Open question #1: Exercise and WED

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Frunobulax
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Open question #1: Exercise and WED

Postby Frunobulax » Tue Sep 02, 2014 3:01 pm

Hi,

if nobody objects I would like to post a number of questions where I think that answering them would help our understanding of WED.

First question:
A lot of WED patients report consistently that high-intensity exercise severely excarbates their WED symptoms, while moderate-intensity exercise helps. As far as I am concerned, this seems to be true - WED symptoms increase even days after the high-intensity exercixes. The common knowledge is that high-intensity exercise is good for depression and may increase dopamine production, so one would expect that it should help with WED symptoms - but apparently it doesn't. Why?

Speculation: Since SSRIs may cause WED, could this be connected to the fact that high-intensity exercise increases seratonin levels?

Regards, F.

Rustsmith
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Re: Open question #1: Exercise and WED

Postby Rustsmith » Tue Sep 02, 2014 7:56 pm

Interesting question and speculation. I am one who does not have a correlation between WED and vigorous exercise, which is good since I am continually training to race either track events or road races (up to the marathon). Running does occasionally trigger my migraine headaches, but I have never seen it cause WED problems.

I only started running when I was age 40. Up until that time I struggled with bouts of depression and looking back, I should have been under a doctor's care. However, the depression went away once I first started jogging and has not returned since I moved up to competitive running. I remember my wife telling me soon after I started jogging that she did not care how much time I took for training, she was not going to let me stop running because I was so much easier to live with. I also recognized that I was also much happier.

So, I started a bit of an internet search and quickly came up with this site - http://www.webmd.com/depression/features/serotonin?page=2. About half way down the page they talk about exercise and depression. They state that exercise can be just as effective as medication. They also mention the possible relationship between exercise and serotonin levels, but state that there has not been any research to validate the assumption.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

ViewsAskew
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Re: Open question #1: Exercise and WED

Postby ViewsAskew » Wed Sep 03, 2014 4:28 am

I definitely have that correlation, with one caveat. If I continue the higher-intensity for a long period - at least 2-3 weeks - symptoms have usually declined at that time. But, I may not have been at the high intensity that some people mean.

I've been able to acclimate to the following, but in every case, the symptoms were worse after the first day or two and were OK within 1 to 3 weeks. 1) hiking 4-8 hours a day in the mountains, 2) riding my bike 20 or more miles per day, several days a week, 3) swimming 1 mile a day, 5 days a week, 4) working on a farm, riding horses, moving bales of hay, gardening, mucking stalls, etc. (my day was outdoor work), 5) working out at a gym every day for an hour, 5 days a week.

Your post reminds me of something I was recently reading - it was how the recent belief that chemical imbalances were the cause of many things is a flawed and outdated hypothesis. There are several researchers and doctors trying to move people from this position. http://bbrfoundation.org/discoveries/mo ... depression - in this link, one of the doctor's says, "“But in truth,” Dr. Malenka continues, “the ‘brain soup’ idea is no longer adequate.” It really has reached a dead-end. This is why antidepressants aren’t working for so many people—all the current medications work via these same mechanisms. Therefore, Dr. Malenka reasons, “there’s a great need to understand in greater detail the brain biology that underlies depression’s symptoms” so that novel therapies can be found."

But, how do we get to a greater understanding of brain biology of WED? And, not just brain biology, but of the biology of the entire body, as multiple systems must be involved?

Sorry....not sure I was at all helpful!
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Frunobulax
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Re: Open question #1: Exercise and WED

Postby Frunobulax » Wed Sep 03, 2014 9:57 am

I think it is an interesting read :-)
I have two thoughts about that.

(1) There is a good chance that WED is not caused by a chemical imbalance. However, since we are not sure about this it would be foolish not to explore this option: If WED _does_ come from a chemical imbalance, then we may be able to do something about it. So I'm trying to go that road and explore it until I come to a dead end, or to the end of my wits - knowing that there is a high chance that I won't find conclusive evidence for one or the other :-)
It is also possible that a "chemical imbalance" is the cause for WED only in some cases.

(2) Personally, there are some clear indications that something is "off" in my brain balance. I mentioned several times that I've got 2 heavenly weeks of complete WED symptoms relief from taking high doses of vitamin B12 (while continuing my opioid, so I wasn't without medication). In this time I clearly had a "high" in my mood, feeling suddenly very energetic and motivated (after 3-4 days of being extremely tired, which was probably a recovery phase from the hellish months before that). After two weeks, WED symptoms started to come back and get worse. But I do feel that my sleep is more restful than before, even though I do not sleep longer than in the time "before vitamin B12". Otherwise, there was no change in life circumstances, nutrition and so on. Also, when I recently switched to oxycodone I experienced something similar: I had pretty much complete relief for a week, but then WED symptoms started to break through again.

My interpretation is as follows: If there is no chemical imbalance, why did taking up substances that obviously changed the brain balance (most likely by producing more dopamine) relieve my symptoms completely?
On the other hand, the fact that WED symptoms returned after a short time could be explained in two ways:
(a) (Assuming that the "chemical imbalance" hypothesis is wrong.) The neurotransmitter levels remain changed, and my body quickly adjusts to changed neurotransmitter levels. This would be extremely bad news, because this would mean that there can be no permanent relief from changing neurotransmitter levels. This would fit the hypothesis that WED is caused by an imbalance between D1 and D2 receptors - when the dopamine levels rise, the imbalance is restored after a short time through a downregulation of the D2 receptors.
(b) (Assuming that the "chemical imbalance" hypothesis is true.) The neurotransmitter levels returned to the previous state. Assuming there is an imbalance and one substance/neurotransmitter is missing, it could be because both vitamin B12 and Oxycodone may have forced the body to use more of the substance in short supply. Think of it this way: If we are exercising at a high level for a prolonged time (say by running/jogging for a long time), then we will get exhausted eventually and be forced to reduce speed/intensity. If we don't rest, we will be able to go on for quite a long time, slowing down more and more. Now, if there is a sufficient stimulation (say actual, acute danger), adrenaline will kick in and we're able to increase speed for a short time - but of course this effect will be short and temporary, since only rest will restore the energy reserves. Now, if we compare WED symptoms (low levels of a substance, possibly dopamine) to being exhausted and energy reserves being depleted (low levels of ATP, glucose and such), then both my vitamin B12 and Oxycodone experiences could be the equivalent of the adrenaline burst - for a short time the body increased the production of the missing substance (dopamine?), but it did not change the state of the "reserves being depleted".

<and now back to the original question>

Of course, in my original post I mentioned just one of the two obvious possiblities: That one "harmful" substance (possibly serotonin) is increased as effect of the vigorous exercise (and I'm very much with you in the intensity, working the cross trainer in a gym at a level that I'm exhausted after 45 minutes will cause WED symptoms if I do it 2-3 times over the course of 3-5 days). The other possibility is of course that exercise reduces the level of a "necessary" substance that is required to manufacture dopamine (or whatever is needed to prevent WED). As mentioned in the beer eperiments, the body replenishes ATP after exercise, consuming creatine (among others), which has to be replenished later. ATP production happens much faster than my WED symptoms persist (if I recall correctly), so creatine is a candidate: Either low creatine levels excarbate WED symptoms, or the manufacturing of creatine requires another substance (for instance SAMe) which is necessary for dopamine production.

To sum it up: There is a difference in moderate exercise and vigorous exercise. It appears that in "vigorous" conditions, either one (or more) substance(s) is/are produced whose presence is responsible for the WED symptoms, or one or more substance(s) are used up and WED symptoms arise as a direct consequence (WED is connected to the lower levels of these substances) or indirect consequence (WED comes from the shortage of a different substance, which can't be produced because of the shortage of the other substances).

Now, what's the difference between "moderate" and "vigorous" exercise? Aerobic/anaerobic energy conversion? Is the depletion of glucose reserves (which happens in the first 30-60 minutes of a moderate exercise IIRC) beneficial for WED, and fat burning (and change insuline levels), which happens if we exercise longer or with higher intensity, excarbate WED symptoms?

jul2873
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Re: Open question #1: Exercise and WED

Postby jul2873 » Wed Sep 03, 2014 9:38 pm

I don't have anything to add, but am really enjoying the discussion.

Rustsmith
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Re: Open question #1: Exercise and WED

Postby Rustsmith » Wed Sep 03, 2014 10:30 pm

You might be close with the aerobic vs. anaerobic differentiation. I know that because I am training almost every day, my energy systems work differently from someone who only works out a couple of times a week. So even my hard, anaerobic workouts probably have a different impact. Or maybe it has something to do with waste product buildup or the minor the muscle damage that occurs with occasional training.

As for the B-12 and beer experiments, I think that it is probably closer to the concept of rate-limiting step in chemistry. If you have a string of chemical reactions A to B to C to D to E, the rate of the overall reaction from A to E is usually controlled by one step, say C to D. To put this into WED terms, we could be talking about the metabolic sequence: L-Tyrosine to L-DOPA to Dopamine to Norepinephrine to Epinephrine. Each step requires certain other chemicals in order to proceed and the rate of that reaction depends upon how much of each is present. Therefore, if you were short on one of the chemicals that was needed for C to D, but then fixed the shortage (by taking B-12), then the overall A-E reaction rate speeds up along with reaction C to D. However, with the increase in the C-D rate, one of the other reactions (maybe A-B) becomes rate limiting. This means that adding more of the chemical required for C-D will not increase the overall A-E rate because A-B is not controlling everything.

So in WED terms, if ferritin is low and is required for dopamine generation, then increasing ferritin can help less the symptoms. However, if the rate limiting step was somewhere else (like maybe too few D2 receptors), then adding iron will not be particularly beneficial.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Frunobulax
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Re: Open question #1: Exercise and WED

Postby Frunobulax » Thu Sep 04, 2014 5:11 pm

Yes, I though about something like that. As for the B12, my WED symptoms basically reverted back to previous severity, but the jury is still out on that (it's been only 2 months). So it is still a bit of a mystery why it helped in the first place.
As for the exercise, it is very possible that the exercise may make an already existing bottleneck even tighter. It could be a problem to locate that bottleneck though, since Dopamine alone is part of so many processes...

ViewsAskew
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Re: Open question #1: Exercise and WED

Postby ViewsAskew » Fri Sep 05, 2014 5:56 am

Frunobulax wrote:Yes, I though about something like that. As for the B12, my WED symptoms basically reverted back to previous severity, but the jury is still out on that (it's been only 2 months). So it is still a bit of a mystery why it helped in the first place.


If I had a penny for every time someone said that about their WED, I'd have a LOT of pennies!

This seems to be a common phenomenon, and doesn't seem to relate to the treatment. For so many people, adding a supplement, changing diet, and much more works for a couple weeks. It's gotten to the point that the moderators all ask people to wait at least 3-4 weeks before reporting success with something. I've talked to Dr Buchfuhrer about it - he says he hears it quite frequently, too.

What if it isn't what we do, but that we did something?
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

badnights
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Re: Open question #1: Exercise and WED

Postby badnights » Sat Nov 01, 2014 4:55 am

What an interesting discussion. Too bad I am so late on all of this, and so slow.

Isn't exercise is better known for increasing endogenous opioids than for increasing serotonin or dopamine? Not that this would change the substance of the discussion. I always felt that my exercise (hockey/broomball 5 nights per week in the winter; walking in the bush all day in the summers) kept me from needing more medication. It certainly kept me sane.

I have tried to be objective and still I have never been able to correlate my WED to my level of exercise, other than sometimes I think it has gotten worse for a few days when I stop exercising (eg. after hockey season, before the summer).
Beth - Wishing you a restful sleep tonight
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Rustsmith
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Re: Open question #1: Exercise and WED

Postby Rustsmith » Wed Sep 23, 2015 8:45 am

I realize that this is reopening an old discussion thread, but I had bit of an epiphany last night that relates to why exercise acts as a trigger for some, yet I am continually training as a runner and if anything, hard workouts seem to help quell problems in my legs. At the time, I was thinking about how kratom has little effect upon me. Then I realized that as a runner whose workouts last for over an hour 3 to 4 times per week, that I am frequently flooding my brain with endorphins, i.e. natural opiates. I would therefore not expect kratom and any other mild opiate to provide a benefit simply because I am already "using" a mild opiate that is generated within my body.

In order to get these endorphins, you need to exercise at at least a moderate level for 20 to 30 minutes. The problem may be that if you don't exercise this long then you do not get the benefit and if your workout is long enough but too hard, then you trigger a number of other physiological changes that then lead to an RLS event.

So the message may be that if you regularly exercise for long enough at whatever moderate is to your current physical condition, then you get a benefit. But if you don't exercise long enough or you try to do too much, you not only do not get the benefit but may also result in a triggered event. The keys therefore being "moderate" and at least 20 to 30 minutes. For many, a brisk walk is moderate exercise.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

badnights
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Re: Open question #1: Exercise and WED

Postby badnights » Tue Oct 06, 2015 12:33 am

sounds reasonable. I often get worsened symptoms when I have an intense workout at the gym. Never after 1.5 hr of hockey, though. The gym workout is shorter - maybe 30 min spread across an hour - but more intense.
Beth - Wishing you a restful sleep tonight
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gfischer4
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Re: Open question #1: Exercise and WED

Postby gfischer4 » Sun Jun 30, 2019 2:52 pm

Greetings
I am 69 I have always exercised on bike(I call my power ride). I had foot surgery 3 years ago and has seriously limited my ability to get out there do to fact I still have pain in my foot.. Errrr.. I live in the woods and miss biking alot.. But now since the surgery 3 years ago, I have developed RLS. It was a slow onset.. to squirmish legs ordeal when trying t sleep.. now it starts somewhat around early eve.. as I settle down . granted I still have pain in foot.
So I can see lack of exercise as usual is part of this problem .. I am now taking Ropinerole.. to sleep.. but don't know what to do with the gap from early afternoon.. till I take my pill bout 8:00 waiting for when I can crash.. note here is Ropinerole gives me sound sleep.. but can be awakened by a twitch or 2 8 hours later.. weird... some times even a hand twitch.. Folks please jump on here, to share any successes... It will be very appreciated.
Respectfully Gene ( I am not overweight,, but starting to gain....) not good.

Rustsmith
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Re: Open question #1: Exercise and WED

Postby Rustsmith » Sun Jun 30, 2019 3:57 pm

Exercise to help prevent RLS symptoms is something that seems to have mixed results. Some find it helps, some find that it causes problems and some (like me) don't think that it has any impact. My personal feelings on this is that it has to do with individual fitness levels and the degree of exercise. However, since your foot probably limits exercise other than swimming, it becomes a bit of a moot point for you until your foot pain is resolved.

As for weight gain, this is a fairly common complaint from people who take any of the dopamine agonists (like ropinerole). A known side effect of any dopamine agonist is compulsive behaviors. It could be that you are experiencing compulsive eating. Compulsive behavior is not something that you are likely to be able to see in yourself, so you might want to ask someone close to you whether you are starting to show signs of this. If so, you should probably talk with your doctor about switching to a non-dopamine med for your RLS.

Finally, did your doctor do blood work prior to starting you on ropinerole? Do you know your ferritin number? RLS is due to low iron levels in the brain and the only way to evaluate this is a ferritin test. Blood ferritin is a poor indicator of brain iron, but it is currently the only way to do it. Your ferritin level should be at least 75 and better yet, over 100. If it isn't, then you should consider some sort of iron supplement. Having a ferritin level over 75 could help with your RLS symptoms, but is important to anyone taking a dopamine med because it helps delay the onset of augmentation.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

gfischer4
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Re: Open question #1: Exercise and WED

Postby gfischer4 » Mon Jul 01, 2019 1:46 am

Here is test results May 31.. Test Name: FERRITIN
Result: 135.8
Units: ng/mL
Reference Range: 10.0-250.0
Lab Test: Iron Panel Chemistry

I believe this is correct test? Seems with in. 135.

You know I am paying attention to what makes things worse.. Today I purposely slowed down. cu my time on my feet bout in half today..
They still hurt.. left one a little bit due to hammer toe,,, but right much more sensitive.. at night it's the worse.. I have used ice gel pack for 3 years...
from first surgery.. It seems like the sensitive feet initiate the whole orchestra.. I have muscle contractions.. not so much just moving legs..they move more so as they seem( my legs etc seem frustrated...c
Did an EMG month ago.. to check back out I have Spinal Stenosis.. which primary symptom is numb legs when standing in place for too long 30 min.
That was ok..

Doc( Ortho) back doc gave me a shot in back 2 weeks ago, to quiet nerve in foot.. didn't do much of anything..

I am sitting here tonite at my computer, foot hurts a little bout 50% less than usual. but its quite sensitive. the original surgery was bunion joining and hammertoe repair.. 15 weeks ago I had them remove hardware. as I hoped pain would get better.. No twitching. just movement of foot.

Long story.. My foot wouln't be this way if podiatrist had done job right and recommended bigger toe box.. in my shoes..

Thanks Much for help, see my VA primary the 3rd.. to get to the bottom of this pain etc RLS.

Gene

fuz_mind
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Re: Open question #1: Exercise and WED

Postby fuz_mind » Mon Jul 01, 2019 5:03 am

my idea of exercise and RLS is very simplistic. overdoing (depending on the state of your body) it causes depletion of iron --> triggers symptoms


certainly not as sophisticated as the above discussion which I'm enjoying (and trying to follow)


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