Case history.  Do you, or anyone you know, experience this as well?

Patient X came to see me with severe burning down both his legs, challenges with balance and progressive numbness in his legs. Standard investigation with various specialists turned up nothing and the treatment protocols were unsuccessful in alleviating his pain and discomfort. After taking an extensive history and a few blood tests not already measured, I put him on a dietary and intensive vitamin regime aimed at addressing the root cause of peripheral neuropathy.  Considerations in diagnosis were.

1. Cost of investigative tests. A deep dive into measuring vitamin levels (see why this is important below) would have been very helpful but the cost in SA is prohibitive and not covered by medical aids.
2. The possibility that his S/S were due to an auto-immune disease called multiple sclerosis. Peripheral neuropathy can be a symptom of multiple sclerosis (MS),  as are other symptoms such as numbness, tingling, or weakness in the limbs. In MS, the body’s immune system attacks the myelin sheath that covers the nerve fibers in the central nervous system, which can lead to a variety of symptoms.

Peripheral neuropathy in MS typically affects the sensory nerves in the feet and legs, causing numbness, tingling, burning, or a pins-and-needles sensation. It may also affect the motor nerves, causing weakness or muscle cramps. The symptoms of peripheral neuropathy in MS can be similar to those of other conditions, such as diabetes or vitamin deficiencies, so in the case of patient x, MS (or vitamin deficiencies) were a consideration as diabetes had been ruled out.  Unfortunately, diagnostic tests to make a definitive diagnosis of MS are also very expensive and this was beyond the budget for this patient. Plus, to rush headlong into treating MS using the common treatments of interferon beta-1a and natalizumab may have worsened the symptoms as these drugs are themselves associated with neuropathy.

• The consideration that a degree of educated guesswork was necessary, as funds were limited so treatment needed to be stepped from most cost effective (without compromising efficacy) before immediately going to most expensive. 
• This is an example of why vitamins and minerals should never be dismissed as being unimportant in favour of allopathic drugs

What is peripheral neuropathy?

Peripheral neuropathy refers to damage or dysfunction of the peripheral nerves, which are the nerves that transmit information from the brain and spinal cord to the rest of the body. The symptoms of peripheral neuropathy can vary depending on which nerves are affected and the severity of the damage.

Most common signs and symptoms of peripheral neuropathy:

1. Numbness or tingling: Many people with peripheral neuropathy experience numbness, tingling, or a pins-and-needles sensation in their hands or feet. The sensation may also be described as burning or freezing.
2. Weakness: Peripheral neuropathy can cause muscle weakness, particularly in the legs and feet. You may feel like your legs are heavy or that you have difficulty lifting your feet. This may be described as a feeling of lameness.
3. Pain: Some people with peripheral neuropathy experience pain, which can be sharp, shooting, or burning. The pain may be constant or intermittent and can range from mild to severe.
4. Loss of coordination: Peripheral neuropathy can affect your balance and coordination, making it difficult to walk or perform everyday tasks.
5. Sensitivity to touch: Some people with peripheral neuropathy are sensitive to touch or pressure, which can make wearing shoes or clothing uncomfortable.
6. Muscle cramping or twitching: Peripheral neuropathy can cause muscle cramps or twitching, particularly in the legs and feet.
7. Difficulty with fine motor skills: Peripheral neuropathy can affect your ability to perform fine motor tasks, such as buttoning a shirt or picking up small objects.
8. Changes in skin, hair, or nails: Peripheral neuropathy can cause changes in the appearance of the skin, hair, or nails, such as thinning or loss of hair, brittle nails, or dry, cracked skin.

Causes of Peripheral Neuropathy

1. The MTHFR gene SNP.

This is a more complex cause and is accompanied by other s/s.  It is a genetic variation common in approximately 10-30% of the population, in varying combinations that influence the severity of the symptoms.  A practitioner experienced in gene SNP variations will be able to assist in this diagnosis.  (Anyone interested in gene profiling can go here for more information. ). Other s/s that may indicate the presence of this gene SNP are:

• High homocysteine
• Childhood neural tube defects
• Repeated miscarriages
• Migraines
• Depression
• Early cognitive decline
• Cancer
• Peripheral neuropathy
• Autism
• Schizophrenia
• Diabetes

Diabetes, either uncontrolled or of long standing, leads to peripheral neuropathy through various physiological processes. Have your HBA1C regularly checked and check your fasting blood sugar daily. Do not assume that because you are on metformin or insulin (metformin inhibits the absorption of vitamin B1) that you no longer need to take particular care of your diet and lifestyle if you suffer from diabetes.

• Vitamin Deficiencies

• Vitamin B1 (thiamine) deficiency: Thiamine is essential for nerve function, and a deficiency can lead to peripheral neuropathy. Thiamine deficiency is most commonly seen in people with alcoholism, but it can also occur in people with poor nutrition, as well as diabetics taking metformin.
• Vitamin B6 (pyridoxine) deficiency: Vitamin B6 is also important for nerve function, and a deficiency can cause peripheral neuropathy. Vitamin B6 deficiency can occur in people with poor nutrition or in those taking certain medications.
• Vitamin B12 deficiency: Vitamin B12 is critical for nerve function, and a deficiency can lead to peripheral neuropathy. Vitamin B12 deficiency is most commonly seen in people with pernicious anemia or other malabsorption syndromes.
• Vitamin E deficiency: Vitamin E is an antioxidant that protects nerves from damage. A deficiency can lead to peripheral neuropathy, although it is rare.
• Vitamin D deficiency: Vitamin D is important for nerve function, and a deficiency can contribute to peripheral neuropathy. Vitamin D deficiency is common, especially in people with limited sun exposure or poor nutrition.

• Certain Medications

• Chemotherapy drugs: Chemotherapy drugs, such as paclitaxel, cisplatin, and vincristine, are known to cause peripheral neuropathy in some people.
• Antiretroviral drugs: Certain antiretroviral drugs used to treat HIV, such as didanosine, stavudine, and zalcitabine, can cause peripheral neuropathy.
• Antibiotics: Some antibiotics, including metronidazole and fluoroquinolones like ciprofloxacin, can cause peripheral neuropathy as a side effect.
• Anticonvulsants: Certain anticonvulsant medications, such as phenytoin and carbamazepine, can cause peripheral neuropathy, especially at high doses.
• Antidepressants: Some antidepressant medications, including amitriptyline and imipramine, can cause peripheral neuropathy as a side effect.
• Statins: Statin medications used to lower cholesterol levels, such as atorvastatin and simvastatin, can cause peripheral neuropathy in some people.

• Mitochondrial Cytopathies (Damage to mitochondria)

Mitochondria are the “powerhouses” of the cell, responsible for producing energy in the form of ATP. Peripheral nerves, which control movement and sensation, require a lot of energy to function correctly. Thus, mitochondrial dysfunction can lead to peripheral neuropathy. To read more about energy synthesis click here.

There are several more rare mitochondrial diseases that can cause peripheral neuropathy, but people do not realise how our daily exposure to free radicals, smoking, alcohol, medications, pesticides, and heavy metals also attack our mitochondria.

It’s essential to note that mitochondrial dysfunction can also contribute to other neurological conditions, such as Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS). If you are experiencing symptoms of peripheral neuropathy or other neurological problems, it’s important to see a healthcare professional for proper evaluation and treatment.

Vitamin B1, Thiamin, is particularly important in mitochondrial health and it’s important to note that thiamine deficiency can cause a variety of symptoms, including peripheral neuropathy, muscle weakness, and heart problems. Thiamine deficiency, (and other vitamin deficiencies), are more common than we think. Not only is our diet deficient in B1, but many of us take medications, or have lifestyle habits, that deplete B1.

What lifestyle habits deplete vitamin B1?

• Alcohol consumption: Heavy alcohol consumption can interfere with the absorption, utilization, and storage of thiamine in the body, leading to a deficiency.
• Processed and refined foods: A diet that is high in processed and refined foods can lead to a thiamine deficiency because these foods are often low in vitamins and minerals, including thiamine.
• High sugar intake: Consuming high amounts of sugar can increase the body’s need for thiamine, and a deficiency can occur if thiamine intake is insufficient.
• Chronic illness: Certain chronic illnesses, such as Crohn’s disease, HIV/AIDS, and heart failure, can increase the risk of thiamine deficiency due to impaired absorption and utilization of nutrients.
• Aging: As we age, our bodies become less efficient at absorbing and utilizing thiamine, which can lead to a deficiency.

What allopathic medicine depletes vitamin B1

• Diuretics: Diuretics, also known as water pills, are medications that help the body eliminate excess water and salt. Some diuretics, such as furosemide and hydrochlorothiazide, can deplete thiamine levels.
• Anticonvulsants: Anticonvulsants, such as phenytoin and carbamazepine, are medications used to treat seizures. These medications can interfere with the absorption and metabolism of thiamine, leading to depletion.
• Antibiotics: Certain antibiotics, such as ampicillin, can interfere with the absorption of thiamine and lead to depletion.
• Alcohol: Chronic alcohol consumption can interfere with the absorption and metabolism of thiamine, leading to depletion.
• Oral contraceptives: Some oral contraceptives have been shown to deplete thiamine levels, although the mechanism is not well understood.

Summary

If you are suffering from peripheral neuropathy, then see a functional medicine practitioner or your doctor to determine the cause but keep the above points in mind because lifestyle and nutritional causes are often missed by medical professionals.

Establishing the root cause will not only afford a better chance of a successful result but also mean funds are not depleted on useless and expensive treatments.