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Monday, April 24 2017

Peripheral Neuropathy

About 20 million people in the U.S. suffer from a condition called peripheral neuropathy.  Neuropathy means nerve disease or damage, and in the case of peripheral neuropathy it is usually damage to the small nerve fibers that extend to the feet and hands.  These small nerves could be sensory nerves which transmit messages to the spinal cord and brain with feelings of cold, burning, numbness or tingling.  It could also affect motor nerves which would transmit exaggerated feelings of pain, muscle wasting, balance difficulties, and paralysis.  It is also possible that neuropathy can cause autonomic nerve damage to blood vessels, and organs resulting in impaired sweating, urination, and breathing.  Essentially this means the communication wiring from the brain to the extremities or organs is not working properly. Although neuropathy isn’t fatal, it can take a painful and debilitating course which causes suffering over many years. 


Types and Causes

There are about 100 types of peripheral neuropathy with carpal tunnel syndrome perhaps one of the more common types. It is estimated that there may be about 80 known causes.  Some of the causes include Diabetes, Hypothyroidism, Cancer, Autoimmune Diseases, B12 deficiency, Alcoholism, Drugs, infections such as Lyme, physical trauma, environmental toxicity, and for about 30% of the cases it is idiopathic, meaning there is no known reason.  If one nerve is affected it is called mononeuropathy and if more than one nerve is affected it is polyneuropathy. 


Diabetes/Insulin Resistance

The growth of type two diabetics in the U.S. has resulted in a surge of diabetic peripheral neuropathy.  About 60-70% of diabetics have a mild to severe form of nervous system damage that can affect the sensory, motor and autonomic nervous system.  There is also a similar type called prediabetic peripheral neuropathy which describes the patient with slightly elevated blood sugar and hemoglobin A1C and this is often referred to as insulin resistance.  Dr. Smith and Dr. Singleton from the University of Utah believe that insulin resistance is a major cause of idiopathic peripheral neuropathy. 


The most common reason of peripheral neuropathy is associated with elevations of blood sugar.  The tissues most commonly affected by high blood sugar are the retina, kidney and peripheral nervesWhy?  In these tissues glucose is converted into sorbitol by aldose reductase which is then converted into fructose.  However, these tissues lack an enzyme called sorbitol dehydrogenase, so the conversion into fructose is impaired, causing a rise in sorbitol.  This causes edema which then damages the tissues.  Increased sorbitol can also increase A.G.E.’s or advanced glycation end products which severely impair our immune system and result in an elevated Hemoglobin A1C and LDL cholesterol.  Interestingly, this is why medical treatments for peripheral neuropathy also include aldose reductase inhibiting medications such as Epalrestat. 


Statin medications can increase the chance of developing neuropathy by 4-14x according to a 2002 study. Statins reduce a strong antioxidant Coenzyme Q10 which is the very nutrient we need to stop statin induced diabetes. By lowering cholesterol we reduce what the nerves need to form myelin, and the cell walls around nerves. Blood pressure drugs, chemotherapy or radiation all can lead to peripheral neuropathy symptoms. 


Medical Treatments

There are many drugs that are regularly prescribed to treat peripheral neuropathy.  Lyrica and Neurontin which fall under anti-seizure drugs, antidepressants such as Effexor and Cymbalta, or the opioid painkillers such as Oxycodone or topical pain patches such as Lidoderm or Zostrix.  Although these drugs have their place, in many cases patients become habituated to them, meaning they need stronger doses to be effective over time and they don’t address the true cause of peripheral neuropathy.


Most neurologists use tests such as NCV (nerve conduction velocity) tests and EMG (electromyograph) test to determine peripheral nerve damage but the evidence is that these tests are useless for the diagnosis of small fiber peripheral neuropathyNewer testing such as the QSART test or the Sudoscan can detect autonomic changes by measuring sweat gland changes.  The Intra Epidermal Nerve Fiber Density Test, is a more invasive test requiring a skin biopsy to see microscopically if nerve cells are degenerating.


Natural Treatments

Alternative and functional neurological medicine could offer solutions for many peripheral neuropathy patients.  For trauma related problems, Chiropractic, massage, and other soft tissue techniques focused on the fascia are useful.  Exercise of any kind is helpful, even if it just balance exercises. 


From a functional medicine perspective, diet modifications to help with blood sugar irregularities is vitally important for diabetics and those with insulin resistance.  There are holistic perspectives to treat chronic infections and autoimmune issues as well.  Identifying those with food sensitivities such as gluten can improve outcomes. Nutritional supplementation to help each of these problems is individualistic but in general here are some classic remedies that have had some evidence of benefit.

R lipoic Acid: A stronger form of alpha lipoic acid is helpful for improving blood sugar problems. 

Glutathione:  The most powerful antioxidant in the body and can protect neurons from the damage of A.G.E.’s and other damaging chemicals in our environment.

Acetyl L-Carnitine and L-Carnitine:  Helpful for insulin resistance. 

B1,Thiamine and Benfotiamine and B12 and B6, and Folate:  Many B vitamins are helpful for peripheral neuropathy.  B6 and B12 specifically help the nervous system.  Benfotiamine is a fat soluble form of B1 that is more readily absorbed by the digestive tract. 

Vitamins C, D, and E: 

Zinc, chromium, and manganese:  

Grape Seed Extract:

Natural anti-inflammatories such as curcumin, and omega 3 fatty acids.

Posted by: Dr. Paul Goldstein AT 01:19 pm   |  Permalink   |  0 Comments  |  Email

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