Peripheral Neuropathy – More Than Just A Tingling

Nerves are the body’s communication system. 

Information about the body’s functions, sensation and movement are carried by electrical impulses passed from one nerve cell (neuron) to the next nerve cell along the pathway they form (nerve).

The peripheral nerves make up an intricate network that connects the brain and spinal cord to the muscles, skin, and internal organs.

Nerve fibers of the Peripheral nervous system (PNS) are classified according to their involvement in motor or sensory, somatic or visceral pathways.

Motor nerves control movements of all muscles under conscious control, such as those used for walking, grasping things, or talking.

Sensory nerves transmit information about sensory experiences, such as the feeling of a light touch or the pain resulting from a cut.

Autonomic nerves send impulses to the internal (visceral) organs and regulate biological activities that people do not control consciously, such as breathing, digesting food, and heart and gland functions.

Unlike the central nervous system, the PNS is not protected by bone or the blood-brain barrier, leaving it exposed to toxins and mechanical injuries.
When nerves in the peripheral nervous system are damaged, the messages they carry can getmixed up, or perhaps don’t get through properly, and therefore can cause Peripheral Neuropathy.

Although some neuropathies may affect all three types of nerves, others primarily affect one or two types.

Peripheral neuropathy most often strikes nerves in the extremities, but the term actually covers more than 100 medically recognized conditions.

26% of diabetic adults attending specialist diabetes services had peripheral neuropathy in Australia 2002 (NADC, 2003, Australia’s Health 2004, AIHW)

What Can Cause Peripheral Neuropathy

• Nerve injury
• Genetics
• Cancer
• Nutritional deficiencies (B1, B6, B12, Vitamin E)
• Alcoholism
• Toxins (mould; heavy metals- Arsenic, Mercury,Lead; solvents)
• Vascular disease
• Metabolic disorders – Diabetes
• Infections (HIV, Leprosy, Lyme Disease)
• Auto-immune disease
• Medications/Drugs (chemotherapy, statins, hypertension drugs, antipsychotic drugs )

In many cases, however, a specific cause cannot be identified.

Mutations of the gene encoding mitofusin 2 (MFN2) have recently been identified as the cause of approximately one-third of cases of the degenerative forms of Charcot-Marie-Tooth disease, a type of inherited neuropathy.

By reducing the amount of blood that can perfuse the tissue of the lower legs and feet, cardiovascular disease can also cause neuropathy and chronic pain.

Symptoms of Peripheral Nerve Damage:

• Muscle weakness or muscle atrophy
• Painful cramps and muscle twitching
• Pins and needles, or tingling, or numbness
• Bone degeneration
• Loss of reflexes
• Loss of coordination
• Loss of pain sensation
• Loss of sense of temperature
• Loss of balance and coordination
• Changes in the skin, hair, and nails
• Inability to sweat normally, which may lead to heat intolerance
• Loss of bladder control, which may cause infection or incontinence
• Problems eating or swallowing

Pain receptors in the skin can also become oversensitized, so that people may feel severe pain (allodynia) from stimuli that are normally painless.

Neuropathic pain is often worse at night, seriously disrupting sleep and can seriously affect emotional well-being and overall quality of life.

People with peripheral neuropathy are at risk for serious complications, including infections, such as gangrene, irregular heart beats, and impaired breathing.

Neuropathy’s course is variable; it can come and go, slowly progressing over many years, or it can become severe and debilitating. However, if diagnosed early, it can often be controlled

The good news is that peripheral nerves have the ability to regenerate, as long as the nerve cell itself has not been killed. Symptoms often can be controlled, and eliminating the causes of specific forms of neuropathy often can prevent new damage.

How to Treat Peripheral Neuropathy

Alpha Lipoic Acid (ALA) is an anti-oxidant that helps prevent the neuropathy seen in diabetes.

ALA promotes the removal of free radicals (an excess of which contributes to oxidative stress) and increases levels of other natural antioxidants such as glutathione and vitamins A and C.

The NATHAN 1 randomised control trial was conducted over 4 years and involved 460 people who had diabetes and mild to moderate peripheral neuropathy. ALA (taken orally) at doses of 600mg daily significantly improved the peripheral neuropathy over that time.

L-acetyl- carnitine (LAC) may assist in improving the proper nerve conduction and also been found effective for chemotherapy-induced peripheral neuropathy. Clinical studies point to a possible LAC deficiency in diabetic peripheral neuropathy.

Vitamin E deficiency is associated with significant neurological pathology, including PN. Therefore, a vitamin E deficiency should always be ruled out in cases of PN of unknown origin.

B complex vitamins (especially biotin, choline, inositol, B12, folic acid, niacin (B3) , pyridoxine (B6), and thiamine (B1) promote proper nerve function.

Chronic alcoholics commonly develop a thiamine deficiency, resulting in peripheral neuropathy.

Vitamin B12 deficiency has been associated with significant neurological pathology, including peripheral neuropathy.

One of the mechanisms believed to be at play in vitamin B12 deficiency neuropathy is hypomethylation in the central nervous system. Inhibition of the B12- dependent enzyme methionine synthase results in a fall in the ratio of S-adenosylmethionine (SAM) to S-adenosylhomocysteine. Deficiency in SAM impairs methylation reactions in the myelin sheath. The methylation of homocysteine to methionine requires both methylcobalamin (an active form of vitamin B12) and the active form of folic acid (5- methyltetrahydrofolate).

Gamma-linolenic acid is an essential fatty acid found mostly in Evening Primrose Oil, which provides nutrition to the nerves and assists in the proper nerve conduction of sensory impulses. Diabetics appear to have impaired conversion of linoleic acid to GLA.

Omega-3 fatty acids are also essential for healthy nerve cell membranes structure and blood flow.

Magnesium is known to be necessary for nerve conduction; deficiency is known to cause peripheral neuropathy symptoms and studies suggest that a deficiency in magnesium may worsen blood glucose control in type 2 diabetes.

T.E.N.S. or transcutaneous electrical nerve stimulation, is a nonsurgical technique to relieve pain. A T.E.N.S. unit can be used for severe nerve pain by directly targeting where the pain is.

Lifestyle Tips

• Avoid exposure to toxins
• Avoid or limit alcohol consumption
• Regular gentle exercise (active and passive) helps to maintain good blood flow in the extremities, and can help reduce cramps, improve muscle strength, and prevent muscle wasting in paralyzed limbs.
• Quitting smoking! Smoking constricts the blood vessels that supply nutrients to the peripheral nerves and can worsen neuropathic symptoms.
• Control blood glucose levels to avoid further nerve damage.
• Pay attention to the skin on the hands and feet
• Gentle massage and acupuncture can help improve blood and lymph circulation, nourish the nerve tissues and help repair the nerve functions and reduce pain.
• Use relaxation techniques like yoga, meditation, deep breathing exercises, visualisation to help reduce muscle tension and help relieve pain and discomfort.
• Wear loose fitting but supportive padded shoes and innersoles.

Useful Tests:

Homocysteine Level Test, MTHFR Gene test and Folate Metabolism (MTHFR) Genetic Testing

Hyperhomocysteinemia is associated with impairment of endothelial function, providing a mechanism for its possible involvement in diabetic complications, including neuropathy.

Hair Mineral Analysis

Heavy Metal toxicity from Mercury, Lead, Arsenic, and Germanium has been associated with peripheral neuropathy.

Thyroid Hormone Profile

Deposits in soft tissue resulting in nerve compression and carpal tunnel-like symptoms have been implicated in neuropathy associated with hyperthyroidism.

Emed’s Nutrient Status Profile

This test profile can help determine the levels of your B vitamins and which nutrients your body needs for optimal health.

Recommended Reading

• Diabetes – The New Health Epidemic
• Alcohol Addiction – Not The Way To Cope With Grief, Trauma and Fear
• T.E.N.S – The Alternative To Pain Killers

References:

Ziegler, D, Low, PA, Litchy, WJ, et al. (2011). Efficacy and safety of antioxidant treatment with alpha-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trial, Diabetes Care, 34 (9): 2054-60.

R. Ouvrier, S. Grew “Mechanisms of disease and clinical features of mutations of the gene for mitofusin 2: an important cause of hereditary, peripheral neuropathy with striking clinical variability in children and adults”, 2010, Developmental Medicine & Child neurology, Vol. 52, Issue 4, p. 328-330

Maestri A, De Pasquale Ceratti A, Cundari S, et al. A pilot study on the effect of acetyl-L-carnitine in paclitaxel- and cisplatin-induced peripheral neuropathy. Tumori 2005;91:135-138.

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