Taking the Sugar Challenge
Could the culprit be sugar?
Lacking clarity of scientific understanding of RLS or its treatment from an extensive clinical literature, after ascertaining that RLS is real, one might look for real-world evidence, including well-performed N-of-1 trials.
I am an antisugar guy. Read my prior Medscape columns. I practice what I preach, but sugar does taste good.
Early in November 2023, after a healthy, conservative dinner at home with some wine, I enjoyed a mini Dove bar for dessert. But I didn’t stop there.
Mini Dove bars contain 11 grams sugar. It was also just a few days after Halloween. Having had fewer trick-or-treaters than expected, we had leftovers. Snickers, Milky Ways, Twix mini bars, each with at least 20 grams of sugar.
I ate several of these not long before bedtime. Lo and behold, in the dark of that night, and continuing off and on for a few fitful hours, I had bad RLS. Shifting, tossing, turning, compulsively seeking a new sleeping position only to have to soon move again. Plus, I had repetitive leg cramps and that creepy-crawly skin sensation. An altogether unpleasant experience. Sound sleep eventually arrived, and there were no recurrences over subsequent weeks.
The classic way to determine whether a drug is causing a reaction, condition, or disease is to apply the challenge-dechallenge-rechallenge testing method.
Give the drug, the patient demonstrates the disease finding. Remove the drug, the problem disappears. Rinse and repeat three times. We pathologists first worked this out for drug-induced liver disease, such as steatosis, in the late 1960s. Blinding or double blinding in these N-of-1 situations would be nice but often not practical.
Siwert de Groot, in the Netherlands, published a very convincing use of this technique in 2023: Big-time sugar consumption for a week, then low intake of sugar for the following week, repeated three times on one patient.
Very elaborate RLS symptom reporting. I’m pretty convinced from my unintentional challenge and single dechallenge that my unusually high sugar intake resulted in RLS. I will not undergo a rechallenge, although it might be fun to binge on sucrose and see what happens.
If you are serious about identifying or treating RLS, I suggest that you incorporate the International Restless Legs Study Group Severity Rating Scale into your practice, and begin the systematic use of the dechallenge-rechallenge exclusion process for your patients with RLS. Start with sugar and see what happens. Keep records and let the world know what you discover. Be your own clinical investigator. Social media offers you abundant opportunity to share your results, whatever they may be.
How many millions of dollars would Big Pharma lose if patients with RLS just said no to sugar and it worked? Of course, humans being humans, many would probably prefer to continue to gorge on sugar, gain weight, develop diabetes, and then take medications to control their RLS symptoms. But patients ought to at least be given an informed choice.
I will be watching for your reports.
Dr. Lundberg had no disclosures.
A version of this article appeared on Medscape.com.