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NEUROPATHY

By Dr. Keith E. Lewis
May 22, 2008


Millions of people are living with some form of neuropathy. The term neuropathy means a condition in a nerve or a group of nerves that causes pain and dysfunction. There are many different causes of neuropathy and a broad range of symptoms. Unfortunately, to date, there is no single good treatment for most neuropathies; at least medical treatments and many neuropathies have no known cause. There are a number of prescription drugs that have been used to treat neuropathies. Most have been very ineffective plus many have adverse side effects and none actually correct the underlying nerve defect that causes the pain.

Nutritional supplementation offers a promising alternative for people who want to avoid the side effects of prescription drugs.

Neuropathies can originate either within the central nervous system or in the peripheral nerves which lie outside the central nervous system. These are also called peripheral neuropathies and account for the majority of the cases. There can be many causes of neuropathies such as toxins, including alcohol, metabolic disease, diabetes which is the most common peripheral neuropathy, HIV, AIDS, spinal stenosis, secondary effect of chemotherapy, and other unknown causes. In all forms of neuropathy, there is an abnormal stimulation of nerves or damage that results in pain.

Peripheral nerves are sensitive conduits that carry impulses from the extremities back to the central nervous system. Impulses are transmitted along nerves by changes in the electrical charge of the cell membrane caused by movement of an ion such as sodium, potassium, and calcium.  Impulses are transmitted between nerves by transmitters such as acetylcholine and substance P, which is responsible for transmitting pain impulses.  For protection, most nerves are covered with a thin sheath called myelin with is made from choline and lipids. The myelin functions like a rubber wrapping around an electric cord.  It is likely insulation around an extension cord. It insulates the nerve fibers and prevents abnormal nerve transmission. 

Depending on the nature of the specific neuropathy, some part of the system breaks down. In diabetic neuropathy, for example, there is a change in the microvascular network that supplies the nerve with nutrients. This lack of blood supply nutrients causes the nerve to function abnormally. Diabetic neuropathy tends to occur in more than one nerve area and when it does, this is called polyneuropathy and may cause loss of sensation and pain that typically worsens at night. In severe cases, diabetics can suffer from a kind of neuropathy called autonomic neuropathy. In this case, the autonomic nervous system which controls automatic functions of the body is affected with possible serious consequences, including gastrointestinal problems, bladder emptying problems, abnormal heart rhythms, and sudden death. Neuropathies can also be caused by specific nutritional deficiencies such as B12 and infectious diseases such as syphilis. Pain associated with neuropathy can be very intense and may describe as a cutting, stabbing, crushing, burning, shooting, gnawing, or grinding. In some cases, a minimal stimulus such as light touch can trigger a severe pain or pain may be even felt in the absence of any stimulus. If a problem with a motor nerve has continued over a length of time, the muscle itself may shrink or atrophy or lack of muscle tone may be noticed.

Unfortunately, the treatment options for neuropathy are somewhat limited. For diabetic neuropathy, blood glucose control is essential because glucose causes high levels of oxidative stress throughout the body. Vitamin B12 deficiency can cause peripheral neuropathies. For neuropathies caused by an autoimmune disorder such as rheumatoid arthritis, lupus, or Guillain-Barre, treatment is generally aimed at the underlying inflammatory condition.

For neuropathies caused by nerve pressure, treatment focuses on relieving the source of the pressure. This strategy may include ergonomic changes to alter any repetitive motions or positions that cause the neuropathy or even surgery to alleviate some of the internal pressures. For neuropathy caused by exposure to toxic metals such as lead or mercury or to medications, treatment focuses on reducing exposure to offending substance and reducing blood levels of any toxin. Antioxidants are frequently used to reduce oxidative stress.

For many serious neuropathies, medications given would include Neurontin, Tegretol, Dilantin, Cymbalta, and Lyrica. Many of these drugs are originally intended to treat seizure disorders such as epilepsy but they have been shown to at least reduce to some degree the pain of neuropathy even if only temporarily.

There are several nutritional treatment options for neuropathy that have shown great promise in the management of this condition.

Acetyl-L-carnitine is known to have neuroprotective properties. It has also been shown to limit the neuropathy associated with diabetes.

L-carnitine as well in 500 to 1000 mg doses seems to reduce the pain.

Alpha Lipoic acid is another powerful antioxidant. It positively affects important aspects of diabetes including prevention, blood sugar control, and the development of long-term complication such as heart disease, kidney disease, and disease of small blood vessels.

N acetylcysteine is a powerful antioxidant and precursor to glutathione, an intrinsic antioxidant. Studies have shown N acetylcysteine to inhibit diabetic neuropathy and protect against neuropathies caused by chemotherapy drugs.

Curcumin helps to relieve neuropathy by causing release of disease-associated protein that are produced by mutated genes. Omega-3 and 6 fatty acids help reduce the inflammatory process and reduce pain levels.

Vitamin B1 had been effective in the treatment of alcoholic and diabetic neuropathies. Vitamin B6 has also shown to be very effective in treating diabetic neuropathy.

B12 supplementation has also been shown to be useful in treatment of diabetic neuropathy.

Other supplements, methylcobolamine, vitamin C, capsaicin, vitamin E have all been effective in the treatment of diabetic neuropathies. 

In our clinical practice have found a great deal of success using low-level laser therapy and particularly cold lasers in combination with infrared therapy, use of high volt muscle stimulation, and ionic cleanse foot bath have also shown great, great improvement in our patients experiencing neuropathy.

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