect it’s probably the blood sugar. Maybe it’s an infection. I don’t know. I’m going to have to flush that out. But for now, what I learned is: when the inflammation is high, remember I said that elevates and impacts the hepcidin. And hepcidin is what traps that iron together. It traps it and sequesters it. The inflammation activates the microglia, so then there’s increased hyperexcitability in the nerves. It disrupts dopamine signaling and prevents that nervous system from downshifting at night and going into that rest state. So the nerves are more reactive, the sleep is disrupted, etc. So I believe getting this inflammation under control is absolutely number one.
Her hematocrit was just a little bit on the high side. That can indicate insulin resistance and maybe low-grade inflammation. Her ALT was 35. I like to see it less than 30. So that liver is probably under a little bit of stress. And again, remember I talked about when the liver is not working well, we’re not going to have good hepcidin, and we’re not going to have good regulation of sugar — metabolic dysregulation in the glucose handling system. So iron storage is going to be altered, hepcidin production is going to be impacted, and dopamine breakdown.
Her B12 was also kind of low for a neurological-type condition. It was 338, and I’d like to have it up between probably 600 and 900. I don’t think it needs to go over 900, but it does need to be a bit higher. So I’m going to give her a little bit of B12 just to see if I can help.
And then I’m also factoring in the fact that she lost her husband. So the nervous system when that happens… I mean, my gosh. You kissed your sweetheart goodbye in the morning and the person is gone from you six, seven hours later. That’s massive disruption to the nervous system. So I know that even now it’s still probably in a state of high alert — like what’s the next shoe that’s going to drop? It makes it harder for the body to relax at night. Probably lowers the threshold otherwise when the legs would get a little bit restless at night — just because of the trauma and the stress. So I don’t think it caused it clearly, because that came later, but I don’t think it’s helping either.
And then we also have the whole change of hormones. The test that her functional medicine practice ordered — they ordered a bunch of lab tests, blood work on hormones, which is not my favorite. You all know that. But we do know that estrogen helps to calm the nervous system. Estrogen, progesterone help with sleep, right? So if those things are missing because she’s going into menopause, well, that’s not causing the RLS clearly, but it is not helping it either.
And on top of that, her antibodies — her thyroid antibodies — were high, both of them. The TPO is 168 and the thyroglobulin antibodies are 25. So menopause often will unmask autoimmunity. Now, I looked back at some of her past lab tests and I knew that she’d had Hashimoto’s, but the values just keep going up. So the inflammation — the process of inflammation — that’s going to be continuing. I don’t know if it’s Epstein-Barr, I don’t know if it’s gluten, I don’t know what it is yet. I’ve got to get that figured out. But when you go into menopause, often these autoimmune diseases will kind of poke their head up and they’ll start talking a little bit faster.
So I just know that now, after I learned all the stuff about iron and the brain and dopamine and hepcidin and the liver and the gut and dysbiosis and bile… I knew some of those things were a factor, but now I have all this information. She’s over here still up at night, and I’m like, “Hang on, girl. I’m getting it. Just hang on.” I probably put her on a two- or three-week pause. She goes, “I’ll wait as long as I have to wait. I don’t care. I’ve been doing this for 20 years. I will do whatever I have to do.” I said, “Okay, give me some time.”
So then I went back and I said, “Okay, here’s what I know.” I’ve pulled in pages and pages and pages of notes. I’ve pulled in all this information. And I’ve used AI to some degree — not a ton — but I’ve used AI to help me pull studies that I could work from. And then I would ask AI to help me summarize the studies. So I would find the ones that I could get the whole paper on, and then I would say, “Give me a summary of this,” and that kept me from having to read the whole thing and trying to digest it that way.
So I went back and I said, okay, what is true for her? One: I know her CRP is elevated. Her glucose and A1C is elevated. She has Hashi’s. She has low-ish B12. She’s severely constipated. She can’t handle fats. And she’s got really a loss of adaptogenic potential, I suppose, in the stress handling system because of the loss of her husband — and also just the stress of being ill. So I looked at all of that again through a different lens, and I thought, “Oh…” and it was kind of that face-palm moment where I went, “Oh my gosh.” And I was trying to use valerian and magnesium. No wonder it wasn’t working. It didn’t work before. It didn’t work this time. It’s not going to work ever.
So now I thought, okay, the first thing I have to do is I’ve got to get the excitability out of the nervous system. I’ve got to stop that firing of those nerves at night because that’s her big complaint. So I know the number one thing I have to do is deal with the inflammation. I’ve got to fix that. And for me, I feel like blood sugar is sort of on the heels of that because right now that’s my number one clue. And I know that high blood sugar is going to be a cause of inflammation. And she’s had this creeping up, creeping up, creeping up over time. So, okay: I’m going to start with inflammation. I’m going to start with blood sugar. And then I think I’m going to work on the nervous system.
Now, she does still have an underlying thyroid autoimmunity situation. Maybe there’s a stealth infection. I don’t know. But what I know is that if I don’t get the inflammation down, we’re not going to get off of home base. I’m not even going to get to first base. Not even going to get close. I would say inflammation and blood sugar are going to be my two top things. Now, she’s constipated. She’s got bile issues, so we know her digestion is not working. Well, of course it’s not working because she’s in a sympathetic state all the time. Oh — and I found out too — she said, “Oh, I only drink about 15 to 20 ounces of water a day.” Like, okay. Well, we probably need to fix that, too. So I had her start adding salt in the water — Celtic sea salt.
And so I told her, “Listen, we’re going to start here. And this is what I want you to look for. I want you to start looking for sleep onset feeling less panicky for you. And I want you to notice that maybe the urge to move softens a little bit. It’s not maybe so jerky or harsh. It’s less intense. Or maybe it takes a little bit longer to appear at night.” And I always say this to practitioners: when you are making a change to someone in their protocol — you’re giving them something to do — if anytime the patient experiences a change in duration, frequency, or intensity, you’re winning. Doesn’t mean that the symptom’s going to go away right away. But changes in duration, frequency, and intensity — that’s the expectation you have to have as well. That’s a conversation you have to have with the patient at your first new patient appointment. And this is a business thing, like from a practice business standpoint: setting those expectations right in the beginning and saying, “This is what I want you to look for.” Otherwise, you know, the patient might think, “Well, I’m taking these supplements and it’s been one week and I’m not any better.” But they’re not looking for the right clues, right? So the clues are any changes in frequency, duration, and intensity.
So now here’s what I did. This is my protocol. I wrote up a long description of what my thoughts were, what my findings were. I had AI help me a little bit, but I put it together myself. And then I used Claude this time, and I said, “Please write this out for me in a way that it’s going to make sense to the patient and it communicates very clearly and sets a proper expectation.” And I prompted it and gave it all my information, and it was beautifully done, by the way.
So my first thing that I’m going to do is I’ve got to get that CRP down to below 1.5. That’s my number one thing. I have to get her blood sugar stable, and then that’s going to help me get that neurological firing at night. So these were the things that I told her to do. And when she got the recap, she’s like, “You’re killing me.” And I said, “Listen, do as many of them as you can.” And there’s quite a few. I’m going to read them for you. The ones you don’t get to right now, we’re just going to get to them in a week or two. We’re just going to slowly add. Pick the ones that you can. Some of them are easy. Some are going to be a little bit harder.
So I said: nothing that has diphenhydramine. None of the Advil PM, NyQuil, nighttime — none of that. Because in the studies it showed that that actually makes restless legs worse. Yes. And she was taking it every night. So she said, “I don’t think I’m going to sleep.” And I said, “Well, it’s making it worse. So what are you going to do? You can keep going with it, but it’s not helping you. It’s making it worse.” So you might have a little bit of a rebound, but it’s going to be worth it. You’ve got to get off of it. And I gave her the links to a couple of studies.
Number two: water. You have to have water. Because if you don’t have water, we’re not even going to get one step off of home base. We’ve got to make sure you’re hydrated well. And then I said: focus on protein and as much fat as you can tolerate. And of course, I told you we have to fix the fat situation. So I gave her something that’s going to help her break fats down — some bile salts, something very similar to that — to help her break those fats down because I have a suspicion that not breaking the fat down is probably contributing — not exclusively, but contributing — to the constipation.
So: drink clean water. Eat more protein and fat. We’ll give her that one supplement for that. And then I want coffee only in the morning. There is research that shows that coffee in the afternoon or even later in the evening can be aggravating and stimulating to the neurological misfiring. So coffee only in the morning. And I said you might try a decaf coffee or even a coffee alternative — maybe every other morning or every few mornings — and see if it makes a change in the RLS, because for some patients, coffee absolutely made the RLS worse. So worth an experiment. I said, “You don’t have to do it right away.” This is one she pushed back on. I said, “You don’t have to do it right away, but it’s worth trying. Might as well try. Just see.” How bad do you want to get better? I don’t get to be your boss over here. But how bad do you want to get better? I’m just the messenger. Don’t shoot the messenger.
So then I said: dinner has to be protein-rich, and you need to eat about an hour and a half or two hours before you go to bed. No later than that. In other words: no snacking, no nothing, none of that before you go to bed, because I’m trying to reduce the volatility of the glucose in the middle of the night. And then I told her: if you can — weather permitting — she lives in a moderately okay climate in the South — if weather permits, I want you to go for a 15-minute walk after dinner to burn off some of that excess glucose. And she said that should not be hard. I said, start with dinner because nighttime is the problem time, and then add in lunch, and then add in breakfast.
No blue light before bed. Even though the study said that restless legs was independent of sleep hygiene, I still said, “Just try.” Like, we need to get your nervous system quiet. And then no alcohol within four hours of bed. There was a strong correlation between alcohol consumption and restless legs. Then exposure to first morning light. So I said get outside for about 10 minutes and get that first morning light within the first hour of the morning. And then make sure that you go to bed same time — sleep consistency — bedtime, wake time, very consistent. And then don’t eat at night was my last one. That one was hard. She goes, “I don’t know how I’m going to do that.” I said, “I don’t know — watch a movie.” And then I said, “Wait a minute. I’m telling you don’t do blue light.” So maybe read a book — with a non-blue light, an incandescent light or a filter or something. So we’re still working on that. That one’s a little bit harder for her.
So what I did was — here’s the supplements I gave her. You ready? This is what I gave her. So I’m in phase one right now. But I am confident now. I feel like I have a good plan. Like, I know now what I’m after — what my end goal is — and I know more of what the mechanism is behind this. And if I can decrease the inflammation, I’m going to have to improve liver, get the blood sugar working, get her bile going. Remember I told you in the beginning that there are multi-things going on here. We can’t rebuild Rome in a day. I say that all the time. You can’t do all the things at one time. Never, ever treat more than three things at a time because the body just can’t do more than that. The more intentional we are with what we give, the more able the body is going to be to implement the changes and heal.
It’s when we start throwing all the spaghetti at the wall — I see practitioners do this all the time and I just throw up my arms. I don’t even know what to say. If all you’re doing is saying, “Well, let’s do… okay, well, I’ll give you something for stress, and then I’m going to give you something for your hormones, and then let’s go ahead and fix your digestion. And over here, I’m going to give you some turmeric for inflammation, and then I’m going to give you vitamin mineral from Doctor’s Research, which we love, and then I’m going to give you something else for your hemorrhoids…” The poor body is like, “What would you like me to do first?” Like, what is the priority? So I always say: start with just no more than three things. No more than three things.
So here’s what I started with with her. I made the choice to use Doctor’s Research for a couple of reasons. One: the prices are a little less expensive. Two: they work really well. Three: the dosage is typically lower, so we don’t get pill count fatigue. And four: if I can find everything that I think I need for her from one vendor — i.e., Doctor’s Research — then I can order them all in one fell swoop, so to speak. And I don’t have to have some things on Fullscript and some things over here and some things get drop-shipped. It just makes it a lot easier. So that was just my clinical choice. You guys do whatever you’re going to do.
But here’s what I gave her. I gave her turmeric. They have a turmeric product. So I gave her turmeric and I had her do two twice a day. That was what I started with. It’s turmeric-boswellia. I know that’s going to start to reduce that inflammation. I’ve got to get that CRP down. It’s my number one priority of all. Number two: I gave her omega-3 because that pairs so nicely with the turmeric and the boswellia. That helps support healthy nerve cell membranes, and it creates a more quiet, stable environment for sleep and reduces that motor “noise” I was talking about in the nervous system.
Then I gave her — Doctor’s Research has a product called Vitamin B6, B12, Folate — that I like. I don’t use it too, too often, but if I need the B12 and the folate, I’m going to do that. Now, the functional medicine people did not order a folate. I don’t know what it is. But the B12 is on the lower side, so let me give you kind of the breakdown of these three nutrients and how they impact. B6 helps to balance the calming neurotransmitters that support sleep and also movement — normal movement. So B6 can reduce nerve excitability, but it’s not stimulating. And that’s what I wanted. I don’t want to do anything stimulating to the nervous system. I’m trying to calm it. So that’s why B6 is good. B12, as you know, is needed for nerve repair. It helps with signaling, myelin sheath, etc. So B12 is never going to be wrong. And my goal is 600 to 900 with her. And again, it does not stimulate the nervous system. It helps to calm the nervous system. And then folate helps with methylation in the liver, also with good nervous system repair, and supports the brain and nerves — giving them more stability. It just kind of levels everything out. So I felt good about that.
And then I gave her choline complex. The reason I did that is because choline helps with communication between the nerve cells, and it helps the brain send clearer signals — like there’s no static in the line. So it can help with sleep transitions. And I’m thinking it’s going to help stop the misfiring that’s going to lead to those restless sensations. We’re going to find out. She’s been on them for a couple of weeks as of this recording, and so far so good. She said she is doing better at night. The restless legs don’t seem to be quite so angry — that’s how she termed them. Like they’re not as jerky. The movement is still happening, but it’s not as jerky or severe. It’s like a softer kind of a jerking, which I’m so happy about. Remember I said we want changes in duration, frequency, and intensity. And in this case, it would be intensity. So I’m super happy about that.
The next nutrient that I know is missing — and I kind of feel a little bit better about this about myself — is magnesium. I didn’t want to do like a magnesium glycinate or taurate or anything like that. I wanted to get one from food, which is another reason why I chose Doctor’s Research. Magnesium helps quiet those overactive nerves and muscles because it raises the threshold at which they fire. So it helps the body relax a little bit better so that the nervous system isn’t so excitable. So I gave her magnesium from Doctor’s Research.
And then I had her do bone broth. Now you might say, why bone broth? Because bone broth has glycine. It’s rich in glycine — if you get good fatty bones with good marrow, you know, like leg bones. That amino acid glycine helps the nervous system shift from wakefulness into sleep. That’s kind of its job. Glycine helps support a more stable, deep sleep without feeling sedated. And it quiets those motor signals, but it’s not stimulatory. So I just sent her a bone broth recipe and I said, “Just make this. Leave it on in your crockpot for a week.” It’s called a perpetual bone broth. You just add a little water to it, keep drinking out of it all week long. When it gets too watery, throw it out and do another batch.
And then the last thing I had her do was Celtic sea salt. I said, “Just shoot for a teaspoon a day. Put some in your water, sprinkle it on your eggs — whatever it is that you’re going to do.” So I’m going to have her do this — my goal was three weeks. We’re in two weeks, and she’s already seeing improvement.
So this is kind of what I’m thinking. Phase one. Phase two, I’m going to go work on the blood sugar. Notice — do you see how that first one… see, I didn’t give her everything. And I know some of y’all listening are like, you know, going through the catalog like, let’s go. We’re going to give her all the things. No. No, no, no, no. We are going to go low and slow. So I gave her turmeric. I gave her omega. B6, B12, choline, magnesium. So there’s five supplements, salt, and bone broth. And that’s plenty.
So now after week three-ish, I’m going to shift into blood sugar. And maybe a little bit to see if I can help her sleep and get her to sleep a little bit better. So I’m kind of thinking I’ll probably do something like — I’ll probably stick with Doctor’s Research just because I can — but I might do the… they have one called Glucose Sugar Balance that I really like. And by the way, I’m not getting promoted — I’m not getting paid or anything to say any of this. I’m just being honest about what I’m using. But I do like… there’s a MediHerb product called Metabol Complex. I’m thinking ahead. I might add that one as well. Maybe. I don’t know. But definitely the Glucose Sugar Balance. I like it because it’s got a little gymnema in it. And we’ll probably continue the phase one supplements, and then I’ll just add on one — maybe two — blood sugar supplements. And then by that time, I’m hoping that the nighttime eating is going to decrease because the firing is decreasing and the inflammation is starting to go down.
So this is, so far, my first attempt at this. Two weeks-ish in — she’s already doing better. Her diet was already good, so I didn’t have to really worry about that. But I’m going to add on the blood sugar in probably another week or two, and then I’m going to see how she does. After that, my next phase is going to be to start to rewire the nervous system. And that’s when I might start going after maybe some autoimmunity. I might look a little deeper at the gut. I don’t know. I’ve got to see how she does. This is the problem. I can kind of plan it out, but I can’t say for sure because I don’t know how she’s going to respond. But for now, I have to keep it simple, and I have to get what I know is the smoking gun. And the smoking gun — 100% the smoking gun — is the inflammation, at least for right now. So that’s where I have to go first.
And I think, you know, as I was looking back over this case, I knew I was going to share it with you all. And I hope this was helpful for you. It was so helpful for me to learn more about iron — iron sequestration, iron in the brain, dopamine, and all that — and restless leg. It was eye-opening. It made me kind of feel bad on one hand that I didn’t do it sooner. But I think this one was a case — a patient case — that kind of humbled me. You know, most of the time, our physiology is pretty easy to fix. Most of the time we can figure it out. This one was just harder for me. I tried once and failed. I tried the second time and failed. And now here I am the third time. And I have every reason to believe now that I’m going to get this this time for her, because I’m super committed.
Before, I was treating restless legs like a peripheral problem — not a nervous system problem. I’m thinking muscles and sleep and adrenals. And it would’ve been real easy for me to say, “Oh, well, they’re real bad because you lost your husband. Your husband died. You went into menopause. Of course that’s why it’s all flaring up again.” But there was just so much more to it. I kind of had to go back to square one. And sometimes we get those cases where that’s just what we have to do. We just have to go back to the beginning, look back through your notes, look back through the intake forms, look for clues that you may have missed the first time. You have to stop and be honest enough to ask yourself: okay, why is this not working? Why am I not making progress? If what I’m doing isn’t working, then I need to do something different. And restless leg is a central nervous system problem. Well then I have to figure out: why is the central nervous system not working?
I know that the functional medicine system that tried to lure her in — it’s a broken system. I love the concept. The philosophy. We all do. That’s why we’re here, right? I love that. But what I don’t love is this: throwing a bazillion supplements at someone, doing a gazillion dollars worth of testing, and then thinking we’re going to come out the other side and have magical answers and get the patient all fixed. I just don’t think it works that way.
When I went back, I took the time to dig a little bit deeper, ask the hard questions — like, “What am I missing? What am I missing?” Restless leg — this is the embarrassing part — when I went and looked, I started finding the studies, I almost cried because I felt so bad. I should have done that before, and I didn’t. But I am now. And now I’m going to help her. And she’s already getting better just in two weeks. And I haven’t even touched the restless leg. All I did was work on the inflammation. So that’s what I got for you.
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Ronda Nelson: If you want to know how I think about these cases — which you’re getting a peek into — I’ve got a free resource for you. Just go to rondanelson.com/6principles — the number six principles — and you can download it. It’s called the Six Principles of Clinical Thinking, and it’s basically the way that I think about working through a clinical case. This is just how my brain works. I don’t know. It’s my superpower. I can take something complicated and my brain just does all the math and it makes it simple. I don’t know why it works that way. I wish I could figure it out, but I can’t. It’s just my superpower. So I’m simplifying it for you and helping you be able to take the same thinking concept and apply it to your own patient. So just go to rondanelson.com/6principles. It’s part of this clinical thinking series. We’ve got three more episodes to go. Next week I have a really good case for you that you are going to love. We’re going to talk about a patient that was treated for H. pylori four times, and each time it came back — and came back with a vengeance — and I’m going to tell you what I did and how it worked. Take care, my friends. I hope to see you soon. Have a great week.
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