Can folic acid deficiency cause restless legs?

December 8, 2025 •

4 min read

According to the Restless Legs Syndrome Foundation, iron deficiency is a well-known contributor to RLS, but a less-discussed association exists: can folic acid deficiency cause restless legs? Studies show a link, particularly in certain patient groups, with folic acid playing a crucial role in nervous system function and neurotransmitter production.

Quick Summary

Folic acid deficiency can contribute to restless legs syndrome (RLS) by impacting nervous system function and dopamine synthesis. Low folate levels are sometimes associated with RLS, and correction of the deficiency can help improve symptoms, especially in cases where nutritional factors are the root cause. Diagnosis involves blood tests and consideration of other factors, including iron levels.

Key Points

Folic Acid is Linked to RLS: Evidence suggests that a deficiency in folic acid can be a contributing factor to the neurological symptoms of restless legs syndrome.
Impacts Neurotransmitter Production: Folic acid is critical for the synthesis of dopamine, a neurotransmitter whose dysfunction is central to RLS development.
Deficiency Can Cause Neurological Symptoms: Low folate levels can disrupt nervous system function and lead to neurological signs that manifest as RLS sensations and movement.
Often Exists Alongside Iron Deficiency: It is important to check both folate and iron levels when investigating RLS, as deficiencies can co-occur.
Supplementation Can Improve Symptoms: If a folic acid deficiency is identified, supplementing can help correct the underlying imbalance and alleviate RLS symptoms.
Treatment Addresses Multiple Factors: Beyond supplementation, managing RLS involves lifestyle changes such as diet, exercise, and avoiding triggers like caffeine.

Understanding the Link Between Folic Acid and Restless Legs Syndrome

Restless Legs Syndrome (RLS), also known as Willis-Ekbom disease, is a neurological condition characterized by an irresistible urge to move the legs, often accompanied by uncomfortable sensations. While often associated with iron deficiency, research indicates that other nutritional factors can also play a significant role. Among these, folic acid deficiency has been identified as a potential cause or contributing factor, particularly in certain populations like pregnant women or those with specific absorption issues. The connection lies in folic acid’s critical function within the central nervous system, specifically its involvement in synthesizing neurotransmitters like dopamine.

The Role of Folic Acid in Neurological Health

Folic acid (vitamin B9) is essential for numerous bodily processes, including DNA synthesis, cell growth, and the production of red blood cells. Its importance extends to the nervous system, where it plays a vital role in regulating mood and synthesizing key neurotransmitters. A deficiency can lead to elevated homocysteine levels, which are linked to neuroinflammation and can disrupt normal nerve function. Low folate can also reduce the production of tetrahydrobiopterin (BH4), a cofactor for the enzyme tyrosine hydroxylase, which is essential for dopamine synthesis. Dopamine dysfunction is a well-established mechanism in the development of RLS symptoms, and addressing a folate deficiency may help support the dopaminergic system and alleviate symptoms.

How Deficiency Can Lead to Restless Legs

The pathway from low folate to RLS involves several interconnected processes:

Neurotransmitter Production: As mentioned, folic acid is crucial for producing dopamine. A shortage can impede this process, leading to the dopamine irregularities associated with RLS. Dopamine helps control muscle movement, and low levels can cause the involuntary movements and sensations characteristic of the disorder.
Nerve Health: Folate deficiency is known to cause a range of neurological issues, from minor signs like vibration sense impairment to major issues affecting nerve function. These nervous system disruptions can directly contribute to the abnormal sensations and motor restlessness experienced with RLS.
Metabolic Impact: The one-carbon metabolism cycle, for which folate is a key component, affects methylation processes critical for brain function. Disruptions can lead to imbalances that increase susceptibility to neurological issues, including motor disturbances.

Identifying Folic Acid Deficiency and RLS

Diagnosing the underlying cause of RLS requires a thorough evaluation, often starting with blood tests to check for nutritional deficiencies. A healthcare provider will typically investigate both iron and folate levels. In many cases, correcting the deficiency can be the first line of treatment.

Comparison of RLS Causes


Cause	Mechanism	Relevance to RLS	Common Treatments
Iron Deficiency	Reduces dopamine synthesis due to impact on tyrosine hydroxylase enzyme.	Strongest documented link; a primary cause of RLS, often requiring iron supplementation.	Iron supplements (oral or IV), dietary changes.
Folic Acid Deficiency	Impairs production of neurotransmitters like dopamine; linked to neurological signs.	Identified as a contributing factor in certain cases; especially noted in pregnant women.	Folic acid supplements, dietary changes.
Vitamin B12 Deficiency	Can cause neuropathy and nervous system issues; often linked with folate metabolism.	Sometimes associated with RLS; evaluation and correction of deficiency may help.	B12 supplementation.
Chronic Kidney Disease	Contributes to iron deficiency and other metabolic imbalances.	A known risk factor for RLS.	Management of kidney disease, iron supplementation.

Treatment and Management

Managing RLS symptoms often involves a multi-pronged approach. If a folate deficiency is confirmed, supplementation is a direct and effective treatment pathway. Lifestyle adjustments are also critical for managing RLS, regardless of the underlying cause:

Moderate Exercise: Regular, moderate-intensity exercise, particularly involving the legs, can help alleviate symptoms. However, excessive exercise or exercising too late in the day can worsen symptoms.
Good Sleep Hygiene: Establishing a cool, quiet, and comfortable sleeping environment is important, as fatigue can exacerbate RLS symptoms.
Avoiding Triggers: Some individuals find that caffeine, alcohol, and nicotine can worsen their symptoms. It is often recommended to cut back on or eliminate these substances to see if symptoms improve.
Other Therapies: Warm baths, leg massages, and the use of warm or cool packs can provide temporary relief. For persistent symptoms, a doctor may prescribe medications, though they are often used only when lifestyle changes and deficiency correction are not enough. For further authoritative information on RLS diagnosis and treatment, visit the National Institute of Neurological Disorders and Stroke.

Conclusion

While iron deficiency is a more commonly recognized culprit, low folic acid levels can indeed contribute to restless legs syndrome. The deficiency’s impact on neurotransmitter production and overall nervous system health creates a plausible biological mechanism for the development of RLS symptoms. Proper diagnosis, which includes testing for both iron and folate, is key to identifying the root cause. For those with a confirmed folate deficiency, targeted supplementation and dietary changes, alongside other lifestyle modifications, can lead to significant symptom improvement. Anyone experiencing persistent RLS symptoms should consult a healthcare provider for a comprehensive evaluation and personalized treatment plan.

Frequently Asked Questions

A shortage of folic acid can lead to neurological issues by disrupting the production of key neurotransmitters, impacting nerve function, and potentially causing conditions like neuropathy.

If a folic acid deficiency is the root cause of your RLS, taking supplements under medical supervision can be an effective way to improve your symptoms. However, supplements should only be taken after a confirmed diagnosis of deficiency.

No, RLS can be caused by various factors, including genetics, other medical conditions like kidney disease or diabetes, or even certain medications. Deficiencies in iron, folate, and other vitamins are just some of the potential contributing factors.

Folate is the natural form of vitamin B9 found in food, while folic acid is the synthetic form used in supplements and fortified foods. Both are important for maintaining adequate vitamin B9 levels.

Diagnosis typically involves a blood test to check your serum folate levels. It is often done in conjunction with tests for other potential deficiencies, like iron, as part of a complete medical evaluation for RLS.

Yes, other nutritional deficiencies linked to RLS include iron, vitamin B12, and vitamin D. Ensuring a balanced diet and investigating all potential deficiencies is important.

Yes, RLS is more common during the last trimester of pregnancy, and studies have shown a link with lower folate levels in pregnant women with RLS compared to those without.