Restless Legs Syndrome (RLS) Discussion Board

In the Fall edition of Nightwalkers, the RLS magazine, the RLS Medical bulletin said that Iron supplements should be taken in the evening with 250 mg Vitamin C. Why in the evening and why with Vitamin C?

In an interview with RLS specialist Dr Buchfuhrer he said that taking pramipexole no more than 3x weekly would prevent augmentation. This is welcome news for me since I have been taking 0.125 mg pramipexole intermittently for over 10 years with no augmenration

The suggestions to take it in the evening is a rather new recommendation that comes from Dr. Earley at Johns Hopkins. His rationale for the evening is that ferritin levels vary throughout the day and are lowest at night. So taking it at bedtime adds iron to your body at the time when your ferritin is lowest. As for Vitamin C, the doctors will say that it is used to keep the stomach acidic enough to keep the iron in solution so that the body can absorb it. But the chemist in me will tell you that the vitamin C is ascorbic acid and that it chelates the iron to keep it in solution when it enters the intestinal tract and can be exposed to a few compounds (sulfides from gut bacteria) that would react with the iron (as iron sulfide) and make it unavailable for absorption.

Rustsmith wrote: ↑

Wed Oct 27, 2021 2:22 pm

As for Vitamin C, the doctors will say that it is used to keep the stomach acidic enough to keep the iron in solution so that the body can adsorb it. But the chemist in me will tell you that the vitamin C is ascorbic acid and that it chelates the iron to keep it in solution when it enters the intestinal tract and can be exposed to a few compounds (sulfides from gut bacteria) that would react with the iron (as iron sulfide) and make it unavailable for adsorption.

Interesting thought. I thought it was best to take iron on an empty stomach (easy to manage if you do intermittent fasting) or together with some Betain HCL. Would you agree?

Yes, it is best to take iron on an empty stomach. There are only a limited cells in the intestines that adsorb divalent metal ions (primarily calcium, magnesium, zinc and iron) and iron gets the lowest priority. So if you take it with a meal with any of these other minerals, most of the iron doesn't get adsorbed and goes out the other end. Taking it on an empty stomach helps improve the chances of adsorption.

I wish I could take it on an empty stomach. I have so many other medications and supplements that need to be taken separately, that I don't think I could manage the timing. Sigh.

I understand the timing problem—with some meds needing to be taken with food, some on an empty stomach, some can't be taken together. It's a balancing act for sure. I even take my thyroid medicine in the middle of the night but with RLS that's no problem as I'm up several times throughout the night.

I religiously took the recommended Iron and C for well over a year. Never heard of the evening thing. I found it hard on my empty stomach. I saw no improvement of symptoms and (unscientific) had less after I quit. I would have a hard time convincing myself to do it again.

If it's too hard on an empty stomach, it's ok to take it with food. Try to avoid taking it with coffee or tea, vegetables, eggs, or dairy, and do add some vitamin C.

To clarify why it's good to take it in the evening, that's when the concentrations of iron and ferritin in a normal person's blood are the lowest. When blood iron and ferritin are low, the body absorbs more iron from the gut.

Who knows if that's the case with us, though I just came across a study showing that sleep deprivation shortens the period of the iron cycle, and throws it out of whack in other ways (if you're interested, the abstract is at https://link.springer.com/article/10.1007%2FBF02334070. In part: "[Five days of ]sleep deprivation markedly reduced the mean level of iron, diminished the absolute and relative amplitude of oscillations, disturbed the shape of the daily course of serum iron and gradually decreased the computative acrophase, i.e., shortened the period of rhythm. Forty-eight hours of recovery resulted only in a partial normalization of all the observed changes."