Basically, there is strong evidence that the right diet has the potential to help a lot of people with various symptoms including RLS, but it may not be the diet that you learned to be healthy during the last 50 years or so. I'm talking about a ketogenic diet, with regular fasting intervals that avoids most allergenic materials (including lectins). The general idea is that the diet has to be strictly anti inflammatory, it's designed to reduce all kind of (silent) inflammation in your body, especially in your brain. And I do consider it possible that RLS is caused by silent inflammation in the brain, like many other diseases. (This does mesh well with the BID observation, even though it would mean that BID is another symptom of the inflammation and not the cause of RLS.)
There has been a recent change in what we consider healthy (say in the last 10 years), and there is overwhelming scientific evidence that a low carb high fat diet that is low in lectins and high in prebiotics and polyphenols is much healthier for us than the typical western diet https://www.dietdoctor.com/low-carb/science. ("Change" is perhaps not entirely correct. "Landslide" is more appropriate.) Basically, avoid carbs and sugar in general, all processed foods, antibiotics (in most meat), eat plenty of salad, vegetables, nuts, fish, olive oil, coconut oil. Avoid lectins, other vegetable oils and soy products. There is some discussion as to whether animal protein is healthy, some say aye ("carnivor diet"), many say nay. I'd recommend tolLimit protein as it will be converted to Glucose in your liver, but personally think that organic meat, grass fed if possible, should be part of the diet. Saturated/animal fats are under discussion too, they seem to be a lot healthier than most people think.
There has been success treating alzheimer, other dementia, depression, autism and multiple sclerosis using primary a dietary approach, all diseases that were considered untreatable just a short while ago. Don't you think this could work for RLS too? There are several different approaches to the diet, but all of them are low carb and high in anti inflammatory food.
It is also a very good idea to fast on a regular basis, at least for some extended time to clean up the metabolic syndrom if you're insulin resistent (if you don't know, do have your HOMA checked - 75% of the US general population over 65 is insulin resistent). I find intermittent fasting the easiest to maintain and went to OMAD (one meal a day) recently. But other forms of fasting are perfectly fine too (traditional fast where you don't eat for a week, or 5/2 where you don't eat anything on 2 days during a week, whatever works for you). But if you are insulin resistent, you might need some months of low-carb diet before you can tolerate long breaks between meals.
My story is this: I went on a low-carb diet about 9 months ago (just before christmas) and cut out lectins 4 months later and basically went keto (only 25-50g carbs per day). I went to 16/8 fasting (16h break, 8h eating) 3 months ago, and to 22/2 (OMAD) a couple of weeks ago, as I finally reached the level of metabolic flexibility where I can do this. (I tried intermittent fasting before, but failed.)
- I cut my RLS medication from 30mg oxycodone a day to 25mg after 6 months and to 20mg after 8 months, and hope that I'll be able to reduce it further. (The process does take time. Don't expect results after a couple of weeks.)
- I lost 24 pounds, most of that during the last 3 months when I started intermittent fasting.
- I was able to drop my PPIs (stomach acid reducers), see http://bb.rls.org/viewtopic.php?f=4&t=10519. No heartburn to speak of, unless I eat certain stuff like bell peppers, raw tomatoes or peanuts which trigger heartburn reliably.
- I also dropped my gout medication (allopurinol) and my uric acid is better than before.
- My psoriasis disappeared and I'm no longer taking any ointments.
- My ME/CFS got so much better that I'm once more able to work 4h a day, I was pretty much confined to bed a year ago. (And that's rare, usually ME/CFS has only one direction and that's towards becoming a vegetable.)
- Triglycerides and Cholesterol returned to normal range. Starting triglycerides were over 440 (with <150 considered normal, 150-200 increased risk).
- Michael Eades talks about Paleopathology (hard evidence that high carb is responsible for most civilization diseases), for example https://www.youtube.com/watch?v=VSRDfkt-wJY. He's a very good speaker and I strongly recommend to check out his other talks that are out there.
- Steven Gundry thinks that lectins are the main problem (https://www.youtube.com/watch?v=q4KfKapvnuI), and makes a good case for it in his books. He has a vlog with lots of videos on youtube, and has a lot about lectins on his home page (https://drgundry.com/lectin-guide/). Again a very good speaker, strictly scientific, has a study to back up every sentence.
- David Perlmutter is another advocate of a low carb diet https://www.youtube.com/watch?v=KRXl_N0OtX4.
- Sten Ekberg has a lot of stuff on different topics on youtube. The ones I saw were very good, but you'll need to have some knowledge on low-carb basics.https://www.youtube.com/user/drekberg/videos
- David Ludwig on processed food https://www.youtube.com/watch?v=vmCrg4XhndA.
So why would you go against the advice of 90% of all nutritionists? To give some background, I have ME/CFS, a disease where we are completly abandoned by conventional medicine. There is no treatment at all. But some patients get a bit better through smart food selection, so I have read hundreds of articles and watched even more videos, and even though there were a lot of conflicting topics, there can't be any doubt that we need to thoroughly re-evaluate what we consider healthy. And carbs are a problem, fat isn't.
You know, black powder consists of sulfur, charcoal, and potassium nitrate. If you cut out charcoal, it won't explode. Would you derive from that that charcoal is evil and sulfur and potassium nitrate is good? Of course not, but this happens with nutrition/fat. We have a very unhealthy combination of carbs, fat, antibiotics, insecticides and lectins in our diet. Especially carbs + fat seems to be a fairly bad combination, and cutting out either will give short-term positive effects (weight loss, better insulin etc.). But it turns out that going low-fat high-carb has devastating long-term effects, as diabetes, arteriosclerosis, dementia and autoimmune diseases become rampant. There are several studies that compare different cultures, for example indians in the same region, once 500 years ago when they became corn farmers, and 4000 years ago when they were still hunter-gatherers. We assume that they had basically the same gene pool as it was the same region, and ~4000 years are nothing in evolution. Turns out that the hunter-gatherers were healthy and had a much longer life expectancy, while the corn farmers had all kinds of terrible diseases. Similar studies exist for other ancient civilisations like the Egyptians.
Why did we come to wrong conclusions, about 40 years ago when everybody "knew" that fat is bad? In nutrition, many studies have found correlations and constructed cause-effect-relations without any further proof. Other studies have been massively manipulated, or just drew weird conclusions.
- A famous study that "proved" that saturated fat is bad (I think it was the Oslo study), and is quoted whenever that discussion comes up. Participants were separated into 2 groups. The control group would not change any eating habits. The "low-fat" group received intensive dietary counselling, and it turned out that they reduced sugar to 40g a day, less than half of the general population, among other healthy changes. Of course, all health benefits were attributed to the "low fat" and not to the other changes. (The "low sugar" and the counselling weren't even mentioned in the study. Apparently one of the authors wrote a book decades later where this nugget of information could be found.)
- The same patterns implicitly happen in many other studies. They eliminated fat (or just saturated fat) from the diet, and relized that health gets better. Fine, but the conclusion is that fat is bad, and that's wrong on so many levels, because fat was not the only thing eliminated. Going low-fat means you cut out a lot of junk food, like chocolate bars (fat + carbs), antibiotics (from animal fat), processed food (food with high glycemic index). From this you get massive health benefits that have nothing to do with fat. But if you eat just high-fat (saturated or not) without the sugar, antibiotics and processed food (ketogenic diet) you'll get health benefits that are even better than just going low fat, and better long-term benefits. (By "long-term" I'm talking about decades.)
- Many low-fat studies do not distinguish between fats. There is a lot of evidence that many vegetable fats/oils are very bad (canola, soy, sunflower oil and the like, which contains a lot of lectins) and play a major role in the recent diabetes epidemic. (We've seen a dramatic increase of consumed vegetable oils in the last 20 years. At the same time obesity went through the roof.) Other vegetable fats are in fact very healthy (olive oil, coconut oil, linseed oil). Trans fats are bad, no doubt there. Going low-fat means you get rid of all the bad fat, but that of course does not allow any conclusion that the other fats (the good ones) are evil.
- As for saturated fat, I firmly believe that the antibiotics in the meat (and we have a LOT of that) kill off bacteria in the gut microbiome and are maybe the #1 reason for a lot of the weird diseases that we have (dementia, depression, autoimmune, all the diseases where doctors don't have a clue about the pathogenesis). Saturated fat = animal fat (mostly), and cutting out saturated fat means you get rid of those antibiotics. However, there are both paleopathology studies that realize that a lot of hunter-gatherers were very healthy even though they consumed a lot more meat than we do today, and modern studies that show benefits from carnivor diets. Thus, the conclusion is that saturated fats are fine if you make sure they don't contain other bad stuff. Eating meat from grass fed beasts (organic farming only without antibiotics, soy fodder and the like) is very likely fine, and coconut oil of course is considered healty in any case.
- Cholesterol is a disease marker but not the cause. Yes, there is a clear correlation between cholesterol and heart disease, but correlation is not causation. Ambulances are usually present whenever a traffic accident happens, but it's a very bad idea to fight ambulances. Cholesterol is a repair protein, it will be produced by your body if there is some damage. So monitoring cholesterol is OK, but don't worry too much about it, it will return to normal with the right diet. Don't use statins, a healthy diet will make sure that you don't need them. OTOH trigycerides are a severe problem, you should worry about getting triglycerides back to normal range (<150 mg/dL).
So my advice would be this. (But I'm no doctor, so kids don't do this at home, do talk to your doctor first, and read more about this to make an informed decision.)
- Transition to low carb. (Up to 2 months.)
Slowly migrate to a low-carb diet (like Atkins or a low glycemic index diet) with at most 100g carbs a day. It may take a few months until your body adapts to that. Have your insulin resistence checked (HOMA) and check for leaky gut (zonulin).
Throw in some supplements. Have your vitamin D checked, most people are deficient. Add omega 3 fatty acids. Throw in some glutamin and inulin to aid leaky gut. Eat plenty of polyphenols and prebiotics, and take some probiotics. Add coenzyme Q10, alpha lipoic acid and carnitin, most people over 50 are deficient in these 3. (Transition phase and cleanup phase, perhaps longer.)
- Do a long "cleanup" phase. (This may be anything from 2 months up to a year or more, depending on how insulin resistent you are.)
In this phase, eat mostly ketogenic (max 25g carbs a day) and do some fasting. Avoid lectins and limit dairy products. The more fasting and the less carbs, the quicker you'll be through the phase. A few cheat days are OK, and especially at the start you'll violate that protocol (most likely) on occasions, because nobody eats right 100% of the time. But the longer you go the less you'll crave for carbs and sugar, and at some point you'll be able to eat whenever you want, and it's no problem to go 24h or 48h without any food.
There should be some gradual improvement of your symptoms (including RLS) during this phase, but again, don't expect quick results. We violated our body for many decades with bad diet, and it takes a while to repair that damage.
The cleanup phase ends if (a) your HOMA is in a good range (no insulin resistence), (b) you have metabolic flexibility (you can fast without preparation, and use all kinds of different foods without symptoms, like high carb one day, carnivor the next, keto for the rest of the week), (c) you're happy with your weight, and (d) there has been no recent improvements of your symptoms in a while. (As long as you're getting better, don't stop the cleanup phase.)
- For the rest of your life stick to low carb. If you go back to a western diet, your symptoms will reappear and you'll become insulin resistent again. Some of you may have to remain on keto, everybody is different, but most of you should be OK with some carbs as long as you're far away from the 300g a day that most people eat today. Do some fasting now and then -- evolution has prepared us for streaks with much food and carbs (summer) but expects a holiday for our pancreas (winter). For example, go to 22-2 fasting for 2-3 months during the winter, perhaps starting Jan to undo some damage from Christmas and Thanksgiving Or fast a week (traditional fasting, no food) 3-4 times a year. Something like that. As a rule of thumb, if your diet and metabolic flexibility is fine you'll be able to fast anytime you want. If not, you strayed off the path and need another cleanup phase.
- Olive oil, coconut oil, linseed oil, avocados.
- Nuts (but no peanuts or cashews, they are not nuts).
- Leafy vegetables, most salad/vegetables unless high in starch or lectins (nightshades contain lectins)
- Fish and pasture-raised meats and eggs
- almond, coconut or cassava flour as replacement of wheat flour
- Stevia, xylitol or inulin instead of other artificial sweeteners
- Fruit in moderation, avoid fruit high in sugar and starches (mangoes, bananas, grapes, some apples etc.)