By Dr. Laura Korman  

     Neuropathy is a condition in which there is damage, disease, or dysfunction to one or more nerves of the body, most commonly affecting the peripheral nerves of the hands and feet. The symptoms of neuropathy include numbness, tingling, pain, burning, muscle cramping and/or weakness, and can be caused by disease, infection, injury, medication, toxins, or vitamin deficiencies. In this article peripheral neuropathy will be explained in more depth, how it develops and what the root causes are. Conventional treatments will be discussed as well as natural strategies and therapies that are available to lessen symptoms and improve the wellbeing of people struggling with this uncomfortable and often debilitating disease.   

     According to the National Institute of Health, more than 20 million people in the United States have peripheral neuropathy, and this figure may be significantly higher as not all people with symptoms of neuropathy are tested for the disease. The peripheral nervous system is like an electrical cord that carries signals or messages from the brain and spinal cord to the rest of the body and relays sensory information perceived from the body back to the spinal cord and brain. Some forms of peripheral neuropathy involve only a single nerve, called mononeuropathy and is typically caused by trauma, damage or disease to the spinal cord or nerve fibers on one side of the body. Polyneuropathy involves more than one nerve, usually affecting both the right and left sides of the body, i.e., both feet and/or hands, and is caused by a systemic, metabolic, or inflammatory condition, such as diabetes, infection, toxin, medication, or auto-immune disease (when the body’s immune system becomes dysfunctional and attacks self-tissue). Symptoms of neuropathy usually start as mild and intermittent and include numbness, tingling, stiffness, pain and/or muscle cramping. Unless root causes of neuropathy are uncovered and addressed early in the disease, the condition often worsens, becoming disabling with increasing severity and frequency of numbness, tingling, and cramping with sharp, shooting pain often experienced at night. Symptoms of polyneuropathy involving the feet can lead to the complete loss of sensation, leading to gait instability and an increased risk of falling. As a functional medicine physician, Dr. Korman’s goal is to find the root cause and resolution to a patient presenting complaints or condition. Following will be a closer look at some of the most predominant root causes of peripheral neuropathy.   

     While Type 2 Diabetes is the most common and well-known cause of neuropathy, pre-diabetes, or early diabetes, it is a significant yet unknown player in the development of this destructive disease. Prediabetes occurs when a person's blood sugar is higher than normal, but not high enough to be diagnosed with diabetes. According to the CDC, 38% of American adults have prediabetes and 80% of them are unaware they have it.  The problem is, people with early diabetes usually have no symptoms, and may remain in this abnormal and dangerous metabolic state for years before ever being diagnosed with diabetes. So do not let the “pre” fool you, as reported in the CDC article titled “The Surprising Truth About Prediabetes”, the CDC warns that early diabetes is a serious health condition increasing the risk of developing type 2 diabetes, heart disease and stroke. This means that the 38% of the population who now have prediabetes may also have ongoing damage occurring to their nervous system, and not even know it.  

     Having an auto-immune condition such as Multiple Sclerosis, Hashimoto's, Lupus, Rheumatoid Arthritis or Sjogren's syndrome will put you at risk for neuropathy due to the increased inflammation created by an ongoing overactive immune response against self-tissue. Both acute and chronic infection can be a source of neuropathy as can exposure to toxins like lead, mercury, or arsenic, industrial chemicals, and excess alcohol. One overlooked cause of neuropathy is prescription medications, including certain antimicrobials, antiretrovirals, chemotherapy agents, psychotropic, anti-convulsant and cardiovascular drugs such as statins, commonly prescribed to lower cholesterol. The good news is that medication induced neuropathies typically go away once the medication is discontinued or lowered.     

     Prescribed medications, poor dietary or lifestyle choices as well as genetics play a role in promoting nutrient deficiencies which can lead to neuropathy. Common deficiencies include Vitamins B12, B1, B3, and/or Vitamin D and E. When it comes to Vitamin B6 it has been shown that both deficiency and excess can be contributing factors in developing neuropathy.  

Traditional medical treatment focuses on decreasing nerve pain or numbness, with medication including Gabapentin, Pregabalin, Duloxetine, or tricyclic antidepressants like Nortriptyline or Amitriptyline, and may also include topical lidocaine or capsaicin. In some cases, stronger pain medications like tramadol may be prescribed. According to a 2019 article by PAIN Medicine 45% of patients with neuropathic pain and 90% of those with diabetic painful peripheral neuropathy will require a combination of two or more medications to manage their symptoms. Many of these combinations are associated with intolerable side effects and efficacy is often on a trial-and-error basis. Looking at identifying specific root causes and supporting the patient with natural strategies may go a long way in managing neuropathy symptoms, improving quality of life and optimizing health.   

     The earlier the symptoms of neuropathy can be recognized and managed, the better the long-term results and outcome. Since inflammation is a root cause of all chronic illness, including neuropathy, Dr. Korman runs lab tests that identify the potential source and level of inflammation including a CBC, a complete metabolic panel, thyroid function, HgbA1c, fasting insulin, CRP (hs), homocysteine, ferritin (stored iron) and Vitamin D (optimal levels should be between 50-80ng/ml) She may also run tests to identify suspected auto immunities, nutrient deficiencies, or toxicities.   

     When managing a patient with neuropathy, it is vital they understand the importance of following an anti-inflammatory, nutrient dense diet, and supplement as necessary to provide the needed nutrients for optimal nerve function. Other therapies that may be beneficial include laser therapy, vibration, electrical muscle stimulation, infrared lights, pulsed electromagnetic frequency, spinal decompression and/or manipulation when a diagnosis of spinal degeneration, stenosis or nerve compression is a factor. Regenerative Medicine and mesenchymal stem cells are showing promise in the management of auto-immune induced neuropathies as they can dampen the self-destructive immune response as well as lower systemic inflammation and promote circulation. As you have learned, neuropathy is a complex and individual condition with many contributing factors. Identifying and addressing the root causes of neuropathy provides a viable option for managing and reversing the symptoms of this otherwise progressive and potentially debilitating disease.   

Dr. Laura Korman is the lead practitioner at Korman Relief and Wellness Center, located at 16954 Toledo Blade Blvd., Port Charlotte. For more information and to schedule an appointment, call 941-629-6700 or visit DrLauraKorman.com