Deficiencies involved in Peripheral Neuropathy
Peripheral neuropathy — the damage or dysfunction of nerves outside the brain and spinal cord — can be influenced or even caused by a range of nutritional deficiencies, many of which are overlooked by conventional medicine. From a holistic and alternative perspective, root causes often include metabolic imbalance, toxin accumulation, gut dysfunction, and nutrient depletion.
Key Deficiencies Involved in Peripheral Neuropathy
1. Vitamin B12 (Cobalamin)
- Role: Maintains myelin sheath and nerve signal transmission.
- Deficiency Symptoms: Tingling, numbness, burning, electric-shock sensations, balance problems.
- Causes: Poor absorption (due to low stomach acid or antacids), vegan/vegetarian diet, metformin, alcohol, nitrous oxide.
2. Vitamin B1 (Thiamine)
- Role: Supports nerve conduction and energy metabolism.
- Deficiency Symptoms: Burning feet, irritability, fatigue, nerve pain.
- Forms: Thiamine HCl (basic) vs. Benfotiamine (fat-soluble, more bioavailable for nerves).
- Common in: Alcoholics, diabetics, high-carb eaters.
3. Vitamin B6 (Pyridoxine)
- Role: Neurotransmitter synthesis, nerve health.
- Issue: Both deficiency and overdose can cause neuropathy.
- Watch for: Supplement dosages over 100mg/day long-term can cause toxicity.
4. Folate (Vitamin B9)
- Role: Methylation, nerve repair, red blood cell production.
- Causes of deficiency: Poor diet, alcohol, MTHFR mutation.
5. Vitamin D
- Role: Modulates immune response, inflammation, and nerve pain perception.
- Low levels linked to: Increased nerve pain, slower recovery, mood disturbance.
6. Alpha-Lipoic Acid (ALA)
- Role: Powerful antioxidant and mitochondrial support.
- Used in Europe for diabetic neuropathy.
- Deficiency (or need for high-dose): Associated with oxidative nerve damage.
7. Magnesium
- Role: Regulates nerve excitability and muscle relaxation.
- Deficiency Causes: Muscle cramps, fasciculations, restless legs, hypersensitive nerves.
8. Zinc
- Role: Immune and nerve repair, inflammation control.
- Deficiency: Delayed healing, heightened nerve sensitivity.
9. Omega-3 Fatty Acids (EPA/DHA)
- Role: Myelin sheath integrity, anti-inflammatory.
- Deficiency Symptoms: Neurological dysfunction, mood imbalance.
10. Acetyl-L-Carnitine
- Role: Nerve regeneration, energy production in neurons.
- Low levels: Seen in diabetics and chronic fatigue states.
Testing Recommendations
- Serum B12 + MMA (methylmalonic acid) for functional B12 levels.
- Homocysteine (indirect indicator of B12, B6, folate status).
- Serum Vitamin D (25-OH D)
- Intracellular magnesium, zinc
- Omega-3 Index
Holistic Considerations
- Gut health (malabsorption from leaky gut, dysbiosis)
- Liver detox burden (sluggish phase II detox may impair B vitamin recycling)
- Toxin exposure (heavy metals, mold, pesticides — all neurotoxic)
- Diabetes or insulin resistance (destroys peripheral nerves via oxidative and glycation pathways)
- Statins and medications (many deplete CoQ10, B vitamins, or cause neuropathy)
Recommendations
- B-complex with methylated B12 (methylcobalamin) and folate (5-MTHF)
- Benfotiamine and ALA stack for diabetic or burning neuropathy
- Magnesium glycinate or threonate
- Omega-3s (2–4g/day EPA/DHA)
- Nerve tonics like lion’s mane mushroom, skullcap, and St. John’s Wort (under supervision)
- Detox pathways support: milk thistle, NAC, glutathione
