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What Causes Neuropathy—and How To Treat It

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There are a number of potential causes of neuropathy. Find out how to address the underlying cause of the problem for the most effective and longest-lasting change.

Revolution Health Radio podcast, Chris Kresser

This is an important topic and something that’s fairly commonly experienced. There’s not a lot of great information out there in the conventional medical world on how to troubleshoot neuropathy if you’re experiencing it.

In this episode, we cover:

2:28 Potential Causes of Neuropathy
5:44 Testing for B12 Deficiency
10:10 Four stages of B12 Deficiency
14:40 Five Potential Causes of B12 Deficiency
17:36 Treating B12 Deficiency 

Chris Kresser:  Hey, everyone. It’s Chris here. Steve is away. Unfortunately, he had a death in the family and Jordan is not available. So you’re stuck just listening to me go on and on for this episode. We’ll keep it relatively short, since listening to a monologue is never as interesting as a conversation.

But this is an important topic and I figured I would just go ahead and do it, because it’s something that’s fairly commonly experienced, and there’s not a lot of great information out there in the conventional medical world on how to troubleshoot this if you’re experiencing it. Let’s go ahead and listen to the question, and then we’ll get started.

Matt:  Hi, Chris. My question is, what sort of dietary changes, lifestyle changes, and possible supplementation would you recommend for neuropathy? As neuropathy can be associated with diabetes, B12 deficiency, toxin exposure, among other things, what tweaks would you make to your approach of those conditions, if neuropathy is also an issue? Similarly, if one just has idiopathic neuropathy, what recommendations would you suggest? Thanks.

Chris Kresser:  Again, great question. As is often the case, diagnosis is really key. In functional medicine, we always want to address the underlying cause of a problem. That’s what’s going to lead to the most effective and longest-lasting change and solution.

That’s the difference with the conventional model, which is often oriented more around symptoms suppression and disease management, irrespective of the underlying cause. For example, if you have high blood pressure, you take a medication to lower it. If you have high cholesterol, you take a medication to lower it. There’s oftentimes very little investigation into what the underlying causes of those symptoms or conditions may be.

Potential Causes of Neuropathy

With neuropathy, there are a number of potential causes, too many to cover in detail here. We’re going to focus on the ones that I think are the most common and most likely for listeners to be experiencing. Just to give you an idea of the many different things that can lead to neuropathy: we’ve got B12 deficiency; diabetes; toxic exposure, heavy metals; mold toxicity or something called chronic inflammatory response syndrome (CIRS), which I’m going to be talking more about in the future; liver-kidney disease; infections like Lyme disease; obstructive sleep apnea can worsen neuropathy. Then you have some drugs that have neuropathy as a side effect. Cardiac drugs for arrhythmias, certain antibiotics and antivirals that are used to treat HIV, some blood pressure medications, psychiatric drugs that are used to treat bipolar disorders, and anti-seizure medications.

To use a really simple example, if you’re taking one of these drugs and you have neuropathy, the simplest solution would be to talk to your doctor about finding another alternative treatment that’s not going to cause that kind of side effect. But for most people who are listening to this, I imagine that the cause of their neuropathy is something else.

B12 deficiency is, in my experience, by far the most common, and definitely the most common in my patient population. Statistically speaking, in the US, probably diabetes is the most common cause of neuropathy, because diabetes is just epidemic at this point. Then things like toxic exposure, mold toxicity, liver-kidney disease, and infections are probably less common causes.

Again, the most effective treatment here will depend on the cause. If blood sugar is the issue, diabetic neuropathy, then there is some evidence that a ketogenic diet may be helpful. There’s one account in the scientific literature of a complete reversal of diabetic neuropathy after two months of a ketogenic diet. The caveat is that the study was done in mice, not humans, so we can’t say for sure that that’s going to apply to humans. But we have enough research behind the effects of ketogenic diets in many other conditions with humans that I think it’s at least plausible.

And of course, all of the other things that we’ve talked about on the show and on my website and in my book about managing blood sugar, making sure you’re eating enough protein, making sure you’re getting enough exercise, particularly high-intensity exercise and strength training, can be helpful for improving metabolic health.  You want to make sure you’re getting enough sleep. We have tons of research now that shows how poor sleep contributes to diabetes and obesity. You want to make sure you’re managing your stress, reducing your intake of all of the highly-processed and refined foods that contribute to obesity and diabetes, and really focusing on real nutrient-dense, whole foods. We have all those basics. On top of that, doing a ketogenic approach for a period of time might be helpful, as the study I mentioned suggests.

Testing for B12 Deficiency

The next cause is B12 deficiency. We’re going to spend a little bit more time on this, because it’s much more poorly understood in general, even in the sort of functional, alternative medicine community I think.

I’ve written a couple of articles on B12 deficiency that you should definitely check out, if you haven’t already. If you just Google “Chris Kresser B12,” they’ll pop right up at the top. I go into some detail about the prevalence of B12 deficiency in various populations: omnivores, vegans, vegetarians. We talked about some really important information, not very well-known information about testing and diagnosis of B12 deficiency, which I’m going to kind of review here. Then we talked a little bit about treatment.

One of the most important things to understand about B12 deficiency is that the serum B12 is not a very reliable marker for diagnosing B12 deficiency. When you measure B12 in the serum, you’re measuring all of the different cobalamins. Cobalamins are all the different B12 compounds. That ranges from the most inactive forms of cobalamin, like cyanocobalamin, to the more active forms of cobalamin, like methylcobalamin and adenosylcobalamin, which are referred to as active B12. That’s the type of B12 that can actually be delivered, get in the cells, and do what it’s supposed to do. Then there are intermediate forms of cobalamins, like hydroxocobalamin, which are not super active, but more active than something like cyanocobalamin.

When you measure serum B12, you’re measuring all of those different B12s. So it would be possible to have a normal or even high level of serum B12, and have most of that be inactive, and still be suffering from B12 deficiency, because you don’t really have enough of the active B12 that gets in the cells.

I’ve definitely seen that in my practice when I run B12 tests. Every patient that comes to my practice gets a blood test that includes B12. In many cases, we’ll also go on to do more advanced testing for B12 deficiency, which I’m about to tell you about. And I see many patients who have normal B12 levels in the serum, but have evidence of B12 deficiency using the more sensitive markers. So this is something that’s really important to understand.

What are those sensitive markers? Well, the most practical and most available at this time is methylmalonic acid, or MMA for short. You can test methylmalonic acid in the urine or the serum. Methylmalonic acid is an organic acid. It’s a by-product of normal cellular metabolism. It’s converted into succinic acid via a B12-dependent enzyme. That enzyme only can use active B12. So if methylmalonic acid (MMA) is elevated, it suggests there’s not enough active B12 to make that conversion. Therefore, it’s a sensitive indicator for active B12 deficiency.

Urine methylmalonic acid is thought to be more sensitive than serum methylmalonic acid as a marker, because MMA is more concentrated in the urine than it is in the serum. But there are a couple of caveats. Urine methylmalonic acid is not accurate in the case of kidney disease. So if you have kidney issues, it’s not a good marker for B12 deficiency. And serum methylmalonic acid is not accurate in cases of intestinal bacterial overgrowth, which we know is very common. In my patient population, intestinal bacterial overgrowth is far, far more common than kidney disease. In fact, in all the years that I’ve been doing this, I think I’ve only had a few patients with full-blown kidney disease. So I run urine methylmalonic acid as a result, because it’s much more reliable in my patient population.

There is another marker that’s even more sensitive for detecting B12 deficiency. That’s called holotranscobalamin (holoTC). HoloTC is composed of B12 attached to transcobalamin. This represents the biologically active part of B12 that can be delivered into the cells.

Four Stages of B12 Deficiency

There are actually four stages of B12 deficiency. I want to go over them with you, because it really highlights the importance of using this more sensitive testing and the limitations of using serum B12, and then also markers like hemoglobin and red blood cells—the markers of anemia—to detect B12 deficiency.

Stage I and II of B12 deficiency is when the plasma and cell stores of B12 become depleted, and transcobalamin is reduced. That’s all that happens in stage I and II. Typically, there are no other noticeable signs or symptoms. That is what holotranscobalamin (holoTC) will pick up. So there’s no other way that we know of right now to detect B12 deficiency in stage I and II, other than holotranscobalamin.

Stage III characterizes functional B12 imbalance, which involves elevated homocysteine and blood methylmalonic acid. That’s where you can detect B12 deficiency using methylmalonic acid as a marker, in that stage III. That may manifest in some symptoms, but it’s often not obvious to either the patient or the doctor, that those symptoms are B12-related.

I mentioned homocysteine. This is another marker that can be used to detect B12 deficiency at an earlier stage than serum B12. Homocysteine requires B12 and folate to be converted back into methionine. So if you see elevated homocysteine, you can suspect either B12 or folate deficiency. It’s important to understand that homocysteine is not specific to B12. The elevated homocysteine could be more related to folate deficiency than B12, so you can’t use it as an exclusive marker for B12 deficiency. But used in combination with methylmalonic acid, it can be really helpful for detecting B12 deficiency at that earlier stage.

Stage IV of B12 deficiency is when the clinical signs and symptoms of it become evident. That’s when you start to see things like neuropathy, anemia, severe fatigue, and other symptoms that develop with B12 deficiency.

If you think about this, in the conventional model, most people won’t even end up at the doctor until stage III or IV, because that’s when the symptoms start to become evident. By then, B12 deficiency has already progressed to the later stages. If it’s stage III, the doctor runs a serum B12 test, it’s in the normal range, they’ll say, “Oh, this isn’t a problem. Nothing to worry about.” But if you run homocysteine or methylmalonic acid in that stage, you’ll actually be able to detect it before it progresses into that stage IV, where in some cases, the effects of B12 deficiency, neurological damage, can be irreversible. So it’s really, really important to intervene at an early point here.

So why not test holoTC, since it can detect stage I and stage II B12 deficiency? I would love to be able to test that. Unfortunately, it’s not a readily available marker right now. When I wrote the article that I mentioned earlier, Quest Diagnostics had listed it on their website. It’s listed as a test that’s available. But at least here in the Bay Area, it’s not yet available at any Quest lab location. I have yet to hear anyone that’s been able to reliably order it. Hopefully, that will change in the near future. For now, we can use methylmalonic acid and homocysteine to at least detect B12 deficiency that’s progressed to stage III. Fortunately, if you intervene at that point, it’s usually, in my experience, the symptoms of B12 deficiency, including neuropathy, are reversible at that point.

Potential Causes of B12 Deficiency

Let’s talk a little bit about what the potential causes of B12 deficiency are, because it is, as I mentioned, at least in my patient population, the most common cause of neuropathy.

One would be pernicious anemia. This is often missed, I find. I’ve diagnosed several patients with pernicious anemia that didn’t know that they had it. This is an autoimmune disease that involves destruction of the parietal cells in the stomach. The parietal cells are where intrinsic factor is produced. Intrinsic factor binds to B12. The complex of intrinsic factor in B12 is absorbed in the small intestine. If you can’t produce intrinsic factor because your parietal cells are being attacked by your immune system, then essentially, you can’t absorb B12 orally. So people could be eating meat and all kinds of B12-rich foods like liver and shellfish, and they can still be B12 deficient. That’s important to understand, because it’s definitely true that B12 deficiency is way more common in vegans and vegetarians. According to recent tests that have used these more sensitive markers like methylmalonic acid, about 83% of vegans are deficient in B12 and 68% of vegetarians are deficient in B12, versus 5% of omnivores. But an omnivore who has pernicious anemia, for example, could still have B12 deficiency.

Small intestinal bacterial overgrowth (SIBO) and low stomach acid can both impair the absorption of B vitamins, including B12. So I see B12 deficiency in people with SIBO.

Glutathione deficiency can lower B12 levels because one of glutathione’s roles is to protect B12 in the circulation. If it can’t protect it, then B12 gets damaged, and it can’t activate the cells as it should. So you could be glutathione-deficient if you have any kind of autoimmune disease, if you’re suffering from oxidative stress, if you’re not sleeping enough, if you’re not getting enough exercise or getting too much. Basically, anything that causes oxidative stress can deplete glutathione levels.

Then impaired methylation can cause B12 deficiency or interfere with B12 metabolism. We talked a lot about methylation on a recent episode, so I’ll just refer you to that.

Of course, inadequate dietary intake can cause B12 deficiency, which is why vegans and vegetarians have such high levels of B12 deficiency. There are really no adequate sources of B12 in the vegan and vegetarian diet. So if they’re not supplementing with B12 and preferably active forms of B12, then they could definitely have this problem.

Addressing B12 Deficiency

In terms of addressing this, if it is B12 deficiency and it is dietary intake, of course, adding animal foods that contain B12 to your diet is a good idea, if you’re open to that. I list what the highest sources of B12 are in the articles that I mentioned, so check that out. Shellfish, organ meats, and meats, red meat in general, are among the higher sources of B12. If you’re going to supplement with B12, it’s best to take an active form. So methylcobalamin and/or adenosylcobalamin, which is sometimes referred to as dibencozide, are the best forms of B12. If you’re dealing with pernicious anemia, SIBO, or low stomach acid, you’re going to have problems digesting capsules or tablets of B12. The best thing to do would be to use a sublingual form, so that the B12 gets absorbed that way and bypasses the digestive route. I think I carry a form of B12 in my store that I recommend, which is Jarrow Formulas sublingual lozenge of methylcobalamin.

There are studies that show that higher dose sublingual administration of B12 is as effective as injections in some cases. But what I’ve seen is that while most patients do well with B12 lozenges, sublingual form, some actually do better with injections, and they’re not comparable. So if you’re really dealing with pretty serious neuropathy, you’ve got B12 deficiency and have had it for a while, you’ve tried the sublingual lozenges and they’re not working for you, you may want to talk to your doctor about injections. You can get the active forms of vitamin B12 in injection. The typical injection that a doctor will prescribe will be the inactive form, cyanocobalamin. But you can get methylcobalamin injections. Those will generally be more effective.

There are some other supportive nutrients for B12 deficiency. Those include folate; trimethylglycine; vitamin B6, or the active form, which is pyridoxal-5-phosphate (P5P); and vitamin B2, or the active form, which is riboflavin 5’-phosphate (R5P).

If you’re dealing with a lot of oxidative stress and glutathione deficiency, then the antioxidants like vitamin A, E, and C, CoQ10, glutathione itself, selenium, which is important for immune regulation and glutathione production, N-acetylcysteine (NAC), and alpha lipoic acid (ALA) can all be really helpful in putting the brakes on oxidative stress.

I think we’ll stop there. I know that was a ton of information. I didn’t have Steve to interrupt me and help you to absorb everything. Hopefully, that helps those of you who are dealing with neuropathy, especially if it’s related to B12 deficiency.

We’ll talk to you next week. Steve will be back. Keep sending us your questions. We continue to get some really great questions and SI want this show to be all about you and what you want to know, so keep the questions coming in. We’ll talk to you next week.

91 Comments

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  1. Post #1

    Here’s my situation. I am more interested in sharing my experience in the event that someone else in a similar situation comes along searching for answers or wants to compare notes.

    I am fortunate to have excellent health insurance and be able to afford decent supplements, but I am unable to afford the out-of-pocket costs to see a functional medicine practitioner or have specialty tests performed.

    I am a 47 y/o female and have had occasional neuropathy in my legs since around 2010. I have experienced about 4-5 incidents. In each case, the symptoms have presented with numbness and tingling, rarely spreading past my thighs. The symptoms have always resolved without intervention, and at most it has never taken more than 2 months.

    I have Bipolar I disorder. Since 2010, I have run the gamut of various antipsychotic medications and antidepressants. Most recently I have been prescribed Effexor XR and Lamictal. I have been on the Effexor since early July 2016 and the Lamictal for a couple of years. I also take 200mg Topamax for occasional migraines, especially with each menstrual cycle. This was also recently prescribed in June 2016.

    Almost immediately upon starting the Effexor at 37.5mg, I started having symptoms of intermittent urinary retention. I live in the Mojave, and at the time temps were in the triple digits. I figured it was dehydration and increased my fluid intake. When I increased my dose to 75mg in mid-August, the urinary retention was here to stay. I cut my dose by half and by the next day noticed tingling in my feet that progressively moved to my pelvic area (which of course complicated matters with the urinary retention, because now I can’t feel it now when I go – at either end). I went back to the 75mg dose without relief of the neuropathy, which is the worst it has ever been.

    After a couple of weeks my primary care doc ordered some labs. My B12 came back the other day at 367. Now, I understand that serum B12 doesn’t measure active B12. I already suspected I was deficient anyway, so I started taking the Jarrow 5000mcg B12 lozenges on Sunday. Today I started taking 600mg ALA and 3000mg acetyl-l-carnitine for probable nerve damage.

    I messaged my doc today and he ordered a lab test for methylmalonic acid which is a sensitive marker for B12 deficiency. I’ll have that done today, and then I have an appointment tomorrow with my psychiatrist and then Thursday with my neuro. My intention is to get off the Effexor asap. The Lamictal isn’t known to cause any of these issues, but then, there could be some obscure drug-drug interaction too. There is also the fact that I wasn’t taking Effexor when I had these other bouts of neuropathy, although I was taking SSRI’s (Effexor is an SNRI – same difference :). My past B12 levels are unknown.

    I am not diabetic, do not have anemia, have not had gastric bypass surgery or other obvious known causes for the neuropathy. I largely consume a grain-free diet and take my frequent red meat medium-rare (honey I’m no vegan….lemme show you my tattoos….lol!).

    I would like to come back to update this post as more information becomes available.

    Ring

  2. Any updates on what can be done with idiopathic small fiber neuropathy anyone? What therapies, supplements besides ALA and B-12 can affect a reversal or halting of the progress of this condition?

    • Have your B6 checked? Toxicity is happening people and doctors aren’t aware. B6 is everywhere.

    • I was diagnosed with idiopathic small fiber neuropathy, put on Neurontin, and told there was no cure. However, I read gluten intolerance/sensitivity can cause neuropathy; and thought I’d try giving up gluten. In that process, I went Paleo (following Chris and Sarah Ballentyne). and then did Autoimmune Protocol (via Sarah Ballentyne, Ph. D., AKA The Paleo Mom). The Autoimmune Protocol was very helpful b/c I found several foods (especially grains and dairy) that made my symptoms worse. I tried Digestive Enzymes and that also helped decrease my symptoms. I eliminated toxic household cleaners and personal care products/cosmetics. It took a year to experiment and eliminate these foods and toxins, but I became symptom-free. I think I could have been more aggressive in the elimination process and felt better sooner. I also take the supplements mentioned by Chris. Best wishes on your health journey.

      • Dear Charlene,
        I have small fiber neuropathy from Head to toe….
        A D DOctors have told me no cure….
        Your Message has touched my heart. AMe gives me Light
        I dont know IF It IS ok but coukd I write you privately please?
        Could you give your email?? So you coukd tell me in detail your process??
        I would Thank you very much Since I Am in lots Of pain and very lost.

        Thank you

          • Hello Mona,
            Unfortunately I Have not received any information from Charlene which is very sad with all This pain.
            Coukd you please help me???
            Thank you

            • i’m so sorry I wish I had any helpful advice for you! I was actually looking for the same… do you know the cause of your neuropathy?

      • wow. thanks for that out. I have small fiber neuropathy, almost 2 yrs now. I am gluten intolerant and have gone 100 percent g free as well as on a Paleo diet. would love to talk more about this with you to compare symptoms.

  3. After scaling of my teeth I have developed a sensation of rubbery sticky something surrounding my front lower teeth. I need to gargle with water frequently to get relief. Consulted the best dentists, ENT doctors, peridontists, etc but all said I am normal and I should drink a lot of water. Some said I have dry mouth while others said I have psychological feeling that will go away with time. But then I took the issue in my hands and starting searching on internet and used my commonsense. I went to a physician and he suggested blood tests. The test revealed very low vitamin B12. So, I found this on my own while famous doctors failed to suggest me blood tests. On further reading on the internet I found that B12 causes problems in nerves. I have taken 2cc injections of B12 five times and have started feeling better. Now am continuing with B12 pills.
    If anyone has any suggestions please share here or write to me at [email protected]

  4. I have small fiber neuropathy all over but most of it in the bottoms of my feet so severe that I am pretty much homebound.
    Alpha lipoic acid 600 mg. and A-cetyl carnitine 1500 mg. a day does bring some relief. I first noticed it in my abdomen after a hysterectomy. I also have MGUS which some doctors are now realizing can cause small fiber neuropathy.

    • Hi Darlene,
      Yes, I’ve had SFN for about 22 years. I believe I had MGUS for many years, but I didn’t know it. I was diagnosed with Waldenstrom’s mcroglobulinemia (WM) in 2012. It’s a rare lymphoma that is often preceded by WM. I take R-alpha lipoic acid, primrose evening oil, and I also found that frankincense and myrrh rubbing oil for neuropathy helps. You can find it at http://www.frankincensemyrrh.com and I wish you well. I find that a good medical massage therapist and a good acupuncturist can also help tremendously. I’ve recent developed some back issues, which have exacerbated the neuropathy. I’ve been getting spinal decompression treatments from my chiropractor, and that’s another means of alleviating the tingling sensations and discomfort. I wish you well and hope this information may be of some help to you as well. God bless.

      • I meant to say that often MGUS precedes WM. MGUS stands for Monoclonal Gammopathy of Undetermined Significance. Those of us with MGUS and/or WM have too much IgM in our blood. IgM is an immunoglobin that we need to fight infection. But too much can cause the blood to become hyperviscous, meaning it’s thickness makes it difficult to circulate properly. Also, the IgM does effect the nervous system of many with MGUS and WM. I just wanted to clarify my previous post. ‘Sorry for the typo in the first post.

    • Darlene if you take evening primrose oil and wait an hour or 2 and then take 5000mcg of methyl B12 twice daily I think you will see a great improvement in your situation possibly a cure over a few years. Jerry

  5. Fluoroquinolone antibiotics – cipro/ciprofloxacin, levaquin/levofloxacin, avelox/moxifloxacin, and floxin/ofloxacin – can cause PERMANENT peripheral neuropathy. The FDA added permanent peripheral neuropathy to the warning labels in 2013. People need to be aware of the permanent damage that can be done by fluoroquinolones. They are dangerous drugs that should only be used in life-or-death situations. http://floxiehope.com/2013/08/22/fda-permanent-peripheral-neuropathy-warning-label-fluoroquinolone-antibiotics/

  6. I am experiencing a lot of tingling and piercing pain for the last 5 weeks in my knee and heels. I am suppose to be prediabetic with fatty liver and a couple of benign hemangiomas on my liver which were diagnosed and confirmed through MR scanning 3 months ago. I started having these pains after a motor cycle injury (not serious) but in the same time starting using bio-identical hormones. I am also diagnosed with acute ebv for the last 18 months and since it is very difficult to keep my uric acid at the right optimal levels, i still don’t know what is causing these pains. I am trying to alkafizz every day to keep the ph right, but can you give me any other advice apart from slow release magnesium combined with good calcium combined with vit K2 and vit d3? I still have a lot of pain at intervals, even if i am following this regime for the last 8 days.

    • Julia, Heel pain is common in menopause, also with low nitric oxide (NO). Knee pain is also common in menopause again due to low hormones and related collagen changes, and can be compounded by acidic diet, food sensitivities, alcohol, poor nutritional foundation, kneeling, high impact exercise, overweight, and/or other inflammatory and degenerative setups.

      If the HRT is not relieving the heel pain, you might try a supplement related to NO such as l-arginine amino acid or l-citrulline, ideally in powder form for flexibility in amount and rapid absorption. Too much of either of these can aggravate herpes/shingles especially in hot weather, so use just what works, if it works. It’s a cheap experiment. If it’s going to work, you should see a change within 1-2 weeks.

  7. Greetings,

    I am a 39 year old male and have been recently diagnosed with small fiber neuropathy. I do have a 4 year history of alcohol abuse…mainly beer and that’s what my neurologist claims to have caused this. I have no numbness and very mild burning on my hands and feet. However, the burning or sunburn sensation is not limited to those areas. I have these burning/stinging sensations on my arms shoulders, and face on occasion. i also have postural hypotension..

    From what I’ve researched, this seems to be a non length dependent progression. I am with the understanding that alcoholic neuropathy is only length dependent. Would you mind clarifying this, as I think there may be another cause.

    Second, I’ve been battling gut issues for the last 14 months and think I have dysbiosis and leaky gut. According to great plains lab I am also sensitive to gluten, brewers yeast, and dairy. Do you think this could be causing the neuropathy? I do still have beer on occasion.

    Any guidance will be greatly appreciated.

  8. What is neuropathy? I did a search for kidney and this item showed up in the search.

  9. I would like to know if you can recommend a Dr. or clinic in the Portland, Or. area who would be well versed in getting to the cause of a persons neuropathy. My mother has developed this in the last year which has progressed to the point that she now has little or no use of her hands and has to use a walker to walk. Her Drs. seem to be stabbing wildly in the dark giving her cytoxin infusions and other immune suppressing drugs that have done nothing to help. At the rate of progression she is experiencing, I feel that it is important to find someone emmediatly who has more knowledge in this area of medicine. Or even if someone would could tell me the right questions to ask when seeking a Dr. for her.

    Sincerely
    Linda Quaiz

  10. Bee,
    Your problem may be that you are using folic acid, which is synthetic and toxic. Please see this writing on this subject from my website: http://haelanlifestream.com/journal/minding-methylation-2-2/.
    I would recommend that you have a complete gene mutation report run from http://www.23andMe.com and then interpreted through the app at http://www.NutraHacker.com.
    In fact, I would recommend this kind of study to all who are posting their concerns on this blog stream.
    This is life critical information about how your genes are mutated in the areas of detoxification, neurotransmitters, methylation, endocrine, cardiovascular, digestion, and vitamin/mineral activity.

  11. More On b12 for for neuropathy from cemo for stage3 non hodgkins which they found when I was diagnosed with autoimmune lambic encephalitis, thank you

  12. Hi Chris, Thanks for the info on B12. I am wondering about the ‘reverse’ of the situation that you describe – ie. overall serum B12 level measured as low, but active form measured in high normal level. To supplement or not??

  13. While it’s important to get enough B12, I’ve experienced and otherwise observed that It’s also possible to get too much B12. Since B12 sensitizes the nerves, new nerve pain, especially in tops of the feet and teeth, can be a clue a person is taking too much B12. It’s commonly assumed that B12 is water soluble so you can’t overdose and any excess is just excreted — however, substance can have many actions both positive and negative, desirable and undesirable, before any excess is excreted. There is not a lot of documentation on this, but it should be common sense in retrospect.

    Further, sublingual, topical, and injected forms of a substance are going to be stronger per mg or mcg than a regular oral swallowed pill, due to mostly avoiding a regular pill’s first-pass-thru-the-liver that reduces amount of the substance available to get into tissues. So tooth pain can be common with sublingual B12 since the nerves are close to where the substance is being directly absorbed – again obvious in retrospect, especially if we understand the principles of nerve sensitization and the extra strength of sublinguals.

    Persons who are already “sensitives” for some reason, such as being hypothyroid (even if well medicated), having other very low hormones, very low dopamine, or having severe chronic insomnia, for example, may be more susceptible to experiencing B12 overdoses.

    I mention all this since many health professionals and public don’t seem to take these things into account, so end up overdosing patients or themselves and wondering why they have excruciating nerve pains, etc.

  14. You mention that in Stage 1 and 2, plasma and cell levels of B12 are lowered, yet measuring serum in not an accurate reflection because it measures many inactive forms of cobalamin. Is measuring holoTC the only other option? What about measuring the amount in of active cobalamins in plasma- since those are low in the early stages?
    I am aware that, unlike most water soluble vitamins, B12 is stored and that it can take several (3-5) years for a deficiency to be picked up on labs, so these early markers are important.

  15. I have also read about taking acetyl-L-carnitine in treating neuropathy, do you know anything about this approach?

    • i recently did the sarapin injections had 4 in the hips and 3 in the back above waist, had this done by a nurse now in chiropratic offices, did not really do much for my nerve damage

  16. I have idiopathic neuropathy in 3 toes on each foot and the ball of each foot. I adopted a Primal Blueprint diet 3 years ago with amazing health effects (diabetes Type 2 gone in 3 days, high blood pressure down to 108/66 in 7 months, sleep apnea gone, 99.5 lbs weight loss, way better mood/sleep/dreams). About 6 years ago the neuropathy started and kept progressing. After the diet change the neuropathy got about 15% better after one year. The only cause that I could link to the neuropathy was long term (20 years) of (allorpurinol) medicine for my gout. I stopped taking allorpurinol over 2 years ago and my doctor says that my uric acid level is still well within normal range.
    Seven weeks ago I bought a Dolphin Neurostim double-unit and have been treating myself once or twice a day. At this point I am about 60% improved. The Dolphin Neurostim is based on acupuncture but uses small electrical currents instead of needles. I don’t know if I will get to 100%, but I am noticing improvements each and every week. I spoke with the doctor that developed the Dolphin Neurostim and he reports that having any type of incision from surgery can interrupt energy flow around the body. I have two incisions (lower back and right knee) that I am treating with the Neurostim unit. Something is working in the treatment!

    BTW, eating an ancestral diet is in no way limiting as there are so many meats and vegetables to choose from (and fruits and nuts in moderation). Get good fats from good sources!

  17. Hello Chris,
    Could you elaborate on the possible treatments for someone with severe peripheral neuropathy from taking a blood pressure medicine about 10 year ago (off it for a long time now). Thanks you.

  18. I developed severe small fiber PN about 5 yrs ago. I was told its diabetic neuropathy, even though as yet, it’s prediabetes ( normal FBS w elevated 2 hr glucose tolerance.)
    I have sleep apnea and have not been helped with CPAP.
    I also have the genetic issue MTHFR++A12989C (normal serum B12)

    I am now on Tramadol 3-400 mg/day for pain, Nuvigil 150 mg and Cymbalta, among many other meds including post breast cancer Anastrozole.

    My homocysteine is very high, along with CRP. I do take the active forms of folate and B12… But maybe not enough? B6 exacerbates the nerve pain, so the amount I can take of that is very limited.

    I’m exhausted all the time…from all of the above.

    I’m 67 and just don’t know where to go from here . I do have more pain should I eat sweets, but this pain thing seems very disproportionate to the degree of ‘diabetes’. So I suspect compounding factors, but my neurologist sees it purely as diabetic neuropathy.

    I need help to sort all this all out.

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